Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder,Journal of the American Academy of Child and Adolescent Psychiatry

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Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder
Journal of the American Academy of Child and Adolescent Psychiatry ( IF 9.2 ) Pub Date : 2021-09-28 , DOI: 10.1016/j.jaac.2021.05.027
Luis C Farhat ₁ , Edoardo F Q Vattimo ₁ , Divya Ramakrishnan ₂ , Jessica L S Levine ₂ , Jessica A Johnson ₃ , Bekir B Artukoglu ₄ , Angeli Landeros-Weisenberger ₂ , Fernando R Asbahr ₁ , Sandra L Cepeda ₅ , Jonathan S Comer ₆ , Daniel Fatori ₁ , Martin E Franklin ₇ , Jennifer B Freeman ₈ , Daniel A Geller ₉ , Paul J Grant ₁₀ , Wayne K Goodman ₅ , Isobel Heyman ₁₁ , Tord Ivarsson ₁₂ , Fabian Lenhard ₁₃ , Adam B Lewin ₁₄ , Fenghua Li ₂ , Lisa J Merlo ₁₅ , Hamid Mohsenabadi ₁₆ , Tara S Peris ₁₇ , John Piacentini ₁₇ , Ana I Rosa-Alcázar ₁₈ , Àngel Rosa-Alcázar ₁₈ , Michelle Rozenman ₁₉ , Jeffrey J Sapyta ₂₀ , Eva Serlachius ₁₃ , Mohammad J Shabani ₁₆ , Roseli G Shavitt ₁ , Brent J Small ₂₁ , Gudmundur Skarphedinsson ₂₂ , Susan E Swedo ₂₃ , Per Hove Thomsen ₂₄ , Cynthia Turner ₂₅ , Bernhard Weidle ₂₆ , Euripedes C Miguel ₁ , Eric A Storch ₅ , David Mataix-Cols ₁₃ , Michael H Bloch ₂

Affiliation

Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil.
Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut.
Columbia University New York, New York; Columbia School of Nursing, New York.
SUNY Downstate Health Sciences University, New York.
Baylor College of Medicine, Texas.
Center for Children and Families, Florida International University, Miami, Florida.
University of Pennsylvania, Philadelphia; Rogers Memorial Hospital, Oconomowoc, Wisconsin.
Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Washington, DC.
Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden.
University of South Florida, Hillsborough County.
University of Florida, Miami.
Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, IR.
Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles.
University of Murcia, Spain.
University of Denver, Colorado.
Duke University School of Medicine, Durham, North Carolina.
School of Aging Studies, University of South Florida, Hillsborough County.
Faculty of Psychology, University of Iceland, Reykjavik.
National Institutes of Health, Bethesda, Maryland.
Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Aarhus University Hospital, Skejby, Denmark.
Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; St. Olav's University Hospital, Trondheim, Norway.

Objective

A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children’s Yale−Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes.

Method

A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively.

Results

The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a ≥35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7−84.1; specificity = 81.7, 95% CI = 81.5−81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8−82.2; specificity = 84.6, 95% CI = 84.4−84.8).

Conclusion

Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.

中文翻译：

系统评价和荟萃分析：定义小儿强迫症治疗反应和缓解的经验方法

客观的

儿科强迫症 (OCD) 的缓解和缓解缺乏通用定义阻碍了试验结果的可比性。为了解决这个问题，我们进行了个体参与者数据诊断测试准确性荟萃分析，以评估儿童耶鲁-布朗强迫症量表 (CY-BOCS) 在确定反应和缓解方面的辨别能力。我们还旨在为这些结果生成基于经验的 CY-BOCS 截止值。

方法

对 PubMed、PsycINFO、Embase 和 CENTRAL 的系统评价确定了 5,401 篇参考文献；42 项随机对照临床试验被认为符合条件，21 项提供了纳入数据（N = 1,234）。选择临床总体印象改善和严重程度评分≤2 分来分别定义缓解和缓解。建立了一个两阶段的随机效应荟萃分析模型。计算曲线下面积 (AUC) 和约登指数以分别指示 CY-BOCS 的区分能力和指导最佳截止值。

结果

CY-BOCS 有足够的辨别能力来确定反应（AUC = 0.89）和缓解（AUC = 0.92）。反应的最佳截止值是从基线到治疗后降低 ≥35%（敏感性 = 83.9，95% CI = 83.7-84.1；特异性 = 81.7，95% CI = 81.5-81.9）。缓解的最佳截止值是治疗后原始评分≤12（敏感性 = 82.0，95% CI = 81.8-82.2；特异性 = 84.6，95% CI = 84.4-84.8）。