A Double-Blind, Randomized, Controlled Trial of Fluoxetine Plus Quetiapine or Clomipramine Versus Fluoxetine Plus Placebo for Obsessive-Compulsive Disorder

Autor(es)

Diniz, Juliana Belo ^{[1, 2]} ; Shavitt, Roseli Gedanke ^{[1, 2]} ; Fossaluza, Victor ^{[3, 1, 2]} ; Koran, Lorrin ^[4] ; de Braganca Pereira, Carlos Alberto ^{[3, 1, 2]} ; Miguel, Euripedes Constantino ^{[1, 2]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Hosp Clin, Dept Psychiat, BR-05403010 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Hosp Clin, Inst Psychiat, BR-05403010 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Math & Stat Inst, BR-05403010 Sao Paulo - Brazil

^[4] Stanford Univ, Med Ctr, Dept Psychiat & Behav Sci, Stanford, CA 94305 - USA

• Tipo de documento: Artigo Científico
• Fonte: Journal of Clinical Psychopharmacology; v. 31, n. 6, p. 763-768, DEC 2011.
• Citações Web of Science: 33

Resumo

Obsessive-compulsive disorder patients who do not improve sufficiently after treatment with a selective serotonin reuptake inhibitor might improve further if other drugs were added to the treatment regimen. The authors present a double-blind, placebo-controlled trial comparing the efficacy of adding quetiapine or clomipramine to a treatment regimen consisting of fluoxetine. Between May 2007 and March 2010, a total of 54 patients with a primary diagnosis of obsessive-compulsive disorder, as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and a current Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of at least 16, the score having dropped by less than 35% after fluoxetine monotherapy, were allocated to 1 of 3 arms (n = 18 per arm): quetiapine + fluoxetine (<= 200 and <= 40 mg/d, respectively), clomipramine + fluoxetine (<= 75 and <= 40 mg/d, respectively), or placebo + fluoxetine (<= 80 mg/d of fluoxetine). Follow-up was 12 weeks. The Y-BOCS scores were the main outcome measure. No severe adverse events occurred during the trial, and 40 patients (74%) completed the 12-week protocol. The Y-BOCS scores (mean {[}SD]) were significantly better in the placebo + fluoxetine and clomipramine + fluoxetine groups than in the quetiapine + fluoxetine group (final: 18 {[}7] and 18 {[}7], respectively, vs 25 {[}6], P < 0.001) (reduction from baseline: -6.7 {[}confidence interval [CI], -9.6 to -3.8; and -6.5 {[}CI, -9.0 to -3.9], respectively, vs -0.1 {[}CI, -2.9 to 2.7], P < 0.001; number needed to treat = 2.4). The clomipramine-fluoxetine combination is a safe and effective treatment for fluoxetine nonresponders, especially those who cannot tolerate high doses of fluoxetine. However, the period of monotherapy with the maximum dose of fluoxetine should be extended before a combination treatment strategy is applied. (AU)

• Processo FAPESP: 06/50273-0 - Estratégia de potencialização medicamentosa no transtorno obsessivo-compulsivo resistente: um estudo duplo-cego controlado
• Beneficiário: Juliana Belo Diniz
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto