Can early improvement be an indicator of treatment response in obsessive-compulsive disorder? Implications for early-treatment decision-making

Autor(es)

da Conceicao Costa, Daniel Lucas ^[1] ; Shavitt, Roseli Gedanke ^[1] ; Castro Cesar, Raony Cassab ^[2] ; Joaquim, Marines Alves ^[1] ; Borcato, Sonia ^[1] ; Valerio, Carolina ^[1] ; Miguel, Euripedes Constantino ^[1] ; Diniz, Juliana Belo ^[1]

Afiliação do(s) autor(es)

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

^[2] Univ Sao Paulo, Dept Stat, Inst Math & Stat, BR-05403010 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF PSYCHIATRIC RESEARCH; v. 47, n. 11, p. 1700-1707, NOV 2013.
• Citações Web of Science: 13

Resumo

In major depression, early response to treatment has been strongly associated with final outcome. We aimed to investigate the ability of early improvement (4 weeks) to predict treatment response at 12 weeks in DSM-IV-defined obsessive-compulsive disorder (OCD) patients treated with serotonin reuptake inhibitors (SRI). We conducted an SRI practical trial with 128 subjects. Inclusion criteria: age range 18-65 years-old, baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score > 16, and absence of previous adequate pharmacological treatment. Systematic assessments were performed at baseline, 4 and 12 weeks of treatment. Treatment response at 12 weeks was defined as a 35% or greater reduction in baseline Y-BOCS score. Stepwise logistic regression was used to test the relationship between early improvement and treatment response at 12 weeks, taking into account additional potential predictive factors. Different thresholds of early improvement were tested and their predictive power was calculated. Early improvement, defined as a 20% or greater reduction from baseline Y-BOCS score at 4 weeks, predicted response at 12 weeks with 75.6% sensitivity and 61.9% specificity. According to a logistic regression including demographic and clinical features as explaining variables, early improvement was the best predictor of treatment response (OR = 1.05, p < 0.0001). Only 19.8% of patients who did not improve at 4 weeks were responders after 12 weeks. In contrast, 55.3% of the individuals who showed early improvement were responders at 12 weeks (Pearson Chi-Square = 17.06, p < 0.001). Early improvement predicted OCD treatment response with relatively good sensitivity and specificity, such that its role in early decision-making warrants further investigation in wider samples. Trial registration: clinicaltrials.gov Identifier NCT00680602. (C) 2013 Elsevier Ltd. All rights reserved. (AU)

• Processo FAPESP: 11/51485-9 - Potencialização de inibidores da recaptura de serotonina com N-acetilcisteína no tratamento do transtorno obsessivo-compulsivo resistente: um estudo duplo-cego controlado
• Beneficiário: Roseli Gedanke Shavitt
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 12/14070-8 - Potencialização de inibidores da recaptura de serotonina com N-acetilcisteína no tratamento do transtorno obsessivo-compulsivo resistente: um estudo duplo-cego controlado
• Beneficiário: Daniel Lucas da Conceição Costa
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto
• Processo FAPESP: 11/00968-0 - Condicionamento, extinção e recuperação da resposta de medo em pacientes com transtorno obsessivo-compulsivo versus controles e após o tratamento com inibidores seletivos da recaptura de serotonina.
• Beneficiário: Juliana Belo Diniz
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado