Journal: The World Journal of Biological Psychiatry (2023)
Authors: Satish Suhas,Palash Kumar Malo,Vijay Kumar,Thomas Gregor Issac,Nellai K. Chithra,Binukumar Bhaskarapillai,Y. C. Janardhan Reddy &Naren P. Rao
Treatment-resistant obsessive-compulsive disorder (OCD) is a chronic debilitating illness. Numerous interventions have been studied, to varying success, in published randomized controlled trials.
Conduct a network meta-analysis (NMA) to compare the efficacy of all interventions in SRI-resistant OCD from published Randomised controlled trials.
RCTs using all modalities of treatments were included in the analysis, including pharmacological, psychological, neuromodulation, neurosurgery, and deep brain stimulation. The design-by-treatment interaction inconsistency model within the frequentist framework was adopted with a change in Yale-Brown Obsessive-Compulsive Scale score as the primary outcome. Sensitivity analyses were conducted, excluding studies examining neurosurgical interventions, deep brain stimulation, studies in the paediatric population, and studies from a single geographical region.
55 RCTs examining 19 treatments or placebo involving 2,011 participants were included in the NMA.
The best 4 treatments were ranked based on Surface Under the Cumulative Ranking (SUCRA) percentage values:
| Treatment | Standardised Mean Difference | SUCRA Percentage Values |
| Ondansetron | −2.01 (95% CI: −3.19, −0.83) | 85.4% |
| Deep TMS | – 1.95 (95% CI: −3.25, −0.65) | 83.2% |
| Therapist Administered Cognitive Behavioural Therapy | −1.46 (95% CI: −2.93, 0.01) | 80.3% |
| Aripiprazole | −1.36 (95% CI: −2.56, −0.17) | 67.9% |
In sensitivity analyses, Deep TMS was ranked as the best treatment strategy for SRI-resistant OCD. The small number of subjects in individual studies, higher confidence interval limits, and wider prediction interval for most agents warrant a cautious interpretation.
Considering the principal analysis and sensitivity analyses together, Deep TMS, ondansetron, CBT[TA], and aripiprazole may be considered a first-line intervention for SRI-resistant OCD in adults.
Full Article:
https://www.tandfonline.com/doi/abs/10.1080/15622975.2022.2082525
