| Literature DB >> 31698111 |
David Rosenfield1, Jasper A J Smits2, Stefan G Hofmann3, David Mataix-Cols4, Lorena Fernández de la Cruz4, Erik Andersson5, Christian Rück4, Benedetta Monzani6, Ana Pérez-Vigil5, Paolo Frumento7, Michael Davis8, Rianne A de Kleine9, JoAnn Difede10, Boadie W Dunlop8, Lara J Farrell11, Daniel Geller12, Maryrose Gerardi8, Adam J Guastella13, Gert-Jan Hendriks14, Matt G Kushner15, Francis S Lee10, Eric J Lenze16, Cheri A Levinson16, Harry McConnell17, Jens Plag18, Mark H Pollack19, Kerry J Ressler20, Thomas L Rodebaugh8, Barbara O Rothbaum8, Eric A Storch21, Andreas Ströhle18, Candyce D Tart22, David F Tolin23, Agnes van Minnen24, Allison M Waters25, Carl F Weems26, Sabine Wilhelm12, Katarzyna Wyka27, Margaret Altemus28, Page Anderson29, Judith Cukor10, Claudia Finck30, Gary R Geffken31, Fabian Golfels32, Wayne K Goodman33, Cassidy A Gutner34, Isobel Heyman35, Tanja Jovanovic8, Adam B Lewin36, Joseph P McNamara37, Tanya K Murphy36, Seth Norrholm8, Paul Thuras15, Cynthia Turner38, Michael W Otto3.
Abstract
The apparent efficacy of d-cycloserine (DCS) for enhancing exposure treatment for anxiety disorders appears to have declined over the past 14 years. We examined whether variations in how DCS has been administered can account for this "declining effect". We also investigated the association between DCS administration characteristics and treatment outcome to find optimal dosing parameters. We conducted a secondary analysis of individual participant data obtained from 1047 participants in 21 studies testing the efficacy of DCS-augmented exposure treatments. Different outcome measures in different studies were harmonized to a 0-100 scale. Intent-to-treat analyses showed that, in participants randomized to DCS augmentation (n = 523), fewer DCS doses, later timing of DCS dose, and lower baseline severity appear to account for this decline effect. More DCS doses were related to better outcomes, but this advantage leveled-off at nine doses. Administering DCS more than 60 minutes before exposures was also related to better outcomes. These predictors were not significant in the placebo arm (n = 521). Results suggested that optimal DCS administration could increase pre-to-follow-up DCS effect size by 50%. In conclusion, the apparent declining effectiveness of DCS over time may be accounted for by how it has been administered. Optimal DCS administration may substantially improve outcomes. Registration: The analysis plan for this manuscript was registered on Open Science Framework (https://osf.io/c39p8/).Entities:
Keywords: augmentation; d-cycloserine; decline effect; dosing; exposure
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Year: 2019 PMID： 31698111 PMCID： PMC9119697 DOI： 10.1016/j.janxdis.2019.102149
Source DB: PubMed Journal: J Anxiety Disord ISSN： 0887-6185