Luis C Farhat1, Edoardo F Q Vattimo1, Divya Ramakrishnan2, Jessica L S Levine2, Jessica A Johnson3, Bekir B Artukoglu4, Angeli Landeros-Weisenberger2, Fernando R Asbahr1, Sandra L Cepeda5, Jonathan S Comer6, Daniel Fatori1, Martin E Franklin7, Jennifer B Freeman8, Daniel A Geller9, Paul J Grant10, Wayne K Goodman5, Isobel Heyman11, Tord Ivarsson12, Fabian Lenhard13, Adam B Lewin14, Fenghua Li2, Lisa J Merlo15, Hamid Mohsenabadi16, Tara S Peris17, John Piacentini17, Ana I Rosa-Alcázar18, Àngel Rosa-Alcázar18, Michelle Rozenman19, Jeffrey J Sapyta20, Eva Serlachius13, Mohammad J Shabani16, Roseli G Shavitt1, Brent J Small21, Gudmundur Skarphedinsson22, Susan E Swedo23, Per Hove Thomsen24, Cynthia Turner25, Bernhard Weidle26, Euripedes C Miguel1, Eric A Storch5, David Mataix-Cols13, Michael H Bloch27. 1. Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil. 2. Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut. 3. Columbia University New York, New York; Columbia School of Nursing, New York. 4. SUNY Downstate Health Sciences University, New York. 5. Baylor College of Medicine, Texas. 6. Center for Children and Families, Florida International University, Miami, Florida. 7. University of Pennsylvania, Philadelphia; Rogers Memorial Hospital, Oconomowoc, Wisconsin. 8. Warren Alpert Medical School, Brown University, Providence, Rhode Island. 9. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 10. Washington, DC. 11. Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom. 12. 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. 13. Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden. 14. University of South Florida, Hillsborough County. 15. University of Florida, Miami. 16. Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, IR. 17. Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles. 18. University of Murcia, Spain. 19. University of Denver, Colorado. 20. Duke University School of Medicine, Durham, North Carolina. 21. School of Aging Studies, University of South Florida, Hillsborough County. 22. Faculty of Psychology, University of Iceland, Reykjavik. 23. National Institutes of Health, Bethesda, Maryland. 24. 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. 25. Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia. 26. 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. 27. Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut. Electronic address: michael.bloch@yale.edu.
Abstract
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.
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.
Authors: Lara J Farrell; Allison M Waters; Evelin Tiralongo; Sharna Mathieu; Matthew McKenzie; Vinay Garbharran; Robert S Ware; Melanie J Zimmer-Gembeck; Harry McConnell; Cassie Lavell; Jacinda Cadman; Thomas H Ollendick; Jennifer L Hudson; Ronald M Rapee; Brett McDermott; Daniel Geller; Eric A Storch Journal: Depress Anxiety Date: 2022-01-27 Impact factor: 8.128