Comparative efficacy and tolerability of antipsychotics as augmentations in adults with treatment-resistant obsessive-compulsive disorder: A network meta-analysis. (April 2019)

• Record Type: Journal Article
• Authors: Zhou, Dong-Dong; Zhou, Xiao-Xin; Lv, Zhen; Chen, Xiao-Rong; Wang, Wo; Wang, Gao-Mao; Liu, Chuan; Li, Da-Qi; Kuang, Li
• Is Part Of: Journal of psychiatric research. Volume 111(2019)
• Page Start: 51
• Page End: 58
• Publication Date: 2019-04
• Subjects: Obsessive compulsive disorder -- Network meta-analysis -- Antipsychotics; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2019.01.014
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: We performed a network meta-analysis to build clear hierarchies of efficacy and tolerability of antipsychotics to augment serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in adults. PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched on September 8, 2018. Randomized controlled trials investigating antipsychotics as augmentation agents were included. Network meta-analyses were performed using frequentist methods. Efficacy was measured by the Yale-Brown Obsessive-Compulsive Scale. Tolerability was measured by side-effect discontinuations. Mean differences (MDs) and odds ratios (ORs) were reported with 95% confidence intervals (CIs). Twenty articles with 790 patients were included. Our analyses showed that there was no significant difference in efficacy between antipsychotic agents. The order of efficacy rankings was inconsistent between primary analysis and sensitivity analyses. We found that there was considerable heterogeneity between studies. Comorbid tics was identified as a significant moderator. All antipsychotics except paliperidone were significantly superior to placebo in the subgroup without comorbid tics, while no antipsychotics was significantly superior to placebo in the comorbid tics subgroup. With respect to tolerability, quetiapine (OR, 3.45; 95% CI, 1.04–11.11) and paliperidone (20.00; 1.01->100) were significantly less tolerable than placebo. Based on this network meta-analysis, antipsychotic agents as augmentations to SRIs might be more effective in treatment-resistant OCD patients without comorbid tics. Definitive determination of which drug is optimal cannot be drawn currently because of the limited numbers of studies and heterogeneity across studies. Highlights: Both placebo-controlled and head-to-head RCTs were included in a single analysis. Antipsychotics might be more effective for patients without comorbid tics. Antipsychotics should be administered after at least 12 weeks of SRI treatment.