Early Improvement as a Predictor of Treatment Response in Patients With Obsessive-Compulsive Disorder: A 12-Week Randomized Trial of Sertraline and Fluvoxamine.

Abstract

Objective: Early response to selective serotonin reuptake inhibitors (SSRIs) at 4 weeks may predict response at 12 weeks. The objective of this study was to examine if early response to SSRIs can reliably indicate future response to the same drug, while simultaneously comparing 2 medications frequently used to treat obsessive-compulsive disorder (OCD): sertraline and fluvoxamine.Methods: This was a randomized, open-label prospective study of 50 drug-naive patients with OCD (per DSM-5 criteria) conducted from January 2019 to November 2020 in the outpatient department of a tertiary care teaching hospital in North India. Patients were randomly assigned to receive either sertraline or fluvoxamine after assessing the severity of illness with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Following the induction phase of treatment for 2 weeks, patients were assessed for early response, defined as ≥ 20% reduction in YBOCS score after 4 weeks of reaching the minimum therapeutic dose of each drug. The final YBOCS assessment to evaluate response was conducted at 12 weeks.Results: A total of 60% (n = 30) of patients with OCD showed early response at week 4 with a mean dose of sertraline 95 mg and fluvoxamine 102 mg/d. Both drugs showed significant reduction in YBOCS score at week 12. However, fluvoxamine fared significantly better than sertraline (P = .012).Conclusions: The study results show that early response can predict future response to the drug with a good sensitivity and specificity.Trial Registration: Clinical Trial Registry of India: CTRI/2020/01/022890.