Network Meta-Analysis of the Relative Efficacy of Pharmacological and Psychological Interventions in Adults with Obsessive Compulsive Disorder.

Abstract

Obsessive compulsive disorder (OCD) is the fourth most common mental disorder in the UK with a prevalence of 1.5%. Both pharmacological and psychological interventions are used in the treatment with the treatment course usually chronic. This study estimates the relative efficacy of pharmacological and psychological treatments or combinations of both. A systematic review was conducted to identify RCTs of clomipramine, SSRIs, venlafaxine, and psychological interventions with a behavioural, cognitive or cognitive behavioural component. A Bayesian random effects network meta-analyses (NMA) was used to obtain coherent estimates of relative efficacy of every pair of the different interventions, even when direct evidence was not available. The primary endpoint was mean change in Yale-Brown obsessive compulsive scale (YBOCS). We assumed that treatment effects for the different SSRIs were similar in the sense that they came from a common Normal distribution of treatment effects with an overall SSRI class effect mean, and between treatment within class heterogeneity. There were 55 eligible studies identified in the systematic review. The intervention with the greatest decrease in YBOCS was behavioural therapy (“exposure and response prevention”) showing a decrease of 13.86 (CrI 9.34 to 18.31). The second and third greatest decrease was cognitive therapy (12.80 CrI 7.39 to 18.18) and behavioural therapy plus clomipramine (12.47 CrI 5.80 to 19.08) respectively. The SSRI class effect showed a relative decrease in mean YBOCS of 2.89 (CrI 1.05 to 4.71) compared to pharmacological placebo. The Results of the individual SSRIs ranged from a decrease of 2.49 (sertraline) to 3.10 (fluvoxamine). This analysis showed a combination of behavioural therapy plus clomipramine has the greatest decrease in YBOCS. There is little evidence to show a difference between SSRIs.