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Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis

Cervin, Matti LU ; McGuire, Joseph ; D'Souza, Johann ; De Nadai, Alessandro ; Aspvall, Kristina ; Goodman, Wayne K. ; Andrén, Per LU ; Schneider, Sophie C. ; Geller, Daniel and Mataix-Cols, David LU , et al. (2024) In Journal of Child Psychology and Psychiatry
Abstract
Background
Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT).
Methods
PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy... (More)
Background
Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT).
Methods
PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis).
Results
Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95–11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [−2.51, 4.21]; moderate), SRIs (MD: 3.07 [−0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: −1.20 [−5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low.
Conclusions
In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.
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publication status
epub
subject
in
Journal of Child Psychology and Psychiatry
publisher
Wiley-Blackwell
external identifiers
  • scopus:85181241065
  • pmid:38171647
ISSN
0021-9630
DOI
10.1111/jcpp.13934
language
English
LU publication?
yes
id
3002b04e-dd82-4165-8dcd-57f81241f070
date added to LUP
2024-01-05 20:20:59
date last changed
2024-04-06 03:00:08
@article{3002b04e-dd82-4165-8dcd-57f81241f070,
  abstract     = {{Background<br/>Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT).<br/>Methods<br/>PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis).<br/>Results<br/>Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95–11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [−2.51, 4.21]; moderate), SRIs (MD: 3.07 [−0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: −1.20 [−5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low.<br/>Conclusions<br/>In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.<br/>}},
  author       = {{Cervin, Matti and McGuire, Joseph and D'Souza, Johann and De Nadai, Alessandro and Aspvall, Kristina and Goodman, Wayne K. and Andrén, Per and Schneider, Sophie C. and Geller, Daniel and Mataix-Cols, David and Storch, Eric}},
  issn         = {{0021-9630}},
  language     = {{eng}},
  month        = {{01}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Child Psychology and Psychiatry}},
  title        = {{Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis}},
  url          = {{http://dx.doi.org/10.1111/jcpp.13934}},
  doi          = {{10.1111/jcpp.13934}},
  year         = {{2024}},
}