Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, Brazil.
J Psychiatr Res. 2013 Nov;47(11):1700-7. doi: 10.1016/j.jpsychires.2013.07.006. Epub 2013 Aug 13.
In major depression, early response to treatment has been strongly associated with final outcome. We aimed to investigate the ability of early improvement (4 weeks) to predict treatment response at 12 weeks in DSM-IV-defined obsessive-compulsive disorder (OCD) patients treated with serotonin reuptake inhibitors (SRI). We conducted an SRI practical trial with 128 subjects.
age range 18-65 years-old, baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score ≥ 16, and absence of previous adequate pharmacological treatment. Systematic assessments were performed at baseline, 4 and 12 weeks of treatment. Treatment response at 12 weeks was defined as a 35% or greater reduction in baseline Y-BOCS score. Stepwise logistic regression was used to test the relationship between early improvement and treatment response at 12 weeks, taking into account additional potential predictive factors. Different thresholds of early improvement were tested and their predictive power was calculated. Early improvement, defined as a 20% or greater reduction from baseline Y-BOCS score at 4 weeks, predicted response at 12 weeks with 75.6% sensitivity and 61.9% specificity. According to a logistic regression including demographic and clinical features as explaining variables, early improvement was the best predictor of treatment response (OR = 1.05, p < 0.0001). Only 19.8% of patients who did not improve at 4 weeks were responders after 12 weeks. In contrast, 55.3% of the individuals who showed early improvement were responders at 12 weeks (Pearson Chi-Square = 17.06, p < 0.001). Early improvement predicted OCD treatment response with relatively good sensitivity and specificity, such that its role in early decision-making warrants further investigation in wider samples.
clinicaltrials.gov Identifier NCT00680602.
在重度抑郁症中，早期治疗反应与最终结果密切相关。我们旨在探讨在接受选择性 5-羟色胺再摄取抑制剂（SSRI）治疗的DSM-IV 定义的强迫症（OCD）患者中，4 周时的早期改善（4 周）能否预测 12 周时的治疗反应。
我们进行了一项包含 128 名患者的 SSRI 实际试验。
年龄 18-65 岁，基线耶鲁-布朗强迫症量表（Y-BOCS）评分≥16，且无先前充分的药物治疗史。在基线、治疗 4 周和 12 周时进行系统评估。治疗 12 周时的反应定义为基线 Y-BOCS 评分下降≥35%。逐步逻辑回归用于测试早期改善与 12 周时治疗反应之间的关系，同时考虑其他潜在的预测因素。测试了不同的早期改善阈值，并计算了它们的预测能力。早期改善定义为基线 Y-BOCS 评分在 4 周时下降≥20%，可预测 12 周时的反应，敏感性为 75.6%，特异性为 61.9%。根据包括人口统计学和临床特征的解释变量的逻辑回归，早期改善是治疗反应的最佳预测因素（OR=1.05，p<0.0001）。在 4 周时没有改善的患者中，只有 19.8%在 12 周时是反应者。相比之下，在 12 周时，55.3%表现出早期改善的患者是反应者（Pearson Chi-Square=17.06，p<0.001）。早期改善可预测 OCD 治疗反应，具有相对较高的敏感性和特异性，因此其在早期决策中的作用值得在更大的样本中进一步研究。
clinicaltrials.gov 标识符 NCT00680602。
