Exploring the minimal important difference in the treatment of paediatric obsessive-compulsive disorder using selective serotonin reuptake inhibitors

• Published in: BMJ mental health Vol. 27; no. 1; p. e300999
• Main Authors: Cohen, Sem E, Denys, Damiaan A J P, Mattila, Taina Kristiina, Storosum, Bram W C, de Boer, Anthonius, Zantvoord, Jasper Brian
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd, Royal College of Psychiatrists and British Psychological Society 19.06.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adolescent; Benchmarks; Child; child & adolescent psychiatry; Correspondence; data interpretation, statistical; Gender; Humans; Mental depression; Neuroses; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - drug therapy; Patients; Pediatrics; Psychiatry; Selective Serotonin Reuptake Inhibitors - therapeutic use; Serotonin; Teenagers; data interpretation, statistical; child & adolescent psychiatry
• ISSN: 2755-9734; 2755-9734
• DOI: 10.1136/bmjment-2024-300999

Study selection and analysis We used individual participant data from short-term double-blind, randomised, placebo-controlled trials with selective serotonin reuptake inhibitors (SSRIs) that were submitted to the Dutch Medicines Evaluation Board (MEB). Table 1 Patient characteristics at baseline Placebo Active treatment P value N 146 147 N gender F (%) N gender M (%) 69 (47) 77 (53) 68 (46) 79 (54) 0.9 Mean age (SD) 12.6 (2.7) 12.7 (3.0) 0.78 Mean CYBOCS (SD) 23.4 (5.6) 24.0 (4.6) 0.37 Mean CGI-S (SD) 4.6 (0.79) 4.7 (0.73) 0.31 Severity categories N mild (%) N moderate (%) N severe (%) 111 (38) 145 (49) 37 (13) P value after t-test (age, CYBOCS, CGI-S) or χ 2-test (gender) . In a recent meta-analysis assessing the efficacy of SSRIs compared with placebo in paediatric OCD, a small standardised mean difference was demonstrated, yet mean CYBOCS differences were not reported which impedes interpretability.6 For assessing clinical relevance, it would be valuable to determine whether the placebo-active treatment separation equals the MID in youth with OCD. [...]because we were unable to use patient-reported outcome measures, and because the CGI-I focusses on illness-specific symptoms, our MID is assessor-based and does not incorporate non-illness-specific factors such as quality of life.