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

• Published in: Journal of child psychology and psychiatry Vol. 65; no. 5; pp. 594 - 609
• Main Authors: Cervin, Matti, McGuire, Joseph F., D'Souza, Johann M., De Nadai, Alessandro S., Aspvall, Kristina, Goodman, Wayne K., Andrén, Per, Schneider, Sophie C., Geller, Daniel A., Mataix‐Cols, David, Storch, Eric A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2024
• Subjects: Adolescent; adolescents; Anxiety Disorders; Behavior modification; CBT; Child; children; Clinical Medicine; Clinical trials; Cognitive Behavioral Therapy; Cognitive therapy; Cognitive-behavioral factors; Combined Modality Therapy; Confidence; Discontinued; Efficacy; Health care management; Humans; Klinisk medicin; Medical and Health Sciences; medication; Medicin och hälsovetenskap; Meta-analysis; Network Meta-Analysis; Networks; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - therapy; OCD; Pediatrics; pharmacotherapy; Psychiatry; Psykiatri; Randomized Controlled Trials; Relaxation; Relaxation training; Selective Serotonin Reuptake Inhibitors; Serotonin reuptake inhibitors; Systematic review; Treatment Outcome; Webcams; OCD; CBT; adolescents; children; pharmacotherapy; medication; meta‐analysis; efficacy
• ISSN: 0021-9630; 1469-7610; 1469-7610
• DOI: 10.1111/jcpp.13934

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.