Evidence map›Paper›PMID 38350669›Full record

SynthesisBMJ mental health2024

Influence of study characteristics, methodological rigour and publication bias on efficacy of pharmacotherapy in obsessive-compulsive disorder: a systematic review and meta-analysis of randomised, placebo-controlled trials.

Sem E Cohen, Jasper Brian Zantvoord, Bram W C Storosum, Taina Kristiina Mattila, Joost Daams, Babet Wezenberg, Anthonius de Boer, Damiaan A J P Denys

Open access · diamondAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ mental health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
8.9field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. The minimal important difference in obsessive-compulsive disorder: An analysis of double-blind SSRI trials in adults.European psychiatry : the journal of the Association of European Psychiatrists · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

Sem E CohenPsychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands s.e.cohen@amsterdamumc.nl.ORCID http://orcid.org/0000-0002-9733-6146
Jasper Brian ZantvoordPsychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0002-6475-902X
Bram W C StorosumPsychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.ORCID http://orcid.org/0000-0002-0764-8745
Taina Kristiina MattilaMedicines Evaluation Board, Utrecht, The Netherlands.
Joost DaamsMedical Library, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Babet WezenbergPsychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Anthonius de BoerMedicines Evaluation Board, Utrecht, The Netherlands.
Damiaan A J P DenysPsychiatry, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.
Amsterdam Neuroscience · NLAmsterdam University Medical Centers · NLMedicines Evaluation Board · NLUtrecht University · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

questionWe examined the effect of study characteristics, risk of bias and publication bias on the efficacy of pharmacotherapy in randomised controlled trials (RCTs) for obsessive-compulsive disorder (OCD). STUDY SELECTION AND ANALYSIS: We conducted a systematic search of double-blinded, placebo-controlled, short-term RCTs with selective serotonergic reuptake inhibitors (SSRIs) or clomipramine. We performed a random-effect meta-analysis using change in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) as the primary outcome. We performed meta-regression for risk of bias, intervention, sponsor status, number of trial arms, use of placebo run-in, dosing, publication year, age, severity, illness duration and gender distribution. Furthermore, we analysed publication bias using a Bayesian selection model.

findingsWe screened 3729 articles and included 21 studies, with 4102 participants. Meta-analysis showed an effect size of -0.59 (Hedges' G, 95% CI -0.73 to -0.46), equalling a 4.2-point reduction in the YBOCS compared with placebo. The most recent trial was performed in 2007 and most trials were at risk of bias. We found an indication for publication bias, and subsequent correction for this bias resulted in a depleted effect size. In our meta-regression, we found that high risk of bias was associated with a larger effect size. Clomipramine was more effective than SSRIs, even after correcting for risk of bias. After correction for multiple testing, other selected predictors were non-significant.

conclusionsOur findings reveal superiority of clomipramine over SSRIs, even after adjusting for risk of bias. Effect sizes may be attenuated when considering publication bias and methodological rigour, emphasising the importance of robust studies to guide clinical utility of OCD pharmacotherapy. PROSPERO REGISTRATION NUMBER: CRD42023394924.

Indexed as

ClomipramineObsessive-Compulsive DisorderPublication BiasRandomized Controlled Trials as TopicSelective Serotonin Reuptake InhibitorsHumansResearch DesignTreatment OutcomeClomipramineSelective Serotonin Reuptake InhibitorsAdult psychiatryAnxiety disordersData Interpretation, Statistical

Identifiers

PMID38350669
PMCPMC10862307
OpenAlexW4391783202

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.