Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis

作者：Petros Skapinakis, Deborah M Caldwell, William Hollingworth, Peter Bryden, Naomi Fineberg, Paul M. Šalkovskis, Nicky J. Welton, Helen Baxter, David Keßler, Rachel Churchill, Glyn Lewis · 发表于：The Lancet Psychiatry · 年份：2016 · DOI：10.1016/s2215-0366(16)30069-4 · 被引用次数：398 · 研究领域：Obsessive-Compulsive Spectrum Disorders、Personality Disorders and Psychopathology、Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

BACKGROUND: Several interventions are available for management of obsessive-compulsive disorder in adults, but few studies have compared their relative efficacy in a single analysis. We aimed to simultaneously compare all available treatments using both direct and indirect data. METHODS: In this systematic review and network meta-analysis, we searched the two controlled trials registers maintained by the Cochrane Collaboration Common Mental Disorders group for trials published up to Feb 16, 2016. We selected randomised controlled trials in which an active psychotherapeutic or pharmacological intervention had been used in adults with obsessive-compulsive disorder. We allowed all comorbidities except for schizophrenia or bipolar disorder. We excluded studies that focused exclusively on treatment-resistant patient populations defined within the same study. We extracted data from published reports. The primary outcome was symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. We report mean differences with 95% credible intervals compared with placebo. This study is registered with PROSPERO, number CRD42012002441. FINDINGS: We identified 1480 articles in our search and included 53 articles (54 trials; 6652 participants) in the network meta-analysis. Behavioural therapy (mean difference -14·48 [95% credible interval -18·61 to -10·23]; 11 trials and 287 patients), cognitive therapy (-13·36 [-18·40 to -8·21]; six trials and 172 patients), behavioural therapy and ...