Quetiapine augmentation of SRIs in treatment refractory obsessive-compulsive disorder: A double-blind, randomised, placebo-controlled study [ISRCTN83050762]

MRC Research Unit on Anxiety Disorders, University of Stellenbosch, Cape Town, South Africa.
BMC Psychiatry (Impact Factor: 2.21). 02/2005; 5:5. DOI: 10.1186/1471-244X-5-5
Source: PubMed


Although serotonin reuptake inhibitors are effective in the treatment of OCD, many patients fail to respond to these agents. Growing evidence from open-label and placebo-controlled trials suggests a role for augmentation of SRIs with atypical antipsychotics in OCD. Quetiapine is generally well tolerated and previous open-label data has produced mixed results in OCD and additional controlled data is needed.
We undertook a double-blind, randomised, parallel-group, flexible-dose, placebo-controlled study of quetiapine augmentation in subjects who had responded inadequately to open-label treatment with an SRI for 12 weeks. Following informed consent and screening, forty-two subjects were randomised to either placebo or quetiapine for six weeks.
There was significant improvement from baseline to endpoint on the Yale-Brown Obsessive-Compulsive Scale in both the quetiapine and placebo groups (quetiapine, n = 20, p < 0.0001; placebo, n = 21, p = 0.001) with 40% (n = 8) of quetiapine and 47.6% (n = 10) of placebo treated subjects being classified as responders. Quetiapine did not demonstrate a significant benefit over placebo at the end of the six-week treatment period (p = .636). Similarly quetiapine failed to separate from placebo in the subgroup of subjects (n = 10) with co-morbid tics. Quetiapine was generally well tolerated.
In this study, quetiapine augmentation was no more effective than placebo augmentation of SRIs. A number of limitations in study design make comparisons with previous studies in this area difficult and probably contributed to our negative findings. Future work in this important clinical area should address these limitations.

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    • "Symbols: each study is represented by a circle, the area of which is proportional to its statistical weight. Treatment studies: ARI aripiprazole (Muscatello et al. 2011 ; Sayyah et al. 2012), HAL haloperidol (McDougle et al. 1994), OLZ olanzapine (Bystritsky et al. 2004 Shapira et al. 2004), QUE quetiapine (Carey et al. 2005; Denys et al. 2004a, b; Diniz, 2011; Fineberg and Gale 2005; Kordon et al. 2008), RIS risperidone (Erzegovesi et al. 2005; Hollander et al. 2003; McDougle et al. 2000) Psychopharmacology and serotonin receptors were not significantly associated (p>0.05) (Table 3). "
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    • "Outcome data necessary to accomplish this meta-analysis have not been sufficiently reported (missing standard deviations) in 2 studies (McDougle et al., 1994; Erzegovesi et al., 2005). Regarding other potential sources of bias, we noticed that one trial was characterized by significant baseline imbalance in terms of sex distribution (Denys et al., 2004), and in Carey et al. (2005), the minimum duration of the previous SRI treatment at adequate doses was shorter (6 weeks) than in the other incorporated trials. "
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    • "Open studies and case reports have evaluated the efficacy of quetiapine as addon therapy in obsessional states.86,87 In OCD patients refractory to at least two SSRI trials, quetiapine 200 mg/day was shown to be significantly more efficacious than SSRI monotherapy in reducing obsessive symptoms, with 40% of patients rated as responders. "
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