The Nordic Long-term OCD Treatment Study (NordLOTS): A Summary of the Diagnostic Workup and Acute Treatment Stages

TY - ABST

T1 - The Nordic Long-term OCD Treatment Study (NordLOTS): A Summary of the Diagnostic Workup and Acute Treatment Stages

AU - Skarphedinsson, Gudmundur

AU - Jensen, Sanne

AU - Hybel, Katja Anna

AU - Højgaard, David R.M.A.

AU - Nissen, Judith Becker

AU - Torp, Nor Christian

AU - Weidle, Bernhard

AU - Melin, Karin

AU - Thomsen, Per Hove

N1 - Conference code: 20

PY - 2023/7/1

Y1 - 2023/7/1

N2 - The NordLOTS rationale for a stepped-care study was that patients who received serotonin re-uptake inhibitors (SRI) were mainly CBT non-responders while RCTs examining the outcome of SRI were treatment naive. We argued that CBT non-responders may have an attenuated SRI response, and that continued CBT would be the preferable control contingency as we had reason to believe that CBT (particularly focusing on exposure and response prevention (ERP)) may still show some efficacy. A 3-year follow-up of all patients was added to inform on treatment durability.In NordLOTS, 269 step-1 participants had a pre-ERP average CY-BOCS score of 24.6, and completers (n = 241) of ERP treatment had a response rate (post ERP CY-BOCS ≤ 15 points) of 72.6% with a mean symptom reduction of 52.9%. Out of 69 non- or partial responders to step 1 ERP, 54 patients accepted step 2 randomization to continued ERP or sertraline (mean CY-BOCS = 27.3 and 25.2, respectively). Due to attrition, the final intent-to-treat sample included 50 participants (48% males). Twenty-one of 28 participants (75 %) completed continued ERP while 15 of 22 participants (69.2%) completed sertraline. The CY-BOCS total score examination revealed no differences between treatments (mean = 21.3 and 21.1, respectively) and response rates were 50.0% and 45.4%, respectively.Good step-1 ERP response rates, and equal response to step-2 sertraline or continued ERP showed that extended treatment may be worthwhile in pediatric OCD, and following our 269 participants yearly for three years will demonstrate if treatment durability is acceptable as well.

AB - The NordLOTS rationale for a stepped-care study was that patients who received serotonin re-uptake inhibitors (SRI) were mainly CBT non-responders while RCTs examining the outcome of SRI were treatment naive. We argued that CBT non-responders may have an attenuated SRI response, and that continued CBT would be the preferable control contingency as we had reason to believe that CBT (particularly focusing on exposure and response prevention (ERP)) may still show some efficacy. A 3-year follow-up of all patients was added to inform on treatment durability.In NordLOTS, 269 step-1 participants had a pre-ERP average CY-BOCS score of 24.6, and completers (n = 241) of ERP treatment had a response rate (post ERP CY-BOCS ≤ 15 points) of 72.6% with a mean symptom reduction of 52.9%. Out of 69 non- or partial responders to step 1 ERP, 54 patients accepted step 2 randomization to continued ERP or sertraline (mean CY-BOCS = 27.3 and 25.2, respectively). Due to attrition, the final intent-to-treat sample included 50 participants (48% males). Twenty-one of 28 participants (75 %) completed continued ERP while 15 of 22 participants (69.2%) completed sertraline. The CY-BOCS total score examination revealed no differences between treatments (mean = 21.3 and 21.1, respectively) and response rates were 50.0% and 45.4%, respectively.Good step-1 ERP response rates, and equal response to step-2 sertraline or continued ERP showed that extended treatment may be worthwhile in pediatric OCD, and following our 269 participants yearly for three years will demonstrate if treatment durability is acceptable as well.

M3 - Conference abstract for conference

T2 - 20th International Congress of the European Society for Child and Adolescent Psychiatry

Y2 - 29 June 2023 through 1 July 2023

ER -