CONTEXT Treatments for obsessive-compulsive disorder (OCD) in children and adolescents. OBJECTIVE Evaluate the comparative efficacy of behavioral and pharmacologic treatments. DATA SOURCES Six databases and ClinicalTrials.gov registry; search last updated on 5/15/2024. STUDY SELECTION Dual screening augmented by Abstrackr machine learning algorithm. DATA EXTRACTION/ANALYSIS Participant characteristics, intervention details and risk of bias. RESULTS 71 randomized controlled trials (RCTs). In the random effects network meta-analysis of OCD symptom severity, assessed by the Children's Yale-Brown Obsessive Compulsive Scale Total (CY-BOCS), exposure and response prevention therapy (ERP) is more effective than waitlist (net mean difference [NMD] -10.5; 95% confidence interval [CI]: -12.6, -8.4) and probably more effective vs. behavioral control (NMD -5.3; 95% CI: -8.0, -2.7). Remote ERP is more effective than waitlist (NMD -9.4; 95% CI: -11.9, -7.0) and as effective as in-person ERP. Selective serotonin reuptake inhibitors (SSRIs) are more effective than placebo (NMD -4.4; 95% CI: -6.1, -2.6). Clomipramine is probably more effective than placebo (NMD -4.5; 95% CI: -6.8, -2.1). ERP is probably more effective than SSRI (NMD -2.7; 95% CI -5.4, -0.0) and combined ERP and an SSRI are probably more effective than SSRI alone (NMD -3.0; 95% CI: -5.1, -1.0). Overall, treatments including ERP (ERP+SSRI, ERP and remote ERP) comprise the 3 highest ranked interventions. LIMITATIONS Non CY-BOCS outcomes were sparsely reported. CONCLUSIONS ERP, delivered in-person or via telehealth, SSRIs and clomipramine are all effective treatments. ERP, alone or in combination with an SSRI, is probably more effective than SSRI alone.

中文翻译：

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儿童和青少年强迫症的治疗：荟萃分析。


背景 儿童和青少年强迫症 （OCD） 的治疗。目的 评估行为和药物治疗的比较疗效。数据源 6 个数据库和 ClinicalTrials.gov 个注册表;搜索最后更新于 2024 年 5 月 15 日。研究选择 由 Abstrackr 机器学习算法增强的双重筛选。资料提取/分析 参与者特征、干预细节和偏倚风险。结果 71 项随机对照试验 （RCT）。在由儿童耶鲁-布朗强迫症量表总分 （CY-BOCS） 评估的强迫症症状严重程度的随机效应网络荟萃分析中，暴露和反应预防疗法 （ERP） 比候补名单更有效（净均数差 [NMD] -10.5;95% 置信区间 [CI]：-12.6，-8.4），并且可能比行为控制更有效（NMD -5.3;95% CI：-8.0，-2.7）。远程 ERP 比候补名单更有效（NMD -9.4;95% CI：-11.9，-7.0），并且与面对面 ERP 一样有效。选择性 5-羟色胺再摄取抑制剂 （SSRIs） 比安慰剂更有效 （NMD -4.4;95% CI： -6.1， -2.6）。氯米帕明可能比安慰剂更有效 （NMD -4.5;95% CI： -6.8， -2.1）。ERP 可能比 SSRI 更有效 （NMD -2.7;95% CI -5.4， -0.0），ERP 和 SSRI 联合使用可能比单独使用 SSRI 更有效 （NMD -3.0;95% CI： -5.1， -1.0）。总体而言，包括 ERP（ERP+SSRI、ERP 和远程 ERP）在内的治疗构成了排名最高的 3 种干预措施。局限性 非 CY-BOCS 结局很少报告。结论 面对面或通过远程医疗提供的 ERP、SSRIs 和氯米帕明都是有效的治疗方法。ERP，单独使用或与 SSRI 联合使用，可能比单独使用 SSRI 更有效。