{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:43:03Z","timestamp":1785422583989,"version":"3.56.0"},"reference-count":39,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"unspecified","delay-in-days":226,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291725101335_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In the treatment of obsessive-compulsive disorder (OCD) with antidepressant medication, the earliest reliable indication of treatment failure remains uncertain. We investigated if non-improvement following 4 weeks of treatment predicts nonresponse at the end of the trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725101335_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a random-effects bivariate diagnostic accuracy study using individual patient data from industry-sponsored short-term trials of adults with OCD receiving selective serotonin reuptake inhibitors or clomipramine, submitted for marketing approval. The primary outcome was accuracy of non-improvement (&lt;25% reduction on the Yale\u2013Brown Obsessive Compulsive Scale [YBOCS] after 4\u00a0weeks) in predicting nonresponse (&lt;35% YBOCS reduction at trial endpoint [10\u201313\u00a0weeks]). Secondary outcomes were accuracy of non-improvement after 6\u00a0weeks, nonresponse after 8\u00a0weeks, and inclusion of Clinical Global Impression Scale \u2013 Improvement in definitions of improvement and response. We performed meta-regressions for sex, age, severity, trial duration, dosing regimen, and compound.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725101335_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 11 studies totaling 1,753 patients, non-improvement at week 4 predicted subsequent nonresponse (positive predictive value, PPV) in 86% of cases (95% confidence interval [CI] = 83\u201388%). Sensitivity was 78%, specificity was 70%, and the negative predictive value was 60%. Secondary outcomes showed similar PPV after 6\u00a0weeks and a PPV of 93% for nonresponse after 8\u00a0weeks. Predictive accuracy was significantly higher in men relative to women (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = \u22120.64, 95% CI = \u22121.12 to \u22120.16,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0089).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725101335_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with OCD who do not improve after 4\u00a0weeks of antidepressants will likely not respond to short-term treatment. Thus, a change in strategy should be considered after 4\u00a0weeks without treatment benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291725101335","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T07:49:37Z","timestamp":1755244177000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Does early non-improvement predict treatment failure in pharmacotherapy for obsessive-compulsive disorder? A diagnostic test accuracy meta-analysis with individual participant data"],"prefix":"10.1017","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9733-6146","authenticated-orcid":false,"given":"Sem","family":"Cohen","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03t4gr691","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam UMC"},{"id":[{"id":"https:\/\/ror.org\/05grdyy37","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam Neuroscience Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6475-902X","authenticated-orcid":false,"given":"Jasper Brian","family":"Zantvoord","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03t4gr691","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam UMC"},{"id":[{"id":"https:\/\/ror.org\/05grdyy37","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam Neuroscience Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ton","family":"de Boer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05mv4rb84","id-type":"ROR","asserted-by":"publisher"}],"name":"Medicines Evaluation Board"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5751-265X","authenticated-orcid":false,"given":"Taina","family":"Mattila","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05mv4rb84","id-type":"ROR","asserted-by":"publisher"}],"name":"Medicines Evaluation Board"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3076-5891","authenticated-orcid":false,"given":"Guido","family":"van Wingen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03t4gr691","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam UMC"},{"id":[{"id":"https:\/\/ror.org\/05grdyy37","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam Neuroscience Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3191-3844","authenticated-orcid":false,"given":"Damiaan","family":"Denys","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03t4gr691","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam UMC"},{"id":[{"id":"https:\/\/ror.org\/05grdyy37","id-type":"ROR","asserted-by":"publisher"}],"name":"Amsterdam Neuroscience Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"S0033291725101335_r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2012.03.006"},{"key":"S0033291725101335_r24","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2024.152486"},{"key":"S0033291725101335_r37","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.822976"},{"key":"S0033291725101335_r8","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20984"},{"key":"S0033291725101335_r16","doi-asserted-by":"publisher","DOI":"10.1097\/00004850-199506000-00001"},{"key":"S0033291725101335_r12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2013.07.006"},{"key":"S0033291725101335_r19","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.14r09758"},{"key":"S0033291725101335_r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2014.05.006"},{"key":"S0033291725101335_r29","doi-asserted-by":"publisher","DOI":"10.9740\/mhc.2022.10.300"},{"key":"S0033291725101335_r17","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-7258(99)00048-0"},{"key":"S0033291725101335_r2","unstructured":"Ackerman, D. 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Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is used to distribute the re-used or adapted article and the original article is properly cited. The written permission of Cambridge University Press must be obtained prior to any commercial use.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e237"}}