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Efficacy and Tolerability of Serotonin Transport Inhibitors in Obsessive-compulsive Disorder:  A Meta-analysis

John h. Greist, MD; James W. Jefferson, MD; Kenneth A. Kobak, MSSW; David J. Katzelnick, MD; Ronald C. Serlin, PhD
Arch Gen Psychiatry. 1995;52(1):53-60. doi:10.1001/archpsyc.1995.03950130053006.
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Background:  Questions have been raised regarding the relative efficacy and tolerability of the different serotonin transport inhibitors in the treatment of obsessive-compulsive disorder. We compared the results from four large multicenter placebo-controlled trials of the serotonin transport inhibitors clomipramine hydrochloride (N=520), fluoxetine hydrochloride (N=355), fluvoxamine maleate (N=320), and sertraline hydrochloride (N=325) for the treatment of obsessive-compulsive disorder.

Methods:  Effect size was calculated by subtracting the end-point drug treatment mean change from the endpoint placebo mean change and dividing by the endpoint pooled change standard deviation. A test for overall differences between effect sizes was conducted, followed by all possible pairwise comparisons. The Yale-Brown Obsessive Compulsive Scale was the primary outcome measure for all four studies.

Results:  All four agents were significantly more effective than placebo, with clomipramine significantly more effective than the other three treatments, which did not differ in effect size. A significantly greater percentage of patients treated with clomipramine were rated much or very much improved than were patients treated with fluoxetine, fluvoxamine, or sertraline.

Conclusion:  While the results of this meta-analysis support the superiority of clomipramine, head-to-head, double-blind comparisons of these compounds would be the best test of comparative efficacy and tolerability.

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