51.4 AUGMENTATION OF COGNITIVE-BEHAVIORAL THERAPY WITH d -CYCLOSERINE IN PEDIATRIC OBSESSIVE-COMPULSIVE DISORDER: A RANDOMIZED CONTROLLED TRIAL

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 55; no. 10; p. S341
• Main Authors: Storch, Eric A., PhD, Wilhelm, Sabine, PhD, Sprich, Susan, PhD, Henin, Aude I, Micco, Jamie, Small, Brent J., PhD, McGuire, Joseph, PhD, Mutch, P. Jane, PhD, Lewin, Adam B., ABPP, PhD, Murphy, Tanya K., MD, MS, Geller, Daniel A., MD
• Format: Journal Article
• Language: English
• Published: Baltimore Elsevier Inc 01-10-2016; Elsevier BV
• Subjects: Amino acids; Antidepressants; Anxiety Disorders; Augmentation; Behavior; Child & adolescent psychiatry; Children; Clinical trials; Cognitive ability; Cognitive aspects; Cognitive behavioral therapy; Cycloserine; Dendritic cells; Drug Use; Drugs; Efficacy; Evaluation; Medical diagnosis; Obsessive compulsive disorder; Outcome Measures; Pediatrics; Psychiatry; Psychotherapy; Randomized Controlled Trials; Severity; Youth
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2016.07.425

Objectives: The goals of this session are to examine the relative efficacy of weight-adjusted d-cycloserine (DCS) (25/50 mg) versus placebo augmentation of CBT for youth with OCD and whether concomitant antidepressant medication moderated the effects. Methods: Youth (N = 144; ages 7-17 years) recruited between 2010 and 2014 across two academic health science centers, with a primary diagnosis of OCD, were randomized in a double-blinded fashion to either 10 sessions of DCS + CBT or placebo + CBT. Patients were randomly assigned in a 1:1 ratio to either 10 sessions of DCS + CBT or placebo + CBT, DCS (25 or 50 mg based on weight), or placebo. DCS/placebo was taken 1 hour before sessions 4 through 10. The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) served as the primary outcome measure completed by a treatment-naive clinician. Results: Using all available data, the mixed effects model indicated significant (p < 0.001) declines in the CY-BOCS total score and Clinical Global Impression (CGI)-Severity. No significant interaction (p > 0.05) between treatment group and changes in the CY-BOCS and CGI-Severity indicated that the DCS + CBT and placebo + CBT groups declined at similar rates per assessment point on the CY-BOCS total score (Est. = -2.40, 95% CI = -3.04 to -1.77; Est. = -2.07, 95% CI = -2.71 to -1.42, respectively) and CGI-Severity (Est.= -0.29, 95% CI = -0.38 to -0.20; Est. = -0.22, 95% CI = -0.32 to -0.13, respectively). No group differences in secondary outcomes were present. Antidepressant medication use at baseline did not moderate changes (p > 0.05) for either group. Conclusions: DCS augmentation of CBT did not confer additional benefit relative to placebo among youth with OCD. Other augmentation approaches should be examined to enhance outcome.