Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials
Abstract Obsessive–compulsive disorder (OCD) is the fourth most common mental disorder, and selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of its pharmacological treatment. About 40–60% of the cases are treatment-refractory, and this makes searching for second-line treatment nec...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-11-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-47931-x |
| _version_ | 1797415535319711744 |
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| author | Negin Eissazade Hesam Mosavari Shayan Eghdami Mahsa Boroon Faria Ashrafi Mohammadreza Shalbafan |
| author_facet | Negin Eissazade Hesam Mosavari Shayan Eghdami Mahsa Boroon Faria Ashrafi Mohammadreza Shalbafan |
| author_sort | Negin Eissazade |
| collection | DOAJ |
| description | Abstract Obsessive–compulsive disorder (OCD) is the fourth most common mental disorder, and selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of its pharmacological treatment. About 40–60% of the cases are treatment-refractory, and this makes searching for second-line treatment necessary. 5-Hydroxytryptamine-3 (5-HT3) antagonists are among the many medications that have been used in augmentation with SSRIs. In this systematic review and meta-analysis, we assessed the efficacy and safety of 5-HT3 receptor antagonists in augmentation with SSRIs in treating moderate to severe OCD. We searched PubMed, Web of Science, Scopus, Cochrane library, and Google Scholar for relevant trials published up to December 2022. The effect size was the mean difference in Yale-Brown obsessive compulsive scale (Y-BOCS) scores before and after receiving 5-HT3 receptor antagonist drugs in augmentation with SSRIs in moderate to severe OCD patients. We included 6 randomized-controlled trails (RCTs) with 334 patients assessing the effect of the augmentation of SSRIs with ondansetron, granisetron, and tropisetron on treating moderate to severe OCD. Our results were in favor of the experimental group in total (Z = 8.37, P < 0.00001), in the compulsion subgroup (Z = 5.22, P < 0.00001), and in the obsession subgroup (Z = 8.33, P < 0.00001). They are well-tolerated, and have mild side effects and do not result in withdrawal. Augmentation of 5-HT3 antagonists with SSRIs can be beneficial in treating moderate to severe OCD. Further multi-center trials under adequate conditions in longer periods are needed to help come up with a comprehensive action plan. |
| first_indexed | 2024-03-09T05:50:01Z |
| format | Article |
| id | doaj.art-3ed51d58d5a74866b27c7c72b42de6a5 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-09T05:50:01Z |
| publishDate | 2023-11-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-3ed51d58d5a74866b27c7c72b42de6a52023-12-03T12:18:04ZengNature PortfolioScientific Reports2045-23222023-11-0113111110.1038/s41598-023-47931-xEfficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trialsNegin Eissazade0Hesam Mosavari1Shayan Eghdami2Mahsa Boroon3Faria Ashrafi4Mohammadreza Shalbafan5Student Research Committee, School of Medicine, Iran University of Medical SciencesDepartment of Surgery, General Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical SciencesCellular and Molecular Research Center, Iran University of Medical SciencesDepartment of Psychiatry, Imam Hossein Hospital, School of Medicine, Alborz University of Medical SciencesBrain and Cognition Clinic, Institute for Cognitive Sciences StudiesMental Health Research Center, Psychosocial Health Research Institute (PHRI), Department of Psychiatry, School of Medicine, Iran University of Medical SciencesAbstract Obsessive–compulsive disorder (OCD) is the fourth most common mental disorder, and selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of its pharmacological treatment. About 40–60% of the cases are treatment-refractory, and this makes searching for second-line treatment necessary. 5-Hydroxytryptamine-3 (5-HT3) antagonists are among the many medications that have been used in augmentation with SSRIs. In this systematic review and meta-analysis, we assessed the efficacy and safety of 5-HT3 receptor antagonists in augmentation with SSRIs in treating moderate to severe OCD. We searched PubMed, Web of Science, Scopus, Cochrane library, and Google Scholar for relevant trials published up to December 2022. The effect size was the mean difference in Yale-Brown obsessive compulsive scale (Y-BOCS) scores before and after receiving 5-HT3 receptor antagonist drugs in augmentation with SSRIs in moderate to severe OCD patients. We included 6 randomized-controlled trails (RCTs) with 334 patients assessing the effect of the augmentation of SSRIs with ondansetron, granisetron, and tropisetron on treating moderate to severe OCD. Our results were in favor of the experimental group in total (Z = 8.37, P < 0.00001), in the compulsion subgroup (Z = 5.22, P < 0.00001), and in the obsession subgroup (Z = 8.33, P < 0.00001). They are well-tolerated, and have mild side effects and do not result in withdrawal. Augmentation of 5-HT3 antagonists with SSRIs can be beneficial in treating moderate to severe OCD. Further multi-center trials under adequate conditions in longer periods are needed to help come up with a comprehensive action plan.https://doi.org/10.1038/s41598-023-47931-x |
| spellingShingle | Negin Eissazade Hesam Mosavari Shayan Eghdami Mahsa Boroon Faria Ashrafi Mohammadreza Shalbafan Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials Scientific Reports |
| title | Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials |
| title_full | Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials |
| title_fullStr | Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials |
| title_full_unstemmed | Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials |
| title_short | Efficacy and safety of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists in augmentation with selective serotonin reuptake inhibitors (SSRIs) in the treatment of moderate to severe obsessive–compulsive disorder: a systematic review and meta-analysis of randomized clinical trials |
| title_sort | efficacy and safety of 5 hydroxytryptamine 3 5 ht3 receptor antagonists in augmentation with selective serotonin reuptake inhibitors ssris in the treatment of moderate to severe obsessive compulsive disorder a systematic review and meta analysis of randomized clinical trials |
| url | https://doi.org/10.1038/s41598-023-47931-x |
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