Fluvoxamine in childhood OCD: Long-term treatment

Walkup, John T.; Reeve, Elizabeth A.; Yaruyura-Tobias, J.; Wong, Luchin; Claghorn, James L.; Gaffney, Gary R.; Greist, John H.; Holland, D.; McConville, Brian J.; Pibott, T.; Pravetz, M.; Scahill, Lawrence David; Riddle, Mark A.

doi:10.1016/s0924-977x(99)80399-x

Cited by 5 publications

(19 citation statements)

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“…The difference was clearly evident by 4 weeks on several measures. In OCD, unpublished abstracts indicated acute phase efficacy and further improvement in a 1-year open-label follow-up [30]. Only recently has the data been published to confirm fluvoxamine's efficacy in OCD in children aged 8 years and older [31].…”

Section: Evidence Of Efficacymentioning

confidence: 95%

New developments in pharmacotherapy of pediatric anxiety disorders

Garland¹

2002

Expert Review of Neurotherapeutics

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Anxiety disorders affect about 10% of children and adolescents, are often chronic and impair psychological, academic and social functioning. Recent studies have clearly demonstrated the efficacy of selective serotonin reuptake inhibitors in young people with obsessive-compulsive disorder and mixed or generalized anxiety disorders. Evidence is emerging for effectiveness in social phobia and its variant, selective mutism. Since the effect size for selective serotonin reuptake inhibitors in anxiety greatly exceeds that in depression, studies with small numbers readily show superiority of medication over placebo. Hence, further positive studies are predicted in the next few years. As a result, the rate of prescription of selective serotonin reuptake inhibitors in young people has been rising and will continue to do so. These medications are well-tolerated, but motor and behavioral side effects are more common in young people. Long-term research and postmarketing surveillance are needed.

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Section: Evidence Of Efficacymentioning

confidence: 95%

New developments in pharmacotherapy of pediatric anxiety disorders

Garland¹

2002

Expert Review of Neurotherapeutics

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“…[6,7] One noncomparative trial is published as an abstract. [88] Patients who completed a short-term placebocontrolled phase, [6] along with those who had insufficient response after 6 weeks of double-blind treatment were eligible to participate in the yearlong trial. [88] Patients who completed a short-term placebocontrolled phase, [6] along with those who had insufficient response after 6 weeks of double-blind treatment were eligible to participate in the yearlong trial.…”

Section: Therapeutic Trialsmentioning

confidence: 99%

“…[86] The use of fluvoxamine in the treatment of OCD has also been evaluated in 98 paediatric patients (aged between 8 and 17 years) in a long-term noncomparative trial (reported as an abstract). [88] The fluvoxamine dosage was titrated up to 200 mg/day over the first 3 weeks of treatment. [88] The fluvoxamine dosage was titrated up to 200 mg/day over the first 3 weeks of treatment.…”

Section: Therapeutic Trialsmentioning

confidence: 99%

“…[6,7,[86][87][88] Placebocontrolled trials included a 7-to 14-day washout period, [6] or a 3-week run-in period in which patients received supportive psychoeducational therapy. [6,7,[86][87][88] Placebocontrolled trials included a 7-to 14-day washout period, [6] or a 3-week run-in period in which patients received supportive psychoeducational therapy.…”

Section: Therapeutic Trialsmentioning

confidence: 99%

“…[7] The primary end-points varied among clinical trials. [6,88] Secondary end-points included changes from baseline in the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH-OC) and the Clinical Global Impression Scale (CGI) completed by the clinician, parent or patient. [7] In the placebo-controlled and long-term trials in patients with OCD, the primary end-point was the change in Children's Yale-Brown Obses-sive Compulsive Scale (CY-BOCS) total score from baseline.…”

Section: Therapeutic Trialsmentioning

confidence: 99%

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Fluvoxamine

Cheer¹,

Figgitt²

2001

Paediatric Drugs

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Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which may be used for the management of anxiety disorders in children and adolescents. Absorption of fluvoxamine was similar in adolescents to that in adults, which suggests that the maximum dosage of the drug for patients aged between 12 and 17 years can be as high as 300 mg/day. However, steady-state plasma fluvoxamine [corrected] concentrations were 2 to 3 times higher in children (aged between 6 and 11 years) than in adolescents; thus, the maximum fluvoxamine dosage recommended for children is 200 mg/day. Fluvoxamine (50 to 300 mg/day) for 8 to 16 weeks significantly reduced symptoms of obsessive-compulsive disorder (OCD) [measured across multiple assessment scales] compared with placebo in a well controlled trial in paediatric patients (n = 120) or from baseline in noncomparative trials in adolescent (n = 20) or paediatric (n = 16) patients. Improvements with fluvoxamine (up to 200 mg/day) were observed for up to 1 year in 98 patients with OCD in a noncomparative trial. The drug (up to 250 or 300 mg/day) also improved symptoms of anxiety compared with placebo in an 8-week well controlled trial in 128 paediatric patients with social phobia, separation anxiety disorder or generalised anxiety disorder (GAD). Fluvoxamine (50 to 300 mg/day) appears to be well tolerated in paediatric patients, with most adverse events with the drug (except abdominal discomfort, which occurred more often in patients receiving fluvoxamine) occurring with a similar incidence to those with placebo. The most common adverse events involved the central nervous system or gastrointestinal system. Most adverse events reported by paediatric patients with OCD were similar to those reported by adults. In conclusion, fluvoxamine is generally well tolerated and has demonstrated short-term efficacy compared with placebo in the treatment of OCD, and social phobia, separation anxiety disorder or GAD in well controlled trials in paediatric patients. Reductions in symptoms of anxiety with fluvoxamine have been observed for up to 1 year in children and adolescents with OCD. However, there are currently no comparative trials of fluvoxamine with other pharmacological agents. In the absence of such trials, current consensus opinion recommends that when pharmacotherapy is indicated, fluvoxamine, like other SSRIs, can be used as first-line treatment for anxiety disorders, particularly OCD, in paediatric patients. However, direct comparisons are required to assess the relative efficacy and tolerability of pharmacological agents in order to make firm recommendations for the treatment of anxiety disorders in this patient group.

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Obsessive-compulsive disorder: pharmacological treatment

Thomsen

2000

European Child & Adolescent Psychiatry

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Obsessive-compulsive disorder (OCD) in children and adolescents is often a disabling condition, which demands treatment with medication. Research shows that serotonin is involved in the disorder and empirical treatment studies show that antidepressants with serotonin activity are effective. The first choice of treatment in the psychopharmacological approach to OCD in children and adolescents are the SSRI agents, which have been documented as being effective as well as well-tolerated in children and adolescents. The best-documented SSRI to this point is sertraline. However, fluoxetine and fluoxamine have also undergone systematic studies in children and adolescents. Clomipramine has been proven effective, however, side effects caused by this agent would suggest that an SSRI is a better choice. Treatment with an SSRI seems to have effect in approximately 75 % of patients with OCD. There are still no systematic studies analyzing augmenting medication for children and adolescents with OCD. Research indicates that the combination of medication and psychotherapy (cognitive behavioural therapy) is important in most cases. Based on a few long-term follow-up studies on OCD children and adolescents there is not evidence that all children and adolescents suffer a lifetime course of the disease. It is therefore recommended that discontinuation is attempted after 1-1.5 years of successful treatment.

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Fluvoxamine in childhood OCD: Long-term treatment

Cited by 5 publications

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New developments in pharmacotherapy of pediatric anxiety disorders

New developments in pharmacotherapy of pediatric anxiety disorders

Fluvoxamine

Obsessive-compulsive disorder: pharmacological treatment

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