@article {3092990,
	title = {Maintenance of Wellness in Patients With Obsessive-Compulsive Disorder Who Discontinue Medication After Exposure/Response Prevention Augmentation: A Randomized Clinical Trial},
	journal = {JAMA Psychiatry},
	volume = {79},
	number = {3},
	year = {2022},
	note = {2168-6238Foa, Edna BSimpson, Helen BlairGallagher, TheaWheaton, Michael GGershkovich, MarinaSchmidt, Andrew BHuppert, Jonathan DImms, PatriciaCampeas, Raphael BCahill, ShawnDiChiara, ChristinaTsao, Steven DPuliafico, AnthonyChazin, DanielAsnaani, AnuMoore, KellyTyler, JeremySteinman, Shari ASanches-LaCay, ArturoCapaldi, SandySnorrason, {\'I}varTurk-Karan, ElizabethVermes, DonnaKalanthroff, EyalPinto, AnthonyHamlett, Gabriella EMiddleton, RachelHahn, Chang-GyuXu, BinVan Meter, Page EKatechis, MarthaRosenfield, DavidR01 MH045404/MH/NIMH NIH HHS/United StatesR01 MH045436/MH/NIMH NIH HHS/United StatesJournal ArticleRandomized Controlled TrialResearch Support, N.I.H., Extramural2022/01/27JAMA Psychiatry. 2022 Mar 1;79(3):193-200. doi: 10.1001/jamapsychiatry.2021.3997.},
	month = {Mar 1},
	pages = {193-200},
	abstract = {IMPORTANCE: Serotonin reuptake inhibitors (SRIs) are the only medications approved for obsessive-compulsive disorder (OCD), yet most patients taking SRIs exhibit significant symptoms. Adding exposure/response prevention (EX/RP) therapy improves symptoms, but it is unknown whether patients maintain wellness after discontinuing SRIs. OBJECTIVE: To assess whether patients with OCD who are taking SRIs and have attained wellness after EX/RP augmentation can discontinue their SRI with noninferior outcomes compared with those who continue their SRI therapy. DESIGN, SETTING, AND PARTICIPANTS: A 24-week, double-blind, randomized clinical trial was performed from May 3, 2013, to June 25, 2018. The trial took place at US academic medical centers. Participants included 137 adults with a principal diagnosis of OCD (>=1 year) who were taking an SRI (>=12 weeks), had at least moderate symptoms (defined as Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score >=18 points), and received as many as 25 sessions of EX/RP therapy. Those who attained wellness (Y-BOCS score <=14 points; 103 patients [75.2\%]) were study eligible. Data were analyzed from June 29, 2019, to October 2, 2021. INTERVENTION: Participants were randomly assigned either to receive taper to placebo (taper group) or to continue their SRI (continuation group) and monitored for 24 weeks. MAIN OUTCOME AND MEASURES: The Y-BOCS score (range, 0-40 points) was the primary outcome; the Hamilton Depression Rating Scale (HDRS; range, 0-52 points) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF; range, 0\%-100\%) scores were secondary outcomes. Outcomes were assessed at 8 time points by independent evaluators who were blinded to randomization. The taper regimen was hypothesized to be noninferior to continuation at 24 weeks using a 1-sided α value of .05. RESULTS: A total of 101 patients (mean [SD] age, 31.0 [11.2] years; 55 women [54.5\%]) participated in the trial: 51 patients (50.5\%) in the taper group and 50 patients (49.5\%) in the continuation group. At 24 weeks, patients in the taper group had noninferior results compared with patients in the continuation group (mean [SD] Y-BOCS score: taper group, 11.47 [6.56] points; continuation group: 11.51 [5.97] points; difference, -0.04 points; 1-sided 95\% CI, -$\infty$ to 2.09 points [below the noninferiority margin of 3.0 points]; mean [SD] HDRS score: taper group, 5.69 [3.84] points; continuation group, 4.61 [3.46] points; difference, 1.08 points; 1-sided 95\% CI, -$\infty$ to 2.28 points [below the noninferiority margin of 2.5 points]; mean [SD] Q-LES-Q-SF score: taper group, 68.01\% [15.28\%]; continuation group, 70.01\% [15.59\%]; difference, 2.00\%; 1-sided 95\% CI, -$\infty$ to 6.83 [below the noninferiority margin of 7.75]). However, the taper group had higher rates of clinical worsening (23 of 51 [45\%] vs 12 of 50 [24\%]; P = .04). CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial show that patients with OCD who achieve wellness after EX/RP therapy could, on average, discontinue their SRI with noninferior outcomes compared with those who continued their SRI. Those who tapered the SRI had higher clinical worsening rates. Future research should evaluate if SRI half-life alters these rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01686087.},
	keywords = {*Cognitive Behavioral Therapy/methods, *Implosive Therapy, *Obsessive-Compulsive Disorder/diagnosis, Adult, Combined Modality Therapy, Female, Humans, Male, Serotonin Uptake Inhibitors/therapeutic use, Treatment Outcome},
	isbn = {2168-622X (Print)2168-622x},
	author = {Foa, E. B. and Simpson, H. B. and Gallagher, T. and Wheaton, M. G. and Gershkovich, M. and Schmidt, A. B. and Huppert, J. D. and Imms, P. and Campeas, R. B. and Cahill, S. and DiChiara, C. and Tsao, S. D. and Puliafico, A. and Chazin, D. and Asnaani, A. and Moore, K. and Tyler, J. and Steinman, S. A. and Sanches-LaCay, A. and Capaldi, S. and Snorrason, {\'I} and Turk-Karan, E. and Vermes, D. and Kalanthroff, E. and Pinto, A. and Hamlett, G. E. and Middleton, R. and Hahn, C. G. and Xu, B. and Van Meter, P. E. and Katechis, M. and Rosenfield, D.}
}
