Plain English Summary
Background and study aims
Pediatric Obsessive Compulsive Disorder (OCD) is a serious and often chronic disorder involving obsessive and excessive fears, and behaviours ( i.e., rituals) that aim to neutralize the fears and dangers. The symptoms lead to impairment and reduced quality of life. There is impressive evidence for the effectiveness of Cognitive Behaviour Therapy (CBT) with exposure [to the feared situations] and response prevention [of the rituals]. Moreover, CBT gives good symptom relief in many, better than drug treatments (i.e., serotonin re-uptake inhibiting drugs (SSRI)). SSRI treatment also has an impressive evidence base. However, little is known about what treatments to offer in children and adolescents who do not benefit from CBT. So, our study aims at investigating whether continued CBT or a switch to sertraline (a SSRI) is best in these non-responding children and adolescents. However, we are also interested in investigating whether regular child and adolescent clinicians can be taught such CBT and be as efficient as psychotherapists working in specialized OCD clinics.
Who can participate?
Children and adolescents, aged 7-17, with moderate to severe OCD.
What does the study involve?
Following a thorough baseline diagnostic work-up, patients participate in 14 sessions of CBT. Assessments are made also at 7th and 13th week of the therapy. Youngsters who do not benefit from CBT are then randomly allocated to either sertraline or to continued CBT.
What are the possible benefits and risks of participating?
The participants receive state of the art CBT and drug treatment which increase the chance of symptom relief, while the risks are small.
Where is the study run from?
Three Scandinavian (Sweden, Norway and Denmark) countries contribute. The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP) is the data center.
When is the study starting and how long is it expected to run for?
The study started in 2008, has now stopped inclusion, and is currently working on a long-term follow-up scheme to study whether gains from therapy are durable.
Who is funding the study?
All participating centers finance their own contribution with the aid of the local hospital or grants from research foundations. At RBUP, grants from research foundations has covered costs associated with graduate students. RBUP and the Norwegian Research Council has contributed to an electronic data capture system.
Who is the main contact?
Dr Tord Ivarsson
tord.ivarsson@r-bup.no
Trial website
Contact information
Type
Scientific
Primary contact
Dr Tord Ivarsson
ORCID ID
Contact details
Gullhaug Torg 4B
Oslo
0484
Norway
+47 (0)22 58 60 00
tord.ivarsson@r-bup.no
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
NordLOTS protocol 1.2
Study information
Scientific title
Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study
Acronym
NordLOTS
Study hypothesis
Children and adolescents with obsessive compulsive disorder (OCD) who do not respond to a course of cognitive behaviour therapy (CBT) will benefit equally from sertraline and from continued CBT. Identification of CBT versus sertraline responders is possible. Non responders to CBT and sertraline will benefit from aripiprazol augmentation.
Ethics approval
1. Denmark, Institutional Review Board (IRB) (Den videnskabsetiske komité for Region Midtjylland), ref: 20070140
2. Sweden, IRB, 04/02/2008
3. Norway, IRB, 10/03/2008
Study design
Randomised, active controlled trial with three steps:
1: Open uncontrolled
2: Randomised and controlled
3: Open uncontrolled
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Not specified
Trial type
Treatment
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet
Condition
Obsessive compulsive disorder
Intervention
Step 1: Cognitive behaviour therapy (CBT)
Step 2: Sertraline plus CBT support (less intensive CBT) or intensive CBT
Step 3: Sertraline plus CBT support plus aripiprazol
Non-responders to CBT are randomised to continued CBT or sertraline with CBT support. CBT plus sertraline non-responders are treated un-controlled with aripiprazol. Outcome is studied for 36 months.
Dosing schedule of sertraline:
Week 0: no dose given
Week 1: 25 mg for 3 days, then 50 mg (range: 25 - 50 mg)
Week 2: 75 mg (range: 50 - 75 mg)
Weeks 3 - 4: 100 mg (range: 75 - 100 mg)
Weeks 5 - 7: 150 mg (range: 75 - 150 mg)
Weeks 8 - 12: 200 mg (range: 75 - 200 mg)
Weeks 6 - 12: 200 mg (range: 75 - 200 mg)
Dosing schedule of aripiprazol:
Week 0: no dose given
Week 1: 2.5 mg for 7 days (range: 2.5 mg)
Weeks 2 - 4: 5 mg (range: 2.5 - 5 mg)
Weeks 5 - 7: 7.5 mg (range: 2.5 - 7.5 mg)
Weeks 8 - 12: 10 - 20 mg (range: 2.5 - 20 mg)
Weeks 12 onwards: 2.5 - 20 mg
Intervention type
Drug
Phase
Not Applicable
Drug names
Sertraline, aripiprazol
Primary outcome measure
1. CYBOCS
2. Clinical Global Impression Scale
3. Clinical Global Improvement Scale
4. Children's OCD Impact Scale
Outcomes measured (approximately) at weeks 0, 7, 13, and months 6, 12, 24, 36.
Secondary outcome measures
1. Screen for Child Anxiety Related Disorders Revised (SCARED-R)
2. Mood and Feelings Questionnaire (MFQ)
3. Children's Global Assessment Scale (CGAS)
4. Child Behaviour Checklist (CBCL)
5. Family Accomodation Scale (FAS)
6. Need to add another treatment
Outcomes measured (approximately) at weeks 0, 7, 13, and months 6, 12, 24, 36.
Overall trial start date
01/01/2008
Overall trial end date
31/12/2013
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Patients 7 - 17 years of age
2. Moderate-severe obsessive compulsive disorder according to Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV). Severity is defined by Children's Yale-Brown Obsessive Compulsive Scales (CY-BOCS) scores of 16 or above
Participant type
Patient
Age group
Child
Gender
Both
Target number of participants
300 in step 1; 100 in step 2; 30 in step 3
Participant exclusion criteria
1. Co-morbidity has not higher treatment priority (e.g. psychosis, anorexia nervosa, severe depression with suicidality, an autistic disorder or Asperger's syndrome)
2. Pervasive developmental disorders (PDD) not otherwise specified (NOS) is allowed if Clinical Global Impression (CGI) score for the PDD is less than or equal to 3 and CGI for the PDD NOS is less than or equal to CGI for the OCD
3. Mental retardation (intelligence quotient [IQ] less than 70)
4. Patients have not been treated with selective serotonin reuptake inhibitor (SSRI) or CBT for their OCD during the last year
5. If the patient is of non-Nordic ethnicity both the patient and one parent must speak a Nordic language
Recruitment start date
01/01/2008
Recruitment end date
31/12/2013
Locations
Countries of recruitment
Denmark, Norway, Sweden
Trial participating centre
Gullhaug Torg 4B
Oslo
0484
Norway
Sponsor information
Organisation
The Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (R.BUP) (Norway)
Sponsor details
Gullhaug Torg 4B
Oslo
0484
Norway
+47 (0)22 58 60 00
tord.ivarsson@r-bup.no
Sponsor type
Research organisation
Website
Funders
Funder type
Research organisation
Funder name
The Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (Regionsenter for Barn og Unges Psykiske helse [R.BUP]) (Norway) - for the Nordic coordination
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
The participating clinics finance their participation from local funding agencies
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2014 results in: http://www.ncbi.nlm.nih.gov/pubmed/25358486
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/25721185