Escitalopram의 강박증 치료반응 예측 인자

Predictors of Clinical Response to Escitalopram in Obsessive-Compulsive Disorder

본 연구는 서울대학교병원 신경정신과 강박증 클리닉 외래에 내원한 강박증 환자 223명의 의무기록을 검토하여 후향적 으로 이루어졌다. 본 연구에서는 연구대상군의 분류 기준으로서 ESC 투여 중 최종 평가시점에서의 CGI-I 점수를 선택 하여, 최종 평가시의 CGI-I 점수가 1점 또는 2점에 해당하는 증례는 반응군(responder)으로, 그리고 최종 평가시의 CGII 점수가 3점 이상인 증례는 비반응군(non-responder)으로 분류한 후, 반응군과 비반응군 사이에서 강박증의 여러 임상적 변인들을 비교하였고, 또한 ESC 투여시의 임상적 반응도를 예측하기 위한 가설적 모형의 타당도를 검증하였다. 이를 통해, 공격성 강박증상군을 가지는 강박증 환자들이 이러한 증상을 가지지 않는 강박증 환자들의 경우와 비교하여 ESC에 대한 치료반응이 상대적으로 낮음을 알 수 있었고, 강박증 환자에게 약물 투여를 시작하기 전 해당 약물에 대한 치료적 반응을 가늠할 수 있는 예측 인자로서 강박증상 종류의 유용성을 재확인하였다.

Objective In this study, we aimed to investigate the predictors of clinical response to escitalopram (ESC) in obsessive-compulsive disorder (OCD) from the baseline clinical characteristics. In addition, we aimed to search the differences of prescription pattern between responders and non-responders to ESC. Methods Two hundred and twenty-three patients who met the DSM-IV criteria for OCD and visited at least once after the initiation of ESC prescription were included in this study. A primary outcome measure was the Clinical Global Impression-Improvement scale (CGI-I), which was scored at the time of retrospective chart review. Responders were defined as those with a CGI-I score of 1 or 2 at the final point of evaluation. Baseline clinical characteristics, prescription patterns, and adverse events were compared between responders and non-responders. We also examined the validity of the prediction model regarding treatment response to ESC. Results The OCD patients having aggressive obsessions and related compulsions showed significantly decreased response rate to ESC (odd ratio=0.285) in comparison with the OCD patients not having aggressive symptom dimension (p=0.002). The maximum dose of ESC prescription and rate of antipsychotics combination were higher in responders in comparison to the nonresponders. Among the adverse effects, sedation and constipation showed significantly different occurrence rate between responders versus non-responders. Conclusion Aggressive obsessions and related compulsions seem to be associated with poor clinical response to ESC in OCD. Obsessive-compulsive symptom dimension should be considered when choosing a serotonin reuptake inhibitor for OCD.