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Granisetron Adjunct to Fluvoxamine for Moderate to Severe Obsessive-Compulsive Disorder

A Randomized, Double-Blind, Placebo-Controlled Trial

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Abstract

Background: Several small studies have shown beneficial effects of ondansetron, a serotonin 5-HT3 receptor antagonist, in the treatment of obsessivecompulsive disorder (OCD). The efficacy of other 5-HT3 receptor antagonists in patients with OCD is still unclear. Granisetron does not alter cytochrome P450 activity and might have a lower risk of drug interactions, a longer duration of action and a better tolerability profile than other 5-HT3 receptor antagonists.

Objective: The objective of this study was to assess the efficacy and tolerability of granisetron augmentation of fluvoxamine in patients with OCD.

Study Design: This was a two-centre, randomized, double-blind, placebocontrolled, parallel-group study conducted from November 2011 to March 2012.

Study Setting: The study setting was outpatient clinics of two large referral centres.

Patients: Study participants were men and women, aged 1860 years, who met the diagnostic criteria of OCD based on the DSM-IV-TR and who had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of at least 21.

Interventions: Participants were randomly assigned to granisetron (Kytril®; SmithKline Beecham, Philadelphia, PA, USA) 1mg every 12 hours or placebo every 12 hours in addition to fluvoxamine for 8 weeks.

Main Outcome Measure: Patients were assessed using the Y-BOCS at baseline, second, fourth, sixth and eighth weeks. The primary outcome measure was the difference in the score change of Y-BOCS total score from baseline to week 8 between the two groups. We also compared changes in the obsession and compulsion subscales of the Y-BOCS, and frequencies of partial response (≤25% reduction in Y-BOCS score), complete response (35% reduction in Y-BOCS score) and remission (Y-BOCS score ≥16) between the two groups.

Results: Of the 42 included patients, 39 (20 in the placebo group, 19 in the granisetron group) completed the study. Significant time X treatment interaction was observed for total Y-BOCS (F [2.097, 79.678] = 4.941, p = 0.009), obsession (F [2.337, 88.799] = 4.938, p = 0.006) and compulsion (F [2.050, 77.899] = 4.674, p = 0.012) subscales. By week 8, complete response and remission were achieved by 20 (100%) and 18 (90%) patients in the granisetron group and by 7 (35%) patients in the placebo group (p-value of Fishers exact test <0.001, risk ratio (RR) [95% CI] = 3.857 [2.039, 7.297]). There was no significant difference in the tolerability between the two regimens.

Conclusion: ranisetron is an efficacious adjunct for the short-term treatment of patients with moderate to severe OCD and is well tolerated.

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Acknowledgements

No conflict of interest exists for any of the authors associated with the manuscript and there was no source of extra-institutional commercial funding.

This study was Dr Neda Askari’s postgraduate thesis toward qualification for the Iranian Board of Psychiatry under supervision of Prof. Shahin Akhondzadeh. This study was supported by a grant from the Tehran University of Medical Sciences to Prof. Shahin Akhondzadeh (grant number: 10387).

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Correspondence to Shahin Akhondzadeh Ph.D..

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Askari, N., Moin, M., Sanati, M. et al. Granisetron Adjunct to Fluvoxamine for Moderate to Severe Obsessive-Compulsive Disorder. CNS Drugs 26, 883–892 (2012). https://doi.org/10.2165/11635850-000000000-00000

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