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

Granisetron Adjunct to Fluvoxamine for Moderate to Severe Obsessive-Compulsive Disorder
Source: CNS Drugs. 2012 Oct 1;26(10):883-892.

BACKGROUND:
Several small studies have shown beneficial effects of ondansetron, a serotonin 5-HT(3) receptor antagonist, in the treatment of obsessive-compulsive disorder (OCD). The efficacy of other 5-HT(3) 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-HT(3) receptor antagonists.

STUDY DESIGN:
This was a two-centre, randomized, double-blind, placebo-controlled, parallel-group study conducted from November 2011 to March 2012.

PATIENTS:
Study participants were men and women, aged 18-60 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 1 mg 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 Fisher's 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:
Granisetron is an efficacious adjunct for the short-term treatment of patients with moderate to severe OCD and is well tolerated.