A Cochrane review [Abstract] 1 included 9 studies with a total of 320 subjects. Five studies were conducted in children aged 3-17 years, using fenfluramine, fluoxetine, fluvoxamine and citalopram. Four studies were conducted in adults aged 18-60 years using fluoxetine, fluvoxamine, and citalopram. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence of participants. Eighteen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive-compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study, and data were unsuitable for meta-analysis except for one outcome (proportion improvement).
One large, high quality study in children showed no evidence of positive effect of citalopram. Three small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression and another in anxiety. One study reported significantly more adverse events in children on citalopram compared to placebo and one serious adverse event, a prolonged seizure. Both studies of fenfluramine reported adverse effects in children, including withdrawal and sadness which prompted dosage changes, and weight loss. With monitoring, dose adjustment and time, all but one of these adverse effects were resolved.The adult studies (fluvoxamine and fluoxetine) both reported that treatment was well tolerated.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding), by indirectness (lack of long-term data), and by imprecise results (limited study size for each comparison).
Primary/Secondary Keywords