Efficacy of Topiramate in treating Obsessive Compulsive Disorder: a Systematic Review and Meta-analysis

Background This systematic review and meta-analysis aimed to synthesize the evidence of efficacy and tolerability of adjunctive topiramate treatment for patients with obsessive-compulsive disorder. Methods A systematic search was conducted on MEDLINE, Cochrane Central Register of Controlled Trials, and OpenGrey to identify randomized controlled trials assigning participants with OCD to pharmacological intervention with topiramate. Study inclusion and data extraction were undertaken by two reviewers independently. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scale score, as a continuous variable within-subject OCD illness severity before and after treatment. The weighted mean difference (WMD) with 95% confidence interval was calculated between the topiramate group and the control group. Results Five studies were selected for inclusion in the systematic review, 4 of which were also included in the quantitative synthesis of data. The WMD in the Y-BOCS score between topiramate and placebo subjects was -0.49 (-2.28, 1.30) (p=0.00); The results show a trend towards an effect of topiramate, but the estimate was not significant. Subgroup analysis revealed a significant effect at 12 weeks but not at 16 weeks (p=0.00). Limitations Low quality of the studies included and small sample size. Conclusion There is a small positive signal for an anti-obsessive/compulsive effect in OCD patients which should encourage further research with larger, randomized, and placebo-controlled trials to assess topiramate's potential role in OCD treatment comprehensively.