Author Affiliations
Article Information
JAMA Psychiatry. Published online April 29, 2020. doi:10.1001/jamapsychiatry.2020.0440
Comment
Editorial
A Randomized Clinical Trial in Patients With a Pedophilic Disorder
Peer Briken, MD
Key Points
Question Can a gonadotropin-releasing hormone antagonist rapidly reduce the risk for committing child sexual abuse in men with pedophilic disorder who are seeking help?
Findings In this randomized clinical trial of 52 men with pedophilic disorder, treatment with degarelix statistically significantly reduced the risk for committing child sexual abuse 2 weeks after the initial injection.
Meaning This finding suggests that degarelix may serve as a rapid-onset, risk-reducing medication for men with pedophilic disorder.
Abstract
Importance Evidence-based treatments from randomized clinical trials for pedophilic disorder are lacking.
Objective To determine whether a gonadotropin-releasing hormone antagonist reduces dynamic risk factors for committing child sexual abuse.
Design, Setting, and Participants This academically initiated, double-blind, placebo-controlled, parallel-group, phase 2 randomized clinical trial was conducted at the ANOVA center in Stockholm, Sweden, from March 1, 2016, to April 30, 2019. Individuals who contacted PrevenTell, the national telephone helpline for unwanted sexuality, were recruited. Eligible participants were men seeking help aged 18 to 66 years with a pedophilic disorder diagnosis and no contraindications to the intervention. The primary end point was assessed by intent-to-treat analysis.
Interventions Randomization to receive either 2 subcutaneous injections of 120 mg of degarelix acetate or equal volume of placebo.
Main Outcomes and Measures The primary end point was the mean change between baseline and 2 weeks in the composite risk score of 5 domains of child sexual abuse ranging from 0 to 15 points; each domain could be rated from 0 to 3 points. Secondary end points included efficacy at 2 and 10 weeks as measured by the composite score, each risk domain, quality of life, self-reported effects, and adverse events.
Results A total of 52 male participants (mean [SD] age, 36 [12] years) were randomized to receive either degarelix (n = 25; with 1 withdrawal) or placebo (n = 26). At 2 weeks, the composite risk score decreased from 7.4 to 4.4 for participants in the degarelix group and from 7.8 to 6.6 for the placebo group, a mean between-group difference of –1.8 (95% CI, –3.2 to –0.5; P = .01). A decrease was seen in the composite score at 10 weeks (−2.2 [95% CI, −3.6 to −0.7]) as well as in the domains of pedophilic disorder (2 weeks: −0.7 [95% CI, −1.4 to 0.0]; 10 weeks: −1.1 [95% CI, −1.8 to −0.4]) and sexual preoccupation (2 weeks: −0.7 [95% CI, −1.2 to −0.3]; 10 weeks: −0.8 [95% CI, −1.3 to −0.3]) in the degarelix group compared with the placebo group. No difference was seen for the domains of self-rated risk (2 weeks: −0.4 [95% CI, −0.9 to 0.1]; 10 weeks: −0.5 [95% CI, −1 to 0.0]), low empathy (2 weeks: 0.2 [95% CI, −0.3 to 0.6]; 10 weeks: 0.2 [95% CI, −0.2 to 0.6]), and impaired self-regulation (2 weeks: −0.0 [95% CI, −0.7 to 0.6]; 10 weeks: 0.1 [95% CI, −0.5 to 0.8]), or quality of life (EuroQol 5 Dimensions questionnaire index score, 2 weeks: 0.06 [95% CI, −0.00 to 0.12], and 10 weeks: 0.04; 95% CI, −0.02 to 0.10; EuroQol visual analog scale, 2 weeks: 0.6 [95% CI, −9.7 to 10.9], and 10 weeks: 4.2 [95% CI, −6.0 to 14.4]). Two hospitalizations occurred from increased suicidal ideation, and more injection site reactions (degarelix: 22 of 25 [88%]; placebo: 1 of 26 [4%]) and hepatobiliary enzyme level elevations were reported by participants who received degarelix (degarelix: 11 of 25 [44%]; placebo: 2 of 26 [8%]). Among the 26 participants randomized to receive degarelix, 20 (77%) experienced positive effects (eg, improved attitude or behavior) on sexuality and 23 (89%) reported adverse effects on the body.
Conclusion and Relevance This trial found that degarelix reduced the risk score for committing child sexual abuse in men with pedophilic disorder 2 weeks after initial injection, suggesting use of the drug as a rapid-onset treatment option. Further studies are warranted into the effects and long-term adverse effects of hormone deficiency.
Trial Registration EU Clinical Trials Register Identifier: 2014-000647-32