Optimization of Treatment and Management of Schizophrenia in Europe

Conditions

Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder

Keywords

Schizophrenia, Schizophreniform disorder, Schizoaffective disorder, Imaging, Prognosis, Treatment guidelines, Pharmacogenetics

Brief summary

The purpose of the study is optimising current treatments in schizophrenia and explore novel therapeutic options for schizophrenia. The study intends to both address basic, but so far unanswered, questions in the treatment of schizophrenia and develop new interventions. It is expected that the project will lead to evidence that is directly applicable to treatment guidelines, and will identify potential mechanisms for new drug development.

Detailed description

Despite nearly fifty years of pharmacological and psychosocial research, the overall prognosis of schizophrenia has improved only marginally. While the efficacy of most antipsychotic medication is generally uncontested, their overall functional impact has been modest. In order to improve this unsatisfactory result, this study aims to optimize current treatments in schizophrenia and explore novel therapeutic options for schizophrenia. The study comprises a medication intervention component, a psychosocial intervention component, a biological predictor component and an MRI component. MRI assessments are performed at baseline, and used to determine whether potential organic causes for psychotic symptoms are present, and to test prospective value of these assessments for subsequent treatment response. MRI assessments of healthy volunteers will be included to test for deviations in patients' assessments; these volunteers will not participate in any other protocol procedure. The medication intervention component comprises a first 4-week phase of amisulpride treatment. Non-responders will subsequently be randomised to a 6-week double blind phase on either amisulpride or olanzapine. Patients who classify as non-responders at the end of this phase, a 12-week open label treatment with clozapine is initiated. Patients who classify as a responder in phase I, II or III, are drop outs or who are non-responders at the end of phase III flow to the psychosocial intervention component of the study. During this part, several interventions are tested, aimed to increase treatment compliance and keep patients on the medication to which they've responded well. Through the biological predictor component, it is determined whether glutamatergic markers predict response to first and second line treatments, and if an empirical combination of pharmacogenetic, proteomics- and metabolomic markers can provide clinical valuable predictive value.

Lyliana G. Nasib, Inge Winter-van Rossum, Nicolaas P. A. Zuithoff, Zimbo S. R. M. Boudewijns, Stefan Leucht et al. (6 authors)

The Journal of Clinical Psychiatry2023-03-231 citations

10.4088/jcp.22m14531

The role of depression in the prediction of a "late" remission in first-episode psychosis: An analysis of the OPTiMiSE study.

Fraguas D, Díaz-Caneja CM, Pina-Camacho L, Winter van Rossum I, Baandrup L, Sommer IE, Glenthøj B, Kahn RS, Leucht S, Arango C.

2021-04-078 citations

10.1016/j.schres.2021.03.010

Baseline Levels of C-Reactive Protein and Proinflammatory Cytokines Are Not Associated With Early Response to Amisulpride in Patients With First Episode Psychosis: The OPTiMiSE Cohort Study

Susana Barbosa, Emanuela Martinuzzi, Iris E. Sommer, Paola Dazzan, Philip McGuire et al. (84 authors)

Schizophrenia Bulletin Open2021-01-014 citations

10.1093/schizbullopen/sgab017

Relationship Between Serum NMDA Receptor Antibodies and Response to Antipsychotic Treatment in First-Episode Psychosis.

Pollak TA, Vincent A, Iyegbe C, Coutinho E, Jacobson L, Rujescu D, Stone J, Jezequel J, Rogemond V, Jamain S, Groc L, David A, Egerton A, Kahn RS, Honnorat J, Dazzan P, Leboyer M, McGuire P.

2020-11-2416 citations

10.1016/j.biopsych.2020.11.014

Amisulpride and olanzapine followed by open-label treatment with clozapine in first-episode schizophrenia and schizophreniform disorder (OPTiMiSE): a three-phase switching study.

Kahn RS, Winter van Rossum I, Leucht S, McGuire P, Lewis SW, Leboyer M, Arango C, Dazzan P, Drake R, Heres S, Díaz-Caneja CM, Rujescu D, Weiser M, Galderisi S, Glenthøj B, Eijkemans MJC, Fleischhacker WW, Kapur S, Sommer IE, OPTiMiSE study group.

2018-08-13135 citations

10.1016/s2215-0366(18)30252-9

Interventions

DRUGAmisulpride open label

4-week open label amisulpride treatment

DRUG6-week amisulpride double blind treatment

6-week amisulpride double blind treatment

DRUG6-week olanzapine double blind treatment

6-week olanzapine double blind treatment

DRUG12-week clozapine open-label treatment

12-week clozapine open-label treatment

BEHAVIORALPsychosocial intervention

Psychosocial intervention

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

ALL

Age

18 Years to 40 Years

Healthy volunteers

No

Inclusion criteria

1. Diagnosis of schizophrenia as defined by DSM-IV-R as determined by the M.I.N.I.plus 2. Age 18 or older. 3. The first psychosis occurred at least one year and no more than 7 years ago.\* 4. If patients are using an antipsychotic drug, a medication switch is currently under consideration. 5. Capable of providing written informed consent.

Exclusion criteria

1. Intolerance / hypersensitivity to one of the drugs (including active substances, metabolites and excipients) in this study including oral risperidone, paliperidone and aripiprazole and/or hypersensitivity to risperidone. 2. Pregnancy or lactation. 3. Patients who are currently using clozapine. 4. Patients who do not fully comprehend the purpose or are not competent to make a rational decision whether or not to participate. 5. Patients with a documented history of non-response and/or intolerance to any of the study medications and/or a documented history of non-response to a treatment with one of the study drugs of at least 6 weeks within the registered dose range. 6. Forensic patients. 7. Patients who have been treated with an investigational drug within 30 days prior to screening. 8. Simultaneous participation in another intervention study (neither medication or psychosocial intervention).

Design outcomes

Primary

Measure	Time frame	Description
MRI assessments	jan 2016	MRI component objective: the percentage of first episode patients that show radiological abnormalities suggestive of neurological disorders which may explain the occurrence of psychotic symptoms - measurement at baseline only.
Sellwood rating scale	Jan 2016	Psychosocial intervention component, objective A: drug adherence rates as a function of (standardized self report and) Sellwood rating scales after 12 and 52 weeks.
Biological profile	jan 2016	Biological predictors component, objective A: drug response (remission vs non-remission) as a function of biological profile, after 4 weeks, 10 weeks and 22 weeks (after each medication phase).
MRS measures	jan 2016	Biological predictors component, objective B: using MRS scans, differences between responders and non-responders in regional glutamate levels a) at baseline and b) between baseline and after one month of treatment with amisulpiride.
SOFAS global functioning	jan 2016	Psychosocial intervention component, objective B: drug adherence rates as a function of standardized global functioning (SOFAS score after 1 year) following psychosocial intervention vs treatment as usual.
PANSS	Jan 2016	Study consists of multiple components, each with their own objectives. For this (medication) component: number of patients in remission, based on PANSS scores (criteria of Andreasen et al.; 2005) after 4 weeks open label amisulpride, after 6 weeks double blind amisulpride or olanzapine and after 12 weeks of open label clozapine.

Secondary

Measure	Time frame	Description
All cause discontinuation	jan 2016	Psychosocial intervention component has multiple secondary objectives, most important one is all-cause treatment discontinuation between treatment groups after 12 and 52 weeks.
Biological markers	jan 2016	Biological predictors component has multiple secondary objectives, most important one is the ability of biological markers to predict response to antipsychotic and treatment tolerability in schizophrenia, after 4, 10 and 22 weeks.
MRI assessments	jan 2016	The ability of MRI to predict response to antipsychotic treatment in schizophrenia, after 4, 10 and 22 weeks.
All cause treatment discontinuation	jan 2016	The different components of the study have their own secondary objectives: Medication component has multiple secondary objectives, most important one is all-cause treatment discontinuation after 4 weeks, 10 weeks and 22 weeks. Number and reason for premature discontinuations (treatment discontinuation) of the amisulpride and the olanzapine group will be compared (after 10 weeks).

Countries

Australia, Austria, Belgium, Bulgaria, Czechia, Denmark, France, Germany, Israel, Italy, Netherlands, Poland, Romania, Spain, Switzerland, United Kingdom

Outcome results

None listed