Clozapine for the Prevention of Violence in Schizophrenia: a Randomized Clinical Trial
- Conditions
- SchizophreniaSchizoaffective Disorder
- Interventions
- Registration Number
- NCT05208190
- Lead Sponsor
- New York State Psychiatric Institute
- Brief Summary
Two-hundred and eighty individuals with schizophrenia who have a recent history of violent acts will be randomized in this 2-arm, parallel-group, 24-week, open-label, 7-site clinical trial to examine the effects of treatment with clozapine vs antipsychotic treatment as usual (TAU) for reducing the risk of violent acts in real-world settings
- Detailed Description
This is a single-blind, open-label, randomized, active comparator (TAU) controlled clinical trial to examine the effects of clozapine vs. TAU on the risk for violent acts as measured by the MacArthur Community Violence Interview (MCVI) and to examine the effects of clozapine vs. TAU on the Excitement Factor of the PANSS. Adults age 18-65 with schizophrenia or schizoaffective disorder who have committed a violent act within 6 months and are appropriate for treatment with clozapine or TAU will receive treatment for 24 weeks which will be naturalistically administered. Participants will also participate in assessments and appropriate medical monitoring which will include blood draws, pharmacokinetic blood samples, and physical exams, etc. Cox proportional hazards survival modeling will be used to test the association between treatment group and time until first violent act after randomization (i.e., number of weeks form randomization to violent act).
The NYSPI site is currently paused and has been paused since an institutional pause on human subjects research began in June, 2023. (The IO in concurrence with the IRB paused human subjects research on June 12, 2023. The U.S. Department of Health and Human Services (HHS) Office of Human Research Protections (OHRP) issued an FWA restriction on NYSPI research that also included a pause of human subjects research as of June 23, 2023.) Therefore, the NYSPI site is not enrolling at this time.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 280
- Diagnostic and Statistical Manual-5 (DSM-5) diagnosis of schizophrenia or schizoaffective disorder by the Structured Clinical Interview for DSM-5 (SCID-5)
- commission of a minor or serious act of violence as measured by the MCVI in the last six months
- willing and able to provide informed consent
- medically stable in judgment of physician providing study treatment
- appropriate for treatment with either clozapine or TAU, i.e., that there is clinical equipoise between the two treatment options. Individuals who are currently medication free or on any antipsychotic, with the exception of clozapine or long-acting injectable medication with a dosing interval of more than 30 days will be eligible
- An unstable of serious medical or neurological condition including a myeloproliferative disorder or condition that surprises the bone marrow
- A history of intolerance/allergy to clozapine (e.g., agranulocytosis, small bowel obstruction, or myocarditis)
- A history of intellectual impairment
- pregnant or lactating women; women who are able to become pregnant but who are not willing to sue effective methods of birth control
- Individuals who score a 3, 4, or 5 within the previous month on the suicidal ideation section of the Columbia Suicide Severity Rating Scale (CSSRS), have any suicidal behavior (not including Not Suicidal Self Injury) within the previous 3 months, or are, in the opinion of the investigator, at too high of a risk for suicide to be safety treated in a randomized trial in which they may not be treated with clozapine
- Documented intolerance to or lack of any therapeutic benefit with clozapine after a full trial
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Treatment as usual treatment as usual open label naturalistic treatment as usual with any antipsychotic other than clozapine Clozapine Clozapine treatment with clozapine naturalistically administered (as per clinical guideline).
- Primary Outcome Measures
Name Time Method Effectiveness outcome: Violent acts Time to violent act from randomization to treatment completion (24 weeks) violent acts as measured by the MacArthur Community Violence Interview
Target engagement outcome: Excitement Factor of the Positive and Negative Syndrome Scale (PANSS) Randomization to end of study treatment (24 weeks) a composite of the scores of excitement, uncooperativeness, poor impulse control, and hostility)
- Secondary Outcome Measures
Name Time Method Positive symptoms and substance use Randomization to end of treatment (24 weeks) explore effects of clozapine vs TAU on the positive symptom sub scale of the PANSS and alcohol and illicit substance use, how these effects influence the risk for violent acts, and the degree to which clozapine's effects on the Excitement Factor of the PANSS are independent of its effects on total positive symptoms and substance use.
Effect on aggression Randomization to end of treatment (24 weeks) examine the effects of clozapine vs TAU on aggression as measured by the Point Subtraction Aggression Paradigm
Trial Locations
- Locations (7)
University of California, Los Angeles
🇺🇸Los Angeles, California, United States
Augusta University Research Institute, Inc.
🇺🇸Augusta, Georgia, United States
University of Maryland School of Medicine
🇺🇸Baltimore, Maryland, United States
NYU Langone Medical Center
🇺🇸New York, New York, United States
New York State Psychiatric Institute
🇺🇸New York, New York, United States
Manhattan Psychiatric Center
🇺🇸New York, New York, United States
University of North Carolina at Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States