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临床试验/NCT00403546
NCT00403546已完成3 期

High-Dose Oral Ziprasidone Versus Conventional Dosing in Schizophrenia Patients With Residual Symptoms

Donald C. Goff, MD9 个研究点 分布在 1 个国家目标入组 131 人开始时间: 2006年1月最近更新:
适应症
干预措施
相关药物

试验速览

阶段
3 期
状态
已完成
发起方
入组人数
131
试验地点
9
主要终点
Percentage of Participants With Response

研究概览

简要总结

The primary aims of this study are to assess tolerability of ziprasidone dose escalation to 320 milligrams per day (mg/d) compared to continued standard treatment (placebo) as measured by the Side Effect Checklist, Simpson Angus Scale for Extrapyramidal Symptoms (SAS), Barnes Akathisia Scale (BAS), serum prolactin concentrations, vital signs, electrocardiogram (EKG) and completion rates and to assess whether ziprasidone dose escalation improves overall psychopathology compared to continued standard treatment as measured by the change from baseline in the Positive and Negative Syndrome Scale (PANSS) total score and response rates as defined by a 20% or greater reduction in PANSS total score.

The secondary aims of this study are to assess whether ziprasidone dose escalation improves psychotic symptoms compared to continued standard treatment as measured by the Positive Symptom Subscale of the PANSS, to assess whether ziprasidone dose escalation improves negative symptoms compared to standard treatment as measured by the Negative Symptom Subscale of the PANSS, to assess whether ziprasidone dose escalation improves depressive symptoms compared to continued standard treatment as measured by the Calgary Depression Rating Scale (CDRS), and to assess whether ziprasidone dose escalation improves overall functioning with the Clinical Global Impression - Severity (CGI-S), Clinical Global Impression - Improvement (CGI-I), Global Assessment of Functioning (GAF) and the Schizophrenia Cognition Rating Scale (SCoRS).

研究设计

研究类型
Interventional
分配方式
Randomized
干预模型
Parallel
主要目的
Treatment
盲法
Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

入排标准

年龄范围
18 Years 至 65 Years(Adult, Older Adult)
性别
All
接受健康志愿者
否

入选标准

  • •Schizophrenia or Schizoaffective disorder, any subtype
  • •Age 18-65 years
  • •Treated with ziprasidone at a dose of 160 mg/d for at least 3 weeks with adequate compliance
  • •Concomitant standing or other medications as needed (except other antipsychotics and those noted as contraindicated in the ziprasidone package insert) are permitted during all treatment phases if they were present at a stable dose for at least 6 weeks prior to the start of initial ziprasidone treatment
  • •A score of 4 (moderate) or greater on any of the 7 items of the PANSS Positive Symptom Subscale
  • •Clinical judgment by the investigator that doses higher than 160 mg/day are warranted due to suboptimal clinical outcome despite adequate treatment at that dose
  • •Participant is judged capable of understanding all relevant risks and potential benefits of the study and has signed informed consent
  • •Comorbid axis 1 conditions (including anxiety disorders, eating disorders, impulse control disorders) are permitted if they have been stable and have not been a primary focus of treatment over the previous 6 months

排除标准

  • •Past or current intolerance of ziprasidone side effects
  • •Presence of significant cardiac disease, including uncompensated congestive heart failure, myocardial infarction within the past 6 months or known history of congenital long QT interval syndrome
  • •Corrected QT interval (QTc) greater than or equal to 500 milliseconds (msec)
  • •Serum potassium and magnesium concentrations outside of normal limits.
  • •Currently taking any medications which may affect cardiac conduction
  • •Presence of any unstable or untreated medical disorder
  • •Any history of seizures or seizure disorder other than febrile seizures of childhood
  • •History of positive hepatitis B surface antigen
  • •Human immunodeficiency virus (HIV) positive or has diagnosis of acquired immune deficiency syndrome (AIDS)
  • •Any abnormal laboratory test that is judged to be clinically significant by the investigator
  • •History of neuroleptic malignant syndrome (NMS), hypersensitivity or allergic response to antipsychotic therapy, including ziprasidone
  • •History of clozapine treatment for refractory psychotic symptoms
  • •Alcohol or substance dependence within the past 12 months or abuse within the past 3 months. Any subject with positive urine toxicology or alcohol use that is considered abnormal at baseline.
  • •Clinically significant suicidal or homicidal behavior or attempts within past 6 months
  • •Any subject judged by the investigator to present a danger to self or others.
  • •Women of childbearing potential who are not using adequate contraception (oral contraceptives, barrier methods or who are clearly abstinent)
  • •Pregnancy or breast-feeding
  • •Any subject who is judged by the investigator to be unable or unlikely to comply with all study requirements, including adherence with prescribed medication regimen

研究组 & 干预措施

Placebo, Standard Treatment Ziprasidone

Placebo Comparator

Participants with schizophrenia or schizoaffective disorder who remain symptomatic despite treatment with ziprasidone 160 mg/d for at least 3 weeks will be instructed to take matching placebo oral capsule twice daily added to their regular open-label ziprasidone dose of 160 mg/d. After the first week, the matching placebo will be increased to two capsules twice daily and their regular open-label ziprasidone will remain the same (160 mg/d) for 7 weeks.

干预措施: Placebo (Drug)

High-Dose Ziprasidone

Experimental

Participants with schizophrenia or schizoaffective disorder who remain symptomatic despite treatment with ziprasidone 160 mg/d for at least 3 weeks will be instructed to take ziprasidone oral capsule twice daily added to their regular open-label ziprasidone dose (total of 240 mg/d). After the first week, the study drug will be increased to a total ziprasidone dose of 320 mg/d for 7 weeks.

干预措施: Ziprasidone 80-160 mg/d (Drug)

Placebo, Standard Treatment Ziprasidone

Placebo Comparator

Participants with schizophrenia or schizoaffective disorder who remain symptomatic despite treatment with ziprasidone 160 mg/d for at least 3 weeks will be instructed to take matching placebo oral capsule twice daily added to their regular open-label ziprasidone dose of 160 mg/d. After the first week, the matching placebo will be increased to two capsules twice daily and their regular open-label ziprasidone will remain the same (160 mg/d) for 7 weeks.

干预措施: Ziprasidone 160 mg/d (Drug)

High-Dose Ziprasidone

Experimental

Participants with schizophrenia or schizoaffective disorder who remain symptomatic despite treatment with ziprasidone 160 mg/d for at least 3 weeks will be instructed to take ziprasidone oral capsule twice daily added to their regular open-label ziprasidone dose (total of 240 mg/d). After the first week, the study drug will be increased to a total ziprasidone dose of 320 mg/d for 7 weeks.

干预措施: Ziprasidone 160 mg/d (Drug)

结局指标

主要结局

Percentage of Participants With Response

时间窗: Baseline, Week 2, Week 4, Week 6, Week 8

Response was defined as a reduction in the PANSS total score from baseline by 20% or greater, calculated by first subtracting 30 (the PANSS minimum possible total score). Response rate is the percentage of participants with a response.

Number of Events Recorded Based on Ziprasidone Side Effects Checklist During Randomized Trial

时间窗: From Baseline up to Week 8

Side effects were tracked using the Side Effect Checklist for ziprasidone, which is a well-validated 17 item scale that records the presence or absence of side effects. Total number of side effect events is reported here.

Change From Baseline in Simpson Angus Scale for Extrapyramidal Symptoms (SAS)

时间窗: Baseline, Week 2, Week 4, Week 6, Week 8

The SAS is a 10-item testing instrument used to evaluate drug-related extrapyramidal syndromes. The following items are included in the SAS: gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, glabella reflex, tremor, and salivation. Total score ranges from 0 to 40 with a higher score indicating increased severity. A positive change from baseline indicates a worse outcome.

Number of Participants With High and Low Levels in Serum Prolactin Concentration

时间窗: Baseline, Week 8

Blood samples were taken at baseline and Week 8 to measure serum prolactin concentrations. Normal range for females (non-pregnant) is 2-29 nanograms per deciliter (ng/dL) and for males 2-18 ng/dL. Values above the normal range were reported as High and values below the normal range were reported as Low. Reported here is the number of participants with high prolactin concentration and the number of participants with low prolactin concentration.

Change From Baseline in the Barnes Akathisia Scale (BAS)

时间窗: Baseline, Week 2, Week 4, Week 6, Week 8

BAS is a rating scale that is administered by physicians to assess the severity of drug-induced akathisia, which is a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting. The following subcategories are scored: objective akathisia, subjective awareness of restlessness and subjective distress related to restlessness and are rated on a 4-point scale from 0 - 3. In addition, the global clinical assessment of akathisia uses a 6-point scale ranging from 0 - 5. Total score ranges from 0 to 14 with a higher score indicating increased severity. A positive change from baseline indicates a worse outcome.

Electrocardiogram (EKG): Number of Participants With an Increase From Baseline to Corrected QT (QTc) Interval >/= 500 Milliseconds (Msec)

时间窗: 6 hours after dosing of Weeks 1, 2 and 8

QT interval is a measure of the time between the start of the Q wave and the end of the T wave as determined by electrocardiogram (EKG). The corrected QT Interval (QTc) adjusts the QT interval for heart rate. The number of participants with an increase to QTc interval \>/= 500 msec was reported.

Vital Signs: Systolic and Diastolic Blood Pressure Levels

时间窗: Baseline, Week 1, Week 2, Week 4, Week 6, Week 8

Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at regular times during the study. Normal SBP is defined as 120 millimeters of mercury (mmHg) or below and normal DBP is defined as 80 mmHg or below. Change from baseline is indicated for each time point. A positive change from baseline indicates and increase in blood pressure and a negative change from baseline indicates a decrease.

Change From Baseline in Abnormal Involuntary Movement Scale (AIMS) Score

时间窗: Baseline, Week 2, Week 4, Week 6, Week 8

AIMS is a rating scale measuring involuntary movements known as tardive dyskinesia, that sometimes develop as a side effect of long-term treatment with antipsychotic medications. The AIMS score was calculated as the sum of questions 1 through 7 of the AIMS instrument, which includes assessments of involuntary movements in the face, lips, jaw, tongue, upper and lower extremities, and neck/shoulders/hips. Each item is rated on a five-point scale of severity from 0-4 with 0 (none), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe). Total scores range from 0 to 28. A negative change from baseline indicates an improvement.

Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score

时间窗: Baseline, Week 2, Week 4, Week 6, Week 8

The PANSS is a medical scale and was used for measuring symptom severity of participants with schizophrenia in this study. Total PANSS score consists of 7 items in the Negative subscale, 7 items in the Positive subscale and 16 items in the General Psychopathology scale. Total PANSS score ranges from 30 to 210. A higher score indicates a worse outcome. A negative change from baseline indicates an improvement.

Number of Treatment-emergent Adverse Events During Randomized Trial

时间窗: From Baseline up to Week 8

Adverse event: any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the treatment. An adverse event can therefore be any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Preexisting conditions which worsen during a study are also considered as adverse events. Serious adverse event (SAE): significant hazard, contraindication, side effect, or precaution, which fulfilled any of the following criteria: fatal (resulted in death), life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect, was medically significant or required intervention to prevent any of the other outcomes listed here.

次要结局

  • Change From Baseline in Positive Subscale Score of PANSS(Baseline, Week 2, Week 4, Week 6, Week 8)
  • Change From Baseline in the Calgary Depression Rating Scale (CDRS) Total Score(Baseline, Week 2, Week 4, Week 6, Week 8)
  • Change From Baseline in Clinical Global Impression - Improvement (CGI-I) Score(Baseline, Week 8)
  • Change From Baseline in Global Assessment of Functioning (GAF) Score(Baseline, Week 8)
  • Change From Baseline in PANSS Negative Subscale Score(Baseline, Week 2, Week 4, Week 6, Week 8)
  • Change From Baseline in Clinical Global Impression- Severity (CGI-S) Score(Baseline, Week 8)
  • Change in Schizophrenia Cognition Rating Scale (SCoRS) Score(Baseline, Week 8)

研究者

发起方
Donald C. Goff, MD
申办方类型
Other
责任方
Sponsor Investigator
主要研究者

Donald C. Goff, MD

Director of the Schizophrenia Clinical and Research Program

Massachusetts General Hospital

研究点 (9)

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