Adjunctive Minocycline in Clozapine Treated Schizophrenia Patients
Overview
- Phase
- Not Applicable
- Intervention
- Minocycline
- Conditions
- Schizophrenia
- Sponsor
- University of Maryland, Baltimore
- Enrollment
- 52
- Locations
- 1
- Primary Endpoint
- Brief Psychiatric Rating Scale (BPRS) Positive Symptom Domain Scores Between Minocycline and Placebo.
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
Schizophrenia is a devastating and costly illness. One-third to one-half of people with schizophrenia do not respond to the most current drugs leaving clozapine as the best alternative for treatment. However, over 60% of people treated with clozapine continue to have persistent symptoms and cognitive impairments. Little data is available to support evidence-based recommendations to guide clinicians in treating these patients. Preliminary data has suggested that adjunct treatment with minocycline may offer robust symptom improvement in patients with schizophrenia, including those taking clozapine. Minocycline has had interesting effects; including suggesting it may have a significant role in treatment of neurologic and psychiatric disorders. Minocycline is currently available generically; its side effects are well-described and minimal. The proposed double-blind treatment study seeks to demonstrate that adjunctive minocycline offers patients superior efficacy for persistent positive symptoms, cognitive impairments, and/or other components of schizophrenia pathology. This knowledge could lead to the more effective treatment of patients with schizophrenia. The research itself may lead to a better understanding of the pathophysiology of positive symptoms and cognitive impairments, which could contribute to improved treatments in the future.
Investigators
MPRC
Deanna L. Kelly, Pharm.D., BCPP
University of Maryland, Baltimore
Eligibility Criteria
Inclusion Criteria
- •DSM-IV diagnosis of schizophrenia or schizoaffective disorder
- •Male or Female
- •Age: 18 to 65 years
- •Caucasian or Non-Caucasian
- •At least six months of clozapine treatment
- •Clozapine treatment for incomplete symptoms response (evidence of two failed previous trials of antipsychotics)
- •Current dose of 200 mg/day for at least 3 months AND a documented clozapine blood level 350 ng/ml prior to study start (maximum clozapine dose of 900 mg/day)
- •BPRS total score of 45 or more on the 18 item version (scale: 1-7)
- •BPRS positive symptom item total score of 8 or more
- •BPRS positive symptom score of 4 or greater on at least one item
Exclusion Criteria
- •History of organic brain disease
- •DSM-IV diagnosis of Mental Retardation
- •DSM-IV diagnosis of Alcohol or Substance Dependence within the last six months (except nicotine)
- •DSM-IV diagnosis of Alcohol or Substance Abuse within the last one month (except nicotine)
- •Pregnancy or lactation
- •Significant renal or liver impairment
- •Previous known hypersensitivity to tetracyclines
- •Current treatment with tetracycline or derivative
- •Current treatment with lamotrigine
- •Treatment with oral contraceptives
Arms & Interventions
Minocycline
Intervention: Minocycline
Sugar Pill
Intervention: Placebo
Outcomes
Primary Outcomes
Brief Psychiatric Rating Scale (BPRS) Positive Symptom Domain Scores Between Minocycline and Placebo.
Time Frame: 10 Weeks
Adjunct minocycline to clozapine will be compared to placebo to test its efficacy to improve positive psychotic symptoms. The 4 item positive sub factor of the Brief Psychiatric Rating Scale (BPRS) will be the primary outcome over the 10 week randomized study. Total maximum score is 28, and total minimum score is 4. The positive domain score consists of conceptual disorganization (item 4), suspiciousness (item 11) hallucinatory behavior (item 12), and unusual thought content (item 15). All data is reported as the difference between baseline and 10 weeks. The lower the score the better the outcome.
Effect of Minocycline on Cognitive Symptoms as Measured by the MATRICS Consensus Cognitive Battery.
Time Frame: 10 Weeks
Adjunct minocycline will be compared to placebo to test its efficacy in improving cognitive function. Neuropsychological testing will be done at baseline and endpoint using the MATRICS battery. A composite score as well as individual scores will be will be the primary outcome over the 10 week randomized study. This assessment total minimum score of -10 and maximum score of 80. He higher the score the better the outcome.
Secondary Outcomes
- The Effect of Adjunct Minocycline to Placebo to Improve Depressive Symptoms as Measured by the Calgary Depression Scale(10 Weeks)
- The Effect of Adjunct Minocycline to Placebo on Global Clinical Improvement of Symptoms.(10 Weeks)
- The Effect of Minocycline Compared to Placebo to Improve Negative Symptoms as Measured by the Scale for the Assessment of Negative Symptoms (SANS)(10 Weeks)