Clozapine Versus Amisulpride in Treatment-resistant Schizophrenia Patients

Schizophrenia Clinical Trial

— ClozAmi  

Official title:

Clozapine Versus Amisulpride Versus Their Combination in the Treatment of Drug-resistant Schizophrenia Patients

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT01448499
• Other study ID #: GMCH-014-11
• Status: Withdrawn
• Phase: N/A
• First received: October 2, 2011
• Last updated: December 8, 2015
• Start date: October 2011

Study information

• Verified date: December 2015
• Source: Geha Mental Health Center
• Contact: n/a
• Is FDA regulated: No
• Health authority: Israel: Ministry of Health
• Study type: Interventional

Clinical Trial Summary

Background: schizophrenia is a debilitating mental disorder affecting about 1% of the general population. About 30% of patients will not react to current drug treatment and defined as treatment-resistant schizophrenia patients (TRSP). The best studied therapeutic option for this population is clozapine therapy. Clozapine was shown to be effective than any other antipsychotic drug in TRSP. Moreover, augmentation of clozapine was not demonstrated to be more effective than clozapine monotherapy. Albeit Clozapine superiority in TRSP, its use may be involved with many adverse effects, some of them are life-threatening, and need for routine blood tests. Amisulpride is an atypical antipsychotic drug with a different mechanism of action than clozapine, with less adverse effects. No study compared directly amisulpride and clozapine in TRSP.

Study objective: to compare, for the first time, the broad clinical effectiveness of clozapine and amisulpride and their combination in TRSP.

Study Design: a clinical, prospective, naturalistic, randomized, comparative study simulating a real-world approach of clinical decision making.

Methods: a total of 140 TRSP will be recruited from a large regional mental health center. Participants will be randomized into two treatment groups (70 in each group): clozapine monotherapy and amisulpride monotherapy. Assessment will be done following 10 and 20 weeks of treatment. In case of treatment failure (insufficient clinical response or severe adverse effect) participants will be offered either to switch to clozapine treatment (for failed amisulpride treatment) or to augment clozapine with amisulpride (for failed clozapine monotherapy patients). Thereafter, participants will be followed-up for a year. Assessment will be made using clinician rated scales and self-completed questionnaires, rating the broad phenomenology of schizophrenia (psychosis, mood, anxiety, obsessive-compulsive, cognitive and quality of life) and drug-related adverse effects (objective and subjective).

Analysis: comparison of the effectiveness of the three treatment groups: amisulpride, clozapine and their combination, in the various dimensions of TRSP.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. primary completion date: October 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

1. Confirmed diagnosis of schizophrenia according to DSM-IV-TR criteria

2. Treatment-resistant schizophrenia, defined as: documented treatment failure (insufficient clinical response or severe adverse effects) of two antipsychotics (one of them should be atypical) for an adequate duration of 6 weeks and in a sufficient dose of at least 600 mg/day of chlorpromazine equivalent

3. Age 18-65 years

4. Basal PANSS > 75

5. CGI-S >3

6. Persistent positive psychotic symptoms, with rating scores of moderate or worse on at least two of four positive symptom items (delusions, conceptual disorganization, hallucinatory behavior, and suspiciousness/persecution) on Positive and Negative Syndrome Scale (PANSS).

7. Competent and willing to provide written, informed consent

Exclusion Criteria:

1. Patients with concomitant treatment with lithium, anticonvulsants, antidepressants

2. Patients with underlying severe medical illness, such as cardiovascular disease, cerebrovascular disease, bone marrow suppression or epilepsy

3. A previous trial of clozapine or amisulpride

4. Any known contraindication for treatment with clozapine or amisulpride

5. Any woman who is pregnant or planning a pregnancy, and any woman of child bearing potential unless using adequate contraception

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Schizophrenia
• Treatment Resistant Disorders

Intervention

Drug:
• Clozapine
escalating dose of clozapine up to 900 mg/day
• Amisulpride
escalating dose of amisulpride up to 800 mg/day
• Clozapine+Amisulpride
augmentation of clozapine with amisulpride

Locations

Country	Name	City	State
Israel	Geha Mental Health Center	Petach-Tikva

Sponsors (1)

Lead Sponsor	Collaborator
Geha Mental Health Center

Country where clinical trial is conducted

Israel, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change from baseline in Positive and Negative Syndrome Scale (PANSS)		10, 20 weeks and endpoint	No
Secondary	Change from baseline in Clinical Global Impression - Severity (CGI-S)		10 , 20 weeks and endpoint	No
Secondary	Change from baseline in Beck Depression Inventory (BDI)		10 , 20 weeks and endpoint	No
Secondary	Change from baseline in Beck Anxiety Inventory (BAI)		10, 20 weeks and endpoint	No
Secondary	Change from baseline in Schizophrenia Quality of Life Scale (SQLS)		10, 20 weeks and endpoint	No
Secondary	Change from baseline in Simpson-Angus Scale (SAS)		5, 10, 15, 20 weeks, endpoint	Yes
Secondary	Change from baseline in Clozapine Adverse Effects Inventory (CAEI)		5, 10 ,15, 20 weeks, endpoint	Yes