The Effect of a Six Week Intensified Pharmacological Treatment for Schizophrenia Compared to Treatment as Usual in Subjects Who Had a First-time Treatment Failure on Their First-line Treatment.

Launched by DR. INGE WINTER · Jul 20, 2023

Keywords

ClinConnect Summary

The INTENSIFY-Schizophrenia trial is studying whether an intensified treatment approach for schizophrenia can be more helpful for patients who haven't responded well to their first treatment. Currently, many patients are treated with standard medications, but when these don’t work, they might benefit from a more powerful medication called clozapine, which is usually reserved for later stages of treatment due to some risks. This trial aims to see if starting clozapine earlier could improve outcomes for patients, potentially reducing the need for ineffective treatments and hospital stays.

To be eligible for this trial, participants need to be adults aged 18 to 70 who have been diagnosed with schizophrenia or related disorders and are experiencing their first treatment failure. They should also be willing to provide consent to participate. If chosen, participants will receive close monitoring and support during the six-week treatment period. This study is part of a larger project aiming to improve treatment strategies for mental health conditions and could lead to better care for people with schizophrenia in the future.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. In- or out patients, at least 18 years of age up until 70.
• • 2. Being willing and able to provide written informed consent. Having a legal guardian to cosign is allowed. Informed consent will be signed at visit 1, before any study procedure.
• • 3. Female subjects of child bearing potential must use effective contraception during the trial as per the requirements of the applicable SmPCs and should have a negative pregnancy test at visit 1 or 2 (before randomisation; section 8.2).
• • 4. Meeting diagnostic criteria for a primary diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder, according to DSM-5. The primary diagnosis will be confirmed by the Mini International Neuropsychiatric Interview (MINI v7.0.2).
• • 5. Subject experiences his/her first treatment failure due to lack of efficacy in the current episode, as confirmed by a CGI-I ≥3; this treatment is a first-line pharmacotherapeutic agent for the primary DSM-5 diagnosis, and was prescribed for at least 4 weeks within an effective dose range as specified in the Summary of Product Characteristics (SmPCs).
• • 6. Subject and clinician intend to change pharmacotherapeutic treatment.
• • 7. A minimum symptom severity threshold needs to be present (moderate level; see below) and subject needs to experience functional impairment.
• • The minimum symptom severity threshold is at least 2 PANSS positive or negative items with a score of 4, or at least one PANSS positive or negative item with a score of 5.
• • Functional impairment is defined as a score of 5 or higher on any of the three scales of the Sheehan Disability Scale (SDS).
• Exclusion criteria:
• • 1. Being pregnant or breastfeeding.
• • 2. Subject has used clozapine in the past.
• • 3. Subject has a known intolerance to clozapine or to all TAU medication options.
• • 4. Meeting any of the contraindications of clozapine or to all TAU medication options, as specified within the applicable SmPC.
• • 5. Subject has participated in another clinical trial in which the subject received an experimental or investigational drug or agent within 30 days before visit 1.
• • 6. Subject experiences any other significant disease or disorder which, in the opinion of the investigator, may either put the subjects at risk because of participation in the trial, or may influence the result of the trial, or the subject's ability to participate in the trial.
• • 7. Subjects with active suicidal ideation with some intent to act, without specific plan ("Yes" to question 4 of the Columbia-Suicide Severity Rating Scale (C-SSRS)) or active suicidal ideation with specific plan and intent ("Yes" to question 5 of the C-SSRS), followed by an assessment by the treating clinician who determines it is not safe for the subject to participate in the study
• • 8. Subject meets criteria for current substance use disorder, as confirmed by the Mini International Neuropsychiatric Interview (MINI v7.0.2). Nicotine dependency is allowed, as well as mild and moderate alcohol and/or cannabis use disorder (as defined by MINI v7.0.2). Severe alcohol and/or cannabis use disorder are not allowed.
• • 9. Subjects have not been committed to an institution by virtue of an order issued either by the judicial or the administrative authorities.
• • 10. Subjects who meet the modified Andreasen criteria for remission.
• • 11. Subjects that have any clinically significant abnormal values on the local laboratory test (especially ANC/WBC and liver values), electrocardiogram (ECG) or physician examinations.
• • 12. Subjects dependent on the sponsor, investigator or trial site must be excluded from participation in advance