Optimization of Treatment and Management of Schizophrenia in Europe (OPTIMISE)

This study is currently recruiting participants. (see Contacts and Locations)
Verified March 2014 by UMC Utrecht
Sponsor:
Collaborators:
King's College London
Technische Universität München
University of Manchester
Ludwig-Maximilians - University of Munich
Information provided by (Responsible Party):
Rene Kahn, UMC Utrecht
ClinicalTrials.gov Identifier:
NCT01248195
First received: October 20, 2010
Last updated: March 12, 2014
Last verified: March 2014

October 20, 2010
March 12, 2014
May 2011
January 2016   (final data collection date for primary outcome measure)
  • PANSS [ Time Frame: Jan 2016 ] [ Designated as safety issue: No ]
    Study consists of multiple components, each with their own objectives. For this (medication) component: number of patients in remission, based on PANSS scores (criteria of Andreasen et al.; 2005) after 4 weeks open label amisulpride, after 6 weeks double blind amisulpride or olanzapine and after 12 weeks of open label clozapine.
  • Sellwood rating scale [ Time Frame: Jan 2016 ] [ Designated as safety issue: No ]
    Psychosocial intervention component, objective A: drug adherence rates as a function of (standardized self report and) Sellwood rating scales after 12 and 52 weeks.
  • Biological profile [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    Biological predictors component, objective A: drug response (remission vs non-remission) as a function of biological profile, after 4 weeks, 10 weeks and 22 weeks (after each medication phase).
  • MRS measures [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    Biological predictors component, objective B: using MRS scans, differences between responders and non-responders in regional glutamate levels a) at baseline and b) between baseline and after one month of treatment with amisulpiride.
  • SOFAS global functioning [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    Psychosocial intervention component, objective B: drug adherence rates as a function of standardized global functioning (SOFAS score after 1 year) following psychosocial intervention vs treatment as usual.
  • MRI assessments [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    MRI component objective: the percentage of first episode patients that show radiological abnormalities suggestive of neurological disorders which may explain the occurrence of psychotic symptoms - measurement at baseline only.
Same as current
Complete list of historical versions of study NCT01248195 on ClinicalTrials.gov Archive Site
  • All cause treatment discontinuation [ Time Frame: jan 2016 ] [ Designated as safety issue: Yes ]

    The different components of the study have their own secondary objectives:

    Medication component has multiple secondary objectives, most important one is all-cause treatment discontinuation after 4 weeks, 10 weeks and 22 weeks. Number and reason for premature discontinuations (treatment discontinuation) of the amisulpride and the olanzapine group will be compared (after 10 weeks).

  • All cause discontinuation [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    Psychosocial intervention component has multiple secondary objectives, most important one is all-cause treatment discontinuation between treatment groups after 12 and 52 weeks.
  • Biological markers [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    Biological predictors component has multiple secondary objectives, most important one is the ability of biological markers to predict response to antipsychotic and treatment tolerability in schizophrenia, after 4, 10 and 22 weeks.
  • MRI assessments [ Time Frame: jan 2016 ] [ Designated as safety issue: No ]
    The ability of MRI to predict response to antipsychotic treatment in schizophrenia, after 4, 10 and 22 weeks.
Same as current
Not Provided
Not Provided
 
Optimization of Treatment and Management of Schizophrenia in Europe
Optimization of Treatment and Management of Schizophrenia in Europe

The purpose of the study is optimising current treatments in schizophrenia and explore novel therapeutic options for schizophrenia. The study intends to both address basic, but so far unanswered, questions in the treatment of schizophrenia and develop new interventions. It is expected that the project will lead to evidence that is directly applicable to treatment guidelines, and will identify potential mechanisms for new drug development.

Despite nearly fifty years of pharmacological and psychosocial research, the overall prognosis of schizophrenia has improved only marginally. While the efficacy of most antipsychotic medication is generally uncontested, their overall functional impact has been modest. In order to improve this unsatisfactory result, this study aims to optimize current treatments in schizophrenia and explore novel therapeutic options for schizophrenia. The study comprises a medication intervention component, a psychosocial intervention component, a biological predictor component and an MRI component. MRI assessments are performed at baseline, and used to determine whether potential organic causes for psychotic symptoms are present, and to test prospective value of these assessments for subsequent treatment response. MRI assessments of healthy volunteers will be included to test for deviations in patients' assessments; these volunteers will not participate in any other protocol procedure. The medication intervention component comprises a first 4-week phase of amisulpride treatment. Non-responders will subsequently be randomised to a 6-week double blind phase on either amisulpride or olanzapine. Patients who classify as non-responders at the end of this phase, a 12-week open label treatment with clozapine is initiated. Patients who classify as a responder in phase I, II or III, are drop outs or who are non-responders at the end of phase III flow to the psychosocial intervention component of the study. During this part, several interventions are tested, aimed to increase treatment compliance and keep patients on the medication to which they've responded well. Through the biological predictor component, it is determined whether glutamatergic markers predict response to first and second line treatments, and if an empirical combination of pharmacogenetic, proteomics- and metabolomic markers can provide clinical valuable predictive value.

Interventional
Phase 4
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Schizophrenia
  • Schizophreniform Disorder
  • Schizoaffective Disorder
  • Drug: Amisulpride open label
    4-week open label amisulpride treatment
  • Drug: 6-week amisulpride double blind treatment
    6-week amisulpride double blind treatment
  • Drug: 6-week olanzapine double blind treatment
    6-week olanzapine double blind treatment
  • Drug: 12-week clozapine open-label treatment
    12-week clozapine open-label treatment
  • Behavioral: Psychosocial intervention
    Psychosocial intervention
  • Phase I: 1 arm 'amisulpride open label'
    For 4 weeks, all patients will be treated with amisulpride open label.
    Intervention: Drug: Amisulpride open label
  • Active Comparator: Phase II: 'amisulpride double blind'
    Patients who do not meet remission criteria during phase I (4 weeks open label amisulpride), flow to phase II where they are randomised to 1 of 2 6-week double blind treatment arms, one of which is 'amisulpride double blind'
    Intervention: Drug: 6-week amisulpride double blind treatment
  • Active Comparator: Phase II 'olanzapine double blind'
    Patients who do not meet remission criteria during phase I (4 weeks open label amisulpride), flow to phase II where they are randomised to 1 of 2 6-week double blind treatment arms, one of which is 'olanzapine double blind'
    Intervention: Drug: 6-week olanzapine double blind treatment
  • Phase III: 1 arm 'clozapine open label'
    Patients who do not meet remission criteria during phase II (6-week double blind amisulpride vs olanzapine), flow to phase III, where only 1 arm is available: 'clozapine open label'
    Intervention: Drug: 12-week clozapine open-label treatment
  • Experimental: Psychosocial intervention
    Patients who meet remission criteria during any of the phases of the medication component, patients who drop out of the medication component and patients who did not meet remission criteria at the end of the medication component, will flow to the psychosocial intervention component, where they are randomised to 1 of 2 arms, one of which is the 'Psychosocial Intervention' arm.
    Intervention: Behavioral: Psychosocial intervention
  • No Intervention: Psychosocial Intervention phase: 'TAU'
    Patients who meet remission criteria during any of the phases of the medication component, patients who drop out of the medication component and patients who did not meet remission criteria at the end of the medication component, will flow to the psychosocial intervention component, where they are randomised to 1 of 2 arms, one of which is the 'Treatment as usual' arm.
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
350
January 2016
January 2016   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • schizophrenia, schizophreniform or schizoaffective disorder as defined by DSM-IV
  • Age 18-40 years
  • Written informed consent.
  • Female patients of childbearing potential need to utilize a proper method of contraception.

Exclusion Criteria:

  • A time interval between the onset of psychosis and study entry exceeding two years.
  • Prior use of antipsychotic medication longer than an episode of two weeks in the previous year and/or 6 weeks lifetime.
  • Intolerance to one of the drugs in this study.
  • Patients who are coercively treated at a psychiatric guardian (based on a judicial ruling)
  • Patients who are represented by a legal ward or under legal custody
  • The presence of one or more of the contraindications against any of the study drugs as mentioned in the IB texts
  • Pregnancy, as determined through a pregnancy test, or lactation
Both
18 Years to 40 Years
Yes
Australia,   Austria,   Belgium,   Bulgaria,   Czech Republic,   Denmark,   France,   Germany,   Israel,   Italy,   Netherlands,   Poland,   Romania,   Spain,   Switzerland,   United Kingdom
 
NCT01248195
KP7242114, 2010-020185-19
Yes
Rene Kahn, UMC Utrecht
Rene Kahn
  • King's College London
  • Technische Universität München
  • University of Manchester
  • Ludwig-Maximilians - University of Munich
Principal Investigator: René Kahn, MD, PhD University Medical Center Utrecht, the Netherlands
UMC Utrecht
March 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP