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Add-On Therapy to Risperidonein Schizophrenia (DM)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01189006
Recruitment Status : Completed
First Posted : August 26, 2010
Last Update Posted : February 28, 2013
Sponsor:
Information provided by (Responsible Party):
National Cheng-Kung University Hospital

Brief Summary:
These results suggest that the DA neuroprotection provided by DM in the inflammation-related neurodegenerative models is not mediated through the NMDA receptor.

Condition or disease Intervention/treatment Phase
Schizophrenia Drug: Dextromethorphan Phase 2 Phase 3

Detailed Description:
Liu et al. (2003) have reported that DM protected dopamine (DA) neurons against inflammation-mediated degeneration. Zhang et al.'s (2004) novel finding was that 1-10 μM DM protected DA neurons against LPS (10 ng/mL)-induced reduction of DA uptake functionally in rat primary mixed mesencephalic neuron-glia cultures. Morphologically, in lipopolysaccharide (LPS)-treated cultures, in addition to the reduction of abundance of DA neurons, the dendrites of the remaining DA neurons were significantly less elaborate than those of controls. In cultures pretreated with DM (10 μM) before LPS stimulation, DA neurons were significantly more numerous and the dendrites less affected. Significant neuroprotective was observed in cultures with DM added up to 60 minutes after the addition of LPS. Thus, DM significantly protects DA neurons not only with pretreatment but also with post-treatment (Zhang et al. 2004). The mechanism of the neuronprotective effect of DM is associated with the inhibition of microglia activation but not with its NMDA receptor antagonist property. Zhang et al. (2005) have examined several N-methyl-D-aspartate (NMDA) receptor antagonists, including MK801, AP5, and memantine. Results from these studies indicate that among these compounds tested there was no correlation between the affinity of NMDA receptor antagonist activity and potency of the neuroprotective on DA neurons. On the contrary, a better correlation was found between the anti-inflammatory potency and the neuron protection. These results suggest that the DA neuroprotection provided by DM in the inflammation-related neurodegenerative models is not mediated through the NMDA receptor. This conclusion is not in conflict with the previous reports, indicating that NMDA receptor blockade is associated with the neuroprotective effect of DM in acute glutamate-induced excitotoxicity models. The above evidences of benefit on auto-immune system with dextromethorphan would support that dextromethorphan as add-on therapy to atypical antipsychotics might be more effective than atypical antipsychotics alone on improvement of both positive and negative symptoms in schizophrenia.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 161 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Double-blind, Placebo-Controlled, Randomized Study of the Efficacy of Dextromethorphan as Add-On Therapy to Risperidone Versus Risperidone Alone in Patients With Schizophrenia
Study Start Date : January 2005
Actual Primary Completion Date : December 2008
Actual Study Completion Date : December 2008

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Schizophrenia

Arm Intervention/treatment
Experimental: dextromethorphan
Research clinical trial of double-blind, stratified randomized, parallel group, double-centre study
Drug: Dextromethorphan
Add-On double-blind study treatment commenced at randomization for 11 weeks while patients were continuing open-label risperidone. Randomization was immediately preceded by a one week open-label Risperidone-Only Treatment period. Patients who were receiving antipsychotics medication(s) at screen other than risperidone alone was withdrawn from previous non-risperidone medication(s) and at the same time commenced risperidone in titrating doses over a week. This Antipsychotic Switch-Over Period occurred between Screen and Risperidone-Only Treatment period. Patients remained hospitalized for at least during the Risperidone-Only treatment Period and first week of Add-On treatment Period.




Primary Outcome Measures :
  1. positive and negative symptoms in schizophrenia [ Time Frame: baseline ]
  2. positive and negative symptoms in schizophrenia [ Time Frame: week1 ]
  3. positive and negative symptoms in schizophrenia [ Time Frame: week2 ]
  4. positive and negative symptoms in schizophrenia [ Time Frame: week4 ]
  5. positive and negative symptoms in schizophrenia [ Time Frame: week6 ]
  6. positive and negative symptoms in schizophrenia [ Time Frame: week8 ]
  7. positive and negative symptoms in schizophrenia [ Time Frame: week11 ]

Secondary Outcome Measures :
  1. Specific Serum Immunological Parameters [ Time Frame: baseline ]
    SGOT, SGPT, gamma-GT, BUN and creatinine

  2. Specific Serum Immunological Parameters [ Time Frame: week11 ]
  3. lipid profiles [ Time Frame: based line, after treatment ]


Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Male or female patient aged ≧18 and ≦60 years.
  2. A diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV criteria made by a specialist in psychiatry.
  3. Acute exacerbation of schizophrenia.
  4. A total of PANSS score of at least 60 at screen.
  5. History of schizophrenia ≦ 15 years (from onset of prodromal symptoms).
  6. Signed informed consent by patient or legal representative
  7. Patient or a reliable caregiver can be expected to ensure acceptable compliance and visit attendance for the duration of the study.

Exclusion Criteria:

  1. Women of childbearing potential not using adequate contraception as per investigator judgement or not willing to comply with contraception for duration of study.
  2. Less than a full cycle has lapsed at time of screening following the last injection of a depot antipsychotic
  3. Females who are pregnant or nursing.
  4. Patient has received dextromethorphan, or other selective cyclo- oxygenase 2 inhibitors, or other anti-inflammatory medication within 1 week prior to first dose of double-blind medication.
  5. Axis-I DSM-IV diagnosis other than schizophrenia or schizoaffective disorder.
  6. Current evidence of an uncontrolled and/or clinically significant medical condition, e.g., cardiac, hepatic and renal failure that in the judgement of the investigator, would compromise patient safety or preclude study participation.
  7. History of intolerance to risperidone or dextromethorphan or other Cox-2 inhibitors.
  8. History of sensitivity reaction (e.g., urticaria, angioedema, bronchospasm, severe rhinitis, anaphylactic shock) precipitated by dextromethorphan.
  9. Patient has received electroconvulsive therapy (ECT) within 4 weeks prior to first dose of double-blind medication.
  10. Diagnosis of or treatment for oesophageal, gastric, pyloric channel, or duodenal ulceration or related complications (bleeding and/or perforation) within 30 days prior to receiving first dose of double-blind medication.
  11. Inclusion in another schizophrenia study or study for another indication with psychotropics within the last 30 days prior to start of study.
  12. Increase in total SGOT, SGPT, gamma-GT, BUN and creatinine by more than 3X ULN (upper limit of normal).
  13. History of idiopathic or drug-induced agranulocytosis.
  14. Alcohol, illegal or other substance-abuse within 6 months prior to study start, as defined by DSM-IV criteria.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01189006


Locations
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Taiwan
Ru-Band Lu
Tainan, Taiwan, 704
Sponsors and Collaborators
National Cheng-Kung University Hospital
Investigators
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Principal Investigator: Ru-Band Lu, MD National Cheng-Kung University Hospital

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: National Cheng-Kung University Hospital
ClinicalTrials.gov Identifier: NCT01189006    
Other Study ID Numbers: DM-Schizo
Taiwan NIH ( Other Grant/Funding Number: DOH-95-TD-I-111-004 )
First Posted: August 26, 2010    Key Record Dates
Last Update Posted: February 28, 2013
Last Verified: August 2010
Additional relevant MeSH terms:
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Schizophrenia
Schizophrenia Spectrum and Other Psychotic Disorders
Mental Disorders
Dextromethorphan
Risperidone
Serotonin Antagonists
Serotonin Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Dopamine Antagonists
Dopamine Agents
Antitussive Agents
Respiratory System Agents
Excitatory Amino Acid Antagonists
Excitatory Amino Acid Agents