Exploring the effects of an anti-inflammatory medication on negative symptoms of schizophrenia

Targeting Inflammation-Induced Changes in Brain Reward Signaling and Motivational Deficits in Patients With Schizophrenia Using an Anti-Inflammatory Challenge.

This study is testing if an anti-inflammatory medication can help people with schizophrenia who have low motivation and high inflammation feel better.

Quick facts

• Phase: Phase 4
• Study type: Interventional
• Enrollment: 20 (estimated)
• Ages: 18 Years to 45 Years
• Sex: All
• Sponsor: Emory University (Academic / other)
• Drugs / interventions: methotrexate, infliximab
• Locations: 2 sites (Atlanta, Georgia and 1 other locations)
• Trial ID: NCT05823532 on ClinicalTrials.gov

What this trial studies

This research project investigates the connection between inflammation and negative symptoms of schizophrenia, particularly motivational deficits. Participants will receive either an infusion of the anti-inflammatory medication infliximab or a placebo, with a focus on those exhibiting high levels of inflammation. The study involves multiple visits for assessments, including mood evaluations, blood tests, and MRI safety screenings. The goal is to determine if reducing inflammation can improve these challenging symptoms that are often resistant to traditional antipsychotic treatments.

Who should consider this trial

Good fit: Ideal candidates are men and women aged 18-45 with a diagnosis of schizophrenia or schizoaffective disorder and significant motivational deficits.

Not a fit: Patients with autoimmune disorders or a history of tuberculosis may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to new treatment options for the negative symptoms of schizophrenia, improving patient outcomes and quality of life.

How similar studies have performed: While the approach of targeting inflammation in schizophrenia is emerging, this specific intervention with infliximab is novel and has not been extensively tested in this context.

Eligibility criteria

Inclusion Criteria:

* Men or women, 18-45 years of age with a primary diagnosis of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) schizophrenia or schizoaffective disorder;
* Willing and able to give written informed consent;
* Plasma CRP 3mg/L;
* Significant motivational deficit as reflected by a score \>17 on the Motivation and Pleasure Domain of the Brief Negative Symptom Scale. Of note, for patients who exhibit CRP\>10mg/L, additional CRP testing will be conducted at 2-week intervals as per American Heart Association/ Center for Disease and Control Prevention guidelines to establish stability and rule out acute inflammation/infection (along with physical exam and laboratory testing).
* Patients must also have a negative urine drug screen at all study visits.

Exclusion Criteria:

* Any autoimmune disorder (as confirmed by laboratory testing);
* History of tuberculosis infection as determined by QuantiFERON Gold or high risk of tuberculosis exposure;
* Active hepatitis B or C infection or human immunodeficiency virus infection (as established by laboratory testing);
* History of any type of cancer;
* History of fungal infection;
* History of recurrent viral or bacterial infections;
* Unstable cardiovascular (including evidence of congestive heart failure as determined by physical examination and laboratory testing), endocrinologic, hematologic, hepatic, renal, and neurological disease (as determined by physical examination and laboratory testing);
* Demyelinating brain disease and/or a concerning structural abnormality seen on MRI;
* Substance abuse/dependence within 6 months of study entry (as determined by MINI and urine drug screen);
* Primary diagnosis of mood or anxiety disorder (i.e., major depressive disorder, bipolar disorder, post-traumatic stress disorder) as determined by the International Neuropsychiatric Interview for Schizophrenia and Psychotic Disorders (MINI).
* Active suicidal ideation or plan;
* An active eating disorder;
* A history of cognitive disorder or Mini-Mental State Exam (MMSE) \< 24 (indicating cognitive impairment);
* Pregnancy or lactation;
* Treatment with clozapine (given increased risk of neutropenia/agranulocytosis);
* Women of childbearing potential who are not using a medically accepted means of contraception;
* Known allergy to murine products or other biologic therapies;
* Previous organ transplant;
* Administration of any modified live virus vaccine within one month of study entry, during the study, and for at least one month after the final study visit;
* Oral glucocorticoids, immunosuppressive drugs (e.g. anti-cytokine therapies or methotrexate), or any other drugs targeting the immune system within 6 months of baseline;
* Chronic use of non-steroidal anti-inflammatory agents (NSAIDs; excluding 81mg of aspirin), glucocorticoid-containing medications, or minocycline or non-prescription supplements with known or suspected anti-inflammatory properties (e.g. fish oil supplements, curcumin, pre- or probiotics) within 2 weeks of baseline or at any time during the study;
* Use of non-steroidal anti-inflammatory agents (NSAIDs), and glucocorticoid medications at any time during the study;
* Any contraindication to MRI. Due to the high co-morbidity between schizophrenia and mood/anxiety disorders, the study team plans to include patients with these diagnoses as long as schizophrenia is the primary diagnosis.
* Subjects may be taking psychotropic medications at the time of the study (including antipsychotics, antidepressants, mood stabilizers, and benzodiazepines) but may have no psychotropic medication changes for one month before study enrollment or during participation in the study. Patients with stable medical conditions and on medications for those conditions will not be excluded. No patient will be removed from antipsychotic treatment for this study.

Where this trial is running

Atlanta, Georgia and 1 other locations

• Grady Memorial Hospital — Atlanta, Georgia, United States (Not_yet_recruiting)
• Emory University Hospital — Atlanta, Georgia, United States (Recruiting)

Study contacts

• Principal investigator: David R Goldsmith, MD — Assistant Professor
• Study coordinator: David R Goldsmith, MD

Conditions Schizophrenia; Inflammation; Reward-related Brain Regions