Intensified treatment for schizophrenia after first treatment failure

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This clinical trial investigates the effects of a six-week intensified pharmacological treatment using clozapine compared to standard treatment for patients with schizophrenia who have experienced their first treatment failure. The study aims to determine if initiating clozapine earlier in the treatment process can lead to better outcomes for patients who have not responded to first-line antipsychotics. Participants will be monitored closely due to the potential risks associated with clozapine, but the goal is to improve the quality of life and reduce the burden of the illness. The trial will include both inpatients and outpatients aged 18 to 70 who meet specific diagnostic criteria.

Why it matters

Who can join: the full rules

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 a treatment failure due to lack of efficacy in the current episode, as confirmed by a CGI-I ≥3; preferably 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). However, other lines of treatment are accepted as well.
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

Where it's running

• Medical University Innsbruck
  Innsbruck, Austria Recruiting
• Universitätsklinik für Psychiatrie und Psychotherapie Bielefeld
  Bielefeld, Germany Recruiting
• LWL-Klinik Dortmund, Bereich Forschung & Wissenschaft
  Dortmund, Germany Recruiting
• University Hospital Frankfurt am Main - Goethe University
  Frankfurt am Main, Germany Recruiting
• Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz
  Mainz, Germany Recruiting
• Westfälische Wilhelms-Universität Münster
  Münster, Germany Recruiting

Study contacts

• Study coordinator: Inge Winter, Dr.
• Email: i.winter@umcutrecht.nl
• Phone: +31875553227

Similar studies

Other studies for the same condition or treatment. Recruiting studies are listed first.

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.