Effects of early clozapine treatment on remission rates in acute schizophrenia (the EARLY trial): protocol of a randomized-controlled multicentric trial

  • Background Quick symptomatic remission after the onset of psychotic symptoms is critical in schizophrenia treatment, determining the subsequent disease course and recovery. In this context, only every second patient with acute schizophrenia achieves symptomatic remission within three months of initiating antipsychotic treatment. The potential indication extension of clozapine—the most effective antipsychotic—to be introduced at an earlier stage (before treatment-resistance) is supported by several lines of evidence, but respective clinical trials are lacking. Methods Two hundred-twenty patients with acute non-treatment-resistant schizophrenia will be randomized in this double-blind, 8-week parallel-group multicentric trial to either clozapine or olanzapine. The primary endpoint is the number of patients in symptomatic remission at the end of week 8 according to international consensus criteria (‘Andreasen criteria’). Secondary endpoints and other assessments comprise a comprehensiveBackground Quick symptomatic remission after the onset of psychotic symptoms is critical in schizophrenia treatment, determining the subsequent disease course and recovery. In this context, only every second patient with acute schizophrenia achieves symptomatic remission within three months of initiating antipsychotic treatment. The potential indication extension of clozapine—the most effective antipsychotic—to be introduced at an earlier stage (before treatment-resistance) is supported by several lines of evidence, but respective clinical trials are lacking. Methods Two hundred-twenty patients with acute non-treatment-resistant schizophrenia will be randomized in this double-blind, 8-week parallel-group multicentric trial to either clozapine or olanzapine. The primary endpoint is the number of patients in symptomatic remission at the end of week 8 according to international consensus criteria (‘Andreasen criteria’). Secondary endpoints and other assessments comprise a comprehensive safety assessment (i. e., myocarditis screening), changes in psychopathology, global functioning, cognition, affective symptoms and quality of life, and patients’ and relatives’ views on treatment. Discussion This multicentre trial aims to examine whether clozapine is more effective than a highly effective second-generation antipsychotics (SGAs), olanzapine, in acute schizophrenia patients who do not meet the criteria for treatment-naïve or treatment-resistant schizophrenia. Increasing the likelihood to achieve symptomatic remission in acute schizophrenia can improve the overall outcome, reduce disease-associated burden and potentially prevent mid- and long-term disease chronicity.show moreshow less

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Metadaten
Author:Elias WagnerGND, Wolfgang StrubeORCiDGND, Thomas GörlitzGND, Aslihan Aksar, Ingrid BauerGND, Mattia Campana, Joanna Moussiopoulou, Alexander Hapfelmeier, Petra Wagner, Silvia Egert-Schwender, Robert Bittner, Kathrin Eckstein, Igor Nenadić, Tilo Kircher, Berthold Langguth, Eva Meisenzahl, Martin Lambert, Sigrid Neff, Berend Malchow, Peter Falkai, Dusan Hirjak, Kent-Tjorben Böttcher, Andreas Meyer-Lindenberg, Christiane Blankenstein, Stefan Leucht, Alkomiet HasanORCiDGND
URN:urn:nbn:de:bvb:384-opus4-1068309
Frontdoor URLhttps://opus.bibliothek.uni-augsburg.de/opus4/106830
ISSN:0176-3679OPAC
ISSN:1439-0795OPAC
Parent Title (English):Pharmacopsychiatry
Publisher:Georg Thieme Verlag KG
Type:Article
Language:English
Year of first Publication:2023
Publishing Institution:Universität Augsburg
Release Date:2023/08/18
Tag:Pharmacology (medical); Psychiatry and Mental health; General Medicine
Volume:56
Issue:5
First Page:169
Last Page:181
DOI:https://doi.org/10.1055/a-2110-4259
Institutes:Medizinische Fakultät
Medizinische Fakultät / Lehrstuhl für Psychiatrie und Psychotherapie
Medizinische Fakultät / Professur für Evidenzbasierte Psychiatrie und Psychotherapie
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):CC-BY-NC-ND 4.0: Creative Commons: Namensnennung - Nicht kommerziell - Keine Bearbeitung (mit Print on Demand)