Treatment With Risperidone Long Acting Injectable (RLAI) in an Early Phase of Psychosis

May 16, 2011 updated by: Janssen Pharmaceutica N.V., Belgium

Is Premorbid Functioning a Predictor of Outcome in Patients With Early Onset Psychosis Treated With Risperdal Consta?

The purpose of this research study is to see how well patients in an early phase of their illness respond to treatment and whether this depends on how well they functioned socially, academically and vocationally before becoming ill. The study also examines whether patients with more insight into their illness have better outcomes.

Study Overview

Detailed Description

Intervention with antipsychotic medications during the early stages of schizophrenia may result in a better outcome for patients, with a higher number of patients achieving full remission, a shorter time to remission and decreased risk of relapse. In addition, there is evidence to suggest that a critical window of opportunity exists in the early period of syndromal differentiation, when pharmacological intervention and intensive engagement of the patient may impact favourably on symptoms in the longer term.

The long-acting injectable formulation of risperidone has shown improvements in measures of disease severity over the oral formulation, and demonstrated an improved safety and tolerability profile because of its lower peak-trough levels. A recent study has demonstrated that patients in the early phase of their illness (0-3 years) benefit from treatment with RLAI.

Although premorbid functioning is accepted to be a predictor of outcome and to affect treatment adherence, prospective clinical data are scarce. RLAI addresses the problem of adherence by eliminating the need for daily medication intake. In this study we investigate whether patients with good premorbid functioning respond better to treatment with RLAI compared to patients with poor premorbid functioning. Moreover, patients with schizophrenia often fail to acknowledge their illness and need for treatment - so-called 'lack of insight'. Previous studies investigating the relationship between acute psychopathology and insight have produced conflicting results. Multiple administrations of a structured measure of insight (SAI-E) and symptom measures will provide here a means to evaluate whether insight is correlated with clinical change, whether insight changes over time and whether changes in insight are related to changes in psychopathology.

A physical examination will be performed, including heart rate, blood pressure, and weight. Interviews and assessments will be made to complete standard rating scales (Positive and Negative Symptom Score (PANSS), Scale for Assessment of Insight-Expanded version (SAI-E), Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), and Extrapyramidal Symptom Rating Scale (ESRS)). The Short-Form-36 questionnaire (SF-36) will be completed by the patient. Any health problems and medicines of the patient will be recorded.

The primary hypothesis, that patients with "Stable-good" premorbid functioning will have better outcomes than those with "Stable-poor" premorbid functioning will be examined by dividing patients into a "Stable-good" and "Stable-poor" premorbid functioning groups based on their total scores on the Premorbid Adjustment Scale (PAS). Statistically significant differences between the "Stable-good" vs. "Stable-poor" pre-morbid groups on the combined change measure at the 5% level will be interpreted as supporting the hypothesis.

Association of insight and outcomes will be examined using Scale for Assessment of Insight-Expanded version (SAI-E )and insight item (G 12) from Positive and Negative Symptom Score (PANSS). Effectiveness [Clinical Global Impression (CGI-S/C), PANSS, retention rate), functioning [Short-Form-36 questionnaire (SF-36, rehospitalisation rates)] and safety and tolerability will be assessed. The observation period is 6 months. RLAI is given as intramuscular injections every 2 weeks. The starting dose of RLAI will be in accordance with the product label (usually 25 mg). If necessary, the dosage of the injection may be increased gradually. Treatment duration is 26 weeks. To ensure continued antipsychotic coverage until the main release of risperidone from the microspheres, previous antipsychotic therapy will be continued concomitantly during the first three weeks of the study.

Study Type

Interventional

Enrollment (Actual)

303

Phase

  • Phase 4

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Diagnosis of schizophrenia/schizoaffective disorder for no longer than 2 years
  • At least 2 previous psychotic episodes
  • At least 6 months of antipsychotic treatment required
  • maximum total Positive and Negative Symptom Score (PANSS) score of < = 80
  • Patients may be currently treated with any antipsychotic (with the exception of clozapine and depot neuroleptics) at doses not exceeding the registered highest recommended dose.

Exclusion Criteria:

  • Already on treatment with RLAI
  • Patients requiring treatment at entry with mood stabilizers or antidepressants may enter the study only if a stable dose has been received for 3 months prior to study entry
  • Previously received treatment with clozapine
  • Known non-responders to previous treatment with at least 2 antipsychotics
  • Mental retardation
  • Patients with conditions and symptoms that are listed in the SmPC under special warnings and special precautions for use
  • Acute risk of suicide in the investigator's opinion at study entry or history of suicidal attempt(s) in the last 3 months before the study entry

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
To assess the use of RLAI in patients in the early phases of psychosis and to test the hypothesis that patients with good vs. poor premorbid functioning will have better treatment response over 6 months as assessed with the Premorbid Adjustment Scale.

Secondary Outcome Measures

Outcome Measure
The association of insight and outcomes will be examined using SAI-E and insight item (G 12) from PANSS. Effectiveness (CGI-S/C, PANSS, retention rate), functioning (SF-36, rehospitalisation rates) and safety and tolerability will be assessed.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2006

Primary Completion

December 7, 2022

Study Completion (Actual)

November 1, 2007

Study Registration Dates

First Submitted

August 25, 2006

First Submitted That Met QC Criteria

August 25, 2006

First Posted (Estimate)

August 29, 2006

Study Record Updates

Last Update Posted (Estimate)

May 17, 2011

Last Update Submitted That Met QC Criteria

May 16, 2011

Last Verified

April 1, 2010

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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