Memantine add-on for Cognitive and Negative Symptoms of Schizophrenia

Memantine add-on for Improving Cognitive Impairments and Negative Symptoms in Patients With Schizophrenia

The specific aim of this project is to test if memantine add-on therapy will be helpful for patients with first episode schizophrenia who present with or without cognitive impairments and negative symptoms, to examine the efficacy and safety of memantine as an adjuvant agent to their ongoing maintenance therapy with atypical antipsychotics. Our objectives include:

1. Test memantine add-on by 2 different dosages comparing to a placebo-controlled group of clinically stable first episode schizophrenic patients who are under second-generation antipsychotic maintenance therapy. The results will give us information regarding effective dosage and the profile of adverse drug reactions while using on this population.
2. Examine whether the effect of memantine add-on will be affected by any significant baseline clinical variables or predisposed cognitive deficits. That is to say, if memantine will only demonstrate adjunctive effect on those who are cognitively impaired or its effect is independent from baseline cognitive functioning or the severity of baseline psychopathology.
3. Examine the changes in negative symptoms as the secondary outcomes to see if such a cognitive enhancing effect to be concurrent with an improvement in negative symptoms or independent from changes in negative symptoms.
4. Treat the changes in positive symptoms and other clinical outcomes, such as readmission, being employed/going back to school, and psycho-social functioning scores as the tertiary outcomes to examine the effectiveness of memantine add-on.

Study Overview

• Status: Unknown
• Conditions: Schizophrenia
• Intervention / Treatment: Drug: Memantine; Drug: Placebo

Detailed Description

Study design:

This is a 12-week double-blind randomized placebo-controlled trial of memantine add-on to concurrent antipsychotic therapy for clinically stable patients with first episode schizophrenia.

Study procedures:

Patients will be recruited from the outpatient clinic of the study hospital. We will hold information campaigns to encourage referrals once the clinical trial procedure is set. Patients will be assessed for eligibility based on the criteria detailed below. Written informed consent will be obtained from eligible subjects or the subjects' parents if they are younger than the age of 18 years. Baseline clinical and neuropsychological assessments will be done at first. Patients will receive a single dose of memantine 5 mg to test if any allergic reactions to those who have never used it before. And then they will be randomized into 3 groups: the first group receives a target dose of memantine 10 mg/day, the second group receives a target dose of memantine 20 mg/day, and the third is a placebo control group. Both the participants and the clinicians are blinded to the agents and dosage they are taking. The dose titrating schedule for medication groups will be 5 mg/day for the first week with an increment of 5 mg per week to reach their designated targeted dose. So the10 mg add-on group will reach their target dose by the beginning of the second week and the 20 mg/day add-on group will reach their target dose by the beginning of the fourth week. Participants will be scheduled to return visit on week 1, 2, 4, 8, and 12 for dispense of medication and clinical assessments. By the end of the 12-week trial, they will receive all clinical and neuropsychological assessments again.

To use the least resources and to make most use of the information, as well as take into account of attrition, we plan to recruit 40 patients for each group with a total of 120 participants.

• Study Type: Interventional
• Enrollment (Anticipated): 120
• Phase: Phase 3

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan
    • Recruiting
    • National Taiwan University Hospital
    • Contact: Chen-Chung Liu, MD,PhD; Phone Number: 66130 +886-2-23123456; Email: chchliu@ntu.edu.tw
    • Sub-Investigator: Yi-Ting Lin, MD PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Both male and female outpatients
• Age 18-45 years old at the time of screening
• A diagnosis of schizophrenia based on the Structured Clinical Interview for DSM-IV
• Currently receiving treatment mainly by an atypical antipsychotic (risperidone, olanzapine, amisulpride, aripiprazole, quetiapine, ziprasidone, paliperidone), including long-acting injectable antipsychotic
• A first generation antipsychotic agent only for a low-dose, as needed use purpose
• No revised use of benzodiazepines, antidepressants, anticholinergics, or other concomitant medications during past 3 months

Exclusion Criteria:

• A score of 5 or more on any of the 7 positive symptom items of the PANSS rating at screening
• Scores of 4 on at least 3 of the 7 positive symptom items of the PANSS rating at screening
• Currently under clozapine treatment
• A change of current antipsychotic medication in recent 3 months
• Mental retardation known as IQ below 70 prior to the diagnosis of schizophrenia
• A history of pervasive mental disorder or bipolar disorder
• A medical condition with significant cognitive sequelae
• A history of substance dependence
• A history of hypersensitivity to memantine or other drugs of the same class, such as amantadine
• Pregnancy, plan to get pregnant during the study period, or lactating women
• Abnormal liver function (AST, ALT higher than doubling the upper limits of normal range) or abnormal renal function (blood creatinine > 1.3 mg/dL)
• A history of epilepsy
• A history of myocardial infarction, congestive heart failure, uncontrolled hypertension, stroke, or severe heart block.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Memantine 10 mg/day; Dosing titration with 5 mg incremental each week Clinical follow-up/assessment at week 1, 2, 4, 8, and 12 Treatment duration: 12 weeks	Drug: Memantine; Pills of memantine, including 5 or 10 mg, all prepared in the same capsules as used in the placebo arm. The Memantine 10 mg intervention arm will take 1 capsule of memantine and 1 capsule of placebo going into week 3.; Other Names: Ebixa; Drug: Placebo; Capsules with starch inside manufactured using the same capsules as used in the other 2 arms.
Active Comparator: Memantine 20 mg/day; Dosing titration with 5 mg incremental each week Clinical follow-up/assessment at week 1, 2, 4, 8, and 12 Treatment duration: 12 weeks	Drug: Memantine; Pills of memantine, including 5 or 10 mg, all prepared in the same capsules as used in the placebo arm. The Memantine 10 mg intervention arm will take 1 capsule of memantine and 1 capsule of placebo going into week 3.; Other Names: Ebixa
Placebo Comparator: Placebo; Clinical follow-up/assessment at week 1, 2, 4, 8, and 12 Treatment duration: 12 weeks	Drug: Placebo; Capsules with starch inside manufactured using the same capsules as used in the other 2 arms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in neurocognitive function	Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), Trail Making Tests, Mandarin version of Verbal Fluency Test and Wechsler Memory Scale-Third Edition (WMS-III).	Baseline, Week 12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in symptom severity during 12 weeks	Mandarin version Positive and Negative Symptom Scale (PANSS) of Schizophrenia	Baseline, Week 1, 2, 4, 8, 12
Change from baseline in adverse events during 12 weeks	Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale	Baseline, Week 1, 2, 4, 8, 12

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Investigators: Principal Investigator: Chen-Chung Liu, MD, PhD, National Taiwan University Hospital

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (Anticipated): July 1, 2016
• Study Completion (Anticipated): December 1, 2017

Study Registration Dates

• First Submitted: November 27, 2013
• First Submitted That Met QC Criteria: November 27, 2013
• First Posted (Estimate): December 4, 2013

Study Record Updates

• Last Update Posted (Estimate): July 12, 2016
• Last Update Submitted That Met QC Criteria: July 11, 2016
• Last Verified: July 1, 2016

More Information

Terms related to this study

• Keywords: adjuvant therapy; cognitive deficits; negative symptoms; memantine; first episode schizophrenia; glutamate hypothesis
• Additional Relevant MeSH Terms: Mental Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Excitatory Amino Acid Antagonists; Excitatory Amino Acid Agents; Dopamine Agents; Antiparkinson Agents; Anti-Dyskinesia Agents; Memantine
• Other Study ID Numbers: 201112171MID