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CC BY-NC-ND 4.0 · Pharmacopsychiatry 2023; 56(05): 169-181
DOI: 10.1055/a-2110-4259
Original Paper

Effects of Early Clozapine Treatment on Remission Rates in Acute Schizophrenia (The EARLY Trial): Protocol of a Randomized-Controlled Multicentric Trial

EARLY Study Group*
Elias Wagner
1   Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
,
Wolfgang Strube
2   Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
,
Thomas Görlitz
2   Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
,
Aslihan Aksar
2   Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
,
Ingrid Bauer
2   Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
,
Mattia Campana
1   Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
,
Joanna Moussiopoulou
1   Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
,
Alexander Hapfelmeier
3   Institute of AI and Informatics in Medicine, School of Medicine, Technical University of Munich, Munich, Germany
4   Institute of General Practice and Health Services Research, School of Medicine, Technical University of Munich, Munich, Germany
,
Petra Wagner
5   Münchner Studienzentrum, Technical University of Munich, School of Medicine, Munich, Germany
,
Silvia Egert-Schwender
5   Münchner Studienzentrum, Technical University of Munich, School of Medicine, Munich, Germany
,
Robert Bittner
6   Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
,
Kathrin Eckstein
7   Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
,
Igor Nenadić
8   Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
,
Tilo Kircher
8   Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
,
Berthold Langguth
9   Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
,
Eva Meisenzahl
10   Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Kliniken der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
,
Martin Lambert
11   Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
,
Sigrid Neff
12   Department of Psychiatry and Psychotherapy 1 und 2, Rheinhessen-Fachklinik Alzey, Academic Hospital of the University of Mainz, Alzey, Germany
,
Berend Malchow
13   Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
,
Peter Falkai
1   Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
,
Dusan Hirjak
14   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Kent-Tjorben Böttcher
14   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Andreas Meyer-Lindenberg
14   Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
,
Christiane Blankenstein
5   Münchner Studienzentrum, Technical University of Munich, School of Medicine, Munich, Germany
,
Stefan Leucht
15   Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
,
Alkomiet Hasan
2   Department of Psychiatry, Psychotherapy, and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
› Institutsangaben Funding The study is funded by the Deutsche Forschungsgemeinschaft (DFG), grant number: HA 6091/4–1, project number: 316096538 (http://gepris.dfg.de/gepris/projekt/316096538).

Clinical trial Trial registration: Prior to the inclusion of the first patient, the study was registered on the International Clinical Trials Registry Platform (https://trialsearch.who.int/Trial2.aspx?TrialID = DRKS00016043) and on the European EudraCT platform with the number 2018-001514-15.
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Abstract

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 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.

Key Words

schizophrenia - randomized-controlled trial - clozapine - remission - second-line treatment

+ EARLY Study Group: Mohamed Abdelnaim, Lisa Löhrs, Isabel Maurus, Sofia Bauer, Anja Baumgartner, Maximilian Hansbauer, Irina Papazova, Franziska Weber, Vladislav Yakimov, Peter Zill, Maria Simon-Strauß, Gerhard Gründer, Ina Kluge, Kyeon Raab, Bettina Klos, Sarah Kayser, Stefanie Engelhardt, David Prvulovic, Jürgen Gallinat, Andreas Reif, Peter Kreuzer, Robert Stark, Thorsten Nolting, Milenko Kujovic, David Zilles.


Supplementary Material



Publikationsverlauf

Eingereicht: 21. April 2023
Eingereicht: 13. Mai 2023

Angenommen: 15. Mai 2023

Artikel online veröffentlicht:
28. Juli 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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