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RECRUITING
NCT05958875
PHASE4

The Effect of a Six Week Intensified Pharmacological Treatment for Schizophrenia Compared to Treatment as Usual in Subjects Who Had a First-time Treatment Failure on Their First-line Treatment.

Sponsor: Dr. Inge Winter

View on ClinicalTrials.gov

Summary

Schizophrenia (SZ) affects approximately 4.5 million people across the European Union (EU) and is associated with annual healthcare and societal costs of 29 billion Euros. The impact on the daily life of patients is huge, ranging from frequent relapses and hospitalisations, the inability to maintain a job or continue scholing, to a low quality of life, impaired cognitive functioning, suicidal ideation and an increase morbidity rate, next to the large burden for carers 1. When diagnosed with schizophrenia or related disorder, patients are commonly prescribed antipsychotics. One-third of the schizophrenia patients are regarded treatment-resistant (TR), meaning that at least two antipsychotic trials have failed. Typically, clozapine is prescribed for TR patients, which is effective for approximately 40% of patients. Clozapine is among the most effective treatments, with the lowest all-cause mortality. Although it is among the most effective antipsychotics, it is generally not used earlier in the illness course due to a small risk of severe neutropenia/agranulocytosis, which is why patients treated with clozapine are intensely monitored. However, this small risk outweighs the burden of not receiving an effective treatment. Since clozapine is among the most effective treatments, this leads to the research question whether earlier initiation of third-line treatment ('early intensified' pharmacological treatment; EIPT) would be more beneficial than the current second-line treatments (treatment as usual; TAU). If this is indeed the case, this could lead to the prevention of unnecessary trials of ineffective treatments, hospitalisations, and recommendations for adaptations of worldwide guidelines as well as a reduction of healthcare and societal costs The INTENSIFY-Schizophrenia trial is part of the larger Horizon 2021 project Psych-STRATA, with the central goal of paving the way for a shift towards a treatment decision-making process tailored for the individual at risk for treatment resistance. To that end, the inestigators aim to establish evidence-based criteria to make decisions of early intense treatment in individuals at risk for treatment resistance across the major psychiatric disorders of schizophrenia, bipolar disorder and major depression. The current protocol focuses on the sample of schizophrenia patients.

Official title: A Randomised, Controlled Trial to Investigate the Effect of a Six Week Intensified Pharmacological Treatment for Schizophrenia Compared to Treatment as Usual in Subjects Who Had a First-time Treatment Failure on Their First-line Treatment.

Key Details

Gender

All

Age Range

18 Years - 70 Years

Study Type

INTERVENTIONAL

Enrollment

418

Start Date

2024-08-01

Completion Date

2028-06-30

Last Updated

2025-09-26

Healthy Volunteers

No

Interventions

DRUG

Clozapine

Participants are randomized to clozapine or second-line antipsychotics. When randomised to clozapine, they will receive clozapine for six weeks.

DRUG

Second-line Antipsychotics (treatment as usual)

Participants are randomized to clozapine or second-line antipsychotics. When randomized to second-line antipsychotics, this means participants will receive treatment as usual. The physician has the choice to administer any second-line antipsychotic. More specification is not possible, as this is a choice the physician makes with the participant based on the characteristic and preference of the participant (in line with standard clinical practice).

Locations (13)

Medical University Innsbruck

Innsbruck, Austria

Bezirkskliniken Schwaben, Bezirkskrankenhaus Augsburg

Augsburg, Germany

Universitätsklinik für Psychiatrie und Psychotherapie Bielefeld

Bielefeld, Germany

LWL-Klinik Dortmund, Bereich Forschung & Wissenschaft

Dortmund, Germany

University Hospital Frankfurt am Main - Goethe University

Frankfurt am Main, Germany

Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz

Mainz, Germany

Westfälische Wilhelms-Universität Münster

Münster, Germany

Universita degli Studi di Brescia

Brescia, Italy

University of Cagliari

Cagliari, Italy

Università degli studi della Campania Luigi Vanvitelli

Naples, Italy

Azienda Ospedaliero-Universitaria "Città della Salute e della Scienza di Torino"

Turin, Italy

Fundació Clínic per a la Recerca Biomèdica

Barcelona, Spain

King's College London, Psychiatry & Cognitive Neuroscience

London, United Kingdom