Estradiol as add-on to Antipsychotics (EST-S-02)
Primary Purpose
Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorders
Status
Unknown status
Phase
Phase 3
Locations
Moldova, Republic of
Study Type
Interventional
Intervention
Estradiol
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Schizophrenia
Eligibility Criteria
Inclusion Criteria:
- Female above 38, up to 45 years of age, inclusive
- Willing and able to provide informed consent, after the nature of the study has been fully explained
- Current DSM-V diagnosis of schizophrenia, schizoaffective or schizophreniform disorder as confirmed by modified SCID.
- Total PANSS score > 70 and (PANSS positive subscale >15 and/or PANSS negative subscale >15)
- Must be on a stable dose of any antipsychotic drug, for at least 2 weeks prior to the baseline visit, at doses within the PORT criteria, whenever possible. Patients receiving higher doses will have their records reviewed to ensure that their dose is required and, if possible, will be stabilized on a lower dose prior to study entry.
- Patients who are physically and endocrinologically healthy,
- Not menopausal as assessed by asking patients if they are menstruating
- Inpatients or outpatients. Inpatients will be randomized 3 days or more after admission
Exclusion Criteria:
- Unwilling or unable, in the opinion of the Investigator, to comply with study instructions
- Pregnant or breast-feeding
- Women who are menopausal.
- Patients treated with oral estrogen preparations containing estradiol greater than 30 mcg.
- Women who have known severe abnormalities in the hypothalamo-pituitary gonadal axis, thyroid disorders, severe medical conditions and disorders that would contraindicate estrogen use (breast cancer, migraine with aura or stroke)
- History of endometrial cancer or breast cancer, history of breast or uterine cancer, no history of 1st and 2nd grade family with breast or uterine cancer, vaginal bleeding between periods.
- Likely allergy or sensitivity to estradiol.
- Schizoaffective disorder in the manic phase.
- At significant risk of committing suicide, or in the opinion of the Investigator, currently at imminent risk of suicide or harming others.
- Patients with a current DSM-V substance or alcohol abuse. Patients with a history of and/or current recreational use of cannabinoids or alcohol, and/or patients who smoke cigarettes can be included.
- Concurrent delirium, mental retardation, drug-induced psychosis, or history of clinically significant brain trauma documented by CT or MRI.
- Patients receiving phenobarbital, phenytoin, carbamazepine, rifampicin, rifabutin, nevirapine, efavirenz, ritonavir and nelfinavir,or Hypericum perforatum.
Sites / Locations
- Centrul Comunitar de Sănătate Mintală BotanicaRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Active Comparator
Placebo Comparator
Arm Description
Estradiol 200µg
Placebo
Outcomes
Primary Outcome Measures
Change in total PANSS scores at the end of the trial
The Positive and Negative Syndrome Scale (PANSS) is a well validated, standardized method of evaluating and monitoring psychotic symptoms. The PANSS assesses: positive (hallucinations, delusions, thought disorder), negative (blunted affect, abstract thinking and general symptomatology. The positive and negative subscale each consist of 7 items rated from 1(absent) - 7(extreme) with a minimum score = 7, maximum score = 49. The general subscale consists of 16 items with a minimum score = 16, maximum score = 112. A Total PANSS score (positive+ negative + general scores) has a minimum of 30 and maximum of 210. Higher scores represent more severity in symptoms.
Secondary Outcome Measures
Positive and Negative Syndrome Scale (PANSS) and general psychopathology scales
To evaluate the effects of Estradiol on Positive and Negative Syndrome Scale (PANSS)
Clinical Global Impression Scale-Severity (CGI-S) and Global Impression Scale-Improvement (CGI-I),
To evaluate the effects of Estradiol vs Placebo on Clinical Global Impression
Montgomery-Asberg Depression Rating Scale
To evaluate the effects of Estradiol on depressive symptoms
Rates of drop outs before the end of the trial
To evaluate the rate of drop outs
Full Information
NCT ID
NCT04093518
First Posted
September 16, 2019
Last Updated
May 21, 2020
Sponsor
Tangent Data
Collaborators
Stanley Medical Research Institute, MediStat Ltd., PCI pharma services (formerly BIOTEC SERVICES INTERNATIONAL LIMITED), S.C. IMUNOTEHNOMED S.R.L., Tangent Data Srl
1. Study Identification
Unique Protocol Identification Number
NCT04093518
Brief Title
Estradiol as add-on to Antipsychotics
Acronym
EST-S-02
Official Title
A Randomized Trial Administering Estradiol Patch vs. Placebo Patch as add-on to Antipsychotics in Female Patients Above the Age of 38 With Schizophrenia, Schizoaffective or Schizophreniform Disorder
Study Type
Interventional
2. Study Status
Record Verification Date
September 2019
Overall Recruitment Status
Unknown status
Study Start Date
December 2, 2019 (Actual)
Primary Completion Date
October 15, 2020 (Anticipated)
Study Completion Date
November 1, 2020 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Tangent Data
Collaborators
Stanley Medical Research Institute, MediStat Ltd., PCI pharma services (formerly BIOTEC SERVICES INTERNATIONAL LIMITED), S.C. IMUNOTEHNOMED S.R.L., Tangent Data Srl
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
The objective of the study is to evaluate the efficacy of Estradiol patch compared to placebo, as add-on to anti-psychotics in the treatment of women 38 and older with schizophrenia, schizoaffective or schizophreniform disorder.
Detailed Description
Several lines of evidence suggest that estrogen affects the course of schizophrenia. The onset of schizophrenia is 2-4 years later in women than in men, and women have a lower incidence of schizophrenia until menopause, after which women have an increased incidence, so that the lifetime prevalence is similar in both genders. Women are more likely to have their first schizophrenic episode during an estradiol trough in the menstrual cycle. These gender differences in the natural course of schizophrenia are well replicated and provide a major lead to understanding and treating the illness, and have led to several randomized controlled trials administering oral estradiol to patients with schizophrenia. Studies on transdermal estradiol have been more encouraging, and four RCTs, have shown that estradiol patches are efficacious in treating schizophrenia The most recent study was performed our group and showed that overall estradiol patches were efficacious with an effect size of 0.41 for total PANSS, with significant improvements in PANSS positive, negative and general-psychopathology scores. Post hoc analyses showed that the improvements in symptoms were found almost exclusively in women who were 38 and older, in whom the effect of estrogen patches vs placebo reached an effect size of 0.58 for PANSS total.
The currently proposed study is based on the post-hoc finding of improvement in participants aged 38 and above, and we will a-priori recruit women with schizophrenia 38 and above, in order to test the efficacy of 200 µg estradiol patches vs placebo in these woman.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorders
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Randomized, add-on to anti-psychotics, double blind, placebo-controlled, parallel group clinical trial
Masking
ParticipantCare ProviderInvestigator
Masking Description
Triple
Allocation
Randomized
Enrollment
100 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Active Comparator
Arm Type
Active Comparator
Arm Description
Estradiol 200µg
Arm Title
Placebo Comparator
Arm Type
Placebo Comparator
Arm Description
Placebo
Intervention Type
Drug
Intervention Name(s)
Estradiol
Other Intervention Name(s)
trans dermal patches
Intervention Description
2 transdermal patches to be changed twice a week for the duration of 16 weeks
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
trans dermal patches
Intervention Description
2 transdermal patches to be changed twice a week for the duration of 16 weeks
Primary Outcome Measure Information:
Title
Change in total PANSS scores at the end of the trial
Description
The Positive and Negative Syndrome Scale (PANSS) is a well validated, standardized method of evaluating and monitoring psychotic symptoms. The PANSS assesses: positive (hallucinations, delusions, thought disorder), negative (blunted affect, abstract thinking and general symptomatology. The positive and negative subscale each consist of 7 items rated from 1(absent) - 7(extreme) with a minimum score = 7, maximum score = 49. The general subscale consists of 16 items with a minimum score = 16, maximum score = 112. A Total PANSS score (positive+ negative + general scores) has a minimum of 30 and maximum of 210. Higher scores represent more severity in symptoms.
Time Frame
Change from Baseline at 16 weeks
Secondary Outcome Measure Information:
Title
Positive and Negative Syndrome Scale (PANSS) and general psychopathology scales
Description
To evaluate the effects of Estradiol on Positive and Negative Syndrome Scale (PANSS)
Time Frame
through study, 16 weeks
Title
Clinical Global Impression Scale-Severity (CGI-S) and Global Impression Scale-Improvement (CGI-I),
Description
To evaluate the effects of Estradiol vs Placebo on Clinical Global Impression
Time Frame
through study, 16 weeks
Title
Montgomery-Asberg Depression Rating Scale
Description
To evaluate the effects of Estradiol on depressive symptoms
Time Frame
through study, 16 weeks
Title
Rates of drop outs before the end of the trial
Description
To evaluate the rate of drop outs
Time Frame
through study completion, an average of 1 year
10. Eligibility
Sex
Female
Gender Based
Yes
Gender Eligibility Description
Gender identity
Minimum Age & Unit of Time
38 Years
Maximum Age & Unit of Time
48 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Female above 38, up to 45 years of age, inclusive
Willing and able to provide informed consent, after the nature of the study has been fully explained
Current DSM-V diagnosis of schizophrenia, schizoaffective or schizophreniform disorder as confirmed by modified SCID.
Total PANSS score > 70 and (PANSS positive subscale >15 and/or PANSS negative subscale >15)
Must be on a stable dose of any antipsychotic drug, for at least 2 weeks prior to the baseline visit, at doses within the PORT criteria, whenever possible. Patients receiving higher doses will have their records reviewed to ensure that their dose is required and, if possible, will be stabilized on a lower dose prior to study entry.
Patients who are physically and endocrinologically healthy,
Not menopausal as assessed by asking patients if they are menstruating
Inpatients or outpatients. Inpatients will be randomized 3 days or more after admission
Exclusion Criteria:
Unwilling or unable, in the opinion of the Investigator, to comply with study instructions
Pregnant or breast-feeding
Women who are menopausal.
Patients treated with oral estrogen preparations containing estradiol greater than 30 mcg.
Women who have known severe abnormalities in the hypothalamo-pituitary gonadal axis, thyroid disorders, severe medical conditions and disorders that would contraindicate estrogen use (breast cancer, migraine with aura or stroke)
History of endometrial cancer or breast cancer, history of breast or uterine cancer, no history of 1st and 2nd grade family with breast or uterine cancer, vaginal bleeding between periods.
Likely allergy or sensitivity to estradiol.
Schizoaffective disorder in the manic phase.
At significant risk of committing suicide, or in the opinion of the Investigator, currently at imminent risk of suicide or harming others.
Patients with a current DSM-V substance or alcohol abuse. Patients with a history of and/or current recreational use of cannabinoids or alcohol, and/or patients who smoke cigarettes can be included.
Concurrent delirium, mental retardation, drug-induced psychosis, or history of clinically significant brain trauma documented by CT or MRI.
Patients receiving phenobarbital, phenytoin, carbamazepine, rifampicin, rifabutin, nevirapine, efavirenz, ritonavir and nelfinavir,or Hypericum perforatum.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Paull G Radu, M.D.
Phone
+407 2323 4545
Email
paull.radu@tangentdata.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mark Weiser, M.D.
Organizational Affiliation
Sheba Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centrul Comunitar de Sănătate Mintală Botanica
City
Chisinau
ZIP/Postal Code
MD2072
Country
Moldova, Republic of
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Nicolae Cebotari, M.D.
Phone
+373 6927 4593
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
2374885
Citation
Angermeyer MC, Kuhn L, Goldstein JM. Gender and the course of schizophrenia: differences in treated outcomes. Schizophr Bull. 1990;16(2):293-307. doi: 10.1093/schbul/16.2.293.
Results Reference
result
PubMed Identifier
1503131
Citation
Goff DC, Henderson DC, Amico E. Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry. 1992 Sep;149(9):1189-94. doi: 10.1176/ajp.149.9.1189.
Results Reference
result
PubMed Identifier
8817704
Citation
Harrison G, Croudace T, Mason P, Glazebrook C, Medley I. Predicting the long-term outcome of schizophrenia. Psychol Med. 1996 Jul;26(4):697-705. doi: 10.1017/s0033291700037715.
Results Reference
result
PubMed Identifier
25914107
Citation
Heringa SM, Begemann MJ, Goverde AJ, Sommer IE. Sex hormones and oxytocin augmentation strategies in schizophrenia: A quantitative review. Schizophr Res. 2015 Nov;168(3):603-13. doi: 10.1016/j.schres.2015.04.002. Epub 2015 Apr 23.
Results Reference
result
PubMed Identifier
8783894
Citation
Jeste DV, Lindamer LA, Evans J, Lacro JP. Relationship of ethnicity and gender to schizophrenia and pharmacology of neuroleptics. Psychopharmacol Bull. 1996;32(2):243-51.
Results Reference
result
PubMed Identifier
22626057
Citation
Kulkarni J, Gavrilidis E, Worsley R, Hayes E. Role of estrogen treatment in the management of schizophrenia. CNS Drugs. 2012 Jul 1;26(7):549-57. doi: 10.2165/11630660-000000000-00000.
Results Reference
result
PubMed Identifier
9707298
Citation
Magharious W, Goff DC, Amico E. Relationship of gender and menstrual status to symptoms and medication side effects in patients with schizophrenia. Psychiatry Res. 1998 Feb 27;77(3):159-66. doi: 10.1016/s0165-1781(97)00137-6.
Results Reference
result
PubMed Identifier
11318766
Citation
Melkersson KI, Hulting AL, Rane AJ. Dose requirement and prolactin elevation of antipsychotics in male and female patients with schizophrenia or related psychoses. Br J Clin Pharmacol. 2001 Apr;51(4):317-24. doi: 10.1046/j.1365-2125.2001.01352.x.
Results Reference
result
PubMed Identifier
2028808
Citation
Opjordsmoen S. Long-term clinical outcome of schizophrenia with special reference to gender differences. Acta Psychiatr Scand. 1991 Apr;83(4):307-13. doi: 10.1111/j.1600-0447.1991.tb05545.x.
Results Reference
result
PubMed Identifier
447850
Citation
Pardridge WM, Mietus LJ. Transport of steroid hormones through the rat blood-brain barrier. Primary role of albumin-bound hormone. J Clin Invest. 1979 Jul;64(1):145-54. doi: 10.1172/JCI109433.
Results Reference
result
PubMed Identifier
9000318
Citation
Pinals DA, Malhotra AK, Missar CD, Pickar D, Breier A. Lack of gender differences in neuroleptic response in patients with schizophrenia. Schizophr Res. 1996 Dec 15;22(3):215-22. doi: 10.1016/s0920-9964(96)00067-9.
Results Reference
result
PubMed Identifier
15285956
Citation
Seeman MV. Gender differences in the prescribing of antipsychotic drugs. Am J Psychiatry. 2004 Aug;161(8):1324-33. doi: 10.1176/appi.ajp.161.8.1324.
Results Reference
result
PubMed Identifier
7726309
Citation
Szymanski S, Lieberman JA, Alvir JM, Mayerhoff D, Loebel A, Geisler S, Chakos M, Koreen A, Jody D, Kane J, et al. Gender differences in onset of illness, treatment response, course, and biologic indexes in first-episode schizophrenic patients. Am J Psychiatry. 1995 May;152(5):698-703. doi: 10.1176/ajp.152.5.698.
Results Reference
result
PubMed Identifier
10622350
Citation
Torgalsboen AK. Full recovery from schizophrenia: the prognostic role of premorbid adjustment, symptoms at first admission, precipitating events and gender. Psychiatry Res. 1999 Nov 8;88(2):143-52. doi: 10.1016/s0165-1781(99)00077-3.
Results Reference
result
PubMed Identifier
11458304
Citation
Usall J, Araya S, Ochoa S, Busquets E, Gost A, Marquez M; Assessment Research Group in Schizophrenia (NEDES). Gender differences in a sample of schizophrenic outpatients. Compr Psychiatry. 2001 Jul-Aug;42(4):301-5. doi: 10.1053/comp.2001.24582.
Results Reference
result
PubMed Identifier
8532098
Citation
an der Heiden W, Krumm B, Muller S, Weber I, Biehl H, Schafer M. [The Mannheim long-term study of schizophrenia. Initial results of follow-up of the illness over 14 years after initial inpatient treatment]. Nervenarzt. 1995 Nov;66(11):820-7. German.
Results Reference
result
PubMed Identifier
23244442
Citation
van der Werf M, Hanssen M, Kohler S, Verkaaik M, Verhey FR; RISE Investigators; van Winkel R, van Os J, Allardyce J. Systematic review and collaborative recalculation of 133,693 incident cases of schizophrenia. Psychol Med. 2014 Jan;44(1):9-16. doi: 10.1017/S0033291712002796. Epub 2012 Dec 17.
Results Reference
result
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Estradiol as add-on to Antipsychotics
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