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R33: Levetiracetam in Early Psychosis

Primary Purpose

Early Psychosis

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Levetiracetam Pill
Placebo
Sponsored by
NYU Langone Health
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Early Psychosis

Eligibility Criteria

16 Years - 40 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria

  • Males and females 16 to 40 years of age, inclusive, at time of informed consent
  • Must have experienced a first episode of nonaffective psychosis within 5 years and exhibit current psychosis, as defined by a score of ≥ 4 on one of the following psychosis items on the BPRS: conceptual disorganization, suspiciousness, hallucinations, unusual thought content, or grandiosity, for at least 4 days per week for at least 4 weeks
  • Must have a diagnosis of either schizophrenia, schizoaffective disorder or schizophreniform disorder as established by a Structured Clinical Interview for DSM-V (SCID)
  • Must have taken antipsychotic medication for a minimum of 8 weeks and at a stable dose for at least 4 weeks prior to randomization
  • If assigned female at birth and of childbearing potential, patients must:

    • Have a negative urine pregnancy test (all participants assigned female at birth regardless of childbearing potential will be required to submit a pregnancy test) and
    • Not be nursing or planning a pregnancy for the duration of the study through 30 days after the last dosing visit and
    • Be abstinent or willing to use a reliable method of birth control from the screening visit and continue with the same method until termination from the study

Exclusion Criteria

  • Current substance abuse or dependence for substances other than nicotine and THC (i.e. alcohol, amphetamines, barbiturates)

    • A positive urine toxic screen (excluding THC, tricyclic antidepressants, or benzodiazepines (if prescribed))
    • Moderate or severe cannabis use disorder
  • Diagnosis of major mood disorder or other Axis I disorder other than Schizophrenia, Schizoaffective Disorder or Schizophreniform Disorder
  • Current suicidal ideation. Suicidal ideation with intent or plan (indicated by affirmative answers to items 4 or 5 of the suicidal ideation section of the baseline C-SSRS) in the 6 months prior to screening or subjects who represent a significant risk of suicide in the opinion of the Principal Investigator
  • Pregnant, nursing or positive urine pregnancy test
  • Significant medical or neurological illness by history or physical exam including seizure disorder, history of loss of consciousness related to head trauma or developmental disorder including mental retardation
  • Renal insufficiency (if serum creatinine is greater than laboratory limits for normal, estimated creatinine clearance must be greater than 80)
  • Contraindications to MRI: metal implants, pacemaker, or other metal in the body, or claustrophobia. Individuals with tattoos will be excluded from imaging if tattoos cover more than 5% of the body surface, if a tattoo is greater than 20 cm, or if the tattoo is located on the face, neck or genitals. (Individuals with a contraindication to MRI may participate in the trial but will be excluded from the elective MRI component)
  • Significant history of serious violence

    • For both inpatient and outpatient subjects, a history of serious violence as assessed by the Buss-Perry Aggression Questionnaire
    • For outpatient subjects only, a score of 5 (moderately severe) or higher on the BPRS hostility item at screening or baseline

Sites / Locations

  • NYU Langone HealthRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Study Drug group

Placebo Group

Arm Description

Participants in this group will receive 500 mg of levetiracetam twice daily for 12 weeks. After 12 weeks, levetiracetam will be gradually decreased and stopped over the next 9 days. Questionnaires will be administered at each visit to examine how participants are responding to the treatment. In addition, a brain scan and cognitive testing will be performed when feasible at the beginning and the end of the study.

Participants in this group will receive a placebo that looks like the levetiracetam pill twice daily for 12 weeks. After 12 weeks, the levetiracetam dose will be tapered for the next 9 days. Questionnaires will be administered at each visit to examine how participants are responding to the treatment. In addition, a brain scan and cognitive testing will be performed when feasible at the beginning and the end of the study.

Outcomes

Primary Outcome Measures

The symptoms measured by the BPRS total score
The efficacy of levetiracetam 500 mg bid vs. placebo on symptoms will be measured by the BPRS total score. Brief Psychiatric Rating Scale (BPRS) is an 24-item scale that measures positive symptoms, negative symptoms, general psychopathology and affective symptoms. Individual items are scored on a seven point likert scale. A higher score on the BPRS items indicate increased severity.

Secondary Outcome Measures

Compared to placebo, levetiracetam will improve psychotic symptoms measured by the BPRS psychosis subscale.
The efficacy of levetiracetam 500 mg bid vs. placebo on symptoms will be measured by the BPRS total score. Brief Psychiatric Rating Scale (BPRS) is an 24-item scale that measures positive symptoms, negative symptoms, general psychopathology and affective symptoms. Individual items are scored on a seven point likert scale.
Compared to placebo, levetiracetam will be associated with less hippocampal volume loss over 12 weeks.
Hippocampal volume loss will be measured by assessing change in cerebral blood flow (CBF) as measured by Arterial Spin Labeling (ASL).
Compare to placebo, levetiracetam will improve negative symptoms measured by the modified SANS total score.
Scale for Assessment of Negative Symptoms (SANS) will be the instrument for measurement of negative symptoms. Factor analysis has revealed good construct validity for all items of the SANS scale except the Attention subscale which clusters with measures of cognitive impairment rather than negative symptoms. Two, three and five domain models have been proposed based on factor analysis; this research will use the total score (minus the Attention Subscale) and the two factor solution (avolition and affective expression) to measure negative symptoms.
Compared to placebo, levetiracetam will improve cognitive functioning measured by the MATRICS composite score.
Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery is the standard tool for assessing cognitive change in trials of cognitive-enhancing agents in schizophrenia. It will be administered at baseline, week 6 and at week 12 to measure whether cognitive function has increased.

Full Information

First Posted
March 19, 2020
Last Updated
February 27, 2023
Sponsor
NYU Langone Health
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1. Study Identification

Unique Protocol Identification Number
NCT04317807
Brief Title
R33: Levetiracetam in Early Psychosis
Official Title
A 12-week Randomized, Double-blind, Placebo-controlled Trial Investigating the Effects of Levetiracetam in Early Psychosis
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 1, 2020 (Actual)
Primary Completion Date
January 2024 (Anticipated)
Study Completion Date
January 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NYU Langone Health

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a 12-week study of levetiracetam added to a second generation antipsychotic in early psychosis patients who have been ill for less than 5 years and continue to experience psychotic symptoms despite at least 8 weeks of antipsychotic treatment. Levetiracetam (Keppra) is a medication approved for the treatment of epilepsy; it reduces excessive activity in the brain. This study will test the hypotheses that adding levetiracetam will improve psychotic symptoms that are unresponsive to antipsychotic treatment and will protect the brain from atrophy (volume loss). .
Detailed Description
Participants will complete screening and baseline visits before being randomized in a 2:1 ratio to levetiracetam or placebo added to the antipsychotic medication. They will complete weekly study visits for the first 4 weeks (Baseline, Weeks 2-4) and then additional visits at Week 6, 8, and 12. Participants will be studied both by assessing change in symptom severity and cognitive performance over the 12 weeks as well as using an imaging measure of hippocampal volume integrity at baseline and week 12. After completing Week 12 or decision to withdraw prematurely from the study, participants will complete a 9 day medication tapering regimen.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Early Psychosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
84 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Study Drug group
Arm Type
Active Comparator
Arm Description
Participants in this group will receive 500 mg of levetiracetam twice daily for 12 weeks. After 12 weeks, levetiracetam will be gradually decreased and stopped over the next 9 days. Questionnaires will be administered at each visit to examine how participants are responding to the treatment. In addition, a brain scan and cognitive testing will be performed when feasible at the beginning and the end of the study.
Arm Title
Placebo Group
Arm Type
Placebo Comparator
Arm Description
Participants in this group will receive a placebo that looks like the levetiracetam pill twice daily for 12 weeks. After 12 weeks, the levetiracetam dose will be tapered for the next 9 days. Questionnaires will be administered at each visit to examine how participants are responding to the treatment. In addition, a brain scan and cognitive testing will be performed when feasible at the beginning and the end of the study.
Intervention Type
Drug
Intervention Name(s)
Levetiracetam Pill
Other Intervention Name(s)
Keppra
Intervention Description
Levetiracetam is an anticonvulsant that is frequently used to treat epilepsy in children and adults due to its superior tolerability, ease of use and excellent safety profile. It is rapidly absorbed and rapidly crosses the blood-brain barrier. Levetiracetam does not affect metabolism of antipsychotic drugs and may normalize hippocampal hyperactivity by decreasing excessive glutamatergic and dopaminergic transmission, thereby making it an ideal agent to test the hypothesis that reducing excessive hippocampal activity may enhance treatment of early psychosis and prevent antipsychotic toxicity. Levetiracetam will be administered in 500 mg capsules twice a day.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
The placebo pill (sugar pill) will look just like the levetiracetam pill but does not contain levetiracetam. Placebo will be taken along with optimal antipsychotic medication selected by either the outpatient provider or the hospital staff responsible for the participant's care. Participants will be instructed to take the placebo pill twice daily for 12 weeks.
Primary Outcome Measure Information:
Title
The symptoms measured by the BPRS total score
Description
The efficacy of levetiracetam 500 mg bid vs. placebo on symptoms will be measured by the BPRS total score. Brief Psychiatric Rating Scale (BPRS) is an 24-item scale that measures positive symptoms, negative symptoms, general psychopathology and affective symptoms. Individual items are scored on a seven point likert scale. A higher score on the BPRS items indicate increased severity.
Time Frame
up to week 12
Secondary Outcome Measure Information:
Title
Compared to placebo, levetiracetam will improve psychotic symptoms measured by the BPRS psychosis subscale.
Description
The efficacy of levetiracetam 500 mg bid vs. placebo on symptoms will be measured by the BPRS total score. Brief Psychiatric Rating Scale (BPRS) is an 24-item scale that measures positive symptoms, negative symptoms, general psychopathology and affective symptoms. Individual items are scored on a seven point likert scale.
Time Frame
Baseline visit (week 0), Week 12 visit
Title
Compared to placebo, levetiracetam will be associated with less hippocampal volume loss over 12 weeks.
Description
Hippocampal volume loss will be measured by assessing change in cerebral blood flow (CBF) as measured by Arterial Spin Labeling (ASL).
Time Frame
Baseline visit (week 0), Week 12 visit
Title
Compare to placebo, levetiracetam will improve negative symptoms measured by the modified SANS total score.
Description
Scale for Assessment of Negative Symptoms (SANS) will be the instrument for measurement of negative symptoms. Factor analysis has revealed good construct validity for all items of the SANS scale except the Attention subscale which clusters with measures of cognitive impairment rather than negative symptoms. Two, three and five domain models have been proposed based on factor analysis; this research will use the total score (minus the Attention Subscale) and the two factor solution (avolition and affective expression) to measure negative symptoms.
Time Frame
Baseline visit (week 0), Week 12 visit
Title
Compared to placebo, levetiracetam will improve cognitive functioning measured by the MATRICS composite score.
Description
Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery is the standard tool for assessing cognitive change in trials of cognitive-enhancing agents in schizophrenia. It will be administered at baseline, week 6 and at week 12 to measure whether cognitive function has increased.
Time Frame
Baseline visit (week 0), Week 6 visit, Week 12 visit

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Males and females 16 to 40 years of age, inclusive, at time of informed consent Must have experienced a first episode of nonaffective psychosis within 5 years and exhibit current psychosis, as defined by a score of ≥ 4 on one of the following psychosis items on the BPRS: conceptual disorganization, suspiciousness, hallucinations, unusual thought content, or grandiosity, for at least 4 days per week for at least 4 weeks Must have a diagnosis of either schizophrenia, schizoaffective disorder or schizophreniform disorder as established by a Structured Clinical Interview for DSM-V (SCID) Must have taken antipsychotic medication for a minimum of 8 weeks and at a stable dose for at least 4 weeks prior to randomization If assigned female at birth and of childbearing potential, patients must: Have a negative urine pregnancy test (all participants assigned female at birth regardless of childbearing potential will be required to submit a pregnancy test) and Not be nursing or planning a pregnancy for the duration of the study through 30 days after the last dosing visit and Be abstinent or willing to use a reliable method of birth control from the screening visit and continue with the same method until termination from the study Exclusion Criteria Current substance abuse or dependence for substances other than nicotine and THC (i.e. alcohol, amphetamines, barbiturates) A positive urine toxic screen (excluding THC, tricyclic antidepressants, or benzodiazepines (if prescribed)) Moderate or severe cannabis use disorder Diagnosis of major mood disorder or other Axis I disorder other than Schizophrenia, Schizoaffective Disorder or Schizophreniform Disorder Current suicidal ideation. Suicidal ideation with intent or plan (indicated by affirmative answers to items 4 or 5 of the suicidal ideation section of the baseline C-SSRS) in the 6 months prior to screening or subjects who represent a significant risk of suicide in the opinion of the Principal Investigator Pregnant, nursing or positive urine pregnancy test Significant medical or neurological illness by history or physical exam including seizure disorder, history of loss of consciousness related to head trauma or developmental disorder including mental retardation Renal insufficiency (if serum creatinine is greater than laboratory limits for normal, estimated creatinine clearance must be greater than 80) Contraindications to MRI: metal implants, pacemaker, or other metal in the body, or claustrophobia. Individuals with tattoos will be excluded from imaging if tattoos cover more than 5% of the body surface, if a tattoo is greater than 20 cm, or if the tattoo is located on the face, neck or genitals. (Individuals with a contraindication to MRI may participate in the trial but will be excluded from the elective MRI component) Significant history of serious violence For both inpatient and outpatient subjects, a history of serious violence as assessed by the Buss-Perry Aggression Questionnaire For outpatient subjects only, a score of 5 (moderately severe) or higher on the BPRS hostility item at screening or baseline
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gillian Capichioni
Phone
917-628-0552
Email
gillian.capichioni@nyulangone.org
First Name & Middle Initial & Last Name or Official Title & Degree
Fumika Ando
Phone
917-628-0552
Email
fumika.ando@nyulangone.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Donald Goff
Organizational Affiliation
NYU Langone Health
Official's Role
Principal Investigator
Facility Information:
Facility Name
NYU Langone Health
City
New York
State/Province
New York
ZIP/Postal Code
10016
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gillian Capichioni, BS
Phone
917-628-0552
Email
gillian.capichioni@nyulangone.org
First Name & Middle Initial & Last Name & Degree
Fumika Ando
Phone
917-628-0552
Email
fumika.ando@nyulangone.org
First Name & Middle Initial & Last Name & Degree
Donald Goff, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices).
IPD Sharing Time Frame
Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.
IPD Sharing Access Criteria
The investigator who proposed to use the data. Upon reasonable request. Requests should be directed to Donald.goff@nyulangone.org. To gain access, data requestors will need to sign a data access agreement.

Learn more about this trial

R33: Levetiracetam in Early Psychosis

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