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SchizophreniaPhase 4PAFIP2NCT02305823

Comparative Study of Aripiprazole, Quetiapine and Ziprasidone in the Treatment of First Episode Nonaffective Psychosis

A Phase 4 study testing Aripiprazole, Quetiapine and Ziprasidone in people with Schizophrenia and Psychotic Disorders, run by Fundación Marques de Valdecilla at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The selection of antipsychotic in early stages of the illness is mainly determined by its clinical effectiveness. Second generation antipsychotics (SGAs) are the first line drug treatment for individuals suffering from schizophrenia. Read more about this study

Who is it for?
Ages 15 to 60 yearsHealthy volunteers can take part
Conditions the study is for
Schizophrenia, Psychotic Disorders
What is being tested?
Aripiprazole, Quetiapine and Ziprasidone
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
203 participants
Where
1 siteSpain
Study dates
Oct 2005to May 2014
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 15 to 60 years
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult

Who may be able to join

  • 15-60 years.
  • Living in the catchment area.
  • Experiencing their first episode of psychosis.
  • No prior treatment with antipsychotic medication or, if previously treated, a total life time of adequate antipsychotic treatment of less than 6 weeks.
  • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for brief psychotic disorder, schizophreniform disorder, schizophrenia, or schizoaffective disorder.

Who cannot join

  • Meeting DSM-IV criteria for drug dependence
  • Meeting DSM-IV criteria for mental retardation
  • Having a history of neurological disease or head injury.

Trial locations and contacts

1 site in 1 country.

Spain1 site
  • University Hospital Marques de Valdecilla

    Santander, Cantabria, 39008

Other trials in Spain

About this study

Official title: Phase IV Study of the Effectiveness of Aripiprazole, Quetiapine, and Ziprasidone in the Treatment of First Episode of Non-affective Psychosis Individuals Included in the First Episode Psychosis Clinical Program II (PAFIP II)

The selection of antipsychotic in early stages of the illness is mainly determined by its clinical effectiveness. Second generation antipsychotics (SGAs) are the first line drug treatment for individuals suffering from schizophrenia. It is clear that SGAs are not a homogeneous group and clinical effects and profile of side effects differ between SGAs. Differences among antipsychotics in terms of effectiveness have turned out to be a topic of increasing research interest, although comparisons between the different SGAs are scarce. In first episode of psychosis, SGAs have shown a higher treatment effectiveness compared to first generation antipsychotics (FGAs) (findings primarily driven by Haloperidol). Less evident seems to be the notion that some of the SGAs might be more effective (in terms of treatment discontinuation) than others. Most of the medium-term randomized studies have shown similar rates of all-cause treatment discontinuation in first episode patients treated with different SGAs. It may be concluded that more randomized controlled trails should be accomplished to determine the position of frequently used SGAs in clinical practice. The investigators undertook this study with the major objective of comparing the clinical effectiveness of three widely utilized SGAs (Aripiprazole, Ziprasidone and Quetiapine) in the acute treatment of first-episode non-affective psychosis individuals.

Read the detailed description

Study setting and financial support: data for the present investigation were obtained from an ongoing epidemiological and three-year longitudinal intervention program of first-episode psychosis (PAFIP) conducted at the outpatient clinic and the inpatient unit at the University Hospital Marqués de Valdecilla, Spain. Conforming to international standards for research ethics, this program was approved by the local institutional review board. Patients meeting inclusion criteria and their families provided written informed consent to be included in the PAFIP. The Mental Health Services of Cantabria provided funding for implementing the program. None pharmaceutical company supplied any financial support to it.

Study design: this is a prospective, randomized, flexible-dose, open-label study. At study intake, all patients but eight were antipsychotic naïve. Dose ranges were 5-20 mg /day Aripiprazole, 40-160 mg/day Ziprasidone and 100-600 mg/day Quetiapine. Rapid titration schedule (5-day), until optimal dose was reached, was as a rule used unless severe side effects occur. At the treating physician´s discretion, the dose and type of antipsychotic medication could be changed based on clinical efficacy and the profile of side effects during the follow-up period. Antimuscarinic medication, Lormetazepam and Clonazepam were permitted for clinical reasons. No antimuscarinic agents were administered prophylactically. Antidepressants (Sertraline) and mood stabilizers (lithium) were permitted if clinically needed.

The severity scale of the Clinical Global Impression (CGI) scale, the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Positive symptoms (SAPS), the Scale for the Assessment of Negative symptoms (SANS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Young Mania Rating Scale (YMRS) were used to evaluate symptomatology. To assess general adverse event experiences the Scale of the Udvalg for Kliniske Undersogelser (UKU), the Simpson-Angus Rating Scale (SARS) and the Barnes Akathisia Scale (BAS) were used. The same trained psychiatrist (BC-F) completed all clinical assessments.

The adverse events were evaluated using the UKU Side effect rating scale. Those treatment-emergent adverse events that occurred at a rate of at least 10% in either treatment group are considered. Treatment-emergent akathisia (BAS) and extrapyramidal symptoms (SARS) were assessed by both baseline-to-end changes and newly emergent categorical changes.

Being tested
Aripiprazole, Quetiapine, Ziprasidone
Keywords
psychosis, antipsychotic agents, treatment, effectiveness
Medical subject headings
Schizophrenia, Psychotic Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AripiprazoleDrug

    Also called Abilify

  • QuetiapineDrug

    Also called Seroquel

  • ZiprasidoneDrug

    Also called Zeldox

Study groups in NCT02305823
Study groupRoleWhat they receive
AripiprazoleActive comparatorOral, dose range 5-30 mg/day, once or twice a day, during study duration
Receives: Drug: Aripiprazole
QuetiapineActive comparatorOral, dose range 100-600 mg/day, once or twice a day, during study duration
Receives: Drug: Quetiapine
ZiprasidoneActive comparatorOral, dose range 40-160 mg/day, once or twice a day, during study duration
Receives: Drug: Ziprasidone

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Effectiveness of antipsychotics (percentage of discontinuation of the initially assigned treatment)

    The main outcomes of effectiveness were the percentage of discontinuation of the initially assigned treatment (patients who completed the 6 weeks follow-up assessment and changed initial antipsychotic) and the mean time to all-cause medication discontinuation. Four reasons for the discontinuation were recorded: 1.- insufficient efficacy; 2.- marked side-effects; 3.- patient reported non-adherence and 4.- other causes. If more than one reason for discontinuation was present, the most important reason according to the above ranking was selected. Data on antipsychotic treatment (doses, discontinuation and concomitant medications) were registered weekly during the first 4 weeks and at 6 week. Insufficient efficacy was established at the treating physician´s judgment only after at least three weeks of treatment.

    Measured: 6 weeks

Secondary outcomes (5)
  1. Change in general psychopathology measured by the Brief Psychiatric Rating Scale (BPRS)

    Measured by BPRS. The patients were defined as responders to the optimum dose of antipsychotic at 6 weeks if a >40% reduction of the BPRS scores at intake and had a CGI severity score of ≤ 4. In addition, we also explored to rate of responders if a cutoff of ≥ 50% reduction of the BPRS total scores at intake was used.

    Measured: 6 weeks, 3 months and 1 year

  2. Change in positive and negative symptoms measured by the Scale for the Assessment of Negative and Positive Symptoms (SANS and SAPS)

    Measured by SANS and SAPS.

    Measured: 6 weeks, 3 months and 1 year

  3. Change in the severity of depressive symptoms measured by the Calgary Depression Scale (CDS)

    Measured by CDS.

    Measured: 6 weeks, 3 months and 1 year

  4. Change in maniac symptoms measured by the Young Mania Rating Scale (YMRS)

    Measured by YMRS.

    Measured: 6 weeks, 3 months and 1 year

  5. Adherence to treatment

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Dec 2014 (estimated)
  2. Study startOct 2005
  3. Primary completionFeb 2011
  4. Study completionMay 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
203 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02305823
Sponsor's protocol ID
AZQ2005
Other IDs
CI 2005-0308007
Acronym
PAFIP2
Status last verified
Mar 2017
First submitted
20 Nov 2014
Last updated
14 Mar 2017
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Son J MV, Gomez-Revuelta M, Ayesa-Arriola R, Vazquez-Bourgon J, Foz VO, Ruiz-Veguilla M, Garrido N, Tordesillas-Gutierrez D, Setien-Suero E, Crespo-Facorro B. Comparison of aripiprazole and risperidone effectiveness in first episode non-affective psychosis: Rationale and design of a prospective, randomized, 3-phase, investigator-initiated study (PAFIP-3). Rev Psiquiatr Salud Ment (Engl Ed). 2021 Jul-Sep;14(3):157-163. doi: 10.1016/j.rpsmen.2021.08.002.

    PubMed 34456030
  • Delgado-Alvarado M, Tordesillas-Gutierrez D, Ayesa-Arriola R, Canal M, de la Foz VO, Labad J, Crespo-Facorro B. Plasma prolactin levels are associated with the severity of illness in drug-naive first-episode psychosis female patients. Arch Womens Ment Health. 2019 Jun;22(3):367-373. doi: 10.1007/s00737-018-0899-x. Epub 2018 Aug 10.

    PubMed 30097769
  • Tordesillas-Gutierrez D, Ayesa-Arriola R, Delgado-Alvarado M, Robinson JL, Lopez-Morinigo J, Pujol J, Dominguez-Ballesteros ME, David AS, Crespo-Facorro B. The right occipital lobe and poor insight in first-episode psychosis. PLoS One. 2018 Jun 1;13(6):e0197715. doi: 10.1371/journal.pone.0197715. eCollection 2018.

    PubMed 29856773
  • Pelayo-Teran JM, Gajardo-Galan V, Gomez-Revuelta M, Ortiz-Garcia de la Foz V, Ayesa-Arriola R, Tabares-Seisdedos R, Crespo-Facorro B. Duration of active psychosis and functional outcomes in first-episode non-affective psychosis. Eur Psychiatry. 2018 Aug;52:29-37. doi: 10.1016/j.eurpsy.2018.03.003. Epub 2018 Mar 31.

    PubMed 29614389
  • Vazquez-Bourgon J, Perez-Iglesias R, Ortiz-Garcia de la Foz V, Suarez Pinilla P, Diaz Martinez A, Crespo-Facorro B. Long-term metabolic effects of aripiprazole, ziprasidone and quetiapine: a pragmatic clinical trial in drug-naive patients with a first-episode of non-affective psychosis. Psychopharmacology (Berl). 2018 Jan;235(1):245-255. doi: 10.1007/s00213-017-4763-x. Epub 2017 Oct 26.

    PubMed 29075885
  • Ayesa-Arriola R, Alcaraz EG, Hernandez BV, Perez-Iglesias R, Lopez Morinigo JD, Duta R, David AS, Tabares-Seisdedos R, Crespo-Facorro B. Suicidal behaviour in first-episode non-affective psychosis: Specific risk periods and stage-related factors. Eur Neuropsychopharmacol. 2015 Dec;25(12):2278-88. doi: 10.1016/j.euroneuro.2015.09.008. Epub 2015 Sep 28.

    PubMed 26475577

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Aripiprazole, Quetiapine and Ziprasidone in people with Schizophrenia and Psychotic Disorders, run by Fundación Marques de Valdecilla at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Mar 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Effectiveness of antipsychotics (percentage of discontinuation of the initially assigned treatment) (time frame: 6 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02305823, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Mar 2017.

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