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SchizophreniaPhase 3RAPSODINCT03043820

Raloxifene Augmentation in Patients With a Schizophrenia Spectrum Disorder

A Phase 3 study testing Raloxifene in people with Schizophrenia and Schizoaffective Disorder, run by Iris Sommer at 1 site in Netherlands.

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

There is increasing clinical and molecular evidence for the role of hormones and specifically estrogen and its receptor in schizophrenia. A selective estrogen receptor modulator, raloxifene, stimulates estrogen-like activity in brain and can improve cognition in older adults. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Raloxifene
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
110 participants
Where
1 siteNetherlands
Study dates
Aug 2016to 1 Jul 2021
Phase
Phase 3
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • A DSM-IV-R diagnosis of: 295.x (schizophrenia, schizophreniform disorder, schizoaffective disorder, or psychotic disorder NOS)
  • Capable of understanding the purpose and details of the study in order to provide written informed consent;
  • On a stable dose of antipsychotic medication for at least two weeks;
  • For female patients:
  • Female patients who are sexually active must be willing and capable to use a non-estrogenic contraceptive (intrauterine device, cervical cap, condom or diaphragm) in case of sexual intercourse for the complete duration of the study;
  • Female patients with post coital uterine bleeding must have documented normal PAP smear and pelvic examination in the preceding two years.

Who cannot join

  • Pre-existing cardiovascular disease;
  • History of thrombo-embolic events;
  • History of breast cancer;
  • Familial tendency to form blood clots (such as familial factor V Leiden);
  • Use of vitamin K antagonists;
  • Use of cholestyramine or other anion exchange resins;
Show all 13Show fewer
  • Hypertriglyceridemia (triglycerides > 3 times the upper limit of normal (ULN));
  • Liver function or enzyme disorders (serum bilirubin, alkaline phosphatase (AF), gamma-glutamyl transpeptidase (γ - GT), aspartate aminotransferase (ASAT) or alanine aminotransferase (ALAT) > 3 times the ULN as measured at baseline);
  • Severe kidney failure (eGFR <30 ml/min as measured at baseline);
  • Use of any form of estrogen, progestin or androgen as hormonal therapy, or antiandrogen including tibolone or use of phytoestrogen supplements as powder or tablet in the past three months.
  • For female patients:
  • Abnormality observed during physical breast examination;
  • Pregnancy or breast feeding;

Trial locations and contacts

1 site in 1 country.

Netherlands1 site
  • UMC Utrecht

    Utrecht, 3508GA

Other trials in Netherlands

About this study

Official title: Raloxifene Augmentation in Patients With a Schizophrenia Spectrum Disorder to Reduce Symptoms and Improve Cognition

There is increasing clinical and molecular evidence for the role of hormones and specifically estrogen and its receptor in schizophrenia. A selective estrogen receptor modulator, raloxifene, stimulates estrogen-like activity in brain and can improve cognition in older adults. The present study will test the extent to which adjunctive raloxifene treatment improved cognition and reduced symptoms in young to middle-age men and women with schizophrenia.

110 patients with a schizophrenia spectrum disorder will be recruited in a multicenter twelve-week, randomized, double-blind, placebo-controlled, parallel trial of adjunctive 120mg raloxifene treatment in addition to their usual antipsychotic medications.

The investigators hypothesize that daily treatment with raloxifene 120 milligrams (mg) in addition to antipsychotic treatment improves cognition, reduces psychotic symptoms, increases social and personal functioning and reduces health care costs, as compared to placebo.

Read the detailed description

Rationale:

Patients with a schizophrenia spectrum disorder experience substantial impairments in multiple domains of everyday life, including the ability to maintain social relationships, sustain employment, and live independently. These problems often persist, even after successful treatment of psychosis. Currently, no consistent evidence exists for the efficacy of interventions to reduce cognitive and negative symptoms, while in fact these are the factors that determine functioning to a great extent.

Premenopausal women with schizophrenia have less psychotic and negative symptoms, and better cognitive and social functioning, in comparison to men and older women. This has been related to protective effects of estrogens in the brain. Administering estrogens has positive effects on psychotic symptoms, but exerts long-term side effects, especially in men.

Raloxifene is a selective estrogen receptor modulator, with a beneficial side effect profile in women and in men. It has been shown to be effective in reducing symptoms in postmenopausal women with schizophrenia. Recently, positive results were found in premenopausal women and in men. It is important to replicate these results in an independent sample and to investigate the effects of raloxifene on functioning.

Hypotheses: Daily treatment with raloxifene 120 milligrams (mg) in addition to antipsychotic treatment improves cognition, reduces psychotic symptoms, increases social and personal functioning and reduces health care costs, as compared to placebo.

Objective:

The primary objective of this trial is to investigate the hypothesized beneficial effect of raloxifene as compared to placebo when given for twelve weeks in addition to antipsychotic medication to patients with a psychotic disorder. The investigators expect lower symptom severity as measured with the Positive And Negative Symptom Scale (PANSS) and improvements of cognitive functioning as measured with the Brief Assessment of Cognition in Schizophrenia (BACS).

Secondary objectives include reducement of negative symptoms as measured with the Brief Negative Symptom Scale (BNSS), improvement of Personal and Social Performance (using the PSP-scale), reduction of thought disorder symptoms measures with the Thought And Language Disorder-scale (TALD), reduction use of health care recourses using the institute for Medical Technology Assessment's Medical Consumption Questionnaire (iMTA-MCQ), productivity using the institute for Medical Technology Assessment's Productivity Cost Questionnaire (iMTA-PCQ), improvement of quality of life using the EuroQol-5 dimensions scale (EQ-5D), improvement in both speed and error rates in the Stroop test, reduction of comorbid depression using Beck's Depression Inventory (BDI), improvement of language production and various hormonal and inflammatory parameters.

Study design: Randomized placebo-controlled multicenter double-blind trial

Study population:

110 men and women diagnosed with schizophrenia, schizoaffective or schizophreniform disorder, or psychotic disorder not otherwise specified (DSM-IV 295.*)

Intervention:

Patients will be randomized 1:1 to either 120mg raloxifene or placebo daily for a period of 12 weeks. Identical tablets will be administered.

Main study parameters/endpoints:

Primary outcomes are changes in symptom severity as measured with PANSS and changes in cognition as measured with BACS. Secondary outcome are changes in negative symptoms (measured with BNSS), changes in personal and social performance (measured with PSP), change in severity of thought disorder (measured with TALD), quality of life (measured with EQ-5D), use of healthcare and non-healthcare resources, comorbid depression (measured with BDI), cognitive control (measured with a Stroop Test), language production (measured by analyzing speech samples) and hormonal and inflammatory biomarkers.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Use of raloxifene is associated with a small risk of side effects. The number of patient visits will be limited and mainly requires time invested for physical examinations, questionnaires and cognitive testing sessions (around 9 hours in total over the course of 9 months). Blood will be drawn at three occasions with negligible and known risks (e.g. irritation). The burden and risks are acceptable while the benefits are expected to be considerable.

Being tested
Raloxifene, Placebo
Keywords
raloxifene, selective estrogen receptor modulator (SERM), schizophrenia, psychosis, cognition, negative symptoms
Medical subject headings
Schizophrenia, Psychotic Disorders, Mental Disorders

What participants receive

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

  • RaloxifeneDrug

    Also called Evista

    Oral selective estrogen receptor modulator (SERM).

  • PlaceboDrug

    Tablets identical in form and color to intervention.

Study groups in NCT03043820
Study groupRoleWhat they receive
RaloxifeneActive comparatorRaloxifene 120 mg (2 tablets of 60mg) daily for 12 weeks.
Receives: Drug: Raloxifene
PlaceboPlacebo comparatorPlacebo 2 tablets daily for 12 weeks.
Receives: Drug: Placebo

What is being measured

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

  1. Change in symptom severity as measured with the Positive and Negative Symptom Scale (PANSS)

    Effect of the study therapies on symptom severity.

    Measured: Baseline, at 6 weeks of treatment, at 12 weeks of treatment (end of treatment) and 6 months after end of treatment (follow-up)

  2. Change in cognitive functioning as measured with the Brief Assessment of Cognition in Schizophrenia

    Effect of the study therapies on cognitive functioning

    Measured: Baseline, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

Secondary outcomes (8)
  1. Personal and social performance measured with the Personal and Social Performance scale (PSP)

    Effect of the study therapy on personal and social performance.

    Measured: Baseline, at 6 weeks, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

  2. Thought disorder severity as measured with the Thought And Language Disorder scale (TALD)

    Effect of the study therapy on severity of thought disorder.

    Measured: Baseline, at 6 weeks, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

  3. Participant's Quality of Life as measured with the EQ-5D-5L

    Effect of the study therapy on quality of life.

    Measured: Baseline, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

  4. Comorbid depression as measured with Beck's Depression Inventory (BDI).

    Effect of the study therapy on comorbid depression

    Measured: Baseline, at 6 weeks, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

  5. Use of health-recourses as measured with the iMTA-MCQ

    Effect of the study therapy on use of recourses.

    Measured: Baseline, at 12 weeks (end of treatment) and 6 months follow-up

  6. Use of non-health recourses as measured with the iMTA-PCQ

    Effect of the study therapy on use of recourses.

    Measured: Baseline, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

  7. Language production assessment by analyzing speech samples

    Effect of the study therapy on free speech.

    Measured: Baseline and at 12 weeks of treatment (end of treatment)

  8. Symptom severity as measured with the Brief Negative Symptom Scale (BNSS)

    Effect of the study therapies on symptom severity.

    Measured: Baseline, at 6 weeks, at 12 weeks (end of treatment) and 6 months after end of treatment (follow-up)

Timeline

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

  1. First posted6 Feb 2017 (estimated)
  2. Study startAug 2016
  3. Primary completion1 Jul 2021
  4. Study completion1 Jul 2021

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
110 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03043820
Sponsor's protocol ID
NL.55343.041.16
Other IDs
2015-004483-11, 80-83600-98-40120, 2015
Acronym
RAPSODI
Status last verified
Oct 2021
First submitted
25 Oct 2016
Last updated
8 Oct 2021
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Undecided

Publications

  • 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.

    PubMed 25914107

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Raloxifene in people with Schizophrenia and Schizoaffective Disorder, run by Iris Sommer at 1 site in Netherlands.

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 6 inclusion and 13 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 8 Oct 2021. 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 Netherlands. 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. Some participants in this study may receive a placebo. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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?

Change in symptom severity as measured with the Positive and Negative Symptom Scale (PANSS) (time frame: Baseline, at 6 weeks of treatment, at 12 weeks of treatment (end of treatment) and 6 months after end of treatment (follow-up)). The study lists 2 primary outcomes in all. 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 NCT03043820, which also lists 1 linked publication.

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 8 Oct 2021.

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