Trial of D-Cycloserine in Schizophrenia

• ClinicalTrials.gov Identifier: NCT00000371
• Recruitment Status: Completed
• First Posted: November 3, 1999
• Results First Posted: September 10, 2014
• Last Update Posted: September 10, 2014
• Sponsor: Massachusetts General Hospital
• Information provided by (Responsible Party): Donald C. Goff, MD, Massachusetts General Hospital

Study Description

Brief Summary:

To characterize further the effects of D-cycloserine augmentation of antipsychotic treatment on negative symptoms, performance on neurocognitive tasks, and on markers for glutamatergic, dopaminergic and serotonergic function in serum and cerebrospinal fluid. To determine if negative symptoms and cognitive function improve over time, if these improvements meaningfully impact quality of life factors, if they correlate with markers of neuronal function, and if subpopulations can be identified according to response.

Dysfunction of glutamatergic neuronal systems has recently been implicated in the pathophysiology of schizophrenia based on the finding that non-competitive inhibitors of the NMDA receptor can reproduce in normals the positive symptoms, negative symptoms, and cognitive deficits of schizophrenia. Furthermore, glutamatergic dysfunction may alter forebrain dopaminergic neuronal activity, a system central to the antipsychotic action of typical neuroleptics. It is believed that enhancing NMDA receptor function by systemic treatment with D-cycloserine, a partial agonist at the glycine modulatory site of the NMDA receptor, will reduce symptoms in schizophrenia.

Sixty schizophrenic outpatients with prominent, primary negative symptoms are treated with antipsychotic medication and are randomly assigned to D-cycloserine or placebo for a 6-month, fixed-dose trial. The primary outcome measure is the total score on the Scale for Assessment of Negative Symptoms (SANS). A neuropsychological battery, which emphasizes tests sensitive to prefrontal cortical function, is administered. Blood is obtained at several time points and CSF is obtained at Week 8 for assay of concentrations of D-cycloserine, glutamate, HVA, and 5HIAA.

Condition or disease	Intervention/treatment	Phase
Schizophrenia	Drug: D-cycloserine; Drug: Placebo	Phase 3

Detailed Description:

To characterize further the effects of D-cycloserine augmentation of antipsychotic treatment on negative symptoms, performance on neurocognitive tasks, and on markers for glutamatergic, dopaminergic, and serotonergic function in serum and cerebrospinal fluid. To determine if negative symptoms and cognitive function improve over time, if these improvements meaningfully impact quality of life factors, if they correlate with markers of neuronal function, and if subpopulations can be identified according to response.

Dysfunction of glutamatergic neuronal systems has recently been implicated in the pathophysiology of schizophrenia based on the finding that non-competitive inhibitors of the NMDA receptor can reproduce in normals the positive symptoms, negative symptoms and cognitive deficits of schizophrenia. Furthermore, glutamatergic dysfunction may alter forebrain dopaminergic neuronal activity, a system central to the antipsychotic action of typical neuroleptics. It is believed that enhancing NMDA receptor function by systemic treatment with D-cycloserine, a partial agonist at the glycine modulatory site of the NMDA receptor, will reduce symptoms in schizophrenia.

Sixty schizophrenic outpatients with prominent, primary negative symptoms are treated with antipsychotic medication and are randomly assigned to D-cycloserine or placebo for a 6-month, fixed-dose trial. The primary outcome measure is the total score on the Scale for Assessment of Negative Symptoms (SANS). A neuropsychological battery, which emphasizes tests sensitive to prefrontal cortical function, is administered. Blood is obtained at several time points and CSF is obtained at Week 8 for assay of concentrations of D-cycloserine, glutamate, HVA, and 5HIAA.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 60 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Investigator)
• Primary Purpose: Treatment
• Official Title: A Six Month, Placebo-Controlled Trial of D-Cycloserine Co-Administered With Conventional Antipsychotics in Schizophrenia Patients
• Study Start Date: August 1996
• Actual Primary Completion Date: April 2002
• Actual Study Completion Date: April 2002

Arms and Interventions

Arm	Intervention/treatment
Experimental: D-Cycloserine; Subjects were given 50 mg/day of D-Cycloserine for 24 weeks	Drug: D-cycloserine; 50 mg/daily by mouth; Other Name: Cycloserine
Placebo Comparator: Placebo; Participants were given 50 mg/day of Placebo for 24 weeks.	Drug: Placebo; 50 mg/day of placebo by mouth

Outcome Measures

Primary Outcome Measures :

1. Scale for the Assessment of Negative Symptoms (SANS) [ Time Frame: Baseline, Week 4, Week 8 ]
   The slope of SANS total score from baseline to week 8 in the treatment and placebo groups on the scale for the assessment of negative symptoms (SANS) total score. Total SANS scores range from 0-100. The SANS is comprised of 5 subscores: Affective Flattening or Blunting (score range 0-35), Alogia (score range 0-20), Avolition-Apathy (score range 0-15), Anhedonia-Asociality (score range 0-20), and Attention (0-10). For each scale, the higher the score the more prominent the negative symptoms were. The slopes were obtained by plotting the group SANS total score mean for treatment vs. placebo on Baseline, Week 4, and Week 8 and performing a random slopes model.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Diagnosis of Schizophrenia as per DSM IV criteria
• Have been treated for at least 6 months with any conventional neuroleptic
• Have prominent negative symptoms as defined by a total score of 40 or greater on the scale for the assessment of negative symptoms (SANS)

Exclusion Criteria:

• Active alcohol or drug abuse
• Unstable Medical Illness, seizure disorder, or other serious neurological disorder
• Pregnant or Nursing
• Unable to complete a cognitive battery

Contacts and Locations

Sponsors and Collaborators

Massachusetts General Hospital

Investigators

• Principal Investigator: Donald Goff, MD

More Information

Publications of Results:

Goff DC, Herz L, Posever T, Shih V, Tsai G, Henderson DC, Freudenreich O, Evins AE, Yovel I, Zhang H, Schoenfeld D. A six-month, placebo-controlled trial of D-cycloserine co-administered with conventional antipsychotics in schizophrenia patients. Psychopharmacology (Berl). 2005 Apr;179(1):144-50. Epub 2004 Oct 21.

• Responsible Party: Donald C. Goff, MD, Director of the Schizophrenia Clinical and Research Program, Massachusetts General Hospital
• ClinicalTrials.gov Identifier: NCT00000371
• Other Study ID Numbers: R01MH054245-01A2 ( U.S. NIH Grant/Contract )
• First Posted: November 3, 1999
• Results First Posted: September 10, 2014
• Last Update Posted: September 10, 2014
• Last Verified: September 2014

Keywords provided by Donald C. Goff, MD, Massachusetts General Hospital:

Adult; Cognition; Cycloserine; Dopamine; Female; Glutamic Acid; Human; Male; Receptors, N-Methyl-D-Aspartate; Schizophrenia; Serotonin; Quality of Life; Cycloserine -- *therapeutic use; Dopamine -- blood; Dopamine -- cerebrospinal fluid; Glutamic Acid -- blood; Glutamic Acid -- cerebrospinal fluid; Serotonin -- blood; Serotonin -- cerebrospinal fluid

Additional relevant MeSH terms:

Schizophrenia; Schizophrenia Spectrum and Other Psychotic Disorders; Mental Disorders; Cycloserine; Anti-Infective Agents, Urinary; Anti-Infective Agents; Renal Agents; Antibiotics, Antitubercular; Antitubercular Agents; Anti-Bacterial Agents; Antimetabolites; Molecular Mechanisms of Pharmacological Action