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Antibiotic Treatment Trial for the PANDAS/PANS Phenotype (AZT)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01617083
Recruitment Status : Completed
First Posted : June 12, 2012
Results First Posted : April 10, 2018
Last Update Posted : April 10, 2018
Massachusetts General Hospital
Information provided by (Responsible Party):
University of South Florida

Brief Summary:

The purpose of this research study is to know if the antibiotic azithromycin, an antibiotic approved by the U.S. Food and Drug Administration (FDA) for treating infections, improves symptom severity in children with sudden and severe onset obsessive compulsive symptoms known as PANS, Pediatric Acute Onset Neuropsychiatric Syndrome, and PANDAS, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus. This study seeks to compare the effects of placebo vs. azithromycin on Obsessive Compulsive Disorder (OCD) symptom severity as well as to assess immune risk factors in children with PANDAS/PANS. Obsessions are repetitive, unwanted thoughts or worries that may be unpleasant, silly, or embarrassing. Compulsions are repetitive or ritualistic actions that are performed to ease anxiety or worries. Doctors think these symptoms may be caused or exacerbated by certain infections such as Streptococcus pyogenes, Mycoplasma pneumonia, Borrelia burgordfi, etc. These infections commonly cause strep throat, walking pneumonia, and Lyme Disease, among others.

This study will involve a 4 week double-blind, placebo-controlled randomized trial of azithromycin (Double Blind Phase). At the end of this 4 week trial, the child will be assigned to azithromycin for 8 weeks (Open Label Phase). At the end of these 12 weeks, a Naturalistic Observation phase will assess the child's symptom characteristics for up to 40 weeks.

The study hypothesizes that children receiving antibiotic will show significantly greater overall improvement in severity compared with placebo, and that children with sudden onset of OCD and whose subsequent course shows dramatic fluctuations will have evidence of immune risk factors that predisposes to this presentation.

Condition or disease Intervention/treatment Phase
PANS PANDAS Obsessive Compulsive Disorder (OCD) Drug: Azithromycin Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 47 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Antibiotic Treatment Trial for the PANDAS/PANS Phenotype
Study Start Date : May 2012
Actual Primary Completion Date : December 2014
Actual Study Completion Date : December 2014

Arm Intervention/treatment
Active Comparator: Azithromycin
Antibiotic used to treat infections.
Drug: Azithromycin
Antibiotic used to treat infections
Other Names:
  • Zithromax
  • Zmax

Placebo Comparator: Placebo
Compound thickening agent with sugar and flavor additives.
Drug: Placebo
Thickening compound with sugar and flavoring

Primary Outcome Measures :
  1. Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) [ Time Frame: Before and after 4 week randomization ]
    The CYBOCS is a clinician rated, semi-structured interview for rating the severity of OCD (Scahill, et al., 1997). Total scores range from 0 to 50, with higher scores representing greater severity. The total score is comprised of two subscores, obsessions and compulsions, each with a range of 0-25.

Secondary Outcome Measures :
  1. Clinical Global Impressions-Severity OCD [ Time Frame: Before and after 4 week randomization ]
    The CGI-S scale is a 7-point clinician rating of severity of psychopathology. Severity ratings range from 1 (no illness) to 7 (extremely severe). This instrument has been successfully used in treatment studies (Cook, et al., 2001; Storch, et al., 2007).

  2. Screen for Childhood Anxiety-Related Emotional Disorders (SCARED) [ Time Frame: Before and after 4 week randomization ]
    The Screen for Childhood Anxiety-Related Emotional Disorders (SCARED) is a 41-item parent and participant-completed tool used to measure symptoms of anxiety, including the most common symptoms of panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia. Scores range from 0-82, with higher scores indicating more severe symptoms.The child and parent versions of the SCARED have moderate parent-child agreement and good internal consistency, test-retest reliability, and discriminant validity; it is also sensitive to treatment response (Birmaher et al. 1999). The target population for this rating is 8-18 years of age (Birmaher et al. 1997). The parent and child version of the SCARED were administered before and after week 4 randomization. This measure is not validated for use in 4-7 year olds.

Information from the National Library of Medicine

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Ages Eligible for Study:   4 Years to 14 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Ages 4 -14 years.
  • Presence of OCD and at least two of the following:

    1. Anxieties e.g. new onset separation anxiety
    2. Sensory abnormalities (tactile/auditory/visual defensiveness or visual misperceptions)
    3. Behavioral Regression (e.g. new onset impulsivity, hyperactivity, meltdowns)
    4. Deterioration in school performance or in handwriting
    5. Emotional lability and/or depression
    6. Urinary symptoms (frequent urination or enuresis)
    7. Sleep disturbances Anorexia
  • Current episode OCD of recent onset (less or equal to 6 months) associated with infection
  • Symptom onset appears temporally related to infection or exposure
  • Symptoms are of moderate severity with significant impairment (CGI of moderate or worse) and CY-BOCS of more or equal to 16.
  • Parental willingness to accompany their child for multiple study visits and be responsible for medication compliance.

Exclusion Criteria:

  • History of Rheumatic Fever including Sydenham's Chorea (heart murmur, frank chorea, EKG PR or QTc prolongation, abnormal reflexes (Gordon-Hey reflex)).
  • Diagnosis of autism (moderate - severe), schizophrenia, mental retardation or chronic degenerative neurological disease.
  • Any illness for which antibiotic treatment may be contraindicated (e.g. Liver disease).
  • Personal history of adverse reaction or allergy to azithromycin.
  • Recent or planned psychopharmacologic (4 weeks for most medications or 8 weeks for SSRIs) treatment changes.
  • Antibiotic prophylaxis therapy or history of neuropsychiatric non-response to prior antibiotic trial.
  • Currently participating in cognitive behavioral therapy or habit reversal therapy for OCD and/or tics.
  • Weight less than 15 kilograms
  • Concurrent therapy with medications that may increase adverse effects (eg. pimozide, citalopram, tricyclic antidepressants, etc).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01617083

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United States, Florida
Rothman Center for Neuropsychiatry
Saint Petersburg, Florida, United States, 33701
Sponsors and Collaborators
University of South Florida
Massachusetts General Hospital
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Principal Investigator: Tanya Murphy, MD University of South Florida
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Diggle, P. Analysis of longitudinal data. Oxford University Press, 2002.
Guy, W. Assessment Manual for Psychopharmacology, rev. edn. Rockville, MD: National Institute of Mental Health, 1976.
Landgraf, J. M., Abetz, L., & Ware, J. E. The CHQ user's manual. Boston: The Health Institute, New England Medical Center, 1996.
Meyers, J., & Meyers, K. Rey Complex Figure Test and recognition trial: Professional manual. Psychological Assessment Resources, 1995.
Murphy, T. K., Storch, E. A., & Strawser, M. S. Case Report: Selective Serotonin Reuptake Inhibitor-Induced Behavioral Activation in the PANDAS Subtype. [case report]. Primary Psychiatry, 13(8), 87-89, 2006.
Piacentini, J. C., & Jaffer, M. P., J. C., & Jaffer, M. Measuring functional impairment in youngsters with OCD: Manual for the Child OCD Impact Scale (COIS). Los Angeles, UCLA Department of Psychiatry, 1999.
Seber, G. A. F. Multivariate Observations. New York: Wiley, 1984.
Swanson, J. M. School-based assessments and interventions for ADD students. Irvine, CA: K C Publishing, 1992.
Wood, H. F., Feinstein, A. R., Taranta, A., & Simpson, R. Rheumatic fever in children and adolescents III. Comparative effectiveness of three prophylaxis regimens in preventing streptococcal infections and rheumatic fever. Annuals of Internal Medicine, 60(supplement 5), 31-46, 1964.

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Responsible Party: University of South Florida Identifier: NCT01617083    
Other Study ID Numbers: 6119-128500
270332 ( Other Grant/Funding Number: Massachusetts General Hospital (MGH) )
First Posted: June 12, 2012    Key Record Dates
Results First Posted: April 10, 2018
Last Update Posted: April 10, 2018
Last Verified: March 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by University of South Florida:
Antibiotic Treatment
Additional relevant MeSH terms:
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Compulsive Personality Disorder
Obsessive-Compulsive Disorder
Personality Disorders
Mental Disorders
Anxiety Disorders
Anti-Bacterial Agents
Anti-Infective Agents