Adjunctive Minocycline in Clozapine-Treated Schizophrenia Patients with Persistent Symptoms

Deanna L. Kelly, Kelli M. Sullivan, Joseph Patrick McEvoy, Robert P. McMahon, Heidi J. Wehring, James M. Gold, Fang Liu, Dale Warfel, Gopal Vyas, Charles M. Richardson, Bernard A. Fischer, William R. Keller, Maju Mathew Koola, Stephanie M. Feldman, Jessica C. Russ, Richard S.E. Keefe, Jennifer Osing, Leeka Hubzin, Sharon August, Trina M. WalkerRobert W. Buchanan

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective Clozapine is the most effective antipsychotic for treatment refractory people with schizophrenia, yet many patients only partially respond. Accumulating preclinical and clinical data suggest benefits with minocycline. We tested adjunct minocycline to clozapine in a 10-week, double-blind, placebo-controlled trial. Primary outcomes tested were positive, and cognitive symptoms, while avolition, anxiety/depression, and negative symptoms were secondary outcomes. Methods Schizophrenia and schizoaffective participants (n = 52) with persistent positive symptoms were randomized to receive adjunct minocycline (100 mg oral capsule twice daily; n = 29) or placebo (n = 23). Results Brief Psychiatric Rating Scale (BPRS) psychosis factor (P = 0.098; effect size [ES], 0.39) and BPRS total score (P = 0.075; ES, 0.55) were not significant. A change in total BPRS symptoms of more than or equal to 30% was observed in 7 (25%) of 28 among minocycline and 1 (4%) of 23 among placebo participants, respectively (P = 0.044). Global cognitive function (MATRICS Consensus Cognitive Battery) did not differ, although there was a significant variation in size of treatment effects among cognitive domains (P = 0.03), with significant improvement in working memory favoring minocycline (P = 0.023; ES, 0.41). The Scale for the Assessment of Negative Symptoms total score did not differ, but significant improvement in avolition with minocycline was noted (P = 0.012; ES, 0.34). Significant improvement in the BPRS anxiety/depression factor was observed with minocycline (P = 0.028; ES, 0.49). Minocycline was well tolerated with significantly fewer headaches and constipation compared with placebo. Conclusions Minocycline's effect on the MATRICS Consensus Cognitive Battery composite score and positive symptoms were not statistically significant. Significant improvements with minocycline were seen in working memory, avolition, and anxiety/depressive symptoms in a chronic population with persistent symptoms. Larger studies are needed to validate these findings.

Original languageEnglish (US)
Pages (from-to)374-381
Number of pages8
JournalJournal of Clinical Psychopharmacology
Volume35
Issue number4
DOIs
StatePublished - Aug 11 2015

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Minocycline
Clozapine
Schizophrenia
Brief Psychiatric Rating Scale
Placebos
Anxiety
Depression
Short-Term Memory
Consensus
Neurobehavioral Manifestations
Symptom Assessment
Constipation
Psychotic Disorders
Cognition
Antipsychotic Agents
Capsules
Headache

Keywords

  • adjunct
  • clozapine
  • glutamate
  • minocycline
  • schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Adjunctive Minocycline in Clozapine-Treated Schizophrenia Patients with Persistent Symptoms. / Kelly, Deanna L.; Sullivan, Kelli M.; McEvoy, Joseph Patrick; McMahon, Robert P.; Wehring, Heidi J.; Gold, James M.; Liu, Fang; Warfel, Dale; Vyas, Gopal; Richardson, Charles M.; Fischer, Bernard A.; Keller, William R.; Koola, Maju Mathew; Feldman, Stephanie M.; Russ, Jessica C.; Keefe, Richard S.E.; Osing, Jennifer; Hubzin, Leeka; August, Sharon; Walker, Trina M.; Buchanan, Robert W.

In: Journal of Clinical Psychopharmacology, Vol. 35, No. 4, 11.08.2015, p. 374-381.

Research output: Contribution to journalArticle

Kelly, DL, Sullivan, KM, McEvoy, JP, McMahon, RP, Wehring, HJ, Gold, JM, Liu, F, Warfel, D, Vyas, G, Richardson, CM, Fischer, BA, Keller, WR, Koola, MM, Feldman, SM, Russ, JC, Keefe, RSE, Osing, J, Hubzin, L, August, S, Walker, TM & Buchanan, RW 2015, 'Adjunctive Minocycline in Clozapine-Treated Schizophrenia Patients with Persistent Symptoms', Journal of Clinical Psychopharmacology, vol. 35, no. 4, pp. 374-381. https://doi.org/10.1097/JCP.0000000000000345
Kelly, Deanna L. ; Sullivan, Kelli M. ; McEvoy, Joseph Patrick ; McMahon, Robert P. ; Wehring, Heidi J. ; Gold, James M. ; Liu, Fang ; Warfel, Dale ; Vyas, Gopal ; Richardson, Charles M. ; Fischer, Bernard A. ; Keller, William R. ; Koola, Maju Mathew ; Feldman, Stephanie M. ; Russ, Jessica C. ; Keefe, Richard S.E. ; Osing, Jennifer ; Hubzin, Leeka ; August, Sharon ; Walker, Trina M. ; Buchanan, Robert W. / Adjunctive Minocycline in Clozapine-Treated Schizophrenia Patients with Persistent Symptoms. In: Journal of Clinical Psychopharmacology. 2015 ; Vol. 35, No. 4. pp. 374-381.
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abstract = "Objective Clozapine is the most effective antipsychotic for treatment refractory people with schizophrenia, yet many patients only partially respond. Accumulating preclinical and clinical data suggest benefits with minocycline. We tested adjunct minocycline to clozapine in a 10-week, double-blind, placebo-controlled trial. Primary outcomes tested were positive, and cognitive symptoms, while avolition, anxiety/depression, and negative symptoms were secondary outcomes. Methods Schizophrenia and schizoaffective participants (n = 52) with persistent positive symptoms were randomized to receive adjunct minocycline (100 mg oral capsule twice daily; n = 29) or placebo (n = 23). Results Brief Psychiatric Rating Scale (BPRS) psychosis factor (P = 0.098; effect size [ES], 0.39) and BPRS total score (P = 0.075; ES, 0.55) were not significant. A change in total BPRS symptoms of more than or equal to 30{\%} was observed in 7 (25{\%}) of 28 among minocycline and 1 (4{\%}) of 23 among placebo participants, respectively (P = 0.044). Global cognitive function (MATRICS Consensus Cognitive Battery) did not differ, although there was a significant variation in size of treatment effects among cognitive domains (P = 0.03), with significant improvement in working memory favoring minocycline (P = 0.023; ES, 0.41). The Scale for the Assessment of Negative Symptoms total score did not differ, but significant improvement in avolition with minocycline was noted (P = 0.012; ES, 0.34). Significant improvement in the BPRS anxiety/depression factor was observed with minocycline (P = 0.028; ES, 0.49). Minocycline was well tolerated with significantly fewer headaches and constipation compared with placebo. Conclusions Minocycline's effect on the MATRICS Consensus Cognitive Battery composite score and positive symptoms were not statistically significant. Significant improvements with minocycline were seen in working memory, avolition, and anxiety/depressive symptoms in a chronic population with persistent symptoms. Larger studies are needed to validate these findings.",
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AU - Kelly, Deanna L.

AU - Sullivan, Kelli M.

AU - McEvoy, Joseph Patrick

AU - McMahon, Robert P.

AU - Wehring, Heidi J.

AU - Gold, James M.

AU - Liu, Fang

AU - Warfel, Dale

AU - Vyas, Gopal

AU - Richardson, Charles M.

AU - Fischer, Bernard A.

AU - Keller, William R.

AU - Koola, Maju Mathew

AU - Feldman, Stephanie M.

AU - Russ, Jessica C.

AU - Keefe, Richard S.E.

AU - Osing, Jennifer

AU - Hubzin, Leeka

AU - August, Sharon

AU - Walker, Trina M.

AU - Buchanan, Robert W.

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N2 - Objective Clozapine is the most effective antipsychotic for treatment refractory people with schizophrenia, yet many patients only partially respond. Accumulating preclinical and clinical data suggest benefits with minocycline. We tested adjunct minocycline to clozapine in a 10-week, double-blind, placebo-controlled trial. Primary outcomes tested were positive, and cognitive symptoms, while avolition, anxiety/depression, and negative symptoms were secondary outcomes. Methods Schizophrenia and schizoaffective participants (n = 52) with persistent positive symptoms were randomized to receive adjunct minocycline (100 mg oral capsule twice daily; n = 29) or placebo (n = 23). Results Brief Psychiatric Rating Scale (BPRS) psychosis factor (P = 0.098; effect size [ES], 0.39) and BPRS total score (P = 0.075; ES, 0.55) were not significant. A change in total BPRS symptoms of more than or equal to 30% was observed in 7 (25%) of 28 among minocycline and 1 (4%) of 23 among placebo participants, respectively (P = 0.044). Global cognitive function (MATRICS Consensus Cognitive Battery) did not differ, although there was a significant variation in size of treatment effects among cognitive domains (P = 0.03), with significant improvement in working memory favoring minocycline (P = 0.023; ES, 0.41). The Scale for the Assessment of Negative Symptoms total score did not differ, but significant improvement in avolition with minocycline was noted (P = 0.012; ES, 0.34). Significant improvement in the BPRS anxiety/depression factor was observed with minocycline (P = 0.028; ES, 0.49). Minocycline was well tolerated with significantly fewer headaches and constipation compared with placebo. Conclusions Minocycline's effect on the MATRICS Consensus Cognitive Battery composite score and positive symptoms were not statistically significant. Significant improvements with minocycline were seen in working memory, avolition, and anxiety/depressive symptoms in a chronic population with persistent symptoms. Larger studies are needed to validate these findings.

AB - Objective Clozapine is the most effective antipsychotic for treatment refractory people with schizophrenia, yet many patients only partially respond. Accumulating preclinical and clinical data suggest benefits with minocycline. We tested adjunct minocycline to clozapine in a 10-week, double-blind, placebo-controlled trial. Primary outcomes tested were positive, and cognitive symptoms, while avolition, anxiety/depression, and negative symptoms were secondary outcomes. Methods Schizophrenia and schizoaffective participants (n = 52) with persistent positive symptoms were randomized to receive adjunct minocycline (100 mg oral capsule twice daily; n = 29) or placebo (n = 23). Results Brief Psychiatric Rating Scale (BPRS) psychosis factor (P = 0.098; effect size [ES], 0.39) and BPRS total score (P = 0.075; ES, 0.55) were not significant. A change in total BPRS symptoms of more than or equal to 30% was observed in 7 (25%) of 28 among minocycline and 1 (4%) of 23 among placebo participants, respectively (P = 0.044). Global cognitive function (MATRICS Consensus Cognitive Battery) did not differ, although there was a significant variation in size of treatment effects among cognitive domains (P = 0.03), with significant improvement in working memory favoring minocycline (P = 0.023; ES, 0.41). The Scale for the Assessment of Negative Symptoms total score did not differ, but significant improvement in avolition with minocycline was noted (P = 0.012; ES, 0.34). Significant improvement in the BPRS anxiety/depression factor was observed with minocycline (P = 0.028; ES, 0.49). Minocycline was well tolerated with significantly fewer headaches and constipation compared with placebo. Conclusions Minocycline's effect on the MATRICS Consensus Cognitive Battery composite score and positive symptoms were not statistically significant. Significant improvements with minocycline were seen in working memory, avolition, and anxiety/depressive symptoms in a chronic population with persistent symptoms. Larger studies are needed to validate these findings.

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