Glycine and D-Cycloserine in Schizophrenia

NCT ID: NCT00000372

Last Updated: 2014-06-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE3

Study Classification

INTERVENTIONAL

Study Start Date

1998-03-31

Study Completion Date

2005-11-30

Brief Summary

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The purpose of this study is to compare the effects of D-cycloserine and glycine for treating negative symptoms (such as loss of interest, loss of energy, loss of warmth, and loss of humor) which occur between phases of positive symptoms (marked by hallucinations, delusions, and thought confusions) in schizophrenics.

Clozapine is currently the most effective treatment for negative symptoms of schizophrenia. Two other drugs, D-cycloserine and glycine, are being investigated as new treatments. D-cycloserine improves negative symptoms when added to some drugs, but may worsen these symptoms when given with clozapine. Glycine also improves negative symptoms and may still be able to improve these symptoms when given with clozapine. This study gives either D-cycloserine or glycine (or an inactive placebo) with clozapine to determine which is the best combination.

Patients will be assigned to 1 of 3 groups. Group 1 will receive D-cycloserine plus clozapine. Group 2 will receive glycine plus clozapine. Group 3 will receive an inactive placebo plus clozapine. Patients will receive these medications for 8 weeks. Negative symptoms of schizophrenia will be monitored through the Scale for the Assessment of Negative Symptoms, Positive symptoms will be monitored through the Positive and Negative Syndrome Scale, and additionally subjects will complete the Brief Psychiatric Rating Scale and the Global Assessment Scale.

An individual may be eligible for this study if he/she is 18 to 65 years old and has been diagnosed with schizophrenia.

Detailed Description

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To determine if glycine produces improvement in negative symptoms and D-cycloserine produces worsening in symptoms compared to placebo, patients will undergo a double blind study of d-cycloserine and glycine treatment added to clozapine.

Clozapine is more effective for negative symptoms of schizophrenia than conventional neuroleptics, but the neurochemical actions contributing to this superior clinical efficacy remain unclear. Recent evidence points to a role for glutamatergic dysregulation in schizophrenia, as well as important differences between conventional agents and clozapine in effects upon glutamatergic systems. D-cycloserine, a partial agonist at the glycine modulatory site of the N-methyl-D-aspartate (NMDA) receptor, improves negative symptoms when added to conventional agents and worsens negative symptoms when added to clozapine. High-dose glycine also improves negative symptoms and has provided preliminary evidence suggesting that glycine improves negative symptoms when added to clozapine. Serum concentrations of glycine predicted response to both high-dose glycine and D-cycloserine. Both clozapine and D-cycloserine may improve negative symptoms by activation of the glycine modulatory site of the NMDA receptor complex. Because D-cycloserine is a partial agonist, it may act as an antagonist at the glycine site in the presence of clozapine, whereas the full agonist, glycine, would not be expected to worsen negative symptoms in the presence of clozapine.

This study proposes to administer a fixed-dose of D-cycloserine, glycine, or placebo added to clozapine in 45 patients with schizophrenia. Because assessments are standardized between studies, results from this study can be compared with results from a previous study of D-cycloserine added to conventional neuroleptic.

The study was ultimately suspended before participants were enrolled, due to definitive findings indicating that pairing treatment of D-cycloserine with Clozapine resulted in worsening of negative symptoms.

Conditions

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Schizophrenia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Glycine

The patients will undergo a 2 week single blind placebo lead in followed by an 8 week randomly assigned double blind treatment phase with 30 grams of glycine in 7 ounces of lemonade twice a day in addition to clozapine treatment.

Group Type EXPERIMENTAL

Glycine

Intervention Type DRUG

Clozapine

Intervention Type DRUG

Placebo

The patients will undergo a 2 week single blind placebo lead in followed by an 8 week randomly assigned double blind treatment phase with 30 grams of placebo powder in 7 ounces of lemonade twice a day in addition to clozapine treatment.

Group Type PLACEBO_COMPARATOR

Clozapine

Intervention Type DRUG

Placebo

Intervention Type DRUG

D-Cycloserine

The patients will undergo a 2 week single blind placebo lead in followed by an 8 week randomly assigned double blind treatment phase with D-cycloserine in addition to clozapine treatment.

Group Type EXPERIMENTAL

D-cycloserine

Intervention Type DRUG

Clozapine

Intervention Type DRUG

Interventions

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D-cycloserine

Intervention Type DRUG

Glycine

Intervention Type DRUG

Clozapine

Intervention Type DRUG

Placebo

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of Schizophrenia
* Score of 27 or greater on the Scale for the Assessment of Negative Symptoms (SANS)
* Treatment with stable dose of clozapine for at least 4 weeks
* Between 18 and 65 years old

Exclusion Criteria

* No other antipsychotic medications in oral for for at least 3 months or in depot form for 6 months
* Current major depressive episode
* Current substance abuse diagnosis
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Massachusetts General Hospital

OTHER

Sponsor Role lead

Responsible Party

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Donald C. Goff, MD

Director of the Schizophrenia Clinical and Research Program

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Donald Goff, MD

Role: PRINCIPAL_INVESTIGATOR

Locations

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Freedom Trail Clinic

Boston, Massachusetts, United States

Site Status

Countries

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United States

References

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Koc-Vural U, Kerimova-Kose L, Kiremitci A. Long-term clinical comparison of a resin-based composite and resin modified glass ionomer in the treatment of cervical caries lesions. Odontology. 2025 Jan;113(1):404-415. doi: 10.1007/s10266-024-00958-6. Epub 2024 Jun 5.

Reference Type DERIVED
PMID: 38837034 (View on PubMed)

Other Identifiers

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DSIR

Identifier Type: -

Identifier Source: secondary_id

R01MH057708-02

Identifier Type: NIH

Identifier Source: org_study_id

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