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      Efficacy and Safety of Roluperidone for the Treatment of Negative Symptoms of Schizophrenia

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          Abstract

          Background

          This is a placebo-controlled multi-national trial of roluperidone, a compound with antagonist properties for 5-HT 2A, sigma 2, and α 1A-adrenergic receptors, targeting negative symptoms in patients with schizophrenia. This trial follows a previous trial that demonstrated roluperidone superiority over placebo in a similar patient population.

          Methods

          Roluperidone 32 mg/day, roluperidone 64 mg/day, or placebo was administered for 12 weeks to 513 patients with schizophrenia with moderate to severe negative symptoms. The primary endpoint was the PANSS-derived Negative Symptom Factor Score (NSFS) and the key secondary endpoint was Personal and Social Performance scale (PSP) total score.

          Results

          NSFS scores were lower (improved) for roluperidone 64 mg compared to placebo and marginally missing statistical significance for the intent-to-treat (ITT) analysis data set ( P ≤ .064), but reached nominal significance ( P ≤ .044) for the modified-ITT (m-ITT) data set. Changes in PSP total score were statistically significantly better on roluperidone 64 mg compared to placebo for both ITT and m-ITT ( P ≤ .021 and P ≤ .017, respectively).

          Conclusions

          Results of this trial confirm the potential of roluperidone as a treatment of negative symptoms and improving everyday functioning in patients with schizophrenia. Study registration: Eudra-CT: 2017-003333-29; NCT03397134.

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          Most cited references44

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          Small sample inference for fixed effects from restricted maximum likelihood.

          Restricted maximum likelihood (REML) is now well established as a method for estimating the parameters of the general Gaussian linear model with a structured covariance matrix, in particular for mixed linear models. Conventionally, estimates of precision and inference for fixed effects are based on their asymptotic distribution, which is known to be inadequate for some small-sample problems. In this paper, we present a scaled Wald statistic, together with an F approximation to its sampling distribution, that is shown to perform well in a range of small sample settings. The statistic uses an adjusted estimator of the covariance matrix that has reduced small sample bias. This approach has the advantage that it reproduces both the statistics and F distributions in those settings where the latter is exact, namely for Hotelling T2 type statistics and for analysis of variance F-ratios. The performance of the modified statistics is assessed through simulation studies of four different REML analyses and the methods are illustrated using three examples.
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            Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial.

            Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before. To compare rates of recovery in patients with remitted FEP after 7 years of follow-up of a dose reduction/discontinuation (DR) vs maintenance treatment (MT) trial. Seven-year follow-up of a 2-year open randomized clinical trial comparing MT and DR. One hundred twenty-eight patients participating in the original trial were recruited from 257 patients with FEP referred from October 2001 to December 2002 to 7 mental health care services in a 3.2 million-population catchment area. Of these, 111 patients refused to participate and 18 patients did not experience remission. PARTICIPANTS After 7 years, 103 patients (80.5%) of 128 patients who were included in the original trial were located and consented to follow-up assessment. After 6 months of remission, patients were randomly assigned to DR strategy or MT for 18 months. After the trial, treatment was at the discretion of the clinician. Primary outcome was rate of recovery, defined as meeting the criteria of symptomatic and functional remission. Determinants of recovery were examined using logistic regression analysis; the treatment strategy (MT or DR) was controlled for baseline parameters. The DR patients experienced twice the recovery rate of the MT patients (40.4% vs 17.6%). Logistic regression showed an odds ratio of 3.49 (P = .01). Better DR recovery rates were related to higher functional remission rates in the DR group but were not related to symptomatic remission rates. Dose reduction/discontinuation of antipsychotics during the early stages of remitted FEP shows superior long-term recovery rates compared with the rates achieved with MT. To our knowledge, this is the first study showing long-term gains of an early-course DR strategy in patients with remitted FEP. Additional studies are necessary before these results are incorporated into general practice. isrctn.org Identifier: ISRCTN16228411.
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              Negative symptoms of schizophrenia: new developments and unanswered research questions

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                Author and article information

                Contributors
                Journal
                Schizophr Bull
                Schizophr Bull
                schbul
                Schizophrenia Bulletin
                Oxford University Press (US )
                0586-7614
                1745-1701
                May 2022
                25 February 2022
                25 February 2022
                : 48
                : 3
                : 609-619
                Affiliations
                Minerva Neurosciences , Watham, MA, USA
                Department Of Psychiatry Nicosia Cyprus, Nicosia University Medical School , Egkomi, Cyprus
                Minerva Neurosciences , Watham, MA, USA
                PPRS, 4e Av. du Général de Gaulle , Colmar, Grand EST, France
                PPRS, 4e Av. du Général de Gaulle , Colmar, Grand EST, France
                PPRS, 4e Av. du Général de Gaulle , Colmar, Grand EST, France
                PPRS, 4e Av. du Général de Gaulle , Colmar, Grand EST, France
                Collaborative Neuroscience Network , Suite 3, Garden Grove, CA, USA
                University of Tel Aviv School of Medicine , Ramat Aviv, Israel
                Department of Psychiatry, University of Miami Miller School of Medicine , Miami, FL, USA
                Department of Psychology, University of Georgia , Athens, GA, USA
                Minerva Neurosciences , Watham, MA, USA
                Author notes
                To whom correspondence should be addressed; 11 Nitzana street, Tel Aviv 68117, Israel. tel: +972524446520; fax: +972 3 682004, email: mdavidson@ 123456minervaneurosciences.com ; mdavidson6@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-4698-1719
                Article
                sbac013
                10.1093/schbul/sbac013
                9077422
                35211743
                4a5735d6-fecf-46d7-959a-38fab79200a2
                © The Author(s) 2022. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Page count
                Pages: 11
                Categories
                Regular Articles
                AcademicSubjects/MED00810

                Neurology
                schizophrenia,negative symptoms,treatment
                Neurology
                schizophrenia, negative symptoms, treatment

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