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What is causing the reduced drug-placebo difference in recent schizophrenia clinical trials and what can be done about it?

Abstract：

:On September 18, 2007, a collaborative session between the International Society for CNS Clinical Trials and Methodology and the International Society for CNS Drug Development was held in Brussels, Belgium. Both groups, with membership from industry, academia, and governmental and nongovernmental agencies, have been formed to address scientific, clinical, regulatory, and methodological challenges in the development of central nervous system therapeutic agents. The focus of this joint session was the apparent diminution of drug-placebo differences in recent multicenter trials of antipsychotic medications for schizophrenia. To characterize the nature of the problem, some presenters reported data from several recent trials that indicated higher rates of placebo response and lower rates of drug response (even to previously established, comparator drugs), when compared with earlier trials. As a means to identify the possible causes of the problem, discussions covered a range of methodological factors such as participant characteristics, trial designs, site characteristics, clinical setting (inpatient vs outpatient), inclusion/exclusion criteria, and diagnostic specificity. Finally, possible solutions were discussed, such as improving precision of participant selection criteria, improving assessment instruments and/or assessment methodology to increase reliability of outcome measures, innovative methods to encourage greater subject adherence and investigator involvement, improved rater training and accountability metrics at clinical sites to increase quality assurance, and advanced methods of pharmacokinetic/pharmacodynamic modeling to optimize dosing prior to initiating large phase 3 trials. The session closed with a roundtable discussion and recommendations for data sharing to further explore potential causes and viable solutions to be applied in future trials.

journal_name

Schizophr Bull

journal_title

Schizophrenia bulletin

authors

Kemp AS,Schooler NR,Kalali AH,Alphs L,Anand R,Awad G,Davidson M,Dubé S,Ereshefsky L,Gharabawi G,Leon AC,Lepine JP,Potkin SG,Vermeulen A

doi

10.1093/schbul/sbn110

subject

Has Abstract

pub_date

2010-05-01 00:00:00

pages

504-9

issue

eissn

0586-7614

issn

1745-1701

pii

sbn110

journal_volume

pub_type

杂志文章

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What is causing the reduced drug-placebo difference in recent schizophrenia clinical trials and what can be done about it?