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Lin CH, Chen YM, Lane HY. Novel Treatment for the Most Resistant Schizophrenia: Dual Activation of NMDA Receptor and Antioxidant. Curr Drug Targets 2021; 21:610-615. [PMID: 31660823 DOI: 10.2174/1389450120666191011163539] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023]
Abstract
Clozapine has been regarded as the last-line antipsychotic agent for patients with refractory schizophrenia. However, many patients remain unresponsive to clozapine, referred to as "clozapineresistant", "ultra-treatment-resistant", or remain in incurable state. There has been no convincing evidence for augmentation on clozapine so far. Novel treatments including numerous N-methyl-Daspartate (NMDA) receptor (NMDAR) enhancers, such as glycine, D-serine, D-cycloserine, and Nmethylglycine (sarcosine) failed in clinical trials. Earlier, the inhibition of D-amino acid oxidase (DAAO) that may metabolize D-amino acids and activate NMDAR has been reported to be beneficial for patients with schizophrenia receiving antipsychotics except for clozapine. A recent randomized, double-blind, placebo-controlled clinical trial found that add-on sodium benzoate, a DAAO inhibitor, improved the clinical symptoms in patients with clozapine- resistant schizophrenia, possibly through DAAO inhibition (and thereby NMDAR activation) and antioxidation as well; additionally, sodium benzoate showed no obvious side effects, indicating that the treatment is safe at doses up to 2 g per day for 6 weeks. More studies are warranted to elucidate the mechanisms of sodium benzoate for the treatment of schizophrenia and the etiology of this severe brain disease. If the finding can be reconfirmed, this approach may bring new hope for the treatment of the most refractory schizophrenia. This review summarizes the current status of clinical trials and related mechanisms for treatmentresistant, especially, clozapine-resistant schizophrenia. The importance of understanding the molecular circuit switches is also highlighted which can restore brain function in patients with schizophrenia. Future directions in developing better treatments for the most difficult to cure schizophrenia are also discussed.
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Affiliation(s)
- Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Yu-Ming Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Scott JG, Baker A, Lim CCW, Foley S, Dark F, Gordon A, Ward D, Richardson D, Bruxner G, Beckmann KM, Hatherill S, Stathis S, Dixon K, Ryan AE, McWhinney BC, Ungerer JPJ, Berk M, Dean OM, Saha S, McGrath J. Effect of Sodium Benzoate vs Placebo Among Individuals With Early Psychosis: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2024335. [PMID: 33170261 PMCID: PMC7656289 DOI: 10.1001/jamanetworkopen.2020.24335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE There is evidence that sodium benzoate (BZ) may be an effective adjunctive treatment for schizophrenia. The clinical efficacy of BZ has been investigated in chronic schizophrenia; however, the efficacy of this agent has not been studied in individuals with early psychosis. OBJECTIVE To examine the clinical efficacy of the adjunctive use of BZ for symptoms in people with early psychosis. DESIGN, SETTING, AND PARTICIPANTS Using a placebo-controlled double-masked parallel-group design, this randomized clinical trial was conducted from August 2015 to July 2018. Participants aged between 15 and 45 years experiencing early psychosis were enrolled from 5 major clinical sites in Queensland, Australia. Data analysis was conducted from October 2018 to February 2020. INTERVENTIONS Participants were randomized 1:1 (50 participants in each group) to receive 500 mg of sodium benzoate twice daily or placebo for 12 weeks. MAIN OUTCOMES AND MEASURES The primary efficacy outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 12 weeks. The key secondary efficacy measures were (1) the Clinical Global Impression score, (2) the Hamilton Depression Rating Scale for depression, (3) functioning as assessed by the clinician-rated Global Assessment of Function, and (4) the Assessment of Quality of Life Scale. The PANSS subscale scores and impact on selected amino acid concentrations were also assessed. RESULTS The study comprised 100 participants with a mean (SD) age of 21.4 (4.1) years, of whom 73 (73%) were male individuals. The mean (SD) baseline PANSS score was 75.3 (15.4). We found no improvement in total PANSS score in the BZ group compared with the placebo group. The end result of least-squares mean difference (SE) for total PANSS was -1.2 (2.4) (P = .63). There were no differences in any subscales of the PANSS, any secondary measures, nor any amino acid concentrations. The dose of BZ was well tolerated without any clinically significant treatment-emergent adverse event differences between BZ and placebo groups. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, there was no evidence that adjunctive use of 500 mg of BZ twice daily is an effective treatment for individuals with early psychosis. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12615000187549.
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Affiliation(s)
- James G. Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
- Metro North Mental Health Service, Herston, Australia
| | - Andrea Baker
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Carmen C. W. Lim
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Australia
| | - Sharon Foley
- Emotional Health Unit, Mater Hospital, South Brisbane, Australia
| | | | - Anne Gordon
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Australia
| | - David Ward
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Australia
| | | | - George Bruxner
- Metro North Mental Health, Caboolture and Redcliffe Hospitals, Caboolture, Australia
| | - K. Martin Beckmann
- School of Medicine, Logan Hospital, Griffith University, Meadowbrook, Australia
- Child and Youth Mental Health Service, Metro South Mental Health, Logan Hospital, Meadowbrook, Australia
| | - Sean Hatherill
- Metro South Addiction and Mental Health Services, Logan Hospital, Meadowbrook, Australia
| | - Stephen Stathis
- Queensland Children’s Hospital, South Brisbane, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Krystal Dixon
- Mental Health and Addiction Services, Sunshine Coast Hospital and Health Service, Birtinya, Australia
- School of Medicine, Sunshine Coast University Hospital, Griffith University, Birtinya, Australia
| | - Alexander E. Ryan
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- QIMR Berghofer Medical Research Institute, Herston, Australia
- University of Queensland Centre for Clinical Research, Herston, Australia
| | - Brett C. McWhinney
- Department of Chemical Pathology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Herston, Australia
| | - Jacobus P. J. Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Australia
- School of Biomedical Sciences, University of Queensland, St Lucia, Australia
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Olivia M. Dean
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Australia
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Australia
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
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