Disproving Hypothesis Clears Path for Research into New Treatment Options for Schizophrenia
Treatment with low-dose dopamine-1 receptor agonists does not improve schizophrenia symptoms
NEW YORK, NY (March 10, 2016) Researchers reported results from the first repeated-dose study of a dopamine-1 receptor (D1R) agonist for treating the cognitive and negative symptoms of schizophrenia today in the Journal of Psychopharmacology.
Cognitive and negative symptoms, such as problems with social interactions, affect and responsiveness, slowed movement and speech, and memory problems, are central features of schizophrenia and cause major limitations in functional capacity for patients. These symptoms can begin even before psychotic symptoms of the disorder manifest. Currently, there are no effective treatments for these symptoms.
Based on preclinical research published in 2000, which suggested that reduced signaling through the D1R might contribute to cognitive and negative symptoms, scientists speculated that administering ultra-low doses of D1R agonists might help counteract these symptoms in patients with schizophrenia. For over a decade, researchers have sought to reproduce comparable results in clinical studies, with mixed findings and no definitive answers.
In this study, the researchers randomized 49 participants to receive low intermittent doses of a D1R agonist or placebo over three weeks. Functional magnetic resonance imaging was used to evaluate the effects of the drug on brain activity during a working memory task. No treatment effects were observed.
“This study does not support the hypothesis that ultra-low amounts of D1R stimulation would be beneficial in treating cognitive or negative symptoms in schizophrenia.” said Jeffrey A. Lieberman, MD, the Lawrence C. Kolb professor and chair of psychiatry at Columbia University Medical Center (CUMC), director of the New York State Psychiatric Institute (NYSPI), and the senior author of the study. “However, our findings do not preclude the possibility that a D1R agonist administered at higher doses might be therapeutic.”
“Resources should be directed to seeking novel drugs that stimulate the D1R at higher levels, and with longer durations of action and exposure,” noted lead author Ragy Girgis, MD, assistant professor of clinical psychiatry at CUMC and director of the COPE Clinic at NYSPI. “The challenge to develop better paradigms that test the efficacy of higher dose treatments without causing unacceptable side effects is the focus of the next stage of our research.”
This study was supported by a grant to Dr. Lieberman from the National Institute of Mental Health (U01 MH076544).
Dr. Girgis discloses that he receives research support from Genentech and Otsuka Pharmaceutical. Drs. van Snellenberg, Thompson, Wall, and Cho, and Mr. Glass, have no disclosures. Dr. Kegeles discloses that he receives research support from Amgen and Pfizer. Dr. Carter has served as a consultant for Merck, Eli Lilly, Pfizer, and Labaratoires Servier. Dr. Slifstein has consulted for Amgen and has received research support from Pierre Fabre. Dr. Abi-Dargham has received research support from Pierre Fabre and Forest Laboratories, and has been a consultant for or on the scientific advisory board of Roche Holding, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Amgen, and Shire. Dr. Lieberman serves on the advisory board of Intra-Cellular Therapies. He receives grant support from Allon, Biomarin, Eli Lilly, F. Hoffman–La Roche, Genentech, GlaxoSmithKline, Merck, Novartis, Pfizer, Psychogenics, Sepracor (Sunovion), and Targacept, and holds a patent from Repligen.
New York State Psychiatric Institute (founded in 1896) and the Columbia University Department of Psychiatry have been closely affiliated since 1925. Their co-location in a New York State facility on the New York-Presbyterian/Columbia University Medical Center campus provides the setting for a rich and productive collaborative relationship among scientists and physicians in a variety of disciplines. NYSPI/Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding of and current treatment for psychiatric disorders. The Department and Institute are home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders and childhood psychiatric disorders. Their combined expertise provides state of the art clinical care for patients, and training for the next generation of psychiatrists and psychiatric researchers.