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Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia.

Publication ,  Journal Article
Marx, CE; Lee, J; Subramaniam, M; Rapisarda, A; Bautista, DCT; Chan, E; Kilts, JD; Buchanan, RW; Wai, EP; Verma, S; Sim, K; Hariram, J ...
Published in: Psychopharmacology (Berl)
September 2014

RATIONALE: Preclinical and clinical data suggest that pregnenolone may be a promising therapeutic in schizophrenia. Pregnenolone is neuroprotective and enhances learning and memory, myelination, and microtubule polymerization. Treatment with pregnenolone elevates allopregnanolone (a neurosteroid that enhances GABAA receptor responses) and pregnenolone sulfate (a positive NMDA receptor modulator). Pregnenolone could thus potentially mitigate GABA dysregulation and/or NMDA receptor hypofunction in schizophrenia via metabolism to other neurosteroids. OBJECTIVE: The objective of this study is to conduct a randomized controlled trial of adjunctive pregnenolone in schizophrenia. METHODS: Following a placebo lead-in, 120 participants were randomized to pregnenolone or placebo for 8 weeks (Institute for Mental Health, Singapore). Primary endpoints were changes in MATRICS Consensus Cognitive Battery (MCCB) composite scores (cognitive symptoms), UCSD Performance-based Skills Assessment-Brief (UPSA-B) composite scores (functional capacity), and Scale for Assessment of Negative Symptoms (SANS) total scores (negative symptoms). A modified intent-to-treat analysis approach was utilized. RESULTS: No significant changes compared to placebo were demonstrated in composite MCCB scores. In contrast, participants randomized to pregnenolone (n = 56) demonstrated greater improvements in functional capacity (UPSA-B composite changes) compared to placebo (n = 55), p = 0.03. Pregnenolone was also superior to placebo in the communication subscale of the UPSA-B (p < 0.001). Serum pregnenolone changes post-treatment were correlated with UPSA-B composite score changes in females (r s = 0.497, p < 0.042, n = 17) but not in males. Mean total SANS scores were very low at baseline and did not improve further post-treatment. Pregnenolone was well-tolerated. CONCLUSIONS: Pregnenolone improved functional capacity in participants with schizophrenia, but did not improve cognitive symptoms over an 8-week treatment period. Neurosteroid changes correlated with functional improvements in female participants. Neurosteroid interventions may exhibit promise as new therapeutic leads for schizophrenia.

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Published In

Psychopharmacology (Berl)

DOI

EISSN

1432-2072

Publication Date

September 2014

Volume

231

Issue

17

Start / End Page

3647 / 3662

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Sex Characteristics
  • Schizophrenic Psychology
  • Schizophrenia
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Pregnenolone
  • Neurotransmitter Agents
  • Male
  • Humans
 

Citation

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Marx, C. E., Lee, J., Subramaniam, M., Rapisarda, A., Bautista, D. C. T., Chan, E., … Chong, S. A. (2014). Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia. Psychopharmacology (Berl), 231(17), 3647–3662. https://doi.org/10.1007/s00213-014-3673-4
Marx, Christine E., Jimmy Lee, Mythily Subramaniam, Attilio Rapisarda, Dianne C. T. Bautista, Edwin Chan, Jason D. Kilts, et al. “Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia.Psychopharmacology (Berl) 231, no. 17 (September 2014): 3647–62. https://doi.org/10.1007/s00213-014-3673-4.
Marx CE, Lee J, Subramaniam M, Rapisarda A, Bautista DCT, Chan E, et al. Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia. Psychopharmacology (Berl). 2014 Sep;231(17):3647–62.
Marx, Christine E., et al. “Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia.Psychopharmacology (Berl), vol. 231, no. 17, Sept. 2014, pp. 3647–62. Pubmed, doi:10.1007/s00213-014-3673-4.
Marx CE, Lee J, Subramaniam M, Rapisarda A, Bautista DCT, Chan E, Kilts JD, Buchanan RW, Wai EP, Verma S, Sim K, Hariram J, Jacob R, Keefe RSE, Chong SA. Proof-of-concept randomized controlled trial of pregnenolone in schizophrenia. Psychopharmacology (Berl). 2014 Sep;231(17):3647–3662.
Journal cover image

Published In

Psychopharmacology (Berl)

DOI

EISSN

1432-2072

Publication Date

September 2014

Volume

231

Issue

17

Start / End Page

3647 / 3662

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Sex Characteristics
  • Schizophrenic Psychology
  • Schizophrenia
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Pregnenolone
  • Neurotransmitter Agents
  • Male
  • Humans