Beneficial antipsychotic effects of celecoxib add-on therapy compared to risperidone alone in schizophrenia
Beneficial antipsychotic effects of celecoxib add-on therapy compared to risperidone alone in schizophrenia
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DOI：
10.1176/appi.ajp.159.6.1029
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发表时间：
2002-06-01
影响因子：
17.7
通讯作者：
Schwarz, MJ
中科院分区：
文献类型：
--
作者：
Müller, N;Riedel, M;Schwarz, MJ
目的：探讨精神分裂症患者免疫系统的异常。然而，重要的发现，如高水平的活化细胞因子在CSF和CNS炎症的迹象一直存在争议。作者进行了一项试验，新的选择性环氧合酶-2抑制剂塞来昔布，免疫调节药物，在精神分裂症patients.Method，以评估其治疗效果：在一个前瞻性的，双盲评价，50例精神分裂症急性加重患者被随机分配到利培酮加塞来昔布或利培酮加安慰剂。在洗脱期后，25名患者接受2-6 mg/天的利培酮加安慰剂，25名患者接受利培酮加400 mg/天的塞来昔布，持续5周。通过协方差分析计算治疗效果。年龄，性别，持续时间或疾病或精神病理学的严重程度，或利培酮剂量或血浆level.Results组之间没有显着差异：超过5周，两组患者的阳性和阴性症状量表和所有子量表的分数显着改善。然而，塞来昔布组表现出显着更大的改善，在总scores.Conclusions：额外的治疗与塞来昔布有显着的积极作用，利培酮的治疗作用，总精神分裂症的精神病理学。此外，免疫调节药物治疗对精神分裂症症状表现出有益作用的事实表明，精神分裂症中的免疫功能障碍不仅仅是一种附带现象，而是与疾病的病理机制有关。然而，必须考虑到塞来昔布由N-甲基-D-天冬氨酸受体介导的非免疫治疗作用。
Objective: Abnormalities in the immune system in schizophrenia have been described. However, important findings such as high levels of activating cytokines in the CSF and signs of CNS inflammation have been controversial. The authors conducted a trial of the new selective cyclooxygenase-2 inhibitor celecoxib, an immunomodulatory drug, in schizophrenic patients to evaluate its therapeutic effects.Method: In a prospective, double-blind evaluation, 50 patients with an acute exacerbation of schizophrenia were randomly assigned to either risperidone plus celecoxib or risperidone plus placebo. After a washout period, 25 patients received 2-6 mg/day of risperidone plus placebo and 25 received risperidone plus 400 mg/day of celecoxib for 5 weeks. The treatment effect was calculated by analysis of covariance. There were no significant differences between groups in age, sex, duration or severity of disease or psychopathology, or risperidone dose or plasma level.Results: Over 5 weeks, both groups of patients showed significant improvement in scores on the Positive and Negative Syndrome Scale and on all subscales. However, the celecoxib group showed significantly greater improvement in the total score.Conclusions: Additional treatment with celecoxib has significant positive effects on the therapeutic action of risperidone with regard to total schizophrenia psychopathology. Moreover, the fact that treatment with an immunomodulatory drug showed beneficial effects on schizophrenia symptoms indicates that immune dysfunction in schizophrenia is not just an epiphenomenon but is related to the pathomechanism of the disorder. However, a non immunological therapeutic effect of celecoxib mediated by the N-methyl-D-aspartic acid receptor has to be taken into account.