A Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Tocilizumab, an Interleukin-6 Receptor Antibody, for Residual Symptoms in Schizophrenia
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology | 2 Nov 2017
RR Girgis, A Ciarleglio, T Choo, G Haynes, JM Bathon, S Cremers, JT Kantrowitz, JA Lieberman and AS Brown
Evidence from preclinical, epidemiological, and human studies indicates that inflammation, and in particular elevated IL-6 activity, may be related to clinical manifestations and pathophysiology of schizophrenia. Furthermore, studies in preclinical models suggest that decreasing IL-6 activity may mitigate or reverse some of these deficits. The purpose of this trial was to test whether an IL-6 receptor antibody, tocilizumab, would improve residual positive and negative symptoms and cognitive deficits in schizophrenia. We randomized 36 clinically stable, moderately symptomatic (ie, PANSS>60) individuals with schizophrenia to 3 monthly infusions of 8 mg/kg tocilizumab or placebo (normal saline). The primary outcome was effect at week 12 on the PANSS Total Score. Effects on the MATRICS, other PANSS subscales, CGI, and GAF were secondary outcomes. There were no observed treatment effects on any behavioral outcome measure. Baseline C-reactive protein (CRP) or cytokine levels did not predict treatment outcome, nor were there correlations between changes in these inflammatory markers and the measured outcomes. As expected, IL-6 and IL-8 increased, while CRP decreased, in the tocilizumab group compared to the placebo group. This study did not reveal any evidence that an IL-6 receptor antibody affects behavioral outcomes in schizophrenia. One potential explanation is the lack of capacity of this agent to penetrate the central nervous system. Additional trials of medications aimed at targeting cytokine overactivity that act directly on brain function and/or treatment in early stage psychosis populations are needed.Neuropsychopharmacology accepted article preview online, 01 November 2017. doi:10.1038/npp.2017.258.
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