Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia.
Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.
Schizophr Bull. 2022 Nov 18;48(6):1263-1272. doi: 10.1093/schbul/sbac065.
Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N-acetylcysteine (NAC).
A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks.
NAC did not significantly improve negative symptoms (P = .62), overall cognition (P = .71) or quality of life (Manchester quality of life: P = .11; Assessment of quality of life: P = .57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P = .26).
NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with "Australian and New Zealand Clinical Trials" on the 30 May, 2016 (Registration Number: ACTRN12615001273572).
氯氮平是治疗难治性精神分裂症最有效的抗精神病药物，但尽管使用了适当剂量的氯氮平，仍有相当一部分患者继续出现致残症状。需要辅助治疗来增强氯氮平的疗效，尤其是针对阴性和认知症状。一种潜在的药物是谷胱甘肽前体 N-乙酰半胱氨酸（NAC）。
对持续存在精神病症状的氯氮平患者（n = 84）进行了一项随机、双盲、多中心、安慰剂对照试验，以研究辅助 NAC（每日 2 克）对阴性症状、认知和生活质量（QoL）的疗效。在第 8、24 和 52 周评估疗效。
NAC 治疗 1 年期间，在任何时间点均未显著改善阴性症状（P =.62）、整体认知（P =.71）或生活质量（曼彻斯特生活质量：P =.11；生活质量评估：P =.57）。两组之间报告的副作用没有差异（P =.26）。
NAC 不能显著改善服用氯氮平的难治性患者的精神分裂症症状、认知或生活质量。该试验于 2016 年 5 月 30 日在“澳大利亚和新西兰临床试验”注册（注册号：ACTRN12615001273572）。
