Celecoxib Helpful Add-On Therapy in Schizophrenia

Laurie Barclay, MD

June 27, 2002

June 28, 2002 — The cyclooxygenase 2 (COX-2) inhibitor celecoxib may prove useful as short-term, add-on therapy for acute schizophrenia exacerbations, according to results of a double-blind, randomized trial of risperidone with or without celecoxib reported in the June issue of the American Journal of Psychiatry.

"Additional treatment with celecoxib has significant positive effects on the therapeutic action of risperidone with regard to total schizophrenia psychopathology," write Norbert Müller, MD, and colleagues from the Psychiatric and Psychotherapeutic Hospital, Ludwig Maximilians University, in Munich, Germany. "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."

In this prospective study, 50 patients with an acute exacerbation of schizophrenia were randomized to treatment with either risperidone 2-6 mg/day plus celecoxib 400 mg/day, or risperidone plus placebo. After a washout period, treatment lasted for five weeks. The groups were well-matched in age, sex, duration and severity of disease, psychopathology, and risperidone dose and plasma level.

Although both groups of patients improved significantly in scores on the Positive and Negative Syndrome Scale and on all subscales, the celecoxib group showed significantly greater improvement in the total score.

The authors suggest that the immunomodulatory effect of celecoxib is most significant, but that "a nonimmunological therapeutic effect of celecoxib mediated by the N-methyl-D-aspartic acid receptor has to be taken into account."

Am J Psychiatry. 2002;159:1029-1034

Reviewed by Gary D. Vogin, MD


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