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IoP receives £5m to advance personalised treatment for schizophrenia

The Institute of Psychiatry (IoP) at King’s College London has been awarded £5m from the Medical Research Council (MRC) to set up a research consortium to advance personalised medicine for schizophrenia.

Led by Professor Shitij Kapur, Dean and Head of School of the IoP at King’s, the project will use neuroimaging and genetic studies to develop objective markers capable of predicting which people will respond to which medications, and ultimately aim to address the current ‘trial and error’ method of prescribing antipsychotic medications.

People with schizophrenia suffer from a range of symptoms including hallucinations (such as hearing voices), delusions (false beliefs) and thought disorder (thoughts not flowing in a logical way), as well as 'negative symptoms' such as a lack of motivation and withdrawal from social contact.

Currently, antipsychotic medication is the mainstay of treatment of schizophrenia and all existing antipsychotic medications are thought to work by acting to reduce transmission of a brain chemical called dopamine. However, even after attempts to treat the disorder with two different antipsychotics, around 30% of patients still fail to improve. When this happens, the medical guidelines recommend treatment with a different drug called clozapine. However clozapine has several side effects and requires regular blood tests, so people do not like taking it. It is also ineffective in some patients.

The result is that a large number of patients spend too long on ineffective drugs which impact greatly on their mental health, well-being and quality of life whilst the costs of ineffective treatment is a huge financial burden to the NHS, consuming 25-50% of the total national mental health budget.

This set of studies aims to build on new evidence from neuroimaging and genetics studies suggesting that those who do not respond may actually have a completely different neurochemical abnormality causing their symptoms, involving a different chemical called glutamate. There are some new medicines under development that researchers hope will help people whose illness has not responded to standard medicines acting on dopamine. The researchers aim to develop a method to predict, ultimately as early as first admission, which patients will respond to standard dopamine drugs, and which people are instead more likely to respond to the new glutamate drugs. This will allow people to receive the medicines they need straight away, without having to try ineffective drugs first.

Professor Kapur says: “Over the past 50 years, there have been few advances in developing new antipsychotic medications. There are still too many patients with schizophrenia who spend far too long on drugs which are not helping their symptoms. This project will build on cutting edge neuroimaging and genetics research, including work done at the IoP, to understand the different neurochemical imbalances associated with the symptoms of schizophrenia, and how these are affected by different medications.  Ultimately, our aim is to ensure that patients have access to the medications they need straight away, avoiding years of unnecessary distress.”

Dr James MacCabe, who has had a central role in pulling together the collaboration says: “We are delighted that the MRC has recognised the potential for personalised medicine in the treatment of schizophrenia.  This consortium brings together five of the leading academic centres around the UK, including Imperial College London and the Universities of Manchester, Cardiff and Edinburgh.  We will also be working in partnership with pharmaceutical companies, service users and mental health charities.  This work will build on our burgeoning programme of research on treatment-resistant schizophrenia, including the EU-funded CRESTAR collaboration, also led from KCL.  In some areas of medicine, particularly cancer treatment, outcomes for patients have been dramatically improved by using biological markers to tailor treatments to the individual.  We hope that this work will result in similar advances in the treatment of schizophrenia.” 

The research programme, called STRATA - Schizophrenia: Treatment Resistance And Therapeutic Advances is broken down into several parts:

1.  The first set of studies will use cutting edge brain scans to confirm that those patients who don't respond to standard treatments have higher glutamate levels, but normal dopamine levels.

2.  The researchers will then develop tests, using genetic markers, brain scans and clinical information, to identify in advance which people will respond to which medication types.

3.  If this is successful, they will conduct a clinical trial to see whether prescribing medicines according to the test results gives better outcomes for patients than the current 'trial and error' method of prescribing medicines.

4.  Finally, the researchers will investigate economic benefits and, with Service User groups, investigate the acceptability of an early identification tool from the patient perspective.

The award was announced at the MRC ‘Stratified medicine showcase’ on October 30th 2013 at the Royal College of General Practitioners and further details can be found here.  

For further information please contact Louise Pratt, PR & Communications Manager, King’s College London Institute of Psychiatry 020 7848