The following article is a part of conference coverage from the American Psychiatric Association Annual Meeting 2021, held virtually from May 1 to 3, 2021. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the APA 2021.
Troriluzole, a third-generation glutamate modulator, improves symptoms in adults with obsessive-compulsive disorder (OCD) when used as adjunctive therapy, especially among those with treatment resistance or with more severe illness, according to study results presented at the annual meeting of the American Psychiatric Association, held virtually from May 1 to 3, 2021.
The objective of this randomized, double-blind, placebo-controlled proof of concept study was to evaluate the efficacy of troriluzole in patients with OCD who reported having an inadequate response to the current standard of care medications. Treatment outcomes were further evaluated to understand the impact of disease severity at baseline.
A total of 244 adults with a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of 19 or greater and who were on a stable standard of care medication regimen were included in the study. Participants were randomly assigned to receive adjunctive troriluzole (n=122) or placebo (n=122) for a period of 12 weeks with assessment visits at weeks 4, 8, and 12. Change in Y-BOCS scores from baseline to week 12 was the primary study endpoint.
Across all visits, the troriluzole group reported a numerically greater improvement vs the placebo group; however, the treatment difference did not always reach statistical significance. At week 8, the mean change in Y-BOCS scores from baseline was -5.1 points for the troriluzole group vs -3.6 points for the placebo group; the treatment difference was considered statistically significant (-1.5 points; P =.041). At week 12, the change in scores from baseline was -5.9 points for the troriluzole group vs -4.9 points for the placebo group, but the treatment difference was not statistically significant (-1.0 points; P =.22).
In post hoc analyses, participants who had more severe OCD symptoms at baseline (Y-BOCS scores ≥24) demonstrated greater treatment difference between troriluzole (n=80) and placebo (n=83) groups. In this subset of patients, the change in Y-BOCS scores from baseline to week 8 was -5.7 points for the troriluzole group vs-3.8 for the placebo group; the treatment difference was -1.9 points (P =.051). At week 12, the change in Y-BOCS scores was- 6.7 points for the troriluzole group vs -5.0 for the placebo group; the treatment difference was -1.7 points (P =.105).
Investigators concluded that troriluzole used as an adjunctive treatment for adults with OCD revealed consistent improvement in obsessive-compulsive symptoms over time; patients with more severe illness at baseline demonstrated larger treatment effects.
The investigators suggested that new therapies such as troriluzole may benefit patients with OCD, especially those who experience treatment resistance, and that future studies include larger sample sizes and enroll participants with more severe illness.
Disclosure: This clinical trial was supported by Biohaven Pharmaceuticals Holding Co. Please see the original reference for a full list of authors’ disclosures.
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Aguiar L, Bystritsky A, Munivar A, Pittenger C. Efficacy of troriluzole, a novel glutamate modulator, as adjunctive therapy in patients with obsessive compulsive: Analysis by illness severity. Presented at: APA annual meeting May 1-3, 2021. Abstract/Poster 5144.