Raloxifene Augmentation Improves Outcomes in Schizophrenia Spectrum Disorder

By Will Boggs MD

NEW YORK—Raloxifene as an augmentation to antipsychotic medication improves outcomes in men and women with a schizophrenia spectrum disorder, according to a systematic review and meta-analysis.

"We were most surprised by the large effects raloxifene has on positive symptoms,” Dr. Janna de Boer from University Medical Center Utrecht in the Netherlands told Reuters Health. “We expected to find most effects in the negative and cognitive symptoms, since the first results on raloxifene use suggested mostly cognitive benefits.”

Several studies have shown benefits of estrogen augmentation therapy in premenopausal women with schizophrenia, but long-term use of estrogen is not safe in women, and estrogen augmentation is not indicated in men because of its feminizing effects.

Selective estrogen-receptor modulators (SERMs) like raloxifene and tamoxifen do not carry these side effects and might provide therapeutic benefits in schizophrenia patients of both sexes.

Dr. de Boer's team evaluated the effect of raloxifene in schizophrenia spectrum disorders in their quantitative systematic review of nine studies that included a total of 561 patients.

Raloxifene augmentation was associated with moderate but significant effects on total symptom severity as measured by Positive and Negative Syndrome Scale (PANSS) total score, as well as on positive, negative and general symptom subscales, the researchers report in npj Schizophrenia, online January 10.

There were no significant effects of raloxifene augmentation on depression or cognitive outcome measures, but there were few studies that assessed these outcomes.

“Addition of raloxifene is a safe and effective option to target both positive and negative symptoms,” Dr. de Boer said.

“The influence of sex hormones on the symptomatology and disease pattern of patients with a psychosis is a relatively under-investigated topic that should receive more attention from the field,” she added. “Future research should aim to personalize medicine, to see whether certain hormone profiles/estrogen receptors are more receptive to raloxifene use.”

SOURCE: https://bit.ly/2ob1fP3

npj Schizophrenia 2018.

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