Monoclonal Antibody Therapy in Autoantibody-Associated Psychotic Disorders and Schizophrenia: Narrative Review of Past and Current Clinical Trials.

ABSTRACT

Neural cell-surface autoantibody-associated psychiatric disease and a subgroup of psychotic disorders are probably caused by an immune dysregulation such as B-cell related autoantibody production. In this review we describe past and current randomized placebo-controlled trials investigating monoclonal antibodies as therapy for autoantibody-associated psychiatric disease and psychotic disorders, aiming to delineate the current landscape of such monoclonal antibodies in autoantibody-associated psychiatric disease and psychotic disorders, as well as perspectives for future trials. Rituximab and ocrelizumab are now being tested in clinical trials, whereas the initial results on tocilizumab are controversial, as they demonstrated a cognitive-function benefit in an open label study in schizophrenic patients - results that were not replicated in a randomized placebo-controlled trial. Adalinumab as TNF-alpha blockage was effective in treating positive and negative symptoms in schizophrenia. These findings demonstrate that monoclonal antibody therapy is a potentially promising option to treat subgroups of schizophrenia and autoantibody-associated psychiatric patients, but it should be investigated in more placebo-controlled, double-blind trials with large cohorts.