Promoting schizophrenia research in Europe: the contribution of the European Group for Research in Schizophrenia

The European Group for Research in Schizophrenia (EGRIS) was founded in the late 1990s to develop strategies for the promotion and coordination of schizophrenia research in Europe.

The founding members were W. Fleischhacker (Austria), J. Peuskens (Belgium), D. Naber (Germany), I. Bitter (Hungary), J. Gerlach (Denmark), J.‐J. Lopez‐Ibor (Spain), S. Galderisi (Italy), J. Libiger (Czech Republic), M. Paes de Sousa (Portugal) and T. Burns (UK). W. Fleischhacker was the chairperson of the group, and J. Peuskens the co‐chair.

The primary aim of the group was to encourage independent collaboration in schizophrenia research across Europe, by identifying research gaps, exploring innovative approaches, and favoring “technology transfer” across centers joining the research proj‐ ects designed by the group.

The group met two times per year. Open as well as in‐depth scientific discussions, together with a friendly and pleasant atmosphere, characterized the meetings. The group discussed drafts of research protocols prepared and presented by one or more members, sometimes enriching them or, more often, after an in‐depth discussion, either tabling them until the next meeting, with some suggestions for revision, or rejecting them.

Of the many protocols drafted and discussed during the meetings, very few survived the criticisms of the group members and were proposed to external bodies for funding. The first very successful initiative was the European First Episode Schizophrenia Trial (EUFEST), the largest randomized trial comparing the clinical effectiveness of second‐ vs. first‐generation (haloperidol below 5 mg/day) antipsychotics in first‐episode schizophrenia‐spectrum patients ¹ .

This has been the first trial in a relatively unselected group of first‐episode schizophrenia patients performed across a large number of European countries. Its focus was effectiveness of antipsychotic treatment, measured as retention of patients on treatment (non‐retention can be the result of insufficient clinical efficacy and/or poor tolerability/acceptability). The primary outcome was the 1‐year retention rate in first‐episode patients treated with haloperidol, olanzapine, quetiapine, amisulpride or ziprasidone. Secondary objectives included the comparison of changes in various dimensions of psychopathology, social needs and quality of life, substance abuse and cognitive functions in response to treatment with the above antipsychotics, as well as the assessment of their side effects. The main paper was published in the Lancet ² . The group discussed many proposals for secondary analyses and, for the approved ones, invited contributions by other group members, in addition to those who had presented the proposal.

The large database generated by the study resulted in over 40 papers, many by the EUFEST study group, and some by researchers who had not participated in the study, but later had shown interest in the study findings and conducted post‐hoc analyses.

Through the EUFEST study, we learnt a lot about challenges and opportunities in running multicenter, multinational trials, and the EGRIS grew in terms of cohesion, skills and enthusiasm.

Over time, the composition of the group changed, with the admission of new members (based on the recommendations of existing ones), adopting a one country/one member policy. By 2009, for instance, the group had included five more members/countries, i.e., S. Dollfus (France), M. Davidson (Israel), R. Kahn (The Netherlands), W. Rössler (Switzerland) and J. Rybakowski (Poland); in addition, B. Glenthoj (Denmark) had joined the group, as J. Gerlach had retired.

While searching for innovative ideas, drafting new research protocols, and applying for funds, the group joined the European College of Neuropsychopharmacology (ECNP) Network Initiative, and created the ECNP Schizophrenia Network. However, after a couple of years, the EGRIS decided to return to its previous autonomy and working style. Part of the group also remained in the ECNP Schizophrenia Network, and, under my leadership, the Network included new members, who had never been EGRIS members, and focused on research on negative symptoms of schizophrenia ³ , ⁴ .

In 2012, the EGRIS approved another large multicenter, multinational study, the European Long‐acting Antipsychotics in Schizophrenia Trial (EULAST). The group moved from the evidence that discontinuation of antipsychotic medication is by far the most important reason for relapse, and concluded that a study comparing long‐acting injectable antipsychotic drugs (LAIs) to corresponding oral formulations could shed some light on the ongoing discussion concerning the effectiveness of different formulations in reducing relapses ⁵ .

It took a few years to design the study, identify participating centers and find the resources to conduct the study. Fifty psychiatric centers located in 15 European countries and Israel joined this large, pragmatic, open label, randomized clinical trial comparing LAIs with their oral equivalents in schizophrenia patients in the early phase of their illness. At the beginning of 2015, the study centers started the recruitment of patients, which ended in December 2018, with the final study visit taking place in August 2020. The paper reporting the study findings has been recently published ⁶ .

The EGRIS has recently renewed its composition and leadership. I will lead the group in the role of chair, P. Falkai (Germany) in the role of co‐chair; M. Weiser (Israel) will be the group treasurer; and I. Winter (The Netherlands) will support the group in the role of secretary. The other group members are C. Arango (Spain), I. Bitter (Hungary), P. Dazzan (UK), S. Dollfus (France), B. Glenthoj (Denmark), A. Hofer (Austria), P. Mohr (Czech Republic), N. Stefanis (Greece), J. Tiihonen (Sweden) and R. van Winkel (Belgium).

In its current composition, the group will further pursue the mission of identifying and targeting gaps in European research in schizophrenia, applying innovative approaches, and favoring translation of research findings into clinical practice across Europe.