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Study of Quetiapine Monotherapy in Ambulatory Bipolar Spectrum Disorder With Moderate-to-Severe Hypomanic Symptoms or Mild Manic Symptoms

Primary Purpose

Bipolar Disorder

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Quetiapine
Sponsored by
Lindner Center of HOPE
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Disorder focused on measuring currently experiencing hypomania or mild mania

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subjects must be 18 years of age or older. Subjects must have bipolar I, II, or not otherwise specified (NOS) disorder as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. Of note, bipolar NOS disorder will include subjects with either recurrent or sporadic brief hypomanias (hypomanias of 1 to 3 days in duration). Subjects must have moderate-to-severe hypomanic symptoms or mild manic symptoms that must be clinically significant (at least mild) but no worse than moderately severe, defined as a CGI-BP scale for mania > 3 and < 5, on at least 2 assessment days at least 3 days apart during the screening phase. Subjects must not be receiving mood stabilizing, antidepressant, or antipsychotic medication for > one week. Subjects or their legally authorized representative must sign the Informed Consent document after the nature of the trial has been fully explained. If female, subjects must be: postmenopausal, surgically incapable of childbearing, or practicing medically acceptable, effective method(s) of contraception (e.g., hormonal methods, intrauterine device) for at least one month prior to study entry and throughout the study. Exclusion Criteria: Criteria for exclusion from this study will be any of the following: Subjects who do not have bipolar disorder by DSM-IV-TR criteria. Subjects who are receiving treatment with an antimanic or mood stabilizing medication (lithium, valproate, carbamazepine, or an antipsychotic), and in the investigators' judgment, require ongoing treatment with that medication. Subjects whose bipolar manic symptoms are presently less than mild (CGI-BP < 2) or more than markedly ill (CGI-BP > 5 or YMRS > 21) Subjects who have severe depressive symptoms (IDS > 39 ) or psychotic features (as defined in DSM-IV) Subjects with clinically significant suicidal or homicidal ideation. Subjects with a current DSM-IV Axis I diagnosis of delirium, dementia, amnesia, or other cognitive disorders; a DSM-IV diagnosis of a substance use disorder within the past six months; a lifetime DSM-IV psychotic disorder (e.g., schizophrenia or schizoaffective disorder). Subjects with serious general medical illnesses including hepatic, renal, respiratory, cardiovascular, endocrine, neurologic, or hematologic disease as determined by the clinical judgment of the clinical investigator. Subjects with hypo- or hyperthyroidism unless stabilized on thyroid replacement > 3 months. Subjects who are allergic to or who have demonstrated hypersensitivity to quetiapine. Women who are pregnant or nursing. Subjects who have received an experimental drug or used an experimental device within 30 days. Subjects who have a history of neuroleptic malignant syndrome.

Sites / Locations

  • University of Cincinnati Medical Center

Outcomes

Primary Outcome Measures

Change in manic symptoms (as measured by Young Mania Rating Scale)

Secondary Outcome Measures

Change in total burden of affective symptoms, depressive symptoms alone, and anxiety symptoms alone; change in clinical global improvement; adherence with study medication; and degree and severity of side effects experienced.

Full Information

First Posted
January 12, 2006
Last Updated
March 12, 2009
Sponsor
Lindner Center of HOPE
Collaborators
AstraZeneca, University of Cincinnati
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1. Study Identification

Unique Protocol Identification Number
NCT00277667
Brief Title
Study of Quetiapine Monotherapy in Ambulatory Bipolar Spectrum Disorder With Moderate-to-Severe Hypomanic Symptoms or Mild Manic Symptoms
Official Title
A Randomized, Double-Blind, Placebo-Controlled Study of Quetiapine Monotherapy in Ambulatory Bipolar Spectrum Disorder With Moderate-to-Severe Hypomanic Symptoms or Mild Manic Symptoms
Study Type
Interventional

2. Study Status

Record Verification Date
March 2009
Overall Recruitment Status
Completed
Study Start Date
February 2004 (undefined)
Primary Completion Date
December 2007 (Actual)
Study Completion Date
December 2007 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Lindner Center of HOPE
Collaborators
AstraZeneca, University of Cincinnati

4. Oversight

5. Study Description

Brief Summary
The purpose of this research study is to evaluate the safety, tolerability, and efficacy of quetiapine compared to placebo (sugar pill without medication) in the treatment of bipolar disorder with moderate to severe hypomania or mild mania. Quetiapine is approved by the United States Food and Drug Administration (FDA) for the treatment of schizophrenia and bipolar mania.
Detailed Description
Methods and Procedures This is a single center, eight-week, randomized, double-blind, placebo-controlled, parallel group, flexible-dose study in 40 outpatients with bipolar disorder types I, II, or NOS by DSM-IV-TR criteria who also have moderate-to-severe hypomanic symptoms or mild manic symptoms (defined as a score of > 3 but <5 on the Clinical Global Impressions Scale Modified for Bipolar Disorder [CGI-BP]). Subjects may have concurrent depressive or anxiety symptoms or syndromes, but they may not have psychotic features (as defined in DSM-IV) or substance dependence. The primary outcome measure will be change in the Young Mania Rating Scale (YMRS) scores. Secondary outcome measures will include the total of the YMRS and the Inventory for Depressive Symptoms (IDS), the IDS alone, the Hamilton Rating Scale for Anxiety (HAM-A), the CGI-BP, the Global Assessment of Functioning (GAF), the Life Functioning Questionnaire (LFQ), and the Sheehan Disability Scale (DSD). Of note, the YMRS-IDS total reflects a novel means of assessing total affective burden. Also, IDS will be used to assess depressive symptoms because of our experience in the Stanley Foundation Bipolar Network indicating that this scale better assesses the signs and symptoms of bipolar depression as compared to both the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Depression Scale (MADRAS). The LFQ is a validated gender neutral scale specifically designed to assess functional outcome in bipolar disorder. The Abnormal Involuntary Movement Scale (AIMS), Simpson Angus Scale (SAS), and Barnes Akathisia Scale (BARS), will be used to assess for degree and severity of extrapyramidal side effects experienced. Data Analysis and Data Monitoring All subjects with observations available from the baseline and at least one post-baseline visit will be included in analyses. The primary outcome measure will be the change in YMRS scale scores from baseline to last observation. The difference in YMRS change between treatment groups will be tested for significance (alpha=0.05, two-tailed) using an independent-samples t-test. Measures of change in total affective burden, depressive and anxiety symptoms, global improvement, use of adjunctive anxiolytic and hypnotic medication, adherence to study medication, frequency and severity of side effects, and reasons for early termination will also be analyzed. The final dose achieved by each subject will be correlated with scale score change. Tolerability will be assessed based on adverse experiences, clinical laboratory tests, vital signs (blood pressure and pulse), weight, and discontinuation rates.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Disorder
Keywords
currently experiencing hypomania or mild mania

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Quetiapine
Intervention Description
Oral dosing: 50mg (Day 1), 100mg (Day 2), 150mg (Day 3), 200mg (Day 4), followed by flexible dosing from 50mg to 800mg through day 56.
Primary Outcome Measure Information:
Title
Change in manic symptoms (as measured by Young Mania Rating Scale)
Time Frame
baseline to endpoint
Secondary Outcome Measure Information:
Title
Change in total burden of affective symptoms, depressive symptoms alone, and anxiety symptoms alone; change in clinical global improvement; adherence with study medication; and degree and severity of side effects experienced.
Time Frame
baseline to endpoint

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must be 18 years of age or older. Subjects must have bipolar I, II, or not otherwise specified (NOS) disorder as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria. Of note, bipolar NOS disorder will include subjects with either recurrent or sporadic brief hypomanias (hypomanias of 1 to 3 days in duration). Subjects must have moderate-to-severe hypomanic symptoms or mild manic symptoms that must be clinically significant (at least mild) but no worse than moderately severe, defined as a CGI-BP scale for mania > 3 and < 5, on at least 2 assessment days at least 3 days apart during the screening phase. Subjects must not be receiving mood stabilizing, antidepressant, or antipsychotic medication for > one week. Subjects or their legally authorized representative must sign the Informed Consent document after the nature of the trial has been fully explained. If female, subjects must be: postmenopausal, surgically incapable of childbearing, or practicing medically acceptable, effective method(s) of contraception (e.g., hormonal methods, intrauterine device) for at least one month prior to study entry and throughout the study. Exclusion Criteria: Criteria for exclusion from this study will be any of the following: Subjects who do not have bipolar disorder by DSM-IV-TR criteria. Subjects who are receiving treatment with an antimanic or mood stabilizing medication (lithium, valproate, carbamazepine, or an antipsychotic), and in the investigators' judgment, require ongoing treatment with that medication. Subjects whose bipolar manic symptoms are presently less than mild (CGI-BP < 2) or more than markedly ill (CGI-BP > 5 or YMRS > 21) Subjects who have severe depressive symptoms (IDS > 39 ) or psychotic features (as defined in DSM-IV) Subjects with clinically significant suicidal or homicidal ideation. Subjects with a current DSM-IV Axis I diagnosis of delirium, dementia, amnesia, or other cognitive disorders; a DSM-IV diagnosis of a substance use disorder within the past six months; a lifetime DSM-IV psychotic disorder (e.g., schizophrenia or schizoaffective disorder). Subjects with serious general medical illnesses including hepatic, renal, respiratory, cardiovascular, endocrine, neurologic, or hematologic disease as determined by the clinical judgment of the clinical investigator. Subjects with hypo- or hyperthyroidism unless stabilized on thyroid replacement > 3 months. Subjects who are allergic to or who have demonstrated hypersensitivity to quetiapine. Women who are pregnant or nursing. Subjects who have received an experimental drug or used an experimental device within 30 days. Subjects who have a history of neuroleptic malignant syndrome.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Susan L. McElroy, MD
Organizational Affiliation
University of Cincinnati
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Cincinnati Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45267-0559
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
19963274
Citation
McElroy SL, Martens BE, Winstanley EL, Creech R, Malhotra S, Keck PE Jr. Placebo-controlled study of quetiapine monotherapy in ambulatory bipolar spectrum disorder with moderate-to-severe hypomania or mild mania. J Affect Disord. 2010 Jul;124(1-2):157-63. doi: 10.1016/j.jad.2009.11.014. Epub 2009 Dec 5.
Results Reference
derived

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Study of Quetiapine Monotherapy in Ambulatory Bipolar Spectrum Disorder With Moderate-to-Severe Hypomanic Symptoms or Mild Manic Symptoms

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