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Ziprasidone in Bipolar Disorder With Comorbid Lifetime Panic or Generalized Anxiety Disorder(GAD) (Pfizer Anxiety)

Primary Purpose

Bipolar Disorder, Panic Disorder, Generalized Anxiety Disorder

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Ziprasidone
Placebo
Sponsored by
VA Palo Alto Health Care System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Disorder focused on measuring Bipolar disorder, Anxiety, Panic, GAD, Generalized Anxiety Disorder

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Subjects must at least age of 18 years of age and not older than 65.
  • Subjects must have lifetime bipolar I, II, or NOS disorder as defined by DSM-IV TR criteria (26).
  • Subjects must have lifetime panic disorder or generalized anxiety disorder (GAD) as defined by DSM-IV criteria (except clause "does not occur exclusively during a mood disorder" of Criterion F for GAD).
  • Subjects' bipolar symptoms must be no more than moderate in severity, defined as a CGI-BP< 4 (27).
  • Subjects' anxiety symptoms must be at least moderate in severity, defined as a CGI-S > 4 (28).
  • Subjects must not be receiving regular mood stabilizing, antidepressant, antipsychotic, or anxiolytic medication for at least one week prior to baseline. Patients receiving fluoxetine or depot antipsychotics should be off these medications for at least four weeks prior to baseline.
  • 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, barrier methods, intrauterine device) for at least one month prior to study entry and throughout the study.

Exclusion Criteria:

  • Subjects who do not have lifetime bipolar disorder by DSM-IV-TR criteria (26).
  • Subjects who do not have lifetime panic disorder or generalized anxiety disorder by DSM-IV-TR criteria (26).
  • Subjects who are receiving treatment with an anti-manic or mood stabilizing medication (lithium, valproate, carbamazepine, or an antipsychotic), and in the investigators' judgment, require ongoing treatment with that medication.
  • Subjects whose bipolar symptoms are presently more than moderately severe (CGI-BP > 5) (27).
  • Subjects whose anxiety symptoms are presently less than moderately severe (CGI-S < 3) (28).
  • Subjects with clinically significant suicidal or homicidal ideation.
  • Subjects with a current DSM-IV TR Axis I diagnosis of delirium, dementia, amnesia, or other cognitive disorders; a DSM-IV TR diagnosis of a substance dependence disorder within the past six months; a lifetime DSM-IV TR psychotic disorder (e.g., schizophrenia or schizoaffective disorder).
  • Subjects with serious general medical illnesses including hepatic, renal, respiratory, cardiovascular, endocrine, neurological, or hematological disease as determined by the clinical judgment of the clinical investigator. Subjects with hypo- or hyperthyroidism unless stabilized on thyroid replacement > 3 months.
  • Subjects with a clinically significant abnormality in their pre-study physical exam, vital signs, EKG, or laboratory tests.
  • Subjects who are allergic to or who have demonstrated hypersensitivity or intolerance to ziprasidone.
  • 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.
  • A patient with diabetes mellitus (DM) fulfilling one of the following criteria:

    • Unstable DM defined as enrollment glycosylated hemoglobin (HbAlc) >8.5%
    • Admitted to hospital for treatment of DM or DM related illness within the past 12 weeks
    • Not under physician care for DM
    • Physician responsible for patient's DM care has not indicated that the patient's DM is controlled
    • Physician responsible for patient's DM care has not approved the patient's participation in the study
    • Has not been on the same dose of oral hypoglycemic drug(s) and/or diet for the 4 weeks before randomization. For thiazolidinediones(glitazones)this period should not be less than 8 weeks before randomization.
    • Taking insulin whose daily dose on one occasion in the past 4 weeks has been more than 10% above or below their mean dose in the preceding 4 weeks

Note: If a patient with DM meets one of these criteria, the patient is to be excluded even if the treating physician believes that the patient is stable and can participate in the study

Sites / Locations

  • VA Palo Alto Health Care System & Stanford School of Medicine
  • University of South Florida Institute for Research in Psychiatry
  • Lindner Center of Hope University of Cincinnati Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

ziprasidone

Placebo

Arm Description

Outcomes

Primary Outcome Measures

CGI-21
The primary outcome measure is the Clinician Global Improvement Scale for Anxiety Symptoms (CGI-21)

Secondary Outcome Measures

Sheehan Panic Disorder Scale (SPS), (HAM-A), Young Mania Rating Scale (YMRS), Sheehan Irritability Scale (SIS), Rapid Ideas Scale RISC, MADRS, PGI-21 symptoms, CGI-BP, Family Impact Scale (FIS), Sheehan Disability Scale (SDS).
Sheehan Panic Disorder Scale (SPS), (HAM-A), Young Mania Rating Scale (YMRS), Sheehan Irritability Scale (SIS), Rapid Ideas Scale RISC, MADRS, PGI-21 for anxiety symptoms, CGI-BP, Family Impact Scale (FIS), Sheehan Disability Scale (SDS).

Full Information

First Posted
April 16, 2010
Last Updated
March 16, 2012
Sponsor
VA Palo Alto Health Care System
Collaborators
Pfizer, University of South Florida, Lindner Center of HOPE
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1. Study Identification

Unique Protocol Identification Number
NCT01172652
Brief Title
Ziprasidone in Bipolar Disorder With Comorbid Lifetime Panic or Generalized Anxiety Disorder(GAD)
Acronym
Pfizer Anxiety
Official Title
A Randomized, Double-Blind, Placebo-Controlled Study of Ziprasidone in Bipolar Disorder With Comorbid Lifetime Panic or Generalized Anxiety Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
March 2012
Overall Recruitment Status
Completed
Study Start Date
April 2010 (undefined)
Primary Completion Date
October 2011 (Actual)
Study Completion Date
October 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
VA Palo Alto Health Care System
Collaborators
Pfizer, University of South Florida, Lindner Center of HOPE

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The specific aim of this study is to evaluate the efficacy, tolerability, and safety of ziprasidone monotherapy in comparison to placebo in the treatment of ambulatory bipolar disorder with co-morbid lifetime panic disorder or generalized anxiety disorder and current at least moderately severe anxiety.
Detailed Description
This is a randomized, double-blind, placebo controlled, parallel-group, 8-week trial of ziprasidone compared to placebo in outpatient subjects with a lifetime bipolar I, II, or NOS disorder, a lifetime panic or generalized anxiety disorder, and current diagnosis at least moderately severe anxiety symptoms. Approximately 50 subjects will be randomized. Subjects will be randomized to ziprasidone or placebo in a 1:1 ratio. No concomitant psychotropic medication will be allowed throughout the study except for prn lorazepam during the first two weeks for the management of affective and anxiety symptoms, prn zolpidem and zaleplon for the management of insomnia and benztropine for the management of EPS. Throughout the study, psychiatric scales will be used to assess psychiatric symptoms and the presence of treatment-emergent adverse events will be monitored and recorded.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Disorder, Panic Disorder, Generalized Anxiety Disorder
Keywords
Bipolar disorder, Anxiety, Panic, GAD, Generalized Anxiety Disorder

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
49 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ziprasidone
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Intervention Type
Drug
Intervention Name(s)
Ziprasidone
Other Intervention Name(s)
Geodon, Zeldox
Intervention Description
The minimum dose during study participation will be 40 mg/day, and the maximum dose allowed will be 160 mg/day.
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
sugar pill
Intervention Description
Inactive control
Primary Outcome Measure Information:
Title
CGI-21
Description
The primary outcome measure is the Clinician Global Improvement Scale for Anxiety Symptoms (CGI-21)
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Sheehan Panic Disorder Scale (SPS), (HAM-A), Young Mania Rating Scale (YMRS), Sheehan Irritability Scale (SIS), Rapid Ideas Scale RISC, MADRS, PGI-21 symptoms, CGI-BP, Family Impact Scale (FIS), Sheehan Disability Scale (SDS).
Description
Sheehan Panic Disorder Scale (SPS), (HAM-A), Young Mania Rating Scale (YMRS), Sheehan Irritability Scale (SIS), Rapid Ideas Scale RISC, MADRS, PGI-21 for anxiety symptoms, CGI-BP, Family Impact Scale (FIS), Sheehan Disability Scale (SDS).
Time Frame
8 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Subjects must at least age of 18 years of age and not older than 65. Subjects must have lifetime bipolar I, II, or NOS disorder as defined by DSM-IV TR criteria (26). Subjects must have lifetime panic disorder or generalized anxiety disorder (GAD) as defined by DSM-IV criteria (except clause "does not occur exclusively during a mood disorder" of Criterion F for GAD). Subjects' bipolar symptoms must be no more than moderate in severity, defined as a CGI-BP< 4 (27). Subjects' anxiety symptoms must be at least moderate in severity, defined as a CGI-S > 4 (28). Subjects must not be receiving regular mood stabilizing, antidepressant, antipsychotic, or anxiolytic medication for at least one week prior to baseline. Patients receiving fluoxetine or depot antipsychotics should be off these medications for at least four weeks prior to baseline. 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, barrier methods, intrauterine device) for at least one month prior to study entry and throughout the study. Exclusion Criteria: Subjects who do not have lifetime bipolar disorder by DSM-IV-TR criteria (26). Subjects who do not have lifetime panic disorder or generalized anxiety disorder by DSM-IV-TR criteria (26). Subjects who are receiving treatment with an anti-manic or mood stabilizing medication (lithium, valproate, carbamazepine, or an antipsychotic), and in the investigators' judgment, require ongoing treatment with that medication. Subjects whose bipolar symptoms are presently more than moderately severe (CGI-BP > 5) (27). Subjects whose anxiety symptoms are presently less than moderately severe (CGI-S < 3) (28). Subjects with clinically significant suicidal or homicidal ideation. Subjects with a current DSM-IV TR Axis I diagnosis of delirium, dementia, amnesia, or other cognitive disorders; a DSM-IV TR diagnosis of a substance dependence disorder within the past six months; a lifetime DSM-IV TR psychotic disorder (e.g., schizophrenia or schizoaffective disorder). Subjects with serious general medical illnesses including hepatic, renal, respiratory, cardiovascular, endocrine, neurological, or hematological disease as determined by the clinical judgment of the clinical investigator. Subjects with hypo- or hyperthyroidism unless stabilized on thyroid replacement > 3 months. Subjects with a clinically significant abnormality in their pre-study physical exam, vital signs, EKG, or laboratory tests. Subjects who are allergic to or who have demonstrated hypersensitivity or intolerance to ziprasidone. 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. A patient with diabetes mellitus (DM) fulfilling one of the following criteria: Unstable DM defined as enrollment glycosylated hemoglobin (HbAlc) >8.5% Admitted to hospital for treatment of DM or DM related illness within the past 12 weeks Not under physician care for DM Physician responsible for patient's DM care has not indicated that the patient's DM is controlled Physician responsible for patient's DM care has not approved the patient's participation in the study Has not been on the same dose of oral hypoglycemic drug(s) and/or diet for the 4 weeks before randomization. For thiazolidinediones(glitazones)this period should not be less than 8 weeks before randomization. Taking insulin whose daily dose on one occasion in the past 4 weeks has been more than 10% above or below their mean dose in the preceding 4 weeks Note: If a patient with DM meets one of these criteria, the patient is to be excluded even if the treating physician believes that the patient is stable and can participate in the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Trisha Suppes, MD, PhD
Organizational Affiliation
VA Palo Alto Health Care System & Stanford School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
VA Palo Alto Health Care System & Stanford School of Medicine
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Name
University of South Florida Institute for Research in Psychiatry
City
Tampa
State/Province
Florida
ZIP/Postal Code
33613
Country
United States
Facility Name
Lindner Center of Hope University of Cincinnati Medical Center
City
Mason
State/Province
Ohio
ZIP/Postal Code
45040
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
24345758
Citation
Suppes T, McElroy SL, Sheehan DV, Hidalgo RB, Cosgrove VE, Gwizdowski IS, Feldman NS. A randomized, double-blind, placebo-controlled study of ziprasidone monotherapy in bipolar disorder with co-occurring lifetime panic or generalized anxiety disorder. J Clin Psychiatry. 2014 Jan;75(1):77-84. doi: 10.4088/JCP.12m08297.
Results Reference
derived

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Ziprasidone in Bipolar Disorder With Comorbid Lifetime Panic or Generalized Anxiety Disorder(GAD)

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