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A Trial to Assess Brexpiprazole Versus Placebo for the Treatment of Acute Manic Episodes, Associated With Bipolar I Disorder

Primary Purpose

Bipolar I Disorder, Manic Episode

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Brexpiprazole
Placebo
Sponsored by
Otsuka Pharmaceutical Development & Commercialization, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar I Disorder focused on measuring Brexpiprazole, Bipolar, Manic episode

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female participants, ages 18 to 65 years, inclusive, at the time of informed consent.
  • Participants willing to discontinue all prohibited medications to meet protocol-required washouts prior to and during the trial period.
  • Participants with a Diagnostic & Statistical Manual on Mental Disorders, 5th Edition (DSM-5) diagnosis of bipolar I disorder displaying an acute manic episode with or without mixed features requiring hospitalization. Diagnosis confirmed by the MINI International Neuropsychiatric Interview (MINI) and a history of at least one previous manic episode with or without mixed features with manic symptoms of sufficient severity to require one of the following interventions: hospitalization or treatment with a mood stabilizer, or treatment with an antipsychotic agent. "Require" was defined as an intervention that occurred rather than one that was recommended.
  • Young-mania rating scale (YMRS) score of ≥ 24 at screening and baseline

Exclusion Criteria:

  • Sexually active male or women of childbearing potential (WOCBP) who did not agree to practice 2 different methods of birth control or remain abstinent during the trial and for 30 days after the last dose of investigational medicinal product (IMP).
  • Females who were breastfeeding and/or who had a positive pregnancy test result prior to receiving trial medication.
  • Participants considered unresponsive to clozapine or who were only responsive to clozapine.
  • Participants with a history of DSM-5 diagnosis other than bipolar I disorder, including schizophrenia, schizoaffective disorder, major depressive disorder, attention-deficit/hyperactivity disorder, delirium, dementia, amnestic, or other cognitive disorders. Also, participants with borderline, paranoid, histrionic, schizotypal, schizoid, or antisocial personality disorder. All other current diagnoses must have been discussed with the medical monitor.
  • Participants whose current manic episode had lasted for more than 4 weeks overall, or who had required hospitalization > 21 days for the current acute episode at the time of the screening visit, excluding hospitalization for psychosocial reasons.
  • Participant with manic symptoms better accounted for by another general medical condition or direct physiological effect of substance (for example, medications).
  • Participants who have had electroconvulsive treatment within the past 2 months.
  • Participants with a positive drug screen for cocaine or other illicit drugs.
  • Abnormal laboratory test results, vital signs or electrocardiogram findings, unless, based on investigator's judgment, the findings are not medically significant and would not impact the safety of the participant or the interpretation of the trial results.
  • Rapid cyclers with more than 6 episodes in the previous year.
  • Participants with hypothyroidism or hyperthyroidism (unless condition has been stabilized with medications for at least the past 90 days) or an abnormal result for free thyroxine at screening.
  • Participants with uncontrolled hypertension or symptomatic hypotension or orthostatic hypotension.
  • Participants with epilepsy or history of seizures.
  • Participants who participated in a clinical trial within the last 60 days or who participated in more than 2 clinical trials within the past year.
  • Use of psychotropic medications (other than benzodiazepines) within 7 days of the baseline YMRS.
  • Participants who currently had clinically significant neurological, hepatic, renal, metabolic, hematological, immunological, cardiovascular, pulmonary, or gastrointestinal disorders
  • Participants who received brexpiprazole in any prior clinical trial or currently taking commercially available brexpiprazole (Rexulti).

Sites / Locations

  • Atria Clinical Research
  • Woodland International Research Group, LLC
  • CiTrials
  • CNS Research Science Inc.
  • Apostle Clinical Trials
  • CNRI-San Diego
  • Artemis Institute for Clinical Research
  • CiTrials
  • Collaborative Neuroscience Network, LLC
  • Shreenath Clinical Service
  • Galiz Research
  • Research Centers of America LLC
  • South Florida Research Phase I-IV
  • Optimus U Corporation
  • Meridien Research
  • iResearch Atlanta, LLC
  • Uptown Research Institute LLC
  • Neuropsychiatric Research & Associates, LTD
  • Louisiana Clinical Research
  • Arch Clinical Trials, LLC
  • St Louis Clinical Trials LLC
  • Hassman Research Institute
  • CNS Research Science, Inc.
  • New Hope Clinical Research
  • University of Cincinnati Department of Psychiatry and Behavorial Science
  • InSite Clinical Research LLC
  • Pillar Clinical Research, LLC
  • Clinical Hospital Centre Rijeka
  • Communal Institution "Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov
  • SI ""Institute of Neurology, Psychiatry and Narcology of National Academy of Medical Sciences of Ukraine
  • Communal Establishment "Kherson Regional Psychiatric Hospital" of Kherson Regional Council
  • Kyiv Regional Medical Incorporation "Psychiatry", Center for Novel Treatment and Rehabilitation of Psychotic disorders
  • Communal Institution of Lviv Regional Council "Lviv Regional Clinical Psychiatric Hospital", Department #20
  • Communal Institution of Lviv Regional Council "Lviv Regional Clinical Psychiatric Hospital", Department #25
  • Communal Establishment "Odesa Regional Psychiatric Hospital #2
  • O.F. Maltsev Poltava Regional Psychiatric Hospital
  • Ternopil Regional Municipal Clinical Psychoneurolgical Hospital
  • Communal Establishment "Acad. O.I. Iushchenko Vinnytsia Regional Psychoneurologic Hospital"

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Brexpiprazole

Placebo

Arm Description

Participants received a starting dose of 2 milligrams (mg)/day brexpiprazole from Days 1 to 3, followed by titration to 3 mg/day on Day 4. Participants may have been titrated (or re-titrated) to a higher dose of brexpiprazole, up to a maximum of 4 mg/day, based on treatment response and at the investigator's discretion anytime at Day 7 or thereafter. Participants who were unable to tolerate their current dose could have been titrated down to a minimum of 2 mg/day any time after Day 4.

Matching placebo was administered in the same way as brexpiprazole to maintain the blind

Outcomes

Primary Outcome Measures

Change From Baseline In Young-Mania Rating Scale (YMRS) Score At Week 3
The YMRS was utilized to assess a participant's level of manic symptoms. It consists of 11 items: 1) elevated mood, 2) increased motor activity-energy, 3) sexual interest, 4) sleep, 5) irritability, 6) speech (rate and amount), 7) language-thought disorder, 8) content, 9) disruptive-aggressive behavior, 10) appearance, and 11) insight. Seven items are rated on a 0- to 4-scale, while four items (Items 5, 6, 8, and 9) are rated on a 0- to 8-scale with 0, 2, 4, 6, and 8 being the possible scores (twice the weight of the other items). For all items, 0 is the "best" rating and the highest score (4 or 8) is the 'worst' rating. The YMRS total score is the sum of ratings for all 11 items; therefore, possible total scores range from 0 to 60, with higher scores signifying more severe manic symptoms. Comparison between treatment groups was carried out using mixed-effect model repeated measure (MRMM).

Secondary Outcome Measures

Change From Baseline In Clinical Global Impression-Bipolar (CGI-BP) Severity Score In Mania At Week 3
The CGI-BP scale refers to the global impression of the participant with respect to bipolar disorder. The scale rates the participant's severity of illness (CGI-BP severity of illness: mania, depression, and overall bipolar illness) based on a 7-point scale: 1 = normal, not at all ill, 2 = minimally ill, 3 = mildly ill, 4 = moderately ill, 5 = markedly ill, 6 = severely ill, 7 = very severely ill.

Full Information

First Posted
August 4, 2017
Last Updated
February 3, 2020
Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.
Collaborators
H. Lundbeck A/S
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1. Study Identification

Unique Protocol Identification Number
NCT03257865
Brief Title
A Trial to Assess Brexpiprazole Versus Placebo for the Treatment of Acute Manic Episodes, Associated With Bipolar I Disorder
Official Title
A Multicenter, Randomized, Double-blind Trial of Brexpiprazole Versus Placebo for the Acute Treatment Manic Episodes, With or Without Mixed Features, Associated With Bipolar I Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Completed
Study Start Date
September 19, 2017 (Actual)
Primary Completion Date
January 22, 2019 (Actual)
Study Completion Date
January 22, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.
Collaborators
H. Lundbeck A/S

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
To demonstrate the efficacy of brexpiprazole for the acute treatment of manic episodes, with or without mixed features, in participants with a diagnosis of bipolar I disorder.
Detailed Description
A multicenter, randomized, double-blind trial of brexpiprazole versus placebo for the acute treatment of manic episodes, with or without mixed features, associated with bipolar I disorder. This study also demonstrated the safety and tolerability of brexpiprazole in the study population of males and females aged 18 to 65 years (inclusive, at time of consent).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar I Disorder, Manic Episode
Keywords
Brexpiprazole, Bipolar, Manic episode

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Participants received a dose of brexpiprazole or placebo for a maximum of 21 days and were evaluated throughout the duration of the study.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
333 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Brexpiprazole
Arm Type
Experimental
Arm Description
Participants received a starting dose of 2 milligrams (mg)/day brexpiprazole from Days 1 to 3, followed by titration to 3 mg/day on Day 4. Participants may have been titrated (or re-titrated) to a higher dose of brexpiprazole, up to a maximum of 4 mg/day, based on treatment response and at the investigator's discretion anytime at Day 7 or thereafter. Participants who were unable to tolerate their current dose could have been titrated down to a minimum of 2 mg/day any time after Day 4.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Matching placebo was administered in the same way as brexpiprazole to maintain the blind
Intervention Type
Drug
Intervention Name(s)
Brexpiprazole
Intervention Description
Brexpiprazole was administered orally with flexible dosing from 2 to 4 mg/day; titrated to a maximum of 4 mg/day for 3 weeks.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Administered orally daily for 3 weeks.
Primary Outcome Measure Information:
Title
Change From Baseline In Young-Mania Rating Scale (YMRS) Score At Week 3
Description
The YMRS was utilized to assess a participant's level of manic symptoms. It consists of 11 items: 1) elevated mood, 2) increased motor activity-energy, 3) sexual interest, 4) sleep, 5) irritability, 6) speech (rate and amount), 7) language-thought disorder, 8) content, 9) disruptive-aggressive behavior, 10) appearance, and 11) insight. Seven items are rated on a 0- to 4-scale, while four items (Items 5, 6, 8, and 9) are rated on a 0- to 8-scale with 0, 2, 4, 6, and 8 being the possible scores (twice the weight of the other items). For all items, 0 is the "best" rating and the highest score (4 or 8) is the 'worst' rating. The YMRS total score is the sum of ratings for all 11 items; therefore, possible total scores range from 0 to 60, with higher scores signifying more severe manic symptoms. Comparison between treatment groups was carried out using mixed-effect model repeated measure (MRMM).
Time Frame
Baseline, Week 3
Secondary Outcome Measure Information:
Title
Change From Baseline In Clinical Global Impression-Bipolar (CGI-BP) Severity Score In Mania At Week 3
Description
The CGI-BP scale refers to the global impression of the participant with respect to bipolar disorder. The scale rates the participant's severity of illness (CGI-BP severity of illness: mania, depression, and overall bipolar illness) based on a 7-point scale: 1 = normal, not at all ill, 2 = minimally ill, 3 = mildly ill, 4 = moderately ill, 5 = markedly ill, 6 = severely ill, 7 = very severely ill.
Time Frame
Baseline, Week 3

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female participants, ages 18 to 65 years, inclusive, at the time of informed consent. Participants willing to discontinue all prohibited medications to meet protocol-required washouts prior to and during the trial period. Participants with a Diagnostic & Statistical Manual on Mental Disorders, 5th Edition (DSM-5) diagnosis of bipolar I disorder displaying an acute manic episode with or without mixed features requiring hospitalization. Diagnosis confirmed by the MINI International Neuropsychiatric Interview (MINI) and a history of at least one previous manic episode with or without mixed features with manic symptoms of sufficient severity to require one of the following interventions: hospitalization or treatment with a mood stabilizer, or treatment with an antipsychotic agent. "Require" was defined as an intervention that occurred rather than one that was recommended. Young-mania rating scale (YMRS) score of ≥ 24 at screening and baseline Exclusion Criteria: Sexually active male or women of childbearing potential (WOCBP) who did not agree to practice 2 different methods of birth control or remain abstinent during the trial and for 30 days after the last dose of investigational medicinal product (IMP). Females who were breastfeeding and/or who had a positive pregnancy test result prior to receiving trial medication. Participants considered unresponsive to clozapine or who were only responsive to clozapine. Participants with a history of DSM-5 diagnosis other than bipolar I disorder, including schizophrenia, schizoaffective disorder, major depressive disorder, attention-deficit/hyperactivity disorder, delirium, dementia, amnestic, or other cognitive disorders. Also, participants with borderline, paranoid, histrionic, schizotypal, schizoid, or antisocial personality disorder. All other current diagnoses must have been discussed with the medical monitor. Participants whose current manic episode had lasted for more than 4 weeks overall, or who had required hospitalization > 21 days for the current acute episode at the time of the screening visit, excluding hospitalization for psychosocial reasons. Participant with manic symptoms better accounted for by another general medical condition or direct physiological effect of substance (for example, medications). Participants who have had electroconvulsive treatment within the past 2 months. Participants with a positive drug screen for cocaine or other illicit drugs. Abnormal laboratory test results, vital signs or electrocardiogram findings, unless, based on investigator's judgment, the findings are not medically significant and would not impact the safety of the participant or the interpretation of the trial results. Rapid cyclers with more than 6 episodes in the previous year. Participants with hypothyroidism or hyperthyroidism (unless condition has been stabilized with medications for at least the past 90 days) or an abnormal result for free thyroxine at screening. Participants with uncontrolled hypertension or symptomatic hypotension or orthostatic hypotension. Participants with epilepsy or history of seizures. Participants who participated in a clinical trial within the last 60 days or who participated in more than 2 clinical trials within the past year. Use of psychotropic medications (other than benzodiazepines) within 7 days of the baseline YMRS. Participants who currently had clinically significant neurological, hepatic, renal, metabolic, hematological, immunological, cardiovascular, pulmonary, or gastrointestinal disorders Participants who received brexpiprazole in any prior clinical trial or currently taking commercially available brexpiprazole (Rexulti).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Matthew Leoni, M.D.
Organizational Affiliation
Otsuka Pharmaceutical Development & Commercialization, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Atria Clinical Research
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72209
Country
United States
Facility Name
Woodland International Research Group, LLC
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72211
Country
United States
Facility Name
CiTrials
City
Bellflower
State/Province
California
ZIP/Postal Code
90706
Country
United States
Facility Name
CNS Research Science Inc.
City
Cerritos
State/Province
California
ZIP/Postal Code
90703
Country
United States
Facility Name
Apostle Clinical Trials
City
Long Beach
State/Province
California
ZIP/Postal Code
90813
Country
United States
Facility Name
CNRI-San Diego
City
San Diego
State/Province
California
ZIP/Postal Code
92102
Country
United States
Facility Name
Artemis Institute for Clinical Research
City
San Diego
State/Province
California
ZIP/Postal Code
92103
Country
United States
Facility Name
CiTrials
City
Santa Ana
State/Province
California
ZIP/Postal Code
92705
Country
United States
Facility Name
Collaborative Neuroscience Network, LLC
City
Torrance
State/Province
California
ZIP/Postal Code
90502
Country
United States
Facility Name
Shreenath Clinical Service
City
Yorba Linda
State/Province
California
ZIP/Postal Code
92886
Country
United States
Facility Name
Galiz Research
City
Hialeah
State/Province
Florida
ZIP/Postal Code
33016
Country
United States
Facility Name
Research Centers of America LLC
City
Hollywood
State/Province
Florida
ZIP/Postal Code
33024
Country
United States
Facility Name
South Florida Research Phase I-IV
City
Miami Springs
State/Province
Florida
ZIP/Postal Code
33166
Country
United States
Facility Name
Optimus U Corporation
City
Miami
State/Province
Florida
ZIP/Postal Code
33125
Country
United States
Facility Name
Meridien Research
City
Orlando
State/Province
Florida
ZIP/Postal Code
32801
Country
United States
Facility Name
iResearch Atlanta, LLC
City
Decatur
State/Province
Georgia
ZIP/Postal Code
30030
Country
United States
Facility Name
Uptown Research Institute LLC
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60640
Country
United States
Facility Name
Neuropsychiatric Research & Associates, LTD
City
Winfield
State/Province
Illinois
ZIP/Postal Code
60190
Country
United States
Facility Name
Louisiana Clinical Research
City
Shreveport
State/Province
Louisiana
ZIP/Postal Code
71101
Country
United States
Facility Name
Arch Clinical Trials, LLC
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63118
Country
United States
Facility Name
St Louis Clinical Trials LLC
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63141
Country
United States
Facility Name
Hassman Research Institute
City
Berlin
State/Province
New Jersey
ZIP/Postal Code
08009
Country
United States
Facility Name
CNS Research Science, Inc.
City
Jamaica
State/Province
New York
ZIP/Postal Code
11432
Country
United States
Facility Name
New Hope Clinical Research
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28211
Country
United States
Facility Name
University of Cincinnati Department of Psychiatry and Behavorial Science
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45219
Country
United States
Facility Name
InSite Clinical Research LLC
City
DeSoto
State/Province
Texas
ZIP/Postal Code
75115
Country
United States
Facility Name
Pillar Clinical Research, LLC
City
Richardson
State/Province
Texas
ZIP/Postal Code
75080
Country
United States
Facility Name
Clinical Hospital Centre Rijeka
City
Rijeka
ZIP/Postal Code
51000
Country
Croatia
Facility Name
Communal Institution "Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov
City
Dnipro
ZIP/Postal Code
49005
Country
Ukraine
Facility Name
SI ""Institute of Neurology, Psychiatry and Narcology of National Academy of Medical Sciences of Ukraine
City
Kharkiv
ZIP/Postal Code
61068
Country
Ukraine
Facility Name
Communal Establishment "Kherson Regional Psychiatric Hospital" of Kherson Regional Council
City
Kherson
ZIP/Postal Code
73488
Country
Ukraine
Facility Name
Kyiv Regional Medical Incorporation "Psychiatry", Center for Novel Treatment and Rehabilitation of Psychotic disorders
City
Kyiv
ZIP/Postal Code
04080
Country
Ukraine
Facility Name
Communal Institution of Lviv Regional Council "Lviv Regional Clinical Psychiatric Hospital", Department #20
City
Lviv
ZIP/Postal Code
79021
Country
Ukraine
Facility Name
Communal Institution of Lviv Regional Council "Lviv Regional Clinical Psychiatric Hospital", Department #25
City
Lviv
ZIP/Postal Code
79021
Country
Ukraine
Facility Name
Communal Establishment "Odesa Regional Psychiatric Hospital #2
City
Oleksandrivka
ZIP/Postal Code
67513
Country
Ukraine
Facility Name
O.F. Maltsev Poltava Regional Psychiatric Hospital
City
Poltava
ZIP/Postal Code
36013
Country
Ukraine
Facility Name
Ternopil Regional Municipal Clinical Psychoneurolgical Hospital
City
Ternopil'
ZIP/Postal Code
46027
Country
Ukraine
Facility Name
Communal Establishment "Acad. O.I. Iushchenko Vinnytsia Regional Psychoneurologic Hospital"
City
Vinnytsia
ZIP/Postal Code
21005
Country
Ukraine

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Anonymized Individual participant data (IPD) that underlie the results of this study will be shared with researchers to achieve aims pre-specified in a methodologically sound research proposal. Small studies with less than 25 participants are excluded from data sharing.
IPD Sharing Time Frame
Data will be available after marketing approval in global markets, or beginning 1-3 years following article publication. There is no end date to the availability of the data.
IPD Sharing Access Criteria
Otsuka will share data on an Otsuka-owned remotely accessible data sharing platform with Python and R analytical software. Research requests should be directed to clinicaltransparency@Otsuka-us.com

Learn more about this trial

A Trial to Assess Brexpiprazole Versus Placebo for the Treatment of Acute Manic Episodes, Associated With Bipolar I Disorder

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