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DB/Maintenance of Equetro (Carbamazepine) in Children With Acute Manic or Mixed Bipolar 1 Disorder

Primary Purpose

Bipolar Disorder

Status
Terminated
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Carbamazepine
Placebo
Sponsored by
Validus Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Disorder focused on measuring Carbamazepine, Equetro, Bipolar I Disorder, Bipolar I Disorder in Children

Eligibility Criteria

10 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Written, signed and dated informed consent from subject, parents or legal guardians.
  • Subject must be willing to participate for the duration of the study (8-10 months)
  • Subject must meet DSM-V criteria for a primary diagnosis of bipolar I disorder.
  • MINI KID administered and ruled out other psychiatric diagnosis.
  • ADHD Rating Scale-IV is ruled negative.
  • YMRS Score 20 or greater
  • CGI-S score of 4 or greater
  • CGI-I Global Evaluation score of 4 or less
  • Must be aged between 10 and 17 years
  • Male and non-pregnant, non-lactating females who agree to comply with contraceptive requirements
  • Functioning at an age appropriate level intellectually as deemed by the Investigator
  • Subject has no co-morbid conditions that would affect efficacy, safety or tolerability or in any way interfere with the subject's participation in the study
  • Subject, parents and legal guardians are able to and willing to comply with study procedures and restrictions
  • Must have a satisfactory medical assessment with no clinically significant abnormalities
  • Able to avoid grapefruit and grapefruit juice for the duration of the study

Exclusion Criteria:

  • Subject has a current controlled or uncontrolled co-morbid psychiatric that could interfere with clinical assessments or study conduct.
  • Naive subjects whose symptoms are being controlled on their prescribed medication(s) will not be eligible to participate.
  • History of lack of therapeutic response to an adequate trial of carbamazepine to treat bipolar I disorder
  • Believed by the Investigator to be acutely at risk for suicidal or violent behavior towards him/her or others, or a history of a suicide attempt requiring general medical intervention
  • Subject's bipolar diagnosis is believed secondary to traumatic injury or another general medical condition.
  • A history or known presence of clinically significant cardiovascular, hepatic, hematological, immunological (including human immunodeficiency virus, gastro-intestinal or renal disease or any other unstable medical illness that could affect the action, absorption or disposition of the investigational product, or clinical or laboratory assessments
  • A history of aplastic anemia, agranulocytosis or bone marrow depression
  • A history of seizure disorder, other than a single childhood febrile seizure\
  • A history of severe, unstable asthma
  • Currently hospitalized for the treatment of psychiatric symptoms.
  • Presence of any mental disorder due to a general medical condition
  • Presence of abnormal thyroid function that is not adequately treated in the opinion of the Investigator
  • Use of ECT, any investigational drug, CYP450 3A4 inhibitors, antidepressants, anxiolytics, sedative hypnotics, antipsychotics, mood stabilizers, ADHD medications, or clozapine in a specified time period prior to the initiation of the study
  • Use of any nutraceutical to include, but not limited to any over the counter herbal preparations e.g. Gingko Biloba, St John's Wort, Kava Kava and Ephedra.
  • Positive urine drug screen
  • History of alcohol or other substance abuse or dependence as defined by DSM-V (except caffeine or nicotine) within the last 6months
  • Female subjects with a positive pregnancy test or who are pregnant, lactating, who are less than 6 months post partum, or who cannot be relied upon to use adequate birth control
  • Subjects who have previously been enrolled in the Phase IV Multi-Center , Open-Label Safety and Effectiveness Study of Extended-Release Carbamazepine in the Treatment of Acute Manic or Mixed Bipolar I Disorder and subsequently withdrawn
  • Subjects with a body weight of ≤65kg
  • Family of investigational site staff

Sites / Locations

  • APG Research, LLC
  • Kennedy Krieger Institute
  • PsychCare Consultants
  • Red Oak Psychiatry Associates, PA

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Equetro

Placebo

Arm Description

200-1200 mg of Equetro (carbamazepine) by mouth given in divided doses in the morning and in the evening. Dosage is titrated in 200 mg increments weekly as needed according to subject response.

Placebo dosage to match the active Equetro treatment given in 2 daily doses in the morning and in the evening.

Outcomes

Primary Outcome Measures

Dose tolerance and safety of Equetro based on occurrence of adverse events, lab values, physical exams, vital signs, ECG's, and trough serum levels of study medications

Secondary Outcome Measures

Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured using the Young Mania Rating Score (YMRS)
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured using Clinical Global Impressions - Improvement and Severity (CGI-I, CGI-S)
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured using the Children's Depression Rating Scale - Revised (CDRS-R)
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured by assessing the subject's manic episodes throughout the study period
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured by assessing the subject's weekly use of study medication
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured by assessing the duration of subject's nighttime sleep monitored using a diary or e-diary

Full Information

First Posted
November 24, 2015
Last Updated
March 1, 2023
Sponsor
Validus Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02623504
Brief Title
DB/Maintenance of Equetro (Carbamazepine) in Children With Acute Manic or Mixed Bipolar 1 Disorder
Official Title
A Double Blind Study To Evaluate the Dose Tolerance and Safety of Equetro (Carbamazepine) Versus Placebo Followed by a Long-Term Maintenance in Children and Adolescents Aged 10-17 Years With Acute Manic or Mixed Bipolar I Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Terminated
Why Stopped
No apparent therapeutic effects that was superior to placebo
Study Start Date
October 24, 2016 (Actual)
Primary Completion Date
November 1, 2018 (Actual)
Study Completion Date
November 1, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Validus Pharmaceuticals

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A phase 4 unequal randomization, double blind study to evaluate the dose tolerance and safety of extended release Equetro (carbamazepine) versus placebo followed by an Open label and long term maintenance treatment in children and adolescents aged 10-17 years diagnosed with acute manic or mixed Bipolar I Disorder
Detailed Description
The primary objective of this study is to evaluate under double blind conditions the dose tolerance and safety of extended release Equetro (carbamazepine) versus placebo followed by an open label and long term maintenance treatment on extended release Equetro in children and adolescents aged 10-17 year diagnosed with acute manic or mixed bipolar I disorder. The safety evaluations will be based on the occurrence of treatment-emergent adverse events, laboratory values, physical examination, vital signs ECG and trough serum level of study medication. The secondary objective is to evaluate under double blind conditions the efficacy of extended release Equetro versus placebo followed by an open label and long term maintenance treatment on extended release Equetro in children and Adolescents Aged 10-17 years diagnosed with acute manic or mixed Bipolar I disorder. Efficacy evaluations will be based on the measures of YMRS, CGI-S, CGI-I, CDRS-R. Manic episodes over double blind and open label periods will comprise the use of study medication and duration of night time sleep as monitored using a daily diary. Subject's will be enrolled in the double blind period for two months and evaluated on a weekly basis. Once completing the db phase they will continue on Equetro for long term maintenance for an additional six months. Placebo subject will have the opportunity to continue for another eight months in the study. The first two months will be the titration period as was done in the db phase and then they will have the option to continue in the study for an open long term maintenance for and additional 6 months. During the maintenance period subjects will be evaluated for safety and efficacy on a monthly basis. At the end of the study there will be a 30 day follow-up.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Disorder
Keywords
Carbamazepine, Equetro, Bipolar I Disorder, Bipolar I Disorder in Children

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Equetro
Arm Type
Experimental
Arm Description
200-1200 mg of Equetro (carbamazepine) by mouth given in divided doses in the morning and in the evening. Dosage is titrated in 200 mg increments weekly as needed according to subject response.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo dosage to match the active Equetro treatment given in 2 daily doses in the morning and in the evening.
Intervention Type
Drug
Intervention Name(s)
Carbamazepine
Other Intervention Name(s)
Equetro
Intervention Description
200-1200 mg by mouth daily given in divided doses in the morning and the evening. Doses are titrated weekly in 200 mg increments based upon subject's response.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Dosage to match active treatment by mouth twice daily in the morning and in the evening.
Primary Outcome Measure Information:
Title
Dose tolerance and safety of Equetro based on occurrence of adverse events, lab values, physical exams, vital signs, ECG's, and trough serum levels of study medications
Time Frame
Duration of the study (8-10 months)
Secondary Outcome Measure Information:
Title
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured using the Young Mania Rating Score (YMRS)
Time Frame
Weekly during the double blind period (8 weeks), monthly during the maintenance period (6-8 months)
Title
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured using Clinical Global Impressions - Improvement and Severity (CGI-I, CGI-S)
Time Frame
Weekly during the double blind period (8 weeks), monthly during the maintenance period (6-8 months)
Title
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured using the Children's Depression Rating Scale - Revised (CDRS-R)
Time Frame
Weekly during the double blind period, monthly during the maintenance period
Title
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured by assessing the subject's manic episodes throughout the study period
Time Frame
Duration of the study (8-10 months)
Title
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured by assessing the subject's weekly use of study medication
Time Frame
Weekly for the duration of the study (8-10 months)
Title
Efficacy of Equetro in the treatment of children and adolescents aged 10-17 years with acute manic or mixed bipolar I disorder measured by assessing the duration of subject's nighttime sleep monitored using a diary or e-diary
Time Frame
Weekly for the duration of the study (8-10 months)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written, signed and dated informed consent from subject, parents or legal guardians. Subject must be willing to participate for the duration of the study (8-10 months) Subject must meet DSM-V criteria for a primary diagnosis of bipolar I disorder. MINI KID administered and ruled out other psychiatric diagnosis. ADHD Rating Scale-IV is ruled negative. YMRS Score 20 or greater CGI-S score of 4 or greater CGI-I Global Evaluation score of 4 or less Must be aged between 10 and 17 years Male and non-pregnant, non-lactating females who agree to comply with contraceptive requirements Functioning at an age appropriate level intellectually as deemed by the Investigator Subject has no co-morbid conditions that would affect efficacy, safety or tolerability or in any way interfere with the subject's participation in the study Subject, parents and legal guardians are able to and willing to comply with study procedures and restrictions Must have a satisfactory medical assessment with no clinically significant abnormalities Able to avoid grapefruit and grapefruit juice for the duration of the study Exclusion Criteria: Subject has a current controlled or uncontrolled co-morbid psychiatric that could interfere with clinical assessments or study conduct. Naive subjects whose symptoms are being controlled on their prescribed medication(s) will not be eligible to participate. History of lack of therapeutic response to an adequate trial of carbamazepine to treat bipolar I disorder Believed by the Investigator to be acutely at risk for suicidal or violent behavior towards him/her or others, or a history of a suicide attempt requiring general medical intervention Subject's bipolar diagnosis is believed secondary to traumatic injury or another general medical condition. A history or known presence of clinically significant cardiovascular, hepatic, hematological, immunological (including human immunodeficiency virus, gastro-intestinal or renal disease or any other unstable medical illness that could affect the action, absorption or disposition of the investigational product, or clinical or laboratory assessments A history of aplastic anemia, agranulocytosis or bone marrow depression A history of seizure disorder, other than a single childhood febrile seizure\ A history of severe, unstable asthma Currently hospitalized for the treatment of psychiatric symptoms. Presence of any mental disorder due to a general medical condition Presence of abnormal thyroid function that is not adequately treated in the opinion of the Investigator Use of ECT, any investigational drug, CYP450 3A4 inhibitors, antidepressants, anxiolytics, sedative hypnotics, antipsychotics, mood stabilizers, ADHD medications, or clozapine in a specified time period prior to the initiation of the study Use of any nutraceutical to include, but not limited to any over the counter herbal preparations e.g. Gingko Biloba, St John's Wort, Kava Kava and Ephedra. Positive urine drug screen History of alcohol or other substance abuse or dependence as defined by DSM-V (except caffeine or nicotine) within the last 6months Female subjects with a positive pregnancy test or who are pregnant, lactating, who are less than 6 months post partum, or who cannot be relied upon to use adequate birth control Subjects who have previously been enrolled in the Phase IV Multi-Center , Open-Label Safety and Effectiveness Study of Extended-Release Carbamazepine in the Treatment of Acute Manic or Mixed Bipolar I Disorder and subsequently withdrawn Subjects with a body weight of ≤65kg Family of investigational site staff
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Findling, MD
Organizational Affiliation
John Hopkins - Kennedy Krieger Research
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Lawrence Ginsberg, MD
Organizational Affiliation
Red Oak Psychiatry
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Morteza Nadjafi, MD
Organizational Affiliation
APG Research
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mohd Azfar Malik, MD
Organizational Affiliation
Psych Care Consultants Research
Official's Role
Principal Investigator
Facility Information:
Facility Name
APG Research, LLC
City
Orlando
State/Province
Florida
ZIP/Postal Code
32803
Country
United States
Facility Name
Kennedy Krieger Institute
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21205
Country
United States
Facility Name
PsychCare Consultants
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63128
Country
United States
Facility Name
Red Oak Psychiatry Associates, PA
City
Houston
State/Province
Texas
ZIP/Postal Code
77090
Country
United States

12. IPD Sharing Statement

Learn more about this trial

DB/Maintenance of Equetro (Carbamazepine) in Children With Acute Manic or Mixed Bipolar 1 Disorder

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