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Study of the Impact of Aripiprazole (Abilify®) Once Monthly Versus Standard of Care Oral Antipsychotic Medications on Changes in Brain Structure and Metabolism

Primary Purpose

Schizophrenia

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Standard of Care Oral antipsychotics
IM aripiprazole once monthly
No Treatment
Sponsored by
Deborah Yurgelun-Todd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Schizophrenia focused on measuring MRI, Imaging, Antipsychotic

Eligibility Criteria

18 Years - 35 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria for All Subjects

  • Are able to provide written informed consent.
  • Are male and female subjects 18 to 35 years of age, inclusive, at time of informed consent.

Inclusion Criteria for Subjects with Schizophrenia

  • Have a current diagnosis of schizophrenia as defined by DSM IV-TR criteria and a history of the illness for at least 1 year prior to screening and at least two prior psychotic episodes based on medical records or a qualified and reliable health care provider.
  • Require, in the investigator's judgment, chronic treatment with an antipsychotic medication.
  • Are able to understand the nature of the study and follow protocol requirements, including the prescribed dosage regimens, tablet ingestion, IM depot injection, and discontinuation of prohibited concomitant medications, read and understand the written word in order to complete subject-reported outcomes measures, and be reliably rated on assessment scales.
  • Are male and female subjects who are surgically sterile (i.e., have undergone orchiectomy or hysterectomy, respectively; female subjects who have been postmenopausal for at least 12 consecutive months; or male and female subjects who agree to remain abstinent or to practice double barrier forms of birth control from trial screening through 30 days (for females) and 90 days (for males) from the last dose of IMP for SOC oral antipsychotics and 150 days for females and 180 days for males for aripiprazole depot. If employing birth control, two of the following precautions must be used: vasectomy, tubal ligation, vaginal diaphragm, intrauterine device, birth control pill, birth control implant, birth control depot injections, condom, or sponge with spermicide.

Exclusion Criteria All Subjects

  • Presence of any metal implants, pacemakers, unremovable prosthetic device, or other device or situation that may preclude imaging
  • History of a head injury with loss of consciousness > 5 minutes
  • Has a significant medical condition that would expose the subject to undue risk or interfere with study assessments.

Exclusion Criteria for Subjects with Schizophrenia

  • Has a current DSM-IV-TR diagnosis other than schizophrenia, including schizophreniform disorder, schizoaffective disorder, major depressive disorder, bipolar disorder, delirium, dementia, amnestic or other cognitive disorders. Also excluded are subjects with borderline, paranoid, histrionic, schizotypal, schizoid, or antisocial personality disorder.
  • Is considered resistant/refractory to antipsychotic treatment by history (failed two prior antipsychotic medication trials) or response only to clozapine.
  • Has a significant risk of violent behavior or a significant risk of committing suicide based on history or investigator's discretion.
  • Has met DSM-IV-TR criteria for any significant substance use disorder within 3 months prior to screening, excluding caffeine, nicotine, or marijuana.
  • Is known to be allergic, intolerant, or unresponsive to prior treatment with aripiprazole or other quinolinones, or hypersensitivity to antipsychotic agents, including aripiprazole.
  • Has a history of neuroleptic malignant syndrome or clinically significant tardive dyskinesia at screening per the investigator's discretion.
  • Has a history of seizures or any other medical condition that would expose the subject to undue risk or interfere with study assessments.
  • Is involuntarily incarcerated.
  • Has undergone electroconvulsive therapy in the 2 years prior to enrollment in the study.
  • Has used an investigational agent or has participated in a clinical study with aripiprazole IM depot or any other antipsychotic depot preparation within 30 days of screening.
  • Has clinically significant abnormalities in laboratory test results, vital signs, or ECG results.
  • Requires more than one benzodiazepine beyond screening (e.g., lorazepam and oxazepam).
  • Fails to washout from prohibited concomitant medications, including the use of or CYP3A4 inducers, a second antipsychotic, antidepressants (including monoamine oxidase inhibitors), and mood stabilizers.

Sites / Locations

  • University of Utah

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Other

Active Comparator

Active Comparator

Arm Label

Healthy Control

Individuals with Schizophrenia (Group A)

Individuals with Schizophrenia (Group B)

Arm Description

Outcomes

Primary Outcome Measures

Number of Participants With Changes in Fractional Anisotropy (FA)
To determine if there are differences in prefrontal white matter fractional anisotropy (FA) in subjects with schizophrenia from baseline at 12 months of treatment with aripiprazole (Abilify®) once monthly compared with standard of care (SOC) oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI (Geodon®)).

Secondary Outcome Measures

Changes in Gamma Aminobutyric Acid (GABA)
To determine if proton metabolites, specifically gamma aminobutyric acid (GABA), glutamine, and glutamate, are altered in subjects with schizophrenia after 6 and 12 months of treatment with aripiprazole (Abilify®) once monthly compared with SOC oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI (Geodon®)).
Changes in Regional White Matter and Gray Matter Volume
To determine if there are differences in regional white matter and gray matter volume in subjects with schizophrenia after 6 and 12 months of treatment with aripiprazole (Abilify®) once monthly compared with SOC oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI (Geodon®)).

Full Information

First Posted
September 3, 2014
Last Updated
January 26, 2021
Sponsor
Deborah Yurgelun-Todd
Collaborators
Otsuka America Pharmaceutical
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1. Study Identification

Unique Protocol Identification Number
NCT02237417
Brief Title
Study of the Impact of Aripiprazole (Abilify®) Once Monthly Versus Standard of Care Oral Antipsychotic Medications on Changes in Brain Structure and Metabolism
Official Title
A Randomized, Open Label, Parallel Group, Study of the Impact of Aripiprazole (Abilify®) Once Monthly Versus Standard of Care Oral Antipsychotic Medications on Changes in Brain Structure and Metabolism
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Completed
Study Start Date
September 1, 2014 (Actual)
Primary Completion Date
November 30, 2018 (Actual)
Study Completion Date
July 30, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Deborah Yurgelun-Todd
Collaborators
Otsuka America Pharmaceutical

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a Phase 4, randomized, open-label, parallel group study designed to assess the clinical and biological effects of 12 months of treatment with long acting intramuscular (IM) aripiprazole (Abilify®) as measured by clinical and behavioral measures, and changes on magnetic resonance imaging (MRI) scans in subjects with schizophrenia compared with SOC oral antipsychotic medications and compared with a healthy control group. It is hypothesized that improved treatment compliance will lead to fewer white matter changes in the brain. Fewer white matter changes will be demonstrated via neuroimaging as increased FA and BPF values in the prefrontal region, and an increase in metabolites in a voxel centered on the anterior cingulate cortex (ACC) as seen with MRS. Therefore, the aim of this study is to examine the structural and metabolic effects of aripiprazole (Abilify®) once monthly in patients with schizophrenia using MRI techniques and to examine these effects in association with cognitive and clinical measures.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Schizophrenia
Keywords
MRI, Imaging, Antipsychotic

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
47 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Healthy Control
Arm Type
Other
Arm Title
Individuals with Schizophrenia (Group A)
Arm Type
Active Comparator
Arm Title
Individuals with Schizophrenia (Group B)
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Standard of Care Oral antipsychotics
Intervention Description
A total of 15 to 20 subjects with schizophrenia will receive SOC oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI(Geodon®)) or once monthly aripiprazole (Abilify®), PO daily, in accordance with their respective product labeling.
Intervention Type
Drug
Intervention Name(s)
IM aripiprazole once monthly
Intervention Description
A total of 30 to 40 subjects with schizophrenia will receive aripiprazole (Abilify®) monthly, at a starting dose of 400 mg IM or an approved dose based on the investigator's judgment and in accordance with product labeling.
Intervention Type
Other
Intervention Name(s)
No Treatment
Intervention Description
A total of 15 healthy controls will participate in the study and will not receive medication
Primary Outcome Measure Information:
Title
Number of Participants With Changes in Fractional Anisotropy (FA)
Description
To determine if there are differences in prefrontal white matter fractional anisotropy (FA) in subjects with schizophrenia from baseline at 12 months of treatment with aripiprazole (Abilify®) once monthly compared with standard of care (SOC) oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI (Geodon®)).
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Changes in Gamma Aminobutyric Acid (GABA)
Description
To determine if proton metabolites, specifically gamma aminobutyric acid (GABA), glutamine, and glutamate, are altered in subjects with schizophrenia after 6 and 12 months of treatment with aripiprazole (Abilify®) once monthly compared with SOC oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI (Geodon®)).
Time Frame
6 and 12 months
Title
Changes in Regional White Matter and Gray Matter Volume
Description
To determine if there are differences in regional white matter and gray matter volume in subjects with schizophrenia after 6 and 12 months of treatment with aripiprazole (Abilify®) once monthly compared with SOC oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI (Geodon®)).
Time Frame
6 and 12 months
Other Pre-specified Outcome Measures:
Title
Association Between Clinical and Neurocognitive Variables and FA, BPF, and Proton Metabolic Concentrations
Description
To determine if there is a demonstrated association between clinical and neurocognitive variables and FA, BPF, and proton metabolite concentrations in subjects with schizophrenia receiving SOC oral antipsychotic medications (e.g., aripiprazole (Abilify®), risperidone (Risperdal®), lurasidone HCI (Latuda®), quetiapine fumarate (Seroquel®), olanzapine (Zyprexa®), and ziprasidone HCI(Geodon®)) or once monthly aripiprazole (Abilify®).
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria for All Subjects Are able to provide written informed consent. Are male and female subjects 18 to 35 years of age, inclusive, at time of informed consent. Inclusion Criteria for Subjects with Schizophrenia Have a current diagnosis of schizophrenia as defined by DSM IV-TR criteria and a history of the illness for at least 1 year prior to screening and at least two prior psychotic episodes based on medical records or a qualified and reliable health care provider. Require, in the investigator's judgment, chronic treatment with an antipsychotic medication. Are able to understand the nature of the study and follow protocol requirements, including the prescribed dosage regimens, tablet ingestion, IM depot injection, and discontinuation of prohibited concomitant medications, read and understand the written word in order to complete subject-reported outcomes measures, and be reliably rated on assessment scales. Are male and female subjects who are surgically sterile (i.e., have undergone orchiectomy or hysterectomy, respectively; female subjects who have been postmenopausal for at least 12 consecutive months; or male and female subjects who agree to remain abstinent or to practice double barrier forms of birth control from trial screening through 30 days (for females) and 90 days (for males) from the last dose of IMP for SOC oral antipsychotics and 150 days for females and 180 days for males for aripiprazole depot. If employing birth control, two of the following precautions must be used: vasectomy, tubal ligation, vaginal diaphragm, intrauterine device, birth control pill, birth control implant, birth control depot injections, condom, or sponge with spermicide. Exclusion Criteria All Subjects Presence of any metal implants, pacemakers, unremovable prosthetic device, or other device or situation that may preclude imaging History of a head injury with loss of consciousness > 5 minutes Has a significant medical condition that would expose the subject to undue risk or interfere with study assessments. Exclusion Criteria for Subjects with Schizophrenia Has a current DSM-IV-TR diagnosis other than schizophrenia, including schizophreniform disorder, schizoaffective disorder, major depressive disorder, bipolar disorder, delirium, dementia, amnestic or other cognitive disorders. Also excluded are subjects with borderline, paranoid, histrionic, schizotypal, schizoid, or antisocial personality disorder. Is considered resistant/refractory to antipsychotic treatment by history (failed two prior antipsychotic medication trials) or response only to clozapine. Has a significant risk of violent behavior or a significant risk of committing suicide based on history or investigator's discretion. Has met DSM-IV-TR criteria for any significant substance use disorder within 3 months prior to screening, excluding caffeine, nicotine, or marijuana. Is known to be allergic, intolerant, or unresponsive to prior treatment with aripiprazole or other quinolinones, or hypersensitivity to antipsychotic agents, including aripiprazole. Has a history of neuroleptic malignant syndrome or clinically significant tardive dyskinesia at screening per the investigator's discretion. Has a history of seizures or any other medical condition that would expose the subject to undue risk or interfere with study assessments. Is involuntarily incarcerated. Has undergone electroconvulsive therapy in the 2 years prior to enrollment in the study. Has used an investigational agent or has participated in a clinical study with aripiprazole IM depot or any other antipsychotic depot preparation within 30 days of screening. Has clinically significant abnormalities in laboratory test results, vital signs, or ECG results. Requires more than one benzodiazepine beyond screening (e.g., lorazepam and oxazepam). Fails to washout from prohibited concomitant medications, including the use of or CYP3A4 inducers, a second antipsychotic, antidepressants (including monoamine oxidase inhibitors), and mood stabilizers.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Deborah Yurgelun-Todd, PhD
Organizational Affiliation
University of Utah
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Utah
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84108
Country
United States

12. IPD Sharing Statement

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Study of the Impact of Aripiprazole (Abilify®) Once Monthly Versus Standard of Care Oral Antipsychotic Medications on Changes in Brain Structure and Metabolism

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