A Study to Evaluate the Efficacy and Safety of SEP-363856 in Acutely Psychotic Adults With Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Intervention: SEP-363856; Placebo - Cap
Intervention description: One SEP-363856 capsule (50 mg or 75 mg) daily for four weeks; One Placebo capsule daily for 4 weeks
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 245.0
Sex: All
Minimum age: 18 Years
Maximum age: 40 Years
Healthy volunteers: No
Keywords: Schizophrenia

Summary:

      A study to evaluate the efficacy and safety of an experimental drug (SEP-363856) in acutely
      psychotic adults with schizophrenia
    

Eligibility criteria:

        Inclusion Criteria:

          1. Subject must give written informed consent and privacy authorization prior to
             participation in the study. Separate consent will be obtained from a caregiver or
             legal guardian if required by local law.

          2. Subject must be willing and able to comply with the study procedures and visit
             schedules, including required hospitalization for the washout period and the
             double-blind treatment period, and must be able to understand and follow verbal and
             written instructions.

          3. Male or female subject between 18 to 40 years of age (inclusive) at the time of
             consent.

          4. Subject meets DSM-5 criteria for schizophrenia as established by clinical interview
             (using the DSM-5 as a reference and confirmed using the SCID-CT). The duration of the
             subject's illness whether treated or untreated must be ≥ 6 months.

          5. Subject must have a CGI-S score ≥ 4 (moderate or greater) at screening and Baseline
             (Day 1).

          6. Subject must have a PANSS total score ≥ 80 and a PANSS item score ≥ 4 (moderate) on 2
             or more of the following PANSS items: delusions, conceptual disorganization,
             hallucinations, and unusual thought content at screening and Baseline (Day 1).

          7. Subject has an acute exacerbation of psychotic symptoms (no longer than 2 months).

             • Subject has marked deterioration of functioning in one or more areas, such as
             occupational, social, or personal care or hygiene.

             • Subject requires hospitalization for an acute psychotic exacerbation at the time of
             screening or has been hospitalized for the purpose of treating an acute psychotic
             exacerbation for no more than 2 consecutive weeks immediately before screening.

             Subjects who have been hospitalized for more than 2 weeks for reasons unrelated to an
             acute psychotic exacerbation may be included if such a hospitalization was for a
             condition other than an acute psychotic relapse. For example, subjects in a long-term
             hospital setting who have an acute exacerbation and are transferred to an acute unit
             are eligible for the study.

          8. Subject has had no more than 2 prior hospitalizations for the treatment of an acute
             exacerbation of schizophrenia (not including the current hospitalization) This history
             must be confirmed based on report by a reliable informant (eg., caregiver or family
             member) or medical records available at the time of screening.

          9. Subject's BMI must be at least 18 kg/m2 but no more than 35 kg/m2.

         10. Female subject must have a negative serum pregnancy test at screening.11. Female
             subject of reproductive potential agrees to remain abstinent or use adequate and
             reliable contraception throughout the study and for at least 30 days after the last
             dose of study drug has been taken. In the Investigator's judgment, the subject will
             adhere to this requirement.

               1. Adequate contraception is defined as continuous use of either two barrier methods
                  (eg, condom and spermicide or diaphragm with spermicide) or a hormonal
                  contraceptive.

                  Acceptable hormonal contraceptives include the following: a) contraceptive
                  implant (such as Norplant®) implanted at least 90 days prior to screening; b)
                  injectable contraception (such as medroxyprogesterone acetate injection) given at
                  least 14 days prior to screening; or c) oral contraception taken as directed for
                  at least 30 days prior to screening.

               2. Subjects who are of non-reproductive potential, ie, subject who is surgically
                  sterile, has undergone tubal ligation, or is postmenopausal (defined as at least
                  12 months of spontaneous amenorrhea or between 6 and 12 months of spontaneous
                  amenorrhea with follicle stimulating hormone (FSH) concentrations within
                  postmenopausal range as determined by laboratory analysis) are not required to
                  remain abstinent or use adequate contraception.

         11. Female subject of reproductive potential agrees to remain abstinent or use highly
             effective and reliable contraception throughout the study and for at least 30 days
             after the last dose of study drug has been taken (See Section 21 Appendix II Highly
             Effective Protocol SEP361-201, Version 3.01 SEP-363856 Confidential and Proprietary 36
             17 August 2017 Contraceptive procedures). In the Investigator's judgment, the subject
             will adhere to this requirement.

         12. Male subjects with female partner(s) of childbearing potential must agree to avoid
             fathering a child and use highly effective methods of birth control (outlined in
             Section 21) from screening until at least 30 days after the last study drug
             administration.

         13. Subject must be able and agree to remain off prior antipsychotic medication for the
             duration of the study.

         14. Subject must have a total score < 5 on the SAS at Baseline (Day 1).

         15. Subject is, in the opinion of the Investigator, generally healthy based on screening
             medical history, PE, neurological examination, vital signs, clinical laboratory values
             (hematology, serum chemistry, urinalysis, lipid panel, coagulation panel, thyroid
             panel, and serum prolactin).

         16. Subject has had a stable living arrangement at the time of screening and agrees to
             return to a similar living arrangement after discharge. This criterion is not meant to
             exclude subjects who have temporarily left a stable living arrangement (eg, due to
             psychosis). Such subjects remain eligible to participate in this protocol. Chronically
             homeless subjects should not be enrolled.

         17. Subject must agree to comply with all restrictions for the required length of time

        Exclusion Criteria:

        1. Subject answers "yes" to "Suicidal Ideation" Item 4 (active suicidal ideation with some
        intent to act, without specific plan) or item 5 (active suicidal ideation with specific
        plan and intent) on the C-SSRS assessment at or during the Screening period (ie, in the
        past one month) and/or at Baseline (ie, since last visit).

        2. Subject does not tolerate venipuncture or has poor venous access that would cause
        difficulty for collecting blood samples.

        3. Subject is currently participating, or has participated in, a study with an
        investigational or marketed compound or device within 6 months prior to signing the
        informed consent, or has participated in 2 or more studies within 24 months prior to
        signing informed consent.

        4. Subject has previously received SEP-363856. 5. Subject has any clinically significant
        unstable medical condition or any clinically significant chronic disease that in the
        opinion of the Investigator, would limit the subject's ability to complete and/or
        participate in the study:

          1. Hematological (including deep vein thrombosis) or bleeding disorder, renal, metabolic,
             endocrine, pulmonary, gastrointestinal, urological, cardiovascular, hepatic,
             neurologic, or allergic disease that is clinically significant or unstable (except for
             untreated, asymptomatic, seasonal allergies at time of dosing).

          2. Subject has a history of neuroleptic malignant syndrome. Protocol SEP361-201, Version
             3.01 SEP-363856 Confidential and Proprietary 37 17 August 2017

          3. Subject has a history of malignancy within 5 years prior to the Screening visit,
             except for adequately treated basal cell or squamous cell skin cancer or in situ
             cervical cancer. Pituitary tumors of any duration are excluded.

          4. Disorder or history of a condition, or previous gastrointestinal surgery (eg,
             cholecystectomy, vagotomy, bowel resection, or any surgical procedure) that may
             interfere with drug absorption, distribution, metabolism, excretion, gastrointestinal
             motility, or pH, or a clinically significant abnormality of the hepatic or renal
             system, or a history of malabsorption.

          5. Subject has Alcohol or Substance Abuse Disorder (DSM-5 criteria). The only exceptions
             include caffeine or nicotine.

          6. Subject has a clinically significant abnormal 12-lead ECG that may jeopardize the
             subject's ability to complete the study or a screening 12-lead ECG demonstrating any
             one of the following: heart rate > 100 beats per minute, QRS > 120 ms, QT interval
             corrected for heart rate using Fridericia's formula (QTcF) > 450 ms (males), QTcF >
             470 ms (females), or PR > 220 ms.

          7. Subjects with known history of human immunodeficiency virus (HIV) seropositivity.6. 6.
             Female subject who is pregnant or lactating.

             7. Subject who has a lifelong history or presence of symptoms consistent with a major
             psychiatric disorder other than schizophrenia as defined by DSM-5. Exclusionary
             disorders include but are not limited to alcohol use disorder (within past 12 months),
             substance (other than nicotine or caffeine) use disorder within past 12 months, major
             depressive disorder, bipolar depression, mania, schizoaffective disorder, obsessive
             compulsive disorder, posttraumatic stress disorder. Previous or current symptoms of
             mild to moderate mood dysphoria or anxiety are allowed so long as these symptoms have
             not been a focus of primary treatment.

             8. Subject tests positive for drugs of abuse at screening, however, a positive test
             for amphetamines, barbiturates, opiates, benzodiazepines may not result in exclusion
             of subjects if the investigator determines that the positive test is as a result of
             prescription medicine(s). In the event a subject tests positive for cannabinoids
             (tetrahydrocannabinol), the Investigator will evaluate the subject's ability to
             abstain from using this substance during the study. This information will be discussed
             with the Medical Monitor prior to study enrollment.

             9. Subject is at significant risk of harming self, others or objects based on the
             Investigator's judgment.

             10. Subject has attempted suicide within 3 months prior to screening. 11. Subject is
             involuntarily hospitalized. 12. Subject has received depot antipsychotics unless the
             last injection was at least one treatment cycle or at least 30 days (whichever is
             longer), prior to the screening phase.

             13. Subject is judged to be resistant to antipsychotic treatment by the Investigator,
             based on failure to respond to 2 or more marketed antipsychotic agents, given at
             adequate dose for at least 4 weeks within a 1 year period prior to Screening.

             14. Subject has a history of treatment with clozapine for refractory psychosis and/or
             subject has been treated with clozapine (for any reason) within 4 months of Screening.

             15. Subject is receiving a total dose of antipsychotic medication equivalent to > 12.0
             mg/day of haloperidol at Screening (see Section 22, Appendix III for table of
             haloperidol dose equivalents). Subject may be eligible if such treatment is less than
             2 weeks in duration after consultation with the Medical Monitor.

             16. Subject has received electroconvulsive therapy treatment within the 3 months prior
             to screening or is expected to require ECT during the study.

             17. Subject takes or has taken other disallowed recent or concomitant medications (see
             Section 10.3). Subjects must taper off antipsychotic medications by Day -1.

             18. Subject has a history of allergic reaction or suspected sensitivity to any
             substance that is contained in the formulation (gelatin).

             19. Subject has any clinically significant abnormal laboratory values (hematology,
             serum chemistry, urinalysis, lipid panel, coagulation panel, thyroid panel, and serum
             prolactin (Note: abnormal findings that may be clinically significant or of
             questionable significance will be discussed with the Medical Monitor prior to
             including subject).

             20. Subject demonstrates evidence of acute hepatitis, clinically significant chronic
             hepatitis, or evidence of clinically significant impaired hepatic function through
             clinical and laboratory evaluation.

             Note: Subjects with serum alanine transaminase (ALT) or aspartate transaminase (AST)
             levels ≥ 3 times the upper limit of the reference ranges provided by the central
             laboratory require retesting. If on retesting, the laboratory value remains ≥ 3 times
             the upper limit, the subject will be excluded.

             21. Subject has a serum blood urea nitrogen (BUN) or serum creatinine (Cr) value ≥ 1.5
             times the upper limit of normal for the reference range.

             22. Subject has experienced significant blood loss (≥ 473 mL) or donated blood within
             60 days prior to first dose of study drug; has donated plasma within 72 hours prior to
             the first dose of study drug or intends to donate plasma or blood or undergo elective
             surgery during study participation or within 60 days after the last study visit.

             23. Subject has used disallowed prescription or disallowed nonprescription drugs,
             vitamins, or dietary or herbal supplements within 14 days prior to dosing or
             anticipates the need for any disallowed medication during their participation in this
             study [exception: female subjects who are taking oral, patch, or intrauterine device
             (IUD) hormonal contraceptives, or progestin implant or injection].

             24. Subject is a staff member or the relative of a staff member. 25. Subjects with a
             fasting blood glucose at screening ≥ 126 mg/dL (7.0 mmol/L) or HbA1c ≥ 6.5% will be
             excluded.

             26. Subject has a prolactin concentration > 100 ng/mL at screening or has a history of
             pituitary adenoma. NOTE: Subjects with prolactin levels > 100 ng/mL and ≤ 200 ng/mL
             Protocol SEP361-201, Version 3.01 SEP-363856 Confidential and Proprietary 39 17 August
             2017 at the Screening visit are permitted to enroll after discussion with the Medical
             Monitor to ensure exclusion of non-psychotropic drug-related causes of elevated
             prolactin levels.

             27. .Subject is in the opinion of the Investigator, unsuitable in any other way to
             participate in this study.

             Randomization Criteria

               1. Subject must have a PANSS total score ≥ 80 at Baseline (Day 1).

               2. Subject must have a PANSS item score ≥ 4 on 2 or more of the following PANSS
                  items: delusions, conceptual disorganization, hallucinations, and unusual thought
                  content at Baseline (Day 1).3. Subject must have a CGI-S score ≥ 4 at Baseline
                  (Day 1).

               3. Subject must not demonstrate a decrease (improvement) of ≥ 20% in the PANSS total
                  score between Screening and Baseline visits, or the PANSS total score falls below
                  80 at Baseline (Day 1).

               4. Subject must have a total score < 5 on the SAS at Baseline (Day 1).

               5. Subject must have a total score < 5 on the SAS at Baseline (Day 1).

               6. Subject must not answer "yes" to "Suicidal Ideation" Item 4 (active suicidal
                  ideation with some intent to act, without specific plan) or Item 5 (active
                  suicidal ideation with specific plan and intent) on the C-SSRS assessment at
                  Baseline (ie, since last visit).

               7. Subject must meet all other inclusion and none of the exclusion criteria at
                  Baseline (Day 1).