Clinical trial NCT06041646: Tachyphylaxis, Tolerance, & Withdrawal Post Treatment With Igalmi for Agitation in Schizophrenia or Bipolar Disorder
Official title: Characterization of Tachyphylaxis, Tolerance, and Withdrawal After Discontinuation of Igalmi in Frequently Agitated Schizophrenic or Bipolar Patients After 7 Days of PRN Treatment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Bipolar Disorder
Schizophrenia
Agitation,Psychomotor
Schizo Affective Disorder
Schizophreniform Disorders
Keywords: Agitation
Schizophrenia
Bipolar
Dexmedetomidine
tachyphylaxis
tolerance
withdrawal
PRN treatment
Open-Label
PEC
CGI
ACES
Safety
Tolerability
Igalmi
Lead sponsor: BioXcel Therapeutics Inc
Sponsor class: INDUSTRY
Collaborators: name: Lotus Clinical Research, LLC
First posted: 2023-09-18
Enrollment: 23
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Open-Label
Primary purpose: TREATMENT

Brief summary: This is an in-clinic, single arm, open-label study assessing tachyphylaxis, tolerance, and withdrawal following repeated doses of Igalmi in adult males and females with agitation associated with schizophrenia or bipolar disorder.

Detailed description: This is an in-clinic, single arm, open-label study assessing tachyphylaxis, tolerance, and withdrawal following repeated doses of Igalmi in adult males and females (18 to 65 years old, inclusive) with agitation associated with schizophrenia or bipolar disorder. Subjects will be screened for eligibility within 15 days of first dose and no study procedures will occur unless subjects provide written informed consent. Subjects will receive single doses of 180 μg of Igalmi as needed for the treatment of agitation over a period of 7 days followed by a 3- day follow-up period during which time no Igalmi will be administered in an effort to characterize any potential withdrawal. Subjects will sublingually self-administer Igalmi for an agitation episode that reaches a pre-dose PEC total score of 14 or greater, as determined by a trained rater. Safety assessments will be conducted before and after each dose. If the subject's agitation is recurrent or persistent, repeat doses of 90 µg may be administered (no more than 2 repeat doses within a 24-hour period) in the absence of any safety concerns or adverse events.

Eligibility criteria: Inclusion Criteria:

1. Male and female subjects between the ages of 18 to 65 years, inclusive.
2. Subjects who have met DSM-5 criteria for schizophrenia, schizoaffective, or schizophreniform disorder or bipolar I or II disorder.
3. Subjects who are currently moderate to severely agitated at least 3 days a week.
4. Subjects who read, understand, and provide written informed consent.
5. Subjects who are in good general health prior to study participation as determined by a detailed medical history and in the opinion of the Principal Investigator.
6. Subjects who agree to use a medically acceptable and effective birth control method
7. Subjects must be willing to remain in-clinic for the duration of the study.

Exclusion Criteria:

1. Subjects with agitation caused by acute intoxication, including positive identification of alcohol by breathalyzer or drugs of abuse during screening.
2. Use of benzodiazepines or other hypnotics or antipsychotic drugs in the 6 hours before study treatment.
3. Subjects with congenital prolonged QT syndrome.
4. Prior treatment with Igalmi

Primary outcomes:
measure: Change From Baseline in the Positive and Negative Syndrome Scale- Excited Component (PEC) Total Score
timeFrame: Baseline and 2 hours post-dose for all doses administered
measure: Clinical Global Impression - Improvement (CGI-I)
timeFrame: 2 hours post-dose for all doses administered
Secondary outcomes:
measure: Incidence of Adverse Events During the Follow-up Period
timeFrame: Day 8 through Day 10
Other outcomes:
Locations:
city: Little Rock
country: United States
facility: BioXcel Clinical Research Site
state: Arkansas
city: Rogers
country: United States
facility: BioXcel Clinical Research Site
state: Arkansas
Study officials:
affiliation: BioXcel Therapeutics
name: Robert Risinger, MD
role: STUDY_CHAIR
References: