Clinical trial NCT00309699: A Study to Evaluate the Efficacy and Safety of Flexible Doses of Extended-release (ER) Paliperidone Compared With Flexible Doses of Quetiapine and Placebo in Patients With Bipolar I Disorder
Official title: Randomized, Double-Blind, Active- and Placebo-Controlled, Parallel Group, Multicenter Study to Evaluate the Efficacy and Safety of Flexibly-Dosed Extended-Release Paliperidone Compared With Flexibly-Dosed Quetiapine and Placebo in the Treatment of Acute Manic and Mixed Episodes in Bipolar Disorder
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Bipolar Disorder
Mood Disorders
Keywords: Affective psychosis
mixed-state
bipolar disorder
manic disorder
manic-depressive psychosis
mania
manic state
paliperidone
paliperidone ER.
Lead sponsor: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
Sponsor class: INDUSTRY
First posted: 2006-04-03
Enrollment: 493
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to evaluate the effectiveness and safety of flexible-doses paliperidone ER (3 to 12 mg as needed) compared with placebo over 3 weeks in patients with Bipolar I Disorder who are experiencing an acute manic or mixed episode. This study will also evaluate the effects of paliperidone ER on global functioning, and will compare the effectiveness of flexible doses of paliperidone ER to that of quetiapine over 12 weeks.

Detailed description: Several treatments are available for the treatment of acute manic and mixed episodes associated with bipolar disorder. Some of these treatments although used for many years, are associated with well-known problems such as poor tolerability, significant toxicities, narrow therapeutic ranges, and drug interactions. Often, several drugs must be used in combination to achieve the best clinical effect. More recently, a group of compounds known as atypical antipsychotics, such as risperidone, have been licensed for use in this indication. Paliperidone has similar properties as risperidone and is expected to be as effective in the treatment of acute manic and mixed episodes associated with bipolar disorder. Paliperidone ER has been shown to be effective in schizophrenia and it has an improved drug delivery system with a reduced potential for drug interactions.

Study drug tablets are designed to deliver the appropriate amount of drug (3 mg or 6 mg) using a "Push-Pull" delivery system based on a patented oral osmotic pump technology (OROS) that allows the drug to be delivered at a relatively controlled rate for 24 hours. This study will test flexibly-dosed paliperidone ER (3 to 12 mg/day compared with placebo (inactive substance) or flexibly-dosed quetiapine (400 to 800 mg/day). There are 4 parts to the study: a screening and washout phase that lasts up to 7 days to determine if patients are eligible for the study and to discontinue all current medications, a double-blind (neither the patient nor the physician knows whether drug or placebo and what dosage is being taken) acute treatment phase that lasts for 3 weeks, a 9-week double-blind maintenance phase to see if the effects of paliperidone are maintained over a longer period, and a follow-up phase that lasts about 1 week after the final visit or early withdrawal from the study. During the acute treatment phase, patients are randomly assigned to receive treatment with placebo, 3 to 12 mg/day of paliperidone ER, or 400 to 800 mg/day of quetiapine. The dosage of paliperidone ER or quetiapine may be adjusted to meet the patient's needs. Patients who receive placebo during the acute phase (first 3 weeks) will receive paliperidone ER (beginning with 6 mg/day) during the maintenance phase (last 9 weeks). All other patients receive the same drug, i.e., either paliperidone ER or quetiapine, during both phases. The dosages during the acute phase begin at 6 mg/day for paliperidone ER and 100 mg/day for quetiapine, and may be adjusted thereafter by the study investigator to meet individual patient needs (after a forced titration of quetiapine to 400 mg/day). Patients will be hospitalized for at least the first 7 days of double-blind treatment, and may be discharged on the seventh day and followed as outpatients based on the judgment of the study doctor. End-of-study/early withdrawal procedures will be done after the last dose of study drug has been received and blood samples have been taken, or if a patient withdraws early. Patients will have a follow-up visit with safety evaluations approximately 1 week later. The study, including the screening and washout phases, will last approximately 98 days or 14 weeks.

Effectiveness will be primarily determined by the change in the total Young Mania Rating Scale (YMRS) score from the beginning (baseline) to the end of the acute treatment phase of the study. The YMRS is an 11-item established measure used to evaluate manic symptoms. A secondary measure of effectiveness is the change in the Global Assessment of Functioning (GAF) scale from baseline to the end of the acute treatment phase of the study. Other measures of effectiveness include the change from baseline to end of the maintenance phase in total YMRS score, the time to onset of therapeutic effect, responder rate (defined as 50% or more reduction from baseline in YMRS score) and changes from baseline to the end of the acute treatment phase in all other assessment scales. Additional assessment scales will be used to evaluate the clinical progress of the patient, psychotic features in bipolar disorder, quality of sleep and daytime drowsiness, health-related function, and rate the severity of the patient's bipolar disorder. Safety will be evaluated by the frequency, severity, and timing of side effects, clinical laboratory tests (including pregnancy tests), 12-lead electrocardiograms (ECGs), vital signs measurements, and physical and neurological examinations.

The study hypotheses for the primary and secondary effectiveness measures are that 1) flexibly dosed (dosages of 3 to 12 mg/day) paliperidone ER have more effect than placebo on the change from baseline in the YMRS total score at the end of 3 weeks of treatment, 2) flexibly-dosed paliperidone ER has more effect than placebo on the change from baseline in GAF score at the end of 3 weeks of treatment, and 3), flexibly-dosed paliperidone ER is not worse than quetiapine in the change in YMRS score at 12 weeks. The potential effect on the variation in genes related to paliperidone ER may be evaluated separately in patients who consent to DNA (deoxyribonucleic acid) testing. All study drug will be administered twice daily. The dosages during the acute phase (first 3 weeks) begin at 6 mg/day for paliperidone ER and 400 mg/day for quetiapine (after a forced titration from 100 mg/day), and may be adjusted thereafter by the investigator to meet individual patient needs within the ranges of 3-12 mg/day and 400-800 mg/day. Patients who receive placebo during the acute phase will receive paliperidone ER (starting with 6 mg/day) during the maintenance phase (last 9 weeks).

Eligibility criteria: Inclusion Criteria:

* Meets Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM IV) criteria for Bipolar I Disorder, Most Recent Episode Manic or Mixed (with or without psychotic features)
* history of at least 1 previously documented manic or mixed episode requiring medical treatment within 3 years before the screening phase
* total score of at least 20 on the YMRS at screening and at baseline
* if taking mood stabilizers, antipsychotics, or antimanic drugs, must have discontinued that medication at least 3 days before baseline
* women must be postmenopausal (no spontaneous menses for at least 2 years), surgically sterile, abstinent, or agree to practice an effective method of birth control if they are sexually active before entry and throughout the study (effective methods of birth control include prescription hormonal contraceptives, intrauterine devices, double-barrier method, and male partner sterilization)
* able and willing to comply with self-administration of medication, or have consistent help or support available.

Exclusion Criteria:

* Meets DSM-IV criteria for rapid cycling and schizoaffective disorder
* In the opinion of the study doctor, is at significant risk for suicidal or violent behavior during the course of the study
* Has used cocaine, phencyclidine, amphetamine, methylphenidate, pemoline, an opioid (excluding codeine), hallucinogen, or any other drug that may be associated with manic symptoms as evidenced by a positive urine drug screen
* Has received benzodiazepines at doses equal to 4 mg/day of lorazepam or higher for a period of 3 months or longer immediately before the screening phase.

Primary outcomes:
measure: The primary effectiveness outcome is the change in the total YMRS score from baseline to the last assessment during the acute treatment phase.
timeFrame: 3 weeks
Secondary outcomes:
measure: The secondary effectiveness outcomes are the change in GAF from baseline to endpoint or the last assessment during the acute treatment phase and the change in total YMRS score from baseline to endpoint or the last assessment during the maintenance phase.
timeFrame: 12 weeks
Other outcomes:
Locations:
city: Cerritos
country: United States
state: California
city: Garden Grove
country: United States
state: California
city: Oceanside
country: United States
state: California
city: San Diego
country: United States
state: California
city: Bradenton
country: United States
state: Florida
city: Fort Lauderdale
country: United States
state: Florida
city: Kissimmee
country: United States
state: Florida
city: Maitland
country: United States
state: Florida
city: South Miami
country: United States
state: Florida
city: Tampa
country: United States
state: Florida
city: Chicago
country: United States
state: Illinois
city: Indianapolis
country: United States
state: Indiana
city: Prairie Village
country: United States
state: Kansas
city: Lake Charles
country: United States
state: Louisiana
city: Shreveport
country: United States
state: Louisiana
city: Flowood
country: United States
state: Mississippi
city: Clementon
country: United States
state: New Jersey
city: Moore
country: United States
state: Oklahoma
city: Oklahoma City
country: United States
state: Oklahoma
city: Philadelphia
country: United States
state: Pennsylvania
city: Memphis
country: United States
state: Tennessee
city: Dallas
country: United States
state: Texas
city: Athens
country: Greece
city: Incheon
country: Korea, Republic of
city: Seoul
country: Korea, Republic of
city: Alytus
country: Lithuania
city: Vilnius
country: Lithuania
city: Kazan
country: Russian Federation
city: Lipetsk
country: Russian Federation
city: Moscow Region
country: Russian Federation
city: Moscow Russia
country: Russian Federation
city: Nizny Novgorod
country: Russian Federation
city: Saratov N/A
country: Russian Federation
city: St-Petersburg Na
country: Russian Federation
city: Changhua
country: Taiwan
city: Kaohsiung
country: Taiwan
city: Taichung
country: Taiwan
city: Taipei
country: Taiwan
city: Ankara
country: Turkey
city: Diyarbakir
country: Turkey
city: Istanbul
country: Turkey
city: Donetsk
country: Ukraine
city: Glevakha
country: Ukraine
city: Kharkov
country: Ukraine
city: Kiev
country: Ukraine
city: Odessa
country: Ukraine
city: Simferopol
country: Ukraine
Study officials:
affiliation: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.
name: Johnson & Johnson Pharmaceutical Research & Development, L.L. C. Clinical Trial
role: STUDY_DIRECTOR
References:
citation: Vieta E, Nuamah IF, Lim P, Yuen EC, Palumbo JM, Hough DW, Berwaerts J. A randomized, placebo- and active-controlled study of paliperidone extended release for the treatment of acute manic and mixed episodes of bipolar I disorder. Bipolar Disord. 2010 May;12(3):230-43. doi: 10.1111/j.1399-5618.2010.00815.x.