CClinicalTrials.gg
CompletedNCT01058668Updated Apr 12, 2017Results posted

Safety and Efficacy of Cariprazine for Bipolar I Disorder

A Phase 3 interventional study of Cariprazine and Placebo in Mania and Bipolar I Disorder, sponsored by Forest Laboratories. Completed at 66 sites in 6 countries. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2017-04-12.

Sponsored by Forest Laboratories · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
497
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

The objective of this study is to evaluate the efficacy, safety, and tolerability of cariprazine monotherapy versus placebo for the treatment of acute manic or mixed episodes associated with bipolar I disorder.

02

Conditions studied

  • Mania
  • Bipolar I Disorder

Browse trials for

Keywords

  • Acute Mania
  • Bipolar I Disorder
03

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Patients who have provided informed consent prior to any study specific procedures
  • Patients currently meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for bipolar I disorder, as confirmed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) manic or mixed type with or without psychotic symptoms
  • Voluntarily hospitalized for current manic episode
  • Patients with normal physical examination, laboratory, vital signs,and/ or electrocardiogram (ECG)

Exclusion criteria

Exclusion Criteria:

  • Patients with a DSM-IV-TR diagnosis of an axis I disorder other than bipolar I disorder that was the primary focus of treatment within the previous six months
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
497 participants (actual)

Study arms

  • Experimental
    Cariprazine (3-6 mg/day)

    Cariprazine 3 milligrams (mg) - 6 mg capsules oral administration, once per day for 3 weeks.

    Drug: Cariprazine

  • Experimental
    Cariprazine (6-12 mg/day)

    Cariprazine 6 mg - 12 mg capsules oral administration, once per day for 3 weeks.

    Drug: Cariprazine

  • Placebo comparator
    Placebo

    Placebo dose-matching cariprazine capsules oral administration, once per day for 3 weeks.

    Drug: Placebo

Interventions

  • DrugCariprazine

    Patients who meet eligibility criteria will be administered a once daily oral dose of cariprazine for three weeks. Upon completion of the study or early termination, patients will undergo a two week safety follow-up period.

  • DrugPlacebo

    Patients who meet eligibility criteria will be administered a once daily oral dose of placebo for three weeks.

05

What researchers measure

Primary outcomes

  1. Change From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3

    The YMRS is an 11-item scale that assesses manic symptoms based on the participant's perception of his or her condition over the previous 48 hours, as well as the physician's clinical observations during the interview. The 11-items are elevated mood, increased motor activity-energy, sexual interest, sleep, irritability, rate and amount of speech, language-thought disorder, content, disruptive-aggressive behavior, appearance, and insight. The severity of the abnormality for 7-items are rated on a five-point scale (0-4) and 4-items on a nine-point scale (0-8). The individual scores are summed for a total possible score of 0 (best) to 60 (worst). A negative change from Baseline indicates improvement. Analysis is a mixed model for repeated measurements (MMRM) using observed cases, with treatment group, pooled study center, visit, treatment group-by-visit interaction as factors, baseline value and baseline-by-visit interaction as covariates and an unstructured covariance matrix.

    Time frame: Baseline, Week 3

Secondary outcomes

  1. Change From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3

    The CGI-S measures the investigator's assessment of overall severity of the participant's illness compared with the severity of illness in other patients the physician has observed using a 7-point scale (1=Normal, not ill at all to 7= Among the most extremely ill participants). A negative change from Baseline indicates improvement. Analysis is based on a MMRM using the observed cases data, with treatment group, pooled study center, visit, treatment group-by-visit interaction as factors, baseline value and baseline-by-visit interaction as covariates and an unstructured covariance matrix.

    Time frame: Baseline, Week 3

06

Results

Posted Apr 12, 2017
Limitations and caveats
All participants from 1 investigative site were excluded due to Good Clinical Practice (GCP) Violations.

Participant flow

Double-blind Treatment Phase
Participant flow — Double-blind Treatment Phase
MilestonePlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)
Started161167169
Completed122129119
Not completed393850
Withdrew: Adverse event81525
Withdrew: Insufficient therapeutic response1525
Withdrew: Protocol violation112
Withdrew: Withdrawal of consent141817
Withdrew: Lost to follow-up011
Withdrew: Other unspecified110
Safety Follow-up
Participant flow — Safety Follow-up
MilestonePlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)
Started144146148
Completed139146141
Not completed507

Outcome measures

PrimaryChange From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3

The YMRS is an 11-item scale that assesses manic symptoms based on the participant's perception of his or her condition over the previous 48 hours, as well as the physician's clinical observations during the interview. The 11-items are elevated mood, increased motor activity-energy, sexual interest, sleep, irritability, rate and amount of speech, language-thought disorder, content, disruptive-aggressive behavior, appearance, and insight. The severity of the abnormality for 7-items are rated on a five-point scale (0-4) and 4-items on a nine-point scale (0-8). The individual scores are summed for a total possible score of 0 (best) to 60 (worst). A negative change from Baseline indicates improvement. Analysis is a mixed model for repeated measurements (MMRM) using observed cases, with treatment group, pooled study center, visit, treatment group-by-visit interaction as factors, baseline value and baseline-by-visit interaction as covariates and an unstructured covariance matrix.

Time frame:
Baseline, Week 3
Reported as:
Least squares mean · score on a scale
Change From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3
score on a scalePlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)
Change From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3-12.5 ± 0.8-18.6 ± 0.8-18.5 ± 0.8
Statistical analysis
  • Placebo vs Cariprazine (3-6 mg/Day) · Mixed Models Analysis · p = <0.001 · Least squares mean difference: -6.1 · 95% CI -8.4 to -3.8cariprazine (3-6 mg/day) - placebo
  • Placebo vs Cariprazine (6-12 mg/Day) · Mixed Models Analysis · p = <0.001 · Least squares mean difference: -5.9 · 95% CI -8.2 to -3.6cariprazine (6-12 mg/day) - placebo
SecondaryChange From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3

The CGI-S measures the investigator's assessment of overall severity of the participant's illness compared with the severity of illness in other patients the physician has observed using a 7-point scale (1=Normal, not ill at all to 7= Among the most extremely ill participants). A negative change from Baseline indicates improvement. Analysis is based on a MMRM using the observed cases data, with treatment group, pooled study center, visit, treatment group-by-visit interaction as factors, baseline value and baseline-by-visit interaction as covariates and an unstructured covariance matrix.

Time frame:
Baseline, Week 3
Reported as:
Least squares mean · score on a scale
Change From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3
score on a scalePlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)
Change From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3-1.3 ± 0.1-1.9 ± 0.1-1.9 ± 0.1
Statistical analysis
  • Placebo vs Cariprazine (3-6 mg/Day) · Mixed Models Analysis · p = <0.001 · Least squares mean difference: -0.6 · 95% CI -0.9 to -0.4cariprazine (3-6 mg/day) - placebo
  • Placebo vs Cariprazine (6-12 mg/Day) · Mixed Models Analysis · p = <0.001 · Least squares mean difference: -0.6 · 95% CI -0.9 to -0.3cariprazine (6-12 mg/day) - placebo

Adverse events

Collected over First dose of study drug to 30 days past last dose (Up to 51 days). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Placebo—5/161 (3.1%)63/161 (39.1%)
Cariprazine (3-6 mg/Day)—9/167 (5.4%)89/167 (53.3%)
Cariprazine (6-12 mg/Day)—5/169 (3%)90/169 (53.3%)
Most frequent serious events
Most frequent serious events
EventPlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)
ManiaPsychiatric disorders3/1613/1673/169
Bipolar disorderPsychiatric disorders1/1611/1670/169
Bipolar I disorderPsychiatric disorders1/1611/1671/169
AggressionPsychiatric disorders0/1611/1670/169
Endometrial cancerNeoplasms benign, malignant and unspecified (incl cysts and polyps)0/1611/1670/169
HospitalisationSurgical and medical procedures0/1611/1670/169
Pulmonary embolismRespiratory, thoracic and mediastinal disorders0/1611/1670/169
DepressionPsychiatric disorders0/1610/1671/169
Most frequent other events
Showing 10 of 12
Most frequent other events
EventPlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)
AkathisiaNervous system disorders8/16129/16738/169
HeadacheNervous system disorders15/16119/16720/169
NauseaGastrointestinal disorders9/16116/16719/169
ConstipationGastrointestinal disorders5/1618/16718/169
InsomniaPsychiatric disorders15/16116/16717/169
Extrapyramidal disorderNervous system disorders8/16116/16712/169
VomitingGastrointestinal disorders10/16115/16714/169
RestlessnessPsychiatric disorders8/16115/16710/169
DiarrhoeaGastrointestinal disorders12/1614/1679/169
DyspepsiaGastrointestinal disorders5/1617/16710/169

Baseline characteristics

Safety Population included all participants who received at least 1 dose of study drug.

Age, Continuous
Age, Continuous(years)PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
Mean41.5 ± 11.443.1 ± 12.241.2 ± 11.341.9 ± 11.7
Sex: Female, Male
Sex: Female, Male(Participants)PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
Female727784233
Male899085264
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
Hispanic or Latino1010424
Not Hispanic or Latino151157165473
Unknown or Not Reported0000
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
White114117114345
Black/African American444451139
Asian1315
American Indian or Alaska Native2114
Native Hawaiian or Other Pacific Islander0101
Other0112
Weight
Weight(kilogram (kg))PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
Mean81.70 ± 15.9682.42 ± 16.2281.49 ± 16.7881.87 ± 16.30
Height
Height(centimeter (cm))PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
Mean170.93 ± 9.88170.99 ± 9.15170.25 ± 9.36170.72 ± 9.45
Body Mass Index (BMI)
Body Mass Index (BMI)(kg/meter(m)^2)PlaceboCariprazine (3-6 mg/Day)Cariprazine (6-12 mg/Day)Total
Mean27.99 ± 5.1528.22 ± 5.2928.04 ± 4.9228.08 ± 5.12
07

Study locations

66 sites
  • Forest Investigative Site 018
    Little Rock, Arkansas 72211, United States
  • Forest Investigative Site 012
    Cerritos, California 90703, United States
  • Forest Investigative Site 010
    Costa Mesa, California 92626, United States
  • Forest Investigative Site 005
    Oceanside, California 92056, United States
  • Forest Investigative Site 023
    San Diego, California 92102, United States
  • Forest Investigative Site 017
    San Diego, California 92103, United States
  • Forest Investigative Site 024
    Santa Ana, California 92701, United States
  • Forest Investigative Site 016
    New Britain, Connecticut 06050, United States
  • Forest Investigative Site 007
    Washington, District of Columbia 20016, United States
  • Forest Investigative Site 002
    Kissimmee, Florida 34741, United States
  • Forest Investigative Site 003
    Orlando, Florida 32821, United States
  • Forest Investigative Site 026
    Atlanta, Georgia 30308, United States
  • Forest Investigative Site 013
    Honolulu, Hawaii 96813, United States
  • Forest Investigative Site 011
    Hoffman Estates, Illinois 60169, United States
  • Forest Investigative Site 021
    Greenwood, Indiana 46143, United States
  • Forest Investigative Site 001
    Shreveport, Louisiana 71115, United States
  • Forest Investigative Site 006
    Rockville, Maryland 20850, United States
  • Forest Investigative Site 025
    St. Louis, Missouri 63118, United States
  • Forest Investigative Site 008
    Cedarhurst, New York 11516, United States
  • Forest Investigative Site 019
    Philadelphia, Pennsylvania 19139, United States
  • Forest Investigative Site 015
    Memphis, Tennessee 38119, United States
  • Forest Investigative Site 004
    Irving, Texas 75062, United States
  • Forest Investigative Site 014
    Bothell, Washington 98011, United States
  • Forest Investigative Site 607
    Rijeka, 51 000, Croatia
  • Forest Investigative Site 602
    Zagreb, 10 000, Croatia
  • Forest Investigative Site 605
    Zagreb, 10 000, Croatia
  • Forest Investigative Site 606
    Zagreb, 10 090, Croatia
  • Forest Investigative Site 204
    Targoviste, Dambovita 130086, Romania
  • Forest Investigative Site 210
    Craiova, Dolj 200745, Romania
  • Forest Investigative Site 211
    Timisoara, Timis 300182, Romania
  • Forest Investigative Site 212
    Focsani, Vrancea 620165, Romania
  • Forest Investigative Site 209
    Arad, 310022, Romania
  • Forest Investigative Site 203
    Bucharest, 041915, Romania
  • Forest Investigative Site 205
    Bucuresti, 041915, Romania
  • Forest Investigative Site 206
    Bucuresti, 041915, Romania
  • Forest Investigative Site 208
    Bucuresti, 041915, Romania
  • Forest Investigative Site 202
    Constanta, 900002, Romania
  • Forest Investigative Site 201
    Craiova, 200260, Romania
  • Forest Investigative Site 501
    Lipetsk, 398007, Russian Federation
  • Forest Investigative Site 503
    Moscow, 115522, Russian Federation
  • Forest Investigative Site 507
    Moscow, 115522, Russian Federation
  • Forest Investigative Site 510
    Moscow, 115522, Russian Federation
  • Forest Investigative Site 506
    Saint Petersburg, 190005, Russian Federation
  • Forest Investigative Site 508
    Saint Petersburg, 190121, Russian Federation
  • Forest Investigative Site 509
    Samara, 443016, Russian Federation
  • Forest Investigative Site 504
    Saratov, 410028, Russian Federation
  • Forest Investigative Site 502
    Smolensk, 214019, Russian Federation
  • Forest Investigative Site 403
    Belgrade, 11000, Serbia
  • Forest Investigative Site 404
    Belgrade, 11000, Serbia
  • Forest Investigative Site 405
    Belgrade, 11000, Serbia
  • Forest Investigative Site 402
    Kragujevac, 34000, Serbia
  • Forest Investigative Site 401
    Senta, 24400, Serbia
  • Forest Investigative Site 308
    Dnipropetrovsk, 49027, Ukraine
  • Forest Investigative Site 315
    Dnipropetrovsk, 49115, Ukraine
  • Forest Investigative Site 301
    Donetsk, 83008, Ukraine
  • Forest Investigative Site 307
    Kharkiv, 61068, Ukraine
  • Forest Investigative Site 310
    Kharkiv, 61068, Ukraine
  • Forest Investigative Site 304
    Kyiv, 01030, Ukraine
  • Forest Investigative Site 305
    Kyiv, 02660, Ukraine
  • Forest Investigative Site 303
    Kyiv, 04080, Ukraine
  • Forest Investigative Site 309
    Kyiv, 04080, Ukraine
  • Forest Investigative Site 312
    Kyiv, 08631, Ukraine
  • Forest Investigative Site 306
    Lugansk, 91045, Ukraine
  • Forest Investigative Site 311
    Lviv, 79021, Ukraine
  • Forest Investigative Site 302
    Odessa, 65006, Ukraine
  • Forest Investigative Site 314
    Poltava, 36006, Ukraine
08

References and documents

Publications

  • McIntyre RS, Masand PS, Earley W, Patel M. Cariprazine for the treatment of bipolar mania with mixed features: A post hoc pooled analysis of 3 trials. J Affect Disord. 2019 Oct 1;257:600-606. doi: 10.1016/j.jad.2019.07.020. Epub 2019 Jul 5. PubMed 31344528 ↗
  • Earley W, Durgam S, Lu K, Ruth A, Nemeth G, Laszlovszky I, Yatham LN. Clinically relevant response and remission outcomes in cariprazine-treated patients with bipolar I disorder. J Affect Disord. 2018 Jan 15;226:239-244. doi: 10.1016/j.jad.2017.09.040. Epub 2017 Sep 25. PubMed 29017067 ↗
  • Calabrese JR, Keck PE Jr, Starace A, Lu K, Ruth A, Laszlovszky I, Nemeth G, Durgam S. Efficacy and safety of low- and high-dose cariprazine in acute and mixed mania associated with bipolar I disorder: a double-blind, placebo-controlled study. J Clin Psychiatry. 2015 Mar;76(3):284-92. doi: 10.4088/JCP.14m09081. PubMed 25562205 ↗
09

Registry details

Key details

Study ID
NCT01058668
Lead sponsor
Forest Laboratories
Collaborators
Gedeon Richter Ltd.
Responsible party
Sponsor
First posted
Jan 29, 2010
Start date
Feb 2010
Primary completion
Dec 2011
Completion
Dec 2011
Results posted
Apr 12, 2017
Last update
Apr 12, 2017

Study contacts

Elizabeth Diaz, MD
study director · Forest Laboratories

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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