A Phase 3 interventional study of Intramuscular (IM) Depot Aripiprazole and Intramuscular (IM) Depot Placebo in Bipolar I Disorder, sponsored by Otsuka Pharmaceutical Development & Commercialization, Inc.. Completed at 77 sites in 7 countries. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2018-08-24.
Sponsored by Otsuka Pharmaceutical Development & Commercialization, Inc. · Phase 3, Interventional, and Treatment
This will be a randomized, double-blind, placebo-controlled trial to assess the time to recurrence of any mood episode in subjects with bipolar I disorder who have maintained stability on aripiprazole IM depot for at least 8 weeks. This trial will include male and female subjects 18 to 65 years of age, inclusive, with a diagnosis of bipolar I disorder, according to DSM-IV-TR criteria and confirmed by the Mini International Neuropsychiatric Interview (MINI), who have experienced at least one previous manic episode of sufficient severity to require hospitalization and/or treatment with a mood stabilizer or antipsychotic agent in addition to their current manic episode. All subjects must be experiencing a manic episode (per DSM-IV-TR criteria) with a YMRS total score ≥ 20 at trial entry. Both inpatients and outpatients are eligible for this trial.
This trial will consist of a screening phase followed by 4 treatment phases. Subjects will undergo screening for eligibility, followed by a conversion to oral aripiprazole monotherapy phase, if needed, an oral aripiprazole stabilization phase, a single-blind aripiprazole IM depot stabilization phase, and, a double-blind, placebo-controlled phase.
Otsuka Pharmaceutical Development & Commercialization, Inc. is the lead sponsor of 289 studies on the registry; 18 are open to participants now.
Of its 104 completed or terminated interventional studies of FDA-regulated products, 69 (66%) have results posted.
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Key Inclusion Criteria:
Key Exclusion Criteria:
Active Comparator: Treatment of Aripiprazole IM Depot
Drug: Intramuscular (IM) Depot Aripiprazole
Placebo Comparator: Treatment of IM Depot Placebo
Drug: Intramuscular (IM) Depot Placebo
Formulation: Intramuscular (IM) Depot Aripiprazole Formulation 400 mg or 300 mg, once a month injection
Formulation: Intramuscular (IM) Depot Placebo 400 mg or 300 mg, once a month injection
Time From Randomization to Recurrence of Any Mood Episode During Double-bind Placebo-controlled Phase.
This endpoint was defined as meeting any of the following criteria: 1. Hospitalization for any mood episode OR 2. Any of the following: 1. YMRS total score ≥ 15 OR 2. MADRS total score ≥ 15 OR 3. CGI-BP-S score \> 4 (overall score) OR 3. SAE of worsening disease (bipolar I disorder) OR 4. Discontinuation due to lack of efficacy or discontinuation due to an AE of worsening disease OR 5. Clinical worsening with the need for treatment of symptoms of an underlying mood disorder by addition of a mood stabilizer, antidepressant treatment, antipsychotic medication, or increase greater than the allowed benzodiazepine doses, or 6. Active suicidality, which is defined as a score of 4 or more on the MADRS item 10 OR an answer of "yes" on question 4 or 5 on the C-SSRS. The time to event is presented in the following table.
Time frame: Baseline of the Double-blind, Placebo-controlled Phase Up to the end of the study (Week 52).
Number of Subjects Meeting Criteria for Recurrence of Any Mood Episode.
To assess the proportion of subjects who met criteria for recurrence of any mood episode (manic, mixed or depressive). Hierarchical procedure was used to preserve the overall Type I error at 0.05.
Time frame: Baseline of the Double-blind, Placebo-controlled Phase Up to the end of the study (Week 52).
Mean Change From Randomization to Endpoint in the CGI-BP-S (Mania) Score.
CGI-BP-S assessed the subject's severity of Illness (mania) based on a 7-point scale ranging from 1 (normal/ not ill at all) to 7 (very severely ill).
Time frame: Baseline of the Double-blind, Placebo-controlled Phase up to the end of the study (Week 52).
Time From Randomization to Recurrence Defined by Hospitalization for a Mood Episode.
Analysis of time from randomization to recurrence defined by hospitalization for a mood episode (Double-blind, Placebo-controlled Phase efficacy sample). Time to recurrence is presented in the following table.
Time frame: Baseline of the Double-blind, Placebo-controlled Phase up to the end of the study (Week 52).
This trial was conducted in 1175 subjects (including 444 screen failures) at 103 trial sites in the following 7 countries: Canada, Japan, Republic of Korea, Poland, Romania, Taiwan, and the United States (US).
| Milestone | Conversion Phase. | Oral Aripiprazole Stabilization Phase. | Intramuscular (IM) Depot Stabilization Phase. | Double-blind Placebo-controlled Phase - Aripiprazole IM Depot. | Double-blind Placebo-controlled Phase - Placebo. |
|---|---|---|---|---|---|
| Started | 466 | 0 | 0 | 0 | 0 |
| Completed | 367 | 0 | 0 | 0 | 0 |
| Not completed | 99 | 0 | 0 | 0 | 0 |
| Withdrew: Protocol deviation | 3 | 0 | 0 | 0 | 0 |
| Withdrew: Met withdrawal criteria | 10 | 0 | 0 | 0 | 0 |
| Withdrew: Withdrawal by subject | 32 | 0 | 0 | 0 | 0 |
| Withdrew: Lost to follow-up | 16 | 0 | 0 | 0 | 0 |
| Withdrew: Lack of efficacy | 2 | 0 | 0 | 0 | 0 |
| Withdrew: Adverse event | 33 | 0 | 0 | 0 | 0 |
| Withdrew: Withdrawn by the investigator | 3 | 0 | 0 | 0 | 0 |
| Milestone | Conversion Phase. | Oral Aripiprazole Stabilization Phase. | Intramuscular (IM) Depot Stabilization Phase. | Double-blind Placebo-controlled Phase - Aripiprazole IM Depot. | Double-blind Placebo-controlled Phase - Placebo. |
|---|---|---|---|---|---|
| Started | 0 | 632 | 0 | 0 | 0 |
| Completed | 0 | 425 | 0 | 0 | 0 |
| Not completed | 0 | 207 | 0 | 0 | 0 |
| Withdrew: Met withdrawal criteria | 0 | 41 | 0 | 0 | 0 |
| Withdrew: Withdrawal by subject | 0 | 45 | 0 | 0 | 0 |
| Withdrew: Lost to follow-up | 0 | 44 | 0 | 0 | 0 |
| Withdrew: Lack of efficacy | 0 | 12 | 0 | 0 | 0 |
| Withdrew: Adverse event | 0 | 63 | 0 | 0 | 0 |
| Withdrew: Withdrawn by the investigator | 0 | 2 | 0 | 0 | 0 |
| Milestone | Conversion Phase. | Oral Aripiprazole Stabilization Phase. | Intramuscular (IM) Depot Stabilization Phase. | Double-blind Placebo-controlled Phase - Aripiprazole IM Depot. | Double-blind Placebo-controlled Phase - Placebo. |
|---|---|---|---|---|---|
| Started | 0 | 0 | 425 | 0 | 0 |
| Completed | 0 | 0 | 266 | 0 | 0 |
| Not completed | 0 | 0 | 159 | 0 | 0 |
| Withdrew: Protocol deviation | 0 | 0 | 5 | 0 | 0 |
| Withdrew: Met withdrawal criteria | 0 | 0 | 26 | 0 | 0 |
| Withdrew: Withdrawal by subject | 0 | 0 | 56 | 0 | 0 |
| Withdrew: Sponsor discontinued study | 0 | 0 | 1 | 0 | 0 |
| Withdrew: Lost to follow-up | 0 | 0 | 21 | 0 | 0 |
| Withdrew: Lack of efficacy | 0 | 0 | 7 | 0 | 0 |
| Withdrew: Adverse event | 0 | 0 | 37 | 0 | 0 |
| Withdrew: Withdrawn by the investigator | 0 | 0 | 6 | 0 | 0 |
| Milestone | Conversion Phase. | Oral Aripiprazole Stabilization Phase. | Intramuscular (IM) Depot Stabilization Phase. | Double-blind Placebo-controlled Phase - Aripiprazole IM Depot. | Double-blind Placebo-controlled Phase - Placebo. |
|---|---|---|---|---|---|
| Started | 0 | 0 | 0 | 133 | 133 |
| Completed | 0 | 0 | 0 | 64 | 38 |
| Not completed | 0 | 0 | 0 | 69 | 95 |
| Withdrew: Protocol deviation | 0 | 0 | 0 | 1 | 1 |
| Withdrew: Recurrence of any mood episode with ae | 0 | 0 | 0 | 16 | 33 |
| Withdrew: Met withdrawal criteria | 0 | 0 | 0 | 4 | 7 |
| Withdrew: Ae without recurrence of any moodepisode | 0 | 0 | 0 | 7 | 1 |
| Withdrew: Withdrawal by subject | 0 | 0 | 0 | 13 | 10 |
| Withdrew: Sponsor discontinued study | 0 | 0 | 0 | 1 | 3 |
| Withdrew: Recurrence of any mood episode withoutae | 0 | 0 | 0 | 19 | 35 |
| Withdrew: Lost to follow-up | 0 | 0 | 0 | 8 | 5 |
This endpoint was defined as meeting any of the following criteria: 1. Hospitalization for any mood episode OR 2. Any of the following: 1. YMRS total score ≥ 15 OR 2. MADRS total score ≥ 15 OR 3. CGI-BP-S score \> 4 (overall score) OR 3. SAE of worsening disease (bipolar I disorder) OR 4. Discontinuation due to lack of efficacy or discontinuation due to an AE of worsening disease OR 5. Clinical worsening with the need for treatment of symptoms of an underlying mood disorder by addition of a mood stabilizer, antidepressant treatment, antipsychotic medication, or increase greater than the allowed benzodiazepine doses, or 6. Active suicidality, which is defined as a score of 4 or more on the MADRS item 10 OR an answer of "yes" on question 4 or 5 on the C-SSRS. The time to event is presented in the following table.
| Days | Aripiprazole IM Depot | Placebo |
|---|---|---|
| Time From Randomization to Recurrence of Any Mood Episode During Double-bind Placebo-controlled Phase. | NA (NA to NA) | 308 (178 to NA) |
To assess the proportion of subjects who met criteria for recurrence of any mood episode (manic, mixed or depressive). Hierarchical procedure was used to preserve the overall Type I error at 0.05.
| Participants | Aripiprazole IM Depot | Placebo |
|---|---|---|
| Number of Subjects Meeting Criteria for Recurrence of Any Mood Episode. | 35 | 68 |
CGI-BP-S assessed the subject's severity of Illness (mania) based on a 7-point scale ranging from 1 (normal/ not ill at all) to 7 (very severely ill).
| Units on a scale | Aripiprazole IM Depot | Placebo |
|---|---|---|
| Mean Change From Randomization to Endpoint in the CGI-BP-S (Mania) Score. | -0.16 ± 0.058 | 0.27 ± 0.126 |
Analysis of time from randomization to recurrence defined by hospitalization for a mood episode (Double-blind, Placebo-controlled Phase efficacy sample). Time to recurrence is presented in the following table.
| Days | Aripiprazole IM Depot | Placebo |
|---|---|---|
| Time From Randomization to Recurrence Defined by Hospitalization for a Mood Episode. | NA (NA to NA) | NA (NA to NA) |
Collected over Any AEs were recorded from the signing of informed consent up to 52 weeks (end of the study).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Conversion Phase. | 0/459 (0%) | 32/459 (7%) | 180/459 (39.2%) |
| Oral Aripiprazole Stabilization Phase. | 1/614 (0.2%) | 35/614 (5.7%) | 196/614 (31.9%) |
| IM Depot Stabilization Phase. | 0/425 (0%) | 36/425 (8.5%) | 194/425 (45.6%) |
| Aripiprazole IM Depot- Double-blind, Placebo-controlled Phase. | 1/132 (0.8%) | 10/132 (7.6%) | 66/132 (50%) |
| Placebo-Double-blind, Placebo-controlled Phase. | 0/133 (0%) | 25/133 (18.8%) | 62/133 (46.6%) |
| Event | Conversion Phase. | Oral Aripiprazole Stabilization Phase. | IM Depot Stabilization Phase. | Aripiprazole IM Depot- Double-blind, Placebo-controlled Phase. | Placebo-Double-blind, Placebo-controlled Phase. |
|---|---|---|---|---|---|
| ManiaPsychiatric disorders | 13/459 | 17/614 | 7/425 | 2/132 | 10/133 |
| Bipolar disorderPsychiatric disorders | 6/459 | 2/614 | 0/425 | 1/132 | 3/133 |
| Bipolar I disorderPsychiatric disorders | 4/459 | 1/614 | 4/425 | 2/132 | 3/133 |
| DepressionPsychiatric disorders | 0/459 | 4/614 | 8/425 | 0/132 | 0/133 |
| Major depressionPsychiatric disorders | 1/459 | 1/614 | 0/425 | 0/132 | 2/133 |
| Atrial FibrillationCardiac disorders | 0/459 | 0/614 | 1/425 | 1/132 | 0/133 |
| Cardio-respiratory arrestCardiac disorders | 0/459 | 0/614 | 0/425 | 1/132 | 0/133 |
| AsthmaRespiratory, thoracic and mediastinal disorders | 1/459 | 0/614 | 1/425 | 1/132 | 0/133 |
| Respiratory failureRespiratory, thoracic and mediastinal disorders | 0/459 | 0/614 | 0/425 | 1/132 | 0/133 |
| AkathisiaNervous system disorders | 3/459 | 1/614 | 0/425 | 1/132 | 0/133 |
| Event | Conversion Phase. | Oral Aripiprazole Stabilization Phase. | IM Depot Stabilization Phase. | Aripiprazole IM Depot- Double-blind, Placebo-controlled Phase. | Placebo-Double-blind, Placebo-controlled Phase. |
|---|---|---|---|---|---|
| Weight increasedInvestigations | 13/459 | 22/614 | 47/425 | 31/132 | 24/133 |
| AkathisiaNervous system disorders | 76/459 | 94/614 | 74/425 | 27/132 | 17/133 |
| NasopharyngitisInfections and infestations | 18/459 | 11/614 | 22/425 | 10/132 | 13/133 |
| InsomniaPsychiatric disorders | 35/459 | 34/614 | 41/425 | 10/132 | 10/133 |
| RestlessnessPsychiatric disorders | 36/459 | 32/614 | 24/425 | 6/132 | 5/133 |
| AnxietyPsychiatric disorders | 19/459 | 24/614 | 30/425 | 9/132 | 6/133 |
| HeadacheNervous system disorders | 31/459 | 13/614 | 12/425 | 4/132 | 9/133 |
| FatigueGeneral disorders | 14/459 | 19/614 | 22/425 | 4/132 | 5/133 |
Baseline characteristics were presented for the subjects randomized to Double-blind Placebo-controlled Phase. The Double-blind, Placebo-controlled Phase Efficacy Sample consisted of all randomized subjects who received at least 1 injection of IMP and had at least 1 post-baseline efficacy assessment.
| Age, Categorical(Participants) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 133 | 132 | 265 |
| >=65 years | 0 | 1 | 1 |
| Age, Continuous(years) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Mean | 40.6 ± 10.8 | 40.6 ± 11.2 | 40.6 ± 11.0 |
| Sex: Female, Male(Participants) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Female | 83 | 70 | 153 |
| Male | 50 | 63 | 113 |
| Region of Enrollment(Participants) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Canada | 2 | 0 | 2 |
| South Korea | 7 | 7 | 14 |
| Romania | 8 | 12 | 20 |
| United States | 101 | 102 | 203 |
| Japan | 9 | 10 | 19 |
| Taiwan | 2 | 1 | 3 |
| Poland | 4 | 1 | 5 |
| Age at first manic episode (years)(years) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Mean | 25.2 ± 10.3 | 24.8 ± 9.9 | 25.0 ± 10.1 |
| Number of mood episodes past 12 months(Mood episodes) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Mean | 2.2 ± 1.2 | 2.2 ± 1.1 | 2.2 ± 1.2 |
| Duration of disease prior to enrollment (years)(years) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Mean | 12.1 ± 9.2 | 13.6 ± 9.8 | 12.9 ± 9.5 |
| Number of prior hospitalizations for a mood episode(Prior hospitalization for mood episode) | Aripiprazole Depot | Placebo | Total |
|---|---|---|---|
| Mean | 3.5 ± 3.9 | 3.5 ± 4.1 | 3.5 ± 4.0 |
3 further baseline measures are reported on the registry.
This study is completed, as verified in Jul 2018. You cannot join it, but the record below documents what was studied.
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Otsuka Pharmaceutical Development & Commercialization, Inc.