Bipolar Disorder
Conditions
Keywords
Mania, Bipolar I Disorder, Acute Mania Associated with Bipolar I Disorder
Brief summary
This is a study designed to evaluate the efficacy, safety, and tolerability of RGH-188 monotherapy in the treatment of acute mania. This study will be 5 weeks in duration; 3 weeks double-blind treatment and 2-weeks safety follow-up. All patients meeting the eligibility criteria will be randomized to one of two treatment groups: RGH-188 or placebo
Interventions
Cariprazine 3 mg - 12 mg oral administration, once per day.
Dose-matched placebo oral administration, once per day.
Sponsors
Study design
Eligibility
Inclusion criteria
* Male or female inpatients 18 to 65 years of age * Meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV) criteria for bipolar I disorder, acute manic or mixed episode * Having a total Young Mania Rating Scale (YMRS) score \>= 20 and a score of at least 4 on two of the following YMRS items: * Irritability, * Speech, * Content, and * Disruptive/Aggressive Behavior
Exclusion criteria
* Patients who exhibit abnormalities on physical examination, have abnormal vital-signs, electrocardiogram (ECG), or clinical laboratory values \[such as thyroid-stimulating hormone (TSH)\]. * Patients with Montgomery-Åsberg Depression Rating Scale (MADRS) total score \>= 18 at Visit 2. * Patients experiencing first manic episode. * Patients that have received electroconvulsive therapy (ECT) or a depot neuroleptic in the 3 months prior to Visit 1.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3 | Baseline, 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. Analyses are based on an Analysis of Covariance (ANCOVA) model for change from Baseline with treatment group and study center as factors and Baseline value as covariate. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3 | Baseline, 3 Weeks | 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. Analyses are based on ANCOVA model for change from Baseline with treatment group and study center as factors and Baseline CGI-S score as covariate. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Placebo dose-matching cariprazine capsules oral administration, once per day for 3 weeks. | 118 |
| Cariprazine Cariprazine 3 mg - 12 mg capsules oral administration, once per day for 3 weeks. | 118 |
| Total | 236 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 13 | 17 |
| Overall Study | Insufficient Therapeutic Response | 18 | 11 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | Protocol Violation | 0 | 2 |
| Overall Study | Withdrawal of Consent | 15 | 13 |
Baseline characteristics
| Characteristic | Placebo | Cariprazine | Total |
|---|---|---|---|
| Age, Continuous | 38.7 years STANDARD_DEVIATION 11 | 38.0 years STANDARD_DEVIATION 10.3 | 38.3 years STANDARD_DEVIATION 10.7 |
| Body Mass Index (BMI) | 27.2 kg/meter(m)^2 STANDARD_DEVIATION 5.8 | 25.8 kg/meter(m)^2 STANDARD_DEVIATION 5.9 | 26.5 kg/meter(m)^2 STANDARD_DEVIATION 5.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 6 Participants | 10 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 114 Participants | 112 Participants | 226 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Height | 170.0 centimeter (cm) STANDARD_DEVIATION 10.4 | 169.9 centimeter (cm) STANDARD_DEVIATION 10 | 170.0 centimeter (cm) STANDARD_DEVIATION 10.2 |
| Race/Ethnicity, Customized Asian | 28 Participants | 30 Participants | 58 Participants |
| Race/Ethnicity, Customized Black | 31 Participants | 36 Participants | 67 Participants |
| Race/Ethnicity, Customized Caucasian | 55 Participants | 47 Participants | 102 Participants |
| Race/Ethnicity, Customized Other | 4 Participants | 5 Participants | 9 Participants |
| Sex: Female, Male Female | 41 Participants | 38 Participants | 79 Participants |
| Sex: Female, Male Male | 77 Participants | 80 Participants | 157 Participants |
| Weight | 79.3 kilogram (kg) STANDARD_DEVIATION 20 | 75.0 kilogram (kg) STANDARD_DEVIATION 20.3 | 77.2 kilogram (kg) STANDARD_DEVIATION 20.2 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 73 / 118 | 90 / 118 |
| serious Total, serious adverse events | 6 / 118 | 7 / 118 |
Outcome results
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. Analyses are based on an Analysis of Covariance (ANCOVA) model for change from Baseline with treatment group and study center as factors and Baseline value as covariate.
Time frame: Baseline, Week 3
Population: Intent-to-treat Population included Participants who received at least 1 dose of study drug and who had at least 1 post-baseline YMRS assessment, last observation carried forward (LOCF).
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3 | -8.91 score on a scale | Standard Error 1.083 |
| Cariprazine | Change From Baseline in the Young Mania Rating Scale (YMRS) Total Score at Week 3 | -15.02 score on a scale | Standard Error 1.078 |
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. Analyses are based on ANCOVA model for change from Baseline with treatment group and study center as factors and Baseline CGI-S score as covariate.
Time frame: Baseline, 3 Weeks
Population: Intent-to-treat Population included all participants who received at least 1 dose of study drug and who had at least 1 post-baseline YMRS assessment, LOCF.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3 | -0.93 score on a scale | Standard Error 0.125 |
| Cariprazine | Change From Baseline in Clinical Global Impression-Severity (CGI-S) Total Score at Week 3 | -1.57 score on a scale | Standard Error 0.125 |