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A Study of Olanzapine in Patients With Schizophrenia

A Double-Blind Confirmatory Study Comparing Rapid-Acting Intramuscular Olanzapine and Rapid-Acting Intramuscular Placebo in Patients With an Exacerbation of Schizophrenia With Acute Psychotic Agitation

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00970281
Enrollment
91
Registered
2009-09-02
Start date
2009-09-30
Completion date
2011-04-30
Last updated
2012-03-07

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Schizophrenia

Brief summary

The primary objectives of the study is to confirm if the efficacy of intramuscular injection (IM) olanzapine 10 milligrams (mg) in patients with an exacerbation of schizophrenia with acute psychotic agitation is greater than intramuscular placebo by comparing changes from baseline to 2 hours after the first IM injection of agitation.

Interventions

DRUGRapid-Acting Intramuscular Olanzapine

Administered by means of intramuscular injection (IM) with the possibility of second 10 milligram (mg) injection 2 to 4 hours after first injection, for a maximum of 2 injections

DRUGPlacebo

Administered by means of IM with the possibility of second injection 2 to 4 hours after first injection, for a maximum of 2 injections

Sponsors

Eli Lilly and Company
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
20 Years to 64 Years
Healthy volunteers
No

Inclusion criteria

* Patients who meet Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) criteria for schizophrenia. * Patients with an exacerbation of schizophrenia with acute psychotic agitation. * Patients who are hospitalized during the study. * Patients, or proxy consenters, understand the nature of the study and sign on an informed consent document. * The investigator or sub-investigator(s) judges that the patients are able to cooperate with all protocol procedures. * Patients who are considered to be with agitation and appropriate candidates for treatment with intramuscular (IM) medication by the investigator or sub-investigator(s). * The investigator or sub-investigator(s) believes that it is safe to administer IM olanzapine to the patients in consideration of safety, including the anticholinergic action of IM olanzapine. * Patients who have a score of 1 or 2 on Agitation-Calmness Evaluation Scale (ACES) before the first IM injection of investigational product.

Exclusion criteria

* Patients whose Global Assessment of Functioning (GAF) score is less than or equal to 40 within last 1 year before informed consent. * Patients with defect. * Patients whose agitation continues more than 2 weeks before informed consent. * Patients who were previously treated with antipsychotics and were considered by the investigator or sub-investigator(s) to be treatment-resistant to antipsychotics. * Patients who were treated by oral olanzapine at a dose of more than 20 milligrams (mg) for more than 4 weeks but did not improve. * Patient who have a history of participation in clozapine trials or treatment with clozapine. * Patients who have co-morbidity of mental retardation and personality disorder. * Patients whose agitation is possibly due to brain lesions such as (but not limited to) head injury, stroke, brain breeding, and cerebral infection. * Patients with sub-stupor or stupor. * One or more seizures without a clear and resolved etiology. However, if the patient has had one or more seizures in the past with an identifiable etiology, and that etiology has been resolved, the patient may be entered. * Patients who have a history of DSM-IV-TR substance (except caffeine and nicotine) abuse within the past 30 days or substance dependence within the past 6 months before informed consent. Or patients who have a history of using illegal drug. * Patients whose agitation is caused by substance abuse or neurologic conditions, in the opinion of the investigator or sub-investigator(s). * Patients who have a diagnosis of Parkinson's disease or dementia. * Patients who are actively suicidal (at high risk for suicide attempt) in the opinion of the investigator or sub-investigator(s). * Patients with inadequately controlled diabetes, or patients whose treatment for diabetes has been changed within 4 weeks before the first IM injection of the investigational product. The investigator's discretion will supersede even if the patients do not meet the above criteria for concurrent diabetes. * Patients who have received haloperidol decanoate fluphenazine decanoate, or fluphenazine enanthate within 8 weeks before the first IM injection of investigational product. * Patients who have received risperidone long-acting injection within 12 weeks before the first IM injection of investigational product. * Patients who have a history of receiving injectable depot antipsychotics other than haloperidol decanoate, fluphenazine decanoate, fluphenazine enanthate and risperidone long-acting injection. * Patients who have received antipsychotics or other prohibited concomitant medicines within 2 hours before the first IM injection of investigational product. * Patients who have received benzodiazepines within 4 hours before the first IM injection of investigational product.

Design outcomes

Primary

MeasureTime frameDescription
Change From Baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) InjectionBaseline, up to 2 hours after first IM injectionMeasures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.

Secondary

MeasureTime frameDescription
Change From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) InjectionBaseline, 15 minutes, 30 minutes, 60 minutes, and 90 minutes after the first injectionMeasures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.
Change From Baseline in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 24 Hours After the First Intramuscular (IM) InjectionBaseline, up to 24 hours after first IM injectionMeasures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.
Percentage of Participants With 40% or Greater Percent Decrease in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) InjectionUp to 2 hours after the first (IM) injectionMeasures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.
Percentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injectionup to 24 hours after the first IM injectionThe ACES differentiates agitation, calmness, and sleep-state, using a 9-point scale: 1 (Marked Agitation) to 9 (Unarousable). Scores of 4 (Normal) to 7 (Marked Calmness) were used for this outcome measure.
Percentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionUp to 24 hours after the first IM injectionAssesses extrapyramidal symptoms attributable to antipsychotics. Consists of 9 items (8 to assess individual symptoms; 1 to assess global severity). Each item is assessed from 0 (none, normal) to 4 (severe). Total points of 8 items are defined as DIEPSS total (0 to 32 points). Items for assessment of individual symptoms are classified into 4 categories of parkinsonism, akathisia, dystonia and dyskinesia. Parkinsonism is assessed by total points of items 1 to 5; akathisia, dystonia and dyskinesia are assessed by points given to corresponding items (item 6, item 7, and item 8, respectively).

Countries

Japan

Participant flow

Participants by arm

ArmCount
10 mg Olanzapine
Administered by means of intramuscular injection (IM) with the possibility of second 10 milligram (mg) injection 2 to 4 hours after first injection, for a maximum of 2 injections.
45
Placebo
Administered by means of IM injection with the possibility of second injection 2 to 4 hours after first injection, for a maximum of 2 injections.
45
Total90

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLack of Efficacy114
Overall StudyPhysician Decision11
Overall StudyWithdrawal by Subject01

Baseline characteristics

Characteristic10 mg OlanzapineTotalPlacebo
Age at Onset24.7 years
STANDARD_DEVIATION 9.4
25.9 years
STANDARD_DEVIATION 9.4
27.2 years
STANDARD_DEVIATION 9.3
Age Continuous46.4 years
STANDARD_DEVIATION 11.7
46.7 years
STANDARD_DEVIATION 11.9
47.0 years
STANDARD_DEVIATION 12.1
Agitation-Calmness Evaluation Scale (ACES) Score1.6 units on a scale
STANDARD_DEVIATION 0.5
1.6 units on a scale
STANDARD_DEVIATION 0.5
1.6 units on a scale
STANDARD_DEVIATION 0.5
Diabetes Mellitus Status
Diabetes Mellitus - No
42 participants84 participants42 participants
Diabetes Mellitus Status
Diabetes Mellitus - Yes
3 participants6 participants3 participants
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Diagnosis Status
Catatonic
0 participants2 participants2 participants
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Diagnosis Status
Disorganized
4 participants7 participants3 participants
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Diagnosis Status
Paranoid
40 participants80 participants40 participants
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Diagnosis Status
Residual
0 participants0 participants0 participants
Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision Diagnosis Status
Undifferentiated
1 participants1 participants0 participants
Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) Total Score23.5 units on a scale
STANDARD_DEVIATION 6.1
23.4 units on a scale
STANDARD_DEVIATION 5.5
23.2 units on a scale
STANDARD_DEVIATION 4.9
Pre-therapy Antipsychotic Usage
No
6 participants10 participants4 participants
Pre-therapy Antipsychotic Usage
Yes (<1000 mg)
27 participants57 participants30 participants
Pre-therapy Antipsychotic Usage
Yes (>=1000 milligrams [mg])
12 participants23 participants11 participants
Region of Enrollment
Japan
45 participants90 participants45 participants
Sex: Female, Male
Female
21 Participants44 Participants23 Participants
Sex: Female, Male
Male
24 Participants46 Participants22 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
13 / 456 / 45
serious
Total, serious adverse events
0 / 450 / 45

Outcome results

Primary

Change From Baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) Injection

Measures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.

Time frame: Baseline, up to 2 hours after first IM injection

Population: Participants with a baseline and a value at the time, last observation carried forward (LOCF).

ArmMeasureValue (MEAN)Dispersion
10 mg OlanzapineChange From Baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) Injection-9.2 units on a scaleStandard Deviation 4.5
PlaceboChange From Baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) Injection-2.8 units on a scaleStandard Deviation 5.6
Comparison: Sample size of at least 45 participants per group was necessary to verify decreases in PANSS-EC total score were significantly greater in olanzapine group than placebo group using a t-test with a power of 90% and a 2-sided significance level of 5%.p-value: <0.001ANOVA
Secondary

Change From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection

Measures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.

Time frame: Baseline, 15 minutes, 30 minutes, 60 minutes, and 90 minutes after the first injection

Population: Full analysis set (FAS): All randomized participants administered at least 1 intramuscular (IM) injection of the investigational product with at least 1 observation after the first IM injection, last observation carried forward (LOCF).

ArmMeasureGroupValue (MEAN)Dispersion
10 mg OlanzapineChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection0.25 hour after First IM Injection-2.4 units on a scaleStandard Deviation 2.9
10 mg OlanzapineChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection0.50 hour after First IM Injection-5.0 units on a scaleStandard Deviation 3.6
10 mg OlanzapineChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection1 hour after First IM Injection-7.3 units on a scaleStandard Deviation 4.9
10 mg OlanzapineChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection1.5 hour after First IM Injection-8.2 units on a scaleStandard Deviation 4.7
PlaceboChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection1.5 hour after First IM Injection-2.7 units on a scaleStandard Deviation 5
PlaceboChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection0.25 hour after First IM Injection-1.0 units on a scaleStandard Deviation 3.1
PlaceboChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection1 hour after First IM Injection-3.0 units on a scaleStandard Deviation 5.2
PlaceboChange From Baseline in PANSS-EC Total Score up to 90 Minutes After the First Intramuscular (IM) Injection0.50 hour after First IM Injection-1.9 units on a scaleStandard Deviation 4.6
p-value: 0.009ANOVA
p-value: <0.001ANOVA
p-value: <0.001ANOVA
p-value: <0.001ANOVA
Secondary

Change From Baseline in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 24 Hours After the First Intramuscular (IM) Injection

Measures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.

Time frame: Baseline, up to 24 hours after first IM injection

Population: Full analysis set (FAS): All randomized participants administered at least 1 intramuscular (IM) injection of the investigational product with at least 1 observation after the first IM injection, last observation carried forward (LOCF).

ArmMeasureValue (MEAN)Dispersion
10 mg OlanzapineChange From Baseline in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 24 Hours After the First Intramuscular (IM) Injection-5.6 units on a scaleStandard Deviation 5.8
PlaceboChange From Baseline in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 24 Hours After the First Intramuscular (IM) Injection-2.8 units on a scaleStandard Deviation 6.4
p-value: 0.008ANOVA
Secondary

Percentage of Participants With 40% or Greater Percent Decrease in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) Injection

Measures excitability and consists of the following 5 items from the PANSS: Excitement, Hostility, Tension, Uncooperativeness, and Poor Impulse Control. Each item is rated on a scale from 1 (absent) to 7 (extreme). The sum of the 5 items is defined as the PANSS-EC total score which ranges from 5 to 35.

Time frame: Up to 2 hours after the first (IM) injection

Population: Full analysis set (FAS): All randomized participants administered at least 1 intramuscular (IM) injection of the investigational product with at least 1 observation after the first IM injection, last observation carried forward (LOCF).

ArmMeasureValue (NUMBER)
10 mg OlanzapinePercentage of Participants With 40% or Greater Percent Decrease in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) Injection40.0 percentage of participants
PlaceboPercentage of Participants With 40% or Greater Percent Decrease in the Positive and Negative Syndrome Scale - Excited Component (PANSS-EC) Total Score up to 2 Hours After the First Intramuscular (IM) Injection13.6 percentage of participants
p-value: 0.008Fisher Exact
Secondary

Percentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection

The ACES differentiates agitation, calmness, and sleep-state, using a 9-point scale: 1 (Marked Agitation) to 9 (Unarousable). Scores of 4 (Normal) to 7 (Marked Calmness) were used for this outcome measure.

Time frame: up to 24 hours after the first IM injection

Population: Participants having a post-baseline measure, last observation carried forward (LOCF).

ArmMeasureGroupValue (NUMBER)
10 mg OlanzapinePercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection1 hour after First IM Injection31.1 percentage of participants
10 mg OlanzapinePercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection2 hours after First IM Injection40.0 percentage of participants
10 mg OlanzapinePercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection1.5 hours after First IM Injection40.0 percentage of participants
10 mg OlanzapinePercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection24 hours after First IM Injection28.9 percentage of participants
10 mg OlanzapinePercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection0.5 hour after First IM Injection24.4 percentage of participants
PlaceboPercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection24 hours after First IM Injection15.9 percentage of participants
PlaceboPercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection0.5 hour after First IM Injection11.4 percentage of participants
PlaceboPercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection1 hour after First IM Injection15.9 percentage of participants
PlaceboPercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection1.5 hours after First IM Injection13.6 percentage of participants
PlaceboPercentage of Participants With Scores of 4 to 7 in the Agitation-Calmness Evaluation Scale (ACES) Score up to 24 Hours After the First Intramuscular (IM) Injection2 hours after First IM Injection13.6 percentage of participants
p-value: 0.167Fisher Exact
p-value: 0.134Fisher Exact
p-value: 0.008Fisher Exact
p-value: 0.008Fisher Exact
p-value: 0.204Fisher Exact
Secondary

Percentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) Injection

Assesses extrapyramidal symptoms attributable to antipsychotics. Consists of 9 items (8 to assess individual symptoms; 1 to assess global severity). Each item is assessed from 0 (none, normal) to 4 (severe). Total points of 8 items are defined as DIEPSS total (0 to 32 points). Items for assessment of individual symptoms are classified into 4 categories of parkinsonism, akathisia, dystonia and dyskinesia. Parkinsonism is assessed by total points of items 1 to 5; akathisia, dystonia and dyskinesia are assessed by points given to corresponding items (item 6, item 7, and item 8, respectively).

Time frame: Up to 24 hours after the first IM injection

Population: Participants with an abnormal value at post-baseline, last observation carried forward (LOCF).

ArmMeasureGroupValue (NUMBER)
10 mg OlanzapinePercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionParkinsonism (N=43, 44)4.7 percentage of participants
10 mg OlanzapinePercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionAkathisia (N=43, 45)0.0 percentage of participants
10 mg OlanzapinePercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionDystonia (N=44, 45)0.0 percentage of participants
10 mg OlanzapinePercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionDyskinesia (N=44, 45)0.0 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionDyskinesia (N=44, 45)0.0 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionParkinsonism (N=43, 44)6.8 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionDystonia (N=44, 45)0.0 percentage of participants
PlaceboPercentage of Participants With Treatment-Emergent Extrapyramidal Symptoms Based on the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) Score up to 24 Hours After the First Intramuscular (IM) InjectionAkathisia (N=43, 45)0.0 percentage of participants
p-value: 1Fisher Exact

Source: ClinicalTrials.gov · Data processed: Mar 24, 2026