Schizophrenia
Conditions
Brief summary
This study is designed to compare 3 doses of LY2140023 for the treatment of schizophrenia as assessed at endpoint (up to 7 weeks) using the Clinical Utility Index (CUI), a measure of efficacy, safety, and tolerability.
Interventions
Administered orally, twice daily for up to 7 weeks of treatment
Administered orally, twice daily for up to 7 weeks of treatment
Sponsors
Study design
Eligibility
Inclusion criteria
* Diagnosis of schizophrenia as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; APA 2000) (Disorganized, 295.10; Catatonic, 295.20; Paranoid 295.30; or Undifferentiated, 295.90) and confirmed by the Structured Clinical Interview for DSM-IV-TR (SCID) * Non pregnant female participants who agree to use acceptable birth control * At entry to the study must be considered moderately ill in the opinion of the investigator * 1 year history of Schizophrenia prior to entering the study * At study entry participants with a history of antipsychotic treatment must have a lifetime history of at least one hospitalization for the treatment of schizophrenia, not including the hospitalization required for study based on the investigator's clinical judgment. Participants who have never taken antipsychotic treatment may enter the study even without a history of hospitalization * At study entry participants with a history of antipsychotic treatment must have a history of at least one episode of illness exacerbation requiring an intensification of treatment intervention or care in the last 2 years, not including the present episode of illness. Participants who have never taken antipsychotic treatment may enter the study without a past history of illness exacerbation and intensification of treatment in the last 2 years * At study entry participants must have experienced an exacerbation of illness within the 4 weeks prior to entering the study, leading to an intensification of psychiatric care in the opinion of the investigator. If exacerbation occurs in participants who are presently hospitalized, the participants must not have been hospitalized longer than 60 days at entry of the study
Exclusion criteria
* Participated in any clinical trial with any pharmacological treatment intervention for which they received a study-related medication in the 6 months prior to visit 1 * Previously completed or withdrawn from this study, or any other study investigating LY2140023 or any predecessor molecules with glutamatergic activity * Have any known history of receiving treatment with clozapine at any dose, as determined at baseline * Have received treatment with a depot formulation of an antipsychotic medication within the 6 months prior entering the study * Participants who are currently suicidal * Females who are pregnant, nursing, or who intend to become pregnant within 30 days of completing the study * Participants with uncorrected narrow-angle glaucoma, uncontrolled diabetes, certain diseases of the liver, renal insufficiency, untreated thyroid condition or other serious or unstable illnesses * Have a history of one or more seizures, except for those who experienced a single simple febrile seizure between ages 6 months and 5 years * Participants are excluded if their biological father, mother, brother, sister, or child has a history of idiopathic epilepsy * Within 1 year of study enrollment, participants have a history of central nervous system infection, uncontrolled migraine, transient ischemic attack (TIA), or head trauma with loss of consciousness or a post-concussive * Participants are excluded if they have a lifetime history of any of the following: * head trauma, stroke, or central nervous system (CNS) infection with persistent neurological deficit (focal or diffuse); * brain surgery; * an electroencephalogram with paroxysmal (epileptiform) activity, or * brain structural lesion, including developmental abnormalities, as determined by examination or previous neuroimaging studies that are consistent with a diagnosable neurological disease or syndrome * Electroconvulsive therapy (ECT) within 3 months of entering the study or who will have ECT at any time during the study * Leukopenia * Medical history of Human Immunodeficiency Virus positive (HIV+) status * Higher than normal blood prolactin levels * Certain electrocardiogram results
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Utility Index (CUI) | Baseline through Week 6 | CUI measures the efficacy (response), tolerability (time on treatment) and safety \[incidence of adverse events (AEs)\] by quantifying these 3 attributes and provides a single metric for overall treatment outcome. Each component is given a score ranging from 0 to 5. The CUI Total Score is the sum of the 3 items and ranges from 0 to 15. The greater the CUI Total Score, the more effective the treatment. If a participant experiences a drug-related seizure/death, the safety component is given a score of 0 resulting in an overall CUI Total Score of 0. Analysis of variance (ANOVA) was used to calculate Least Squares (LS) mean and standard error. LS mean values were controlled for treatment, gender and pooled investigators. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | Baseline, Week 6 | The PANSS consists of 30 items and 3 subscales designed to measure severity of psychopathology in schizophrenia. The PANSS Positive Subscale and the PANSS Negative Subscale each contain 7 items, and the remaining 16 items make up the PANSS General Psychopathology Subscale. Each item is rated from 1 (symptom not present) to 7 (symptom extremely severe). The PANSS Total Score is the sum of the 30 items (range from 30 to 210). The PANSS Positive Subscale and PANSS Negative Subscale scores each range from 7 to 49. The PANSS General Psychopathology Subscale score ranges from 16 to 112. Higher scores indicate greater severity of illness. The Mixed Model Repeated Measures (MMRM) analysis was used to calculate Least Squares (LS) mean and 95% confidence interval. LS mean values were controlled for baseline, treatment, gender, pooled investigator, visit, treatment\*visit and baseline\*visit. |
| Change From Baseline to Week 6 Endpoint in the Clinical Global Impression-Severity Scale (CGI-S) | Baseline, Week 6 | The CGI-S instrument is used to record the severity of mental illness at the time of assessment. The score ranges from 1 (normal, not at all ill) to 7 (among the most extremely ill). Higher scores indicate greater severity of illness. The Mixed Model Repeated Measures (MMRM) analysis was used to calculate Least Squares (LS) mean and 95% confidence interval. LS mean values were controlled for baseline, treatment, gender, pooled investigator, visit, treatment\*visit and baseline\*visit. |
| Change From Baseline to Week 6 Endpoint in the 16-item Negative Symptoms Assessment (NSA-16) | Baseline, Week 6 | The NSA-16 scale is used to help clinicians rate behaviors (not psychopathology) commonly associated with negative symptoms of schizophrenia. The scale rates participants on 16 anchors. Each item (anchor) is rated from 1 (better) to 6 (worse). The NSA-16 Total Score is the sum of the 16 specific items and ranges from 16 to 96. Higher scores indicate greater severity of illness. The Mixed Model Repeated Measures (MMRM) analysis was used to calculate Least Squares (LS) mean and 95% confidence interval. LS mean values were controlled for baseline, treatment, gender, pooled investigator, visit, treatment\*visit and baseline\*visit. |
| The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Baseline up to Week 6 | Columbia Suicide Rating Scale (C-SSRS) captures occurrence, severity, and frequency of suicide-related thoughts and behaviors. Suicidal ideation: a yes answer to any one of 5 suicidal ideation questions: wish to be dead, and 4 different categories of active suicidal ideation. Suicidal behavior: a yes answer to any of 5 suicidal behavior questions: preparatory acts or behavior, aborted attempt, interrupted attempt, non-fatal suicide attempt, and completed suicide. The number of participants with statistically significant changes of the C-SSRS was the number of participants with a treatment-emergent suicidal ideation and behavior (an increase in suicidal behavior or ideation over lead-in baseline.) |
| Percentage of Participants Who Discontinued (Rate of Discontinuation) | Baseline through Week 6 | Rate of discontinuation was calculated as the number of participants who discontinued from study due to any reason divided by the total number of participants who received study drug, then multiplied by 100. |
Countries
Japan, South Korea, Taiwan
Participant flow
Pre-assignment details
This study consisted of a 1-week placebo lead-in period and a 6-week randomized, double-blind treatment period. Placebo responder is defined as ≥25% improvement in Positive and Negative Syndrome Scale (PANSS) Total Score from the start of placebo lead-in period to the end of placebo lead-in period.
Participants by arm
| Arm | Count |
|---|---|
| 10 mg LY2140023 5 milligrams (mg) of LY2140023 orally, twice daily for 6 weeks. | 21 |
| 80 mg LY2140023 40 mg of LY2140023 orally, twice daily for 6 weeks. | 21 |
| 160 mg LY2140023 80 mg of LY2140023 orally, twice daily for 6 weeks. | 20 |
| Placebo Placebo orally, twice daily for 6 weeks. | 20 |
| Total | 82 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Adverse Event | 3 | 0 | 0 | 2 |
| Overall Study | Perceived Lack of Efficacy | 6 | 3 | 7 | 4 |
| Overall Study | Protocol Violation | 1 | 0 | 0 | 0 |
| Overall Study | Sponsor Decision | 0 | 0 | 1 | 1 |
| Overall Study | Withdrawal by Subject | 2 | 1 | 1 | 1 |
Baseline characteristics
| Characteristic | 10 mg LY2140023 | 80 mg LY2140023 | 160 mg LY2140023 | Placebo | Total |
|---|---|---|---|---|---|
| Age, Continuous | 40.99 years STANDARD_DEVIATION 10.98 | 42.03 years STANDARD_DEVIATION 10.41 | 43.16 years STANDARD_DEVIATION 10.33 | 38.34 years STANDARD_DEVIATION 9.91 | 41.14 years STANDARD_DEVIATION 10.38 |
| Race/Ethnicity, Customized Asian | 21 participants | 21 participants | 20 participants | 20 participants | 82 participants |
| Region of Enrollment Japan | 18 participants | 16 participants | 17 participants | 17 participants | 68 participants |
| Region of Enrollment Korea, Republic of | 2 participants | 3 participants | 2 participants | 2 participants | 9 participants |
| Region of Enrollment Taiwan | 1 participants | 2 participants | 1 participants | 1 participants | 5 participants |
| Sex: Female, Male Female | 11 Participants | 10 Participants | 9 Participants | 10 Participants | 40 Participants |
| Sex: Female, Male Male | 10 Participants | 11 Participants | 11 Participants | 10 Participants | 42 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 13 / 21 | 13 / 21 | 12 / 20 | 9 / 20 |
| serious Total, serious adverse events | 1 / 21 | 2 / 21 | 0 / 20 | 2 / 20 |
Outcome results
Clinical Utility Index (CUI)
CUI measures the efficacy (response), tolerability (time on treatment) and safety \[incidence of adverse events (AEs)\] by quantifying these 3 attributes and provides a single metric for overall treatment outcome. Each component is given a score ranging from 0 to 5. The CUI Total Score is the sum of the 3 items and ranges from 0 to 15. The greater the CUI Total Score, the more effective the treatment. If a participant experiences a drug-related seizure/death, the safety component is given a score of 0 resulting in an overall CUI Total Score of 0. Analysis of variance (ANOVA) was used to calculate Least Squares (LS) mean and standard error. LS mean values were controlled for treatment, gender and pooled investigators.
Time frame: Baseline through Week 6
Population: All participants who received at least 1 dose of study drug and had CUI Total Score measurement at Week 6.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| 10 mg LY2140023 | Clinical Utility Index (CUI) | 8.30 units on a scale | Standard Error 0.54 |
| 80 mg LY2140023 | Clinical Utility Index (CUI) | 10.32 units on a scale | Standard Error 0.52 |
| 160 mg LY2140023 | Clinical Utility Index (CUI) | 9.27 units on a scale | Standard Error 0.55 |
Change From Baseline to Week 6 Endpoint in the 16-item Negative Symptoms Assessment (NSA-16)
The NSA-16 scale is used to help clinicians rate behaviors (not psychopathology) commonly associated with negative symptoms of schizophrenia. The scale rates participants on 16 anchors. Each item (anchor) is rated from 1 (better) to 6 (worse). The NSA-16 Total Score is the sum of the 16 specific items and ranges from 16 to 96. Higher scores indicate greater severity of illness. The Mixed Model Repeated Measures (MMRM) analysis was used to calculate Least Squares (LS) mean and 95% confidence interval. LS mean values were controlled for baseline, treatment, gender, pooled investigator, visit, treatment\*visit and baseline\*visit.
Time frame: Baseline, Week 6
Population: All randomized participants who received at least 1 dose of study drug, had a baseline and at least 1 post-baseline NSA-16 Total Score measurement. Placebo responder (defined as ≥25% improvement in the PANSS Total Score from the start of placebo lead-in period to the end of placebo lead-in period) was excluded from the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| 10 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the 16-item Negative Symptoms Assessment (NSA-16) | 3.42 units on a scale |
| 80 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the 16-item Negative Symptoms Assessment (NSA-16) | -0.40 units on a scale |
| 160 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the 16-item Negative Symptoms Assessment (NSA-16) | -6.31 units on a scale |
| Placebo | Change From Baseline to Week 6 Endpoint in the 16-item Negative Symptoms Assessment (NSA-16) | -1.22 units on a scale |
Change From Baseline to Week 6 Endpoint in the Clinical Global Impression-Severity Scale (CGI-S)
The CGI-S instrument is used to record the severity of mental illness at the time of assessment. The score ranges from 1 (normal, not at all ill) to 7 (among the most extremely ill). Higher scores indicate greater severity of illness. The Mixed Model Repeated Measures (MMRM) analysis was used to calculate Least Squares (LS) mean and 95% confidence interval. LS mean values were controlled for baseline, treatment, gender, pooled investigator, visit, treatment\*visit and baseline\*visit.
Time frame: Baseline, Week 6
Population: All randomized participants who received at least 1 dose of study drug, had a baseline and at least 1 post-baseline CGI-S measurement. Placebo responder (defined as ≥25% improvement in the PANSS Total Score from the start of placebo lead-in period to the end of placebo lead-in period) was excluded from the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| 10 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Clinical Global Impression-Severity Scale (CGI-S) | 0.62 units on a scale |
| 80 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Clinical Global Impression-Severity Scale (CGI-S) | -0.49 units on a scale |
| 160 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Clinical Global Impression-Severity Scale (CGI-S) | 0.14 units on a scale |
| Placebo | Change From Baseline to Week 6 Endpoint in the Clinical Global Impression-Severity Scale (CGI-S) | -0.25 units on a scale |
Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale
The PANSS consists of 30 items and 3 subscales designed to measure severity of psychopathology in schizophrenia. The PANSS Positive Subscale and the PANSS Negative Subscale each contain 7 items, and the remaining 16 items make up the PANSS General Psychopathology Subscale. Each item is rated from 1 (symptom not present) to 7 (symptom extremely severe). The PANSS Total Score is the sum of the 30 items (range from 30 to 210). The PANSS Positive Subscale and PANSS Negative Subscale scores each range from 7 to 49. The PANSS General Psychopathology Subscale score ranges from 16 to 112. Higher scores indicate greater severity of illness. The Mixed Model Repeated Measures (MMRM) analysis was used to calculate Least Squares (LS) mean and 95% confidence interval. LS mean values were controlled for baseline, treatment, gender, pooled investigator, visit, treatment\*visit and baseline\*visit.
Time frame: Baseline, Week 6
Population: All randomized participants who received at least 1 dose of study drug, had a baseline and at least 1 post-baseline PANSS measurement. Placebo responder (defined as ≥25% improvement in the PANSS Total Score from the start of placebo lead-in period to the end of placebo lead-in period) was excluded from the analysis.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) |
|---|---|---|---|
| 10 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Total Score | -0.49 units on a scale |
| 10 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Positive Subscore (n=19, 21, 20, 20) | 0.33 units on a scale |
| 10 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Negative Subscore | 0.23 units on a scale |
| 10 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS General Psychopathology Subscore | -0.88 units on a scale |
| 80 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Positive Subscore (n=19, 21, 20, 20) | -2.30 units on a scale |
| 80 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Negative Subscore | -0.22 units on a scale |
| 80 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS General Psychopathology Subscore | -0.31 units on a scale |
| 80 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Total Score | -2.56 units on a scale |
| 160 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Negative Subscore | 0.33 units on a scale |
| 160 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Positive Subscore (n=19, 21, 20, 20) | -0.05 units on a scale |
| 160 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS General Psychopathology Subscore | 1.18 units on a scale |
| 160 mg LY2140023 | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Total Score | 1.40 units on a scale |
| Placebo | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS General Psychopathology Subscore | 4.79 units on a scale |
| Placebo | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Positive Subscore (n=19, 21, 20, 20) | 1.93 units on a scale |
| Placebo | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Total Score | 9.35 units on a scale |
| Placebo | Change From Baseline to Week 6 Endpoint in the Positive and Negative Syndrome Scale (PANSS) Total Score, Positive Score, Negative Score, and Psychopathology Subscale | PANSS Negative Subscore | 2.70 units on a scale |
Percentage of Participants Who Discontinued (Rate of Discontinuation)
Rate of discontinuation was calculated as the number of participants who discontinued from study due to any reason divided by the total number of participants who received study drug, then multiplied by 100.
Time frame: Baseline through Week 6
Population: All randomized participants who received at least 1 dose of study drug.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| 10 mg LY2140023 | Percentage of Participants Who Discontinued (Rate of Discontinuation) | 57.1 percentage of participants |
| 80 mg LY2140023 | Percentage of Participants Who Discontinued (Rate of Discontinuation) | 19.0 percentage of participants |
| 160 mg LY2140023 | Percentage of Participants Who Discontinued (Rate of Discontinuation) | 45.0 percentage of participants |
| Placebo | Percentage of Participants Who Discontinued (Rate of Discontinuation) | 40.0 percentage of participants |
The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS)
Columbia Suicide Rating Scale (C-SSRS) captures occurrence, severity, and frequency of suicide-related thoughts and behaviors. Suicidal ideation: a yes answer to any one of 5 suicidal ideation questions: wish to be dead, and 4 different categories of active suicidal ideation. Suicidal behavior: a yes answer to any of 5 suicidal behavior questions: preparatory acts or behavior, aborted attempt, interrupted attempt, non-fatal suicide attempt, and completed suicide. The number of participants with statistically significant changes of the C-SSRS was the number of participants with a treatment-emergent suicidal ideation and behavior (an increase in suicidal behavior or ideation over lead-in baseline.)
Time frame: Baseline up to Week 6
Population: All randomized participants who received at least 1 dose of study drug and had a baseline and at least 1 post-baseline C-SSRS measurements.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| 10 mg LY2140023 | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Ideation | 1 participants |
| 10 mg LY2140023 | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Behavior | 0 participants |
| 80 mg LY2140023 | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Behavior | 0 participants |
| 80 mg LY2140023 | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Ideation | 1 participants |
| 160 mg LY2140023 | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Ideation | 2 participants |
| 160 mg LY2140023 | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Behavior | 0 participants |
| Placebo | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Ideation | 1 participants |
| Placebo | The Number of Participants With Treatment-Emergent Suicidal Ideation and Behavior Based on the Columbia Suicide Severity Rating Scale (C-SSRS) | Treatment-Emergent Suicidal Behavior | 0 participants |