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A Study to Evaluate the Efficacy of Paliperidone Palmitate in the Prevention of Relapse of the Symptoms of Schizoaffective Disorder

A Randomized, Double-Blind, Placebo-Controlled, Parellel-Group Study of Paliperidone Palmitate Evaluating Time to Relapse in Subjects With Schizoaffective Disorder

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01193153
Enrollment
667
Registered
2010-09-01
Start date
2010-09-30
Completion date
2013-10-31
Last updated
2015-01-05

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

Conditions

Schizoaffective Disorder

Keywords

schizoaffective disorder, paliperidone palmitate, INVEGA SUSTENNA, schizoaffective disorder relapse prevention

Brief summary

This study will evaluate the efficacy of paliperidone palmitate compared with placebo in the delay of relapse of the symptoms of schizoaffective disorder. This study will also assess the safety and tolerability of paliperidone palmitate in patients with schizoaffective disorder.

Detailed description

Schizoaffective disorder is a chronic illness and generally requires life-long treatment. To date however, no medication has been evaluated in the maintenance treatment of schizoaffective disorder. This is a randomized (study drug assigned by chance), double-blind (neither physician nor patient knows the name of the assigned drug), placebo-controlled, parallel-group, multicenter study to evaluate the efficacy and safety of paliperidone palmitate, as monotherapy or as an adjunct to mood stabilizers or antidepressants, relative to placebo in delaying the time to relapse in patients with schizoaffective disorder. This study explores the use of paliperidone palmitate either as monotherapy or as an adjunct to mood stabilizers or antidepressants (MS/AD) because both treatment approaches are commonly used in the clinical management of schizoaffective disorder. Patients with acute symptoms of schizoaffective disorder will be enrolled. The study will consist of 4 periods: an up to 7 days screening/tolerability period, a 13-week open-label flexible dose lead-in period, a 12-week open-label fixed dose stabilization period, and a 15 months double-blind relapse prevention period. Patients without previous exposure to paliperidone ER (Invega), paliperidone palmitate (Invega Sustenna), risperidone, or RISPERDAL CONSTA will be given 4 to 6 days of paliperidone ER 6mg/day for tolerability testing. Patients can continue their current antipsychotic regimen through Day -1 (the day before the start of the study period). During the open-label periods, all patients will be treated with paliperidone palmitate. An initial loading dose of 234 mg (150 mg eq.) of paliperidone palmitate will be given by deltoid injection followed by 156 mg (100 mg eq.) deltoid injection on Day 8. Starting on Day 36, injections may be administered in either the deltoid muscle or the gluteal muscle. Doses at Days 36, 64 and 92 may be increased or decreased within the range of 78 mg (50 mg eq.) and 234 mg (150 mg. eq.) as clinically indicated. Dose will be fixed (at Day 92 dose) during the 12-week stabilization period. Patients who meet pre-determined stabilization criteria will be eligible to enter the double-blind relapse prevention period and will be randomly assigned to either receive paliperidone palmitate (at the Day 92 dose) or placebo treatment. Patients will have intramuscular (i.m.) study drug injection and efficay and saftety evaluations performed every 4 weeks throughout the study. Efficacy will be evaluated during the study using a relapse assessment, the Positive and Negative Symptom Scale (PANSS), the Clinical Global Impression of Severity for Schizoaffective Disorder (CGI-S-SCA), the Personal and Social Performance Scale (PSP), the Young Mania Rating Scale (YMRS), and the Hamilton Rating Scale for Depression (HAM-D). Safety will be assessed throughout the study by monitoring of adverse events, clinical laboratory tests, electrocardiograms (ECGs), vital sign measurements (temperature, pulse, and blood pressure), weight, and the monitoring of extrapyramidal symptoms using the Extrapyramidal Symptom Rating Scale-Abbreviated (ESRS-A). Suicidality will be assessed by the Columbia Suicide Severity Rating Scale (C-SSRS). A 10 milliliter pharmacogenomic blood sample (sample for DNA research) will be collected from patients who give separate written informed consent for this part of the study. Participation in pharmacogenomic research is optional. Blood samples will be taken from patients being treated with lithium or valproate for the measurement of blood lithium or valproate levels. Approximately 52 mL (31 mL for patients who are not receiving lithium or valproate) of whole blood will be collected during the study. All patients will receive paliperidone palmitate 78, 117, 156, 234 mg (50, 75, 100, or 150 mg eq.) monthly by i.m. injection for the the first 25 weeks of the study (open-label periods). During the 15-month double-blind relapse prevention period, one half of the patients will be randomized to paliperidone palmitate treatment (50, 75, 100, or 150 mg eq. monthly i.m. injection) and the other half of the patients will be randomized to monthly placebo injection.

Interventions

DRUGPlacebo

monthly by i.m. injection for 15 months

DRUGpaliperidone palmitate

78, 117, 156, 234 mg (50, 75, 100, or 150 mg eq.) monthly by i.m. injection for 15 months

Sponsors

Janssen Scientific Affairs, LLC
Lead SponsorINDUSTRY

Study design

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

Eligibility

Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No

Inclusion criteria

* DSM-IV diagnosis of schizoaffective disorder * Experiencing an acute exacerbation of psychotic symptoms * A score of \>=4 on at least 3 of the following 7 PANSS items: Delusions (P1), Hallucinatory behavior (P3), Excitement (P4), Hostility (P7), Tension (G4), Uncooperativeness (G8), and Poor Impulse Control (G14) * A score of \>=16 on YMRS and/or a score of \>=16 on the HAM-D-21 * Healthy based on physical examinations, electrocardiogram (ECG), laboratory tests, medical history, and vital signs measurements

Exclusion criteria

* A primary active mental illness diagnosis other than schizoaffective disorder * Have attempted suicide within 12 months or are at imminent risk of suicide or violent behavior * Subjects with first episode of psychosis * Received electroconvulsive therapy in the past 3 months * History of hypersensitivity to or intolerance of paliperidone, risperidone, or 20% Intralipid (placebo) * Received long-acting antipsychotic medication within 2 injection cycles * Received therapy with clozapine within 3 months * A history of neuroleptic malignant syndrome * Previous history of lack of response to antipsychotic medication * Subjects receiving therapy with antidepressants or mood stabilizers that has been initiated and/or changed in dose \<30 days prior to screening * Receiving therapy with carbamazepine * Receiving therapy with monoamine oxidase inhibitors * Pregnant, breast-feeding, or planning to become pregnant

Design outcomes

Primary

MeasureTime frameDescription
Double-blind: Percentage of Participants Who Experienced RelapseDay 1 up to Month 15 of double blind relapse prevention periodRelapse was defined as first occurrence of any 1 of following:psychiatric hospitalization due to worsening symptoms; any intervention employed to avert imminent hospitalization due to worsening symptoms or need for additional antipsychotic,antidepressants/mood stabilizing medication; deliberate self-injury,suicidal/homicidal ideation that is clinically significant as determined by investigator,or violent behavior resulting in clinically significant injury to another person or property damage; worsening of any 1 or more of 8 selected positive and negative syndrome scale(PANSS) items to a score of greater than or equal to (\>= 6) after randomization(if the score for the corresponding item was less than or equal to \[\<=\] 4 at randomization); worsening of certain other measures in specific ways at 2 consecutive visits. Relapse by subgroup of participants on monotherapy,adjunctive therapy to antidepressants/mood stabilizers,participants with psychotic symptoms/mood symptoms was examined.

Secondary

MeasureTime frameDescription
Open-label: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointBaseline and Endpoint (Week 13/LOCF) in Open-label (OL) Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization periodThe PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. A score lying between 71 and 100 indicated a good functioning; one between 31 and 70 indicated varying degrees of difficulty, and a score of \<=30 indicated functioning so poor that participant required intensive supervision.
Double-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointBaseline and Endpoint (Week 64/LOCF) in double-blind periodThe PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. A score lying between 71 and 100 indicated a good functioning; one between 31 and 70 indicated varying degrees of difficulty, and a score of \<=30 indicated functioning so poor that participant required intensive supervision.
Double-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline and Endpoint (Week 64/LOCF) in DB periodThe PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. Number of participants in each specific category; good functioning (PSP total score \>70), variable functioning (PSP total score between 31 and 70), and poor functioning (PSP total score \<=30) were assessed.
Open-label: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointBaseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization periodThe PANSS is a 30-item scale designed to assess various symptoms of schizophrenia including delusions, grandiosity, blunted affect, poor attention, and poor impulse control. The 30 symptoms are rated on a 7-point scale that ranges from 1 (absent) to 7 (extreme psychopathology). The PANSS total score consists of the sum of all 30 PANSS items and ranges from 30 to 210. Higher scores indicate worsening.
Double-blind: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointBaseline and Endpoint (Week 64/LOCF) in double-blind periodThe PANSS is a 30-item scale designed to assess various symptoms of schizophrenia including delusions, grandiosity, blunted affect, poor attention, and poor impulse control. The 30 symptoms are rated on a 7-point scale that ranges from 1 (absent) to 7 (extreme psychopathology). The PANSS total score consists of the sum of all 30 PANSS items and ranges from 30 to 210. Higher scores indicate worsening.
Double-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Week 64 (Total Mixed Model Repeated Measures [MMRM] Analysis of Covariance [ANCOVA])Baseline and Week 64 of double blind relapse prevention periodThe PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. A score lying between 71 and 100 indicated a good functioning; one between 31 and 70 indicated varying degrees of difficulty, and a score of \<=30 indicated functioning so poor that participant required intensive supervision.
Double-blind: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointBaseline and Endpoint (Week 64/LOCF) in double-blind periodThe HAM-D-21 is a 21-item, clinician-rated scale to evaluate depressed mood as well as the vegetative and cognitive symptoms of depression. The items are rated on a 5-point (0 to 4) scale. The 5-point scale items use a rating of 0 (absent), 1 (doubtful to mild), 2 (mild to moderate), 3 (moderate to severe), and 4 (very severe). A rating of 4 is usually reserved for extreme symptoms. The responses for all 21 items are summed to yield the HAM-D-21 total score that ranges from 0-63.
Open-label: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointBaseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization periodThe YMRS was designed to measure the severity of manic symptoms, to gauge the effect of treatment on mania severity, and to detect a return of manic symptoms (for example relapse or recurrence). YMRS is a checklist of 11 items that are ranked on a scale of 0 to 4 or 0 to 8. Seven of the items (elevated mood, increased motor activity, sexual interest, sleep, language-thought disorder, appearance, and insight) are ranked 0 to 4 and have descriptors associated with each severity level (that is, 0, 1, 2, 3, 4). Four of the items (irritability, speech, content, and disruptive-aggressive behavior) are scored 0 to 8 and have descriptors for every other increment (that is, 0, 2, 4, 6, 8). The item score is based on participant's report of his or her condition and clinician's behavioral observations during the interview, with emphasis on the latter. Higher scores indicate worsening. Responses are summed to yield YMRS total score ranging from 0 to 60.
Double-blind: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointBaseline and Endpoint (Week 64/LOCF) in double-blind periodThe YMRS was designed to measure the severity of manic symptoms, to gauge the effect of treatment on mania severity, and to detect a return of manic symptoms (for example relapse or recurrence). YMRS is a checklist of 11 items that are ranked on a scale of 0 to 4 or 0 to 8. Seven of the items (elevated mood, increased motor activity, sexual interest, sleep, language-thought disorder, appearance, and insight) are ranked 0 to 4 and have descriptors associated with each severity level (that is, 0, 1, 2, 3, 4). Four of the items (irritability, speech, content, and disruptive-aggressive behavior) are scored 0 to 8 and have descriptors for every other increment (that is, 0, 2, 4, 6, 8). The item score is based on participant's report of his or her condition and clinician's behavioral observations during the interview, with emphasis on the latter. Higher scores indicate worsening. Responses are summed to yield YMRS total score ranging from 0 to 60.
Open-label: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointBaseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization periodThe CGI-S-SCA is a syndrome-specific 7-point scale (from 1 indicating not ill to 7 indicating very severely ill) that includes an overall severity score as well as scores for the positive, negative, manic, and depressive domains of the illness. The CGI-S-SCA was used to assess the level of overall impairment, as well as that related to each domain, at the time of the visit and for the week prior to the visit.
Double-blind: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointBaseline and Endpoint (Week 64/LOCF) in double-blind periodThe CGI-S-SCA is a syndrome-specific 7-point scale (from 1 indicating not ill to 7 indicating very severely ill) that includes an overall severity score as well as scores for the positive, negative, manic, and depressive domains of the illness. The CGI-S-SCA was used to assess the level of overall impairment, as well as that related to each domain, at the time of the visit and for the week prior to the visit.
Open-label: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointBaseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization periodThe HAM-D-21 is a 21-item, clinician-rated scale to evaluate depressed mood as well as the vegetative and cognitive symptoms of depression. The items are rated on a 5-point (0 to 4) scale. The 5-point scale items use a rating of 0 (absent), 1 (doubtful to mild), 2 (mild to moderate), 3 (moderate to severe), and 4 (very severe). A rating of 4 is usually reserved for extreme symptoms. The responses for all 21 items are summed to yield the HAM-D-21 total score that ranges from 0-63.

Countries

Bulgaria, India, Malaysia, Philippines, Romania, South Africa, Ukraine, United States

Participant flow

Pre-assignment details

Participants without previous exposure to paliperidone extended-release (ER) (Invega), or risperidone, received paliperidone ER 6 milligram (mg)/day for 4 to 6 days (during Screening) to test oral tolerability. Only participants, who had ability to tolerate the drug, as judged by treating physician, were eligible for enrollment in the study.

Participants by arm

ArmCount
Entire Study Population
Included all participants who received at least 1 dose of paliperidone palmitate in open-label lead in period.
667
Total667

Withdrawals & dropouts

PeriodReasonFG000FG001
Double Blind Relapse Prevention Period> 6 Weeks Between 2 Study Drug13
Double Blind Relapse Prevention PeriodAdverse Event123
Double Blind Relapse Prevention PeriodDeath20
Double Blind Relapse Prevention PeriodExperienced Relapse2557
Double Blind Relapse Prevention PeriodLost to Follow-up29
Double Blind Relapse Prevention PeriodOther23
Double Blind Relapse Prevention PeriodPregnancy10
Double Blind Relapse Prevention PeriodWithdrawal by Subject1930
Open-label Lead in Period> 6 Weeks Between 2 Study Drug40
Open-label Lead in PeriodAdverse Event410
Open-label Lead in PeriodDeath10
Open-label Lead in PeriodLack of Efficacy260
Open-label Lead in PeriodLost to Follow-up320
Open-label Lead in PeriodOther140
Open-label Lead in PeriodPregnancy10
Open-label Lead in PeriodSubject Failed Stabilization Criteria470
Open-label Lead in PeriodWithdrawal by Subject690
Open-label Stabilization PeriodAdverse Event90
Open-label Stabilization PeriodDeath20
Open-label Stabilization PeriodLack of Efficacy50
Open-label Stabilization PeriodLost to Follow-up100
Open-label Stabilization PeriodOther80
Open-label Stabilization PeriodSubject Failed Stabilization Criteria350
Open-label Stabilization PeriodWithdrawal by Subject290

Baseline characteristics

CharacteristicEntire Study Population
Age, Continuous39.5 years
STANDARD_DEVIATION 10.7
Sex: Female, Male
Female
310 Participants
Sex: Female, Male
Male
357 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
332 / 66779 / 16462 / 170
serious
Total, serious adverse events
54 / 6679 / 16416 / 170

Outcome results

Primary

Double-blind: Percentage of Participants Who Experienced Relapse

Relapse was defined as first occurrence of any 1 of following:psychiatric hospitalization due to worsening symptoms; any intervention employed to avert imminent hospitalization due to worsening symptoms or need for additional antipsychotic,antidepressants/mood stabilizing medication; deliberate self-injury,suicidal/homicidal ideation that is clinically significant as determined by investigator,or violent behavior resulting in clinically significant injury to another person or property damage; worsening of any 1 or more of 8 selected positive and negative syndrome scale(PANSS) items to a score of greater than or equal to (\>= 6) after randomization(if the score for the corresponding item was less than or equal to \[\<=\] 4 at randomization); worsening of certain other measures in specific ways at 2 consecutive visits. Relapse by subgroup of participants on monotherapy,adjunctive therapy to antidepressants/mood stabilizers,participants with psychotic symptoms/mood symptoms was examined.

Time frame: Day 1 up to Month 15 of double blind relapse prevention period

Population: Double-blind(DB) Intent-to-Treat(ITT) analysis set included all randomly assigned participants who received at least 1 injection of DB study medication.'n' signifies participants who were evaluable for each specified category,for each arm.

ArmMeasureGroupValue (NUMBER)
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms;Depressive (n=164, 170)4.9 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseMonotherapy subset (n=78, 73)11.5 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseAdjunct therapy subset (n=86, 97)18.6 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapsePsychotic Symptoms (n=164, 170)12.8 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms;Any Mood Symptoms (n=164, 170)11.0 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms;Manic (n=164, 170)3.0 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms; Mixed (n=164, 170)3.0 percentage of participants
Paliperidone PalmitateDouble-blind: Percentage of Participants Who Experienced RelapseAll Participants (n=164, 170)15.2 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms;Manic (n=164, 170)9.4 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseAll Participants (n=164, 170)33.5 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms;Any Mood Symptoms (n=164, 170)28.2 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseMonotherapy subset (n=78, 73)32.9 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms; Mixed (n=164, 170)5.3 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseAdjunct therapy subset (n=86, 97)34.0 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapseMood Symptoms;Depressive (n=164, 170)13.5 percentage of participants
PlaceboDouble-blind: Percentage of Participants Who Experienced RelapsePsychotic Symptoms (n=164, 170)31.2 percentage of participants
Comparison: All participants: p-value was calculated using log-rank test.p-value: <0.00195% CI: [1.55, 3.99]Log Rank
Comparison: Monotherapy subset: Hazard ratio and corresponding p-value, and 95% Confidence Interval (CI) were calculated from Cox proportional hazard regression model.p-value: 0.00295% CI: [1.57, 7.28]Regression, Cox
Comparison: Adjunct therapy subset: Hazard ratio and corresponding p-value, and 95% CI were calculated from Cox proportional hazard regression model.p-value: 0.02195% CI: [1.11, 3.68]Regression, Cox
Comparison: Psychotic Symptoms: Hazard ratio and corresponding p-value, and 95% CI were calculated from Cox proportional hazard regression model.p-value: <0.00195% CI: [1.7, 4.67]Regression, Cox
Comparison: Mood Symptoms (Any Mood Symptoms):Hazard ratio and corresponding p-value, and 95% CI were calculated from Cox proportional hazard regression model.p-value: <0.00195% CI: [1.7, 5.04]Regression, Cox
Comparison: Mood Symptoms (Manic): Hazard ratio and corresponding p-value, and 95% CI were calculated from Cox proportional hazard regression model.p-value: 0.01295% CI: [1.32, 9.89]Regression, Cox
Comparison: Mood Symptoms (Depressive): Hazard ratio and corresponding p-value, and 95% CI were calculated from Cox proportional hazard regression model.p-value: 0.00695% CI: [1.39, 6.98]Regression, Cox
Comparison: Mood Symptoms (Mixed): Hazard ratio and corresponding p-value, and 95% CI were calculated from Cox proportional hazard regression model.p-value: 0.23895% CI: [0.65, 5.78]Regression, Cox
Secondary

Double-blind: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at Endpoint

The CGI-S-SCA is a syndrome-specific 7-point scale (from 1 indicating not ill to 7 indicating very severely ill) that includes an overall severity score as well as scores for the positive, negative, manic, and depressive domains of the illness. The CGI-S-SCA was used to assess the level of overall impairment, as well as that related to each domain, at the time of the visit and for the week prior to the visit.

Time frame: Baseline and Endpoint (Week 64/LOCF) in double-blind period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateDouble-blind: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointDouble-blind: Baseline (n=164, 170)2.4 Units on a scaleStandard Deviation 0.68
Paliperidone PalmitateDouble-blind: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointDouble-blind: Change at Endpoint (n=161,168)0.0 Units on a scaleStandard Deviation 1.02
PlaceboDouble-blind: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointDouble-blind: Baseline (n=164, 170)2.5 Units on a scaleStandard Deviation 0.69
PlaceboDouble-blind: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointDouble-blind: Change at Endpoint (n=161,168)0.4 Units on a scaleStandard Deviation 1.15
Secondary

Double-blind: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at Endpoint

The HAM-D-21 is a 21-item, clinician-rated scale to evaluate depressed mood as well as the vegetative and cognitive symptoms of depression. The items are rated on a 5-point (0 to 4) scale. The 5-point scale items use a rating of 0 (absent), 1 (doubtful to mild), 2 (mild to moderate), 3 (moderate to severe), and 4 (very severe). A rating of 4 is usually reserved for extreme symptoms. The responses for all 21 items are summed to yield the HAM-D-21 total score that ranges from 0-63.

Time frame: Baseline and Endpoint (Week 64/LOCF) in double-blind period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateDouble-blind: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointDouble-blind: Baseline (n=164, 170)5.7 Units on a scaleStandard Deviation 3.24
Paliperidone PalmitateDouble-blind: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointDouble-blind: Change at Endpoint (n=161, 168)0.8 Units on a scaleStandard Deviation 5.4
PlaceboDouble-blind: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointDouble-blind: Baseline (n=164, 170)5.6 Units on a scaleStandard Deviation 3.32
PlaceboDouble-blind: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointDouble-blind: Change at Endpoint (n=161, 168)3.4 Units on a scaleStandard Deviation 7.42
Secondary

Double-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Endpoint

The PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. A score lying between 71 and 100 indicated a good functioning; one between 31 and 70 indicated varying degrees of difficulty, and a score of \<=30 indicated functioning so poor that participant required intensive supervision.

Time frame: Baseline and Endpoint (Week 64/LOCF) in double-blind period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (LEAST_SQUARES_MEAN)Dispersion
Paliperidone PalmitateDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointDouble-blind: Baseline (n=164, 170)74.5 Units on a ScaleStandard Error 0.81
Paliperidone PalmitateDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointDouble-blind: Change at Endpoint (n=161,168)0.5 Units on a ScaleStandard Error 1.15
PlaceboDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointDouble-blind: Baseline (n=164, 170)72.8 Units on a ScaleStandard Error 0.81
PlaceboDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointDouble-blind: Change at Endpoint (n=161,168)-4.1 Units on a ScaleStandard Error 1.13
p-value: <0.00195% CI: [1.94, 7.15]ANCOVA
Secondary

Double-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Week 64 (Total Mixed Model Repeated Measures [MMRM] Analysis of Covariance [ANCOVA])

The PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. A score lying between 71 and 100 indicated a good functioning; one between 31 and 70 indicated varying degrees of difficulty, and a score of \<=30 indicated functioning so poor that participant required intensive supervision.

Time frame: Baseline and Week 64 of double blind relapse prevention period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. 'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (LEAST_SQUARES_MEAN)Dispersion
Paliperidone PalmitateDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Week 64 (Total Mixed Model Repeated Measures [MMRM] Analysis of Covariance [ANCOVA])Baseline (n=164, 170)72.8 Units on a scaleStandard Error 0.81
Paliperidone PalmitateDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Week 64 (Total Mixed Model Repeated Measures [MMRM] Analysis of Covariance [ANCOVA])Change at Week 64 (n=98, 65)2.0 Units on a scaleStandard Error 0.92
PlaceboDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Week 64 (Total Mixed Model Repeated Measures [MMRM] Analysis of Covariance [ANCOVA])Baseline (n=164, 170)74.5 Units on a scaleStandard Error 0.81
PlaceboDouble-blind: Change From Baseline in Personal and Social Performance (PSP) Total Score at Week 64 (Total Mixed Model Repeated Measures [MMRM] Analysis of Covariance [ANCOVA])Change at Week 64 (n=98, 65)-1.3 Units on a scaleStandard Error 1.03
Comparison: The null hypothesis is that there is no difference in the mean of the PSP total score between the two treatment groups.p-value: 0.01495% CI: [0.68, 5.95]MMRM ANCOVA
Secondary

Double-blind: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Endpoint

The PANSS is a 30-item scale designed to assess various symptoms of schizophrenia including delusions, grandiosity, blunted affect, poor attention, and poor impulse control. The 30 symptoms are rated on a 7-point scale that ranges from 1 (absent) to 7 (extreme psychopathology). The PANSS total score consists of the sum of all 30 PANSS items and ranges from 30 to 210. Higher scores indicate worsening.

Time frame: Baseline and Endpoint (Week 64/LOCF) in double-blind period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateDouble-blind: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointDouble-blind: Baseline (n=164, 170)51.1 Units on a scaleStandard Deviation 9.5
Paliperidone PalmitateDouble-blind: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointDouble-blind: Change at Endpoint (n=161, 168)0.5 Units on a scaleStandard Deviation 14.01
PlaceboDouble-blind: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointDouble-blind: Baseline (n=164, 170)51.8 Units on a scaleStandard Deviation 9.47
PlaceboDouble-blind: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointDouble-blind: Change at Endpoint (n=161, 168)7.4 Units on a scaleStandard Deviation 18.53
Secondary

Double-blind: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at Endpoint

The YMRS was designed to measure the severity of manic symptoms, to gauge the effect of treatment on mania severity, and to detect a return of manic symptoms (for example relapse or recurrence). YMRS is a checklist of 11 items that are ranked on a scale of 0 to 4 or 0 to 8. Seven of the items (elevated mood, increased motor activity, sexual interest, sleep, language-thought disorder, appearance, and insight) are ranked 0 to 4 and have descriptors associated with each severity level (that is, 0, 1, 2, 3, 4). Four of the items (irritability, speech, content, and disruptive-aggressive behavior) are scored 0 to 8 and have descriptors for every other increment (that is, 0, 2, 4, 6, 8). The item score is based on participant's report of his or her condition and clinician's behavioral observations during the interview, with emphasis on the latter. Higher scores indicate worsening. Responses are summed to yield YMRS total score ranging from 0 to 60.

Time frame: Baseline and Endpoint (Week 64/LOCF) in double-blind period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateDouble-blind: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointDouble-blind: Baseline (n=164, 170)4.4 Units on a scaleStandard Deviation 3.46
Paliperidone PalmitateDouble-blind: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointDouble-blind: Change at Endpoint (n=161,168)-0.1 Units on a scaleStandard Deviation 5.47
PlaceboDouble-blind: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointDouble-blind: Baseline (n=164, 170)4.4 Units on a scaleStandard Deviation 3.4
PlaceboDouble-blind: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointDouble-blind: Change at Endpoint (n=161,168)3.2 Units on a scaleStandard Deviation 7.21
Secondary

Double-blind: Number of Participants With Personal and Social Performance (PSP) Categorical Scores

The PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. Number of participants in each specific category; good functioning (PSP total score \>70), variable functioning (PSP total score between 31 and 70), and poor functioning (PSP total score \<=30) were assessed.

Time frame: Baseline and Endpoint (Week 64/LOCF) in DB period

Population: DB ITT analysis set which included all randomly assigned participants who received at least one injection of double-blind study medication. LOCF method was used to impute missing values.'n' signifies participants who were evaluable at each specified time point for each arm, respectively.

ArmMeasureGroupValue (NUMBER)
Paliperidone PalmitateDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline: Variable (n=164, 170)69 participants
Paliperidone PalmitateDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline: Poor (n=164, 170)0 participants
Paliperidone PalmitateDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresEndpoint: Variable (n=161, 168)65 participants
Paliperidone PalmitateDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline: Good (n=164, 170)95 participants
Paliperidone PalmitateDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresEndpoint: Good (n=161, 168)95 participants
Paliperidone PalmitateDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresEndpoint: Poor (n=161, 168)1 participants
PlaceboDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresEndpoint: Good (n=161, 168)69 participants
PlaceboDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline: Poor (n=164, 170)0 participants
PlaceboDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline: Variable (n=164, 170)84 participants
PlaceboDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresBaseline: Good (n=164, 170)86 participants
PlaceboDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresEndpoint: Poor (n=161, 168)4 participants
PlaceboDouble-blind: Number of Participants With Personal and Social Performance (PSP) Categorical ScoresEndpoint: Variable (n=161, 168)95 participants
Secondary

Open-label: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at Endpoint

The CGI-S-SCA is a syndrome-specific 7-point scale (from 1 indicating not ill to 7 indicating very severely ill) that includes an overall severity score as well as scores for the positive, negative, manic, and depressive domains of the illness. The CGI-S-SCA was used to assess the level of overall impairment, as well as that related to each domain, at the time of the visit and for the week prior to the visit.

Time frame: Baseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization period

Population: OL ITT analysis set which included all randomly assigned participants who received at least one injection of open-label study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateOpen-label: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointOL Lead-in Period:Baseline (n=667)4.4 Units on a scaleStandard Deviation 0.58
Paliperidone PalmitateOpen-label: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointOL Lead-in Period:Change at Endpoint (n=652)-1.3 Units on a scaleStandard Deviation 0.99
Paliperidone PalmitateOpen-label: Change From Baseline in Clinical Global Impression - Severity Schizoaffective Scale (CGI-S-SCA) Overall Score at EndpointOL Stabilization Period:Change at Endpoint (n=652)-1.3 Units on a scaleStandard Deviation 1.07
Secondary

Open-label: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at Endpoint

The HAM-D-21 is a 21-item, clinician-rated scale to evaluate depressed mood as well as the vegetative and cognitive symptoms of depression. The items are rated on a 5-point (0 to 4) scale. The 5-point scale items use a rating of 0 (absent), 1 (doubtful to mild), 2 (mild to moderate), 3 (moderate to severe), and 4 (very severe). A rating of 4 is usually reserved for extreme symptoms. The responses for all 21 items are summed to yield the HAM-D-21 total score that ranges from 0-63.

Time frame: Baseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization period

Population: OL ITT analysis set which included all randomly assigned participants who received at least one injection of open-label study medication. LOCF method was used to impute missing values. n' signifies participants who were evaluable at each specified time point.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateOpen-label: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointOL Lead-in Period:Baseline (n=667)20.4 Units on a scaleStandard Deviation 7.81
Paliperidone PalmitateOpen-label: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointOL Lead-in Period:Change at Endpoint (n=653)-9.7 Units on a scaleStandard Deviation 8.53
Paliperidone PalmitateOpen-label: Change From Baseline in Hamilton Rating Scale for Depression (HAM-D-21) Total Score at EndpointOL Stabilization Period:Change at Endpoint (n=653)-9.9 Units on a scaleStandard Deviation 9.08
Secondary

Open-label: Change From Baseline in Personal and Social Performance (PSP) Total Score at Endpoint

The PSP scale was designed to assess the degree of dysfunction a participant exhibits during a month prior to any visit within 4 domains of behavior: a) socially useful activities, b) personal and social relationships, c) self-care, and d) disturbing and aggressive behavior, each rated on 6-point scale (1=absent to 6=very severe). Total transformed score from 1 to 100 is generated from raw score based on clinical interpretation of scores generated in 4 areas of functioning. A score lying between 71 and 100 indicated a good functioning; one between 31 and 70 indicated varying degrees of difficulty, and a score of \<=30 indicated functioning so poor that participant required intensive supervision.

Time frame: Baseline and Endpoint (Week 13/LOCF) in Open-label (OL) Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization period

Population: OL ITT analysis set which included all randomly assigned participants who received at least one injection of open-label study medication. Last Observation Carried Forward (LOCF) method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateOpen-label: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointOL Lead-in Period:Baseline (n=667)51.4 Units on a ScaleStandard Deviation 11.02
Paliperidone PalmitateOpen-label: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointOL Lead-in Period:Change at Endpoint (n=622)12.6 Units on a ScaleStandard Deviation 13.71
Paliperidone PalmitateOpen-label: Change From Baseline in Personal and Social Performance (PSP) Total Score at EndpointOL Stabilization Period:Change at Endpoint (n=622)13.8 Units on a ScaleStandard Deviation 14.92
Secondary

Open-label: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at Endpoint

The PANSS is a 30-item scale designed to assess various symptoms of schizophrenia including delusions, grandiosity, blunted affect, poor attention, and poor impulse control. The 30 symptoms are rated on a 7-point scale that ranges from 1 (absent) to 7 (extreme psychopathology). The PANSS total score consists of the sum of all 30 PANSS items and ranges from 30 to 210. Higher scores indicate worsening.

Time frame: Baseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization period

Population: OL ITT analysis set which included all randomly assigned participants who received at least one injection of open-label study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateOpen-label: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointOL Lead-in Period:Baseline (n=667)85.8 Units on a scaleStandard Deviation 12.76
Paliperidone PalmitateOpen-label: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointOL Lead-in Period:Change at Endpoint (n=653)-21.8 Units on a scaleStandard Deviation 16.39
Paliperidone PalmitateOpen-label: Change From Baseline in Positive and Negative Syndrome Scale (PANSS) Total Score at EndpointOL Stabilization Period:Change at Endpoint (n=653)-23.8 Units on a scaleStandard Deviation 18.3
Secondary

Open-label: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at Endpoint

The YMRS was designed to measure the severity of manic symptoms, to gauge the effect of treatment on mania severity, and to detect a return of manic symptoms (for example relapse or recurrence). YMRS is a checklist of 11 items that are ranked on a scale of 0 to 4 or 0 to 8. Seven of the items (elevated mood, increased motor activity, sexual interest, sleep, language-thought disorder, appearance, and insight) are ranked 0 to 4 and have descriptors associated with each severity level (that is, 0, 1, 2, 3, 4). Four of the items (irritability, speech, content, and disruptive-aggressive behavior) are scored 0 to 8 and have descriptors for every other increment (that is, 0, 2, 4, 6, 8). The item score is based on participant's report of his or her condition and clinician's behavioral observations during the interview, with emphasis on the latter. Higher scores indicate worsening. Responses are summed to yield YMRS total score ranging from 0 to 60.

Time frame: Baseline and Endpoint (Week 13/LOCF) in OL Lead-in period, Endpoint (Week 25/LOCF) in open-label stabilization period

Population: OL ITT analysis set which included all randomly assigned participants who received at least one injection of open-label study medication. LOCF method was used to impute missing values. 'n' signifies participants who were evaluable at each specified time point.

ArmMeasureGroupValue (MEAN)Dispersion
Paliperidone PalmitateOpen-label: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointOL Lead-in Period:Baseline (n=667)18.6 Units on a scaleStandard Deviation 9.48
Paliperidone PalmitateOpen-label: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointOL Lead-in Period:Change at Endpoint (n=653)-9.9 Units on a scaleStandard Deviation 9.45
Paliperidone PalmitateOpen-label: Change From Baseline in Young Mania Rating Scale (YMRS) Total Score at EndpointOL Stabilization Period:Change at Endpoint (n=653)-10.5 Units on a scaleStandard Deviation 10.14

Source: ClinicalTrials.gov · Data processed: Mar 13, 2026