Bipolar I Disorder, Schizophrenia
Conditions
Keywords
asenapine, pediatric schizophrenia, bipolar I disorder
Brief summary
This study is an open label, sequential-group, two site, multiple dose escalating study of sublingual administered asenapine in a pediatric population with schizophrenia or bipolar I disorder; in one study cohort (3a) participants with other conditions treatable with chronic antipsychotic medication can also be enrolled. Participants will receive a single sublingual placebo dose on Day -1, followed by multiple sublingual doses of asenapine twice daily (b.i.d.) for 6 days (Cohorts 1 and 2), 7 days (Cohort 3b-d), or 11 days (Cohort 3a), and a final once daily administration on Day 7 (Cohorts 1 and 2), Day 8 (Cohort 3b-d) or Day 12 (Cohort 3a).
Interventions
DRUGAsenapine 2.5 mg
Asenapine tablet, sublingually (SL), 2.5 mg b.i.d. on Days 1-6 and one 2.5 mg tablet, SL, on Day 7.
DRUGAsenapine 5 mg
Asenapine tablet, SL, 5 mg b.i.d. on Days 1-6 and one 5 mg tablet, SL, on Day 7.
DRUGAsenapine 10 mg
Asenapine tablets, SL, in a rising dose schedule to 10 mg b.i.d. (with a single 10 mg dose on final day). For Cohorts 3b, 3c and 3d, rising dose schedule begins with asenapine 5 mg b.i.d. on Day 1 and dosing occurs through Day 8. For Cohort 3a, rising dose schedule begins with asenapine 2.5 mg b.i.d. on Day 1 and dosing occurs through Day 12.
Sponsors
Organon and Co
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
10 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
For participants in Cohorts 1, 2, 3b, 3c and 3d: * Diagnosis of schizophrenia or bipolar I disorder * A schizophrenic participant must have a diagnosis of current schizophrenia of paranoid disorganized, catatonic, or undifferentiated subtype as determined by a structured clinical interview at screening * A bipolar I disorder participant must have a primary diagnosis of bipolar I disorder, current episode manic, or mixed as determined by a structured clinical interview at screening For participants in Cohort 3a: * Documented history of schizophrenia, bipolar disorder, autism, conduct disorder, oppositional defiant disorder, or any condition for which the chronic use of antipsychotic medication (e.g, risperidone, olanzapine, aripiprazole, haloperidol) was warranted and/or administered All participants: * Must be at least 10 and not older than 17 years of age at the day of first asenapine dosing (Cohort 3); for Cohort 1 and 2 subjects should be at least 10 and not older than 11 years of age at the day of first asenapine dosing * Must be able and willing to sign an informed assent as required by local regulations before study participation and able to adhere to dose and visit schedules or their parent/authorized legal representative(s) should be able and willing to sign an informed consent, and should be fluent in the language of the informed consent * Must have a caregiver or an identified responsible person who is considered reliable by the investigator and who has agreed to provide support to the subject to ensure compliance with trial treatment, outpatient visits, and protocol procedures * Must be fluent in the language of the investigator, trial staff (including raters) and the informed assent * Must be willing to discontinue all psychotropic medication during the treatment period except for those specified in the protocol * Have discontinued the use of strong inhibitors or inducers of cytochrome P450 (CYP)1A2 and/or CYP2D6 (e.g. fluvoxamine, citalopram, fluoxetine, paroxetine, omeprazole, and rifampicin) and beta-blockers, applying a washout period of 5 half lives or 7 days, whichever is longer, AND be stabilized on non-interacting alternative medication (i.e. medication not interacting with asenapine pharmacokinetics) for 2 weeks prior to baseline if their medical condition requires this * Clinical laboratory tests (complete blood count \[CBC\], blood chemistry, and urinalysis) must be within normal limits or clinically acceptable to the investigator, after discussion with the Sponsor and following agreement of the Sponsor's medical monitor * Screening 12 lead electrocardiogram (ECG) conduction intervals and vital signs recordings (oral body temperature, systolic/diastolic blood pressure and pulse rate) must be clinically acceptable according to the investigator, after discussion with the Sponsor and following agreement of the Sponsor's medical monitor * If male, and non-vasectomized, must agree to use a condom with spermicide (when marketed in the country) or abstain from sexual intercourse, during the trial and for 3 months after stopping the medication Female participants must: If unsterilized, have used a medically accepted method of contraception for 3 months (or abstained from sexual intercourse) prior to the screening period, and agree to use a medically accepted method of contraception during the trial (including the screening period prior to receiving trial medication) and for 2 months after stopping the trial medication. An acceptable method of contraception includes one of the following: * stable oral, transdermal, injectable, or sustained-release vaginal hormonal contraceptive regimen without breakthrough uterine bleeding for 3 months prior to Screening; in addition, during study use of condom and/or spermicide (when marketed in the country) * intrauterine device (inserted at least 2 months prior to Screening visit); in addition, during study use of condom and/or spermicide (when marketed in the country) Note: Vasectomy of the partner is not considered sufficient contraception and one of the 2 methods listed above must be used Females who are not currently sexually active must also consent to use one of these accepted methods of contraception should they become sexually active while participating in the study * condom (male or female) with spermicide (when marketed within the country), * diaphragm or cervical cap with spermicide (when marketed within the country) and condom (male),
Exclusion criteria
The participant will be excluded from entry if ANY of the criteria listed below are met at baseline The participant: * Is pregnant, intends to become pregnant (within 3 months of ending the study), or is breastfeeding * In the opinion of the investigator, will not be able to participate optimally in the study * Has an uncontrolled, unstable clinically significant medical condition (e.g., renal, endocrine, hepatic, respiratory, cardiovascular, hematologic, immunologic, gastrointestinal or cerebrovascular disease, or malignancy) that may interfere with the interpretation of pharmacokinetic, safety and tolerability evaluations in the opinion of the investigator * Has a history of any infectious disease within 4 weeks prior to drug administration that in the opinion of the investigator, affects the subject's ability to participate in the trial * Is positive for hepatitis B surface antigen, hepatitis C antibodies or human immunodeficiency virus (HIV) * Has a positive screen for drugs with a high potential for abuse (during the Screening period or clinical conduct of the trial) * Has a history of psychiatric or personality disorders that in the opinion of the investigator and sponsor, affects the subject's ability to participate in the trial * Has a history of neuroleptic malignant syndrome * Has a diagnosis of mental retardation or organic brain disorder * Has a primary diagnosis other than schizophrenia or bipolar I disorder, current episode manic or mixed, that is primarily responsible for current symptoms and functional impairment; this exclusion is not applicable to participants in Cohort 3a * Has a diagnosis of psychotic disorder or a behavioral disturbance thought to be substance induced or due to substance abuse * Has a current (past 6 months) substance and alcohol abuse or dependence (excluding nicotine and caffeine) * Has a history of tardive dyskinesia or tardive dystonia * If has attention-deficit/hyperactivity disorder (ADHD), has not been on a stable dose of stimulants (e.g. amphetamines, methylphenidate) for the last 3 months (participants who have not taken any stimulants in the last month will not be excluded) * Has a history of alcohol or drug abuse in the past 2 years * Has donated blood in the past 60 days * Has previously received asenapine * Is at imminent risk of self-harm or harm to others, in the investigator's opinion based on clinical judgment * Report at Screening, suicidal ideation, or suicidal behavior in the past 6 months * Is currently participating in another clinical study or have participated in a clinical study (e.g., laboratory or clinical evaluation) within 30 days of baseline * Is part of the study staff personnel or family members of the study staff personnel * Has demonstrated allergic reactions (eg, food, drug, atopic reactions or asthmatic episodes) which, in the opinion of the investigator and sponsor, interfere with their ability to participate in the trial * Smokes more than 10 cigarettes or equivalent tobacco use per day * Has a history of malignancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Plasma Concentration (Cmax) of Asenapine | Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36 and 48 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a) | Cmax is the peak plasma concentration following a dose of the study drug. |
| Time to Maximum Plasma Concentration (Tmax) of Asenapine | Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36 and 48 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a) | tmax is the time from dosing to maximum plasma drug concentration levels. |
| Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6 and 12 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a) | AUC0-12 is the area under the plasma drug-concentration time curve calculated for the 12 hour interval after dosing. |
| Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36 and 48 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a) | Elimination t1/2 is the time it takes for the concentration of the drug in the body to decrease by half during the elimination phase. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Asenapine 2.5 mg - Cohort 1 Participants 10 or 11 years of age; administered asenapine 2.5 mg b.i.d on Days 1-6 and a single asenapine 2.5 mg dose in the morning on Day 7 | 6 |
| Asenapine 5 mg - Cohort 2 Participants 10 or 11 years of age; administered asenapine 5 mg b.i.d on Days 1-6 and a single asenapine 5 mg dose in the morning on Day 7 | 6 |
| Asenapine 10 mg - Cohort 3a Participants 10 or 11 years of age; administered asenapine 2.5 mg b.i.d on Days 1-3, asenapine 2.5 mg in the morning and 5 mg in the evening on Day 4, asenapine 5 mg b.i.d. on Days 5-6, asenapine 5 mg in the morning and 10 mg in the evening on Day 7, asenapine 10 mg b.i.d on Days 8-11, and a single asenapine 10 mg dose in the morning on Day 12 | 6 |
| Asenapine 10 mg - Cohort 3b Participants 12 or 13 years of age; administered asenapine 5 mg b.i.d on Day 1 (an additional day of 5 mg b.i.d could be allowed), asenapine 10 mg b.i.d on Days 2-7, and a single asenapine 10 mg dose in the morning on Day 8 | 4 |
| Asenapine 10 mg - Cohort 3c Participants 14 or 15 years of age; administered asenapine 5 mg b.i.d on Day 1 (an additional day of 5 mg b.i.d could be allowed), asenapine 10 mg b.i.d on Days 2-7, and a single asenapine 10 mg dose in the morning on Day 8 | 4 |
| Asenapine 10 mg - Cohort 3d Participants 16 or 17 years of age; administered asenapine 5 mg b.i.d on Day 1 (an additional day of 5 mg b.i.d could be allowed), asenapine 10 mg b.i.d on Days 2-7, and a single asenapine 10 mg dose in the morning on Day 8 | 4 |
| Total | 30 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Overall Study | Withdrawal by Subject | 0 | 0 | 2 | 0 | 1 | 0 |
Baseline characteristics
| Characteristic | Asenapine 2.5 mg - Cohort 1 | Asenapine 5 mg - Cohort 2 | Asenapine 10 mg - Cohort 3a | Asenapine 10 mg - Cohort 3b | Asenapine 10 mg - Cohort 3c | Asenapine 10 mg - Cohort 3d | Total |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 10.8 years STANDARD_DEVIATION 0.4 | 10.5 years STANDARD_DEVIATION 0.8 | 10.3 years STANDARD_DEVIATION 0.5 | 12.5 years STANDARD_DEVIATION 0.6 | 14.5 years STANDARD_DEVIATION 0.6 | 16.5 years STANDARD_DEVIATION 0.6 | 12.1 years STANDARD_DEVIATION 2.3 |
| Sex: Female, Male Female | 2 Participants | 3 Participants | 2 Participants | 2 Participants | 2 Participants | 2 Participants | 13 Participants |
| Sex: Female, Male Male | 4 Participants | 3 Participants | 4 Participants | 2 Participants | 2 Participants | 2 Participants | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 3 / 6 | 4 / 6 | 11 / 18 |
| serious Total, serious adverse events | 0 / 6 | 0 / 6 | 0 / 18 |
Outcome results
Primary
Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine
AUC0-12 is the area under the plasma drug-concentration time curve calculated for the 12 hour interval after dosing.
Time frame: Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6 and 12 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a)
Population: All participants administered asenapine with evaluable pharmacokinetic data. Two participants in Cohort 3a and one participant in Cohort 3c did not complete the study and are excluded from pharmacokinetic analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Asenapine 2.5 mg - Cohort 1 | Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | 11.4 hr*ng/mL | Standard Deviation 6.1 |
| Asenapine 5 mg - Cohort 2 | Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | 23.6 hr*ng/mL | Standard Deviation 4.02 |
| Asenapine 10 mg - Cohort 3a | Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | 55.2 hr*ng/mL | Standard Deviation 20.9 |
| Asenapine 10 mg - Cohort 3b | Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | 41.3 hr*ng/mL | Standard Deviation 9.59 |
| Asenapine 10 mg - Cohort 3c | Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | 36.5 hr*ng/mL | Standard Deviation 36.7 |
| Asenapine 10 mg - Cohort 3d | Area Under the Plasma Concentration-time Curve From 0 to 12 Hours Post Dose (AUC0-12) of Asenapine | 41.8 hr*ng/mL | Standard Deviation 12.6 |
Primary
Maximum Plasma Concentration (Cmax) of Asenapine
Cmax is the peak plasma concentration following a dose of the study drug.
Time frame: Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36 and 48 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a)
Population: All participants administered asenapine with evaluable pharmacokinetic data. Two participants in Cohort 3a and one participant in Cohort 3c did not complete the study and are excluded from pharmacokinetic analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Asenapine 2.5 mg - Cohort 1 | Maximum Plasma Concentration (Cmax) of Asenapine | 1.84 ng/mL | Standard Deviation 1.17 |
| Asenapine 5 mg - Cohort 2 | Maximum Plasma Concentration (Cmax) of Asenapine | 3.48 ng/mL | Standard Deviation 0.629 |
| Asenapine 10 mg - Cohort 3a | Maximum Plasma Concentration (Cmax) of Asenapine | 9.24 ng/mL | Standard Deviation 5.17 |
| Asenapine 10 mg - Cohort 3b | Maximum Plasma Concentration (Cmax) of Asenapine | 6.75 ng/mL | Standard Deviation 0.701 |
| Asenapine 10 mg - Cohort 3c | Maximum Plasma Concentration (Cmax) of Asenapine | 6.98 ng/mL | Standard Deviation 6.46 |
| Asenapine 10 mg - Cohort 3d | Maximum Plasma Concentration (Cmax) of Asenapine | 7.87 ng/mL | Standard Deviation 2.68 |
Primary
Terminal Phase (Elimination) Half-life (t1/2) of Asenapine
Elimination t1/2 is the time it takes for the concentration of the drug in the body to decrease by half during the elimination phase.
Time frame: Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36 and 48 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a)
Population: All participants administered asenapine with evaluable pharmacokinetic data. Two participants in Cohort 3a and one participant in Cohort 3c did not complete the study and are excluded from pharmacokinetic analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Asenapine 2.5 mg - Cohort 1 | Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | 22.0 hr | Standard Deviation 6.12 |
| Asenapine 5 mg - Cohort 2 | Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | 18.5 hr | Standard Deviation 3.11 |
| Asenapine 10 mg - Cohort 3a | Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | 15.9 hr | Standard Deviation 2.34 |
| Asenapine 10 mg - Cohort 3b | Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | 16.5 hr | Standard Deviation 3.38 |
| Asenapine 10 mg - Cohort 3c | Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | 24.3 hr | Standard Deviation 14.9 |
| Asenapine 10 mg - Cohort 3d | Terminal Phase (Elimination) Half-life (t1/2) of Asenapine | 24.6 hr | Standard Deviation 11.1 |
Primary
Time to Maximum Plasma Concentration (Tmax) of Asenapine
tmax is the time from dosing to maximum plasma drug concentration levels.
Time frame: Predose (0 hours) and 0.5, 1, 1.5, 2, 3, 4, 6, 12, 24, 36 and 48 hours after the final asenapine dose (administered on Day 7 for Cohorts 1 and 2; on Day 8 for Cohorts 3b, 3c and 3d; and on Day 12 for Cohort 3a)
Population: All participants administered asenapine with evaluable pharmacokinetic data. Two participants in Cohort 3a and one participant in Cohort 3c did not complete the study and are excluded from pharmacokinetic analysis.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Asenapine 2.5 mg - Cohort 1 | Time to Maximum Plasma Concentration (Tmax) of Asenapine | 1.0 hr |
| Asenapine 5 mg - Cohort 2 | Time to Maximum Plasma Concentration (Tmax) of Asenapine | 1.8 hr |
| Asenapine 10 mg - Cohort 3a | Time to Maximum Plasma Concentration (Tmax) of Asenapine | 1.5 hr |
| Asenapine 10 mg - Cohort 3b | Time to Maximum Plasma Concentration (Tmax) of Asenapine | 1.0 hr |
| Asenapine 10 mg - Cohort 3c | Time to Maximum Plasma Concentration (Tmax) of Asenapine | 0.5 hr |
| Asenapine 10 mg - Cohort 3d | Time to Maximum Plasma Concentration (Tmax) of Asenapine | 1.0 hr |