ADHD
Conditions
Brief summary
The purpose of this randomized, placebo-controlled, double-blind, parallel group study is to evaluate the clinical efficacy and safety of PRC-063 in adults with ADHD
Detailed description
This study is a randomized, phase III, multicenter, placebo-controlled, parallel-group, forced-dose titration in which adult subjects (18 years of age or older) with ADHD will be randomized to PRC-063 (25, 45, 70 or 100 mg) or placebo for four weeks of double-blind evaluation of safety and efficacy. The study will have four phases: (1) screening and 1-week washout; (2)baseline and double-blind, forced-dose titration over a 2-week period; (3) double-blind evaluation over a 2-week period; and (4) a 14-day safety follow-up. Subjects will be required to visit the site 6 times over a 5 week period. Screening and Washout: Subjects will be screened to establish eligibility for study participation. Subjects who meet eligibility requirements will undergo ADHD medication washout, if applicable.
Interventions
DRUGPlacebo
Oral placebo capsule
DRUGPRC-063 25 mg
Oral 25 mg capsule - active
DRUGPRC-063 45 mg
Oral 45 mg capsule - active
DRUGPRC-063 70 mg
Oral 70 mg capsule - active
DRUGPRC-063 100 mg
Oral 100 mg capsule - active
Sponsors
Purdue Pharma, Canada
Rhodes Pharmaceuticals, L.P.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or non-pregnant, non-nursing female at least 18 years of age and meeting the local, legal definition of adult. * ADHD diagnosis, inattentive, hyperactive/impulsive or combined, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) based on clinician assessment using multiple informants and a structured interview. * Unsatisfied with his or her current pharmacological therapy for treatment of ADHD or not currently receiving pharmacological therapy for ADHD. Inclusion of subjects naïve to pharmacological therapy for ADHD is permitted. * Female subjects must be one of the following: a. surgically sterile prior to screening; b. postmenopausal; c. if of childbearing potential, abstinent or willing to use a reliable method of contraception, such as oral contraceptive, two barrier methods, a barrier method plus a spermicidal agent. * Female subjects of Child-Bearing Potential (FOCP) must have a negative serum β-hCG pregnancy test at screening. * Minimum level of intellectual functioning, as determined by an Intelligence Quotient (IQ) score of 80 or above based on the WASI. * Mentally and physically competent to sign an informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study. * Able and willing to comply with the study procedures for the entire length of the study, including a successful swallow test of an empty 100 mg capsule.
Exclusion criteria
* Having an allergy to methylphenidate or amphetamines or a history of serious adverse reactions to methylphenidate. * Known to be non-responsive to methylphenidate treatment. Non-response is defined as methylphenidate use at various doses for a phase of at least four weeks at each dose with little or no clinical benefit. * Being diagnosed with or having a history of strokes, epilepsy, migraine headaches (greater than 1 instance every two months), glaucoma, thyrotoxicosis, tachyarrhythmias or severe angina pectoris or serious or unstable medical illness. Subjects with controlled or stable asthma or diabetes will be permitted. * Elevated blood pressure, defined as any values above 89 diastolic or 139 systolic, as assessed at Visit 1. * Clinically significant ECG abnormalities, as assessed at Visit 1. * Clinically significant laboratory abnormalities, as assessed at Visit 1. * Currently receiving guanethidine, pressor agents, MAO inhibitors, coumarin anticoagulants, anticonvulsants (e.g. phenobarbital, phenytoin, primidone), phenylbutazone, tricyclic antidepressants (e.g. imipramine, desipramine), selective serotonin reuptake inhibitors (SSRIs) or herbal remedies (unless on a stable dose for 4 weeks). * Subject has known history of symptomatic cardiovascular disease, advanced arteriosclerosis, structural cardiac abnormality, cardiomyopathy, serious heart rhythm abnormalities, coronary heart disease, transient ischemic attack or stroke or other serious cardiac problems that may place the subject at increased vulnerability to the sympathomimetic effects of a stimulant drug. * Subject has a known family history of sudden cardiac death or ventricular arrhythmia. * Subjects who are currently considered a suicide risk by the investigator. * Having a primary diagnosis of schizophrenia, schizoaffective disorder, primary affective disorder, schizotypal personality, major depression, bipolar disorder, generalized anxiety, borderline personality disorder, antisocial personality or another unstable psychiatric condition requiring treatment, as assessed by the structured interview conducted at Visit 1. * Having a history or suspected physiological dependence (excluding nicotine) on narcotic analgesics or other psychoactive drugs (including barbiturates, opiates, cocaine, cannabinoids, amphetamines and benzodiazepines). * Excessive consumption of alcohol (consumes alcohol in quantities greater than 15 drinks per week; 1 drink is defined as 360 mL/12 oz. of beer, 120 mL/4 oz. of wine, or 30 mL/1 oz. of hard liquor), or history (within previous 6 months) of alcohol abuse. * Currently (or within 30 days before the planned start of treatment) receiving an investigational drug or using an experimental medical device. * Homeless.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score | 4 weeks | Participants were monitored for 4 weeks on treatment (final 2 weeks on stable dose). Clinicians rated subject behavior on the ADHD-5-Rating Scale each week. Primary outcome was based on the final week of treatment. The ADHD-5-RS is an 18-item questionnaire that measures the frequency of ADHD symptoms based on DSM-5 criteria. For each item, clinicians rate how often the behavior is displayed on a scale of 0 (Never or Rarely) to 3 (Very Often). Scores can range from 0 to 54, with lower scores indicating a lower frequency of ADHD symptoms. |
Countries
Canada, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Placebo Arm
Placebo: Oral placebo capsule | 78 |
| PRC-063 25 mg PRC-063 25 mg
PRC-063 25 mg: Oral 25 mg capsule - active | 77 |
| PRC-063 45 mg PRC-063 45 mg
PRC-063 45 mg: Oral 45 mg capsule - active | 73 |
| PRC-063 70 mg PRC-063 70 mg
PRC-063 70 mg: Oral 70 mg capsule - active | 73 |
| PRC-063 100 mg PRC-063 100 mg
PRC-063 100 mg: Oral 100 mg capsule - active | 74 |
| Total | 375 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Overall Study | Adverse Event | 2 | 0 | 1 | 2 | 5 |
| Overall Study | incarceration | 0 | 0 | 1 | 0 | 0 |
| Overall Study | Lost to Follow-up | 3 | 2 | 0 | 5 | 4 |
| Overall Study | non-compliant | 1 | 0 | 0 | 2 | 0 |
| Overall Study | Protocol Violation | 0 | 0 | 0 | 1 | 1 |
| Overall Study | subject moved | 1 | 0 | 0 | 0 | 0 |
| Overall Study | Withdrawal by Subject | 2 | 2 | 2 | 2 | 3 |
Baseline characteristics
| Characteristic | Placebo | PRC-063 25 mg | PRC-063 45 mg | PRC-063 70 mg | PRC-063 100 mg | Total |
|---|---|---|---|---|---|---|
| Age, Continuous | 37.4 years STANDARD_DEVIATION 12.4 | 36.3 years STANDARD_DEVIATION 12.48 | 36.0 years STANDARD_DEVIATION 11.82 | 35.1 years STANDARD_DEVIATION 11.19 | 35.3 years STANDARD_DEVIATION 11.68 | 36.0 years STANDARD_DEVIATION 11.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants | 10 Participants | 6 Participants | 13 Participants | 14 Participants | 52 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 68 Participants | 66 Participants | 66 Participants | 60 Participants | 58 Participants | 318 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 1 Participants | 1 Participants | 0 Participants | 2 Participants | 5 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 0 Participants | 2 Participants | 3 Participants | 2 Participants | 10 Participants |
| Race (NIH/OMB) Black or African American | 9 Participants | 8 Participants | 13 Participants | 1 Participants | 10 Participants | 41 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 64 Participants | 69 Participants | 57 Participants | 68 Participants | 59 Participants | 317 Participants |
| Sex: Female, Male Female | 43 Participants | 40 Participants | 36 Participants | 35 Participants | 44 Participants | 198 Participants |
| Sex: Female, Male Male | 35 Participants | 37 Participants | 37 Participants | 38 Participants | 30 Participants | 177 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 25 / 78 | 30 / 77 | 36 / 73 | 45 / 73 | 47 / 74 |
| serious Total, serious adverse events | 2 / 78 | 4 / 77 | 2 / 73 | 2 / 73 | 4 / 74 |
Outcome results
Primary
Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score
Participants were monitored for 4 weeks on treatment (final 2 weeks on stable dose). Clinicians rated subject behavior on the ADHD-5-Rating Scale each week. Primary outcome was based on the final week of treatment. The ADHD-5-RS is an 18-item questionnaire that measures the frequency of ADHD symptoms based on DSM-5 criteria. For each item, clinicians rate how often the behavior is displayed on a scale of 0 (Never or Rarely) to 3 (Very Often). Scores can range from 0 to 54, with lower scores indicating a lower frequency of ADHD symptoms.
Time frame: 4 weeks
Population: The Full Analysis population consists of all randomized subjects who receive any amount of study medication and who have any ADHD-5-Rating Scale assessments.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| PRC-063 25 mg | Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score | 24.2 units on a scale | Standard Deviation 11.88 |
| PRC-063 45 mg | Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score | 19.9 units on a scale | Standard Deviation 12.45 |
| PRC-063 70 mg | Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score | 24.0 units on a scale | Standard Deviation 11.25 |
| PRC-063 100 mg | Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score | 18.7 units on a scale | Standard Deviation 11.48 |
| 0 mg/Day | Change From Baseline in Clinician-administered ADHD-5-Rating Scale Total Score | 26.1 units on a scale | Standard Deviation 11.99 |
Comparison: The null hypothesis is the mean Clinician ADHD-5-RS total score at Visit 6 is not different between the active treatment and placebo.p-value: 0.67595% CI: [-6.6, 2.6]ANCOVA
Comparison: The null hypothesis is the mean Clinician ADHD-5-RS total score at Visit 6 is not different between the active treatment and placebop-value: 0.001395% CI: [-11.5, -2.2]ANCOVA
Comparison: The null hypothesis is the mean Clinician ADHD-5-RS total score at Visit 6 is not different between the active treatment and placebop-value: 0.67295% CI: [-6.8, 2.7]ANCOVA
Comparison: The null hypothesis is the mean Clinician ADHD-5-RS total score at Visit 6 is not different between the active treatment and placebop-value: 0.000295% CI: [-12.9, -3.2]ANCOVA