In a six-week study in adolescents
(13- 17 years old) with schizophrenia, the Otsuka Pharmaceutical Co., Ltd.
and Bristol-Myers Squibb Company (NYSE: BMY) atypical antipsychotic
aripiprazole demonstrated significant improvement compared to placebo on
the primary efficacy endpoint, Positive and Negative Syndrome Scale (PANSS)
Total Score. In the findings first presented here at the 160th annual
meeting of the American Psychiatric Association, approximately 85 percent
of patients completed this six-week study.(1,2)
"Data on the management of schizophrenia in adolescents are limited,"
said Robert Findling, M.D., Director of Child and Adolescent Psychiatry,
University Hospitals Case Medical Center, Cleveland, Ohio. "The findings
from this study contribute important new information about schizophrenia in
adolescents."
Study Design and Findings
The findings are from a six-week, randomized, double-blind, placebo-
controlled study that evaluated the efficacy and safety of aripiprazole in
adolescents, 13-17 years-old, with a primary diagnosis of schizophrenia.
This study, sponsored by Otsuka Pharmaceutical Co., Ltd. and its U.S.
subsidiary, Otsuka Pharmaceutical Development & Commercialization, Inc.
(Princeton, NJ) was conducted at 101 centers in 13 countries with 302
ethnically diverse adolescents. After a minimum three-day washout period
without any antipsychotic treatment, adolescents were randomly assigned to
receive one of two fixed doses of aripiprazole [10 mg/day (n=100) or 30
mg/day (n=102)] or placebo (n=100). Aripiprazole was started at 2 mg/day
and titrated to the target dose. The primary efficacy endpoint was the mean
change from baseline to endpoint (Week Six) in the PANSS Total Score.
Secondary endpoints included the PANSS positive and negative subscales and
the Clinical Global Impression of Improvement (CGI-I) scale. Important
safety measures included incidence of adverse events, discontinuation from
study due to adverse events, and laboratory measures.
Approximately 85 percent of 302 randomized patients completed this six-
week study (83 percent of aripiprazole- and 90 percent of placebo-treated
patients). Both doses of aripiprazole demonstrated improvement compared to
placebo (p-value less than 0.05) in the mean change from baseline in PANSS
Total Score at week six (aripiprazole 10 mg: -26.7; aripiprazole 30 mg:
-28.6; placebo: -21.2).
The mean change from baseline to endpoint on PANSS Positive Subscale
was: -7.6 for aripiprazole 10 mg (p-value less than 0.05), -8.1 for
aripiprazole 30 mg (p-value less than 0.01), and -5.6 for placebo. The mean
change from baseline to endpoint on PANSS Negative Subscale was: -6.9 for
aripiprazole 10 mg (p-value less than 0.05), -6.6 for aripiprazole 30 mg,
and -5.4 for placebo. Improvements were observed in CGI-I [aripiprazole 10
mg: 2.7 (p- value less than 0.05); aripiprazole 30 mg: 2.5 (p-value less
than 0.01); placebo: 3.1].
In this study, the overall incidence of discontinuation due to adverse
events was 4.3 percent for all treatment groups (5.4 percent of
aripiprazole- and 2 percent of placebo-treated patients). The most common
adverse events associated with aripiprazole (greater than 5 percent and at
least twice the incidence compared to placebo) were extrapyramidal disorder
(aripiprazole 10 mg: 13 percent; aripiprazole 30 mg: 21.6 percent; placebo:
5 percent), somnolence (aripiprazole 10 mg: 11 percent; aripiprazole 30 mg:
21.6 percent; placebo: 6 percent), and tremor (aripiprazole 10 mg: 2
percent; aripiprazole 30 mg: 11.8 percent; placebo: 2 percent).
No significant differences were found between aripiprazole and placebo
on the Abnormal Involuntary Movement Scale (AIMS) or Barnes Akathisia
Rating Scale (BARS). Significant differences between aripiprazole and
placebo were observed from baseline (aripiprazole 10 mg: 0.5; aripiprazole
30 mg: 0.3; placebo: -0.3) on the Simpson-Angus Scale (SAS) which measures
signs and symptoms of Parkinsonism.
In this 6-week study, the percentage of patients on aripiprazole with
greater than or equal to 7 percent increase in baseline body weight was 4
percent for aripiprazole 10 mg, 5.2 percent for aripiprazole 30 mg, and 1
percent for placebo. The mean change from baseline in weight was zero for
aripiprazole 10 mg group; 0.2 kg (about 0.4 lbs) for the aripiprazole 30 mg
group, and -0.8 kilograms (kg), or about 1.8 lbs, for placebo group.
Average prolactin levels were decreased relative to baseline in all
treatment groups (10 mg aripiprazole, -12 ng/mL; 30 mg aripiprazole, -17
ng/mL, placebo, -9 ng/mL).
About Aripiprazole
Aripiprazole is indicated for the treatment of schizophrenia including
maintaining stability in adults who had been symptomatically stable on
other antipsychotic medications for periods of three months or longer and
observed for relapse during a period of up to 26 weeks. Aripiprazole is
also indicated for the treatment of acute manic and mixed episodes
associated with Bipolar I Disorder, and for maintaining efficacy in adults
with Bipolar I Disorder with a recent manic or mixed episode who had been
stabilized and then maintained for at least six (6) weeks. Physicians who
elect to use aripiprazole for extended periods should periodically
re-evaluate the long-term usefulness of the drug for the individual.
Aripiprazole Injection is indicated for the treatment of agitation in
adults with schizophrenia or bipolar disorder, manic or mixed.
Initially approved in November 2002, over 10 million prescriptions have
been written for aripiprazole in the U.S.(3)
Aripiprazole is available by prescription only. Aripiprazole is
available in tablets, orally disintegrating tablets, oral solution, and
injection for intramuscular use.
Patients should talk to their healthcare professional for more
information about aripiprazole.
IMPORTANT SAFETY INFORMATION:
Elderly patients with dementia-related psychosis treated with atypical
antipsychotic drugs are at an increased risk (1.6 to 1.7 times) of death
compared to placebo (4.5% vs 2.6%, respectively). Aripiprazole is not
approved for the treatment of patients with dementia-related psychosis (see
Boxed WARNING).
-- Neuroleptic malignant syndrome (NMS) -- As with all antipsychotic
medications, a rare and potentially fatal condition known as NMS has
been reported with aripiprazole. NMS can cause hyperpyrexia, muscle
rigidity, diaphoresis, tachycardia, irregular pulse or blood pressure,
cardiac dysrhythmia, and altered mental status. If signs and symptoms
appear, immediate discontinuation is recommended
-- Tardive dyskinesia (TD) -- The risk of developing TD and the potential
for it to become irreversible may increase as the duration of treatment
and the total cumulative dose increase. Prescribing should be
consistent with the need to minimize TD. If signs and symptoms appear,
discontinuation should be considered since TD may remit, partially or
completely
-- Cerebrovascular adverse events (eg, stroke, transient ischemic attack),
including fatalities, have been reported at an increased incidence in
clinical trials of elderly patients with dementia-related psychosis
treated with aripiprazole
-- Hyperglycemia and diabetes mellitus -- Hyperglycemia, in some cases
associated with ketoacidosis, coma, or death, has been reported in
patients treated with atypical antipsychotics including aripiprazole.
Patients with diabetes should be monitored for worsening of glucose
control; those with risk factors for diabetes should undergo baseline
and periodic fasting blood glucose testing. Patients who develop
symptoms of hyperglycemia should also undergo fasting blood glucose
testing. There have been few reports of hyperglycemia with aripiprazole.
Aripiprazole may be associated with orthostatic hypotension and should
be used with caution in patients with known cardiovascular disease,
cerebrovascular disease, or conditions which would predispose them to
hypotension.
As with other antipsychotic drugs, aripiprazole should be used with
caution in patients with a history of seizures or with conditions that
lower the seizure threshold.
Like other antipsychotics, aripiprazole may have the potential to
impair judgment, thinking, or motor skills. Patients should not drive or
operate hazardous machinery until they are certain aripiprazole does not
affect them adversely.
Disruption of the body's ability to reduce core body temperature has
been attributed to antipsychotics. Appropriate care is advised for patients
who may exercise strenuously, be exposed to extreme heat, receive
concomitant medication with anticholinergic activity, or be subject to
dehydration.
As antipsychotics have been associated with esophageal dysmotility and
aspiration, aripiprazole should be used cautiously in patients at risk for
aspiration pneumonia.
As the possibility of a suicide attempt is inherent in psychotic
illness and bipolar disorder, close supervision of high-risk patients
should accompany drug therapy. Prescriptions for aripiprazole should be
written for the smallest quantity consistent with good patient management
to reduce the risk of overdose.
Physicians should determine if a patient is pregnant or intends to
become pregnant while taking aripiprazole. Patients should be advised not
to breast- feed while taking aripiprazole.
Physicians should advise patients to avoid alcohol while taking
aripiprazole.
Both CYP3A4 and CYP2D6 are responsible for aripiprazole metabolism.
Agents that induce CYP3A4 (eg, carbamazepine) could cause an increase in
aripiprazole clearance and lower blood levels. Inhibitors of CYP3A4 (eg,
ketoconazole) or CYP2D6 (eg, quinidine, fluoxetine, or paroxetine) can
inhibit aripiprazole elimination and cause increased blood levels.
Commonly observed adverse events (greater than or equal to 5% incidence
and at a rate at least twice the rate of placebo for aripiprazole vs
placebo, respectively):
Aripiprazole Oral
In 3-week bipolar mania trials the following were reported: akathisia
(15% vs 3%), constipation (13% vs 6%), sedation (8% vs 3%), tremor (7% vs
3%), restlessness (6% vs 3%), and extrapyramidal disorder (5% vs 2%).
In 4- to 6-week schizophrenia trials the following was reported:
akathisia (8% vs 4%).
A similar adverse event profile was observed in a 26-week trial in
schizophrenia except for a higher incidence of tremor (aripiprazole 8% vs
placebo 2%).
Aripiprazole Injection
In short-term (24 hour) trials in patients with agitation associated with
schizophrenia or bipolar mania the following was reported: nausea (9% vs
3%).
Treatment-emergent adverse events reported with:
Aripiprazole Oral
In short-term trials of patients with schizophrenia (up to 6 weeks) or
bipolar disorder (up to 3 weeks), the following were reported at an
incidence greater than or equal to 10% and greater than placebo,
respectively: headache (30% vs 25%), anxiety (20% vs 17%), insomnia (19%
vs 14%), nausea (16% vs 12%), vomiting (12% vs 6%), dizziness (11% vs
8%), constipation (11% vs 7%), dyspepsia (10% vs 8%), and akathisia (10%
vs 4%).
Aripiprazole Injection
In short-term (24 hour) trials, the following were reported at an
incidence greater than or equal to 5% and greater than placebo,
respectively: headache (12% vs 7%), nausea (9% vs 3%), dizziness (8% vs
5%), and somnolence (7% vs 4%).
About Otsuka Pharmaceutical Co., Ltd. and Bristol-Myers Squibb
Otsuka Pharmaceutical Co., Ltd. and Bristol-Myers Squibb are
collaborative partners in the development and commercialization of
aripiprazole in the United States and major European countries.
Aripiprazole was discovered by Otsuka Pharmaceutical Co., Ltd. Founded
in 1964, Otsuka Pharmaceutical Co., Ltd. is a healthcare company with the
mission statement: "Otsuka - people creating new products for better health
worldwide." Otsuka researches, develops, manufactures and markets
innovative, original products, focusing its core businesses on
pharmaceutical products for the treatment of disease and consumer products
for the maintenance of everyday health. The Otsuka Pharmaceutical Group
comprises 87 companies and employs approximately 27,000 people in 17
countries and regions worldwide. Otsuka and its consolidated subsidiaries
earned US $6.8 billion in consolidated annual revenues in fiscal 2005.
Bristol-Myers Squibb is a global pharmaceutical and related health care
products company whose mission is to extend and enhance human life.
Visit Otsuka Pharmaceutical Co., Ltd. at: otsuka-global
Visit Bristol-Myers Squibb at: bms
Forward Looking Statement
This press release contains "forward-looking statements" as that term
is defined in the Private Securities Litigation Reform Act of 1995,
regarding product development. Such forward-looking statements are based on
current expectations and involve inherent risks and uncertainties,
including factors that could delay, divert or change any of them, and could
cause actual outcomes and results to differ materially from current
expectations. No forward-looking statement can be guaranteed. There can be
no guarantee that a registrational submission will be made to the FDA based
on the data described in this press release or if such registrational
submission is made, that it would receive FDA approval. Forward-looking
statements in this press release should be evaluated together with the many
uncertainties that affect Bristol- Myers Squibb's business, particularly
those identified in the cautionary factors discussion in Bristol-Myers
Squibb's Annual Report on Form 10-K for the year ended December 31, 2006
and in our Quarterly Reports on Form 10-Q. Bristol-Myers Squibb undertakes
no obligation to publicly update any forward- looking statement, whether as
a result of new information, future events or otherwise.
References
(1) Robb AS, Forbes RA, Marcus RN, Carson Jr. WH. Efficacy of aripiprazole
in the treatment of adolescents with schizophrenia. Poster presentation
NR742 at: annual meeting of the American Psychiatric Association, San
Diego, California, Wednesday, May 23, 2007, 3:00 p.m. - 5:00 p.m. PST -
Poster Session 7.
(2) Findling RL, Nyilas M, Auby P, Mallikaarjun S, McQuade RD, Marcus RN,
Carson Jr. WH. Tolerability of aripiprazole in the treatment of
adolescents with schizophrenia. Poster presentation NR741 at: annual
meeting of the American Psychiatric Association, San Diego, California,
Wednesday, May 23, 2007, 3:00 p.m. - 5:00 p.m. PST - Poster Session 7.
(3) IMS Auditrac NGPS: Abilify total monthly retail prescriptions: Data
accessed 11/2006.
Otsuka Pharmaceutical Co., Ltd.
otsuka-global
View drug information on Abilify.
Investigational Study Evaluates The Effectiveness Of Aripiprazole In Adolescents With Schizophrenia
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