Clinical Trial Results:
Six week, double-blind, placebo controlled Phase III trial evaluating the efficacy, safety and pharmacokinetics of flexible doses of oral ziprasidone in adolescent subjects with schizophrenia.
Summary
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EudraCT number |
2005-005501-28 |
Trial protocol |
SE DE |
Global end of trial date |
26 Mar 2009
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Results information
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Results version number |
v1(current) |
This version publication date |
22 Apr 2016
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First version publication date |
16 Jul 2015
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
A1281134
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT00257192 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Pfizer Inc.
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Sponsor organisation address |
235 E 42nd Street, New York, United States, NY 10017
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Public contact |
Pfizer ClinicalTrials.gov Call Center, Pfizer, Inc., ClinicalTrials.gov_Inquiries@pfizer.com
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Scientific contact |
Pfizer ClinicalTrials.gov Call Center, Pfizer, Inc., ClinicalTrials.gov_Inquiries@pfizer.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
Yes
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
29 Sep 2011
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
26 Mar 2009
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
1. To establish efficacy of oral ziprasidone compared to placebo in the treatment of adolescent subjects with schizophrenia, as measured by the change from baseline to Week 6 in Brief Psychiatric Rating Scale - Anchored (BPRS-A) total score.
2. To evaluate the safety and tolerability of oral ziprasidone over 6 weeks in the treatment of adolescent subjects with schizophrenia.
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Protection of trial subjects |
The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were followed.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
25 Apr 2006
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Colombia: 8
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Country: Number of subjects enrolled |
Costa Rica: 5
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Country: Number of subjects enrolled |
India: 38
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Country: Number of subjects enrolled |
Malaysia: 14
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Country: Number of subjects enrolled |
Peru: 9
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Country: Number of subjects enrolled |
Russian Federation: 81
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Country: Number of subjects enrolled |
Singapore: 3
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Country: Number of subjects enrolled |
Ukraine: 56
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Country: Number of subjects enrolled |
United States: 69
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Worldwide total number of subjects |
283
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EEA total number of subjects |
0
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
283
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Adults (18-64 years) |
0
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
Data Safety Monitoring Board (DSMB) recommended to terminate study due to futility per interim analysis charter (p-value=0.9840). Only 1 active subject was affected by this decision. A total of 284 subjects randomized to study. Of these,193 took ziprasidone and 90 took placebo,while 1 subject assigned to placebo did not receive treatment. | |||||||||||||||||||||||||||||||||
Pre-assignment
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Screening details |
Screening visit followed by a 1 to 10 day period to allow for wash-out of exclusionary medications. | |||||||||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall study period (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||||||||||||||
Roles blinded |
Investigator, Carer, Assessor, Subject | |||||||||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Ziprasidone | |||||||||||||||||||||||||||||||||
Arm description |
Ziprasidone capsules administered twice daily (BID) with meals. | |||||||||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Ziprasidone
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
Oral (PO) capsules administered twice daily (BID); titrated from a starting dose of 20 milligrams per day (mg/day) over 2 weeks with dose increase of 20 mg/day every second day up to a target dose range of 120 to 160 mg/day for subjects with body weight greater than or equal to (>=) 45 kilograms (kg); target dose for subjects with body weight less than (<) 45 kg is 60 to 80 mg/day. After titration dose was attained, flexible dosing range of 80 to 160 (if body weight >=45 kg) or 40 to 80 mg/day (if body weight <45 kg) for duration of the study.
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Arm title
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Placebo | |||||||||||||||||||||||||||||||||
Arm description |
Placebo capsules matched to ziprasidone twice daily (BID) with meals. | |||||||||||||||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Capsule
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Routes of administration |
Oral use
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Dosage and administration details |
Placebo matching ziprasidone administration; titrated from a starting dose of 20 mg/day over 2 weeks with dose increases of 20 mg/day every second day up to a target dose range of 120 to 160 mg/day for subjects with body weight >=45 kg; target dose for subjects with body weight <45 kg is 60 to 80 mg/day. After titration dose is attained, flexible dosing range of 80 to 160 (if body weight >=45 kg) or 40 to 80 mg/day (if body weight <45 kg) for duration of the study.
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Baseline characteristics reporting groups
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Reporting group title |
Ziprasidone
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Reporting group description |
Ziprasidone capsules administered twice daily (BID) with meals. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Placebo capsules matched to ziprasidone twice daily (BID) with meals. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Ziprasidone
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Reporting group description |
Ziprasidone capsules administered twice daily (BID) with meals. | ||
Reporting group title |
Placebo
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Reporting group description |
Placebo capsules matched to ziprasidone twice daily (BID) with meals. |
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End point title |
Change From Baseline in Brief Psychiatric Rating Scale - Anchored (BPRS-A) Total Score at Week 6 | ||||||||||||
End point description |
BPRS-A: 18-item clinician rated scale to assess somatic concern, anxiety, emotional withdrawal, disorganization, hallucinatory behavior, guilt feelings, suspiciousness, disorientation, tension, mannerisms, posturing, grandiosity, depressive mood, hostility, motor retardation, uncooperativeness, unusual thought content, blunted affect, and excitement. Ratings anchored to improve consistency for a single rater over time or between raters. Items rated on 7-point scale 0 (not present) to 6 (extremely severe). Total score=sum of items (range 0 to 108); higher scores indicate increased pathology. Intent to treat (ITT): all randomized subjects who had baseline measurements, took at least 1 dose of study medication, and had at least 1 post-baseline visit.
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End point type |
Primary
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End point timeframe |
Baseline, Week 6
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Notes [1] - N= number of subjects with analyzable data at post-baseline observation. [2] - N=number of subjects with analyzable data at post-baseline observation. |
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Statistical analysis title |
Analysis of Change in BPRS-A at Week 6 | ||||||||||||
Statistical analysis description |
Sample size for 85 percent (%) power 2-tailed 0.05 significance level based on expected difference of -5 with average within-group standard deviation=13 was 276 subjects (2 to 1 ratio of enrollment: 184 ziprasidone, 92 placebo). Interim analysis at 60% enrollment (ITT population): may stop trial early for efficacy (2-sided p-value less than (<) 0.0124) or for futility (2-sided p-value greater than (>) 0.4772); The final analysis is to employ a 2-sided p-value <0.0462.
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Comparison groups |
Ziprasidone v Placebo
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Number of subjects included in analysis |
276
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Analysis specification |
Pre-specified
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Analysis type |
superiority [3] | ||||||||||||
P-value |
= 0.153 [4] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
Least squares mean | ||||||||||||
Point estimate |
-1.8
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-4.28 | ||||||||||||
upper limit |
0.67 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
1.26
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Notes [3] - P-value for final analysis is to be adjusted due to planned interim analysis (0.0462). [4] - Mixed effects repeated measures (MMRM) analysis of covariance model with subject as random effect, treatment, region, visit and visit-by-treatment interaction as fixed effects and baseline score as a covariate. |
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End point title |
Change From Baseline in Clinical Global Impression of Severity (CGI-S) Score at Week 6 | ||||||||||||
End point description |
CGI-S: single-item clinician rated scale to rate the severity of a subject's illness over time. Scores range from 1 (normal, not at all ill) to 7 (among the most severely ill subjects); higher score indicates more affected. ITT population.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 6
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Notes [5] - N=number of subjects with analyzable data at post-baseline observation. [6] - N=number of subjects with analyzable data at post-baseline observation. |
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Statistical analysis title |
Analysis of Change in CGI-S Score at Week 6 | ||||||||||||
Statistical analysis description |
Difference from placebo. Hochberg procedure was applied to p-value to preserve type I error in the analysis of key secondary endpoints (Positive and Negative Syndrome Scale (PANSS) total score and CGI-S).
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Comparison groups |
Ziprasidone v Placebo
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Number of subjects included in analysis |
277
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.1289 [7] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
Least squares mean | ||||||||||||
Point estimate |
-0.21
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-0.48 | ||||||||||||
upper limit |
0.06 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.14
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Notes [7] - Mixed effects repeated measures (MMRM) analysis of covariance model with subject as random effect, treatment, region, visit and visit-by-treatment interaction as fixed effects and baseline score as a covariate. |
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End point title |
Change From Baseline in Positive and Negative Syndrome Scale (PANSS) - Total Score at Week 6 | ||||||||||||
End point description |
PANSS: 30-item clinician-rated scale to measure severity of psychopathology (16 items); positive scale (7 items); negative scale (7 items); summarized as positive score, negative score, and total score. Items scored on anchored Likert scale rated 1 (absent symptoms) to 7 (extreme); scores above 1 indicate clinical symptom is present; scores from 2 to 7 indicate increased severity. Total score range 30 to 210: higher score indicates greater severity. ITT population.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 6
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Notes [8] - N=number of subjects with analyzable data at post-baseline observation. [9] - N=number of subjects with analyzable data at post-baseline observation. |
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Statistical analysis title |
Analysis of Change in PANSS Total Score at Week 6 | ||||||||||||
Statistical analysis description |
Total score: difference from placebo. Hochberg procedure was applied to p-value to preserve type I error in the analysis of key secondary endpoints (PANSS total score and CGI-S).
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Comparison groups |
Ziprasidone v Placebo
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Number of subjects included in analysis |
269
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.1987 [10] | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
Least squares mean | ||||||||||||
Point estimate |
-2.57
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-6.5 | ||||||||||||
upper limit |
1.36 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
2
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Notes [10] - Mixed effects repeated measures (MMRM) analysis of covariance model with subject as random effect, treatment, region, visit and visit-by-treatment interaction as fixed effects and baseline score as a covariate. |
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End point title |
Change From Baseline in PANSS: Positive and Negative Subscales at Week 6 | ||||||||||||||||||
End point description |
PANSS: 30-item clinician-rated scale to measure severity of psychopathology (16 items); positive scale (7 items); negative scale (7 items); summarized as positive score, negative score, and total score. Items scored on anchored Likert scale rated 1 (absent symptoms) to 7 (extreme); scores above 1 indicate clinical symptom is present; scores from 2 to 7 indicate increased severity. Total score range 30 to 210: higher score indicates greater severity. ITT population.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 6
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Notes [11] - N=number of subjects with analyzable data at post-baseline observation. [12] - N=number of subjects with analyzable data at post-baseline observation. |
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Statistical analysis title |
Change in Positive Subscale | ||||||||||||||||||
Statistical analysis description |
Positive Score: Difference From Placebo.
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Comparison groups |
Ziprasidone v Placebo
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Number of subjects included in analysis |
269
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||||||||
P-value |
= 0.0412 [13] | ||||||||||||||||||
Method |
ANCOVA | ||||||||||||||||||
Parameter type |
Least squares mean | ||||||||||||||||||
Point estimate |
-1.33
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-2.61 | ||||||||||||||||||
upper limit |
-0.05 | ||||||||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.65
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Notes [13] - Mixed effects repeated measures (MMRM) analysis of covariance model with subject as random effect, treatment, region, visit, and visit-by-treatment interaction as fixed effects and baseline score as a covariate. |
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Statistical analysis title |
Change in Negative Subscales | ||||||||||||||||||
Statistical analysis description |
Negative Score: Difference From Placebo.
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Comparison groups |
Ziprasidone v Placebo
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Number of subjects included in analysis |
269
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||||||||
P-value |
= 0.4661 [14] | ||||||||||||||||||
Method |
ANCOVA | ||||||||||||||||||
Parameter type |
Least squares mean | ||||||||||||||||||
Point estimate |
-0.43
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-1.57 | ||||||||||||||||||
upper limit |
0.72 | ||||||||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.58
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Notes [14] - Mixed effects repeated measures (MMRM) analysis of covariance model with subject as random effect, treatment, region, visit, and visit-by-treatment interaction as fixed effects and baseline score as a covariate. |
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End point title |
Clinical Global Impression of Improvement (CGI-I) Score at Week 6 | ||||||||||||
End point description |
CGI-I: single-item clinician rated scale used to assess the subject's improvement or worsening from baseline. Scores range from 1 (very much improved) to 4 (no change) to 7 (very much worse); higher score indicates more affected. ITT population.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 6
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Notes [15] - N=number of subjects with analyzable data at post-baseline observation. [16] - N=number of subjects with analyzable data at post-baseline observation. |
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Statistical analysis title |
Analysis of CGI-I Score at Week 6 | ||||||||||||
Statistical analysis description |
Difference from placebo.
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Comparison groups |
Ziprasidone v Placebo
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Number of subjects included in analysis |
277
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||
P-value |
= 0.182 [17] | ||||||||||||
Method |
ANOVA | ||||||||||||
Parameter type |
Least squares mean | ||||||||||||
Point estimate |
-0.19
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-0.47 | ||||||||||||
upper limit |
0.09 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.14
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Notes [17] - Mixed effects MMRM with subject as random effect, treatment, region, visit and visit-by-treatment interaction as fixed effects. |
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End point title |
Change From Baseline in Children's Global Assessment Scale (CGAS) | |||||||||||||||||||||||||||
End point description |
CGAS: clinician-rated global assessment item for children based on symptoms and social functioning in home, school, and community settings. Scores on this single item range from 1 to 100 (higher levels indicate greater health) with descriptive anchors for every 10-point interval. Scores above 70 on this scale are considered within the “normal” range; lower score indicates need for increased supervision. ITT population. Here, (n)=number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. ET (Early Termination) includes observations from visits not within windowing criteria. Last observation carried forward [LOCF] imputation used for Week 6 LOCF timepoint.
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End point type |
Secondary
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End point timeframe |
Baseline, Week 2, Week 4, Week 6, ET
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No statistical analyses for this end point |
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End point title |
Change From Baseline in Child Health Questionnaire (CHQ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
CHQ: 50-item, 15 subscale parent or legal guardian assessed instrument of child’s physical, emotional, social well-being, and relative burden of disease on the parents; rated on Likert-type scale: range 0 to 100; higher scores indicate a more positive health status. Global indicators for Physical Health and Psychosocial Health are weighted composites derived from subscale items using scoring algorithms (transformed scores); range 0 to 100: higher scores indicate more positive health status. ITT. ET includes observations from visits not within windowing criteria. LOCF imputation used for Week 6 LOCF timepoint.
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End point type |
Secondary
|
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End point timeframe |
Baseline, Week 6, ET
|
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No statistical analyses for this end point |
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End point title |
Change From Baseline in Children's Problem Behavior and Aggression Questionnaire (CPBAQ) Total Score | |||||||||||||||||||||||||||||||||
End point description |
CPBAQ: 19-item parent or legal guardian completed questionnaire to rate the child's verbal (such as yelling or cursing) and physical aggression (such a fighting with peers or being cruel to an animal) during the past week. Behavior was rated on a 4-point scale; range 0 (behavior did not occur or was not a problem) to 3 (behavior occurred a lot or was severe problem). Total score range 0 to 57; higher scores indicate a greater frequency and severity of aggression. ITT; (n)= number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
|||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 1 through Week 6
|
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Notes [18] - N=number of subjects with analyzable data at baseline. [19] - N=number of subjects with analyzable data at baseline. |
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No statistical analyses for this end point |
|
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End point title |
Change From Baseline in Child Depression Rating Scale - Revised (CDRS-R): Total Score | |||||||||||||||||||||||||||||||||
End point description |
CDRS-R: clinician-rated interview-based scale (with both child and parent or guardian) to assess 17 distinct symptom areas to derive an index of depression severity. Discrepancies between informants' responses were resolved by using most impaired rating given by valid informant. Rated on a 7-point scale; range from 1 (no impairment) to 7 (indicates greater impairment). Total score calculated as sum of the 17 items (range 1 to 119); higher score indicates greater impairment. ITT; (n)=number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
|||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 1 through Week 6
|
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Notes [20] - N=number of subjects with analyzable data at baseline [21] - N=number of subjects with analyzable data at baseline |
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No statistical analyses for this end point |
|
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End point title |
Change From Baseline in Child Depression Rating Scale - Revised (CDRS-R): Suicide Ideation Item 13 | |||||||||||||||||||||||||||||||||
End point description |
CDRS-R: clinician-rated interview-based scale (with both child and parent or guardian) to assess 17 distinct symptom areas to derive an index of depression severity. Discrepancies between informants' responses were resolved by using most impaired rating given by valid informant. Suicide Ideation (Item 13) detects changes in suicidality over time. Rated on a 7-point scale; range from 1 (no impairment) to 7 (indicates greater impairment). ITT; (n)=number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
|||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 1 through Week 6
|
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Notes [22] - N=number of subjects with analyzable data at baseline. [23] - N=number of subjects with analyzable data at baseline. |
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No statistical analyses for this end point |
|
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End point title |
Change From Baseline in Child Depression Rating Scale - Revised (CDRS-R): Impaired Schoolwork Item 1 | |||||||||||||||||||||
End point description |
Clinician-rated interview-based scale (with both child and parent or guardian) to assess 17 distinct symptom areas to derive an index of depression severity. Discrepancies between informants' responses resolved by using most impaired rating given by valid informant. Impaired Schoolwork (Item 1) assesses school function for the subgroup of subjects reported to be in school. Rated on a 7-point scale; range from 1 (no impairment) to 7 (indicates greater impairment). ITT; (n)=number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
|||||||||||||||||||||
End point timeframe |
Baseline, Week 2, Week 6
|
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|
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Notes [24] - N=number of subjects with analyzable data at baseline. [25] - N=number of subjects with analyzable data at baseline. |
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No statistical analyses for this end point |
|
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End point title |
Change From Baseline in Central Nervous System (CNS) Vital Signs Cognitive Test Battery (Includes Sedation Item): Subscales | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
A computerized subject-administered test battery with subtests for verbal and visual memory, processing speed, nonverbal reasoning, executive functioning, working memory, and sustained attention. A computerized 7-point sedation item (0 [not sleepy] to 10 [very sleepy]) was completed prior to test battery. The Neurocognitive index score was derived from subtest scores per an algorithm. The index score and subtest scores assessed the subject’s changes in cognition. Scores were rated as above average (score >109), average (90 to 109), below average (80 to 89), or well below average (70 to 79). ITT; (n)= number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. ET includes observations from visits not within windowing criteria. LOCF imputation used for Week 6 LOCF timepoint (last post-baseline non-missing visit).
|
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End point type |
Secondary
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 6, ET
|
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|
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Notes [26] - N=number of subjects with analyzable data at baseline. [27] - N=number of subjects with analyzable data at baseline. |
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No statistical analyses for this end point |
|
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End point title |
Change From Baseline in CNS Vital Signs Cognitive Test Battery: Neurocognitive Index | |||||||||||||||||||||
End point description |
A computerized subject-administered test battery with subtests for verbal and visual memory, processing speed, nonverbal reasoning, executive functioning, working memory, and sustained attention. A computerized 7-point sedation item (0 [not sleepy] to 10 [very sleepy]) was completed prior to test battery. The Neurocognitive index score was derived from subtest scores per an algorithm. The index score and subtest scores assessed the subject’s changes in cognition. Scores were rated as above average (score >109), average (90 to 109), below average (80 to 89), or well below average (70 to 79). ITT; (n)= number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. ET includes observations from visits not within windowing criteria. LOCF imputation used for Week 6 LOCF timepoint (last post-baseline non-missing visit).
|
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End point type |
Secondary
|
|||||||||||||||||||||
End point timeframe |
Baseline, Week 6, ET
|
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|
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Notes [28] - N=number of subjects with analyzable data at baseline. [29] - N=number of subjects with analyzable data at baseline. |
||||||||||||||||||||||
Statistical analysis title |
Change in Neurocognitive Index Score at Week 6 | |||||||||||||||||||||
Statistical analysis description |
Difference from placebo. Observed cases at Week 6.
|
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Comparison groups |
Ziprasidone v Placebo
|
|||||||||||||||||||||
Number of subjects included in analysis |
247
|
|||||||||||||||||||||
Analysis specification |
Pre-specified
|
|||||||||||||||||||||
Analysis type |
superiority | |||||||||||||||||||||
P-value |
= 0.2613 [30] | |||||||||||||||||||||
Method |
ANCOVA | |||||||||||||||||||||
Parameter type |
Least squares mean | |||||||||||||||||||||
Point estimate |
1.34
|
|||||||||||||||||||||
Confidence interval |
||||||||||||||||||||||
level |
95% | |||||||||||||||||||||
sides |
2-sided
|
|||||||||||||||||||||
lower limit |
-1.01 | |||||||||||||||||||||
upper limit |
3.69 | |||||||||||||||||||||
Variability estimate |
Standard error of the mean
|
|||||||||||||||||||||
Dispersion value |
1.19
|
|||||||||||||||||||||
Notes [30] - SAS PROC MIXED to fit a mixed model analysis of covariance with treatment and region as fixed effects and baseline score as covariate. |
|
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End point title |
Change From Baseline in Movement Disorder Scales: Simpson-Angus Rating Scale (SARS) | |||||||||||||||||||||||||||||||||
End point description |
SARS: 10-item clinician rated instrument to assess parkinsonian symptoms (7 items) and related extrapyramidal side effects (3 items): gait, arm dropping, shoulder shaking, elbow rigidity, leg pendulousness, glabellar tap, tremor, and salivation. Head dropping (modified SARS item 7) substituted for head rotation. Anchored 5-point scale: range 0 (absence of condition, normal) to 4 (most extreme form of condition). Total score is sum of individual item scores (range 0 to 40); higher score indicates more affected. ITT; (n)= number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
|||||||||||||||||||||||||||||||||
End point type |
Secondary
|
|||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 1 through Week 6
|
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|
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Notes [31] - N=number of subjects with analyzable data at baseline. [32] - N=number of subjects with analyzable data at baseline. |
||||||||||||||||||||||||||||||||||
No statistical analyses for this end point |
|
||||||||||||||||||||||||||||||||||
End point title |
Change From Baseline in Movement Disorder Scales: Barnes Akathisia Rating Scale (BAS) Global Clinical Assessment Item | |||||||||||||||||||||||||||||||||
End point description |
BAS: clinician rated scale to assess akathisia to determine the degree of subjective restlessness and distress associated with restlessness. First 3 items (Objective, Subjective, and Distress related to restlessness) rated on a 4-point scale with range 0 (no symptoms) to 3 (increased severity of symptoms). Item 4 Global Clinical Assessment of Akathisia rated on a 6-point scale range 0 (no symptoms) to 5 (increased severity of symptoms); higher score indicates increased severity. All rating are anchored. Only the Global Clinical Assessment of Akathisia was to be analyzed. ITT; (n)= number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
|||||||||||||||||||||||||||||||||
End point type |
Secondary
|
|||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 1 through Week 6
|
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|
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Notes [33] - N=number of subjects with analyzable data at baseline. [34] - N=number of subjects with analyzable data at baseline. |
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No statistical analyses for this end point |
|
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End point title |
Change From Baseline in Movement Disorder Scales: Abnormal Involuntary Movement Scale (AIMS) Movement Cluster Score | |||||||||||||||||||||||||||||||||
End point description |
AIMS: clinician rated 12-item scale to rate 7 body areas and global judgments on the severity of abnormal movements, incapacitation and subject's awareness of abnormal movements. Items 1 to 10 scored 0 (none) to 4 (severe) (total possible score 0 to 40; higher score indicates greater severity); items 11 to 14 are No or Yes response to dental status and sleep movements. Only the sum of the first 7 items to be analyzed (AIMS Movement Cluster score). Total score 0 to 28; higher score indicates greater severity. ITT; (n)=number of subjects with analyzable data at post-baseline observation for ziprasidone and placebo, respectively. LOCF imputation used for Week 6 LOCF timepoint.
|
|||||||||||||||||||||||||||||||||
End point type |
Secondary
|
|||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 1 through Week 6
|
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|
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Notes [35] - N=number of subjects with analyzable data at baseline. [36] - N=number of subjects with analyzable data at baseline. |
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No statistical analyses for this end point |
|
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End point title |
Number of Subjects Per Response on the School Placement Questionnaire: School Situation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
School placement questionnaire: parent or legal guardian assessed questionnaire to determine whether the child is currently enrolled in school (or planned to be enrolled if on school holiday like summer break), whether attending regularly if enrolled, and how well the child is doing overall in school. Questions were modified from those used in the National Institute of Mental Health (NIMH) funded Treatment of Early Onset Schizophrenia Spectrum (TEOSS) study. Results determine whether subjects are currently attending school and qualitatively describe how well they are doing in school. ITT; (n)=number of subjects with analyzable data at baseline and post-baseline observation for ziprasidone and placebo, respectively. ET includes observations from visits not within windowing criteria. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 2, Week 6, ET
|
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|
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Notes [37] - N=number of subjects analyzable for School Placement Questionnaire. [38] - N=number of subjects analyzable for School Placement Questionnaire. |
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No statistical analyses for this end point |
|
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End point title |
Number of Subjects Per Response on the School Placement Questionnaire: School Attendance | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
School placement questionnaire: parent or legal guardian assessed questionnaire to determine whether the child is currently enrolled in school (or planned to be enrolled if on school holiday like summer break), whether attending regularly if enrolled, and how well the child is doing overall in school. Questions were modified from those used in the National Institute of Mental Health (NIMH) funded Treatment of Early Onset Schizophrenia Spectrum (TEOSS) study. Results determine whether subjects are currently attending school and qualitatively describe how well they are doing in school. ITT; (n)=number of subjects with analyzable data at baseline and post-baseline observation for ziprasidone and placebo, respectively. ET includes observations from visits not within windowing criteria. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 2, Week 6, ET
|
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|
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Notes [39] - N=number of subjects analyzable for School Placement Questionnaire. [40] - N=number of subjects analyzable for School Placement Questionnaire. |
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No statistical analyses for this end point |
|
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End point title |
Number of Subjects Per Response on the School Placement Questionnaire: Overall School Performance | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point description |
School placement questionnaire: parent or legal guardian assessed questionnaire to determine whether the child is currently enrolled in school (or planned to be enrolled if on school holiday like summer break), whether attending regularly if enrolled, and how well the child is doing overall in school. Questions were modified from those used in the National Institute of Mental Health (NIMH) funded Treatment of Early Onset Schizophrenia Spectrum (TEOSS) study. Results determine whether subjects are currently attending school and qualitatively describe how well they are doing in school. ITT; (n)=number of subjects with analyzable data at baseline and post-baseline observation for ziprasidone and placebo, respectively. ET includes observations from visits not within windowing criteria. LOCF imputation used for Week 6 LOCF timepoint.
|
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End point type |
Secondary
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
End point timeframe |
Baseline, Week 2, Week 6, ET
|
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|
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Notes [41] - N=number of subjects analyzable for School Placement Questionnaire. [42] - N=number of subjects analyzable for School Placement Questionnaire. |
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No statistical analyses for this end point |
|
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Adverse events information
|
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Timeframe for reporting adverse events |
Treatment emergent adverse events are reported from time of first dose of study treatment up to 6 days after last dose of study treatment.
|
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Adverse event reporting additional description |
Safety population = all randomized subjects with at least 1 dose of study treatment. An Adverse Event (AE) term may be reported as both a serious and non-serious AE, but are distinct events. AE may = serious for 1 subject and = non-serious for another subject or subject may have experienced both a serious and non-serious episode of the same event.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
|
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Dictionary name |
MedDRA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
17.1
|
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Reporting groups
|
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Reporting group title |
Ziprasidone
|
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Reporting group description |
Ziprasidone capsules administered twice daily (BID) with meals. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
|
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Reporting group description |
Placebo matching ziprasidone administration. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||||||
Date |
Amendment |
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06 Dec 2006 |
1. A physical exam including body temperature was completed at week 6 or end of treatment.
2. Extensive electrocardiogram (ECG) monitoring was performed throughout the study, including triplicate ECGs at baseline and excluding Week 4.
3. Subjects who could not tolerate a dose of 120 mg/day were allowed to have a dose reduction and to continue study treatment at 100 mg/day or as low as 80 mg/day. Subjects weighing <45 kilograms (kg) were to be allowed a minimum dose of 40 mg/day. Subjects who could not tolerate the dose range of 80 to 160 mg/day for children above 45 kg or 40-80 mg/day for children <45 kg, discontinue and might be eligible to enter the extension trial.
4. ECGs showing a Fridericia corrected QT (QTcF) of >=460 milliseconds (msec) or a suspected increase from baseline of 60 msec or greater was to be repeated within the same visit. If the QTcF value persisted at >=460 msec and/or the change from baseline persisted at >=60 msec, the study drug was to be discontinued immediately and a pediatric cardiologist or a pediatric intensive care specialist should be contacted to discuss the ECG result.
5. Exposure In Utero definition was amended to include paternal exposure.
6. It was recommended that subjects should complete the CNS Vital Signs battery before any intrusive assessments such as blood draws, if at all possible.
7. Possibly Suicide-Related Adverse Events (PSRAEs) were included in adverse event reporting. |
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09 Nov 2007 |
1. Subjects who could not tolerate a dose of 120 mg/day were allowed to have a reduction and to continue study treatment at 100 mg/day or as low as 80 mg/day. Subjects weighing <45 kg were to be allowed a minimum dose of 40 mg/day. Subjects who could not tolerate the dose range of 80 to 160 mg/day for children above 45 kg or 40-80 mg/day for children <45 kg, should discontinue and might be eligible to enter the extension trial. This statement was added in section summary, Trial Design, Trial Treatments.
2. Concominant medication section amended to include lorazepam(up to 2 mg/day) or (if lorazepam is not available in the country diazepam up to 5 mg/day) for anxiety or agitation.
3. Protocol amended to provide subject status information on supplemental analysis addressing “pre-pause” and "post-pause” study
enrollment, general clarifications and consistencies, and redesign of the study drug blister card to decrease the chance for dosing errors (usually overdosing beyond protocol specified dose). Subjects enrolled prior to the pause used the original blister card packaging, while subjects entering after the pause, used the improved blister card packaging. A sensitivity analysis was performed to assess the effect, if any, of this change. |
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24 Jan 2008 |
1. The scheduling of post-dose sampling paired to ECG measurement was changed from within 10 minutes of ECG to immediately after
ECG. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? Yes | |||||||
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Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||||||
The AE tables were amended to incorporate previously unreported AEs that were found during an independent audit and verified by the investigators. |