E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Mild-to-moderate agitation in adult patients with schizophrenia or bipolar disorder |
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E.1.1.1 | Medical condition in easily understood language |
Agitated patients with schizophrenia or bipolar disorder |
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E.1.1.2 | Therapeutic area | Psychiatry and Psychology [F] - Mental Disorders [F03] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10001497 |
E.1.2 | Term | Agitation |
E.1.2 | System Organ Class | 10037175 - Psychiatric disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the safety profile of self-administered ADASUVE® outside the hospital setting in a population of patients that are known ADASUVE® responders and well trained on the use of the product, with a primary focus on serious adverse events (SAEs) and adverse events of special interest (AESI) related to ADASUVE®, including respiratory events. |
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E.2.2 | Secondary objectives of the trial |
- To evaluate the time to improvement of the agitation episode after the self-adminsitration of ADASUVE® outside the hospital setting.
- To analyse the patient-rated Clinical Global Impression-Improvement (CGI-I) scores up to 2 hours after the initial ADASUVE® self-administered dose outside of a hospital setting.
- To evaluate the treatment satisfaction in ADASUVE® responders after the initial self-administered dose outside the hospital setting.
- To describe the practice patterns for treating a worsening or no improvement of an agitation episode in the hospital setting after self-administration of ADASUVE®.
- To analyse the degree of concordance between the patient/family
member-caregiver and the physician in the diagnosis of the agitation
episode/ administration of ADASUVE®.
- To describe the patient profile and post-treatment outcomes of
agitated patients/caregiver treated with ADASUVE® outside the hospital
setting according to their level of agitation. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male and female patients between the ages of 18-65 years, inclusive
2. Patients (or legal representative) willing and able to provide written Informed Consent Form.
3. Psychiatric patients already diagnosed of schizophrenia or bipolar disorder (according DSM-IV-TR, DSM-V or ICD-10 criteria).
4. Patients with an on-going agitation episode (mild or moderate), or
with a previous one within the 6 months prior to screening, attended and
managed in the hospital setting.
5. Previously treated with ADASUVE® with a positive outcome
(responders) according to (CGI-I) scale (defined as having a CGI-I score
of 1 or 2 at 2 hours after administration of the inhalation) or equivalent
clinical evaluation at the discretion of the investigator and they have not
developed bronchospasm after previous administration.
6. Patients free of active respiratory disease such as acute respiratory signs/symptoms (e.g., wheezing) or with active airways disease (asthma, chronic obstructive pulmonary disease [COPD] or emphysema).
7. Patient and/or caregiver/family able to:
a. understand and follow a specific training for the administration of
ADASUVE® outside the hospital setting,
b. identify/detect a respiratory problem
c. use of a bronchodilator if needed
8. Requirement of family or other caregiver support at study investigator criteria (defined as a patient’s relative or caregiver (male or female) ≤ 80 year old, who spend ≥ 3 consecutive hours with patient, with good physical and psychological health status and without physical limitations, reading and writing educational level and able to understand and follow the study procedures).
9. Availability of patient’s medical records data about the previous treatment with ADASUVE® at hospital setting.
10. If a female is of childbearing potential and sexually active (except if female is surgically sterile or post-menopausal with history of no menses for at least 24 months), patient must be non-lactating and non-pregnant (with a negative pregnancy test result at baseline visit) and have to agree to use a medically acceptable and effective birth control method throughout the study and for one week following the end of the study. |
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E.4 | Principal exclusion criteria |
1. Patient diagnosed with dementia.
2. Patients with serious and unstable illnesses including current hepatic, renal, gastroenterologic, respiratory, cardiovascular (including ischemic heart disease and congestive heart failure), endocrinologic, neurologic (including stroke, transient ischemic attack, subarachnoidal bleeding, brain tumor, encephalopathy, and meningitis).
3. Patients with a history of allergic reactions to loxapine or amoxapine
4. Patients who have received an investigational drug within 30 days prior to the current agitation episode must be excluded.
5. Patients who are considered by the investigator, for any reason, to be unable to self-administer the inhalation device.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint of the study is to assess the frequency of AEs related to ADASUVE®, with focus on SAEs and AESIs (including respiratory events) following the self-administration of ADASUVE® outside of a hospital setting. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Following the self-administration of ADASUVE outside of a hospital setting. |
|
E.5.2 | Secondary end point(s) |
- Incidence of other AEs-non respiratory AESIs related to ADASUVE® self-administration treatment outside the hospital setting.
- Incidence of AEs, SAEs, AESIs and non-respiratory AESIs related to the second dose of ADASUVE® administered at the hospital setting (only in cases with a 2nd dose administration).
- Time to onset of improvement of the current episode of agitation following the ADASUVE® self-administration outside the hospital setting.
- Absolute CGI-I scores up to 2 hours after drug self-administration outside of a hospital setting.
- Percentage of ADASUVE® responders, calculated as the proportion of
patients who achieved a score of 1 ('very much improved') or 2 ('much
improved') in CGI-Improvement scale at 2 hours after selfadministration
of ADASUVE®. Patients' treatment satisfaction in ADASUVE® responders measured with a 5-point Likert scale at the end of the 24-74h follow-up period.
- Patients’ treatment satisfaction in ADASUVE® responders measured with a 5-point Likert scale at the end of the 24-74h follow-up period.
- Description of all anti-agitation medications administered at hospital setting (2nd dose of ADASUVE® or other treatments) for treating a worsening or no improvement of an agitation episode after self-administration of ADASUVE® outside the hospital setting.
- Percentage of observed concordance and the degree of concordance
between the patient/family member-caregiver and physician (clinical
criteria) in identifying the severity of the agitation episode/
administration of ADASUVE®.
- Description of patients and family members/ caregivers´
demographics, and clinical characteristics of agitated patients treated
with ADASUVE® outside the hospital setting.
- Description of possible differences in demographic and clinical profiles
(diagnosis, disease status and agitation episode characteristics including
symptoms of agitation), and post-treatment ADASUVE® outcomes
among mild and moderate levels of agitation based on CGI-S scale. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
- Following the self-administration of ADASUVE® outside the hospital setting.
- Following the second dose of ADASUVE® administered at the hospital setting (only in cases with a 2nd dose administration).
- Following the ADASUVE® self-administration outside the hospital setting.
- Up to 2 hours after drug self-administration outside of a hospital setting.
- At 2 hours after self-administration of ADASUVE®.
- At the end of the 24-74h follow-up period.
- After self-administration of ADASUVE® outside the hospital setting. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 30 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
The study will be finish when:
- the last patient completes the follow-up period at 30 days after the self-administration of ADASUVE® outside the hospital setting,
- or when last patient included has not presented a new episode of agitation up to the 6 months of follow-up from baseline visit. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |