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    Clinical Trial Results:
    A Phase IV, Open-label, Non-randomized, Clinical Trial to Evaluate the Safety of self-administered ADASUVE(R) (Staccato loxapine for inhalation) in Agitated Patients outside the hospital setting

    Summary
    EudraCT number
    2015-003331-36
    Trial protocol
    AT   NO  
    Global end of trial date
    30 Dec 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Oct 2020
    First version publication date
    11 Oct 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    FER-Loxapine-2015-01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02525991
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    FERRER INTERNACIONAL S.A.
    Sponsor organisation address
    Av Diagonal, 549 3rd floor, Barcelona, Spain, 08029
    Public contact
    Thais Baleeiro Teixeira, FERRER INTERNACIONAL S.A., 0034 935082966, tbaleeiro@ferrer.com
    Scientific contact
    Thais Baleeiro Teixeira, FERRER INTERNACIONAL S.A., 0034 935082966, tbaleeiro@ferrer.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Apr 2020
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Dec 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Dec 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    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.
    Protection of trial subjects
    This was a prospective clinical trial study to characterize the safety profile of ADASUVE® in agitated patients when self-administered outside of a hospital setting. All patients received written and verbal information regarding the study prior to any study related procedures. The given information emphasized that participation in the study was voluntary and that the patient could withdraw from the study at any time and for any reason. The study was conducted in compliance with the protocol, regulatory requirements, good clinical practice (GCP) and the ethical principles of the latest revision of the Declaration of Helsinki as adopted by the World Medical Association.
    Background therapy
    Not applicable.
    Evidence for comparator
    Not applicable.
    Actual start date of recruitment
    08 Sep 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Norway: 1
    Country: Number of subjects enrolled
    Spain: 312
    Country: Number of subjects enrolled
    Austria: 2
    Country: Number of subjects enrolled
    Germany: 7
    Worldwide total number of subjects
    322
    EEA total number of subjects
    322
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    317
    From 65 to 84 years
    5
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 323 patients were recruited, of whom one patient was not eligible, and therefore 322 were included in the study. Of these patients, 126 patients presented an agitation episode and therefore were included in the safety population. The study was conducted in 4 countries (Spain, Germany, Norway and Austria).

    Pre-assignment
    Screening details
    Key inclusion criteria: ≥18 years of age, diagnosis of schizophrenia or bipolar disorder, with an on-going agitation episode (mild or moderate) or with a previous one within the 6 months in the hospital setting, previously treated with ADASUVE® with a positive outcome (responders) according to CGI-I scale, and free of active respiratory disease.

    Period 1
    Period 1 title
    Overall period
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    This was an open-label study.

    Arms
    Arm title
    Full analysis set
    Arm description
    Full analysis set (FAS) included all patients included in the study.
    Arm type
    Experimental

    Investigational medicinal product name
    Loxapine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Inhalation powder
    Routes of administration
    Inhalation use
    Dosage and administration details
    Staccato® loxapine for Inhalation (ADASUVE®) is a single-use, hand-held, drug-device combination product that provides rapid systemic delivery by inhalation of a thermally generated aerosol of loxapine. Oral inhalation through the product initiates the controlled rapid heating of a thin film of excipient-freeloxapine to form a thermally generated, highly pure drug vapour. The vapour condenses into aerosol particles with a particle size distribution appropriate for efficient delivery to the deep lung. The rapid absorption of the drug provides peak plasma levels in the systemic circulation within minutes after administration. ADASUVE® (loxapine) is a pre-dispensed (inhalation powder) 9.1 mg, administered using the Staccato® delivery system. Each single-dose inhaler contained 10 mg loxapine (and delivers 9.1 mg loxapine).

    Number of subjects in period 1
    Full analysis set
    Started
    322
    Completed
    126
    Not completed
    196
         Patient moved to other city
    1
         Other reason
    1
         The patient did not use ADASUVE at home
    1
         Patient lost ADASUVE kit
    2
         No new episode of agitation after the 6 months
    139
         The patient is not eligible
    6
         2 agitation episodes
    1
         Consent withdrawn by subject
    1
         Suicide
    1
         No phone call done
    1
         Significantly non-compliant with the requirements
    7
         Patient in a long-term psychi
    1
         Lost to follow-up
    34

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall period
    Reporting group description
    Full analysis set (FAS) included all patients included in the study.

    Reporting group values
    Overall period Total
    Number of subjects
    322 322
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    317 317
        From 65-84 years
    5 5
        85 years and over
    0 0
    Age continuous
    Units: years
        median (full range (min-max))
    40 (18 to 68) -
    Gender categorical
    Units: Subjects
        Female
    126 126
        Male
    195 195
        Missing
    1 1
    Race
    Units: Subjects
        White/Caucasian
    308 308
        American Indian/Alaskan native
    2 2
        Asian/Oriental
    2 2
        Black /African heritage
    4 4
        Other
    5 5
        Missing
    1 1
    Marital status
    Units: Subjects
        Married
    50 50
        Single
    238 238
        Divorced
    32 32
        Widow
    0 0
        Missing
    2 2
    Type of caregiver
    Units: Subjects
        Family caregiver
    271 271
        Professional caregiver
    34 34
        Neighbours or friends
    14 14
        Other
    2 2
        Missing
    1 1
    Disease history: Diagnosis
    Units: Subjects
        Schizophrenia
    171 171
        Bipolar disorder
    144 144
        Other disease
    6 6
        Missing
    1 1
    Disease history: Number of agitation episodes within the last six months
    Units: Subjects
        0 episodes
    2 2
        1 episode
    72 72
        2 episodes
    68 68
        3 episodes
    74 74
        4 episodes
    32 32
        5 episodes
    20 20
        6 episodes
    19 19
        7 episodes
    3 3
        8 episodes
    5 5
        9 episodes
    1 1
        10 episodes
    10 10
        12 episodes
    3 3
        13 episodes
    2 2
        15 episodes
    1 1
        18 episodes
    2 2
        20 episodes
    3 3
        24 episodes
    1 1
        40 episodes
    1 1
        Missing
    3 3
    Last agitation episode: Cause of agitation
    Cause of last agitation episode - in the last 6 months (Hospital setting)
    Units: Subjects
        Schizophrenia
    168 168
        Bipolar disorder
    147 147
        Other cause
    4 4
        Missing
    3 3
    Last agitation episode: Number of ADASUVE doses to control the episode
    Number of ADASUVE doses to control the episode - Last agitation episode in the last 6 months (Hospital setting)
    Units: Subjects
        1 dose
    318 318
        Missing
    4 4
    Respiratory history: Number of subjects with past or current respiratory history
    Units: Subjects
        Number of subjects with respiratory history
    9 9
        Number of subjects without respiratory history
    313 313
    Respiratory history: Past and current disease
    Units: Subjects
        Asthma
    5 5
        Other: Pulmonary resection
    1 1
        Other: Respiratory tract infection
    1 1
        Other: Sleep apnoea syndrome
    1 1
        Other: Acquired diaphragmatic eventration
    1 1
        Patients without respiratory disease
    313 313
    Respiratory history: Smoking habits
    Units: Subjects
        Non-smoker
    95 95
        Ex-smoker
    18 18
        Current smoker
    209 209
    Medical history: Patients with any medical history condition
    In the safety population, 46 patients (36.5%) reported a total of 87 relevant medical conditions in their medical history at the baseline visit. In the full analysis set population, 108 patients (54.0%) reported a total of 200 relevant medical conditions in their medical history at the baseline visit.
    Units: Subjects
        Patients with any medical history conditions
    108 108
        Patients with no medical history conditions
    213 213
        Missing
    1 1
    Medical history: Number of any relevant medical history conditions
    (*) Number of any MH Conditions are presented: N=87 for SAF; N=200 for FAS. The most frequent relevant medical condition by SOC was Metabolism and nutrition disorders (2.3%) and Cardiac disorders (3.5%). Other medical conditions by SOC included Psychiatric disorders (20% of the conditions), mainly drug abuse (6.9%) and drug dependence (4.6%); and Metabolism and nutrition disorders (11.5%) (mainly hypercholesterolemia [3.5%] and obesity [3.5%])
    Units: Subjects
        Cardiac disorders
    5 5
        Congenital, familial and genetic disorders
    1 1
        Endocrine disorders
    1 1
        Infections and infestations
    4 4
        Metabolism and nutrition disorders
    9 9
        Psychiatric disorders
    4 4
        Renal and urinary disorders
    3 3
        Respiratory, thoracic and mediastinal disorders
    2 2
        Surgical and medical procedures
    2 2
        Vascular disorders
    4 4
        Not applicable
    287 287
    Concomitant Medication: Patients with any concomitant medication
    Information only available for the safety population. A total of 117 patients (92.9%) of the safety population received 516 concomitant medications during the study. The most used (>10%) was antipsychotic medication (48.5%), mainly olanzapine (7.0%), quetiapine (6.8%) and paliperidone (6.6%); and antiepileptics (13.2%) (clonazepam [4.3%] and valproate sodium [1.9%]) and antidepressants (10.7%). 71.5% of treatments started before baseline visit.
    Units: Subjects
        Patients receiving concomitant medications
    0 0
        Number of concomitant medications per patient: 1
    0 0
        Number of concomitant medications per patient: 2
    0 0
        Number of concomitant medications per patient: 3
    0 0
        Number of concomitant medications per patient: 4
    0 0
        Number of concomitant medications per patient: 5
    0 0
        Number of concomitant medications per patient: 6
    0 0
        Number of concomitant medications per patient: 7
    0 0
        Number of concomitant medications per patient: 8
    0 0
        Number of concomitant medications per patient: 9
    0 0
        Number of concomitant medications per patient: 10
    0 0
        Number of concomitant medications per patient: 12
    0 0
        Not applicable
    322 322
    Elegibility: Study medication at baseline
    Elegibility at baseline visit.
    Units: Subjects
        Patients receiving study medication at baseline
    319 319
        Patients not receiving medication at baseline
    3 3
    Elegibility: Bronchodilator at baseline
    Units: Subjects
        Patients receiving bronchodilator at baseline
    321 321
        Patients not receiving bronchodilator at baseline
    1 1
    Elegibility: Specific training session for the proper use of ADASUVE
    Units: Subjects
        Patients receiving training for the use of ADASUVE
    321 321
        Patients not receiving training
    1 1
    Elegibility: Diary card/educational material
    Units: Subjects
        Diary card/educational material delivered
    320 320
        Diary card/educational material not delivered
    2 2
    Elegibility: Inclusion/exclusion criteria still met at baseline
    Units: Subjects
        Inclusion/exclusion criteria still met at baseline
    316 316
        Inclusion/exclusion criteria not met at baseline
    6 6
    Disease history: Time from diagnosis
    Units: years
        arithmetic mean (standard deviation)
    11.17 ± 11.07 -
    Last agitation episode: Time from last episode
    Time from last agitation episode in the last 6 months (hospital setting)
    Units: Days
        median (inter-quartile range (Q1-Q3))
    14 (6 to 39) -
    Last agitation episode: Time from last ADASUVE administration
    Time from last ADASUVE administration related to the last agitation episode - in the last 6 months (Hospital setting)
    Units: Days
        median (inter-quartile range (Q1-Q3))
    15 (6 to 68) -
    Last agitation episode: Time to improvement after last ADASUVE administration
    Time to improvement after last ADASUVE administration for the last agitation episode- in the last 6 months (Hospital setting)
    Units: minute
        median (inter-quartile range (Q1-Q3))
    10 (10 to 15) -
    Subject analysis sets

    Subject analysis set title
    Safety set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety set (SAF) included all patients who received the first self-administered dose of ADASUVE® outside the hospital setting, including those who did not complete the study.

    Subject analysis set title
    Mild level of agitation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Patients with mild level of agitation based on CGI-S scale.

    Subject analysis set title
    Moderate level of agitation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Patients with moderate level of agitation based on CGI-S scale.

    Subject analysis set title
    Severe level of agitation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Patients with severe level of agitation based on CGI-S scale.

    Subject analysis sets values
    Safety set Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects
    126
    13
    89
    13
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    123
        From 65-84 years
    3
        85 years and over
    0
    Age continuous
    Units: years
        median (full range (min-max))
    38 (18 to 65)
    41 (25 to 65)
    38 (18 to 65)
    36 (18 to 65)
    Gender categorical
    Units: Subjects
        Female
    46
    4
    31
    8
        Male
    80
    9
    58
    5
        Missing
    0
    0
    0
    0
    Race
    Units: Subjects
        White/Caucasian
    121
    12
    86
    12
        American Indian/Alaskan native
    0
    0
    0
    0
        Asian/Oriental
    0
    0
    0
    0
        Black /African heritage
    1
    0
    1
    0
        Other
    4
    1
    2
    1
        Missing
    0
    0
    0
    0
    Marital status
    Units: Subjects
        Married
    17
    3
    10
    3
        Single
    92
    10
    66
    7
        Divorced
    17
    0
    13
    3
        Widow
    0
    0
    0
    0
        Missing
    0
    0
    0
    0
    Type of caregiver
    Units: Subjects
        Family caregiver
    102
    10
    71
    11
        Professional caregiver
    18
    1
    16
    1
        Neighbours or friends
    4
    1
    2
    1
        Other
    2
    1
    0
    0
        Missing
    0
    Disease history: Diagnosis
    Units: Subjects
        Schizophrenia
    67
    6
    52
    4
        Bipolar disorder
    58
    7
    36
    9
        Other disease
    1
    0
    1
    0
        Missing
    0
    0
    0
    0
    Disease history: Number of agitation episodes within the last six months
    Units: Subjects
        0 episodes
    0
    0
    0
    0
        1 episode
    20
    4
    13
    0
        2 episodes
    20
    2
    15
    1
        3 episodes
    35
    4
    23
    5
        4 episodes
    14
    0
    10
    2
        5 episodes
    10
    1
    9
    0
        6 episodes
    7
    1
    5
    1
        7 episodes
    1
    0
    0
    1
        8 episodes
    4
    0
    2
    2
        9 episodes
    1
    0
    1
    0
        10 episodes
    7
    0
    6
    0
        12 episodes
    2
    1
    1
    0
        13 episodes
    1
    0
    1
    0
        15 episodes
    1
    0
    0
    1
        18 episodes
    0
    0
    0
    0
        20 episodes
    1
    0
    1
    0
        24 episodes
    1
    0
    1
    0
        40 episodes
    1
    0
    1
    0
        Missing
    0
    0
    0
    0
    Last agitation episode: Cause of agitation
    Cause of last agitation episode - in the last 6 months (Hospital setting)
    Units: Subjects
        Schizophrenia
    66
    6
    52
    3
        Bipolar disorder
    57
    7
    35
    9
        Other cause
    3
    0
    2
    1
        Missing
    0
    0
    0
    0
    Last agitation episode: Number of ADASUVE doses to control the episode
    Number of ADASUVE doses to control the episode - Last agitation episode in the last 6 months (Hospital setting)
    Units: Subjects
        1 dose
    126
    13
    89
    13
        Missing
    0
    0
    0
    0
    Respiratory history: Number of subjects with past or current respiratory history
    Units: Subjects
        Number of subjects with respiratory history
    5
    0
    4
    0
        Number of subjects without respiratory history
    121
    13
    85
    13
    Respiratory history: Past and current disease
    Units: Subjects
        Asthma
    2
    0
    2
    0
        Other: Pulmonary resection
    1
    0
    1
    0
        Other: Respiratory tract infection
    1
    0
    1
    0
        Other: Sleep apnoea syndrome
    1
    0
    0
    0
        Other: Acquired diaphragmatic eventration
    0
    0
    0
    0
        Patients without respiratory disease
    121
    13
    85
    13
    Respiratory history: Smoking habits
    Units: Subjects
        Non-smoker
    28
        Ex-smoker
    9
        Current smoker
    89
    Medical history: Patients with any medical history condition
    In the safety population, 46 patients (36.5%) reported a total of 87 relevant medical conditions in their medical history at the baseline visit. In the full analysis set population, 108 patients (54.0%) reported a total of 200 relevant medical conditions in their medical history at the baseline visit.
    Units: Subjects
        Patients with any medical history conditions
    46
        Patients with no medical history conditions
    80
        Missing
    0
    Medical history: Number of any relevant medical history conditions
    (*) Number of any MH Conditions are presented: N=87 for SAF; N=200 for FAS. The most frequent relevant medical condition by SOC was Metabolism and nutrition disorders (2.3%) and Cardiac disorders (3.5%). Other medical conditions by SOC included Psychiatric disorders (20% of the conditions), mainly drug abuse (6.9%) and drug dependence (4.6%); and Metabolism and nutrition disorders (11.5%) (mainly hypercholesterolemia [3.5%] and obesity [3.5%])
    Units: Subjects
        Cardiac disorders
    3
        Congenital, familial and genetic disorders
    0
        Endocrine disorders
    1
        Infections and infestations
    2
        Metabolism and nutrition disorders
    2
        Psychiatric disorders
    1
        Renal and urinary disorders
    1
        Respiratory, thoracic and mediastinal disorders
    1
        Surgical and medical procedures
    0
        Vascular disorders
    1
        Not applicable
    114
    Concomitant Medication: Patients with any concomitant medication
    Information only available for the safety population. A total of 117 patients (92.9%) of the safety population received 516 concomitant medications during the study. The most used (>10%) was antipsychotic medication (48.5%), mainly olanzapine (7.0%), quetiapine (6.8%) and paliperidone (6.6%); and antiepileptics (13.2%) (clonazepam [4.3%] and valproate sodium [1.9%]) and antidepressants (10.7%). 71.5% of treatments started before baseline visit.
    Units: Subjects
        Patients receiving concomitant medications
    117
        Number of concomitant medications per patient: 1
    4
        Number of concomitant medications per patient: 2
    12
        Number of concomitant medications per patient: 3
    29
        Number of concomitant medications per patient: 4
    26
        Number of concomitant medications per patient: 5
    14
        Number of concomitant medications per patient: 6
    17
        Number of concomitant medications per patient: 7
    5
        Number of concomitant medications per patient: 8
    4
        Number of concomitant medications per patient: 9
    4
        Number of concomitant medications per patient: 10
    1
        Number of concomitant medications per patient: 12
    1
        Not applicable
    0
    Elegibility: Study medication at baseline
    Elegibility at baseline visit.
    Units: Subjects
        Patients receiving study medication at baseline
    125
        Patients not receiving medication at baseline
    1
    Elegibility: Bronchodilator at baseline
    Units: Subjects
        Patients receiving bronchodilator at baseline
    125
        Patients not receiving bronchodilator at baseline
    1
    Elegibility: Specific training session for the proper use of ADASUVE
    Units: Subjects
        Patients receiving training for the use of ADASUVE
    125
        Patients not receiving training
    1
    Elegibility: Diary card/educational material
    Units: Subjects
        Diary card/educational material delivered
    126
        Diary card/educational material not delivered
    0
    Elegibility: Inclusion/exclusion criteria still met at baseline
    Units: Subjects
        Inclusion/exclusion criteria still met at baseline
    126
        Inclusion/exclusion criteria not met at baseline
    0
    Disease history: Time from diagnosis
    Units: years
        arithmetic mean (standard deviation)
    10.76 ± 11.25
    13.68 ± 0.088
    10.68 ± 0.014
    6.68 ± 0.011
    Last agitation episode: Time from last episode
    Time from last agitation episode in the last 6 months (hospital setting)
    Units: Days
        median (inter-quartile range (Q1-Q3))
    11 (4 to 31)
    12 (8 to 21)
    11 (4 to 37)
    15 (10 to 32)
    Last agitation episode: Time from last ADASUVE administration
    Time from last ADASUVE administration related to the last agitation episode - in the last 6 months (Hospital setting)
    Units: Days
        median (inter-quartile range (Q1-Q3))
    14 (5 to 66)
    12 (8 to 27)
    14 (5 to 66)
    15 (10 to 32)
    Last agitation episode: Time to improvement after last ADASUVE administration
    Time to improvement after last ADASUVE administration for the last agitation episode- in the last 6 months (Hospital setting)
    Units: minute
        median (inter-quartile range (Q1-Q3))
    10 (10 to 15)
    10 (10 to 15)
    10 (10 to 15)
    12.5 (10 to 22.5)

    End points

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    End points reporting groups
    Reporting group title
    Full analysis set
    Reporting group description
    Full analysis set (FAS) included all patients included in the study.

    Subject analysis set title
    Safety set
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Safety set (SAF) included all patients who received the first self-administered dose of ADASUVE® outside the hospital setting, including those who did not complete the study.

    Subject analysis set title
    Mild level of agitation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Patients with mild level of agitation based on CGI-S scale.

    Subject analysis set title
    Moderate level of agitation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Patients with moderate level of agitation based on CGI-S scale.

    Subject analysis set title
    Severe level of agitation
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Patients with severe level of agitation based on CGI-S scale.

    Primary: 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

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    End point title
    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 [1]
    End point description
    The primary endpoint of the study was 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.
    End point type
    Primary
    End point timeframe
    All AEs related to ADASUVE after self-administration outside the hospital setting were collected.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: The primary safety analysis examined the frequency and percentage of patients experiencing SAEs, AESIs (e.g., respiratory AEs) and other AEs related to ADASUVE® self-administration treatment outside the hospital setting. AEs were characterized according to their severity and outcome. All AE verbatim terms were recorded and coded using Medical Dictionary for Regulatory Activities (MedDRA). AE frequency was tabulated by system organ class (SOC) and preferred term (PT) within each SOC.
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Adverse Events (AEs)
        Number of AEs
    15
        Number of SAEs
    1
        Number of AESIs
    8
        Number of AEs related to ADASUVE
    8
        Number of SAEs related to ADASUVE
    0
        Number of AESIs related to ADASUVE
    4
    No statistical analyses for this end point

    Secondary: Incidence of other AEs-non respiratory AESIs related to ADASUVE® self-administration treatment outside the hospital setting

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    End point title
    Incidence of other AEs-non respiratory AESIs related to ADASUVE® self-administration treatment outside the hospital setting
    End point description
    End point type
    Secondary
    End point timeframe
    All AEs-non respiratory AESIs related to ADASUVE® following the self-administration outside the hospital setting were collected.
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Adverse Events (AEs)
        Number of AEs-non respiratory AESIs
    2
        Number of AEs-non respiratory AESIs related to IMP
    0
    No statistical analyses for this end point

    Secondary: AEs, SAEs, AESIs and non-respiratory AESIs related to the second dose of ADASUVE® administered at the hospital setting

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    End point title
    AEs, SAEs, AESIs and non-respiratory AESIs related to the second dose of ADASUVE® administered at the hospital setting
    End point description
    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 second dose administration).
    End point type
    Secondary
    End point timeframe
    All AEs related to the second dose of ADASUVE administered at the hospital setting.
    End point values
    Safety set
    Number of subjects analysed
    1
    Units: Adverse Events (AEs)
        Number of AEs related to the second dose
    0
        Number of SAEs related to the second dose
    0
        Number of AESIs related to the second dose
    0
    No statistical analyses for this end point

    Secondary: Time to improvement of the current episode of agitation: patients with controlled or uncontrolled episode

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    End point title
    Time to improvement of the current episode of agitation: patients with controlled or uncontrolled episode
    End point description
    End point type
    Secondary
    End point timeframe
    Time to onset of improvement of the current episode of agitation following the ADASUVE® self-administration outside the hospital setting
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Number of subjects
        Subjects with controlled episode
    124
        Subjects with uncontrolled episode
    2
        Number of ADASUVE administration at hospital
    1
        Patients with any improvement
    101
    No statistical analyses for this end point

    Secondary: Time to improvement of the current episode of agitation

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    End point title
    Time to improvement of the current episode of agitation
    End point description
    End point type
    Secondary
    End point timeframe
    Time to onset of improvement of the current episode of agitation following the ADASUVE® self-administration outside the hospital setting
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: minute
    median (inter-quartile range (Q1-Q3))
        Time to onset of improvement (minutes)
    10 (10 to 20)
        Time from baseline to the episode (days)
    22 (6 to 63)
    No statistical analyses for this end point

    Secondary: Severity and improvement of agitation episodes

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    End point title
    Severity and improvement of agitation episodes
    End point description
    Absolute CGI-I scores up to 2 hours after drug self-administration outside of a hospital setting. For the 20, 30 minutes and 1 and 2 hours evaluation, LOCF imputation performed.
    End point type
    Secondary
    End point timeframe
    CGI-S was measured at follow-up visit. CGI-I was measured at 2, 10, 20, 30 minutes and 1 and 2 hours after ADASUVE self-administration outside of a hospital setting.
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Number of subjects
        CGI-S (follow-up visit): Not assessed
    8
        CGI-S (follow-up visit): Normal
    0
        CGI-S (follow-up visit): Borderline mentally ill
    1
        CGI-S (follow-up visit): Mildly ill
    12
        CGI-S (follow-up visit): Moderately ill
    52
        CGI-S (follow-up visit): Markedly ill
    37
        CGI-S (follow-up visit): Severily ill
    11
        CGI-S (follow-up visit): Among most extremely ill
    2
        CGI-S (follow-up visit): Missing
    3
        CGI-I (follow-up 2 minutes): Not assessed
    17
        CGI-I (follow-up 2 minutes): Very much improved
    5
        CGI-I (follow-up 2 minutes): Much improved
    9
        CGI-I (follow-up 2 minutes): Minimally improved
    15
        CGI-I (follow-up 2 minutes): No change
    75
        CGI-I (follow-up 2 minutes): Minimally worse
    1
        CGI-I (follow-up 2 minutes): Much worse
    0
        CGI-I (follow-up 2 minutes): Very much worse
    1
        CGI-I (follow-up 2 minutes): Missing
    3
        CGI-I (follow-up 10 minutes): Not assessed
    0
        CGI-I (follow-up 10 minutes): Very much improved
    23
        CGI-I (follow-up 10 minutes): Much improved
    43
        CGI-I (follow-up 10 minutes): Minimally improved
    33
        CGI-I (follow-up 10 minutes): No change
    20
        CGI-I (follow-up 10 minutes): Minimally worse
    2
        CGI-I (follow-up 10 minutes): Much worse
    0
        CGI-I (follow-up 10 minutes): Very much worse
    0
        CGI-I (follow-up 10 minutes): Missing
    5
        CGI-I (follow-up 20 minutes): Not assessed
    0
        CGI-I (follow-up 20 minutes): Very much improved
    40
        CGI-I (follow-up 20 minutes): Much improved
    47
        CGI-I (follow-up 20 minutes): Minimally improved
    27
        CGI-I (follow-up 20 minutes): No change
    6
        CGI-I (follow-up 20 minutes): Minimally worse
    0
        CGI-I (follow-up 20 minutes): Much worse
    0
        CGI-I (follow-up 20 minutes): Very much worse
    0
        CGI-I (follow-up 20 minutes): Missing
    6
        CGI-I (follow-up 30 minutes): Not assessed
    0
        CGI-I (follow-up 30 minutes): Very much improved
    47
        CGI-I (follow-up 30 minutes): Much improved
    47
        CGI-I (follow-up 30 minutes): Minimally improved
    22
        CGI-I (follow-up 30 minutes): No change
    3
        CGI-I (follow-up 30 minutes): Minimally worse
    1
        CGI-I (follow-up 30 minutes): Much worse
    0
        CGI-I (follow-up 30 minutes): Very much worse
    0
        CGI-I (follow-up 30 minutes): Missing
    6
        CGI-I (follow-up 1 hour): Not assessed
    0
        CGI-I (follow-up 1 hour): Very much improved
    54
        CGI-I (follow-up 1 hour): Much improved
    42
        CGI-I (follow-up 1 hour): Minimally improved
    19
        CGI-I (follow-up 1 hour): No change
    5
        CGI-I (follow-up 1 hour): Minimally worse
    1
        CGI-I (follow-up 1 hour): Much worse
    0
        CGI-I (follow-up 1 hour): Very much worse
    0
        CGI-I (follow-up 1 hour): Missing
    5
        CGI-I (follow-up 2 hours): Not assessed
    0
        CGI-I (follow-up 2 hours): Very much improved
    61
        CGI-I (follow-up 2 hours): Much improved
    35
        CGI-I (follow-up 2 hours): Minimally improved
    19
        CGI-I (follow-up 2 hours): No change
    5
        CGI-I (follow-up 2 hours): Minimally worse
    0
        CGI-I (follow-up 2 hours): Much worse
    1
        CGI-I (follow-up 2 hours): Very much worse
    0
        CGI-I (follow-up 2 hours): Missing
    5
    No statistical analyses for this end point

    Secondary: Treatment satisfaction and responders

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    End point title
    Treatment satisfaction and responders
    End point description
    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 self-administration 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 with CGI 1-2: N=96 Patients with CGI>2: N=25
    End point type
    Secondary
    End point timeframe
    Percentage of patients with CGI-I score of 1 or 2 at 2 hours after self-administration.
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Subjects
        Patients with CGI 1-2
    96
        Patients with CGI 1-2: Very dissatisfied
    0
        Patients with CGI 1-2: Dissatisfied
    0
        Patients with CGI 1-2: Uncertain
    0
        Patients with CGI 1-2: Satisfied
    58
        Patients with CGI 1-2: Very satisfied
    37
        Patients with CGI 1-2: Missing
    1
        Patients with CGI >2: Very dissatisfied
    0
        Patients with CGI >2: Dissatisfied
    1
        Patients with CGI >2: Uncertain
    3
        Patients with CGI >2: Satisfied
    19
        Patients with CGI >2: Very satisfied
    2
        Patients with CGI >2: Missing
    0
    No statistical analyses for this end point

    Secondary: Anti-agitation medications administered at hospital setting for treating a worsening or no improvement of an agitation episode

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    End point title
    Anti-agitation medications administered at hospital setting for treating a worsening or no improvement of an agitation episode
    End point description
    Description of all anti-agitation medications administered at hospital setting (second 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.
    End point type
    Secondary
    End point timeframe
    Anti-agitation medications administered at hospital setting.
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Subjects
        Patients with uncontrolled episodes
    2
        Anti-agitation medication: Lorazepam 1 mg
    1
        Anti-agitation medication: Asenapine Maleate 10 mg
    1
    No statistical analyses for this end point

    Secondary: Patient-Investigator concordance

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    End point title
    Patient-Investigator concordance
    End point description
    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®. Patient-Investigator concordance according to the Cohen's kappa coefficient was moderate (κ=0.47).
    End point type
    Secondary
    End point timeframe
    Degree of concordance of the severity of the agitation episode between the patient/familiy member and the physician.
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Subjects
        Not assessed
    1
        Mildly ill
    6
        Moderately ill
    32
        Borderline mentally ill
    1
        Markedly ill
    21
        Severy ill
    7
        Among the most extremely ill
    1
    No statistical analyses for this end point

    Secondary: General information from patient’s diary

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    End point title
    General information from patient’s diary
    End point description
    Description of patients and family members/ caregivers´ demographics, and clinical characteristics of agitated patients treated with ADASUVE® outside the hospital setting.
    End point type
    Secondary
    End point timeframe
    General information from patient’s diary
    End point values
    Safety set
    Number of subjects analysed
    126
    Units: Subjects
        Person who completed the diary: Patient
    72
        Person who completed the diary: Caregiver
    50
        Person who completed the diary: Missing
    4
        Symptoms: Worried
    55
        Symptoms: Restless
    82
        Symptoms: Anxious
    74
        Symptoms: Grumpy
    53
        Symptoms: Bad-tempered
    51
        Symptoms: Tense
    73
        Symptoms: Nervous
    102
        Symptoms: In danger
    30
        Symptoms: Frightened
    36
        Symptoms: Insulting
    29
        Symptoms: Other
    10
        Patients with AEs 24 hours after administration
    8
        Patients with medication to treat TEAEs
    4
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: demographic characteristics

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: demographic characteristics
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in demographics characteristics compared among mild, moderate and severe levels of agitation based on CGI-S scale.
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        Sex: Female
    4
    31
    8
        Race: White/Caucasian
    12
    86
    12
        Type of caregiver: Family caregiver
    10
    71
    11
        Type of caregiver: Professional caregiver
    1
    16
    1
        Type of caregiver: Neighbours or friends
    1
    2
    1
        Type of caregiver: Other
    1
    0
    0
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: age

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: age
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in age compared among mild, moderate and severe levels of agitation based on CGI-S scale
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: years
    arithmetic mean (standard deviation)
        Age
    44.54 ± 21.00
    38.52 ± 25.00
    36.46 ± 18.00
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: Disease history

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: Disease history
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in patient profile and post-treatment outcomes compared among mild, moderate and severe levels of agitation based on CGI-S scale
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    87
    13
    Units: years
    arithmetic mean (standard deviation)
        Time from diagnosis (years)
    13.68 ± 0.088
    10.68 ± 0.014
    6.68 ± 0.011
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: Disease history

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: Disease history
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in disease history compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’ diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        Diagnosis: Schizophrenia
    6
    52
    4
        Diagnosis: Bipolar disorder
    7
    36
    9
        Diagnosis: Other disease
    0
    1
    0
        1 agitation episode within the last 6 months
    4
    13
    0
        2 agitation episodes within the last 6 months
    2
    15
    1
        3 agitation episodes within the last 6 months
    4
    23
    5
        4 agitation episodes within the last 6 months
    0
    10
    2
        5 agitation episodes within the last 6 months
    1
    9
    0
        6 agitation episodes within the last 6 months
    1
    5
    1
        7 agitation episodes within the last 6 months
    0
    0
    1
        8 agitation episodes within the last 6 months
    0
    2
    2
        9 agitation episodes within the last 6 months
    0
    1
    0
        10 agitation episodes within the last 6 months
    0
    6
    0
        12 agitation episodes within the last 6 months
    1
    1
    0
        13 agitation episodes within the last 6 months
    0
    1
    0
        15 agitation episodes within the last 6 months
    0
    0
    1
        20 agitation episodes within the last 6 months
    0
    1
    0
        24 agitation episodes within the last 6 months
    0
    1
    0
        40 agitation episodes within the last 6 months
    0
    1
    0
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: last agitation episode (hospital setting)

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: last agitation episode (hospital setting)
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in last agitation episode compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’ diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Days
    median (inter-quartile range (Q1-Q3))
        Time from last episode (days)
    12 (8 to 21)
    11 (4 to 37)
    15 (10 to 32)
        Time from last ADASUVE administration (days)
    12 (8 to 27)
    14 (5 to 66)
    15 (10 to 32)
        Time to improvement after last administration(min)
    10 (10 to 15)
    10 (10 to 15)
    12.5 (10 to 22.5)
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: last agitation episode (hospital setting)

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: last agitation episode (hospital setting)
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in last agitation episode compared among mild, moderate and severe levels of agitation based on CGI-S scale (hospital setting)
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        Cause of agitation: Schizophrenia
    6
    52
    3
        Cause of agitation: Bipolar disorder
    7
    35
    9
        Cause of agitation: Other disease
    0
    2
    1
        1 ADASUVE dose to control the episode
    13
    89
    13
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: Disease history

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: Disease history
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in past and current respiratory disease compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’ diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        Subjects with past or current respiratory disease
    0
    4
    0
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: CGI-I evaluation

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: CGI-I evaluation
    End point description
    CGI-I was measured at 2, 10, 20, 30 minutes and 1 and 2 hours after ADASUVE self-administration outside of a hospital setting. Absolute CGI-I scores up to 2 hours after drug self-administration outside of a hospital setting. For the 20, 30 minutes and 1 and 2 hours evaluation, LOCF imputation performed.
    End point type
    Secondary
    End point timeframe
    Differences in the CGI evaluation at each time-point compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’ diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        CGI-I Last agitation episode: Not assessed
    2
    24
    1
        CGI-I Last agitation episode: Very much improved
    7
    21
    4
        CGI-I Last agitation episode: Much improved
    4
    44
    8
        CGI-I Last agitation episode: Minimally improved
    0
    0
    0
        CGI-I Last agitation episode: No change
    0
    0
    0
        CGI-I Last agitation episode: Minimally worse
    0
    0
    0
        CGI-I Last agitation episode: Much worse
    0
    0
    0
        CGI-I Last agitation episode: Very much worse
    0
    0
    0
        CGI-I Last agitation episode: Missing
    0
    0
    0
        CGI-S (follow-up): Not assessed
    0
    0
    0
        CGI-S (follow-up): Normal
    0
    0
    0
        CGI-S (follow-up): Borderline mentally ill
    1
    0
    0
        CGI-S (follow-up): Mildly ill
    12
    0
    0
        CGI-S (follow-up): Moderately ill
    0
    52
    0
        CGI-S (follow-up): Markedly ill
    0
    37
    0
        CGI-S (follow-up): Severity ill
    0
    0
    11
        CGI-S (follow-up): Among the most extremely ill
    0
    0
    2
        CGI-S (follow-up): Missing
    0
    0
    0
        CGI-I (follow-up 2 minutes): Not assessed
    0
    15
    0
        CGI-I (follow-up 2 minutes): Very much improved
    3
    1
    1
        CGI-I (follow-up 2 minutes): Much improved
    1
    8
    0
        CGI-I (follow-up 2 minutes): Minimally improved
    1
    12
    1
        CGI-I (follow-up 2 minutes): No change
    8
    51
    11
        CGI-I (follow-up 2 minutes): Minimally worse
    0
    1
    0
        CGI-I (follow-up 2 minutes): Much worse
    0
    0
    0
        CGI-I (follow-up 2 minutes): Very much worse
    0
    1
    0
        CGI-I (follow-up 2 minutes): Missing
    0
    0
    0
        CGI-I (follow-up 10 minutes): Not assessed
    0
    0
    0
        CGI-I (follow-up 10 minutes): Very much improved
    5
    14
    4
        CGI-I (follow-up 10 minutes): Much improved
    1
    34
    5
        CGI-I (follow-up 10 minutes): Minimally improved
    4
    23
    3
        CGI-I (follow-up 10 minutes): No change
    3
    15
    0
        CGI-I (follow-up 10 minutes): Minimally worse
    0
    1
    1
        CGI-I (follow-up 10 minutes): Much worse
    0
    0
    0
        CGI-I (follow-up 10 minutes): Very much worse
    0
    0
    0
        CGI-I (follow-up 10 minutes): Missing
    0
    2
    0
        CGI-I (follow-up 20 minutes): Not assessed
    0
    0
    0
        CGI-I (follow-up 20 minutes): Very much improved
    4
    29
    5
        CGI-I (follow-up 20 minutes): Much improved
    5
    34
    5
        CGI-I (follow-up 20 minutes): Minimally improved
    3
    20
    3
        CGI-I (follow-up 20 minutes): No change
    0
    4
    0
        CGI-I (follow-up 20 minutes): Minimally worse
    0
    0
    0
        CGI-I (follow-up 20 minutes): Much worse
    0
    0
    0
        CGI-I (follow-up 20 minutes): Very much worse
    0
    0
    0
        CGI-I (follow-up 20 minutes): Missing
    1
    2
    0
        CGI-I (follow-up 30 minutes): Not assessed
    0
    0
    0
        CGI-I (follow-up 30 minutes): Very much improved
    6
    33
    5
        CGI-I (follow-up 30 minutes): Much improved
    4
    35
    6
        CGI-I (follow-up 30 minutes): Minimally improved
    2
    17
    2
        CGI-I (follow-up 30 minutes): No change
    0
    1
    0
        CGI-I (follow-up 30 minutes): Minimally worse
    0
    1
    0
        CGI-I (follow-up 30 minutes): Much worse
    0
    0
    0
        CGI-I (follow-up 30 minutes): Very much worse
    0
    0
    0
        CGI-I (follow-up 30 minutes): Missing
    1
    2
    0
        CGI-I (follow-up 1 hour): Not assessed
    0
    0
    0
        CGI-I (follow-up 1 hour): Very much improved
    7
    40
    5
        CGI-I (follow-up 1 hour): Much improved
    2
    32
    5
        CGI-I (follow-up 1 hour): Minimally improved
    2
    14
    2
        CGI-I (follow-up 1 hour): No change
    1
    2
    0
        CGI-I (follow-up 1 hour): Minimally worse
    0
    0
    1
        CGI-I (follow-up 1 hour): Much worse
    0
    0
    0
        CGI-I (follow-up 1 hour): Very much worse
    0
    0
    0
        CGI-I (follow-up 1 hour): Missing
    1
    1
    0
        CGI-I (follow-up 2 hours): Not assessed
    0
    0
    0
        CGI-I (follow-up 2 hours): Very much improved
    7
    46
    6
        CGI-I (follow-up 2 hours): Much improved
    2
    26
    4
        CGI-I (follow-up 2 hours): Minimally improved
    2
    14
    2
        CGI-I (follow-up 2 hours): No change
    1
    2
    0
        CGI-I (follow-up 2 hours): Minimally worse
    0
    0
    0
        CGI-I (follow-up 2 hours): Much worse
    0
    0
    1
        CGI-I (follow-up 2 hours): Very much worse
    0
    0
    0
        CGI-I (follow-up 2 hours): Missing
    1
    1
    0
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: Time to onset of improvement of the agitation episode after the ADASUVE® self-administration

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: Time to onset of improvement of the agitation episode after the ADASUVE® self-administration
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in the time to onset of improvement of the current episode compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        Patients with any improvement
    11
    73
    11
    No statistical analyses for this end point

    Secondary: Differences in patients with mild, moderate and severe levels of agitation: Time to onset of improvement of the agitation episode after the ADASUVE® self-administration

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    End point title
    Differences in patients with mild, moderate and severe levels of agitation: Time to onset of improvement of the agitation episode after the ADASUVE® self-administration
    End point description
    Time to onset of improvement was calculated as the time to achieved a score 1 or 2 in the CGI scale.
    End point type
    Secondary
    End point timeframe
    Differences in the time to onset of improvement of the current episode compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    12
    89
    13
    Units: Days/minutes
    median (inter-quartile range (Q1-Q3))
        Time from baseline to the episode (days)
    25 (11.5 to 67)
    32 (6 to 75)
    14 (5 to 41)
        Time to onset of improvement (minutes)
    10 (2 to 20)
    10 (10 to 20)
    10 (10 to 10)
    No statistical analyses for this end point

    Secondary: Differences in patient profile and post-treatment outcomes compared among mild, moderate and severe levels of agitation based on CGI-S scale: Patient health status

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    End point title
    Differences in patient profile and post-treatment outcomes compared among mild, moderate and severe levels of agitation based on CGI-S scale: Patient health status
    End point description
    - General patient health status at first 3-month phone call - General patient health status at follow-up visit with controlled episode - General patient health status at 30-days after self-administration phone call
    End point type
    Secondary
    End point timeframe
    Differences in the general patient status compared among mild, moderate and severe levels of agitation based on CGI-S scale according to patients’ diary
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        First 3-month phone call: Very poor
    0
    0
    0
        First 3-month phone call: Poor
    0
    2
    0
        First 3-month phone call: Fair
    0
    2
    0
        First 3-month phone call: Good
    3
    15
    3
        First 3-month phone call: Very good
    0
    4
    0
        First 3-month phone call: Missing
    0
    1
    0
        Follow-up visit: Very poor
    0
    0
    0
        Follow-up visit: Poor
    0
    3
    3
        Follow-up visit: Fair
    0
    3
    3
        Follow-up visit: Good
    10
    64
    4
        Follow-up visit: Very good
    3
    17
    3
        Follow-up visit: Missing
    0
    2
    0
        30-days after self-administration: Very poor
    0
    0
    0
        30-days after self-administration: Poor
    1
    4
    0
        30-days after self-administration: Fair
    0
    2
    1
        30-days after self-administration: Good
    7
    60
    10
        30-days after self-administration: Very good
    2
    17
    0
        30-days after self-administration: Missing
    0
    1
    1
    No statistical analyses for this end point

    Secondary: Differences in patient profile and post-treatment outcomes compared among mild, moderate and severe levels of agitation based on CGI-S scale: Treatment satisfaction

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    End point title
    Differences in patient profile and post-treatment outcomes compared among mild, moderate and severe levels of agitation based on CGI-S scale: Treatment satisfaction
    End point description
    End point type
    Secondary
    End point timeframe
    Differences in the satisfaction after self-administration of ADASUVE® outside the hospital compared among mild, moderate and severe levels of agitation based on CGI-S scale
    End point values
    Mild level of agitation Moderate level of agitation Severe level of agitation
    Number of subjects analysed
    13
    89
    13
    Units: Subjects
        Patients with CGI 1-2
    9
    72
    10
        Patients with CGI 1-2: Very dissatisfied
    0
    0
    0
        Patients with CGI 1-2: Dissatisfied
    0
    0
    0
        Patients with CGI 1-2: Uncertain
    0
    0
    0
        Patients with CGI 1-2: Satisfied
    5
    46
    4
        Patients with CGI 1-2: Very satisfied
    4
    25
    6
        Patients with CGI 1-2: Missing
    0
    1
    0
        Patients with CGI >2: Very dissatisfied
    0
    0
    0
        Patients with CGI >2: Dissatisfied
    0
    0
    0
        Patients with CGI >2: Uncertain
    0
    1
    1
        Patients with CGI >2: Satisfied
    3
    13
    2
        Patients with CGI >2: Very satisfied
    0
    2
    0
        Patients with CGI >2: Missing
    0
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All AEs that occured during the study and all SAEs that appeared after the subject had signed the informed consent form, whether or not causally related with the study drug, were recorded in detail in the subject’s eCRF.
    Adverse event reporting additional description
    AEs were coded according to the Medical Dictionary for Regulatory Activities (MedDRA) system and tabulated by SOC and by Preferred Term (PT). The adverse events analysis examined data collected during the study period immediately following ADASUVE® self-administration outside of a hospital setting for all enrolled patients.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20
    Reporting groups
    Reporting group title
    Safety set
    Reporting group description
    Safety set (SAF) included all patients who received the first self-administered dose of ADASUVE® outside the hospital setting, including those who did not complete the study.

    Reporting group title
    Full analysis set
    Reporting group description
    Full analysis set (FAS) included all patients included in the study.

    Serious adverse events
    Safety set Full analysis set
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 126 (0.79%)
    4 / 322 (1.24%)
         number of deaths (all causes)
    0
    1
         number of deaths resulting from adverse events
    0
    0
    Vascular disorders
    Phlebitis
         subjects affected / exposed
    0 / 126 (0.00%)
    1 / 322 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Stroke
         subjects affected / exposed
    0 / 126 (0.00%)
    1 / 322 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory failure
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Asthmatic attack
         subjects affected / exposed
    0 / 126 (0.00%)
    1 / 322 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicide
         subjects affected / exposed
    0 / 126 (0.00%)
    1 / 322 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    0 / 126 (0.00%)
    1 / 322 (0.31%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety set Full analysis set
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    12 / 126 (9.52%)
    12 / 322 (3.73%)
    Nervous system disorders
    Dysgeusia
         subjects affected / exposed
    3 / 126 (2.38%)
    3 / 322 (0.93%)
         occurrences all number
    3
    3
    Dizziness
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    General disorders and administration site conditions
    Feeling cold
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    Drug ineffective
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    4 / 126 (3.17%)
    4 / 322 (1.24%)
         occurrences all number
    4
    4
    Respiratory failure
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    Wheezing
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    Psychiatric disorders
    Intentional self-injury
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1
    Musculoskeletal and connective tissue disorders
    Neck pain
         subjects affected / exposed
    1 / 126 (0.79%)
    1 / 322 (0.31%)
         occurrences all number
    1
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    19 Oct 2015
    In this amendment (19 October 2015), the beta-agonist bronchodilator used in the study was precisely named in the protocol (salbutamol), as a request of the German Ethics Committee.
    18 Dec 2015
    After reviewing the clarifications received by the Clinical Research Ethics Committees from Spain, in this amendment (18 December 2015) it was decided to amend certain sections of the protocol to clarify some important aspects of the inclusion criteria and the conduct of the Amendment number 3 to the protocol.
    17 May 2016
    In this amendment (17 May 2016) the sponsor decided to amend certain sections of the protocol to confirm the agitation episode would be reliable recognized and managed correctly by the patient/caregiver; better understanding of the target population for the use of ADASUVE® in an outside hospital setting.
    01 Mar 2017
    In this amendment (1 March 2017) the sponsor decided to amend certain sections of the protocol to notify the extension of the patient inclusion period as well rectify some protocol sections to be congruent with inclusion/ exclusion criteria, which were already approved in the previous protocol version.
    11 Oct 2017
    The main reason for this amendment (11 October 2017) was the change of the coordinating investigator. The former coordinating investigator Dr. Andrés Fontalba left the hospital where the study was approved due to personal reasons. Additionally, and for safety purposes, an interim analysis was planned when data for approximately 50 patients who completed the study were available. Also, the number of centres and participating countries and anticipated study period was updated according to feasibility and study recruitment status.
    02 Jul 2018
    The main reason for this amendment (2 July 2018) was the discontinuation of the Norway centre participation. In a subsequent modification of the amendment (30 July 2018), Norway was again listed among the participant countries. Additionally, the anticipated study period was updated according to feasibility and study recruitment status. Also, the marketing authorization holder details were updated.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Although the expected sample size was of 500 patients, with the 323 patients included in the study the upper limit of the 95% CI is between 0,010 and 0,012. Thus, with this number of patients we can discard the prevalence of bronchospasm of 1.0–1.2%.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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