Clinical Trial Results:
A Multicenter, Double-Blind, Randomized, Placebo-Controlled, Flexible- Dosed Parallel-Group Study of Aripiprazole Flexibly Dosed in the Treatment of Children and Adolescents with Autistic Disorder.
Summary
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EudraCT number |
2016-005111-40 |
Trial protocol |
Outside EU/EEA |
Global end of trial date |
28 Apr 2008
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Results information
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Results version number |
v1(current) |
This version publication date |
21 Apr 2018
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First version publication date |
21 Apr 2018
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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 |
CN138178
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT00365859 | ||
WHO universal trial number (UTN) |
- | ||
Other trial identifiers |
IND: 71,501 | ||
Sponsors
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Sponsor organisation name |
Bristol-Myers Squibb
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Sponsor organisation address |
Wallingford, Connecticut, United States, 06492
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Public contact |
Angela Smith, Otsuka Pharmaceutical Development & Commercialization, Inc, =1 8609202209, angela.smith@otsuka-us.com
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Scientific contact |
Angela Smith, Otsuka Pharmaceutical Development & Commercialization, Inc, =1 8609202209, angela.smith@otsuka-us.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? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
21 Oct 2008
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
28 Apr 2008
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Global end of trial reached? |
Yes
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Global end of trial date |
28 Apr 2008
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To compare the efficacy of flexibly dosed aripiprazole with that of placebo in reducing serious behavioral problems specifically irritability, agitation, and self-injurious behavior in children and adolescents with a diagnosis of AD, as measured by change from baseline to endpoint on the Irritability Subscale of the Aberrant Behavior Checklist (ABC).
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Protection of trial subjects |
This study was conducted in accordance with the ethical principles in the Declaration of Helsinki. The rights, safety, and well-being of the study subjects were the most important consideration and prevailed over the interests of science and society. This study was conducted in accordance with Good Clinical Practice, as defined by the International Conference on Harmonization and in accordance with the ethical principles underlying European Union Directive 2001/20/EC and the United States Code of Federal Regulations, Title 21, Part 50 (21CFR50).
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
15 Jun 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 |
United States: 98
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Worldwide total number of subjects |
98
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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) |
77
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Adolescents (12-17 years) |
21
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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 |
A total of 164 patients were enrolled at 19 study centers in the United States. The test product was aripiprazole, 2 to 15 mg/day, flexibly dosed. The reference product was placebo. | ||||||||||||||||||||||||
Pre-assignment
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Screening details |
Screening phase (up to 42 days (consisting of a screening visit (Visit 1), a washout period and interim screening visit (Visit 1a) , and a baseline visit (Visit 2)). During screening eligibility assessments, safety assessments, efficacy assessments and clinical drug supplies were performed. | ||||||||||||||||||||||||
Period 1
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Period 1 title |
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, Subject | ||||||||||||||||||||||||
Blinding implementation details |
Aripiprazole tablets and placebo tablets were indistinguishable in appearance and shape. Study medication for the 2 treatment groups looked identical. Bottles of study medication were labeled with a 3-panel, double-blind label. The labels contained information such as the batch number, container number, number of tablets per bottle, and storage conditions.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Aripiprazole | ||||||||||||||||||||||||
Arm description |
Aripiprazole (oral tablet) flexibly dosed (2 mg to 15 mg/day) taken once daily at the same time each day without regard to meals for 8 weeks. Approximately 100 patients (50 per treatment group) will be randomized to obtain 90 evaluable patients (45 per treatment arm). | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
Investigational medicinal product name |
Aripiprazole
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
All randomized patients received test product aripiprazole at flexible dosing regimen (2 to 15 mg/day) for 8 weeks on the basis of treatment response and medication tolerability. Aripiprazole was given orally at a starting dose of 2 mg. The target daily dose was 5 mg, 10 mg, or 15 mg. The need of increase in dose was done based on the clinical response and tolerability.
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Arm title
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Placebo | ||||||||||||||||||||||||
Arm description |
Randomized patients were treated orally once daily with the matching placebo tablets. | ||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||
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 |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
All randomized patients received matching placebo (oral tablet) at flexible dosing regimen once daily at the same time each day for 8 weeks.
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Baseline characteristics reporting groups
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Reporting group title |
Aripiprazole
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Reporting group description |
Aripiprazole (oral tablet) flexibly dosed (2 mg to 15 mg/day) taken once daily at the same time each day without regard to meals for 8 weeks. Approximately 100 patients (50 per treatment group) will be randomized to obtain 90 evaluable patients (45 per treatment arm). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Randomized patients were treated orally once daily with the matching placebo tablets. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Aripiprazole
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Reporting group description |
Aripiprazole (oral tablet) flexibly dosed (2 mg to 15 mg/day) taken once daily at the same time each day without regard to meals for 8 weeks. Approximately 100 patients (50 per treatment group) will be randomized to obtain 90 evaluable patients (45 per treatment arm). | ||
Reporting group title |
Placebo
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Reporting group description |
Randomized patients were treated orally once daily with the matching placebo tablets. |
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End point title |
Aberrant Behavior Checklist (ABC) irritability subscale score | ||||||||||||||||||
End point description |
To assess the efficacy of flexibly dosed aripiprazole with that of placebo, measured by mean change from baseline to endpoint (Week 8) in the ABC Irritability Subscale score. The ABC is an informant based symptom checklist for assessing the classifying problem behaviors of children and adolescents with mental retardation. The 58 items are rated on a 4-point scale (0 = not at all a problem to 3 = the problem is severe in degree), and resolved into 5 subscales: (1) irritability, agitation; (2) lethargy, social
withdrawal; (3) stereotypic behavior; (4) hyperactivity, noncompliance; and (5) inappropriate speech.
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End point type |
Primary
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End point timeframe |
From screening phase (visit 1 and baseline visit 2 [up to 42 days]) to treatment phase (Week 1 to week
8).
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Statistical analysis title |
Treatment difference from Placebo | ||||||||||||||||||
Comparison groups |
Aripiprazole v Placebo
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Number of subjects included in analysis |
95
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Analysis specification |
Pre-specified
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Analysis type |
non-inferiority | ||||||||||||||||||
P-value |
< 0.001 | ||||||||||||||||||
Method |
ANOVA | ||||||||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||||||||
Point estimate |
-7.9
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-11.7 | ||||||||||||||||||
upper limit |
-4.1 |
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End point title |
Aberrant Behavior Checklist (ABC) other subscale score | ||||||||||||||||||||||||
End point description |
To assess the efficacy of flexibly dosed aripiprazole with that of placebo, measured by mean change from baseline to endpoint (Week 8) in the ABC Irritability Subscale score. The ABC is an informant-based symptom checklist for assessing the classifying problem behaviors of children and adolescents with mental retardation. The 58 items are rated on a 4-point scale (0 = not at all a problem to 3 = the problem is severe in degree), and resolved into 5 subscales: (1) irritability, agitation; (2) lethargy, social withdrawal; (3) stereotypic behavior; (4) hyperactivity, noncompliance; and (5) inappropriate speech.
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End point type |
Secondary
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End point timeframe |
From screening phase (visit 1 and baseline visit 2 [up to 42 days]) to treatment phase (Week 1 to week 8).
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Statistical analysis title |
Treatment difference from Placebo | ||||||||||||||||||||||||
Comparison groups |
Aripiprazole v Placebo
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Number of subjects included in analysis |
95
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Analysis specification |
Pre-specified
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Analysis type |
non-inferiority [1] | ||||||||||||||||||||||||
P-value |
< 0.001 [2] | ||||||||||||||||||||||||
Method |
ANOVA | ||||||||||||||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||||||||||||||
Point estimate |
-7.9
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Confidence interval |
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level |
95% | ||||||||||||||||||||||||
sides |
2-sided
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lower limit |
-11.7 | ||||||||||||||||||||||||
upper limit |
-4.1 | ||||||||||||||||||||||||
Notes [1] - The primary presentation of results will be the model-based estimates and standard errors (SE) and the 95% confidence intervals (CI) for the treatment differences (aripiprazole-placebo), which will be derived from the estimation (ESTIMATE) of the treatment contrast. [2] - P-values were two-tailed tests of significance rounded to three decimal places, based on ANOVA/ANCOVA model. |
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End point title |
Clinical Global Impression of Severity (CGI-S) | ||||||||||||||||||
End point description |
To assess the efficacy of aripiprazole with placebo as measured by the clinician-rated Clinical Global Impression of Improvement (CGI-I) and Clinical Global Impression of Severity (CGI-S). At baseline, a CGI Severity of Illness (CGI-S) assessment is performed, in which the clinician rates the severity of a patient’s condition on a 7-point scale ranging from 1 (no symptoms) to 7 (very severe symptoms). At subsequent visits, the clinician assesses the patient’s improvement relative to the symptoms at baseline on a CGI-Improvement (CGI-I) item, a 7-point scale ranging from 1 (very much improved) to 7 (very much worse).
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End point type |
Secondary
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End point timeframe |
Treatment phase (Visit 3 to visit 9 or early discontinuation).
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Statistical analysis title |
Treatment difference from Placebo (CGI-S) | ||||||||||||||||||
Comparison groups |
Aripiprazole v Placebo
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Number of subjects included in analysis |
95
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Analysis specification |
Pre-specified
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Analysis type |
other [3] | ||||||||||||||||||
P-value |
< 0.001 [4] | ||||||||||||||||||
Method |
ANOVA | ||||||||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||||||||
Point estimate |
-0.8
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-1.2 | ||||||||||||||||||
upper limit |
-0.4 | ||||||||||||||||||
Notes [3] - The primary presentation of results will be the model-based estimates and standard errors (SE) and the 95% confidence intervals (CI) for the treatment differences (aripiprazole-placebo), which will be derived from the estimation (ESTIMATE) of the treatment contrast. [4] - P-values were two-tailed tests of significance rounded to three decimal places, based on ANOVA/ANCOVA model. |
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Statistical analysis title |
Treatment difference from Placebo (CGI-I) | ||||||||||||||||||
Comparison groups |
Placebo v Aripiprazole
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Number of subjects included in analysis |
95
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Analysis specification |
Pre-specified
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Analysis type |
other | ||||||||||||||||||
P-value |
< 0.001 | ||||||||||||||||||
Method |
ANOVA | ||||||||||||||||||
Parameter type |
Median difference (final values) | ||||||||||||||||||
Point estimate |
-1.4
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-1.9 | ||||||||||||||||||
upper limit |
-1 |
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End point title |
Response rate at week 8 | |||||||||||||||
End point description |
Response rate, defined as a reduction of ≥ 25% in ABC Irritability Subscale score compared to baseline and a score of 1 or 2 in the CGI-I scale, was determined at Weeks 1 through week 8 of the study.
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End point type |
Secondary
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End point timeframe |
From week 1 through week 8.
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Statistical analysis title |
Response rate vs Placebo | |||||||||||||||
Comparison groups |
Aripiprazole v Placebo
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Number of subjects included in analysis |
95
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Analysis specification |
Pre-specified
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Analysis type |
other | |||||||||||||||
P-value |
< 0.001 | |||||||||||||||
Method |
Cochran-Mantel-Haenszel | |||||||||||||||
Parameter type |
Risk ratio (RR) | |||||||||||||||
Point estimate |
3.72
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Confidence interval |
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level |
95% | |||||||||||||||
sides |
2-sided
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lower limit |
1.8 | |||||||||||||||
upper limit |
7.7 |
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End point title |
Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) | ||||||||||||||||||
End point description |
The CY-BOCS is a 10-item, clinician-rated scale based on a semi-structured interview that was designed to measure the severity of obsessive-compulsive symptoms in patients below the age of 18. The CY-BOCS contains 5 items pertaining to obsessions (which will not be used in this trial) and 5 items pertaining to compulsions, which rate each symptom domain in terms of time spent, interference with functioning, distress, resistance, and control. Each item is rated on a 5-point scale, from 0 (no symptoms or minimum severity) to 4 (extreme symptoms or maximum severity).
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End point type |
Secondary
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End point timeframe |
At week 8.
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Statistical analysis title |
Difference from Placebo | ||||||||||||||||||
Comparison groups |
Aripiprazole v Placebo
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Number of subjects included in analysis |
87
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Analysis specification |
Pre-specified
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Analysis type |
other [5] | ||||||||||||||||||
P-value |
< 0.001 [6] | ||||||||||||||||||
Method |
ANOVA | ||||||||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||||||||
Point estimate |
-3
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-4.3 | ||||||||||||||||||
upper limit |
-1.6 | ||||||||||||||||||
Notes [5] - The primary presentation of results will be the model-based estimates and standard errors (SE) and the 95% confidence intervals (CI) for the treatment differences (aripiprazole-placebo), which will be derived from the estimation (ESTIMATE) of the treatment contrast. [6] - P-values were two-tailed tests of significance rounded to three decimal places, based on ANOVA/ANCOVA model. |
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Adverse events information
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Timeframe for reporting adverse events |
Treatment period and or early discontinuation.
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Adverse event reporting additional description |
An AE was defined as any new untoward medical occurrence or worsening of a preexisting medical condition regardless of causal relationship with treatment. An AE could be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal.
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Assessment type |
Non-systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
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Reporting groups
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Reporting group title |
Aripiprazole
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Reporting group description |
Aripiprazole 2-mg, 5-mg, 10-mg, or 15-mg tablets, orally, once a day, with a starting dose of 2 mg and a target dose of 5 mg, 10 mg, or 15 mg. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
At the baseline visit, eligible patients were randomized to receive either aripiprazole or placebo according to a computer-generated randomization schedule prepared by BMS using a permuted block design. Treatment assignments were governed by a randomization schedule designed to allocate patients between the 2 treatment arms in a 1:1 ratio. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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04 Dec 2006 |
• Decreased the screening washout period for patients from 2 weeks to 4 days.
• Removed the requirement that sites have separate raters for safety and efficacy assessments.
• Added the Pediatric Quality of Life Inventory with age-appropriate versions and the Caregiver Strain Questionnaire outcome measure scales to the protocol.
• Clarified the requirements for mental age. |
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14 Jun 2007 |
• Decreased the number of days, after the last dose of study drug, that an efficacy evaluation will be included for analysis.
• Specified that there must be documentation that confirms the mental age.
• Added the use of a historical ADI-R as long as it was completed by a documented research reliable ADI-R rater.
• Added height to the Baseline Visit.
• Added the laboratory collection and evaluation of insulin.
• Extended the enrollment period of the study from approximately 18 months to approximately 26 months.
• Clarified that efficacy data will be reviewed by the Data Monitoring Committee but that these data will not be used to stop the trial.
• Deleted the administration of the CY-BOCS from the list of Screening Visit requirements.
• Added mental age assessment as a procedure that must be completed at the Baseline Visit if it was not done at a Screening Visit.
• Corrected the amount of time, after the end of the study, a woman of childbearing potential must use an adequate method of contraception, to make the time periods consistent within this protocol and the other double-blind protocol.
• Updated the medical monitor’s contact information.
• Revised the wording of Reference 17 to be consistent with the reference in the other double-blind protocol.
• Added a new reference for establishing an research reliable ADI-R rater.
• Corrected typographical errors.
• Updated SAE facsimile number |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
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. | |||
None reported |