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    Clinical Trial Results:
    A Phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-design study to assess the efficacy, safety, and tolerability of AVP-786 (deudextromethorphan hydrobromide [d6-DM]/quinidine sulfate [Q]) for the treatment of agitation in patients with dementia of the Alzheimer’s type

    Summary
    EudraCT number
    2017-001339-38
    Trial protocol
    HU   ES   FR   GB   CZ   BG   PL   IT  
    Global end of trial date
    14 Dec 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    09 Mar 2025
    First version publication date
    09 Mar 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    17-AVP-786-305
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03393520
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Otsuka Pharmaceutical Development & Commercialization, Inc.
    Sponsor organisation address
    2440 Research Blvd, Rockville, United States, 2085
    Public contact
    Clinical Transparency, Otsuka Pharmaceutical Development & Commercialization, Inc., +1 8446878522 ,
    Scientific contact
    Clinical Transparency, Otsuka Pharmaceutical Development & Commercialization, Inc., +1 8446878522 ,
    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
    14 Dec 2023
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    14 Dec 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The purpose of the study was to evaluate the efficacy, safety, and tolerability of AVP-786 compared to placebo, for the treatment of agitation in subjects with dementia of the Alzheimer's type.
    Protection of trial subjects
    All study subjects were required to read and sign an Informed Consent Form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    27 Mar 2018
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 288
    Country: Number of subjects enrolled
    South Africa: 36
    Country: Number of subjects enrolled
    Poland: 56
    Country: Number of subjects enrolled
    Spain: 29
    Country: Number of subjects enrolled
    United Kingdom: 19
    Country: Number of subjects enrolled
    Bulgaria: 54
    Country: Number of subjects enrolled
    Czechia: 80
    Country: Number of subjects enrolled
    France: 11
    Country: Number of subjects enrolled
    Hungary: 19
    Country: Number of subjects enrolled
    Italy: 9
    Worldwide total number of subjects
    601
    EEA total number of subjects
    258
    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)
    68
    From 65 to 84 years
    480
    85 years and over
    53

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects took part in the study at investigational sites in the United States, United Kingdom, South Africa, France, Italy, Spain, Hungary, Czech Republic, Poland, and Bulgaria from 27 March 2018 to 14 December 2023.

    Pre-assignment
    Screening details
    Of the total 1143 subjects screened, 601 subjects were randomized to receive AVP-786-28 milligrams (mg) (deudextromethorphan hydrobromide [d6-DM] 28 mg/quinidine sulfate [Q] 4.9 mg), AVP-786-42.63 mg (d6-DM 42.63 mg/Q 4.9 mg) or placebo in 3:3:4 ratio in the study.

    Period 1
    Period 1 title
    Overall study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    Subjects received matched AVP-786 placebo capsules, orally, twice daily (BID) for the 12-week treatment period.
    Arm type
    Experimental

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Matched AVP-786 placebo capsules BID for the 12-week treatment period

    Arm title
    AVP-786-28 mg
    Arm description
    Following a 3-week titration schedule, subjects received AVP-786-18/4.9 capsules, orally, once a day (QD) for the first 7 days of the study, followed by AVP-786-18/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-28/4.9, capsules, BID for 9 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    AVP-786-28
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    AVP-786-18/4.9 capsule, orally, QD for 7 days followed by AVP-786-18/4.9 capsule, BID for next 14 days, and then AVP-786-28/4.9 capsule, BID for the 9 weeks.

    Arm title
    AVP-786-42.63 mg
    Arm description
    Following a 3-week titration schedule, subjects received AVP-786-28/4.9 capsules, orally, QD for the first 7 days of the study, followed by AVP-786-28/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-42.63/4.9, capsules, BID for 9 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    AVP-786-42.63
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    AVP-786-28/4.9 capsule, orally, QD for 7 days followed by AVP-786-28/4.9 capsule, BID for next 14 days, and then AVP-786-42.63/4.9 capsule BID for 9 weeks.

    Number of subjects in period 1
    Placebo AVP-786-28 mg AVP-786-42.63 mg
    Started
    217
    198
    186
    Modified Intent to Treat (mITT)
    164 [1]
    148 [2]
    149 [3]
    Safety
    216
    197
    186
    Completed
    191
    173
    163
    Not completed
    26
    25
    23
         End of Study Form Not Completed
    1
    -
    -
         Study subject withdrawal by parent or guardian
    3
    2
    3
         Physician decision
    -
    1
    1
         Trial site terminated by sponsor
    -
    1
    -
         Death
    3
    1
    -
         Adverse event
    3
    3
    6
         Non-compliance with study drug
    -
    1
    -
         Reason not specified
    4
    6
    2
         Lost to follow-up
    1
    2
    1
         Withdrawal by subject
    10
    8
    9
         Protocol deviation
    1
    -
    1
    Notes
    [1] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: These are the number of subjects for the specified milestone.
    [2] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: These are the number of subjects for the specified milestone.
    [3] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: These are the number of subjects for the specified milestone.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received matched AVP-786 placebo capsules, orally, twice daily (BID) for the 12-week treatment period.

    Reporting group title
    AVP-786-28 mg
    Reporting group description
    Following a 3-week titration schedule, subjects received AVP-786-18/4.9 capsules, orally, once a day (QD) for the first 7 days of the study, followed by AVP-786-18/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-28/4.9, capsules, BID for 9 weeks.

    Reporting group title
    AVP-786-42.63 mg
    Reporting group description
    Following a 3-week titration schedule, subjects received AVP-786-28/4.9 capsules, orally, QD for the first 7 days of the study, followed by AVP-786-28/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-42.63/4.9, capsules, BID for 9 weeks.

    Reporting group values
    Placebo AVP-786-28 mg AVP-786-42.63 mg Total
    Number of subjects
    217 198 186 601
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    74.1 ( 7.61 ) 74.2 ( 7.68 ) 75.1 ( 7.99 ) -
    Gender categorical
    Units: Subjects
        Female
    129 120 99 348
        Male
    88 78 87 253
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    69 60 64 193
        Not Hispanic or Latino
    145 134 118 397
        Not Reported
    3 4 4 11
    Race
    Units: Subjects
        White
    198 175 161 534
        Black or African American
    15 16 19 50
        Asian
    0 0 1 1
        Other
    1 3 1 5
        Not Reported
    3 4 4 11
    CMAI - Total Score
    CMAI is used to assess frequency of manifestations of agitated behaviors categorized into 3 distinct agitation factors (CMAI factors of agitation): Factor 1-Aggressive Behavior, Factor 2-Physically Nonaggressive Behavior, Factor 3-Verbally Agitated Behavior. Each of 29 items was rated on a 7-point scale of frequency ranging from 1=Never to 7=Several times an hour. CMAI total score was sum of ratings for all 29 items, ranged from 29 to 203. Higher score indicate greater frequency of manifestations of agitated behaviour.
    Units: Score on a scale
        arithmetic mean (standard deviation)
    ( ) ( ) ( ) -
    CGIS-Agitation Score
    The CGIS is an observer-rated scale that measures illness severity on a 7-point scale (score range: 1-7, where 1 = normal, not at all ill; 7 = among the most extremely ill subjects).
    Units: Score on a scale
        arithmetic mean (standard deviation)
    ( ) ( ) ( ) -
    Subject analysis sets

    Subject analysis set title
    Placebo
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    mITT population included all randomised subjects who took at least one dose of double-blind medication in double-blind treatment period, were CMAI Factor 1 Aggressive Behavior agitated at baseline & who had a baseline & at least one post-randomisation Cohen-Mansfield Agitation Inventory (CMAI) total score during treatment period.

    Subject analysis set title
    AVP-786-28 mg
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    mITT population included all randomised subjects who took at least one dose of double-blind medication in double-blind treatment period, were CMAI Factor 1 Aggressive Behavior agitated at baseline & who had a baseline & at least one post-randomisation CMAI total score during treatment period.

    Subject analysis set title
    AVP-786-42.63 mg
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    mITT population included all randomised subjects who took at least one dose of double-blind medication in double-blind treatment period, were CMAI Factor 1 Aggressive Behavior agitated at baseline & who had a baseline & at least one post-randomisation CMAI total score during treatment period.

    Subject analysis sets values
    Placebo AVP-786-28 mg AVP-786-42.63 mg
    Number of subjects
    164
    148
    149
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    ( )
    ( )
    ( )
    Gender categorical
    Units: Subjects
        Female
        Male
    Ethnicity
    Units: Subjects
        Hispanic or Latino
        Not Hispanic or Latino
        Not Reported
    Race
    Units: Subjects
        White
        Black or African American
        Asian
        Other
        Not Reported
    CMAI - Total Score
    CMAI is used to assess frequency of manifestations of agitated behaviors categorized into 3 distinct agitation factors (CMAI factors of agitation): Factor 1-Aggressive Behavior, Factor 2-Physically Nonaggressive Behavior, Factor 3-Verbally Agitated Behavior. Each of 29 items was rated on a 7-point scale of frequency ranging from 1=Never to 7=Several times an hour. CMAI total score was sum of ratings for all 29 items, ranged from 29 to 203. Higher score indicate greater frequency of manifestations of agitated behaviour.
    Units: Score on a scale
        arithmetic mean (standard deviation)
    77.0 ( 18.61 )
    73.5 ( 18.09 )
    75.0 ( 18.30 )
    CGIS-Agitation Score
    The CGIS is an observer-rated scale that measures illness severity on a 7-point scale (score range: 1-7, where 1 = normal, not at all ill; 7 = among the most extremely ill subjects).
    Units: Score on a scale
        arithmetic mean (standard deviation)
    4.6 ( 0.68 )
    4.7 ( 0.69 )
    4.6 ( 0.66 )

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received matched AVP-786 placebo capsules, orally, twice daily (BID) for the 12-week treatment period.

    Reporting group title
    AVP-786-28 mg
    Reporting group description
    Following a 3-week titration schedule, subjects received AVP-786-18/4.9 capsules, orally, once a day (QD) for the first 7 days of the study, followed by AVP-786-18/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-28/4.9, capsules, BID for 9 weeks.

    Reporting group title
    AVP-786-42.63 mg
    Reporting group description
    Following a 3-week titration schedule, subjects received AVP-786-28/4.9 capsules, orally, QD for the first 7 days of the study, followed by AVP-786-28/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-42.63/4.9, capsules, BID for 9 weeks.

    Subject analysis set title
    Placebo
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    mITT population included all randomised subjects who took at least one dose of double-blind medication in double-blind treatment period, were CMAI Factor 1 Aggressive Behavior agitated at baseline & who had a baseline & at least one post-randomisation Cohen-Mansfield Agitation Inventory (CMAI) total score during treatment period.

    Subject analysis set title
    AVP-786-28 mg
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    mITT population included all randomised subjects who took at least one dose of double-blind medication in double-blind treatment period, were CMAI Factor 1 Aggressive Behavior agitated at baseline & who had a baseline & at least one post-randomisation CMAI total score during treatment period.

    Subject analysis set title
    AVP-786-42.63 mg
    Subject analysis set type
    Modified intention-to-treat
    Subject analysis set description
    mITT population included all randomised subjects who took at least one dose of double-blind medication in double-blind treatment period, were CMAI Factor 1 Aggressive Behavior agitated at baseline & who had a baseline & at least one post-randomisation CMAI total score during treatment period.

    Primary: Change From Baseline to Week 12 in Cohen-Mansfield Agitation Inventory (CMAI) Total Score

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    End point title
    Change From Baseline to Week 12 in Cohen-Mansfield Agitation Inventory (CMAI) Total Score
    End point description
    CMAI is used to assess frequency of manifestations of agitated behaviors categorized into 3 distinct agitation factors (CMAI factors of agitation): Factor 1-Aggressive Behavior, Factor 2-Physically Nonaggressive Behavior, Factor 3-Verbally Agitated Behavior. Each of 29 items was rated on a 7-point scale of frequency ranging from 1=Never to 7=Several times an hour. CMAI total score was sum of ratings for all 29 items, ranged from 29 to 203. Higher score indicate greater frequency of manifestations of agitated behaviour. Negative change from baseline indicates improvement in condition. mITT population was used. Subjects analysed’ signifies number of subjects evaluable for this endpoint.
    End point type
    Primary
    End point timeframe
    Baseline, Week 12
    End point values
    Placebo AVP-786-28 mg AVP-786-42.63 mg
    Number of subjects analysed
    144
    127
    126
    Units: score on a scale
        least squares mean (standard error)
    -18.0 ( 1.25 )
    -20.7 ( 1.32 )
    -19.7 ( 1.27 )
    Statistical analysis title
    Change from Baseline in CMAI Total Score
    Comparison groups
    Placebo v AVP-786-28 mg
    Number of subjects included in analysis
    271
    Analysis specification
    Pre-specified
    Analysis type
    superiority [1]
    P-value
    = 0.096
    Method
    Mixed Model for Repeated Measures (MMRM)
    Parameter type
    Least Square (LS) Mean Difference
    Point estimate
    -2.8
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -6
         upper limit
    0.5
    Notes
    [1] - MMRM model included fixed class-effect terms for treatment, site, baseline concomitant antipsychotic use, visit week; an interaction term of treatment by visit week; covariates-interaction term of baseline values of CMAI Total Score, Neuropsychiatric Inventory - agitation/aggression (NPI-AA) score by visit week, baseline CMAI Total Score, & NPI-AA score. Heterogeneous Toeplitz (TOEPH) variance-covariance was used.
    Statistical analysis title
    Change from Baseline in CMAI Total Score
    Comparison groups
    Placebo v AVP-786-42.63 mg
    Number of subjects included in analysis
    270
    Analysis specification
    Pre-specified
    Analysis type
    superiority [2]
    P-value
    = 0.302
    Method
    MMRM
    Parameter type
    LS Mean Difference
    Point estimate
    -1.7
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -4.9
         upper limit
    1.5
    Notes
    [2] - MMRM model included fixed class-effect terms for treatment, site, baseline concomitant antipsychotic use, visit week; an interaction term of treatment by visit week; covariates-interaction term of baseline values of CMAI Total Score, NPI-AA score by visit week, baseline CMAI Total Score, & NPI-AA score. Heterogeneous Toeplitz (TOEPH) variance-covariance was used.

    Secondary: Change From Baseline to Week 12 in the Clinical Global Impression of Severity of Illness Scale for Agitation (CGIS-Agitation Score)

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    End point title
    Change From Baseline to Week 12 in the Clinical Global Impression of Severity of Illness Scale for Agitation (CGIS-Agitation Score)
    End point description
    The CGIS is an observer-rated scale that measures illness severity on a 7-point scale (score range: 1-7, where 1 = normal, not at all ill; 7 = among the most extremely ill subjects). A negative change from baseline indicates improvement in condition. mITT population was used. ‘Subjects analysed’ signifies number of subjects evaluable for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 12
    End point values
    Placebo AVP-786-28 mg AVP-786-42.63 mg
    Number of subjects analysed
    142
    127
    125
    Units: score on a scale
        least squares mean (standard error)
    -0.9 ( 0.09 )
    -1.3 ( 0.09 )
    -1.1 ( 0.09 )
    Statistical analysis title
    Change From Baseline in the CGIS-Agitation score
    Comparison groups
    Placebo v AVP-786-28 mg
    Number of subjects included in analysis
    269
    Analysis specification
    Pre-specified
    Analysis type
    superiority [3]
    P-value
    = 0.002
    Method
    MMRM
    Parameter type
    LS Mean Difference
    Point estimate
    -0.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.6
         upper limit
    -0.1
    Notes
    [3] - MMRM included fixed class-effect terms for treatment, site, baseline CGIS-Agitation, NPI-AA Score, baseline concomitant antipsychotic use, visit week; an interaction term of treatment by visit week; covariates: interaction term of baseline values of CGIS-Agitation, Score NPI-AA score by visit week. Compound Symmetry (CS) variance-covariance was used.
    Statistical analysis title
    Change From Baseline in the CGIS-Agitation score
    Comparison groups
    Placebo v AVP-786-42.63 mg
    Number of subjects included in analysis
    267
    Analysis specification
    Pre-specified
    Analysis type
    superiority [4]
    P-value
    = 0.056
    Method
    MMRM
    Parameter type
    LS Mean Difference
    Point estimate
    -0.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.4
         upper limit
    0
    Notes
    [4] - MMRM included fixed class-effect terms for treatment, site, baseline CGIS-Agitation, NPI-AA Score, baseline concomitant antipsychotic use, visit week; an interaction term of treatment by visit week; covariates: interaction term of baseline values of CGIS-Agitation, Score NPI-AA score by visit week. Compound Symmetry (CS) variance-covariance was used.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose of the study drug up to 30 days after last dose of study drug (up to Week 16)
    Adverse event reporting additional description
    Safety population included all randomised subjects who received at least one dose of study treatment.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Placebo
    Reporting group description
    Subjects received matched AVP-786 placebo capsules twice daily (BID) for the 12-week treatment period.

    Reporting group title
    AVP-786-28 mg
    Reporting group description
    Following a 3-week titration schedule, subjects received AVP-786-18/4.9 capsules, orally, once a day (QD) for the first 7 days of the study, followed by AVP-786-18/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-28/4.9, capsules, BID for 9 weeks.

    Reporting group title
    AVP-786-42.63 mg
    Reporting group description
    Following a 3-week titration schedule, subjects received AVP-786-28/4.9 capsules, orally, QD for the first 7 days of the study, followed by AVP-786-28/4.9, capsules, BID for the next 14 days. Beginning on Day 22, subjects received AVP-786-42.63/4.9, capsules, BID for 9 weeks.

    Serious adverse events
    Placebo AVP-786-28 mg AVP-786-42.63 mg
    Total subjects affected by serious adverse events
         subjects affected / exposed
    5 / 216 (2.31%)
    7 / 197 (3.55%)
    8 / 186 (4.30%)
         number of deaths (all causes)
    3
    1
    0
         number of deaths resulting from adverse events
    3
    1
    0
    Investigations
    Streptococcus test positive
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Renal cancer recurrent
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    0 / 216 (0.00%)
    2 / 197 (1.02%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper limb fracture
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Femur fracture
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hip fracture
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Humerus fracture
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pelvic fracture
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Wrist fracture
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Hypertension
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Nervous system disorders
    Altered state of consciousness
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Carotid artery stenosis
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Embolic stroke
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebrovascular accident
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 216 (0.46%)
    0 / 197 (0.00%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Oedema peripheral
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Death
         subjects affected / exposed
    1 / 216 (0.46%)
    0 / 197 (0.00%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Faecaloma
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Bile duct stone
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Cholecystitis acute
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Gallbladder perforation
         subjects affected / exposed
    1 / 216 (0.46%)
    0 / 197 (0.00%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Respiratory failure
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    Psychiatric disorders
    Mental status changes
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Agitation
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Aggression
         subjects affected / exposed
    1 / 216 (0.46%)
    0 / 197 (0.00%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal pain
         subjects affected / exposed
    0 / 216 (0.00%)
    1 / 197 (0.51%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    0 / 216 (0.00%)
    0 / 197 (0.00%)
    1 / 186 (0.54%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    1 / 216 (0.46%)
    0 / 197 (0.00%)
    0 / 186 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Placebo AVP-786-28 mg AVP-786-42.63 mg
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    18 / 216 (8.33%)
    19 / 197 (9.64%)
    22 / 186 (11.83%)
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    6 / 216 (2.78%)
    16 / 197 (8.12%)
    15 / 186 (8.06%)
         occurrences all number
    7
    22
    20
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    14 / 216 (6.48%)
    4 / 197 (2.03%)
    10 / 186 (5.38%)
         occurrences all number
    16
    5
    11

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    31 May 2017
    1. Removed the following secondary efficacy endpoints: change from baseline to week 12 in Zarit Burden Interview (ZBI), Cornell Scale for Depression in Dementia (CSDD), and General Medical Health Rating (GMHR). 2. Removed the Time Up and Go (TUG) test from the safety assessments. 3. Clarified that the CSDD and TUG test administered only at the Screening visit and not at follow-up visits. 4. The CSDD used as a screening tool for major depression and the TUG test as a tool for assessing risk of falls. 5. Removed the ADAS-cog, MMSE, ADCS-CGIC Overall, CSDD, and TUG test assessment at Visit 4 (Week 6). 6. Also, removed the ADCS-CGIC Overall assessment at Visit 4 (Week 6) and clarified that change from baseline will be assessed only at Visit 6 (Week 12).
    17 Jul 2018
    1. Provided a single, global protocol for use in all countries. 2. The number of study centers was revised from 70 centers outside the US to 90 centers worldwide (including North America). 3. Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-cog) removed as secondary efficacy measure. 4. Removed reference to Study 12-AVR-131. 5. Inclusion criteria updated to include clarification that a subject’s authorized representative was based on the applicable local regulations.
    05 Oct 2018
    1. The study objectives were clarified with descriptions of primary and secondary objectives. 2. Added clarification defining the end of trial as the date of the last patient last visit. 3. Country removed from randomization stratification due to potential randomization unbalance among treatment groups. 4. Updated to remove reference to study 15-AVP-786-303 and included a reference to a potential long-term extension study for some subjects. 5. Inclusion Criterion: #9 was updated to include a full definition of women of childbearing potential and clarify acceptable forms of birth control. A specific statement was also added to clarify that women who were lactating, pregnant or plan to become pregnant were excluded. 6. Exclusion Criteria: #6 and #7 were clarified as sub-bullets under Exclusion Criteria #5. In addition, the information about the review of the electrocardiogram (ECG) for screening and baseline were updated to define how the reviews will be performed to determine eligibility for study enrollment.
    30 Mar 2020
    1.Removed secondary endpoints: Modified Alzheimer’s Disease Cooperative Study – Clinical Global Impression of Change Rating (mADCS-CGIC-Agitation), Alzheimer’s Disease Cooperative Study – Clinical Global Impression of Change Rating (ADCS-CGIC Overall), Dementia Quality of Life (DEMQOL), Resource Utilization in Dementia (RUD). 2. Sample size calculations have been updated to address an increase in the dropout and non-evaluable rate from 15% to 20%. 3. Removed the mADCS-CGIC-Agitation, DEMQOL,RUD, and ADCS-CGIC-Overall assessments. 4. Removed ‘in clinic’ requirement for administration of study medication at visits other than Baseline. 5. Clarified terminology for the development of AVP-786 for the treatment of neuropsychiatric conditions. 6. Updated the number of subjects enrolled to 550. 7. Randomization/Stratification updated to reduce and optimize the type and number of stratification factors. 8. Inclusion Criteria and exclusion criteria were updated. 9. Removed information indicating that concomitant use of short acting benzodiazepines was allowed, as these were no longer permitted. 10. Removed the allowance to use rescue medication (lorazepam).
    27 Jan 2022
    1. Sponsor information was updated from Avanir Pharmaceuticals, Inc. to Otsuka Pharmaceutical Development & Commercialization, Inc. 2. Summary of Changes table was added.
    11 May 2023
    1. Brexpiprazole was added to the list of Prohibited Concomitant Medications. 2. The definition of the mITT population was updated for consistency with the statistical analysis plan (SAP).

    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.
    None reported
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