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    Clinical Trial Results:
    A 12-week, Multicenter, Active-treatment Extension Trial to Evaluate the Safety and Tolerability of Brexpiprazole in the Treatment of Subjects With Agitation Associated With Dementia of the Alzheimer’s Type

    Summary
    EudraCT number
    2018-002783-88
    Trial protocol
    BG   ES   HU   SK  
    Global end of trial date
    19 Sep 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    05 Oct 2023
    First version publication date
    05 Oct 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    331-201-00182
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03594123
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Otsuka Pharmaceutical Development & Commercialization, Inc.
    Sponsor organisation address
    2440 Research Boulevard , Rockville, United States, MD 20850
    Public contact
    Global Clinical Development, Otsuka Pharmaceutical Development & Commercialization, Inc, clinicaltransparency@otsuka-us.com
    Scientific contact
    Global Clinical Development, Otsuka Pharmaceutical Development & Commercialization, Inc, clinicaltransparency@otsuka-us.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
    19 Sep 2022
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Sep 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the long-term safety and tolerability of oral brexpiprazole as treatment in adult subjects with agitation associated with dementia of Alzheimer’s type (AAD).
    Protection of trial subjects
    Informed consent was obtained from all subjects participating in the study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    11 Oct 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
    Slovakia: 8
    Country: Number of subjects enrolled
    Spain: 8
    Country: Number of subjects enrolled
    Bulgaria: 26
    Country: Number of subjects enrolled
    Hungary: 5
    Country: Number of subjects enrolled
    Serbia: 17
    Country: Number of subjects enrolled
    United States: 109
    Country: Number of subjects enrolled
    Ukraine: 86
    Worldwide total number of subjects
    259
    EEA total number of subjects
    47
    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)
    29
    From 65 to 84 years
    208
    85 years and over
    22

    Subject disposition

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    Recruitment
    Recruitment details
    This study was conducted at 66 sites from 11 October 2018 to 19 September 2022 in the following countries: Bulgaria, Hungary, Serbia, Slovakia, Spain, Ukraine, and the United States.

    Pre-assignment
    Screening details
    Of the 259 subjects who enrolled in the study, there were 163 subjects who received brexpiprazole, and 96 subjects who received placebo in the parent study (331-14-213). All 259 subjects received brexpiprazole during this study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    Although this was an active-treatment extension trial, dose assignment was handled in a blinded fashion to maintain blinding of subjects’ previous treatment in Trial 331-14-213 (2017-003940-19).

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Prior Brexpiprazole
    Arm description
    Subjects who received brexpiprazole in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received the same dose of brexpiprazole [2 or 3 milligrams (mg)] once daily (QD), orally, as they received during the previous study, for up to 12 weeks with dose adjustment.
    Arm type
    Experimental

    Investigational medicinal product name
    Brexpiprazole
    Investigational medicinal product code
    OPC-34712
    Other name
    Rexulti®
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Brexpiprazole tablets, administered orally, 2-3 mg QD up to Week 12 during the treatment phase. Adjustments could be made to dosing.

    Arm title
    Prior Placebo
    Arm description
    Subjects who received placebo in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received brexpiprazole following a titration schedule, to gradually increase their dose from 0.5 mg QD, in the starting to 2 or 3 mg QD, orally, for up to 12 weeks with dose adjustment.
    Arm type
    Experimental

    Investigational medicinal product name
    Brexpiprazole
    Investigational medicinal product code
    OPC-34712
    Other name
    Rexulti®
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Brexpiprazole tablets, administered orally, in a titration manner starting from 0.5 mg up to 2-3 mg QD, up to Week 12 during the treatment phase. Adjustments could be made to dosing.

    Number of subjects in period 1
    Prior Brexpiprazole Prior Placebo
    Started
    163
    96
    Completed
    142
    87
    Not completed
    21
    9
         Lack of Efficacy
    1
    -
         Adverse Event
    8
    5
         Not Related to COVID-19
    1
    1
         Site Terminated by Sponsor
    4
    1
         Lost to follow-up
    -
    1
         Subject Withdrew Consent to Participate
    7
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Prior Brexpiprazole
    Reporting group description
    Subjects who received brexpiprazole in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received the same dose of brexpiprazole [2 or 3 milligrams (mg)] once daily (QD), orally, as they received during the previous study, for up to 12 weeks with dose adjustment.

    Reporting group title
    Prior Placebo
    Reporting group description
    Subjects who received placebo in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received brexpiprazole following a titration schedule, to gradually increase their dose from 0.5 mg QD, in the starting to 2 or 3 mg QD, orally, for up to 12 weeks with dose adjustment.

    Reporting group values
    Prior Brexpiprazole Prior Placebo Total
    Number of subjects
    163 96 259
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    74.8 ( 7.9 ) 73.4 ( 73.0 ) -
    Gender categorical
    Units: Subjects
        Female
    99 46 145
        Male
    64 50 114
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    52 30 82
        Not Hispanic or Latino
    111 66 177
    Race
    Units: Subjects
        Asian
    2 1 3
        Black or African American
    7 1 8
        White
    154 94 248
        American Indian or Alaska Native
    0 0 0
        Native Hawaiian or Other Pacific Islander
    0 0 0
        Unknown or Not Reported
    0 0 0
        More than one race
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Prior Brexpiprazole
    Reporting group description
    Subjects who received brexpiprazole in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received the same dose of brexpiprazole [2 or 3 milligrams (mg)] once daily (QD), orally, as they received during the previous study, for up to 12 weeks with dose adjustment.

    Reporting group title
    Prior Placebo
    Reporting group description
    Subjects who received placebo in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received brexpiprazole following a titration schedule, to gradually increase their dose from 0.5 mg QD, in the starting to 2 or 3 mg QD, orally, for up to 12 weeks with dose adjustment.

    Primary: Percentage of Subjects With Treatment-Emergent Adverse Events (TEAEs) by Severity

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    End point title
    Percentage of Subjects With Treatment-Emergent Adverse Events (TEAEs) by Severity [1]
    End point description
    An adverse event (AE) was defined as any untoward medical occurrence in a patient or clinical trial subject administered a medicinal product and which does not necessarily have a causal relationship with this treatment. TEAEs were defined as AEs with an onset date on or after the first dose of brexpiprazole. They are all adverse events that started after start of brexpiprazole; or if the event was continuous from baseline and was worsening, serious, study drug-related, or resulted in death, discontinuation, interruption, or reduction of study therapy. AEs were graded on a 3-point scale: 1= Mild: Discomfort noticed, but no disruption to daily activity. 2= Moderate: Discomfort sufficient to reduce or affect normal daily activity. 3= Severe: Inability to work or perform normal daily activity. Safety Sample comprised of those subjects who signed an informed consent form (ICF) for the trial and received at least one dose of brexpiprazole in Trial 331-201-00182.
    End point type
    Primary
    End point timeframe
    From first dose through 30 days after last dose of study drug (Up to approximately Week 16)
    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: Inferential statistical analysis was not performed for the safety endpoint. Descriptive statistics are included (percentage of participants).
    End point values
    Prior Brexpiprazole Prior Placebo
    Number of subjects analysed
    163
    96
    Units: percentage of subjects
    number (not applicable)
        Mild
    20.9
    13.5
        Moderate
    9.2
    19.8
        Severe
    3.1
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose through 30 days after last dose of study drug (Up to approximately Week 16)
    Adverse event reporting additional description
    Safety Sample comprised of those subjects who signed an ICF for the trial and received at least one dose of brexpiprazole in Trial 331-201-00182.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    25.1
    Reporting groups
    Reporting group title
    Prior Brexpiprazole
    Reporting group description
    Subjects who received brexpiprazole in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received the same dose of brexpiprazole [2 or 3 mg], QD, orally, as they received during the previous study, for up to 12 weeks with dose adjustment.

    Reporting group title
    Prior Placebo
    Reporting group description
    Subjects who received placebo in a previous double-blind phase 3 study (Trial 331-14-213 {2017-003940-19}), received brexpiprazole following a titration schedule, to gradually increase their dose from 0.5 mg QD, in the starting to 2 or 3 mg QD, orally, for up to 12 weeks with dose adjustment.

    Serious adverse events
    Prior Brexpiprazole Prior Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 163 (3.68%)
    0 / 96 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Investigations
    Hepatic enzyme increased
         subjects affected / exposed
    1 / 163 (0.61%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    3 / 163 (1.84%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Femur fracture
         subjects affected / exposed
    1 / 163 (0.61%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hip fracture
         subjects affected / exposed
    1 / 163 (0.61%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Syncope
         subjects affected / exposed
    1 / 163 (0.61%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Blood Loss Anaemia
         subjects affected / exposed
    1 / 163 (0.61%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Haemorrhoids
         subjects affected / exposed
    1 / 163 (0.61%)
    0 / 96 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Prior Brexpiprazole Prior Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    0 / 163 (0.00%)
    5 / 96 (5.21%)
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    0 / 163 (0.00%)
    5 / 96 (5.21%)
         occurrences all number
    0
    5

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    26 Jun 2020
    •Addendum for any protocol-specified activities that are not able to be performed or cannot be performed due to COVID-19 considerations. •Added that subjects who are early terminated from Trial 331-14-213, if the trial is terminated due to overwhelming efficacy from the interim analysis, may be offered entry into this trial. •The changes from amendment 1 of protocol 331-201-00182 did not go into effect and the amendment was not distributed to sites or Institutional review boards.
    06 Aug 2020
    • Deleted language stating that subjects who are early terminated from Trial 331-14-213, if the trial is terminated due to overwhelming efficacy from the interim analysis, may be offered entry into this trial.
    22 Sep 2020
    • Added that subjects who are early terminated from Trial 331-14-213, if the trial is terminated due to overwhelming efficacy from the interim analysis, may be offered entry into this trial.

    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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