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    Clinical Trial Results:
    A Randomized, Double-blind, Active Comparator-Controlled Study to Evaluate the Long-term Safety and Tolerability of SEP-363856 in Subjects With Schizophrenia

    Summary
    EudraCT number
    2019-002259-40
    Trial protocol
    RO  
    Global end of trial date
    30 Dec 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    31 Dec 2023
    First version publication date
    31 Dec 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SEP361-304
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04115319
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Sunovion Pharmaceuticals Inc.
    Sponsor organisation address
    84 Waterford Drive, Marlboro, United States, 01752
    Public contact
    CNS Medical Director, Sunovion Pharmaceuticals Inc., 01 18665036351, clinicaltrialdisclosure@sunovion.com
    Scientific contact
    CNS Medical Director, Sunovion Pharmaceuticals Inc., 01 18665036351, clinicaltrialdisclosure@sunovion.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 Dec 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Dec 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Dec 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the long-term safety and tolerability of flexibly-dosed SEP-363856 (50, 75, and 100 mg/day) in clinically stable adult subjects with chronic schizophrenia by the incidence of overall adverse events (AEs), serious AEs (SAEs) and AEs leading to discontinuation.
    Protection of trial subjects
    This study was conducted according to the protocol, ICH Good Clinical Practice (GCP), ICH guidelines and the ethical principles that have their origin in the Declaration of Helsinki
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    21 Nov 2019
    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
    Russian Federation: 124
    Country: Number of subjects enrolled
    Romania: 3
    Country: Number of subjects enrolled
    Ukraine: 63
    Country: Number of subjects enrolled
    United States: 113
    Worldwide total number of subjects
    303
    EEA total number of subjects
    3
    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)
    302
    From 65 to 84 years
    1
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Informed consent will be obtained from subjects before any study procedures are performed. Subjects will be evaluated for eligibility during a Screening/Washout Period of up to 21 days, during which they will be tapered off all psychotropic medications in a manner that is consistent with labeling recommendations and conventional medical practices.

    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
    SEP-363856
    Arm description
    SEP-363856 50mg, 75mg, 100mg, flexibly dosed once daily capsule
    Arm type
    Experimental

    Investigational medicinal product name
    SEP-3638
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    50mg, 75mg, 100mg, flexibly dosed once daily

    Arm title
    Quetiapine XR
    Arm description
    Quetiapine XR, 400, 600, 800 mg, flexibly dosed once daily capsule
    Arm type
    Active comparator

    Investigational medicinal product name
    Quetiapine XR
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    400, 600, 800 mg, flexibly dosed once daily

    Number of subjects in period 1
    SEP-363856 Quetiapine XR
    Started
    201
    102
    Completed
    105
    57
    Not completed
    96
    45
         Consent withdrawn by subject
    17
    9
         Personal reasons
    -
    1
         geopolitical conflict related
    2
    1
         Adverse event, non-fatal
    48
    21
         non compliance with study drug
    5
    1
         deemed unsuitable for participation
    1
    -
         Lost to follow-up
    6
    7
         Covid 19 related
    1
    -
         subject relocated
    5
    2
         Lack of efficacy
    6
    2
         Protocol deviation
    5
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    SEP-363856
    Reporting group description
    SEP-363856 50mg, 75mg, 100mg, flexibly dosed once daily capsule

    Reporting group title
    Quetiapine XR
    Reporting group description
    Quetiapine XR, 400, 600, 800 mg, flexibly dosed once daily capsule

    Reporting group values
    SEP-363856 Quetiapine XR Total
    Number of subjects
    201 102 303
    Age Categorical
    Units: Participants
        >= 12 to < 18 years
    0 0 0
        >=18 to < 65 years
    200 102 302
        >=65 years
    1 0 1
        < 12 years
    0 0 0
    Age Continuous
    Units: Years
        arithmetic mean (standard deviation)
    40.3 ± 11.77 38.4 ± 12.66 -
    Gender, Male/Female
    Units: Participants
        Female
    88 37 125
        Male
    113 65 178
    Race (NIH/OMB)
    Units: Subjects
        American Indian or Alaska Native
    2 0 2
        Asian
    2 0 2
        Black or African American
    47 28 75
        More than one race
    0 0 0
        Native Hawaiian or Other Pacific Islander
    0 0 0
        Other
    0 1 1
        Unknown or Not Reported
    0 0 0
        White
    150 73 223
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    8 4 12
        Not Hispanic or Latino
    193 98 291
        Unknown or Not Reported
    0 0 0
    Country
    Units: Subjects
        Romania
    2 1 3
        Russia
    83 41 124
        Ukarine
    42 21 63
        United States
    74 39 113

    End points

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    End points reporting groups
    Reporting group title
    SEP-363856
    Reporting group description
    SEP-363856 50mg, 75mg, 100mg, flexibly dosed once daily capsule

    Reporting group title
    Quetiapine XR
    Reporting group description
    Quetiapine XR, 400, 600, 800 mg, flexibly dosed once daily capsule

    Primary: The incidence of overall Adverse Events (AEs), Serious Adverse Events (SAEs), and Adverse Events (AEs) leading to discontinuation

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    End point title
    The incidence of overall Adverse Events (AEs), Serious Adverse Events (SAEs), and Adverse Events (AEs) leading to discontinuation [1]
    End point description
    The incidence of AEs, SAEs, and AEs leading to discontinuation
    End point type
    Primary
    End point timeframe
    52 Weeks
    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: This outcome measure was not powered to have a statistical analysis.
    End point values
    SEP-363856 Quetiapine XR
    Number of subjects analysed
    201
    102
    Units: participants
        Any Adverse Events (AEs)
    153
    77
        Serious Adverse Events (SAEs)
    16
    0
        Adverse Events (AEs) leading to discontinuation
    48
    21
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    up to 395 days
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22
    Reporting groups
    Reporting group title
    Quetiapine XR
    Reporting group description
    Quetiapine XR, 400, 600, 800 mg, flexibly dosed once daily capsule

    Reporting group title
    SEP-363856
    Reporting group description
    SEP-363856 50mg, 75mg, 100mg, flexibly dosed once daily capsule

    Serious adverse events
    Quetiapine XR SEP-363856
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 102 (0.00%)
    16 / 201 (7.96%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Injury, poisoning and procedural complications
    Fall
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    1 / 201 (0.50%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Limb injury
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    1 / 201 (0.50%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Multiple injuries
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    2 / 201 (1.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    1 / 201 (0.50%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicide attempt
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    2 / 201 (1.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Anxiety
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    1 / 201 (0.50%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Schizophrenia
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    10 / 201 (4.98%)
         occurrences causally related to treatment / all
    0 / 0
    3 / 10
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Corona virus infection
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    0 / 102 (0.00%)
    1 / 201 (0.50%)
         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
    Quetiapine XR SEP-363856
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    55 / 102 (53.92%)
    103 / 201 (51.24%)
    Investigations
    Weight decreased
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    1 / 102 (0.98%)
    11 / 201 (5.47%)
         occurrences all number
    1
    11
    Weight increased
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    11 / 102 (10.78%)
    9 / 201 (4.48%)
         occurrences all number
    11
    9
    Nervous system disorders
    Akathisia
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    2 / 102 (1.96%)
    14 / 201 (6.97%)
         occurrences all number
    2
    15
    Dizziness
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    5 / 102 (4.90%)
    16 / 201 (7.96%)
         occurrences all number
    5
    18
    Headache
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    8 / 102 (7.84%)
    20 / 201 (9.95%)
         occurrences all number
    8
    29
    Somnolence
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    21 / 102 (20.59%)
    12 / 201 (5.97%)
         occurrences all number
    24
    13
    General disorders and administration site conditions
    Asthenia
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    9 / 102 (8.82%)
    5 / 201 (2.49%)
         occurrences all number
    10
    6
    Gastrointestinal disorders
    Constipation
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    12 / 102 (11.76%)
    7 / 201 (3.48%)
         occurrences all number
    16
    8
    Nausea
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    4 / 102 (3.92%)
    13 / 201 (6.47%)
         occurrences all number
    5
    13
    Psychiatric disorders
    Anxiety
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    10 / 102 (9.80%)
    27 / 201 (13.43%)
         occurrences all number
    12
    41
    Insomnia
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    11 / 102 (10.78%)
    30 / 201 (14.93%)
         occurrences all number
    13
    38
    Schizophrenia
    alternative dictionary used: MedDRA 22.0
         subjects affected / exposed
    6 / 102 (5.88%)
    21 / 201 (10.45%)
         occurrences all number
    6
    23

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    16 Sep 2020
    Protocol Ver1.00 (28 June 2019) was amended: Added Phase of development to synopsis. Minor wording clarifications C-SSRS endpoint. Inclusion 5 was amended and 6,18 were added. Clarified that DSM-5 criteria must be met at screening. Added Sec10.7 for eligibility adjudication process to Sec10. Exclusion 2 subject’s substance use disorder criteria were further restricted. Exclusion 10 part a & part g were updated to exclude subjects with unstable hypertension. Subjects with an ECG that has a centrally overall interpretation of abnormal, significant/potentially clinically significant must be discussed with Medical Monitor(MM). Exclusion 14 was added to require that specific blood pressure thresholds be met. Exclusion 15 was clarified: to indicate who determines clinical significance of abnormal lab values at Screening and to require that the MM approve retesting of clin lab tests and allow extensions to the screening period for technical issues. Exclusion 16 was clarified to always exclude subjects with a positive/indeterminate confirmatory test for hepatitis C. Simplified language for exclusion 21 for positive drug test at screening. Exception for subjects testing positive for cannabinoids at Screening was removed. Exclusion 22 made prior receipt of investigational drug product or device more restrictive. Clarified Other Safety Endpoint that suicidal ideation endpoint includes frequency and severity. Clarified the timing for obtaining consents. Added footnote to indicate a separate consent form is required for the duplicate subject check at screening. Clarified that pretreatment events and adverse events are determined programmatically. Clarified that the PANSS-IC form will be completed as part of PANSS. Sec 10.3 added clarification on collection of data. Clarification was made to allow antipsychotic medications to be reported in eCRF based on subject and caregiver input. Expectations on details of prior psychotropic medications were clarified.
    14 Jan 2021
    The protocol Version 2.00 dated 16 September 2020 is being amended as follows: Updated Exclusion Criteria #2 based on FDA feedback to make the criterion more specific while still maintaining the original intent of the criterion, which is to exclude subjects with a history of substantial substance use disorder that may result in significant confounding on diagnosis, presentation and/or treatment responsiveness. Updated Exclusion Criteria #22 based on FDA feedback to refine the restrictions on prior clinical trial participation to those that would meaningfully interfere with the conduct of the study. Updated frequency of Data Safety Monitoring Board (DSMB) to align with the DSMB charter. Update Sunovion Responsible Physician. Minor changes such as edits to the title page, headers, footers, and approval page of the document to reflect the new version number and document date have also been made. Updates to abbreviations for consistency, added phase of development, minor wording clarifications for readability, corrections to cross-references, and corrections to typographical errors have been made. Updates to the table of contents have also been made. These changes are not described within.

    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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