The continuation of the study enables Lundbeck and Otsuka to further explore the efficacy of brexpiprazole to
address the high medical need in patients suffering from agitation in Alzheimer’s type dementia. Completion of the
trial is expected in the first half of 2022.
The primary outcome in the study is change in the Cohen-Mansfield Agitation Inventory (CMAI) Total score. The
key secondary outcome measure is change in the Clinical Global Impression – Severity of Illness (CGI-S) score, as
related to symptoms of agitation.
Brexpiprazole – phase III in Post-Traumatic Stress Disorder (PTSD)
PTSD is a psychiatric disorder that can develop as a response to traumatic events, such as interpersonal violence,
combat, life-threatening accidents or natural disasters. Core features of PTSD include a variety of symptoms, such
as re-experiencing phenomena (i.e. flashbacks and nightmares), avoidance behavior, numbing (i.e. amnesia,
anhedonia, withdrawal, negativism) and increased arousal (i.e. insomnia, irritability, poor concentration,
hypervigilance). Psychiatric co-morbidities are common, and PTSD sufferers can also present with substance
abuse, mood and other anxiety disorders, impulsive and dangerous behavior and self-harm.
Lundbeck and Otsuka Pharmaceutical reported positive phase II data for the combination treatment of brexpiprazole
and sertraline for the treatment of PTSD in November 2018. On basis of these data, Lundbeck and Otsuka
Pharmaceutical initiated two pivotal phase III trials (NCT04124614; n=577 and NCT04174170; n=733), investigating
the use of brexpiprazole in combination with sertraline in the treatment of PTSD subsequent to an End of Phase II
meeting with the U.S. FDA in May 2019. The execution of those two ongoing studies is challenged by the COVID-
19 pandemic, primarily impacting enrollment activities. Therefore, Lundbeck and Otsuka Pharmaceutical is seeking
phase III program advice from the U.S. FDA.
Brexpiprazole – phase II for borderline personality disorder
Lundbeck and Otsuka Pharmaceutical initiated a proof-of-concept study investigating the use of brexpiprazole in
the treatment of borderline personality disorder (BPD), subsequent to a Type B meeting with the U.S. FDA in May
2019 (NCT04100096). The study has finalized. The brexpiprazole treatment arm did not show statistically significant
separation from placebo at the predefined timepoint for the primary endpoint, change from baseline in the Zanarini
Rating Scale for Borderline Personality Disorder, although improvements greater than placebo were observed at
other timepoints in the study. The observed safety and tolerability profile for the patients suffering from borderline
personality disorder was consistent with the safety and tolerability profile observed for patients treated with
brexpiprazole in other indications. Lundbeck and Otsuka Pharmaceutical has decided not to progress further with
investigating brexpiprazole as monotherapy in adult subjects with BPD.
Aripiprazole – 2-Month Injectable (LAI) formulation
Dosing every second month can add important benefits in terms of convenience for the patients and may increase
treatment adherence as well as minimizing risk of missing doses and it may reduce the potential need for medication
monitoring by healthcare professionals, family and caregivers.
In July 2019, Lundbeck and Otsuka Pharmaceutical initiated a pivotal phase Ib study (NCT04030143) to determine
the safety, tolerability and pharmacokinetics of multiple-dose administrations of aripiprazole to adult participants
with schizophrenia or bipolar I disorder. The study was an open-label, multiple-dose, randomized, parallel-arm,
multicenter study. In addition to assessment of safety and tolerability, the objective was to establish the similarity of
aripiprazole concentrations on the last day of the dosing interval and the exposure in the last dosing interval following
the final administration of aripiprazole into the gluteal muscle site. The study showed that the new 2-Month
formulation, while being safe and tolerable, provided effective plasma concentrations of aripiprazole for two months.