The study is designed to assess the safety,
tolerability and efficacy of brexpiprazole in the
treatment of patients with agitation in Alzheimer’s
dementia. The trial consists of a continuous 12-week
double-blind treatment period with a 30-day follow-
up. The trial population is planned to include 330
male and female patients, aged 55–90 years, with a
diagnosis of probable Alzheimer’s disease.
The continuation of the study enables Lundbeck and
Otsuka to further explore the efficacy of brexpiprazole
to address the high unmet medical need in patients
suffering from agitation in Alzheimer’s type dementia.
The study completed enrolment of all patients early
2022 and is on track for results readout mid-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 rates. Therefore, Lundbeck and Otsuka
Pharmaceutical have been seeking phase III program
advice from the U.S. FDA. At a Type C meeting, the
proposal for how to address the slow enrollment rates
was discussed with the FDA. Provided FDA accepts
the proposal, headline results are expected within the
next 12 months.
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.
No further clinical studies are expected to be required
and as a next step the regulatory agencies in the U.S.
and the EU will be approached. Scale-up of
manufacturing capacity is progressing at Otsuka
Pharmaceuticals with regulatory submission gated on
completing build and validation of new manufacturing
capacity at Otsuka. The new 2-month formulation is
an innovative addition to the LAI franchise and has
patent protection until the early part of the next
decade.