International Classification of Headache Disorders
Third Edition (ICHD-3) and with unsuccessful prior
preventive treatments. A total of 237 patients were
randomly allocated to one of three treatment groups:
high/low dose of ’222 or placebo. The primary
analysis concluded that there was a statistically
significant difference (p=0.01) between ’222 and
placebo in the mean change from baseline in the
number of monthly migraine days over weeks 1 to 4.
‘222 was generally well tolerated. As of the next
steps, a phase IIb study to start in second half of 2024
to establish the full dose range and subcutaneous
efficacy.
Circuitry / neuronal biology
Brexpiprazole – phase III in patients with agitation
associated with dementia due to Alzheimer’s
Disease
On May 10, 2023, the U.S. Food and Drug
Administration (FDA) approved the supplemental
New Drug Application (sNDA) of brexpiprazole for
use in the treatment of agitation associated with
dementia due to Alzheimer’s disease.
The approval was based on two positive phase III, 12-
week, randomized, double-blind, placebo-controlled
fixed-dose studies that evaluated the frequency of
agitation symptoms in patients with dementia due to
Alzheimer’s disease based on the Cohen-Mansfield
Agitation Inventory (CMAI) total score, making
brexpiprazole the first and only pharmacological
treatment approved in the U.S. for agitation
associated with dementia due to Alzheimer’s
disease.
Further, a supplemental New Drug Submission
(sNDS) was formally accepted by Health Canada for
review as of April 12, 2023, with anticipated action in
2024, while a joint application using the Access
pathway was submitted on May 31, 2023 for
Australia, Singapore and Switzerland with anticipated
action in the second quarter of 2024.
Brexpiprazole – phase III in adolescent patients
(13-17 years old) with schizophrenia
The phase III trial 331-10-234 in adolescent patients
with schizophrenia (NCT03198078) read out during
the second quarter of 2023, with the trial meeting its
primary endpoint, as measured by the PANSS total
score change from baseline to week 6 and
demonstrated a significant improvement for
brexpiprazole compared to placebo (p<0.05).
The active reference for the study, aripiprazole, also
separated from placebo on the primary efficacy
analysis, thus validating the study methodology and
patient population.
Brexpiprazole was generally well tolerated in the trial,
and the safety profile was similar to that observed in
adult patients with schizophrenia.
The trial forms part of the brexpiprazole EMA
Paediatric Investigation Plan (PIP), as well as an FDA
Post Marketing Requirement (PMR) following the
U.S. approval of brexpiprazole for treatment of
schizophrenia in adolescent patients. The U.S.
indication was obtained in December 2021 based on
pediatric PK comparability data and extrapolation of
adult efficacy data. For Europe, results of the study
will be submitted to EMA later in 2023.
The EMA PIP includes two further studies that are
currently ongoing:
1) A phase III open-label 2-year extension
study 331-10-236 (NCT03238326) enrolling
patients completing Trial 234
2) An extrapolation study 3331-201-00185
assessing the long-term efficacy in
adolescent subjects with schizophrenia, by
extrapolating data from completed
brexpiprazole trials in both adolescents and
adult subjects with schizophrenia.
Brexpiprazole – phase III in Post-Traumatic
Stress Disorder (PTSD)
Following an exploratory phase II trial, Lundbeck and
Otsuka 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 FDA in May
2019. The execution of those two ongoing studies
was challenged by the COVID-19 pandemic,
primarily impacting enrollment rates. After FDA
feedback, it was decided that the two trials will be
concluded with reduced sample size. Recruitment of
both studies concluded in April 2023 and headline
results are expected in the second half of 2023.
Aripiprazole – 2-month Injectable (LAI)
formulation
The new 2-month formulation is an innovative
addition to the long-acting injectable (LAI) franchise
and has patent protection until the early part of the
next decade.
Lundbeck and Otsuka submitted the Marketing
Authorization Application (MAA) for aripiprazole as
an every-two months ready-to-use (RTU) long-acting
injectable for the maintenance treatment of
schizophrenia in adult patients stabilized with
aripiprazole to the European Medicines Agency
(EMA) on May 26, 2022. Due to a Committee for