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Synopsis – Study 11915A H.Lundbeck A/S Confidential Synopsis – Study 11915A Title of Study A one-year multi-national, multi-centre, randomised, double-blind, parallel-group, fixed-dose bifeprunox study combining a 12-week placebo-controlled, quetiapine-referenced phase with a 12-month quetiapine-controlled phase in patients with schizophrenia Investigators 34 investigators at 34 centres in 7 countries Signatory investigator – Michel Bourin, MD, PharmD, PhD, Neurobiology of Anxiety and Depression, University of Nantes, France Study Centres 34 centres – 2 in Bulgaria, 2 in China, 9 in Romania, 12 in Russian Federation, 4 in Thailand, 2 in Taiwan, and 3 in Ukraine Publications None (as of the date of this report) Study Period First patient first visit – 21 March 2008 Last patient last visit – 18 August 2009 Study terminated – 14 June 2009 Objectives • Primary objective: – to show superior efficacy of fixed doses of bifeprunox (20mg/day) versus placebo following 12 weeks of treatment in patients with schizophrenia inadequately controlled in the maintenance phase • Secondary objectives: – Key secondary objective: • to show non-inferior efficacy of fixed doses of bifeprunox (20mg/day) versus fixed doses of quetiapine (600mg/day) following12 months of treatment in patients with schizophrenia inadequately controlled in the maintenance phase – Other secondary objectives: • to compare the safety and tolerability of 12 weeks of treatment with fixed doses of bifeprunox (20mg/day) to that of placebo and quetiapine (600mg/day) • to compare the safety and tolerability of 12 months of treatment with fixed doses of bifeprunox (20mg/day) to that of quetiapine (600mg/day) • to determine and compare the effect on functional outcomes, quality of life, and treatment compliance of 12 weeks of treatment with fixed doses of bifeprunox (20mg/day) to that of placebo and quetiapine (600mg/day) • to determine and compare the effect on functional outcomes, quality of life, and treatment compliance of 12 months of treatment with fixed doses of bifeprunox (20mg/day) to that of quetiapine (600mg/day) • to investigate any correlations between genotype and treatment response to bifeprunox • to explore biological parameters (messenger ribonucleic acid [mRNA], endogenous metabolites, and proteins) that may be associated with schizophrenia, the effect of treatment, or the treatment response Study 11915A – Abbreviated Clinical Study Report Page 1 of 10 Final: 13-Sep-2010 CLI_099288 v. 1.0 H.Lundbeck A/S Confidential Methodology • This was a one-year, multi-national, multi-centre, randomised, double-blind, parallel-group, fixed-dose study in patients with a primary diagnosis of schizophrenia. The study consisted of a 4-week lead-in period, a 12-week placebo-controlled, quetiapine-referenced period, followed by a 9-month quetiapine-controlled period. • During the lead-in period, the patients’ current antipsychotic medication was kept constant. After the lead-in period, the patients were randomised (1:1:1) to receive one of three treatments: bifeprunox 20mg/day (BX), quetiapine 600mg/day (QUE) or placebo (PBO-BX), and entered a cross-titration double-blind treatment period. Current antipsychotic medication was down-tapered over the first 21 days while bifeprunox and quetiapine were up-titrated until the target dose was reached on Day 22. Patients in the active treatment groups who completed the 12-week placebo-controlled period continued with the same treatment for an additional 9 months while patients in the placebo group were switched to bifeprunox and up-titrated to 20mg/day in 28 days. A safety follow-up visit was scheduled for 7 days after completion of the study or after withdrawal from the study, and 30 days after intake of last dose of the investigational medicinal product (IMP). • Efficacy data were collected at weekly intervals for the first 4 weeks and at 2-week intervals for the next 12 weeks, and thereafter at 4-week intervals. Safety data were collected throughout the study. • This study was terminated following a statistical interim analysis of pooled data (Studies 11915A and 11916A) that was conducted to investigate whether patients were benefitting adequately from treatment with bifeprunox to justify continuation of the study. The interim analysis results did not support a continuation of the study as it was improbable that bifeprunox could be shown to be non-inferior to quetiapine at the end of the study. Number of Patients Planned and Analysed • 450 patients were planned for enrolment: 150 in the BX group, 150 in the QUE group, and 150 in the PBO-BX group. • Patient disposition is tabulated below: BX QUE PBO-BX Total n (%) n (%) n (%) n (%) Patients randomised 82 76 68 226 Patients treated (all- 80 76 68 224 patients-treated set [APTS]): Patients completed 0 (0) 1 (1) 0 (0) 1 (0) Patients withdrawn 80 (100) 75 (99) 68 (100) 223 (100) Primary reason for withdrawal: Adverse events 16 (20) 11 (14) 15 (22) 42 (19) Lack of efficacy 4 (5) 6 (8) 9 (13) 19 (9) Early termination 47 (59) 48 (63) 37 (54) 132 (59) Other 13 (16) 10 (13) 7 (10) 30 (13) Analysis sets: APTS 80 76 68 224 Full-analysis set (FAS) 79 76 68 223 Cross-reference: Tables 1 and 4 Withdrawals from the study by all reasons are summarised in Table 5. • Patients mainly withdrew due to termination of the study. Withdrawal due to adverse events was lowest in the QUE group (14%) and comparable in the BX and PBO-BX groups (20% and 22%, respectively). • Only one patient (QUE group) completed the 12-month study. The mean exposure to IMP was 124 days in the BX group, 160 days in the QUE group, and 125 days in the PBO-BX group (Table 17). The total IMP exposure was 26 patient-years in the BX group, 32 patient-years in the QUE group, and 23 patient-years in the PBO-BX group. The proportion of patients who completed 12 weeks of treatment was comparable in the BX and PBO-BX groups (55% and 56%, respectively) and highest (67%) in the QUE group (Table 3). Study 11915A – Abbreviated Clinical Study Report Page 2 of 10 Final: 13-Sep-2010 CLI_099288 v. 1.0 H.Lundbeck A/S Confidential Diagnosis and Main Inclusion Criteria Inpatients, partially hospitalised patients, or outpatients with a primary diagnosis of schizophrenia according to DSM-IV-TR™ criteria, who: • were ≥18 and ≤65 years of age • had a Clinical Global Impression – Severity of Illness (CGI-S) score ≥4 (moderately ill) at screening and at baseline • had a Positive and Negative Syndrome Scale (PANSS) total score ≥60 at screening and at baseline • had a score of ≤4 on the following PANSS items at screening and at baseline: P2 (conceptual disorganisation), P7 (hostility) and G8 (uncooperativeness) • were in the maintenance phase and did not have an acute exacerbation within 8 weeks prior to screening or 4 weeks prior to baseline • did not have their antipsychotic medications changed within 8 weeks prior to screening (agent) or between screening and baseline (agent and dose) Investigational Medicinal Product, Dose and Mode of Administration, Batch Numbers Bifeprunox – 20 mg/day (patients randomised to bifeprunox at baseline were up-titrated over 21 days during the 12-week double-blind, placebo-controlled treatment period; patients randomised to placebo at baseline were up-titrated over 28 days after completion of the 12-week double-blind, placebo-controlled treatment period); encapsulated tablets, orally; batch Nos. 0.125 mg (E05249-001E, E05211-023E, E05211-070E), 0.25 mg (E05249-002E, E05211-024E, E05211-071E), 0.5 mg (E05249-003E, E05211-025E, E05211-072E), 1 mg (E05249-004E, E05211-026E, E05211-073E), 2 mg (E05249-005E, E05211-027E, E05211-074E), 5 mg (E05249-006E, E05211-028E, E05211-075E), 10 mg (E05249-007E, E05211-029E, E05211-076E), 20 mg (E05249-008E, E05249-041E, E05211-030E, E05211-077E, E05211-145E) Duration of Treatment 12 months: a 12-week placebo-controlled, quetiapine-referenced treatment period (including a 3-week cross-titration period) and a 9-month quetiapine-controlled treatment period Reference Therapies, Doses and Mode of Administration, Batch Numbers Quetiapine (Seroquel®) – 600 mg/day (up-titrated over 21 days); encapsulated tablets, orally; batch Nos. 25 mg (E05249-010E, E05211-032E, E05211-078E), 50 mg (05249-011E, E05211-033E, E05211-079E), 75 mg (E05249-012E, E05211-034E, E05211-080E), 100 mg (E05249-013E, E05211-035E, E05211-081E), 150 mg (E05249-014E, E05211-036E, E05211-082E), 200 mg (E05249-015E, E05211-037E, E05211-083E), 250 mg (E05249-016E, E05211-038E, E05211-084E), 300 mg (E05249-017E, E05249-042E, E05211-039E, E05211-085E) Placebo – encapsulated tablets, orally; batch Nos. E05249-009E, E05211-031E, and E05211-063E Efficacy Assessments • Primary variable – PANSS total score • Secondary variables – PANSS positive symptoms score, PANSS negative symptoms score, PANSS general psychopathology score, CGI-S score, Clinical Global Impression – Global Improvement (CGI-I) score, and Calgary Depression Scale for Schizophrenia (CDSS) Pharmacoeconomic Assessments Schizophrenia Quality of Life (S-QoL) scale, Drug Attitude Inventory (DAI-30), Global Assessment of Functioning (GAF), Personal and Social Performance (PSP) scale, and Client Service Receipt Inventory (CSRI). CSRI will be reported separately. Safety Assessments Adverse events (AEs), clinical safety laboratory tests, vital signs, weight, body mass index (BMI), waist circumference, electrocardiograms (ECGs), physical and neurological examinations, abnormal movement scores obtained from the Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Scale (BARS), and Simpson-Angus Scale
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