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A 6 Month Study to Compare the Metabolic Effects of Paliperidone ER and Olanzapine in Patients With Schizophrenia

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Janssen-Cilag International NV
ClinicalTrials.gov Identifier:
NCT00645099
First received: March 24, 2008
Last updated: April 24, 2014
Last verified: April 2014
  Purpose

The purpose of this 6 month study is to compare the metabolic effects of paliperidone ER and olanzapine in patients with schizophrenia, using the ratio of the concentration of lipids (triglycerides (TG)) in the blood to the concentration of good cholesterol (high density lipoproteins (HDL)) in the blood as the primary parameter. Approximately 456 adult patients will participate in this study.


Condition Intervention Phase
Schizophrenia
Drug: olanzapine
Drug: paliperidone ER
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Prospective Randomized Open-label 6-Month Head-To-Head Trial to Compare Metabolic Effects of Paliperidone ER and Olanzapine in Subjects With Schizophrenia

Resource links provided by NLM:


Further study details as provided by Janssen-Cilag International NV:

Primary Outcome Measures:
  • Change From Baseline to End Point in the Triglycerides (TG) to High Density Lipoprotein (HDL) Ratio (TG:HDL Ratio) [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    Plasma fasting TG and HDL concentrations were measured to determine the TG:HDL ratio.


Secondary Outcome Measures:
  • Change From Baseline to End Point in Triglycerides [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    The TG level was assessed under fasted conditions.

  • Change From Baseline to End Point in High Density Lipoprotein [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    The HDL level was assessed under fasted conditions.

  • Change From Baseline to End Point in Total Cholesterol [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    The total cholesterol level was assessed under fasted conditions.

  • Change From Baseline to End Point in Low Density Lipoprotein Cholesterol (Friedwald QT) [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    The level of low density lipoprotein cholesterol was calculated using the Friedwald QT formula.

  • Change From Baseline to End Point in Converted Insulin [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    The insulin level was assessed under fasted conditions.

  • Change From Baseline to End Point in Fasting Glucose [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
  • Change From Baseline to End Point in Homeostatic Model Assessment of Beta-cell Function (HOMA-%B) [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]

    HOMA-%B is used to assess beta-cell function. HOMA-%B is a dimensionless measure of beta-cell function (higher values present increased insulin secretion for a given glucose level).

    HOMA-%B is normalized so that lean, healthy individuals will have values of HOMA-%B close to 100%.


  • Change From Baseline to End Point in Homeastatic Model Assessment of Insulin Resistance (HOMA-IR) [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    HOMA-IR is used to assess insulin resistance (IR). HOMA-IR is a dimensionless measure of insulin resistance (higher values present more insulin resistance. HOMA-IR are normalized so that lean, healthy individuals will have values of HOMA-IR close to 1.

  • Number of Patients Meeting the Criteria for Type 2 Diabetes Mellitus During Follow-up [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Fasting plasma glucose ≥126 mg/dL or 2-hour post-load plasma glucose ≥200 mg/dL during an oral glucose tolerance test (OGTT) or initiated use of glucose-lowering agents during the course of the study.

  • Number of Patients With Onset of Impaired Glucose Tolerance [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    Glucose ≥140 mg/dL, <200 mg/dL after a 75g OGTT.

  • Number of Patients With Impaired Fasting Glucose [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    Post-baseline glucose level under fasted conditions ≥100 mg/dL but <126 mg/dL.

  • Change From Baseline at End Point of the Insulinogenic Index [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    The insulinogenic index, defined as (insulin at 30 min - insulin at 0)/(glucose at 30 min [G(30)] - glucose at 0 [G(0)]) was used as a measure of early insulin secretion in response to the OGTT. Because the index is undefined when G(30)-G(0)=0, and poorly defined when G(30)-G(0)<0, the index was only calculated when G(30)>G(0).

  • Change From Baseline at End Point of Mari-Type Analysis of Glucose Sensitivity for Insulin [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    As another measure of beta-cell function, the relationship between plasma insulin and glucose concentrations during the OGTT was calculated using a simplified version of the method described by Mari et al. (Mari A, Sallas WM, He YL, Watson C, Ligueros-Saylan M, Dunning BE, Deacon CF, Holst JJ, Foley JE. Vildagliptin, a dipeptidyl peptidase-IV inhibitor, improves model-assessed beta-cell function in patients with type 2 diabetes. J Clin Endocrinol Metab. 2005; 90:4888-4894.).

  • Change From Baseline at End Point in Body Weight [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    Patients were weighed lightly clothed. The same amount of clothing had to be worn each time.

  • Change From Baseline at End Point in Body Mass Index (BMI) [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    BMI is calculated by dividing the body weight (in kg) by the square of height (in meters).

  • Change From Baseline at End Point in Waist Circumference [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    Patients had to be instructed to stand erect with abdomen relaxed, arms at sides, feet together, and weight divided equally over both legs. The tape measure was placed around the bare abdomen midway between the palpated iliac crest and the palpated lowest rib margin in the left and right mid-axillary lines. A nonstretchable tape was evenly placed around the natural waist covering the left and right natural-waist marks. The measurement scale had to face outward, and there could not be any twists in the tape. The tape had to be just touching the skin but not compressing the soft tissue.

  • Number of Patients First Meeting the NCEP/ATP III Criteria for Metabolic Syndrome During Follow-up [ Time Frame: 6 months ] [ Designated as safety issue: No ]

    Metabolic syndrome is defined according the Third Report of the National Cholesterol Education Program Expert Panel on

    Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATPIII) of which 3 out of 5 criteria must be met:

    • waist circumference men > 102 cm; waist circumference women > 88 cm
    • TG ≥ 150 mg/dL
    • HDL cholesterol men <40 mg/dL; HDL cholesterol women <50 mg/dL
    • Blood pressure systolic ≥ 130 mmHg; Blood pressure diastolic ≥ 85 mmHg
    • Fasting glucose ≥ 110 mg /dL

  • Change From Baseline to End Point in Total Positive and Negative Syndrome Scale Score (PANSS) [ Time Frame: Baseline to End Point (up to 6 months) ] [ Designated as safety issue: No ]
    PANSS is an investigator-rated 30-item scale to assess the neuropsychiatric symptoms of schizophrenia. The PANSS provided a total score and scores for 3 subscales, the positive subscale (7 items), the negative subscale (7 items), and the general psychopathology subscale (16 items), each rated on a scale of 1 (absent) to 7 (extreme).


Enrollment: 462
Study Start Date: October 2007
Study Completion Date: April 2009
Primary Completion Date: April 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 001
paliperidone ER 6-mg or 9-mg tablet once daily flexible dosing for 6 months
Drug: paliperidone ER
6-mg or 9-mg tablet once daily flexible dosing for 6 months
Active Comparator: 002
olanzapine 10-15 mg (using 5-mg or 10-mg tablets) once daily flexible dosing for 6 months
Drug: olanzapine
10-15 mg (using 5-mg or 10-mg tablets) once daily flexible dosing for 6 months

Detailed Description:

This is a prospective randomized (study medication is assigned by change) open-label, parallel-group, multicenter, 6 month study to compare the metabolic effects of paliperidone ER and olanzapine in patients with schizophrenia using the ratio of the concentration of lipids (triglycerides) in the blood to the concentration of good cholesterol (high density lipoproteins (HDL)) as the primary parameter. Secondary objectives include evaluation of additional parameters related to the total of the actions of the body to keep it alive (metabolic endpoints) and demonstration of non-inferiority of paliperidone ER versus olanzapine in efficacy as measured by Positive and Negative Syndrome Scale (PANSS). Patients previously treated with any oral antipsychotic, except those treated with paliperidone ER, olanzapine or clozapine during the last 6 months, can be enrolled and will be treated with paliperidone ER (6 to 9 mg/day) or olanzapine (10 to 15 mg/day). Patients will be divided into groups according to the metabolic effects of their previous antipsychotic medication (medication that does not increase body weight vs. medication that increases body weight). Throughout the study flexible dosing is allowed based on the investigator discretion. A study treatment period of 6 months is planned for all patients. Medication to treat symptoms like confusion, blurred vision, constipation, dry mouth, light-headedness, difficulty starting and continuing to urinate, and loss of bladder control may continue up to four weeks and should then be tapered off at the discretion of the investigator. Approximately 456 adult patients (228 in each treatment group) will participate in this study. Efficacy will be assessed with the following measures: PANSS (total score and subscale scores), Clinical Global Impression - Severity (CGI-S), Self-rated health status Survey SF-36, and Sleep and daytime drowsiness evaluation scale. The parameters related to the total of the actions of the body to keep it alive (metabolic endpoints) will be assessed with the following: ratio of blood lipids to blood good cholesterol concentrations (TG:HDL ratio) (for this primary evaluation, plasma fasting lipids and good cholesterol concentrations will be measured), fasting plasma insulin and fasting plasma glucose, plasma glucose and insulin concentrations before and after a 75 gram oral glucose tolerance test (OGTT) to asses insulin sensitivity and changes in insulin secretion, fasting good cholesterol, lipids, and glucose levels for the determination of new onset or presence of metabolic syndrome during treatment according to criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATPIII criteria), weight, Body-Mass-Index and waist circumference for the determination of new onset or presence of a medical condition associated with abdominal obesity, abnormalities in glucose, lipid and cholesterol metabolism, and elevated blood pressure that increases the risk of cardiovascular disease and type 2 diabetes (metabolic syndrome) during treatment according to NCEP/ATP III criteria. All patients who receive trial medication (paliperidone ER or olanzapine) at least once will be included in the analysis of the demographic and baseline characteristic data. 2 dosage levels of paliperidone ER (6 or 9mg per day) and 2 of olanzapine (10 and 15mg per day) are available to the patients. Throughout the study flexible dosing is allowed based on the investigator's discretion. Study medication is to be taken in the morning orally, with water. A study treatment period of 6 months is planned for all patients.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patient meets the DSM-IV criteria for schizophrenia
  • Patient has a PANSS total score at screening of 60 to 100, inclusive
  • Patient must, in the opinion of the investigator, benefit from treatment with paliperidone ER or olanzapine
  • Patients on lipid-lowering therapy must be on a stable dose for at least 4 weeks for statins, niacin, ezetimibe and resins or for at least 12 weeks for fibrates
  • Female patients must be postmenopausal (for at least 1 year), surgically sterile, abstinent, or, if sexually active, be practicing and effective method of birth control (e.g. prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, contraceptive patch, male partner sterilization) before entry and throughout the study
  • Women of child-bearing potential must have a negative urine pregnancy test at screening
  • Patient is healthy on the basis of a physical examination and vital signs at screening

Exclusion Criteria:

  • Patient has previously been treated with paliperidone ER, olanzapine, or clozapine within the past 6 months or has never been treated with an antipsychotic before
  • Treatment with a depot antipsychotic within the past 3 months
  • Treatment with a mood stabilizer or a recently initiated antidepressant (<= 3 months)
  • Patient has abnormal fasting plasma glucose (> 126 mg/dL) or fasting triglycerides (TG) levels (> 400 mg/dL) at screening
  • Relevant history of any significant and/or unstable cardiovascular, respiratory, neurologic (including seizures or significant cerebrovascular), renal, hepatic, endocrine, or immunologic diseases, including recent or present clinically relevant laboratory abnormalities (as deemed by the investigator)
  • History or current symptoms of tardive dyskinesia
  • History of neuroleptic malignant syndrome
  • Pregnant or breast-feeding female
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00645099

  Show 46 Study Locations
Sponsors and Collaborators
Janssen-Cilag International NV
Investigators
Study Director: Janssen-Cilag International NV Clinical Trial Janssen-Cilag International NV
  More Information

Additional Information:
No publications provided

Responsible Party: Janssen-Cilag International NV
ClinicalTrials.gov Identifier: NCT00645099     History of Changes
Other Study ID Numbers: CR013189, R076477SCH3020
Study First Received: March 24, 2008
Results First Received: April 7, 2010
Last Updated: April 24, 2014
Health Authority: Belgium: Ministry of Social Affairs, Public Health and the Environment
Spain: Comité Ético de Investigación Clínica

Keywords provided by Janssen-Cilag International NV:
Paliperidone ER
Olanzapine
Schizophrenia

Additional relevant MeSH terms:
Schizophrenia
Mental Disorders
Schizophrenia and Disorders with Psychotic Features
9-hydroxy-risperidone
Olanzapine
Antiemetics
Antipsychotic Agents
Autonomic Agents
Central Nervous System Agents
Central Nervous System Depressants
Gastrointestinal Agents
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Neurotransmitter Uptake Inhibitors
Peripheral Nervous System Agents
Pharmacologic Actions
Physiological Effects of Drugs
Psychotropic Drugs
Serotonin Agents
Serotonin Uptake Inhibitors
Therapeutic Uses
Tranquilizing Agents

ClinicalTrials.gov processed this record on November 27, 2014