Efficacy and Safety of a Combination of Olanzapine and Samidorphan in Adult Patients With an Acute Exacerbation of Schizophrenia: Outcomes From the Randomized, Phase 3 ENLIGHTEN-1 Study.

Abstract

OBJECTIVE:

To assess the antipsychotic efficacy and safety of a combination of olanzapine and samidorphan (OLZ/SAM).

METHODS:

This 4-week, phase 3, randomized, double-blind, placebo- and olanzapine-controlled study was conducted from December 2015 to June 2017 in adults with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria who were experiencing an acute exacerbation. Patients were randomized 1:1:1 to OLZ/SAM, olanzapine monotherapy, or placebo. The primary and key secondary efficacy endpoint assessed was the change in Positive and Negative Syndrome Scale (PANSS) total score and Clinical Global Impressions-Severity of Illness Scale (CGI-S) score between baseline and week 4, respectively, for OLZ/SAM versus placebo. Safety monitoring occurred throughout.

RESULTS:

401 patients received ≥ 1 dose of study drug; 352 completed treatment. Treatment with OLZ/SAM resulted in significant improvements versus placebo in PANSS total and CGI-S scores from baseline to week 4 (least squares [LS] mean ± SE: -6.4 ± 1.8 [P < .001] and -0.38 ± 0.12 [P = .002], respectively). Olanzapine treatment resulted in similar improvements (PANSS and CGI-S LS mean ± SE of -5.3 ± 1.84 [P = .004] and -0.44 ± 0.12 [P < .001], respectively). Adverse events (AEs) occurred in 54.5%, 54.9%, and 44.8% of patients on OLZ/SAM, olanzapine, and placebo, respectively. Weight gain, somnolence, dry mouth, anxiety, and headache were the most common AEs (ie, ≥ 5%) with active treatment.

CONCLUSIONS:

OLZ/SAM treatment resulted in statistically and clinically significant efficacy improvements over 4 weeks versus placebo in adults with acutely exacerbated schizophrenia. Improvements were similar to those observed with olanzapine. OLZ/SAM was well tolerated, with a safety profile similar to that of olanzapine.

TRIAL REGISTRATIONS:

ClinicalTrials.gov identifier: NCT02634346; EudraCT number: 2015-003373-15​​.

• Authors: Steven G Potkin, Jelena Kunovac, Bernard L Silverman, Adam Simmons, Ying Jiang, Lauren DiPetrillo, David McDonnell
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 81 Issue 2 (03 03 2020) ISSN: 1555-2101 [Electronic] United States
• PMID: 32141723 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Copyright 2020 Physicians Postgraduate Press, Inc.

Chemical References

• Antipsychotic Agents
• Drug Combinations
• Narcotic Antagonists
• Naltrexone
• 3-carboxamido-4-hydroxynaltrexone
• Olanzapine

Topics

• Acute Disease
• Adult
• Antipsychotic Agents (administration & dosage, pharmacology)
• Double-Blind Method
• Drug Combinations
• Female
• Humans
• Male
• Middle Aged
• Naltrexone (administration & dosage, analogs & derivatives, pharmacology)
• Narcotic Antagonists (administration & dosage, pharmacology)
• Olanzapine (administration & dosage, pharmacology)
• Outcome Assessment, Health Care
• Schizophrenia (drug therapy)
• Symptom Flare Up