Asenapine for the Acute Treatment of Pediatric Manic or Mixed Episode of Bipolar I Disorder.

Abstract

OBJECTIVE:

To evaluate asenapine versus placebo in 403 patients aged 10 to 17 years with bipolar I disorder currently in manic or mixed episodes.

METHOD:

In this double-blind, placebo-controlled, international trial, patients were randomized 1:1:1:1 to placebo, asenapine 2.5, 5, or 10 mg b.i.d. (twice daily). Primary efficacy measure was change from baseline in Young-Mania Rating Scale (YMRS) total score at day 21. Analyses of patients with/without attention-deficit/hyperactivity disorder (ADHD) and with/without stimulant use were performed.

RESULTS:

The mean difference in asenapine versus placebo in YMRS was -3.2 (p = .0008), -5.3 (p < .001), and -6.2 (p < .001) for asenapine 2.5, 5, and 10 mg b.i.d., respectively. Treatment-emergent adverse events with an incidence ≥5% and at least twice placebo were somnolence, sedation, hypoesthesia oral, paresthesia oral, and increased appetite. The asenapine groups had a higher incidence of ≥7% weight gain (range, 8.0%-12.0%) versus placebo (1.1%; p < .05). The mean change from baseline in fasting insulin was larger for patients treated with asenapine than those with placebo (asenapine 2.5 mg b.i.d.: 73.375 pmol/L; asenapine 5 mg b.i.d.: 114.042 pmol/L; asenapine 10 mg b.i.d.: 59.846 pmol/L; placebo: 3.690 pmol/L). The mean changes from baseline for lipid parameters and glucose were also larger in asenapine groups than in the placebo group. No safety differences were observed with respect to ADHD and stimulant use.

CONCLUSION:

All asenapine doses versus placebo were superior based on change in YMRS at day 21. Asenapine was generally well tolerated in patients aged 10 to 17 years with bipolar I disorder in manic or mixed states. Increases in weight and fasting insulin were associated with asenapine. Clinical trial registration information-Efficacy and Safety of Asenapine Treatment for Pediatric Bipolar Disorder; http://clinicaltrials.gov; NCT01244815.

• Authors: Robert L Findling, Ronald L Landbloom, Armin Szegedi, Janelle Koppenhaver, Sabine Braat, Qi Zhu, Mary Mackle, Kiki Chang, Maju Mathews
• Journal: Journal of the American Academy of Child and Adolescent Psychiatry (J Am Acad Child Adolesc Psychiatry) Vol. 54 Issue 12 Pg. 1032-41 (Dec 2015) ISSN: 1527-5418 [Electronic] United States
• PMID: 26598478 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antipsychotic Agents
• Dibenzocycloheptenes
• Heterocyclic Compounds, 4 or More Rings
• Benzodiazepines
• asenapine

Topics

• Adolescent
• Antipsychotic Agents (administration & dosage, adverse effects)
• Benzodiazepines (administration & dosage, adverse effects)
• Bipolar Disorder (drug therapy)
• Child
• Dibenzocycloheptenes
• Dose-Response Relationship, Drug
• Double-Blind Method
• Female
• Heterocyclic Compounds, 4 or More Rings (administration & dosage, adverse effects)
• Humans
• Logistic Models
• Male
• Psychiatric Status Rating Scales
• Russia
• United States