Extension Study of the Safety and Efficacy of Armodafinil Treatment as Adjunctive Therapy in Adults With Major Depression Associated With Bipolar I Disorder

Phase 3

Terminated

Conditions: Depression

Interventions: Drug: Armodafinil

Registration Number: NCT01121536

Lead Sponsor: Cephalon

Brief Summary: The primary objective of this study is to evaluate the safety and tolerability of long term (6 months) armodafinil treatment as adjunctive therapy to mood-stabilizing medications in adults with bipolar I disorder.

Detailed Description: Not available

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 867

Inclusion Criteria

The patient has completed 8 weeks of treatment in a Cephalon-sponsored Phase 3, double-blind study of armodafinil treatment in patients with major depression associated with bipolar I disorder.
The patient met criteria for enrollment in the previous double-blind study and, in the opinion of the investigator, is in need of continued treatment for depression.
During the previous double-blind study, the patient must have been taking 1 (or 2) of the following protocol-allowed mood stabilizers: lithium; valproic acid; olanzapine; quetiapine; aripiprazole; lamotrigine; risperidone; ziprasidone, (only if taken in combination with lithium, valproic acid, or lamotrigine). The following criteria must also be met:
1. The mood stabilizers must be taken in an oral formulation, with the exception of risperidone, which can be either in an oral or long-acting injection formulation.
2. The patient may be taking 2 protocol-allowed mood stabilizers only if 1 of the drugs is lithium, valproic acid, or lamotrigine.
3. The patient must be judged by the investigator to be compliant with treatment with the mood stabilizer(s).
4. The patient must be willing to continue treatment with the same protocol-allowed mood stabilizer(s) at dosages considered appropriate by the investigator.
The patient has a Young Mania Rating Scale (YMRS) total score of 14 or less at the enrollment visit. Patients who have a YMRS score of 12 through 14 must be discussed with the medical monitor to determine their suitability for enrollment.

Key

Exclusion Criteria

The patient has any Axis I or Axis II disorder apart from bipolar I disorder that became the primary focus of treatment during the double-blind study.
The patient has psychotic symptoms or had psychosis during the double-blind study.
The patient has current active suicidal ideation, is at imminent risk of self harm, or has a history of significant suicidal ideation or suicide attempt at any time in the past that causes concern at present.
The patient met criteria for alcohol or substance abuse or dependence (with the exception of nicotine dependence) during the double-blind study.
The patient has any history of homicidal ideation or significant aggression or currently has homicidal or significant aggressive ideation.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Armodafinil 150-200 mg/day	Armodafinil	Participants began taking armodafinil at a dosage of 50 mg/day; the dosage was increased by 50 mg/day on days 2 and 4, up to a dosage of 150 mg/day. At the discretion of the investigator, the dosage of armodafinil may be increased to 200 mg/day on day 6 or thereafter, and reduced to 150mg/day if the higher dose is not well tolerated. Treatment was administered for six months.

Primary Outcome Measures

Name	Time	Method
Participants With Clinically Significant Abnormal Vital Signs Values	Day 1 to Month 6	Summary of vital signs tests in which at least one participant had a during study value that was clinically significant abnormal. Criterion for clinically significant abnormal vital signs are based on FDA Neuropharmacological Division criteria: * Pulse high: \>=120 beats per minute (bpm) and increase of \>=15 bpm from baseline * Pulse low: \<=50 bpm and decrease of \>=15 bpm from baseline * Sitting systolic blood pressure high: \>=180 mm Hg and increase of \>=20 mm Hg from baseline * Sitting systolic blood pressure low: \<=90 mm Hg and decrease of \>=20 mm Hg from baseline * Sitting diastolic blood pressure high: \>=105 mm Hg and increase of \>=15 mm Hg from baseline * Sitting diastolic blood pressure low: \<=50 mm Hg and decrease of \>=15 mm Hg from baseline
Participants With Findings During the Open-Label Study on the Columbia-Suicide Severity Rating Scale 'Since Last Visit' Version (C-SSRS-SLV)	Day 1, Week 1, Months 1, 2, 4 and 6 or last post-baseline visit	The C-SSRS is a clinician-rated scale that assesses suicidality from ideation to behaviors and monitors the potential emergence of suicidality in clinical studies. The number of participants who had findings on any of the C-SSRS-SLV (SLV=since last visit) categories at any of the time frames are indicated. - C-SSRS=Columbia Suicide Severity Rating Scale
Participants With Clinically Significant Abnormal Urinalysis Values	Day 1 to Month 6	Summary of urinalysis tests in which at least one participant had a during study value that was clinically significant abnormal. Criterion for clinically significant abnormal urinalysis tests was \>=2 unit increase from baseline.
Physical Examination Shifts From Baseline to Endpoint	Day 0 (baseline), Month 6 (or last post-baseline observation)	Baseline is the day prior to double-blind treatment. Assessments are summarized as normal or abnormal. The first assessment is the baseline assessment followed by the endpoint assessment. For example 'normal/abnormal' indicates participants who were normal at baseline and abnormal at endpoint. HEENT = Head, Eye, Ear, Nose and Throat exam
Participants With Treatment-Emergent Adverse Events (TEAE)	Day 1 up to Month 6	AEs were graded by the investigator for severity on a three-point scale: mild, moderate and severe. Causality is graded as either related or not related. A serious adverse event (SAE) is an AE resulting in death, a life-threatening adverse event, hospitalization, a persistent or significant disability/incapacity, a congenital anomaly/birth defect, or an important medical event that may require medical intervention to prevent any of the previous results. Protocol-defined adverse events requiring expedited reporting included skin rash, hypersensitivity reaction, emergent suicidal ideation or suicide attempt, and psychosis.
Participants With Clinically Significant Abnormal Hematology Values	Day 1 to Month 6	Summary of hematology tests in which at least one participant had a during study value that was clinically significant abnormal. The test name and criterion for clinically significant abnormal appear in each row. * ULN=upper limit of normal * WBC - white blood cell counts with a normal range of 3.8-10.7 10\^9/L. * Hemoglobin with a normal range of 115-181 g/L * Hematocrit with a normal range of 0.34-0.54 L/L * Platelet counts with a normal range of 130-400 10\^9/L * ANC= absolute neutrophil counts with a normal range of 1.96-7.23 10\^9/L
Change From Baseline to Endpoint in Electrocardiogram (ECG) Values	Day 0 (baseline), Month 6 or last post-baseline observation	ECG was conducted at baseline which was before the first dose of study drug in the double-blind study, and at the month-6 visit of the open-label study (or early termination). RR= inter-beat intervals
Participants With Clinically Significant Abnormal Serum Chemistry Values	Day 1 to Month 6	Summary of serum chemistry tests in which at least one participant had a during study value that was clinically significant abnormal. The test name and criterion for clinically significant abnormal appear in each row. * ULN=upper limit of normal * BUN=Blood Urea Nitrogen; Uric acid has a normal range of 125-494 μmol/L. Criterion for clinically significant abnormal are different for men and women. * GGT = gamma-glutamyl transpeptidase with a normal range of 4-61 U/L * ALT = alanine aminotransferase with a normal range of 6-43 U/L * BUN = blood urea nitrogen with a normal range of 1.4-8.6 mmol/L * AST = aspartate aminotransferase with a normal range of 9-36 U/L
Change From Baseline to Endpoint in Body Weight	Day 0 (baseline), Month 6 (or last post-baseline observation)	Baseline was the score before the first dose of study drug in the double-blind study.
Change From Baseline to Endpoint in the Young Mania Rating Scale (YMRS) Total Score	Day 0 (baseline), Month 6 or last post-baseline observation	The YMRS is a clinician-rated, 11-item checklist used to measure the severity of manic episodes. Information for assigning scores is gained from the participant's subjective reported symptoms over the previous 48 hours and from clinical observation during the interview. Seven items are ranked 0 through 4 and have descriptors associated with each severity level. Four items (irritability, speech, content, and disruptive-aggressive behavior) are scored 0 through 8 and have descriptors for every second increment. The total scale is 0-60. A score of ≤12 indicates remission of manic symptoms, and higher scores indicate greater severity of mania. Negative change from baseline scores indicate a decrease in severity of mania. Baseline was the score before the first dose of study drug in the double-blind study.
Change From Baseline to Endpoint in the Hamilton Anxiety Scale (HAM-A) Total Score	Day 0 (baseline), Month 6 or last post-baseline observation	HAM-A measures the severity of anxiety symptoms. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where \<17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe. Negative change from baseline scores indicate a decrease in severity of anxiety. Baseline was the score before the first dose of study drug in the double-blind study.
Change From Baseline to Endpoint in the Insomnia Severity Index (ISI) Total Score	Day 0 (baseline), Month 6 (or last post-baseline observation)	The ISI is a participant-rated, 7-item questionnaire designed to assess the severity of the participant's insomnia. Each item is ranked 0 (none) through 4 (very severe) and has a descriptor associated with each severity level. Total range is 0 (no insomnia) to 28 (very severe insomnia). Responses to each item are added to obtain a total score to determine the severity of insomnia. Negative change from baseline scores indicate a decrease in severity of insomnia. Baseline was the assessment before the first dose of study drug in the double-blind study.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline to Week 1 and Months 1, 2, 4, 6 and Endpoint in the Total Score From the 30-Item Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C30)	Day 0 (baseline), Week 1, Months 1, 2, 4, 6 and the last post-baseline assessment)	The IDS-C30 is a standardized 30-item, clinician-rated scale to assess the severity of a participant's depressive symptoms. Every effort was made to have the same rater evaluate a participant across all visits. Total scores range from 0-84, with a score of 0 indicating no depression and a score of 84 indicating the most severe depression. Negative change from baseline values indicate improvement in the severity of depression. Baseline was the score before the first dose of study drug in the double-blind study.
Change From Baseline to Endpoint in the Global Assessment for Functioning (GAF) Scale	Day 0 (baseline), Month 6 or the last post-baseline assessment)	The Global Assessment of Functioning (GAF) is a numeric scale (1 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. Ratings of 1 - 10 mean the participant is in persistent danger of severely hurting self or others (e.g., recurrent violence) or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death. Ratings of 91 - 100 indicate no symptoms, and the participant exhibits superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. Positive change from baseline values indicate improvement in functioning. Baseline was the score before the first dose of study drug in the double-blind study.
Change From Baseline to Week 1 and Months 1, 2, 4, 6 and Endpoint in the Clinical Global Impression of Severity (CGI-S) for Depression	Day 0 (baseline), Week 1, Months 1, 2, 4, 6 and the last post-baseline assessment)	The CGI-S is an observer-rated scale that measures illness severity on a 7-point scale, with the severity of illness scale using a range of responses from 1 (normal) through to 7 (amongst the most severely ill patients). Negative change from baseline values indicate improvement in the severity of depression. Baseline was the score before the first dose of study drug in the double-blind study.
Change From Baseline to Week 1 and Months 1, 2, 4, 6 and Endpoint in the Total Score From the 16-Item Quick Inventory of Depressive Symptomatology-Clinician-Rated (QIDS-C16)	Day 0 (baseline), Week 1, Months 1, 2, 4, 6 and the last post-baseline assessment)	The QIDS-C16 was derived from specified items in the IDS-C30, clinician-rated scale to assess the severity of a participant's depressive symptoms. Total scores range from 0-27, with a score of 0 indicating no depression and a score of 27 indicating the most severe depression. Negative change from baseline values indicate improvement in the severity of depression. Baseline was the score before the first dose of study drug in the double-blind study.

Trial Locations

Locations (158): Teva Investigational Site 411
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Staten Island, New York, United States
Teva Investigational Site 105
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Raleigh, North Carolina, United States
Teva Investigational Site 603
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Watertown, Massachusetts, United States
Teva Investigational Site 110
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Staten Island, New York, United States
Teva Investigational Site 213
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Canton, Ohio, United States
Teva Investigational Site 103
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Mount Laurel, New Jersey, United States
Teva Investigational Site 406
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Allentown, Pennsylvania, United States
Teva Investigational Site 403
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DeSoto, Texas, United States
Teva Investigational Site 195
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Park Ridge, Illinois, United States
Teva Investigational Site 212
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Mount Laurel, New Jersey, United States
Teva Investigational Site 104
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Brooklyn, New York, United States
Teva Investigational Site 193
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Albuquerque, New Mexico, United States
Teva Investigational Site 207
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Brooklyn, New York, United States
Teva Investigational Site 600
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Lafayette, Indiana, United States
Teva Investigational Site 117
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Media, Pennsylvania, United States
Teva Investigational Site 133
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Saint Louis, Missouri, United States
Teva Investigational Site 697
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Rimavska Sobota, Slovakia
Teva Investigational Site 290
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Flowood, Mississippi, United States
Teva Investigational Site 190
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Beachwood, Ohio, United States
Teva Investigational Site 100
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Bellevue, Washington, United States
Teva Investigational Site 605
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Spokane, Washington, United States
Teva Investigational Site 136
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Buenos Aires, Argentina
Teva Investigational Site 612
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Friendswood, Texas, United States
Teva Investigational Site 224
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Irving, Texas, United States
Teva Investigational Site 712
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Cape Town, South Africa
Teva Investigational Site 299
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Penticton, Canada
Teva Investigational Site 687
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Pisa, Italy
Teva Investigational Site 651
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Dresden, Germany
Teva Investigational Site 106
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Memphis, Tennessee, United States
Teva Investigational Site 134
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Buenos Aires, Argentina
Teva Investigational Site 450
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Buenos Aires, Argentina
Teva Investigational Site 296
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Mississauga, Canada
Teva Investigational Site 688
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Catania, Italy
Teva Investigational Site 881
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Buenos Aires, Argentina
Teva Investigational Site 689
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Firenze, Italy
Teva Investigational Site 141
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Brisbane, Australia
Teva Investigational Site 655
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Achim, Germany
Teva Investigational Site 138
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La Plata, Buenos Aires, Argentina
Teva Investigational Site 249
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Plovdiv, Bulgaria
Teva Investigational Site 145
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Plovdiv, Bulgaria
Teva Investigational Site 286
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Dole, France
Teva Investigational Site 153
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Nimes, France
Teva Investigational Site 884
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Buenos Aires, Argentina
Teva Investigational Site 236
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Cordoba, Argentina
Teva Investigational Site 240
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Malvern, Australia
Teva Investigational Site 624
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Rio de Janeiro, Brazil
Teva Investigational Site 135
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Cordoba, Argentina
Teva Investigational Site 198
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Kelowna, Canada
Teva Investigational Site 336
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Alcoy, Spain
Teva Investigational Site 430
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Vitoria-Gasteiz, Spain
Teva Investigational Site 156
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Kielce, Poland
Teva Investigational Site 692
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Rome, Italy
Teva Investigational Site 661
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Budapest, Hungary
Teva Investigational Site 196
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Mississauga, Canada
Teva Investigational Site 709
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Cape Town, South Africa
Teva Investigational Site 708
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Centurion, South Africa
Teva Investigational Site 434
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Coslada (Madrid), Spain
Teva Investigational Site 175
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Belgrade, Serbia
Teva Investigational Site 255
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Skorzewo, Poland
Teva Investigational Site 873
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Lviv, Ukraine
Teva Investigational Site 183
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Poltava, Ukraine
Teva Investigational Site 433
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Vitoria, Spain
Teva Investigational Site 184
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Simferopol, Ukraine
Teva Investigational Site 180
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Lugansk, Ukraine
Teva Investigational Site 871
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S. Oleksandrivka, Ukraine
Teva Investigational Site 182
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Vinnytsya, Ukraine
Teva Investigational Site 300
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Pikesville, Maryland, United States
Teva Investigational Site 228
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Houston, Texas, United States
Teva Investigational Site 229
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Anaheim, California, United States
Teva Investigational Site 217
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Cerritos, California, United States
Teva Investigational Site 223
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Cerritos, California, United States
Teva Investigational Site 115
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Garden Grove, California, United States
Teva Investigational Site 121
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Imperial, California, United States
Teva Investigational Site 303
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Oceanside, California, United States
Teva Investigational Site 400
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Oceanside, California, United States
Teva Investigational Site 200
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Pico Rivera, California, United States
Teva Investigational Site 122
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Temecula, California, United States
Teva Investigational Site 119
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North Miami, Florida, United States
Teva Investigational Site 606
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Jacksonville Beach, Florida, United States
Teva Investigational Site 132
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Jacksonville, Florida, United States
Teva Investigational Site 295
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Sherman Oaks, California, United States
Teva Investigational Site 192
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Santa Ana, California, United States
Teva Investigational Site 292
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Santa Ana, California, United States
Teva Investigational Site 127
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Lauderhill, Florida, United States
Teva Investigational Site 205
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Atlanta, Georgia, United States
Teva Investigational Site 116
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Atlanta, Georgia, United States
Teva Investigational Site 204
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Smyrna, Georgia, United States
Teva Investigational Site 107
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Naperville, Illinois, United States
Teva Investigational Site 219
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Oakbrook Terrace, Illinois, United States
Teva Investigational Site 102
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Dayton, Ohio, United States
Teva Investigational Site 237
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Buenos Aires, Argentina
Teva Investigational Site 409
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Orem, Utah, United States
Teva Investigational Site 613
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Kirkland, Washington, United States
Teva Investigational Site 148
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Kazanlak, Bulgaria
Teva Investigational Site 852
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Pleven, Bulgaria
Teva Investigational Site 853
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Pazardjik, Bulgaria
Teva Investigational Site 370
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Ruse, Bulgaria
Teva Investigational Site 128
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San Diego, California, United States
Teva Investigational Site 201
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San Diego, California, United States
Teva Investigational Site 610
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Cincinnati, Ohio, United States
Teva Investigational Site 710
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Johannesburg, South Africa
Teva Investigational Site 711
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Paarl, South Africa
Teva Investigational Site 706
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Pretoria, South Africa
Teva Investigational Site 129
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Rochester, New York, United States
Teva Investigational Site 202
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New York, New York, United States
Teva Investigational Site 259
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Bialystok, Poland
Teva Investigational Site 258
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Gdansk, Poland
Teva Investigational Site 256
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Leszno, Poland
Teva Investigational Site 861
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Szczecin, Poland
Teva Investigational Site 157
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Tuszyn, Poland
Teva Investigational Site 833
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Belgrade, Serbia
Teva Investigational Site 837
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Nis, Serbia
Teva Investigational Site 235
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Buenos Aires, Argentina
Teva Investigational Site 462
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Buenos Aires, Argentina
Teva Investigational Site 371
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La Plata, Argentina
Teva Investigational Site 238
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Rosario, Argentina
Teva Investigational Site 245
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Varna, Bulgaria
Teva Investigational Site 851
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Varna, Bulgaria
Teva Investigational Site 113
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Birmingham, Alabama, United States
Teva Investigational Site 225
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Birmingham, Alabama, United States
Teva Investigational Site 608
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Tampa, Florida, United States
Teva Investigational Site 118
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Tampa, Florida, United States
Teva Investigational Site 401
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Oklahoma City, Oklahoma, United States
Teva Investigational Site 609
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Oklahoma City, Oklahoma, United States
Teva Investigational Site 616
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Oklahoma City, Oklahoma, United States
Teva Investigational Site 408
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Salt Lake City, Utah, United States
Teva Investigational Site 696
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Roznava, Slovakia
Teva Investigational Site 146
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Kardzhali, Bulgaria
Teva Investigational Site 155
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Krakow, Poland
Teva Investigational Site 147
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Sofia, Bulgaria
Teva Investigational Site 855
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Sofia, Bulgaria
Teva Investigational Site 247
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Sofia, Bulgaria
Teva Investigational Site 248
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Bourgas, Bulgaria
Teva Investigational Site 634
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Zagreb, Croatia
Teva Investigational Site 633
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Zagreb, Croatia
Teva Investigational Site 666
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Nagykallo, Hungary
Teva Investigational Site 664
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Budapest, Hungary
Teva Investigational Site 854
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Sofia, Bulgaria
Teva Investigational Site 635
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Rijeka, Croatia
Teva Investigational Site 257
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Gdansk, Poland
Teva Investigational Site 831
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Belgrade, Serbia
Teva Investigational Site 698
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Trencin, Slovakia
Teva Investigational Site 832
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Belgrade, Serbia
Teva Investigational Site 176
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Kragujevac, Serbia
Teva Investigational Site 662
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Budapest, Hungary
Teva Investigational Site 177
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Belgrade, Serbia
Teva Investigational Site 834
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Novi Knezevac, Serbia
Teva Investigational Site 699
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Bratislava, Slovakia
Teva Investigational Site 181
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Dnipropetrovsk, Ukraine
Teva Investigational Site 281
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Kiev, Ukraine
Teva Investigational Site 875
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Odessa, Ukraine
Teva Investigational Site 872
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Donetsk, Ukraine
Teva Investigational Site 282
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Kharkiv, Ukraine
Teva Investigational Site 280
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Odessa, Ukraine
Teva Investigational Site 131
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Gainesville, Florida, United States
Teva Investigational Site 404
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Richmond, Virginia, United States
Teva Investigational Site 111
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Austin, Texas, United States
Teva Investigational Site 301
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Naperville, Illinois, United States