Introduction
Borderline Personality Disorder (BPD) is a severe mental illness characterized by instability in affect regulation, self-image, cognition, interpersonal relationships, and impulse control. With a prevalence of 1.8–5.9%, BPD significantly impacts quality of life and has a high risk of suicide. Currently, there are no FDA-approved pharmacotherapies for BPD, and treatment primarily involves off-label medication use and structured psychotherapy.
Study Design
This phase 2, multinational, randomized, double-blind, placebo-controlled trial aimed to evaluate the efficacy and safety of BI 1358894, a novel TRPC4/5 inhibitor, in patients with BPD. The trial involved 390 patients across 67 centers in 17 countries, randomized to receive placebo or BI 1358894 at various doses for 12 weeks.
Results
The trial did not meet its primary endpoint, with no significant differences in BPD symptom improvement between BI 1358894 treatment groups and placebo. A substantial placebo response was observed, complicating the interpretation of treatment efficacy. BI 1358894 was well-tolerated, with a safety profile consistent with previous studies. Adverse events were common across all treatment arms, including placebo, suggesting a nocebo effect.
Discussion
The high placebo response and lack of significant treatment effect highlight the challenges in developing effective pharmacotherapies for BPD. The study underscores the need for innovative trial designs and treatment strategies to address the complex nature of BPD. Despite the lack of efficacy, the safety and tolerability of BI 1358894 support further investigation into its potential therapeutic role.
Conclusion
This phase 2 trial of BI 1358894 in patients with BPD did not demonstrate significant efficacy over placebo but confirmed the drug's safety and tolerability. The findings emphasize the need for continued research into novel treatments for BPD, considering the disorder's complexity and the challenges of high placebo responses in clinical trials.
