Trial Outcomes & Findings for A Study to Assess the Safety and Efficacy of ASP4345 as Add-on Treatment for Cognitive Impairment in Subjects With Schizophrenia on Stable Doses of Antipsychotic Medication (NCT NCT03557931)

NCT ID: NCT03557931

Last Updated: 2024-11-12

Results Overview

The MCCB is a cognitive battery to assess 7 domains recommended by the MATRICS initiative (i.e., working memory, verbal learning, speed of processing, attention/vigilance, visual learning, social cognition, reasoning and problem solving). The MCCB neurocognitive composite score is a standardized mean of the six domain scores (excluding social cognition). Raw scores are converted to age and sex adjusted t-scores which are standardized to normative data, and have a mean of 50 and standard deviation of 10 in the general healthy population. A higher score indicates less impairment.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

233 participants

Primary outcome timeframe

Baseline and week 12/end of treatment (EoT)

Results posted on

2024-11-12

Participant Flow

Participants who were 18 to 55 years of age (inclusive at screening) with stable schizophrenia or schizoaffective disorder with mild extrapyramidal symptoms on up to 2 antipsychotic therapies and who met inclusion criteria and none of the exclusion criteria were enrolled.

Participant milestones

Participant milestones
Measure
Placebo
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 Milligrams (mg)
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Overall Study
STARTED
100
65
68
Overall Study
COMPLETED
69
46
55
Overall Study
NOT COMPLETED
31
19
13

Reasons for withdrawal

Reasons for withdrawal
Measure
Placebo
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 Milligrams (mg)
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Overall Study
Adverse Event
4
6
1
Overall Study
Lost to Follow-up
4
4
1
Overall Study
Protocol Violation
1
4
1
Overall Study
Withdrawal by Subject
14
0
7
Overall Study
Miscellaneous
8
5
3

Baseline Characteristics

ITT population with available data at baseline.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Placebo
n=100 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=65 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=68 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Total
n=233 Participants
Total of all reporting groups
Ethnicity (NIH/OMB)
Not Hispanic or Latino
86 Participants
n=100 Participants
62 Participants
n=65 Participants
64 Participants
n=68 Participants
212 Participants
n=233 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=100 Participants
0 Participants
n=65 Participants
0 Participants
n=68 Participants
0 Participants
n=233 Participants
Age, Continuous
42.8 years
STANDARD_DEVIATION 9.1 • n=100 Participants
42.7 years
STANDARD_DEVIATION 9.2 • n=65 Participants
42.8 years
STANDARD_DEVIATION 9.9 • n=68 Participants
42.8 years
STANDARD_DEVIATION 9.3 • n=233 Participants
Sex: Female, Male
Female
27 Participants
n=100 Participants
23 Participants
n=65 Participants
20 Participants
n=68 Participants
70 Participants
n=233 Participants
Sex: Female, Male
Male
73 Participants
n=100 Participants
42 Participants
n=65 Participants
48 Participants
n=68 Participants
163 Participants
n=233 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
14 Participants
n=100 Participants
3 Participants
n=65 Participants
4 Participants
n=68 Participants
21 Participants
n=233 Participants
Race (NIH/OMB)
American Indian or Alaska Native
1 Participants
n=100 Participants
1 Participants
n=65 Participants
0 Participants
n=68 Participants
2 Participants
n=233 Participants
Race (NIH/OMB)
Asian
2 Participants
n=100 Participants
1 Participants
n=65 Participants
4 Participants
n=68 Participants
7 Participants
n=233 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=100 Participants
0 Participants
n=65 Participants
0 Participants
n=68 Participants
0 Participants
n=233 Participants
Race (NIH/OMB)
Black or African American
72 Participants
n=100 Participants
48 Participants
n=65 Participants
47 Participants
n=68 Participants
167 Participants
n=233 Participants
Race (NIH/OMB)
White
24 Participants
n=100 Participants
14 Participants
n=65 Participants
17 Participants
n=68 Participants
55 Participants
n=233 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=100 Participants
0 Participants
n=65 Participants
0 Participants
n=68 Participants
0 Participants
n=233 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants
n=100 Participants
1 Participants
n=65 Participants
0 Participants
n=68 Participants
2 Participants
n=233 Participants
MATRICS Consensus Cognitive Battery (MCCB) Neurocognitive Composite Score
32.6 T-score
STANDARD_DEVIATION 13.3 • n=99 Participants • ITT population with available data at baseline.
34 T-score
STANDARD_DEVIATION 10.7 • n=65 Participants • ITT population with available data at baseline.
33.7 T-score
STANDARD_DEVIATION 12.3 • n=68 Participants • ITT population with available data at baseline.
33.3 T-score
STANDARD_DEVIATION 12.3 • n=232 Participants • ITT population with available data at baseline.
UPSA-2-ER Total Score
74.4 units on a scale
STANDARD_DEVIATION 16.7 • n=82 Participants • ITT population with available data at baseline.
80.2 units on a scale
STANDARD_DEVIATION 13.2 • n=59 Participants • ITT population with available data at baseline.
78.1 units on a scale
STANDARD_DEVIATION 15.5 • n=63 Participants • ITT population with available data at baseline.
77.2 units on a scale
STANDARD_DEVIATION 15.5 • n=204 Participants • ITT population with available data at baseline.

PRIMARY outcome

Timeframe: Baseline and week 12/end of treatment (EoT)

Population: The full analysis set (FAS) consisted of all participants who were randomized and received at least 1 dose of study drug and had at least 1 postbaseline MCCB measurement. FAS population with available data at baseline and week12/EoT.

The MCCB is a cognitive battery to assess 7 domains recommended by the MATRICS initiative (i.e., working memory, verbal learning, speed of processing, attention/vigilance, visual learning, social cognition, reasoning and problem solving). The MCCB neurocognitive composite score is a standardized mean of the six domain scores (excluding social cognition). Raw scores are converted to age and sex adjusted t-scores which are standardized to normative data, and have a mean of 50 and standard deviation of 10 in the general healthy population. A higher score indicates less impairment.

Outcome measures

Outcome measures
Measure
Placebo
n=67 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=45 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=51 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Change From Baseline to Week 12/End of Treatment (EoT) in Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) Neurocognitive Composite Score
1.15 T-score
Standard Error 0.65
1.34 T-score
Standard Error 0.79
0.87 T-score
Standard Error 0.75

PRIMARY outcome

Timeframe: Baseline up to end of study (EoS) (week 14)

Population: The safety analysis set (SAF) consisted of all participants who took at least 1 dose of study drug.

Treatment emergent adverse event (TEAE) is defined as an AE observed after starting administration of the study drug and 28 days after the last dose of study drug. A study drug-related TEAE is defined as any TEAE with at least possible relationship to study treatment as assessed by the investigator or with missing assessment of the causal relationship. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a medicinal product. Safety was assessed by AEs, which included abnormalities identified during a medical test (e.g. laboratory tests, vital signs, electrocardiogram, metabolic parameters etc.) if the abnormality induced clinical signs or symptoms, needed active intervention, interruption or discontinuation of study medication or was clinically significant.

Outcome measures

Outcome measures
Measure
Placebo
n=100 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=65 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=68 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Number of Participants With Adverse Event (AE)
TEAE
45 participants
28 participants
28 participants
Number of Participants With Adverse Event (AE)
Drug-Related TEAEs
11 participants
13 participants
11 participants
Number of Participants With Adverse Event (AE)
Serious TEAEs
1 participants
3 participants
1 participants
Number of Participants With Adverse Event (AE)
Drug-Related Serious TEAE
0 participants
0 participants
0 participants

PRIMARY outcome

Timeframe: Baseline up to EoS (week 14)

Population: SAF population

The C-SSRS is a questionnaire used for suicide risk assessment. Affirmative or negative responses are provided to items 1 to 5 for suicidal ideation (1. Wish to be dead, 2. Non-specific active suicidal thoughts, 3. Active suicidal ideation with any methods \[not plan\] without intent to act, 4. Active suicidal ideation with some intent to act, without specific plan, 5. Active suicidal ideation with specific plan and intent) and items 6 to 10 for suicide behavior (6. Preparatory acts or behavior, 7. Aborted attempt, 8. Interrupted attempt, 9. Actual attempt, 10. Completed suicide).

Outcome measures

Outcome measures
Measure
Placebo
n=100 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=65 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=68 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Number of Participants With Clinically Significant Differences in Columbia-Suicide Severity Rating Scale (C-SSRS) Values
0 participants
0 participants
0 participants

PRIMARY outcome

Timeframe: Baseline, week 6 and week 12

Population: SAF population with available data at each time point.

AIMS is a 14-item scale. Items 1 to 8 are rated on a 5-point scale ranging from 0 (no dyskinetic movements) to 4 (severe dyskinetic movements). Item 9 assesses the participant's incapacitation due to abnormal movements, and item 10 assesses the participant's awareness of the abnormal movements and associated distress. Items 9 and 10 are rated on 5-point scales ranging from 0 (none or no awareness) to 4 (severe or aware, severe distress). Items 11 to 14 are yes/no questions regarding the global judgement and dental status of the participant. The total score is the sum of the scores for the 14 items and the possible total score ranges from 0 to 44. A higher total score is indicative of more severe dyskinetic movements.

Outcome measures

Outcome measures
Measure
Placebo
n=93 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=62 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=65 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Number of Participants With Clinically Significant Differences in Abnormal Involuntary Movement Scale (AIMS) Values
Baseline
0 participants
0 participants
0 participants
Number of Participants With Clinically Significant Differences in Abnormal Involuntary Movement Scale (AIMS) Values
Week 6
0 participants
0 participants
0 participants
Number of Participants With Clinically Significant Differences in Abnormal Involuntary Movement Scale (AIMS) Values
Week 12
0 participants
0 participants
0 participants

PRIMARY outcome

Timeframe: Baseline, week 6 and week 12

Population: SAF population with available data at each time point.

SAS scale consists of 10 items including 7 items that address bradykinesia-rigidity and additional single items for tremor, glabellar tap, and salivation. Each item represents a specific physical condition and is rated on a 5-point category rating scale ranging from 0 (complete absence of the condition) to 4 (the condition is present to an extreme degree).The total score is obtained by adding the scores for the 10 individual items making the maximum possible score is 40. Higher scores are indicative of more severe Parkinsonian-type symptoms.

Outcome measures

Outcome measures
Measure
Placebo
n=93 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=62 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=65 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Number of Participants With Clinically Significant Differences in Simpson Angus Scale (SAS) Values
Baseline
0 participants
0 participants
0 participants
Number of Participants With Clinically Significant Differences in Simpson Angus Scale (SAS) Values
Week 6
0 participants
0 participants
0 participants
Number of Participants With Clinically Significant Differences in Simpson Angus Scale (SAS) Values
Week 12
0 participants
0 participants
0 participants

PRIMARY outcome

Timeframe: Baseline, week 6 and week 12

Population: SAF population with available data at each time point.

BARS is used to rate observable, restless movements of drug induced akathisia and subjective awareness of restlessness and any distress associated with the akathisia. BARS consists of the following 4 items: objective assessment of akathisia symptoms, subjective assessment of the participants's awareness of inner restlessness, distress restlessness, and global clinical assessment of akathisia. First three items are rated on a 4-point scale ranging from 0 (no abnormal movements or absence of inner restlessness or no distress) to 3 (severe akathisia or awareness of intense compulsion to move most of the time or severe distress). The last item, the global clinical assessment of akathisia, is rated on a 6-point scale, ranging from 0 (no evidence of akathisia) to 5 (severe akathisia). Total BARS score ranges from 0 to 14 with a higher score representing worse results.

Outcome measures

Outcome measures
Measure
Placebo
n=93 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=62 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=66 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Number of Participants With Clinically Significant Differences in Barnes Akathisia Rating Scale (BARS) Values
Baseline
0 participants
0 participants
0 participants
Number of Participants With Clinically Significant Differences in Barnes Akathisia Rating Scale (BARS) Values
Week 6
0 participants
0 participants
0 participants
Number of Participants With Clinically Significant Differences in Barnes Akathisia Rating Scale (BARS) Values
Week 12
0 participants
0 participants
0 participants

SECONDARY outcome

Timeframe: Baseline and week 12/EoT

Population: FAS population with available data at baseline and at week 12/EoT.

The UPSA-2-ER assesses the functional abilities of the participant with schizophrenia in 6 domains: household management, communication, financial skills, transportation, comprehension/planning and medication management. The UPSA-2-ER total score has a range from 0 to 105. A higher score indicates less impairment.

Outcome measures

Outcome measures
Measure
Placebo
n=55 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=40 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=44 Participants
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Change From Baseline to Week 12/EoT in University of California San Diego Performance-based Skills Assessment-2 Extended Range (UPSA-2-ER) Total Score
3.11 units on a scale
Standard Error 1.06
3.86 units on a scale
Standard Error 1.23
2.56 units on a scale
Standard Error 1.17

SECONDARY outcome

Timeframe: Predose: day 7, day 14, day 21, day 42 and day 84/EoT

Population: The pharmacokinetic analysis set (PKAS) consisted of all participants who took at least 1 dose of study drug and who had at least 1 plasma concentration. PKAS population with available data at each time point.

Ctrough concentration for ASP4345 was reported.

Outcome measures

Outcome measures
Measure
Placebo
n=54 Participants
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=60 Participants
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Concentration at Trough Level (Ctrough) for ASP4345
Day 7 Pre-dose
175.041 nanogram per milliliter (ng/mL)
Standard Deviation 159.345
483.84 nanogram per milliliter (ng/mL)
Standard Deviation 452.65
Concentration at Trough Level (Ctrough) for ASP4345
Day 14 Pre-dose
182.903 nanogram per milliliter (ng/mL)
Standard Deviation 165.499
428.88 nanogram per milliliter (ng/mL)
Standard Deviation 516.14
Concentration at Trough Level (Ctrough) for ASP4345
Day 21 Pre-dose
172.040 nanogram per milliliter (ng/mL)
Standard Deviation 128.812
384.48 nanogram per milliliter (ng/mL)
Standard Deviation 331.71
Concentration at Trough Level (Ctrough) for ASP4345
Day 42 Pre-dose
207.145 nanogram per milliliter (ng/mL)
Standard Deviation 167.127
471.78 nanogram per milliliter (ng/mL)
Standard Deviation 546.00
Concentration at Trough Level (Ctrough) for ASP4345
Day 84 Pre-dose
204.914 nanogram per milliliter (ng/mL)
Standard Deviation 154.615
433.56 nanogram per milliliter (ng/mL)
Standard Deviation 427.12

Adverse Events

Placebo

Serious events: 1 serious events
Other events: 3 other events
Deaths: 0 deaths

ASP4345 50 mg

Serious events: 3 serious events
Other events: 5 other events
Deaths: 0 deaths

ASP4345 150 mg

Serious events: 1 serious events
Other events: 7 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Placebo
n=100 participants at risk
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=65 participants at risk
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=68 participants at risk
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Injury, poisoning and procedural complications
Head injury
0.00%
0/100 • Baseline up to EoS (week 14)
1.5%
1/65 • Number of events 1 • Baseline up to EoS (week 14)
0.00%
0/68 • Baseline up to EoS (week 14)
Psychiatric disorders
Psychotic disorder
0.00%
0/100 • Baseline up to EoS (week 14)
1.5%
1/65 • Number of events 1 • Baseline up to EoS (week 14)
1.5%
1/68 • Number of events 1 • Baseline up to EoS (week 14)
Psychiatric disorders
Suicidal ideation
1.0%
1/100 • Number of events 2 • Baseline up to EoS (week 14)
0.00%
0/65 • Baseline up to EoS (week 14)
0.00%
0/68 • Baseline up to EoS (week 14)
Respiratory, thoracic and mediastinal disorders
Acute respiratory failure
0.00%
0/100 • Baseline up to EoS (week 14)
1.5%
1/65 • Number of events 1 • Baseline up to EoS (week 14)
0.00%
0/68 • Baseline up to EoS (week 14)

Other adverse events

Other adverse events
Measure
Placebo
n=100 participants at risk
Participants on stable doses of antipsychotic medication received ASP4345 placebo matching capsules, orally, once daily for 12 weeks.
ASP4345 50 mg
n=65 participants at risk
Participants on stable doses of antipsychotic medication received ASP4345 50 mg, capsules, orally, once daily for 12 weeks.
ASP4345 150 mg
n=68 participants at risk
Participants on stable doses of antipsychotic medication received ASP4345 150 mg, capsules, orally, once daily for 12 weeks.
Nervous system disorders
Dizziness
0.00%
0/100 • Baseline up to EoS (week 14)
1.5%
1/65 • Number of events 1 • Baseline up to EoS (week 14)
5.9%
4/68 • Number of events 4 • Baseline up to EoS (week 14)
Nervous system disorders
Headache
3.0%
3/100 • Number of events 3 • Baseline up to EoS (week 14)
6.2%
4/65 • Number of events 4 • Baseline up to EoS (week 14)
4.4%
3/68 • Number of events 3 • Baseline up to EoS (week 14)

Additional Information

Clinical Trial Disclosure

Astellas Pharma Global Development, Inc.

Phone: 800-888-7704

Results disclosure agreements

  • Principal investigator is a sponsor employee Institute and/or Principal Investigator may publish trial data generated at their specific study site after Sponsor publication of the multi-center data. Sponsor must receive a site's manuscript prior to publication for review and comment as specified in the Investigator Agreement.
  • Publication restrictions are in place

Restriction type: OTHER