Double-blind, Placebo-controlled, Randomised Withdrawal, Extension, Safety and Efficacy Study of LDX in Children and Adolescents Aged 6-17

A Phase III, Double-blind, Placebo-controlled, Randomised Withdrawal, Multicentre, Extension, Safety and Efficacy Study of Lisdexamfetamine Dimesylate (LDX) in Children and Adolescents Aged 6-17 With Attention- Deficit/Hyperactivity Disorder (ADHD)

The main aim of this study is to evaluate the long-term maintenance of efficacy of LDX after administered to children and adolescents aged 6-17 with ADHD for at least 6 months

Study Overview

• Status: Completed
• Conditions: ADHD
• Intervention / Treatment: Drug: Lisdexamfetamine dimesylate (LDX); Drug: Placebo

• Study Type: Interventional
• Enrollment (Actual): 276
• Phase: Phase 3

Contacts and Locations

Study Locations

• Belgium
  • Antwerpen
    • Hoboken, Antwerpen, Belgium, 2660
      • ZNA Antwerpen, Commandant Weynsstraat 165
  • Flemish Brabant
    • Leuven, Flemish Brabant, Belgium, B-3000
      • Afdeling Psychiatrie, UZ Herestraat 49
  • Oost-vlaanderen
    • Ghent, Oost-vlaanderen, Belgium, 9000
      • Universitair Ziekenhuis Gent, Kinder - en Jeugdpsychiatrie
• France
  • Montpellier Cedex 05, France, 34295
    • Hôpital Gui de Chauliac
  • Nice Cedex 03, France, 06202
    • Hospital Archet 2
  • Ile-de-france
    • Paris, Ile-de-france, France, 75019
      • Hopital Robert Debre
• Germany
  • Berlin, Germany, 13353
    • Universitätsmedizin Berlin
  • Fulda, Germany, 36037
    • Praxis Dr. Walter Robert Otto
  • Hagen, Germany, 58093
    • Praxis Dr. Wolff
  • Hamburg, Germany, 22767
    • Praxis für Neuropädiatrie
  • Hamburg, Germany, D-22415
    • Praxis Dr med. Friedrich Kaiser und Dr. med. Ingrid Marinesse
  • Marburg, Germany, 35039
    • Universitätsklinikum Gießen und Marburg GmbH, Universitätsklinikum Gießen und Marburg GmbH, Hans-Sachs-Straße 4,
  • Baden-wuttemberg
    • Freiburg, Baden-wuttemberg, Germany, 79104
      • Albert-Ludwigs-Universität Freiburg
    • Mannheim, Baden-wuttemberg, Germany, 68159
      • Zentralinstitut für Seelische Gesundheit Mannheim
  • Bayern
    • Bamberg, Bayern, Germany, 96047
      • Schwerpunktpraxis für Entwicklung und Lernen
    • Würzburg, Bayern, Germany, 97070
      • Medizinisches Studienzentrum Würzburg
    • Würzburg, Bayern, Germany, 97080
      • Universität Würzburg
  • Hessen
    • Bad Nauheim, Hessen, Germany, 61231
      • Institutsambulanz Bad Nauheim
  • Niedersachsen
    • Göttingen, Niedersachsen, Germany, 37075
      • Universität Göttingen
  • Nordrhein-westfalen
    • Köln, Nordrhein-westfalen, Germany, 50931
      • Universität zu Köln, Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes und Jugendalters
  • Rheinland-pfalz
    • Mainz, Rheinland-pfalz, Germany, 55131
      • Klinikum der Johannes Gutenberg-Universität Mainz
• Hungary
  • Budapest, Hungary, 1021
    • Vadaskert Korhaz es Szakambulancia
  • Gyula, Hungary, 5700
    • Pandy Kalman Korhaz
  • Pécs, Hungary, 7632
    • Gyermek és Ifjúságpszichiátriai Szakrendelés és Gondozó
  • Szeged, Hungary, 6750
    • Szegedi Tudomanyegyetem
• Italy
  • Bari, Italy, 70124
    • Azienda Ospedaliera Policlinico Consorziale
  • Cagliari, Italy, 9124
    • Università degli Studi di Cagliari
  • Messina, Italy, 98125
    • Azienda Ospedaliera Universitaria Policlinico G. Martino
  • Napoli, Italy, 80131
    • Azienda Ospedaliera della 2? Universita di Napoli
• Poland
  • Kujawsko-pomorskie
    • Bydgoszcz, Kujawsko-pomorskie, Poland, 85-094
      • Szpital Uniwersytecki im. Dr. Antoniego Jurasza w Bydgoszczy
    • Torun, Kujawsko-pomorskie, Poland, 87-100
      • Wojewódzki Osrodek Lecznictwa Psychiatrycznego
  • Mazowieckie
    • Warszawa, Mazowieckie, Poland, 00-576
      • Samodzielny Publiczny Dzieciecy Szpital Kliniczny, Poradnia Psychiatryczna, ul. Marszalkowska 24,
  • Pomorskie
    • Gdansk, Pomorskie, Poland, 80-282
      • Gdanski Uniwersytet Medyczna w Gdansku
  • Wielkopolskie
    • Poznan, Wielkopolskie, Poland, 60-792
      • Specjalistyczna Praktyka Lekarska
• Sweden
  • Goteborg, Sweden, 41119
    • Drottning Silvias Barnsjukhus, Otterhällegatan 12A
  • Mariestad, Sweden, 542 24
    • Utvecklingsneurologiska Enheten (UNE)
  • Stockholm, Sweden, 171 76
    • Astrid Lindgren Children's Hospital, Karolinska University Hospital
  • Stockholm, Sweden, 435 30
    • Barn och Ungdomsmedicin klinik Mölnlycke
• United Kingdom
  • Basildon, United Kingdom, SS16 5NL
    • Basildon Hospital - Child Development Centre,
  • Northampton, United Kingdom, NN1 2BG
    • Northampton Child and Adolescent Mental Health Services
  • Wigan, United Kingdom, WN2 2JA
    • Child and Family Mental Health Services
  • England
    • Birmingham, England, United Kingdom, B13 8QE
      • Parkview Clinic
    • Ramsgate, England, United Kingdom, CT11 9DH
      • East Kent NHS and Social Care Partnership Trust
  • Essex
    • Southend-on-Sea, Essex, United Kingdom, SS2 6XT
      • Lighthouse Child Development Centre
  • Fife
    • Kirkcaldy, Fife, United Kingdom, KY2 5AH
      • Victoria Hospital, Paediatric Unit
  • Scotland
    • Dundee, Scotland, United Kingdom, DD1 9SY
      • Tayside Children's Hospital
  • Yorkshire
    • Sheffield, Yorkshire, United Kingdom, S10 5DD
      • Ryegate Children's Centre
• United States
  • California
    • Rolling Hills Estates, California, United States, 66212
      • Peninsula Research Associates, Inc.
  • Florida
    • South Miami, Florida, United States, 47802
      • Miami Research Associates
  • Kansas
    • Overland Park, Kansas, United States, 23112
      • Vince and Associates Clinical Research
  • Tennessee
    • Memphis, Tennessee, United States, 38119
      • CNS Healthcare

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subject's parent or legally authorised representative(LAR) must provide signature of informed consent, and there must be documentation of assent (if applicable) by the subject indicating that the subject is aware of the investigational nature of the study and the required procedures and restrictions in accordance with the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) Guideline E6 and applicable regulations before completing any study-related procedures.
2. Subject and parent/LAR are willing and able to comply with all the testing and requirements defined in this protocol, including oversight of morning dosing. Specifically, the parent/LAR must be available upon awakening, at approximately 7:00AM, to dispense the dose of test product for the duration of the study.
3. Subject is a male or female aged 6-17 years inclusive at the time of consent for the antecedent study (SPD489-325).
4. Subject satisfied all entry criteria for the antecedent study (SPD489-325), and completed a minimum of 4 weeks of double-blind treatment, reached Visit 4 and completed the 1-week post-treatment washout in the antecedent study (SPD489-325), without experiencing any clinically significant AEs that would preclude exposure to LDX.
5. Subject must have a satisfactory medical assessment with no clinically significant or relevant abnormalities as determined by medical history, physical examination findings and clinical laboratory test results.
6. Subject has blood pressure measurements within the 95th percentile for age, gender, and height.

Exclusion Criteria:

1. Subject was terminated from SPD489-325 for non-compliance and/or experienced an SAE or AE resulting in termination from the antecedent study.
2. Subject has a current, controlled (requiring a restricted medication) or uncontrolled, comorbid psychiatric diagnosis with significant symptoms such as any severe comorbid Axis II disorder or severe Axis I disorder (such as Post Traumatic Stress Disorder, psychosis, bipolar illness, pervasive developmental disorder, severe obsessive compulsive disorder, severe depressive or severe anxiety disorder) or other symptomatic manifestations, such as agitated states, marked anxiety, or tension that, in the opinion of the examining clinician, will contraindicate treatment with LDX or confound efficacy or safety assessments. Comorbid psychiatric diagnoses will be established at the Screening Visit (Visit -1)of the antecedent study (SPD489-325)with the Screening interview of the Kiddie-SADS-Present and Lifetime-Diagnostic Interview (K-SADS-PL)and additional modules if warranted by the results of the initial interview. Participation in behavioural therapy is permitted provided the subject was receiving the therapy for at least 1 month at the time of the Baseline Visit (Visit 0) of the antecedent study (SPD489-325).
3. Subject has a conduct disorder. Oppositional defiant disorder is not exclusionary.
4. Subject has any concurrent chronic or acute illness or unstable medical condition that could confound the results of safety assessments, increase risk to the subject or lead to difficulty complying with the protocol.
5. Subject is currently considered a suicide risk, has previously made a suicide attempt or has a prior history of, or is currently, demonstrating active suicidal ideation.
6. Subject is female and is pregnant or lactating.
7. Subject has glaucoma.
8. Subject has any clinically significant ECG at Visit 8 of the antecedent study (SPD489-325) or clinically significant laboratory abnormalities at Visit 7 of the antecedent study (SPD489-325).
9. Subject has a documented allergy, hypersensitivity, or intolerance to amphetamine.
10. Subject has a recent history (within the past 6 months) of suspected substance abuse or dependence disorder (excluding nicotine)in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-TR)criteria.
11. Subject has a history of seizures (other than infantile febrile seizures), a tic disorder, a current diagnosis and or a known family history of Tourette's Disorder.
12. Subject has a known history of symptomatic cardiovascular disease, advanced arteriosclerosis, structural cardiac abnormality, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant drug.
13. Subject has a known family history of sudden cardiac death or ventricular arrhythmia.
14. Subject is taking any medication that is excluded.
15. Subject is taking other medications that have central nervous system (CNS) effects, affect performance, such as sedating antihistamines and decongestant sympathomimetics, or are monoamine oxidase inhibitors (during or within 14 days of investigational medicinal product administration). Stable use of bronchodilator inhalers is not exclusionary.
16. Subject has a documented allergy, hypersensitivity, or intolerance to any excipients in the investigational medicinal product(s).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Drug: Placebo; Placebo capsule once per day (double-blind period)
Experimental: Lisdexamfetamine dimesylate (LDX); Open-label 30, 50, or 70mg	Drug: Lisdexamfetamine dimesylate (LDX); LDX 30, 50, or 70mg capsule once per day (open-label and double-blind periods); Other Names: Vyvanse, SPD489

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of Participants With Treatment Failures at End of The Randomized Withdrawal Period	Treatment failure defined as 50% increase (worsening) in Attention Deficit Hyperactivity Disorder Rating Scale (ADHD-RS-IV) total score and >= 2 point increase (worsening) in the Clinical Global Impression-Severity of Illness (CGI-S) score observed at any visit during the randomized withdrawal period compared to the respective scores at baseline of randomized withdrawal period. Subjects without an endpoint value were classed as treatment failures.	Baseline of the randomized withdrawal period and its relevant endpoint (Up to 6 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Open-Label Baseline in The Attention Deficit Hyperactivity Disorder Rating Scale-Fourth Edition (ADHD-RS-IV) Total Score at Endpoint (Week-26) of The Open-label Period	ADHD-RS-IV consists of 18 items scored on a 4-point scale from 0 (no symptoms) to 3 (severe symptoms) with total score ranging from 0 to 54. A decrease in score indicates an improvement in ADHD symptomology.	Open-label baseline and Endpoint (Week-26)
Change From Randomized Withdrawal Baseline in The ADHD-RS-IV Total Score at Endpoint of The Randomized Withdrawal Period	ADHD-RS-IV consists of 18 items scored on a 4-point scale from 0 (no symptoms) to 3 (severe symptoms) with total score ranging from 0 to 54. A decrease in score indicates an improvement in ADHD symptomology.	Baseline of the randomized withdrawal period and its relevant endpoint (Up to 6 weeks)
Percent of Participants With Clinical Global Impression - Severity of Illness (CGI-S) at Endpoint (Week-26) of The Open-label Period	CGI-S assesses the severity of the subject's condition on a 7-point scale ranging from 1 (normal, not at all ill) to 7 (among the most extremely ill)	At Week 26
Percent of Participants With CGI-S at Endpoint of The Randomized Withdrawal Period, Last Observation Carried Forward (LOCF)	CGI-S assesses the severity of the subject's condition on a 7-point scale ranging from 1 (normal, not at all ill) to 7 (among the most extremely ill)	At endpoint of the randomized withdrawal period (Up to 6 weeks)
Percent of Participants With Improvement on Clinical Global Impression - Improvement (CGI-I) at Endpoint (Week-26) of The Open-label Period	Clinical Global Impression-Improvement (CGI-I) consists of a 7-point scale ranging from 1 (very much improved) to 7 (very much worse). Improvement is defined as a score of 1 (very much improved) or 2 (much improved) on the scale. Improvement includes CGI-I categories of very much improved and much improved. No improvement includes all other assessed categories.	At Week 26
Change From Open-label Baseline in The Health Utilities Index-2 (HUI-2) Scores at Endpoint (Week-26) of The Open-label Period, LOCF	HUI is used to describe health status and to obtain utility scores by collecting data using one or more questionnaires in formats selected to match the specific study design criteria. Scoring ranges from 0.00 (dead) to 1.00 (perfect health). Higher scores represent better health status.	At open-label baseline and endpoint (Week-26) of the open-label period
Change From Randomized Withdrawal Baseline in The HUI-2 Scores at Endpoint of The Randomized Withdrawal Period	HUI is used to describe health status and to obtain utility scores by collecting data using one or more questionnaires in formats selected to match the specific study design criteria. Scoring ranges from 0.00 (dead) to 1.00 (perfect health). Higher scores represent better health status.	Baseline of the randomized withdrawal period and its relevant endpoint (Up to 6 weeks)
Change From Open-label Baseline in The Child Health and Illness Profile, Child Edition: Parent Report Form (CHIP-CE:PRF) Global T-score at Endpoint (Week-26) of The Open-label Period	The CHIP-CE:PRF evaluates health-related quality of life. It is composed of 5 domains (satisfaction, comfort, resilience, avoidance, and achievement) consisting of a total of 76 items. The global score is an average of the scores for the 5 domains. The majority of items assess frequency of events using a 5-point response format. There is no range for a total score. Raw scale scores are used to generate T-scores. Higher scores indicate better health.	At open-label baseline and endpoint (Week-26) of the open-label period
Change From Randomized Withdrawal Baseline in The CHIP-CE:PRF Global T-score at Endpoint of The Randomized Withdrawal Period	The CHIP-CE:PRF evaluates health-related quality of life. It is composed of 5 domains (satisfaction, comfort, resilience, avoidance, and achievement) consisting of a total of 76 items. The global score is an average of the scores for the 5 domains. The majority of items assess frequency of events using a 5-point response format. There is no range for a total score. Raw scale scores are used to generate T-scores. Higher scores indicate better health.	Baseline of the randomized withdrawal period and its relevant endpoint (Up to 6 weeks)
Change From Open-Label Baseline in The Weiss Functional Impairment Rating Scale - Parent Report (WFIRS-P) Global Score at Endpoint (Week-26) of The Open-label Period	The WFIRS-P is a 50-item scale with each item scored from 0 (never/not at all) to 3 (very often/very much). Mean scores range from 0 to 3. Higher scores indicate greater functional impairment.	At open-label baseline and endpoint (Week-26) of the open-label period
Change From Randomized Withdrawal Baseline in The WFIRS-P Global Score at Endpoint of The Randomized Withdrawal Period	The WFIRS-P is a 50-item scale with each item scored from 0 (never/not at all) to 3 (very often/very much). Mean scores range from 0 to 3. Higher scores indicate greater functional impairment.	Baseline of the randomized withdrawal period and its relevant endpoint (Up to 6 weeks)
Change From Open-Label Baseline in The Brief Psychiatric Rating Scale for Children (BPRS-C) Total Score at Endpoint (Week-26) of The Open-label Period	The BPRS-C characterizes psychopathology. A total of 21 items are rated on a scale from 0 (not present) to 6 (extremely severe) with a total score ranging from 0 to 126. A decrease in score indicates a reduction in psychopathology.	At open-label baseline and endpoint (Week-26) of the open-label period
Change From Randomized Withdrawal Baseline in BPRS-C Total Score at Endpoint of The Randomized Withdrawal Period	The BPRS-C characterizes psychopathology. A total of 21 items are rated on a scale from 0 (not present) to 6 (extremely severe) with a total score ranging from 0 to 126. A decrease in score indicates a reduction in psychopathology.	Baseline of the randomized withdrawal period and its relevant endpoint (Up to 6 weeks)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of Participants With CGI-S at Open-label Baseline	CGI-S assesses the severity of the subject's condition on a 7-point scale ranging from 1 (normal, not at all ill) to 7 (among the most extremely ill).	Open-label baseline
Percent of Participants With CGI-S at Randomized Withdrawal Baseline	CGI-S assesses the severity of the subject's condition on a 7-point scale ranging from 1 (normal, not at all ill) to 7 (among the most extremely ill)	Randomized withdrawal baseline
Columbia-Suicide Severity Rating Scale (C-SSRS) During The Open-label Period	C-SSRS is a semi-structured interview that captures the occurence, severity, and frequency of suicide-related thoughts and behaviors during the assessment period. The interview includes definitions and suggested questions to solicit the type of information needed to determine if a suicide-related thought or behaviour occurred. The assessment is done by the nature of the responses, not by a numbered scale.	From open-label baseline to Week-26
C-SSRS During the Randomized Withdrawal Period	C-SSRS is a semi-structured interview that captures the occurence, severity, and frequency of suicide-related thoughts and behaviors during the assessment period. The interview includes definitions and suggested questions to solicit the type of information needed to determine if a suicide-related thought or behaviour occurred. The assessment is done by the nature of the responses, not by a numbered scale.	Baseline of the randomized withdrawal period to end of the study (Up to 6 weeks)

Collaborators and Investigators

• Sponsor: Shire

Publications and helpful links

General Publications

• Banaschewski T, Johnson M, Lecendreux M, Zuddas A, Adeyi B, Hodgkins P, Squires LA, Coghill DR. Health-related quality of life and functional outcomes from a randomized-withdrawal study of long-term lisdexamfetamine dimesylate treatment in children and adolescents with attention-deficit/hyperactivity disorder. CNS Drugs. 2014 Dec;28(12):1191-203. doi: 10.1007/s40263-014-0193-z.
• Coghill DR, Banaschewski T, Lecendreux M, Johnson M, Zuddas A, Anderson CS, Civil R, Dauphin M, Higgins N, Lyne A, Gasior M, Squires LA. Maintenance of efficacy of lisdexamfetamine dimesylate in children and adolescents with attention-deficit/hyperactivity disorder: randomized-withdrawal study design. J Am Acad Child Adolesc Psychiatry. 2014 Jun;53(6):647-657.e1. doi: 10.1016/j.jaac.2014.01.017. Epub 2014 Mar 4.

Study record dates

Study Major Dates

• Study Start (Actual): January 27, 2009
• Primary Completion (Actual): October 26, 2011
• Study Completion (Actual): October 26, 2011

Study Registration Dates

• First Submitted: November 3, 2008
• First Submitted That Met QC Criteria: November 3, 2008
• First Posted (Estimate): November 4, 2008

Study Record Updates

• Last Update Posted (Actual): June 9, 2021
• Last Update Submitted That Met QC Criteria: May 25, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Dopamine Agents; Dopamine Uptake Inhibitors; Central Nervous System Stimulants; Lisdexamfetamine Dimesylate
• Other Study ID Numbers: SPD489-326; 2008-000720-10 (EudraCT Number)