Efficacy Study of OPC-34712 in Adults With Acute Schizophrenia (BEACON)

A Phase 3, Multicenter, Randomized, Double-blind, Placebo-controlled Trial of Fixed-dose OPC-34712 in the Treatment of Adults With Acute Schizophrenia

The purpose of this study is to assess the efficacy, safety, and tolerability of fixed doses of OPC-34712 versus placebo for the treatment of adult subjects with an acute relapse of schizophrenia.

Study Overview

• Status: Completed
• Conditions: Acute Schizophrenia
• Intervention / Treatment: Drug: OPC-34712; Drug: OPC-34712; Drug: OPC-34712; Drug: Placebo

Detailed Description

Schizophrenia is a severely debilitating mental illness that affects approximately 1% of the world population. Hallucinations and delusions are the most striking characteristic positive symptoms of schizophrenia; however, more subtle negative symptoms (eg, social withdrawal and lack of emotion, energy, and motivation) may also be present. The first antipsychotics developed for the treatment of schizophrenia were effective against positive symptoms, but showed little efficacy for negative symptoms and were also associated with a high incidence of side effects. Second generation antipsychotics, represent a significant advancement in the treatment of psychotic disorders because they are effective and at the same time exhibit fewer side effects than first generation antipsychotics. Although generally safer than first generation antipsychotics, the second-generation antipsychotics are not devoid of undesirable side effects such as Hyperprolactinemia and weight gain. In addition, the safety of these drugs vary considerably.

• Study Type: Interventional
• Enrollment (Actual): 674
• Phase: Phase 3

Contacts and Locations

Study Locations

• Colombia
  • Bogota, Colombia, 00000
  • Medellin, Colombia, 00000
  • Pereira, Colombia, 00000
• Croatia
  • Rijeka, Croatia, 51000
  • Zagreb, Croatia, 10000
  • Zagreb, Croatia, 10090
• Mexico
  • Monterrey, Mexico, 64060
  • Distrito Federal
    • Col. Florida, Distrito Federal, Mexico, 01030
    • Mexico, Distrito Federal, Mexico, 05300
  • Nuevo Leon
    • Monterrey, Nuevo Leon, Mexico, 64060
  • San Luis Potos
    • San Luis Potosi, San Luis Potos, Mexico, 78218
• Philippines
  • Cebu City, Philippines, 6000
  • Davano City, Philippines, 8000
  • Makati City, Philippines, 1229
  • Mandaluyong City, Philippines, 1553
  • Manila, Philippines, 1000
• Russian Federation
  • Arkhangelsk, Russian Federation, 163530
  • Moscow, Russian Federation, 119991
  • Moscow, Russian Federation, 117152
  • Moscow Region, Russian Federation, 142601
  • Nizhniy Novgorod, Russian Federation, 603155
  • Petrozavodsk, Russian Federation, 185000
  • Samara, Russian Federation, 443016
  • Saratov, Russian Federation, 410060
  • St. Petersburg, Russian Federation, 190121
  • St. Petersburg, Russian Federation, 192019
  • St. Petersburg, Russian Federation, 197341
  • St. Petersburg, Russian Federation, 190005
  • St. Petersburg, Russian Federation, 194214
  • Tomsk, Russian Federation, 634014
  • Village Nikolskoe, Russian Federation, 188357
• Slovakia
  • Bojnice, Slovakia, 97201
  • Bratislava, Slovakia, 82606
  • Michalovace, Slovakia, 07101
  • Rimavska Sobota, Slovakia, 97912
  • Roznava, Slovakia, 04801
• Taiwan
  • Kaohsiung, Taiwan, 802
  • New Taipei City, Taiwan, 249
  • Taichung, Taiwan, 40447
  • Taipei, Taiwan, 110
  • Taoyuan, Taiwan, 333
• United States
  • Arkansas
    • Little Rock, Arkansas, United States, 72201
    • Springdale, Arkansas, United States, 72764
  • California
    • Escondido, California, United States, 92025
    • Long Beach, California, United States, 90813
    • Orange, California, United States, 92868
    • Pico Rivera, California, United States, 90660
    • San Diego, California, United States, 92102
  • Florida
    • North Miami, Florida, United States, 33161
    • North Miami, Florida, United States, 33162
  • Kansas
    • Overland Park, Kansas, United States, 66212
  • Louisiana
    • Lake Charles, Louisiana, United States, 70629
    • Shreveport, Louisiana, United States, 71104
  • Mississippi
    • Flowood, Mississippi, United States, 39232
  • Missouri
    • St. Louis, Missouri, United States, 63118
  • New York
    • Buffalo, New York, United States, 14215
  • Tennessee
    • Memphis, Tennessee, United States, 38119
  • Texas
    • Austin, Texas, United States, 78756
    • Dallas, Texas, United States, 75243
    • Houston, Texas, United States, 77007

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Male or female subjects between 18 and 65 years of age, with a diagnosis of schizophrenia, as defined by DSM-IV-TR criteria
2. Subjects who have been recently hospitalized or who would benefit from hospitalization for an acute relapse of schizophrenia
3. Subjects experiencing an acute exacerbation of psychotic symptoms
4. Other protocol specific inclusion criteria may apply

Exclusion Criteria:

1. Females who are breast-feeding and/or who have a positive pregnancy test result prior to receiving study drug

2. Subjects with a current DSM-IV-TR Axis I diagnosis of:

   • Schizoaffective disorder
   • MDD
   • Bipolar disorder
   • Delirium, dementia, amnestic or other cognitive disorder
   • Borderline, paranoid, histrionic, schizotypal, schizoid or antisocial personality disorder
3. Subjects presenting with a first episode of schizophrenia
4. Other protocol specific exclusion criteria may apply

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: QUADRUPLE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dose 3 OPC 34712; Higher dose, tablet, once daily, for six weeks	Drug: OPC-34712; Higher dose tablet, once daily, for six weeks,; Drug: OPC-34712; Middle dose tablet, once daily, for six weeks; Drug: OPC-34712; Lower dose tablet, once daily, for six weeks
Experimental: Dose 2 OPC 34712; Middle dose, tablet, once daily, for six weeks	Drug: OPC-34712; Higher dose tablet, once daily, for six weeks,; Drug: OPC-34712; Middle dose tablet, once daily, for six weeks; Drug: OPC-34712; Lower dose tablet, once daily, for six weeks
Experimental: Dose 1 OPC 34712; Lower dose, tablet, once daily, for six weeks	Drug: OPC-34712; Higher dose tablet, once daily, for six weeks,; Drug: OPC-34712; Middle dose tablet, once daily, for six weeks; Drug: OPC-34712; Lower dose tablet, once daily, for six weeks
Placebo Comparator: Placebo; Placebo, once daily, for six weeks	Drug: Placebo; Placebo, once daily, for six weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change From Baseline to Week 6 in Positive and Negative Syndrome Scale (PANSS) Total Score.	The PANSS consisted of three subscales: a total of 30 symptom constructs. For each symptom construct, severity was rated on a 7-point scale, with a score of 1 (absence of symptoms) and a score of 7 (extremely severe symptoms). The PANSS total score was the sum of the rating scores for 7 positive scale items, 7 negative scale items, and 16 general psychopathology scale items from the PANSS panel. The PANSS total score ranged from 30 (best possible outcome) to 210 (worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change From Baseline to Week 6 in Clinical Global Impression-Severity (CGI-S) Score.	Severity of illness for each participant was rated using the CGI-S, which was the key secondary efficacy endpoint. To perform this assessment, the study physician answered the following question: "Considering your total clinical experience with this particular population, how mentally ill is the participant at this time?" Response choices included: 0 = not assessed; 1 = normal, not at all ill; 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; and 7 = among the most extremely ill participants.	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in Personal and Social Performance (PSP) Score.	PSP is a validated clinician-rated scale that measures personal and social functioning in 4 domains: socially useful activities (e.g. work and study), personal and social relationships, self-care, and disturbing and aggressive behaviors. Impairment in each of these domains was rated as absent, mild, manifest, marked, severe, or very severe. These ratings were then converted to a total score based on a 100-point scale using algorithms to identify the appropriate 10-point interval, and the rater's judgment to determine the total score within the 10-point interval. Participants with a PSP total score of 71 to 100 were considered to have mild functional difficulty. Scores of 31 to 70 represented manifest disabilities of various degrees and ratings of 1 to 30 indicated minimal functioning that required intense support and/or supervision.	Baseline, Week 3 and Week 6
Mean Change From Baseline to Week 6 in PANSS Positive Subscale Score.	PANSS consisted of three subscales: a total of 30 symptom constructs. For each construct, severity was rated on a 7-point scale, with a score of 1 (absence of symptoms) and a score of 7 (extremely severe symptoms). The PANSS positive subscale score was the sum of the rating scores for the 7 positive scale items from the PANSS panel. The 7 positive symptom constructs are delusions, conceptual disorganization, hallucinatory behavior, excitement, grandiosity, suspiciousness/persecution, and hostility. The PANSS positive subscale score ranged from 7 (best possible outcome) to 49 (worst possible outcome). The analysis of secondary endpoints was conducted if both comparisons of brexpiprazole 4 mg/day vs placebo and brexpiprazole 2 mg/day vs placebo of the primary endpoint were significant. Although only the comparison of brexpiprazole 4 mg/day vs placebo met the gatekeeping threshold in the primary analysis, statistical testing for the other doses was reported for information.	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in PANSS Negative Subscale Score.	The PANSS consisted of three subscales: a total of 30 symptom constructs. For each symptom construct, severity was rated on a 7-point scale, with a score of 1 (absence of symptoms) and a score of 7 (extremely severe symptoms). The PANSS negative subscale score was the sum of the rating scores for the 7 negative scale items from the PANSS panel. The 7 negative symptom constructs: blunted affect, emotional withdrawal, poor rapport, passive apathetic withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation, stereotyped thinking. The PANSS negative subscale score ranged from 7 (best possible outcome) to 49 (worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Clinical Global Impression-Improvement (CGI-I) Scale Score at Week 6.	The efficacy of trial medication was rated for each participant using the CGI-I. The study physician would rate the participant's total improvement whether or not it is due entirely to drug treatment. All responses were compared to the participant's condition at Baseline prior to the first dose of double-blind study medication. Response choices included: 0 = not assessed, 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change, 5 = minimally worse, 6 = much worse, and 7 = very much worse.	Week 6
Percentage of Participants With Response at Week 6.	The response rate was defined as reduction of ≥30% from Baseline in PANSS Total Score or CGI-I score of 1 or 2.	Week 6
Percentage of Participants With Discontinuation Rate for Lack of Efficacy at Week 6.	Participants discontinued for lack of efficacy during the trial were reported here.	Week 6
Mean Change From Baseline to Week 6 in PANSS Excited Component (PEC) Score.	The PEC score consisted of five PANSS items: excitement (P4), hostility (P7), tension (G4), uncooperativeness (G8), and poor impulse control (G14). Each of the items were rated on a scale of 1 (absent) to 7 (extreme). The PEC scores ranged from 5 (not present) to 35 (extremely severe).	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in PANSS Marder Factor Scores: Positive Symptoms Score.	Retrospective factor analyses have been performed in recent decades using scores for the 30 individual PANSS items to categorize symptoms into 5 dimensions. Collectively, these dimensions are referred to as the PANSS Marder Factor scores and include positive symptoms score, negative symptoms score, thought score, uncontrolled hostility/excitement, anxiety depression score. The positive factor score is the sum of the 8 components of the positive symptoms scale (range: 8 - best possible outcome to 56 - worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in PANSS Marder Factor Scores: Negative Symptoms Score.	Retrospective factor analyses have been performed in recent decades using scores for the 30 individual PANSS items to categorize symptoms into 5 dimensions. Collectively, these dimensions are referred to as the PANSS Marder Factor scores and include positive symptoms score, negative symptoms score, thought score, uncontrolled hostility/excitement, anxiety depression score. The negative factor score is the sum of the 7 items of the negative subscale (range: 8 - best possible outcome to 56 - worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in PANSS Marder Factor Scores: Disorganized Thought Score.	Retrospective factor analyses have been performed in recent decades using scores for the 30 individual PANSS items to categorize symptoms into 5 dimensions. Collectively, these dimensions are referred to as the PANSS Marder Factor scores and include positive symptoms score, negative symptoms score, thought score, uncontrolled hostility/excitement, anxiety depression score. The disorganized thoughts factor score is the sum of score from the 7 items on the disorganized thoughts subscale (range: 7 - best possible outcome to 49 - worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in PANSS Marder Factor Scores: Uncontrolled Hostility and Excitement Score.	Retrospective factor analyses have been performed in recent decades using scores for the 30 individual PANSS items to categorize symptoms into 5 dimensions. Collectively, these dimensions are referred to as the PANSS Marder Factor scores and include positive symptoms score, negative symptoms score, thought score, uncontrolled hostility/excitement, anxiety depression score. The uncontrolled hostility/excitement factor score is the sum of score from the 4 items on the uncontrolled hostility/excitement subscale (range: 4 - best possible outcome to 28 - worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6
Mean Change From Baseline to Week 6 in PANSS Marder Factor Scores: Anxiety and Depression Score.	Retrospective factor analyses have been performed in recent decades using scores for the 30 individual PANSS items to categorize symptoms into 5 dimensions. Collectively, these dimensions are referred to as the PANSS Marder Factor scores and include positive symptoms score, negative symptoms score, thought score, uncontrolled hostility/excitement, anxiety depression score. The anxiety/depression factor score is the sum of score from the 4 items on the anxiety/depression subscale (range: 4 - best possible outcome to 28 - worst possible outcome).	Baseline, Weeks 1, 2, 3, 4, 5, and 6

Collaborators and Investigators

• Sponsor: Otsuka Pharmaceutical Development & Commercialization, Inc.

Publications and helpful links

General Publications

• Correll CU, He Y, Therrien F, MacKenzie E, Meehan SR, Weiss C, Hefting N, Hobart M. Effects of Brexpiprazole on Functioning in Patients With Schizophrenia: Post Hoc Analysis of Short- and Long-Term Studies. J Clin Psychiatry. 2022 Mar 1;83(2):20m13793. doi: 10.4088/JCP.20m13793.
• Marder SR, Meehan SR, Weiss C, Chen D, Hobart M, Hefting N. Effects of Brexpiprazole Across Symptom Domains in Patients With Schizophrenia: Post Hoc Analysis of Short- and Long-Term Studies. Schizophr Bull Open. 2021 May 1;2(1):sgab014. doi: 10.1093/schizbullopen/sgab014. eCollection 2021 Jan.
• Newcomer JW, Eriksson H, Zhang P, Weiller E, Weiss C. Changes in metabolic parameters and body weight in brexpiprazole-treated patients with acute schizophrenia: pooled analyses of phase 3 clinical studies. Curr Med Res Opin. 2018 Dec;34(12):2197-2205. doi: 10.1080/03007995.2018.1498779. Epub 2018 Jul 27.
• Kane JM, Skuban A, Hobart M, Ouyang J, Weiller E, Weiss C, Correll CU. Overview of short- and long-term tolerability and safety of brexpiprazole in patients with schizophrenia. Schizophr Res. 2016 Jul;174(1-3):93-98. doi: 10.1016/j.schres.2016.04.013. Epub 2016 May 14.
• Kane JM, Skuban A, Ouyang J, Hobart M, Pfister S, McQuade RD, Nyilas M, Carson WH, Sanchez R, Eriksson H. A multicenter, randomized, double-blind, controlled phase 3 trial of fixed-dose brexpiprazole for the treatment of adults with acute schizophrenia. Schizophr Res. 2015 May;164(1-3):127-35. doi: 10.1016/j.schres.2015.01.038. Epub 2015 Feb 12.

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Actual): February 1, 2014
• Study Completion (Actual): February 1, 2014

Study Registration Dates

• First Submitted: July 11, 2011
• First Submitted That Met QC Criteria: July 11, 2011
• First Posted (Estimate): July 13, 2011

Study Record Updates

• Last Update Posted (Estimate): November 26, 2015
• Last Update Submitted That Met QC Criteria: October 26, 2015
• Last Verified: October 1, 2015

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia
• Other Study ID Numbers: 331-10-230