New data show that asenapine - a
psychopharmacologic agent being developed by Organon - is effective in
treating acute manic episodes associated with bipolar I disorder. These results,
from two Phase III clinical studies, were presented this week at the 20th
European College of Neuropsychopharmacology (ECNP) Congress.
"The results of these clinical trials add to the body of evidence supporting the clinical
efficacy and safety of asenapine," said Roger S. McIntyre, M.D., Associate Professor
of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood
Disorders Psychopharmacology Unit at the University Health Network, Toronto,
Canada. "The complex nature of bipolar disorders suggests that we should have many
treatment options available to physicians and patients. As such, a new therapy that
provides efficacy while also providing improved tolerability is critical in helping fill this
unmet need."
In a separate safety study, also presented at the ECNP, asenapine demonstrated
minimal effect on the QT interval (QTc) - a measure of the heart's electrical
conductance - in patients with schizophrenia.
Study overview: bipolar I disorder (presented on Tuesday, 16 October at 12:00
p.m. CEST)
In the two Phase III, randomized, double-blind trials (Ares 7501004 and Ares
7501005), 960 adult patients with moderate-to-severe mania associated with bipolar I
disorder received either asenapine (5-10 mg twice daily), olanzapine (5-20 mg once
daily), or placebo for three weeks.
At day 21 in both studies, both asenapine and olanzapine produced significant mean
improvements in mania symptoms versus placebo as measured by changes in YMRS
(Young Mania Rating Scale) score. The YMRS is an 11-item scale used to evaluate
manic symptoms. A difference in YMRS score reduction between the active treatments
and placebo was seen as early as day two1.
The overall incidences of treatment-related adverse events (AEs) for the two studies
were 55.1% and 60.8% in the asenapine groups, 46.8% and 52.9% in the olanzapine
groups, and 27.6% and 36.2% in the placebo groups. Most adverse events were mild
to moderate. The most commonly reported AEs (reported by >5% of the patients and
 
at twice the incidence of placebo in both studies) with asenapine included sedation,
dizziness and somnolence. Olanzapine was most commonly associated with sedation,
dizziness, somnolence and weight increase. The incidence of extrapyramidal
symptoms reported as an adverse event was 10.3% and 7.2% in the asenapine group,
6.8% and 7.9% in the olanzapine group, and 3.1% and 2.9% in the placebo group.
Asenapine-treated patients had approximately a two-fold lower incidence of clinically
significant weight gain (=7%) versus olanzapine-treated patients in Ares 7501004 (7%
vs. 19%, respectively) and in Ares 7501005 (6% vs.13%, respectively).
The study abstract, "Treatment of mania in bipolar I disorder: a placebo and
olanzapine-controlled trial of asenapine," (P.2.e.012) was presented at ECNP on
Tuesday, 16 October by Professor McIntyre.
Study overview: schizophrenia (presented on Sunday, 14 October at 12:00 p.m.
CEST)
This 16-day, multicenter study examined the effects of asenapine on the QT interval -
a measure of the heart's electrical conductance. A QTc >500 milliseconds (msec) and
an increase from baseline of >60 msec are risk factors for a potentially life-threatening
form of ventricular tachycardia called torsades de pointes.
In the study, 151 patients with schizophrenia or schizoaffective disorder were
randomized to asenapine (up to 20 mg twice daily), quetiapine 375 mg twice daily, or
placebo. Investigators measured QTc using electrocardiograms (ECGs), which were
administered several times throughout the 16-day study after asenapine
administration.
Asenapine at doses up to 20 mg twice daily had a minimal, not considered to be
clinically relevant, effect on QTc. Asenapine had an effect equal to or less than
quetiapine on QTc in this study.
The study abstract, "Effect of asenapine versus quetiapine and placebo on QTc
interval in patients with schizophrenia," (P.3.c.050) was presented at ECNP on
Sunday, 14 October by Sheldon H. Preskorn, M.D., Department of Psychiatry,
University of Kansas School of Medicine in Wichita.
About bipolar disorder
Bipolar disorder, commonly referred to as manic-depressive disorder, is a chronic,
episodic illness characterized by mania (episodes of elevated moods, extreme irritability,
and increased energy), depression (overwhelming feelings of sadness, suicidal thoughts),
or a combination of both. It affects approximately one to five percent of adults, including
more than 10 million adults in the United States and more than four million people in
Europe2,3. The condition can start early in childhood or later in life, the average age of
onset is between 15 and 25 years old4. Bipolar disorder is the sixth leading cause of
disability in the world2. About half of the patients with bipolar disorder who recover in
response to treatment experience recurrence two years later5.
About schizophrenia
Schizophrenia is a chronic, disabling brain disorder characterized by hallucinations, delusions,
and disordered thinking. About 24 million people worldwide (or seven in every 1,000 adults in
the population) have schizophrenia6, including more than two million people in the U.S.7 and
more than four million people in Europe8. People with schizophrenia may hear voices other
people don't hear or may believe others are trying to harm them. As a result, they may become
socially withdrawn, fearful, and agitated7.
References
1. National Institute of Mental Health. Available online at:
nimh.nih/publicat/bipolar.cfm
2. Depression and Bipolar Support Alliance (DBSA). Bipolar Disorder Statistics, accessed on
May 10, 2007.
See here.
3. World Health Organization. WHO European Ministry Conference on Mental Health.
Available online at: euro.who.int/document/MNH/emnhqa.pdf. Accessed on
October 2, 2007
4. National Alliance on Mental Health. Understanding Bipolar Disorder and Recovery.
Available online
here.
5. Perlis RH, Ostacher MJ, Patel JK. Predictors of Recurrence in Bipolar Disorder: Primary
Outcomes from the Systemic Treatment Enhancement Program for Bipolar Disorder
(STEP-BD). Am J Psychiatry. 2006;163:210-224.
6. World Health Organization. Available online
here. Accessed on October
2, 2007.
7. National Institute of Mental Health. Available online
here.
8. World Health Organization. WHO European Ministry Conference on Mental Health.
Available online at: euro.who.int/document/MNH/emnhqa.pdf. Accessed on
October 2, 2007.
About Organon
Organon creates, manufactures and markets innovative prescription medicines that improve
the health and quality of human life. Through a combination of innovation and business
partnerships, Organon seeks to leverage its position as a leading biopharmaceutical company
in each of its core therapeutic fields: fertility, gynecology and selected areas of anesthesia. It
has extensive expertise in neuroscience and a rich and focused R&D program. Research areas
also include immunology and specific areas of oncology. Organon products are distributed in
over 100 countries worldwide, of which more than 50 have an Organon subsidiary. Organon is
the human healthcare business unit of Akzo Nobel.
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