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NCT03768726

Extension Study Evaluating The Safety And Tolerability Of Flexible Doses Of Oral Ziprasidone In Children And Adolescents With Bipolar I Disorder

Terminated Phase 3 Results posted Last updated 16 June 2021
What this trial tests

Phase 3 trial testing Ziprasidone in Bipolar Disorder in 23 participants. Terminated before completion.

Timeline
21 December 2018
Primary endpoint
31 July 2020
31 July 2020

Quick facts

Lead sponsorPfizer's Upjohn has merged with Mylan to form Viatris Inc.
PhasePhase 3
StatusTerminated
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment23
Start date21 December 2018
Primary completion31 July 2020
Estimated completion31 July 2020
Sites9 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Pfizer's Upjohn has merged with Mylan to form Viatris Inc. — full company profile →

Who can join

Adults 10 to 17, any sex, with Bipolar Disorder. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) Primary · A1281201: Day 1 up to 35 days after last dose of study medication (maximum up to 31 Weeks)

An adverse event (AE) was any untoward medical occurrence in a participant who received study medication without regard to possibility of causal relationship to it. SAE was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/ incapacity; congenital anomaly. AEs included both serious and all non-serious AEs.

AEs
GroupValue95% CI
Ziprasidone in A1281198 and A12812017
Placebo in A1281198 Then Ziprasidone in A128120112
SAEs
GroupValue95% CI
Ziprasidone in A1281198 and A12812010
Placebo in A1281198 Then Ziprasidone in A12812011
Number of Participants With Laboratory Abnormalities Secondary · A1281201: Day 1 up to 1 Week after last dose of study medication (maximum up to 27 Weeks)

Hemoglobin (Hg), hematocrit, erythrocytes: \<0.8\*lower limits of normal (LLN); platelets: \<0.5\*LLN\>1.75\*upper limits of normal (ULN); leukocytes (leu), glucose-fasting:\<0.6\*LLN\>1.5\*ULN; lymphocytes (lym), lym/leu, neutrophils (neu), neu/leu, protein, albumin, phosphate, free thyroxine, thyroid stimulating hormone: \<0.8\*LLN\>1.2\*ULN; basophils (bas), bas/leu, eosinophils (eos), eos/leu, monocytes(mon), mon/leu: \>1.2\*ULN; bilirubin (total, direct, indirect):\>1.5\*ULN; aspartate aminotransferase(AT), alanine AT, lactate dehydrogenase, alkaline phosphatase:\>3.0\*ULN; blood urea nit

GroupValue95% CI
Ziprasidone in A1281198 and A12812015
Placebo in A1281198 Then Ziprasidone in A128120111
Number of Participants With Physical Examination Abnormalities at Baseline and Week 26 Secondary · Baseline (last measurement from A1281198), Week 26 of A1281201

Parameters assessed for physical examination included: oral/tympanic temperature, general appearance, skin, head, ears, eyes, nose, throat, heart, lungs, breasts (if medically indicated), abdomen, external genitalia (if medically indicated), extremities, back/spinal system, lymph nodes or worsening of medical history conditions. Abnormality in physical examination was at the investigator's discretion.

Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A12812010
Placebo in A1281198 Then Ziprasidone in A12812010
Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A12812010
Placebo in A1281198 Then Ziprasidone in A12812010
Change From Baseline in Blood Pressure at Week 1, 2, 4, 6, 10, 14, 18, 22, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 1, 2, 4, 6, 10, 14, 18, 22, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline in sitting and standing systolic and diastolic blood pressure in millimeter of mercury (mmHg) was reported.

Sitting Systolic Blood Pressure, Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A1281201111.70± 13.712
Placebo in A1281198 Then Ziprasidone in A1281201111.38± 11.384
Sitting Systolic Blood Pressure, Change at Week 1
GroupValue95% CI
Ziprasidone in A1281198 and A12812012.44± 10.944
Placebo in A1281198 Then Ziprasidone in A1281201-1.00± 11.505
Sitting Systolic Blood Pressure, Change at Week 2
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.43± 6.024
Placebo in A1281198 Then Ziprasidone in A12812010.08± 10.431
Sitting Systolic Blood Pressure, Change at Week 4
GroupValue95% CI
Ziprasidone in A1281198 and A12812013.29± 8.036
Placebo in A1281198 Then Ziprasidone in A1281201-1.83± 8.321
Sitting Systolic Blood Pressure, Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812013.17± 6.969
Placebo in A1281198 Then Ziprasidone in A1281201-3.45± 11.903
Sitting Systolic Blood Pressure, Change at Week 10
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-0.80± 9.203
Placebo in A1281198 Then Ziprasidone in A1281201-3.09± 11.674
Sitting Systolic Blood Pressure, Change at Week 14
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-2.80± 9.011
Placebo in A1281198 Then Ziprasidone in A1281201-7.09± 8.949
Sitting Systolic Blood Pressure, Change at Week 18
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-2.67± 8.327
Placebo in A1281198 Then Ziprasidone in A1281201-0.82± 10.852
Change From Baseline in Pulse Rate at Week 1, 2, 4, 6, 10, 14, 18, 22, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 1, 2, 4, 6, 10, 14, 18, 22, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline pulse rate in beats per minute was reported in sitting and standing positions.

Sitting, Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A128120177.90± 9.678
Placebo in A1281198 Then Ziprasidone in A128120173.38± 11.701
Sitting, Change at Week 1
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.78± 8.969
Placebo in A1281198 Then Ziprasidone in A12812012.00± 9.254
Sitting, Change at Week 2
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.00± 6.758
Placebo in A1281198 Then Ziprasidone in A12812018.08± 11.782
Sitting, Change at Week 4
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-3.29± 7.365
Placebo in A1281198 Then Ziprasidone in A12812012.00± 9.789
Sitting, Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-1.17± 7.139
Placebo in A1281198 Then Ziprasidone in A12812012.00± 10.954
Sitting, Change at Week 10
GroupValue95% CI
Ziprasidone in A1281198 and A12812013.40± 11.261
Placebo in A1281198 Then Ziprasidone in A12812010.18± 14.098
Sitting, Change at Week 14
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-3.00± 14.799
Placebo in A1281198 Then Ziprasidone in A1281201-0.91± 13.308
Sitting, Change at Week 18
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-0.33± 8.622
Placebo in A1281198 Then Ziprasidone in A12812011.09± 10.606
Change From Baseline in Height and Waist Circumference at Week 6, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 6, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline in height and waist circumference in centimeter (cm) was reported.

Height, Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A1281201159.82± 10.182
Placebo in A1281198 Then Ziprasidone in A1281201161.69± 11.996
Height, Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.27± 0.455
Placebo in A1281198 Then Ziprasidone in A12812010.77± 0.984
Height, Change at Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A12812012.04± 1.938
Placebo in A1281198 Then Ziprasidone in A12812010.55± 1.535
Height, Change at Follow-up Visit
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.90± 1.562
Placebo in A1281198 Then Ziprasidone in A12812012.42± 1.413
Waist Circumference, Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A128120178.89± 11.278
Placebo in A1281198 Then Ziprasidone in A128120180.23± 13.981
Waist Circumference, Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-0.94± 2.483
Placebo in A1281198 Then Ziprasidone in A12812012.23± 7.527
Waist Circumference, Change at Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-1.02± 2.278
Placebo in A1281198 Then Ziprasidone in A12812011.29± 4.210
Waist Circumference, Change at Follow-up Visit
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-6.40± 13.777
Placebo in A1281198 Then Ziprasidone in A12812012.01± 3.778
Change From Baseline in Body Weight at Week 6, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 6, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline in body weight in kilogram (kg) was reported.

Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A128120157.76± 17.634
Placebo in A1281198 Then Ziprasidone in A128120162.40± 19.375
Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.82± 1.343
Placebo in A1281198 Then Ziprasidone in A12812010.78± 2.530
Change at Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A12812011.62± 2.528
Placebo in A1281198 Then Ziprasidone in A12812012.33± 4.431
Change at Follow-up Visit
GroupValue95% CI
Ziprasidone in A1281198 and A12812011.47± 1.629
Placebo in A1281198 Then Ziprasidone in A12812014.68± 2.639
Change From Baseline in Body Mass Index (BMI) at Week 6, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 6, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline in BMI in kilogram per meter square (kg/m\^2) was reported.

Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A128120122.31± 5.081
Placebo in A1281198 Then Ziprasidone in A128120123.37± 4.709
Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.38± 0.519
Placebo in A1281198 Then Ziprasidone in A12812010.91± 2.234
Change at Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.19± 0.954
Placebo in A1281198 Then Ziprasidone in A12812010.78± 1.800
Change at Follow-up Visit
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.35± 0.589
Placebo in A1281198 Then Ziprasidone in A12812011.54± 1.447
Change From Baseline in Body Mass Index (BMI) Z-score at Week 6, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 6, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

BMI z-score was reported using the Children's Hospital of Philadelphia z-score calculator. Z-score is a statistical measure to describe whether a mean was above or below the standard. A z-score of 0 is equal to the mean and is considered normal. Lower numbers indicate values lower than the mean and higher numbers indicate values higher than the mean. Higher values are indicative of higher BMI.

Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.58± 1.187
Placebo in A1281198 Then Ziprasidone in A12812011.06± 0.852
Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.12± 0.122
Placebo in A1281198 Then Ziprasidone in A1281201-0.02± 0.511
Change at Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.21± 0.747
Placebo in A1281198 Then Ziprasidone in A12812010.11± 0.506
Change at Follow-up Visit
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.01± 0.207
Placebo in A1281198 Then Ziprasidone in A12812010.26± 0.330
Change From Baseline in Heart Rate at Day 1, Week 1, 2, 4, 6, 14, 22, 26 and Follow-up Visit Secondary · Baseline of A1281198, Day 1 (last measurement from A1281198), A1281201: Week 1, 2, 4, 6, 14, 22, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline in heart rate in beats per minute was reported.

Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A128120177.8± 9.19
Placebo in A1281198 Then Ziprasidone in A128120171.5± 14.12
Change at Day 1
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-4.0± 9.40
Placebo in A1281198 Then Ziprasidone in A1281201-1.2± 9.09
Change at Week 1
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-2.0± 19.24
Placebo in A1281198 Then Ziprasidone in A12812010.4± 16.12
Change at Week 2
GroupValue95% CI
Ziprasidone in A1281198 and A12812017.4± 16.69
Placebo in A1281198 Then Ziprasidone in A12812015.0± 16.28
Change at Week 4
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-7.3± 8.08
Placebo in A1281198 Then Ziprasidone in A12812010.4± 13.20
Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-5.0± 13.04
Placebo in A1281198 Then Ziprasidone in A1281201-3.9± 14.49
Change at Week 14
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-0.6± 15.22
Placebo in A1281198 Then Ziprasidone in A1281201-2.6± 15.23
Change at Week 22
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-5.0± 0.00
Placebo in A1281198 Then Ziprasidone in A12812010.3± 16.99
Change From Baseline in Electrocardiogram (ECG) Parameters at Day 1, Week 1, 2, 4, 6, 14, 22, 26 and Follow-up Visit Secondary · Baseline of A1281198, Day 1 (last measurement from A1281198), A1281201: Week 1, 2, 4, 6, 14, 22, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

Change from baseline in PR interval, QT interval corrected using the Bazett's correction (QTcB), QT interval corrected using the Fridericia's formula (QTcF), QT interval, RR interval, QRS duration in millisecond (msec) was reported.

PR interval, Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A1281201145.3± 14.77
Placebo in A1281198 Then Ziprasidone in A1281201148.5± 14.47
PR interval, Change at Day 1
GroupValue95% CI
Ziprasidone in A1281198 and A12812011.0± 9.07
Placebo in A1281198 Then Ziprasidone in A12812010.4± 10.25
PR interval, Change at Week 1
GroupValue95% CI
Ziprasidone in A1281198 and A12812013.6± 14.17
Placebo in A1281198 Then Ziprasidone in A1281201-2.6± 9.17
PR interval, Change at Week 2
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-4.6± 9.22
Placebo in A1281198 Then Ziprasidone in A12812012.3± 11.69
PR interval, Change at Week 4
GroupValue95% CI
Ziprasidone in A1281198 and A12812013.0± 5.16
Placebo in A1281198 Then Ziprasidone in A12812011.1± 10.17
PR interval, Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.0± 12.60
Placebo in A1281198 Then Ziprasidone in A12812014.0± 10.89
PR interval, Change at Week 14
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-6.8± 4.87
Placebo in A1281198 Then Ziprasidone in A1281201-2.0± 9.42
PR interval, Change at Week 22
GroupValue95% CI
Ziprasidone in A1281198 and A128120112.5± 17.68
Placebo in A1281198 Then Ziprasidone in A12812011.7± 9.25
Change From Baseline in Simpson-Angus Rating Scale (SARS) Total Score at Week 1, 2, 4, 6, 10, 14, 18, 22, 26 and Follow-up Visit Secondary · Baseline (last measurement from A1281198), A1281201: Week 1, 2, 4, 6, 10, 14, 18, 22, 26, and Follow-up Visit (1 Week from last dose of study medication, anytime maximum up to Week 27)

SARS: 10-item clinician rated instrument to assess parkinsonian symptoms and related extrapyramidal side effects. All 10 items were anchored on a 5-point scale: range 0 (absence of condition, normal) to 4 (the most extreme form of condition). Total score is sum of individual item scores, ranged from 0 (normal) to 40 (most extreme symptoms and effects); higher score indicates more affected. Rows with only non-zero data/values for change in SARS total score at specified time points, for at least 1 reporting arm, are reported below.

Baseline
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.4± 1.26
Placebo in A1281198 Then Ziprasidone in A12812010.0± 0.00
Change at Week 1
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-0.2± 0.67
Placebo in A1281198 Then Ziprasidone in A12812010.0± 0.00
Change at Week 2
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.0± 0.00
Placebo in A1281198 Then Ziprasidone in A12812010.2± 0.39
Change at Week 4
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.0± 0.00
Placebo in A1281198 Then Ziprasidone in A12812010.2± 0.58
Change at Week 6
GroupValue95% CI
Ziprasidone in A1281198 and A12812010.0± 0.00
Placebo in A1281198 Then Ziprasidone in A12812010.2± 0.40
Change at Week 26
GroupValue95% CI
Ziprasidone in A1281198 and A1281201-0.5± 1.41
Placebo in A1281198 Then Ziprasidone in A12812010.0± 0.00

Adverse events — posted to ClinicalTrials.gov

Time frame: A1281201: Day 1 up to 35 days after last dose of study medication (maximum up to 31 Weeks). Reporting threshold: 2%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Ziprasidone in A1281198 and A1281201
Serious: 0/10 (0%)
Deaths: 0/10
Placebo in A1281198 Then Ziprasidone in A1281201
Serious: 1/13 (8%)
Deaths: 0/13

Serious adverse events (2 terms)

ReactionSystemZiprasidone in A1281198 an…Placebo in A1281198 Then Z…
AggressionPsychiatric disorders
Suicidal ideationPsychiatric disorders
Other adverse events (33 terms — click to expand)

ReactionSystemZiprasidone in A1281198 an…Placebo in A1281198 Then Z…
FatigueGeneral disorders
NauseaGastrointestinal disorders
SomnolenceNervous system disorders
DiarrhoeaGastrointestinal disorders
Dry mouthGastrointestinal disorders
VomitingGastrointestinal disorders
Feeling abnormalGeneral disorders
PainGeneral disorders
Helicobacter infectionInfections and infestations
InfluenzaInfections and infestations
NasopharyngitisInfections and infestations
Pharyngitis streptococcalInfections and infestations
Upper respiratory tract infectionInfections and infestations
Ligament injuryInjury, poisoning and procedural complications
Ligament sprainInjury, poisoning and procedural complications
Blood insulin increasedInvestigations
Streptococcus test positiveInvestigations
Weight decreasedInvestigations
Decreased appetiteMetabolism and nutrition disorders
Musculoskeletal stiffnessMusculoskeletal and connective tissue disorders
AkathisiaNervous system disorders
DizzinessNervous system disorders
DystoniaNervous system disorders
HeadacheNervous system disorders
LethargyNervous system disorders
Memory impairmentNervous system disorders
SedationNervous system disorders
Hallucination, auditoryPsychiatric disorders
InsomniaPsychiatric disorders
DysmenorrhoeaReproductive system and breast disorders
Respiratory disorderRespiratory, thoracic and mediastinal disorders
AlopeciaSkin and subcutaneous tissue disorders
DermatitisSkin and subcutaneous tissue disorders

Most-reported serious reactions: Aggression, Suicidal ideation.

Data from ClinicalTrials.gov NCT03768726 adverse events section.

Sponsor's own description

This 26-week open-label extension study is designed to provide information on the safety and tolerability of oral ziprasidone (20-80 mg BID (twice daily) with meals) during long-term administration in children and adolescents with Bipolar I Disorder (current or most recent episode manic).

Publications & conference data

2 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Efficacy, Safety, and Tolerability of Flexibly Dosed Ziprasidone in Children and Adolescents with Mania in Bipolar I Disorder: A Randomized Placebo-Controlled Replication Study.
    Findling RL, Atkinson S, Bachinsky M, Raiter Y, et al · · 2022 · cited 4× · PMID 35394365 · DOI 10.1089/cap.2021.0121
  2. 26-Week Open-Label Extension Study Evaluating the Safety and Tolerability of Flexible Doses of Oral Ziprasidone in Children and Adolescents with Bipolar I Disorder (Most Recent Episode Manic).
    Atkinson S, Bachinsky M, Raiter Y, Abreu P, et al · · 2022 · PMID 36282771 · DOI 10.1089/cap.2022.0030

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