Post hoc analyses of asenapine treatment in pediatric patients with bipolar I disorder: efficacy related to mixed or manic episode, stage of illness, and body weight

Robert L Findling; Willie Earley; Trisha Suppes; Mehul Patel; Xiao Wu; Cheng-Tao Chang; Roger S McIntyre

doi:10.2147/NDT.S165743

Post hoc analyses of asenapine treatment in pediatric patients with bipolar I disorder: efficacy related to mixed or manic episode, stage of illness, and body weight

Neuropsychiatr Dis Treat. 2018 Aug 2:14:1941-1952. doi: 10.2147/NDT.S165743. eCollection 2018.

Authors

Robert L Findling¹, Willie Earley², Trisha Suppes^{3

4}, Mehul Patel², Xiao Wu², Cheng-Tao Chang², Roger S McIntyre⁵

Affiliations

¹ Johns Hopkins University and the Kennedy Krieger Institute, Baltimore, MD, USA, rfindli1@jhmi.edu.
² Allergan, Madison, NJ, USA.
³ VA Palo Alto Health Care System, Palo Alto, CA, USA.
⁴ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
⁵ Toronto Western Research Institute, Toronto, ON, Canada.

Abstract

Background: Patient characteristics and disease progression may affect response to pharmacologic intervention in bipolar I disorder. Asenapine is approved for acute treatment of manic/mixed episodes of bipolar I disorder in patients 10-17 years old. Post hoc analyses assessed asenapine efficacy in pediatric patients by current manic or mixed episode, number of lifetime episodes, and baseline body mass index (BMI).

Patients and methods: Data were obtained from a 3-week, randomized, double-blind, placebo-controlled, parallel-group trial of asenapine 2.5, 5.0, or 10.0 mg twice daily (BID) in male or female patients (10-17 years) with bipolar I disorder (NCT01244815). Patients were stratified by current episode type (Diagnostic and Statistical Manual of Mental Disorders, fourth edition - defined mixed/manic), number of lifetime episodes (<3, 3-5, >5), and baseline BMI tertile. Changes from baseline to day 21 in Young Mania Rating Scale (YMRS) total score and Clinical Global Impressions Scale for use in Bipolar Illness (CGI-BP) were assessed in asenapine subgroups vs placebo.

Results: In patients with mixed episodes, differences in YMRS and CGI-BP scores were statistically significant for each asenapine dose vs placebo (P<0.001) at day 21; in patients with manic episodes, significant differences vs placebo were seen in all groups (P<0.05) except 2.5 mg BID on the YMRS. In patients with <3 previous mixed/manic episodes, significant differences in YMRS and CGI-BP scores were observed for all asenapine doses vs placebo (P<0.05). In patients with 3-5 or >5 previous episodes, asenapine 10 mg BID was significantly different than placebo (P<0.05) on both scales; differences vs placebo varied for lower doses. Baseline body weight or BMI did not appear to influence the efficacy of asenapine.

Conclusion: Asenapine was effective in the treatment of pediatric patients with bipolar I disorder. Efficacy did not appear to be influenced by the type of current episode, stage of disease progression, or baseline body weight/BMI.

Keywords: adolescent; asenapine; atypical antipsychotic; bipolar disorder; child; second-generation antipsychotic.