RISPERDAL® CONSTA® (Risperidone) Long-Acting Treatment Delayed the Time to Relapse in Patients with Bipolar I Disorder
SAN FRANCISCO, May 19, 2009 - New data demonstrate that maintenance therapy with RISPERDAL® CONSTA® (risperidone) Long-Acting Treatment (RLAT) significantly delayed the time to relapse compared to placebo in patients with Bipolar I Disorder. Results of the study were presented this week at a major medical meeting.
Bipolar Disorder is a brain disorder that causes unusual shifts in a person's mood, energy and ability to function. It is often characterized by debilitating mood swings from extreme highs (mania) to extreme lows (depression). Type I Bipolar Disorder is characterized based on the occurrence of at least one manic episode, with or without the occurrence of a major depressive episode, and affects approximately one percent of the American adult population in any given year.
A randomized, double-blind, placebo-controlled, long-term study was conducted to evaluate the effect of RISPERDAL® CONSTA® as maintenance therapy in patients who met DSM-IV criteria for Bipolar I Disorder who were stable on medications or experiencing an acute manic or mixed episode. In the first phase of the study, 303 patients were stabilized on open-label RISPERDAL® CONSTA® for 26 weeks. In the double-blind phase, patients were randomized to either maintenance therapy with RISPERDAL® CONSTA® (N=154) or placebo (N=149). The median duration of treatment was nine months for patients in the RISPERDAL® CONSTA® group and five months for patients in the placebo group. The primary endpoint was time to relapse of any mood episode (depression, mania, or mixed).
Time to relapse was significantly longer in patients receiving RISPERDAL® CONSTA® monotherapy as compared to placebo (p<0.001). In addition, the rate of relapse during the double-blind treatment phase was lower among patients in the RISPERDAL® CONSTA® group (30 percent; 42/140) compared with the placebo group (56 percent; 76/135). The median dose of RISPERDAL® CONSTA® was 25 mg.
The most common adverse reactions in clinical trials in patients with bipolar disorder were weight increase (5% in monotherapy trial) and tremor and parkinsonism (≥10% in adjunctive therapy).
"This is the first randomized controlled study to demonstrate the efficacy of RLAT as a maintenance therapy in patients with Bipolar Disorder," said Joseph Palumbo, M.D., Franchise Medical Leader, Psychiatry, Central Nervous System and Pain Therapeutic Area, Johnson & Johnson Pharmaceutical Research & Development, L.L.C. (J&JPRD). "These findings are important because the clinical course of Bipolar Disorder is often unpredictable and relapses can be very debilitating."
The study was presented and sponsored by Janssen, a Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc and J&JPRD.
About RISPERDAL® CONSTA® Long Acting Treatment
RISPERDAL® CONSTA® (risperidone) Long-Acting Treatment (RLAT) is a long-acting injectable atypical antipsychotic therapy used for the treatment of schizophrenia and the maintenance treatment of Bipolar I Disorder. It was developed utilizing Alkermes' proprietary Medisorb® drug-delivery technology. Using this technology, risperidone is encapsulated in microspheres made of a biodegradable polymer, which are suspended in a water-based solution and administered to patients by intramuscular injection once every two weeks. RISPERDAL® CONSTA® is manufactured by Alkermes, Inc. and marketed by Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. in the U.S. and Janssen-Cilag outside of the U.S.
About Janssen
Janssen, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., is
based in Titusville, N.J. and is the only large pharmaceutical
company in the U.S. dedicated solely to mental health. It currently
markets prescription medications for the treatment of
schizophrenia, bipolar mania and the treatment of symptoms
associated with autistic disorder. Ortho-McNeil-Janssen
Pharmaceuticals, Inc. is a member of the Johnson & Johnson
family of companies. For more information about Janssen®, visit
http://www.janssen.com/.
About J&JPRD
Johnson & Johnson PharmaceuticalResearch & Development,
L.L.C. (J&JPRD) is a member of the Johnson & Johnson family
of companies, the world's most broadly-based producer of health
care products. J&JPRD is headquartered in Raritan, N.J., and
has facilities throughout Europe, the United States and Asia.
J&JPRD is leveraging drug discovery and drug development in a
variety of therapeutic areas, including CNS, Internal Medicine and
Oncology, to address unmet medical needs worldwide. More
information can be found at
http://www.jnjpharmarnd.com.
IMPORTANT SAFETY INFORMATION FOR CONSUMERS ABOUT RISPERDAL® CONSTA®
Elderly Patients with dementia-related psychosis
treated with antipsychotic drugs are at an increased risk of death
compared to placebo. RISPERDAL® CONSTA® (risperidone) is not approved for the treatment of patients with
dementia-related psychosis.
Neuroleptic Malignant Syndrome (NMS) is a rare and potentially
fatal side effect reported with
RISPERDAL® CONSTA®
and similar medicines. Call your doctor immediately if the person
being treated develops symptoms such as high fever; stiff muscles;
shaking; confusion; sweating; changes in pulse, heart rate, or
blood pressure; or muscle pain and weakness. Treatment should be
stopped if the person being treated has NMS.
Tardive Dyskinesia (TD) is a serious, sometimes permanent side
effect reported with
RISPERDAL® CONSTA®
and similar medications. TD includes uncontrollable movements of
the face, tongue, and other parts of the body. The risk of
developing TD and the chance that it will become permanent is
thought to increase with the length of therapy and the overall dose
taken by the patient. This condition can develop after a brief
period of therapy at low doses, although this is much less common.
There is no known treatment for TD, but it may go away partially or
completely if therapy is stopped.
High blood sugar and diabetes have been reported with RISPERDAL®
CONSTA® and similar medications. If the person being treated has
diabetes or risk factors such as being overweight or a family
history of diabetes, blood sugar testing should be performed at the
beginning and throughout treatment with
RISPERDAL® CONSTA®. Complications of diabetes can be serious and even life
threatening. If signs of high blood sugar or diabetes develop, such
as being thirsty all the time, going to the bathroom a lot, or
feeling weak or hungry, contact your doctor.
RISPERDAL® CONSTA®
and similar medications can raise the blood levels of a hormone
known as prolactin, causing a condition known as
hyperprolactinemia. Blood levels of prolactin remain elevated with
continued use. Some side effects seen with these medications
include the absence of a menstrual period; breasts producing milk;
the development of breasts by males; and the inability to achieve
an erection.
Some people taking
RISPERDAL® CONSTA®
may feel faint or lightheaded when they stand up or sit up too
quickly. By standing up or sitting up slowly and following your
healthcare professional's dosing instructions, this side effect can
be reduced or it may go away over time.
Problems with the blood have been reported with
RISPERDAL® CONSTA® and similar medications. Depending upon condition your doctor may
choose to monitor your blood as you start therapy with RISPERDAL® CONSTA®.
RISPERDAL® CONSTA®
may affect your alertness or driving ability; therefore, do not
drive or operate machinery before talking to your healthcare
professional.
RISPERDAL® CONSTA®
should be used cautiously in people with a seizure disorder, who
have had seizures in the past, or who have conditions that increase
their risk for seizures.
Painful, long lasting erections have been reported with the use of
RISPERDAL® CONSTA®. Call your doctor immediately if you think you are having this
problem.
Extrapyramidal Symptoms (EPS) are usually persistent movement
disorders or muscle disturbances, such as restlessness, tremors,
and muscle stiffness. If you observe any of these symptoms, talk to
your healthcare professional.
Inform your healthcare professional if you become pregnant or
intend to become pregnant during therapy with
RISPERDAL® CONSTA®. Caution should be exercised when administering
RISPERDAL® CONSTA®
to a nursing woman.
RISPERDAL® CONSTA®
may make you more sensitive to heat. You may have trouble cooling
off, or be more likely to become dehydrated, so take care when
exercising or when doing things that make you warm.
Some medications interact with
RISPERDAL® CONSTA®. Please inform your healthcare professional of any medications or
supplements that you are taking. Avoid alcohol while on
RISPERDAL® CONSTA®.
In a study of people taking
RISPERDAL® CONSTA®, the most common side effects in the treatment of schizophrenia
were headache, tremors, dizziness, restlessness, tiredness,
constipation, indigestion, sleepiness, weight gain, pain in the
limbs, and dry mouth.
In a study of people taking RISPERDAL CONSTA, the most common side
effects in the treatment of Bipolar I Disorder were weight gain
(when used alone) and tremors (when used with other medications).
If you have any questions about
RISPERDAL® CONSTA®
or your therapy, talk with your doctor.
IMPORTANT SAFETY INFORMATION FOR PROFESSIONALS
ABOUT RISPERDAL® CONSTA®
WARNING: Increased Mortality in Elderly Patients
with Dementia-Related Psychosis Elderly patients with
dementia-related psychosis treated with antipsychotic drugs are at
an increased risk of death. Analyses of 17 placebo-controlled
trials (modal duration of 10 weeks), largely in patients taking
atypical antipsychotic drugs, revealed a risk of death in the
drug-treated patients of between 1.6 to 1.7 times the risk of
death in placebo-treated patients. Over the course of a typical
10-week controlled trial, the rate of death in drug-treated
patients was about 4.5%, compared to a rate of about 2.6% in the
placebo group. Although the causes of death were varied, most of
the deaths appeared to be either cardiovascular (e.g., heart
failure, sudden death) or infectious (e.g., pneumonia) in nature.
Observational studies suggest that, similar to atypical
antipsychotic drugs, treatment with conventional antipsychotic
drugs may increase mortality. The extent to which the findings of
increased mortality in observational studies may be attributed to
the antipsychotic drug as opposed to some characteristic(s) of the
patients is not clear. RISPERDAL® CONSTA® (risperidone) is not approved for the treatment of patients with
dementia-related psychosis.
Cerebrovascular Adverse Events (CAEs): CAEs,
including fatalities, have been reported in elderly patients with
dementia-related psychosis taking oral risperidone in clinical
trials. The incidence of CAEs with risperidone was significantly
higher than with placebo.
RISPERDAL® CONSTA®
is not approved for the treatment of patients with dementia-related
psychosis.
Neuroleptic Malignant Syndrome (NMS): NMS, a
potentially fatal symptom complex, has been reported with the use
of antipsychotic medications, including
RISPERDAL® CONSTA®. Clinical manifestations include muscle rigidity, fever, altered
mental status and evidence of autonomic instability (see full
Prescribing Information). Management should include immediate
discontinuation of antipsychotic drugs and other drugs not
essential to concurrent therapy, intensive symptomatic treatment
and medical monitoring, and treatment of any concomitant serious
medical problems.
Tardive Dyskinesia (TD): TD is a syndrome of
potentially irreversible, involuntary, dyskinetic movements that
may develop in patients treated with antipsychotic medications. The
risk of developing TD and the likelihood that dyskinetic movements
will become irreversible are believed to increase with duration of
treatment and total cumulative dose. Elderly patients appeared to
be at increased risk for TD. Prescribing should be consistent with
the need to minimize the risk of TD. The syndrome may remit,
partially or completely, if antipsychotic treatment is withdrawn.
Hyperglycemia and Diabetes: Hyperglycemia, some
cases extreme and associated with ketoacidosis, hyperosmolar coma
or death has been reported in patients treated with atypical
antipsychotics (APS), including
RISPERDAL® CONSTA®. Patients starting treatment with APS who have or are at risk for
diabetes should undergo fasting blood glucose testing at the
beginning of and during treatment. Patients who develop symptoms of
hyperglycemia should also undergo fasting blood glucose testing.
Hyperprolactinemia: As with other drugs that
antagonize dopamine D2 receptors,
RISPERDAL® CONSTA®
elevates prolactin levels and the elevation persists during chronic
administration. Risperidone is associated with higher levels of
prolactin elevation than other antipsychotic agents.
Orthostatic Hypotension:
RISPERDAL® CONSTA®
may induce orthostatic hypotension associated with dizziness,
tachycardia, and in some patients, syncope, especially during the
initial dose-titration period. Monitoring should be considered in
patients for whom this may be of concern.
RISPERDAL® CONSTA®
should be used with caution in patients with known cardiovascular
disease, and conditions that would predispose patients to
hypotension.
Leukopenia, Neutropenia and Agranulocytosis has
been reported with antipsychotics, including risperidone. Patients
with a pre-existing low white blood cell count (WBC) or a history
of leukopenia/neutropenia should have frequent complete blood cell
counts during the first few months of therapy. At the first sign of
a decline in WBC and in the absence of other causative factors,
discontinuation of
RISPERDAL® CONSTA®
should be considered.
Potential for Cognitive and Motor Impairment:
RISPERDAL® CONSTA®
has the potential to impair judgment, thinking, or motor skills.
Patients should be cautioned about operating hazardous machinery,
including motor vehicles, until they are reasonably certain that
RISPERDAL® CONSTA®
does not affect them adversely.
Seizures:
RISPERDAL® CONSTA®
should be used cautiously in patients with a history of seizures or
with conditions that potentially lower seizure threshold.
Dysphagia: Esophageal dysmotility and aspiration
can occur. Use cautiously in patients at risk for aspiration
pneumonia.
Priapism has been reported. Severe priapism may
require surgical intervention.
Thrombotic Thrombocytopenic Purpura (TTP) has been
reported.
Administration: Care should be taken to avoid
inadvertent injection into a blood vessel.
Suicide: The possibility of suicide attempt is
inherent in schizophrenia or bipolar disorder. Close supervision of
high-risk patients should accompany drug therapy.
Increased sensitivity in patients with Parkinson's disease or those
with dementia with Lewy bodies has been reported. Manifestations
and features are consistent with NMS.
Use
RISPERDAL® CONSTA®
with caution in patients with conditions and medical conditions
that could affect metabolism or hemodynamic responses (e.g. recent
myocardial infarction or unstable cardiac disease).
Extrapyramidal Symptoms (EPS): The overall
incidence of EPS-related adverse events in patients with
schizophrenia treated with 25 mg and 50 mg of
RISPERDAL® CONSTA®
and placebo, respectively, were akathisia
*
(4%, 11%, 6%), Parkinsonism
†
(8%, 15%, 9%) and tremor (0%, 3%, 0%).
*
Akathisia and restlessness
†
Extrapyramidal disorder, musculoskeletal stiffness, muscle
rigidity, and bradykinesia
The overall incidence of EPS-related adverse events in patients
with Bipolar I Disorder treated with adjunctive therapy with
RISPERDAL® CONSTA®
and placebo respectively were Parkinsonism
**
(15% and 6%), tremor (24% and 16%), and dyskinesia
‡
(6% and 3%).
**
Muscle rigidity, hypokinesia, cogwheel rigidity, and bradykinesia
‡
Muscle twisting and dyskinesia
Weight Gain: In a 12-week trial in patients with
schizophrenia, the percentage of patients experiencing weight gain
(>7% of baseline body weight) was 6% placebo vs 9%
RISPERDAL® CONSTA®.
In a 24-month monotherapy trial in patients with Bipolar I
Disorder, the percentage of patients experiencing weight gain
(>7% of baseline body weight) was 2.8% placebo vs 11.6%
RISPERDAL® CONSTA®.
In a 52-week adjunctive therapy trial in patients with Bipolar I
Disorder, the percentage of patients experiencing weight gain
(>7% of baseline body weight) was 27.3% placebo vs 26.8%
RISPERDAL® CONSTA®.
Maintenance Treatment: Patients should be
periodically reassessed to determine the need for continued
treatment.
Commonly Observed Adverse Reactions for RISPERDAL® CONSTA®: The most common adverse reactions in clinical trials in
patients with schizophrenia (≥5%) were headache, Parkinsonism,
dizziness, akathisia, fatigue, constipation, dyspepsia, sedation,
weight increase, pain in extremities, and dry mouth.
The most common adverse reactions in clinical trials in patients
with Bipolar I Disorder were weight increased (5% in monotherapy
trial) and tremor and Parkinsonism (≥ 10% in adjunctive therapy
trial).
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