Efficacy and Safety of Lumateperone for Treatment of Schizophrenia: A Randomized Clinical Trial

Abstract

Importance: Individuals living with schizophrenia are affected by cardiometabolic, endocrine, and motor adverse effects of current antipsychotic medications. Lumateperone is a serotonin, dopamine, and glutamate modulator with the potential to treat schizophrenia with few adverse effects.

Objective: To examine the efficacy and safety of lumateperone for the short-term treatment of schizophrenia.

Design, setting, and participants: This randomized, double-blind, placebo-controlled, phase 3 clinical trial was conducted from November 13, 2014, to July 20, 2015, with data analyses performed from August 13 to September 15, 2015. Patients with schizophrenia who were aged 18 to 60 years and were experiencing an acute exacerbation of psychosis were enrolled from 12 clinical sites in the United States.

Interventions: Patients were randomized 1:1:1 (150 patients in each arm) to receive lumateperone tosylate, 60 mg; lumateperone tosylate, 40 mg (equivalent to 42 or 28 mg, respectively, of the active moiety lumateperone); or placebo once daily for 4 weeks.

Main outcomes and measures: The prespecified primary efficacy end point was mean change from baseline to day 28 in the Positive and Negative Syndrome Scale (PANSS) total score vs placebo. The key secondary efficacy measure was the Clinical Global Impression-Severity of Illness (CGI-S) score. The PANSS subscale scores, social function, safety, and tolerability were also assessed.

Results: The study comprised 450 patients (mean [SD] age, 42.4 [10.2] years; 346 [77.1%] male; mean [SD] baseline PANSS score, 89.8 [10.3]; mean [SD] baseline CGI-S score, 4.8 [0.6]). In the prespecified modified intent-to-treat efficacy analysis (n = 435), 42 mg of lumateperone met the primary and key secondary efficacy objectives, demonstrating a statistically significant improvement vs placebo from baseline to day 28 on the PANSS total score (least-squares mean difference [LSMD], -4.2; 95% CI, -7.8 to -0.6; P = .02; effect size [ES], -0.3) and the CGI-S (LSMD, -0.3; 95% CI, -0.5 to -0.1; P = .003; ES, -0.4). For 28 mg of lumateperone, the LSMD from baseline to day 28 was -2.6 (95% CI, -6.2 to 1.1; P = .16; ES, -0.2) on the PANSS total score and -0.2 (95% CI, -0.5 to 0.0; P = .02; ES, -0.3) on the CGI-S. Both lumateperone doses were well tolerated without clinically significant treatment-emergent motor adverse effects or changes in cardiometabolic or endocrine factors vs placebo.

Conclusions and relevance: Lumateperone demonstrated efficacy for improving the symptoms of schizophrenia and had a favorable safety profile.

Trial registration: ClinicalTrials.gov identifier: NCT02282761.

Figure 1.. Study Flow and Patient Disposition

ITT indicates intent-to-treat.

Figure 2.. Least-Squares Mean Change in Positive and Negative Syndrome Scale (PANSS) Total Score and Clinical Global Impression–Severity of Illness (CGI-S) and Mean Change in PANSS Positive and Negative Symptom Subscales

Analysis of covariance last observation carried forward was used. P values are nominal and unadjusted for multiplicity. Whiskers represent SEs. ^aP < .05 vs placebo. ^bP < .01 vs placebo.

Figure 3.. Change in Cholesterol, Glucose, Triglycerides, Prolactin, and Insulin Levels and Weight From Baseline

Error bars indicate SE. SI conversion factors: To convert cholesterol to millimoles per liter, multiply by 0.0259; glucose to millimoles per liter, multiply by 0.0555; triglycerides to millimoles per liter, multiply by 0.0113; prolactin to nanograms per liter, multiply by 0.0435; and insulin to picomoles per liter, multiply by 6.945.