Longer-Term Data in Adult Patients

Safety & Tolerability Evaluated in an Open-label Extension

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Clinical Study Design Overview

  • This was a 6-week, open-label study evaluating the effectiveness of switching clinically stable but symptomatic adult outpatients with schizophrenia (N=244) from their previous antipsychotic to LATUDA. Four patients were randomized but exited the study before receiving LATUDA. The study design was based on a cross-tapering approach. During the first week, the dose of the previous (switched-from) antipsychotic was maintained, and treatment with fixed daily doses of LATUDA (either 40 mg or 80 mg) was initiated. For the second week, the dose of the previous antipsychotic was reduced by 50% and LATUDA dosage either maintained (40 mg/day → 40 mg/day, and 80 mg/day → 80 mg/day) or increased (40 mg/day → 80 mg/day). All previous antipsychotics were discontinued completely at the end of Week 2, and patients were treated with flexible doses of LATUDA (40–120 mg/day) dosed in the evening within 30 minutes after eating. Primary outcome was treatment failure defined as: discontinuation due to an adverse event, exacerbation of underlying illness, or insufficient clinical response. Secondary outcomes included the following assessments: safety and tolerability, PANSS total score, and CGI-S score1
  • Study patients were switched from a variety of antipsychotic agents: quetiapine (25.8%); risperidone (21.3%); aripiprazole (18.3%); ziprasidone (11.3%); olanzapine (10.0%); paliperidone (3.8%); perphenazine or fluphenazine (2.9%); haloperidol (2.5%); iloperidone (1.7%); chlorpromazine (1.3%); asenapine (0.8%); thiothixene (0.4%)1

Study Results

  • Similar results were achieved regardless of dosing strategy1
  • The primary endpoint of the study was time to treatment failure1
  • Symptom improvement was seen over the course of the 6-week study1
  • The effect of LATUDA on safety parameters was evaluated and the safety profile was consistent with results from controlled 6-week studies in adult patients with schizophrenia1

6-Week Switch Study in Adult Patients: Results

6-Week Switch Study in adult patients: Over 80% of patients completed treatment

3.11_Long-Term_Adverse_Reactions_Chart

Changes in weight in adult patients

3.11_Long-Term_Weight_Changes_Chart
  • The shaded gray area represents the 6-week, fixed-dose core Study 3 (Meltzer HY, et al), and was followed by a 7-day, fixed-dose, single-blind period that occurred before the first open-label assessment at Week 81, 2
  • Mean change in weight from double-blind baseline to Month 8 for all patients who completed the
    6-month extension of Study 3 was 2.02 kg (4.45 lb)4
  • Mean weight change from open-label baseline to 8 months (observed cases): placebo to LATUDA: 0.9 kg; olanzapine to LATUDA: –1.9 kg; LATUDA to LATUDA: 0.4 kg1
  • Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended3
  • Mean change in BMI from open-label baseline to 8 months (observed cases): placebo to LATUDA 0.4 kg/m2 (n=28), olanzapine to LATUDA –0.7 kg/m2(n=31), LATUDA to LATUDA 0.2 kg/m2 (n=56)1
  • Mean change in waist circumference from open-label baseline to 8 months (observed cases): placebo to LATUDA 0.1 cm (n=28), olanzapine to LATUDA –2.8 cm (n=31), LATUDA to LATUDA 0.0 cm (n=56)1

Changes in lipids and glucose in adult patients

3.11_Long-Term_Lipids_Glucose_Change_Chart
  • Median changes from open-label baseline for all patients who received LATUDA in Study 3 26-week extension were total cholesterol –6.5 mg/dL (n=114); triglycerides –8.5 mg/dL (n=114); and glucose 1.0 mg/dL (n=113)1
  • Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics3
  • Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness3

Changes in prolactin in adult patients

3.11_Long-Term_Prolactin_Changes_Chart
  • As with other drugs that antagonize dopamine D2 receptors, LATUDA elevates prolactin levels. Galactorrhea, amenorrhea, gynecomastia, and sexual dysfunction have been reported in patients receiving prolactin-elevating compounds3

View metabolic changes at year 1 in primarily open-label extension studies (pooled)


References:

1. Stahl SM, Cucchiaro J, Simonelli, D, Hsu J, Pikalov A, Loebel A. Effectiveness of lurasidone for patients with schizophrenia following 6 weeks of acute treatment with lurasidone, olanzapine, or placebo: a 6-month, open-label, extension study. J Clin Psychiatry. 2013;74(5):507-15.
2. Meltzer HY, Cucchiaro J, Silva R, et al. Lurasidone in the treatment of schizophrenia: a randomized, double-blind, placebo- and olanzapine-controlled study. Am J Psychiatry. 2011;168:957-967.
3. Latuda® (lurasidone HCl) prescribing information. Sunovion Pharmaceuticals Inc. February 2017.
4. Data on file. Sunovion Pharmaceuticals Inc.

IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA

INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; and SUICIDAL THOUGHTS AND BEHAVIORS

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. LATUDA is not approved for the treatment of patients with dementia-related psychosis.

Suicidal Thoughts and Behaviors
Antidepressants increased the risk of suicidal thoughts and behaviors in patients aged 24 years and younger. Monitor for clinical worsening and emergence of suicidal thoughts and behavior. LATUDA is not approved for use in pediatric patients with depression.

 

CONTRAINDICATIONS: LATUDA is contraindicated in the following:

Cerebrovascular Adverse Reactions, Including Stroke: In clinical trials, elderly subjects with dementia randomized to risperidone, aripiprazole, and olanzapine had a higher incidence of stroke and transient ischemic attack, including fatal stroke. LATUDA is not approved for the treatment of patients with dementia-related psychosis.

Neuroleptic Malignant Syndrome (NMS): NMS is a potentially fatal symptom complex, reported with administration of antipsychotic drugs. Clinical signs of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability. Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. Manage NMS with immediate discontinuation of antipsychotic drugs, including LATUDA, intensive symptomatic treatment, and monitoring.

Tardive Dyskinesia (TD): The risk of developing TD (a syndrome of abnormal involuntary movements) and the potential for it to become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic increase. The syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses. There is no known treatment for established TD, although the syndrome may remit, partially or completely, if antipsychotic treatment is withdrawn.

Metabolic Changes Atypical antipsychotic drugs have caused metabolic changes including:

Hyperglycemia and Diabetes Mellitus: Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics. Patients with diabetes should be regularly monitored for worsening of glucose control; those with risk factors for diabetes should undergo fasting blood glucose testing at the beginning of and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.

Dyslipidemia: Undesirable alterations in lipids have been observed in patients treated with atypical antipsychotics.

Weight Gain: Weight gain has been observed with atypical antipsychotic use. Clinical monitoring of weight is recommended.

Hyperprolactinemia: As with other drugs that antagonize dopamine D2 receptors, LATUDA elevates prolactin levels. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds.

Leukopenia, Neutropenia, and Agranulocytosis: Leukopenia/neutropenia has been reported with antipsychotics. Agranulocytosis (including fatal cases) has been reported with other agents in the class. Monitor complete blood count in patients with a pre-existing low white blood cell count (WBC)/absolute neutrophil count (ANC) or history of drug-induced leukopenia/neutropenia. Discontinue LATUDA at the first sign of a decline in WBC in the absence of other causative factors.

Orthostatic Hypotension and Syncope: Atypical antipsychotics cause orthostatic hypotension and syncope. Generally, the risk is greatest at the beginning of treatment and when increasing the dose. Monitor patients vulnerable to hypotension and those with cardiovascular and cerebrovascular disease.

Falls: Antipsychotics may cause somnolence, postural hypotension, motor and sensory instability, which may lead to falls causing fractures or other injuries. For patients with disease, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating treatment and recurrently during therapy.

Seizures: LATUDA should be used cautiously in patients with a history of seizures or with conditions that lower seizure threshold.

Potential for Cognitive and Motor Impairment: Patients should be cautioned about operating hazardous machinery, including motor vehicles, until they are reasonably certain that therapy with LATUDA does not affect them adversely.

Body Temperature Regulation: Use LATUDA with caution in patients who may experience conditions that increase body temperature (e.g., exercising strenuously, exposure to extreme heat, concomitant medication with anticholinergic activity, or being subject to dehydration).

Dysphagia: Antipsychotics, including LATUDA, have been associated with esophageal dysmotility and aspiration, and should be used with caution in patients at risk for aspiration pneumonia.

Most Commonly Observed Adverse Reactions: Commonly observed adverse reactions (≥5% incidence and at least twice the rate of placebo) for LATUDA:

To report SUSPECTED ADVERSE REACTIONS, contact Sunovion Pharmaceuticals Inc. at 877-737-7226 or FDA at 1-800-FDA-1088 (www.fda.gov/medwatch).

Indications

LATUDA is indicated for:

Before prescribing LATUDA, please read the full Prescribing Information, including Boxed Warnings.