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Aripiprazole in the treatment of acute manic or mixed episodes in patients with bipolar I disorder: a 3-week placebo-controlled study

Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

Raymond Sanchez

Ronald Marcus

Elyse Stock

Bristol-Myers Squibb Company, Wallingford, CT, USA

Robert Mcquade

William Carson

Otsuka America Pharmaceutical Inc., Princeton, NJ, USA

Neveen Abou-Gharbia

Bristol Myers Squibb Company, Lawrenceville, Princeton, NJ, USA

Cheryl Impellizzeri

Stephen Kaplita

Linda Rollin

Bristol-Myers Squibb Company, Wallingford, CT, USA

Taro Iwamoto

Otsuka Pharmaceutical Co. Ltd, Chiyoda-ku, Tokyo, Japan

This study compares the efficacy, safety, and tolerability of a partial dopamine agonist, aripiprazole, with placebo in the treatment of patients with bipolar I disorder experiencing an acute manic or mixed episode. In total, 272 hospitalized patients were randomized to aripiprazole 30mg/day or placebo in this 3-week, double-blind, placebo-controlled trial. Dosing could be reduced to 15mg/day for tolerability and, subsequently, increased to 30mg/day based on clinical response. Primary efficacy measure was mean change from baseline to endpoint in Young Mania Rating Scale (YMRS) total score; response was defined as 50% decrease from baseline YMRS score. Aripiprazole-treated patients demonstrated significantly greater improvement from baseline to endpoint in mean YMRS total scores compared with placebo-treated patients as early as Day 4 and sustained through Week 3. A significantly higher response rate was observed in aripiprazole-treated patients (53% vs. 32% at endpoint). Aripiprazole produced significantly greater improvements from baseline on other efficacy assessments compared with placebo, including Clinical Global Impression – Bipolar Version Severity and Improvement scores. The 30mg/day dose was maintained by 85% of aripiprazole-treated patients. Incidence of discontinuations due to adverse events was similar for aripiprazole (8.8%) and placebo (7.5%). Aripiprazole treatment resulted in no significant difference from placebo in change in mean body weight and was not associated with elevated serum prolactin or QT_c prolongation. In conclusion, aripiprazole demonstrated superior efficacy to placebo in the treatment of patients with bipolar I disorder presenting with acute manic or mixed episodes, and exhibited a favourable safety and tolerability profile.

Key Words: aripiprazole • bipolar I disorder • efficacy • safety

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