Dexmedetomidine for Agitation in Schizophrenia and Bipolar Disorder

SG
DP
CG
MD
Overseen ByMichel Duval, MD
Age: 18+
Sex: Any
Trial Phase: Phase 3
Sponsor: BioXcel Therapeutics Inc
Must be taking: Psychotropic treatment
Pivotal Trial (Near Approval)This treatment is in the last trial phase before FDA approval
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 1 JurisdictionThis treatment is already approved in other countries

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new medication, BXCL501 (also known as Dexmedetomidine), to evaluate its effectiveness in reducing agitation in individuals with mental health conditions such as bipolar disorder and schizophrenia. The study compares the medication's effects to a placebo, which contains no active ingredients. Individuals who have experienced agitation episodes requiring medical attention or have stable treatment for their condition may be suitable candidates. Participants join only one part of the study, which involves taking a sublingual film (dissolves under the tongue) containing either the medication or a placebo. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants the opportunity to contribute to a potentially groundbreaking treatment.

Will I have to stop taking my current medications?

The trial requires that patients in Part 2 stay on their current stable psychotropic treatment for the duration of the study. However, patients currently treated with certain medications like alpha-1 noradrenergic blockers or alpha-2 adrenergic agonists cannot participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Previous studies have shown that BXCL501 is well-tolerated by patients. Research indicates that patients using BXCL501 at home for episodes of agitation did not experience significant side effects, suggesting the treatment is generally safe. Additionally, BXCL501 is a form of dexmedetomidine, already approved by the FDA for other uses, which provides some confidence about its safety. While no treatment is without risk, existing evidence supports the safety of BXCL501 in managing agitation.12345

Why do researchers think this study treatment might be promising for agitation in schizophrenia and bipolar disorder?

Most treatments for agitation in schizophrenia and bipolar disorder, like antipsychotics and benzodiazepines, primarily target dopamine or GABA receptors to calm the nervous system. But BXCL501 works differently; it's a sublingual film containing dexmedetomidine, which acts on alpha-2 adrenergic receptors to reduce agitation. This novel mechanism offers a potentially quicker onset of action and fewer sedative side effects compared to traditional options. Researchers are particularly excited about its ease of use, as the sublingual film allows for simple administration without the need for injections or pills, making it a convenient option for those in need of immediate relief.

What evidence suggests that BXCL501 could be an effective treatment for agitation in schizophrenia and bipolar disorder?

Research has shown that BXCL501, a form of the drug dexmedetomidine, can greatly reduce feelings of agitation. Earlier studies found it significantly lessened agitation symptoms compared to a placebo, with noticeable effects starting just two hours after administration. In this trial, participants will receive either 60 mcg or 120 mcg of BXCL501, or a matching placebo, to evaluate its effectiveness in treating agitation in people with bipolar disorder and schizophrenia. The treatment comes as a small film placed under the tongue, which helps it work quickly. Early results indicate it can safely and effectively reduce episodes of agitation.13467

Who Is on the Research Team?

MM

Matt Mandel, MD

Principal Investigator

BioXcel Therapeutics

Are You a Good Fit for This Trial?

Adults aged 18-75 with bipolar I or II, schizophrenia, schizoaffective, or schizophreniform disorder who've had recent agitation episodes may join. They must be in good health based on medical exams and agree to use birth control. Exclusions include certain mental disorders pre-dating their diagnosis, recent investigational drug use, specific medication treatments, pregnancy/breastfeeding women, and those with serious neurological conditions.

Inclusion Criteria

Do you often get upset or feel agitated?

Exclusion Criteria

Have you been diagnosed with Parkinson's Disease?
Have you been diagnosed with Meningitis?
Have you been diagnosed with Concussion?
See 12 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Part 1

One-day, in-clinic treatment of 60 mcg dose and post-treatment observation for acute agitation

1 day
1 visit (in-clinic)

Treatment Part 2

12-week study to determine the safety of a 120 mcg dose used as needed for agitation at home

12 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

  • BXCL501
  • Matching Placebo
Trial Overview The trial is testing BXCL501 against a placebo for reducing agitation in patients with bipolar disorder or schizophrenia-related conditions. Participants are randomly assigned to receive either the study drug or a placebo to compare effectiveness.
How Is the Trial Designed?
4Treatment groups
Experimental Treatment
Placebo Group
Group I: Part 2: 120 mcg of BXCL501Experimental Treatment1 Intervention
Group II: Part 1: 60 mcg of BXCL501Experimental Treatment1 Intervention
Group III: Part 2: Matching PlaceboPlacebo Group1 Intervention
Group IV: Part 1: Matching PlaceboPlacebo Group1 Intervention

BXCL501 is already approved in United States for the following indications:

🇺🇸
Approved in United States as IGALMI for:

Find a Clinic Near You

Who Is Running the Clinical Trial?

BioXcel Therapeutics Inc

Lead Sponsor

Trials
20
Recruited
2,400+

Worldwide Clinical Trials

Collaborator

Trials
70
Recruited
15,800+

Published Research Related to This Trial

Dexmedetomidine sublingual film has been shown to be effective in reducing acute agitation in patients with schizophrenia and bipolar disorder, with significant improvements observed as early as 20 minutes after administration in pivotal trials involving these conditions.
The most common side effect was somnolence, while cardiovascular effects were generally mild and temporary, making dexmedetomidine a promising non-invasive alternative to traditional antipsychotics and benzodiazepines for managing agitation.
Dexmedetomidine Sublingual Film: A New Treatment to Reduce Agitation in Schizophrenia and Bipolar Disorders.Karlin, DM., Nelson, LA., Campbell, AR.[2023]
Sublingual dexmedetomidine is an effective and well-tolerated treatment for agitation in adults with schizophrenia and bipolar disorder, with effects starting as quickly as 20 minutes after administration.
While it shows promise, potential side effects include somnolence and hypotension, and further research is needed to assess its use in patients taking other psychiatric medications.
Sublingual dexmedetomidine: repurposing an anesthetic as an anti-agitation agent.Faden, J., Musselman, M., Citrome, L.[2023]
Dexmedetomidine film (BXCL501) and intranasal olanzapine (INP105) are two investigational medications showing promise for the rapid management of acute agitation in patients with schizophrenia or bipolar disorder, based on a review of clinical trials.
While olanzapine is already established in psychiatric treatment, dexmedetomidine represents a novel approach, and both medications offer unique noninvasive administration methods that could enhance patient compliance and treatment outcomes.
The treatment of acute agitation associated with schizophrenia or bipolar disorder: investigational drugs in early stages of their clinical development, and their clinical context and potential place in therapy.Ward, K., Citrome, L.[2020]

Citations

Press ReleaseBXCL501 has been granted Breakthrough Therapy designation by the FDA for the acute treatment of agitation associated with dementia and Fast ...
Press Release - BioXcel TherapeuticsBXCL501 demonstrated a significant mean reduction in mCGI-S score from baseline compared to placebo at 2 hours across 2,433 treated episodes ...
Study Details | NCT05658510 | Dexmedetomidine in the ...This is a randomized, double-blind, placebo-controlled, 2-Part, Phase III study to assess the efficacy, safety, and tolerability of BXCL501 in adult (18-75 ...
Exploratory EndpointsA total PEC score of 14-19 at baseline was considered moderate agitation and a total PEC score of 20-35 at baseline was considered severe agitation.5,6. These ...
Sublingual Dexmedetomidine for Agitation Associated with ...The efficacy and tolerability of 120-µg and 180-µg doses of sublingual dexmedetomidine were evaluated in two similarly designed, randomized, double-blind, ...
BioXcel Therapeutics Announces SERENITY At-Home ...BXCL501 achieved SERENITY At-Home's primary endpoint of being well tolerated in the at-home treatment of agitation episodes in patients with ...
IGALMI® (dexmedetomidine) Patient Site, Bipolar88.8% of patients treated with IGALMI 180 mcg and 79.1% of patients treated with IGALMI 120 mcg experienced at least a 40% reduction in agitation as measured by ...
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