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New Labeling for Quetiapine Includes Monotherapy Safety, Efficacy Data for Acute Manic Episodes
SEROQUEL is the first medication in its class to include monotherapy safety and efficacy data for acute manic episodes associated with bipolar disorder extending beyond three weeks in its label.
"For patients with bipolar disorder and their clinicians, it's important to know that Seroquel is not only effective in reducing symptoms of acute mania the first few weeks, but is also effective in the subsequent 'continuation phase', when patients can still have significant symptoms and are still at risk for relapsing," said Jamie Mullen, MD, Senior Director of Clinical Research, AstraZeneca. "These data demonstrate that SEROQUEL treatment alone works early and continues to work through 12 weeks. For patients coping with this illness, this is good news."
SEROQUEL was originally approved by the FDA in January 2004 as a monotherapy and adjunct therapy with lithium or divalproex, for the short-term treatment of acute manic episodes associated with bipolar I disorder. This approval was based on efficacy results following three weeks of treatment. These trials showed SEROQUEL to be well-tolerated and effective in the treatment of manic episodes - excited mental states seen in bipolar disorder that are characterized by impulsive behaviour, racing thoughts, pressured speech, and decreased need for sleep. (1), (2)
SEROQUEL has received licences for the treatment of mania associated with bipolar disorder in 42 countries, including the US. SEROQUEL has also been licensed for the treatment of schizophrenia since 1997, and is available in 81 countries for the treatment of this condition. SEROQUEL is the fastest growing product among the three leading brands in the atypical antipsychotic market. Sales during 2003 reached US$1.5 billion and the product currently ranks second in the US antipsychotic market for new and total prescription share, having recently overtaken olanzapine.
The new label information is supported by data from two, 12-week, double-blind, randomised, placebo-controlled trials assessing the safety and efficacy of SEROQUEL monotherapy for the treatment of manic episodes in a large cohort of adults with bipolar I disorder. A total of 599 patients experiencing a manic episode were assigned to receive SEROQUEL (from 200 mg/day up to 800 mg/day), placebo, or an active control (lithium or haloperidol). The primary endpoint was change from baseline YMRS (Young Mania Rate Scales) total score at day 21 of treatment (week 3); secondary endpoints included change from baseline YMRS total score at day 84 (week 12).(1) The combined analysis of two 12-week, monotherapy, double-blind, placebo-controlled trials showed that:
- After 12 weeks, 66.8% of SEROQUEL-treated patients achieved a response (defined as greater than or equal to 50% decrease from baseline YMRS score) versus 40.0% of the placebo group (p - After 12 weeks, 65.4% of SEROQUEL-treated patients achieved remission (defined as YMRS less than or equal to 12), versus 35.9% with placebo (p - Improvement in manic symptoms based on change in YMRS score in patients treated with SEROQUEL was significantly greater than placebo-treated patients, as early as day 4 onwards (p=0.02).
Bipolar disorder is a serious mental illness that affects approximately 3-4% of the adult population and is the sixth leading cause of disability in the world.(3),(4),(5),(6) More than half of those with bipolar disorder stop taking their medication at some point during their illness, subjecting themselves to a high risk of relapse and an increased risk of suicide.(7) A medication's overall efficacy and tolerability profile is therefore vital to helping patients comply with their medication.
1. Jones MW, Huizar K, et al. Quetiapine monotherapy for acute mania associated with bipolar disorder (STAMP 1 and STAMP 2) [poster]. Presented at the Fifth International Conference on Bipolar Disporder, Pittsburgh, PA, June 12-14, 2003.
2. Sachs G, Chengappa KNR, Suppes T, et al. Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double-blind, placebo-controlled study. Bipolar Disorders. 2004:6:213-223
3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington DC, American Psychiatric Association, 2000:385;395.
4. Hirschfield et al. Screening for bipolar disorder in the community. J Clin Psychiatry. 2003:64;53-59.
5. Lish JD, Dime-Meenan S, Whybrow PC et al. The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members. J Affect Disord. 1994:31;281-294.
6. World Health Organization and the World Bank. The Global Burden of Disease: Summary. Cambridge, Mass: The Harvard School of Public Health Harvard University Press, 1996.
7. Miklowitz D. The Bipolar Disorder Survival Guide. New York: The Guildford Press, 2002.
[*] Remission defined as a score of less than 12 on the YMRS scale (Young Mania Rating Scale)