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| ID | Type | Description | Link |
|---|---|---|---|
| U54HD090258-01 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | NIH |
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The primary aims of this study focus on characterizing the relationship between atomoxetine exposure and clinical outcomes, as assessed by standardized measures. We will also simultaneously monitor side effect of atomoxetine, another measure of clinical outcomes, and categorize study participants on their ability to tolerate atomoxetine.
Atomoxetine (ATX), Strattera®, is a norepinephrine re-uptake transporter inhibitor that is approved by the Food and Drug Administration (FDA) for the treatment of attention deficit/hyperactivity disorder (ADHD). The drug is often considered a second- or third-line agent, due to the perception that the drug does not work very well. In fact, in a review of studies submitted to the FDA, it reported that there appeared to be discrete classes of response to atomoxetine. After 6-9 weeks of treatment, 47% of the patients were considered "responders" based on changes in the rating scales used to measure ADHD symptoms whereas 40% of patients were considered non-responders. Statistically significant (p<0.001) differences in scores between responders and non-responders were apparent after the first week of treatment. At the relatively low starting doses of the titration scheme, this suggests that there may be a subgroup of patents who are particularly responsive to ATX. We hypothesize that there could be two reasons for this: 1) variability in drug pharmacokinetics (i.e., inadequate drug concentrations in the blood over time could lead to poor response) and 2) variability in drug pharmacodynamics (i.e. differences at the level of the target of drug action that limit the response to a drug, regardless of concentration of drug present in the blood). The CYP2D6 gene, which encodes for the drug metabolizing enzyme CYP2D6, is responsible for the clearance of ATX from the body, is highly polymorphic. ATX metabolism by CYP2D6 protein is one of the major routes of clearance (i.e., removal) of this drug. Genetic variability in the CYP2D6 gene leads to wide inter-individual variability in the activity of the enzyme, ultimately resulting in differing amount of drug in the body (also referred to as "exposure," and is a component of drug pharmacokinetics). Secondly, the SLC6A2 gene which encodes for the norepinephrine reuptake transporter, the drug target for ATX, is also subject to genetic variation. Reported genetic variants of SLC6A2 have been associated with decreased abundance of the transporter. The consequences of SLC6A2 genetic variation with regards to ATX clinical response are currently unknown. In the context of distinct "responder" and "non-responder" groups with a population of atomoxetine-treated patients, non-response could be due to definable differences at the level of the drug target (patients unlikely to respond regardless of the ATX concentrations achieved), or simply a consequence of inadequate exposure in a substantial proportion of population. The goal of this study is to address this issue.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Atomoxetine Hydrochloride | Drug | Atomoxetine dose adjusted to achieve pre-defined concentration |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants Classified as Responders and Non-responders to Intervention | Classification of participants as "responders" versus "non-responders" is based on percent reduction in total National Initiative for Children's Healthcare Quality (NICHQ) Vanderbilt Assessment Scale (3rd edition) score from baseline. Participants with ≥40% reduction in total score from baseline are classified as responders. The scale assesses the presence and severity of 18 DSM-V criteria for attention deficit hyperactivity disorder (ADHD) symptoms. Symptoms are rated on a 4-point Likert-type scale: 0 ("Never") to 3 ("Very Often"). Maximum total symptom score is 54.The measure includes 8 questions assessing functional impairment ("Performance"). Impairment is rated on a 5-point Likert-type scale: 1 ("Excellent") to 5 ("Problematic"). | 6 weeks |
| Number of Participants Classified as Responders and Non-responders to Intervention | Classification of participants as "responders" versus "non-responders" is based on percent reduction in total National Initiative for Children's Healthcare Quality (NICHQ) Vanderbilt Assessment Scale (3rd edition) score from baseline. Participants with ≥40% reduction in total score from baseline are classified as responders. The scale assesses the presence and severity of 18 DSM-V criteria for attention deficit hyperactivity disorder (ADHD) symptoms. Symptoms are rated on a 4-point Likert-type scale: 0 ("Never") to 3 ("Very Often"). Maximum total symptom score is 54.The measure includes 8 questions assessing functional impairment ("Performance"). Impairment is rated on a 5-point Likert-type scale: 1 ("Excellent") to 5 ("Problematic"). | 18 weeks |
| Maximum Plasma Concentration (Cmax) of Atomoxetine | Cmax is the highest concentration of atomoxetine measured over a 12-hour period following administration of the drug on pharmacokinetic study days occurring at baseline (first dose). Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders. | Baseline (first dose) |
| Maximum Plasma Concentration (Cmax) of Atomoxetine |
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Inclusion Criteria:• Males and females 6-18 years of age at the time of enrollment
Diagnosis of ADHD, as confirmed by a Study Physician at intake visit.
Intention of the Study Physician to begin therapy with ATX at intake visit
Willing to provide written permission/assent to participate
ADHD Medication Status is one of the following:
Exclusion Criteria:
An IQ < 70
A diagnosis of Autism Spectrum Disorder
Inability or unwillingness to have blood drawn as described in the protocol schedule of events and consent
Underlying risk for cardiotoxicity, such as presentation of structural cardiac abnormalities, cardiomyopathy, or arrhythmias
Clinically significant abnormal safety laboratory values as determined by treating physician
Diagnosis that may cause abnormal absorption or gastric emptying, such as reflux, inflammatory bowel disease, or Crohn's disease
For females, a positive urine pregnancy test
Previous history of adverse drug reaction to ATX
Use of drugs known to inhibit CYP2D6:
Unwillingness or inability to washout of stimulant ADHD medications
Concurrent or recent use of other psychiatric/behavioral health drugs including SSRIs, SNRIs, antipsychotics, anxiolytics, anti-epileptics, and α2-agonists that would impact the participant's pharmacokinetic and/or pharmacodynamic baseline
Subject is considered by PI to be unsuitable for participation in the study for any reason
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Males and females 6-18 years of age, with a diagnosis of ADHD.
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| Name | Affiliation | Role |
|---|---|---|
| James S Leeder, PharmD, PhD | Children's Mercy Hospital Kansas City | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Children's Mercy Hospital and Clinics | Kansas City | Missouri | 64108 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19318988 | Background | Newcorn JH, Sutton VK, Weiss MD, Sumner CR. Clinical responses to atomoxetine in attention-deficit/hyperactivity disorder: the Integrated Data Exploratory Analysis (IDEA) study. J Am Acad Child Adolesc Psychiatry. 2009 May;48(5):511-518. doi: 10.1097/CHI.0b013e31819c55b2. | |
| 16896954 | Background | Seneca N, Gulyas B, Varrone A, Schou M, Airaksinen A, Tauscher J, Vandenhende F, Kielbasa W, Farde L, Innis RB, Halldin C. Atomoxetine occupies the norepinephrine transporter in a dose-dependent fashion: a PET study in nonhuman primate brain using (S,S)-[18F]FMeNER-D2. Psychopharmacology (Berl). 2006 Sep;188(1):119-27. doi: 10.1007/s00213-006-0483-3. Epub 2006 Aug 4. |
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A total of 51 participants were enrolled in the study. All participants completed a screening visit, and 9 participants screenfailed/were determined to be ineligible.
Participants were recruited over 6 years from a patient population seeking care for Attention Deficit Hyperactivity Disorder (ADHD).
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| ID | Title | Description |
|---|---|---|
| FG000 | Atomoxetine HCl (Strattera) | Study participants will receive atomoxetine at a dose expected to result in steady-state maximum concentration (Cmax,ss) values of 400 ng/mL. Dose will be calculated using a model based on CYP2D6 predicted phenotype, height, weight, body habitus, and gender. Study clinicians may titrate up the dose to reach Cmax,ss values of 600 ng/mL or 800 ng/mL according to participant response. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Atomoxetine HCl (Strattera) | Study participants will receive atomoxetine at a dose expected to result in steady-state maximum concentration (Cmax,ss) values of 400 ng/mL. Individualized dose to achieve the desired Cmax,ss of 400 ng/ml (approximately 90 minutes after dose administration) is determined using a pharmacokinetic model that includes as input information each participant's CYP2D6 genotype-predicted phenotype, height, weight, body habitus, and gender. Study clinicians may titrate up the dose to reach predicted Cmax,ss values of 600 ng/mL or 800 ng/mL according to participant response. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants Classified as Responders and Non-responders to Intervention | Classification of participants as "responders" versus "non-responders" is based on percent reduction in total National Initiative for Children's Healthcare Quality (NICHQ) Vanderbilt Assessment Scale (3rd edition) score from baseline. Participants with ≥40% reduction in total score from baseline are classified as responders. The scale assesses the presence and severity of 18 DSM-V criteria for attention deficit hyperactivity disorder (ADHD) symptoms. Symptoms are rated on a 4-point Likert-type scale: 0 ("Never") to 3 ("Very Often"). Maximum total symptom score is 54.The measure includes 8 questions assessing functional impairment ("Performance"). Impairment is rated on a 5-point Likert-type scale: 1 ("Excellent") to 5 ("Problematic"). | Individuals who completed 6 week milestone | Posted | Count of Participants | Participants | 6 weeks |
|
Adverse event data was collected over the full 18 weeks of participation in the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Atomoxetine HCl (Strattera) | Study participants will receive atomoxetine at a dose expected to result in steady-state maximum concentration (Cmax,ss) values of 400 ng/mL. Dose will be calculated using a model based on CYP2D6 predicted phenotype, height, weight, body habitus, and gender. Study clinicians may titrate up the dose to reach Cmax,ss values of 600 ng/mL or 800 ng/mL according to participant response. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea/Vomiting/Upset Stomach | Gastrointestinal disorders | Non-systematic Assessment |
Recruitment was severely affected by the COVID-19 pandemic, and did not recover as hospital operations adapted to the pandemic. Therefore, study was terminated before enrollment goal was met.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| James Steven Leeder, PharmD, PhD | Children's Mercy Hospital | 816-731-7116 | sleeder@cmh.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 1, 2023 | May 22, 2023 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D001289 | Attention Deficit Disorder with Hyperactivity |
| ID | Term |
|---|---|
| D019958 | Attention Deficit and Disruptive Behavior Disorders |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D000069445 | Atomoxetine Hydrochloride |
| ID | Term |
|---|---|
| D011437 | Propylamines |
| D000588 | Amines |
| D009930 | Organic Chemicals |
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Cmax is the highest concentration of atomoxetine measured following administration of the drug on pharmacokinetic study days occurring at 6 weeks. Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders. |
| 6 weeks |
| Maximum Plasma Concentration (Cmax) of Atomoxetine | Cmax is the highest concentration of atomoxetine measured following administration of the drug on pharmacokinetic study days occurring at 18 weeks. Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders. | 18 weeks |
| Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine | AUC is the area under the plasma concentration-time curve following administration of atomoxetine. For the baseline pharmacokinetic study (first dose of atomoxetine) plasma concentrations were measured at 17 timepoints between 0 and 72 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 48, and 72 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) after dose administration for all other participants. The AUC was generated using a mixed log-linear approach and extrapolated to infinity. AUC is compared between responders and non-responders. | Baseline (first dose) |
| Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine | For the steady-state pharmacokinetic studies at 6 weeks, plasma concentrations were measured at 15 timepoints between 0 and 24 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and at 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) and extrapolated to 24 hours for all other participants. AUC is compared between responders and non-responders. | 6 weeks |
| Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine | For the steady-state pharmacokinetic studies at 18 weeks, plasma concentrations were measured at 15 timepoints between 0 and 24 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and at 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) and extrapolated to 24 hours for all other participants. AUC is compared between responders and non-responders. | 18 weeks |
| Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG) | DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, absolute baseline and pre-dose concentrations of DHPG will be compared between atomoxetine responders and non-responders. | Baseline |
| Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG) | DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, pre-dose concentration of DHPG at the 6-week pharmacokinetic study visit will be compared between atomoxetine responders and non-responders. | 6 weeks |
| Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG) | DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, pre-dose concentration of DHPG at the 18-week pharmacokinetic study visit will be compared between atomoxetine responders and non-responders. | 18 weeks |
| Change in Plasma Concentration of DHPG From Baseline | The change in DHPG will be compared between atomoxetine responders and non-responders. | 6 weeks |
| Change in Plasma Concentration of DHPG From Baseline | The change in DHPG will be compared between atomoxetine responders and non-responders. | 18 weeks |
| 17242628 | Background | Michelson D, Read HA, Ruff DD, Witcher J, Zhang S, McCracken J. CYP2D6 and clinical response to atomoxetine in children and adolescents with ADHD. J Am Acad Child Adolesc Psychiatry. 2007 Feb;46(2):242-51. doi: 10.1097/01.chi.0000246056.83791.b6. |
| 17146058 | Background | Kim CH, Hahn MK, Joung Y, Anderson SL, Steele AH, Mazei-Robinson MS, Gizer I, Teicher MH, Cohen BM, Robertson D, Waldman ID, Blakely RD, Kim KS. A polymorphism in the norepinephrine transporter gene alters promoter activity and is associated with attention-deficit hyperactivity disorder. Proc Natl Acad Sci U S A. 2006 Dec 12;103(50):19164-9. doi: 10.1073/pnas.0510836103. Epub 2006 Dec 4. |
| 22111604 | Background | Gaedigk A, Twist GP, Leeder JS. CYP2D6, SULT1A1 and UGT2B17 copy number variation: quantitative detection by multiplex PCR. Pharmacogenomics. 2012 Jan;13(1):91-111. doi: 10.2217/pgs.11.135. Epub 2011 Nov 23. |
| 17971818 | Background | Gaedigk A, Simon SD, Pearce RE, Bradford LD, Kennedy MJ, Leeder JS. The CYP2D6 activity score: translating genotype information into a qualitative measure of phenotype. Clin Pharmacol Ther. 2008 Feb;83(2):234-42. doi: 10.1038/sj.clpt.6100406. Epub 2007 Oct 31. |
| 17259947 | Background | Gaedigk A, Ndjountche L, Divakaran K, Dianne Bradford L, Zineh I, Oberlander TF, Brousseau DC, McCarver DG, Johnson JA, Alander SW, Wayne Riggs K, Steven Leeder J. Cytochrome P4502D6 (CYP2D6) gene locus heterogeneity: characterization of gene duplication events. Clin Pharmacol Ther. 2007 Feb;81(2):242-51. doi: 10.1038/sj.clpt.6100033. |
| 21833166 | Background | Gaedigk A, Jaime LK, Bertino JS Jr, Berard A, Pratt VM, Bradfordand LD, Leeder JS. Identification of Novel CYP2D7-2D6 Hybrids: Non-Functional and Functional Variants. Front Pharmacol. 2010 Oct 4;1:121. doi: 10.3389/fphar.2010.00121. eCollection 2010. |
| 20017671 | Background | Gaedigk A, Fuhr U, Johnson C, Berard LA, Bradford D, Leeder JS. CYP2D7-2D6 hybrid tandems: identification of novel CYP2D6 duplication arrangements and implications for phenotype prediction. Pharmacogenomics. 2010 Jan;11(1):43-53. doi: 10.2217/pgs.09.133. |
| 24151800 | Background | Gaedigk A. Complexities of CYP2D6 gene analysis and interpretation. Int Rev Psychiatry. 2013 Oct;25(5):534-53. doi: 10.3109/09540261.2013.825581. |
| Physician Decision |
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| Protocol Violation |
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| Withdrawal by Subject |
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| Disruption of study due to COVID-19 |
|
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Neuropsychiatric Comorbidities | Count of Participants | Participants |
|
| Weight | Mean | Standard Deviation | kilograms (kg) |
|
| ADHD Subtype (based on NICHQ Vanderbilt Assessment Scale score) | The NICHQ Vanderbilt Assessment Scales assess the presence and severity of all 18 DSM-V criteria for ADHD (9 inattentive symptoms and 9 hyperactivity/impulsivity symptoms). To meet criteria for an ADHD diagnosis, one must have at least 6 positive responses to the 9 inattentive (inattentive subtype) or 9 hyperactive/impulsivity (hyperactive/impulsive subtype) core symptoms, or both (combined subtype). | Count of Participants | Participants |
|
| ADHD Subtype (based on K-SADS-PL) | The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) is a semi-structured interview that is extensively used in clinical psychology research to diagnose an extensive array of psychopathology, including ADHD and subtype, based on the DSM criteria. | Count of Participants | Participants |
|
| CYP2D6 Activity Score | CYP2D6 genotypes were translated into activity scores as recommended by the Clinical Pharmacogenetics Implementation Consortium (CPIC). Normal function alleles were assigned a value of 1, decreased function alleles a value of 0.25 or 0.5, and non-functional alleles a value of 0; for multiplication events, the value was multiplied by the number of copies detected. The activity score for an individual study participant was assigned as the sum of the scores for each allele, with poor metabolizers defined by an activity score of 0 and ultrarapid metabolizers defined by an activity score >2.25. | Count of Participants | Participants |
|
Study participants will receive atomoxetine at a dose expected to result in Cmax,ss values of 400 ng/mL. Study clinicians may titrate up the dose to reach Cmax,ss values of 600 ng/mL or 800 ng/mL according to participant response. |
|
|
| Primary | Number of Participants Classified as Responders and Non-responders to Intervention | Classification of participants as "responders" versus "non-responders" is based on percent reduction in total National Initiative for Children's Healthcare Quality (NICHQ) Vanderbilt Assessment Scale (3rd edition) score from baseline. Participants with ≥40% reduction in total score from baseline are classified as responders. The scale assesses the presence and severity of 18 DSM-V criteria for attention deficit hyperactivity disorder (ADHD) symptoms. Symptoms are rated on a 4-point Likert-type scale: 0 ("Never") to 3 ("Very Often"). Maximum total symptom score is 54.The measure includes 8 questions assessing functional impairment ("Performance"). Impairment is rated on a 5-point Likert-type scale: 1 ("Excellent") to 5 ("Problematic"). | Participants who completed 18 week milestone | Posted | Count of Participants | Participants | 18 weeks |
|
|
|
| Primary | Maximum Plasma Concentration (Cmax) of Atomoxetine | Cmax is the highest concentration of atomoxetine measured over a 12-hour period following administration of the drug on pharmacokinetic study days occurring at baseline (first dose). Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders. | 6-week and 18-week responder classifications have different sample sizes, as there are 2 milestones within this study. | Posted | Mean | Standard Deviation | ng/mL | Baseline (first dose) |
|
|
|
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| Primary | Maximum Plasma Concentration (Cmax) of Atomoxetine | Cmax is the highest concentration of atomoxetine measured following administration of the drug on pharmacokinetic study days occurring at 6 weeks. Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders. | Participants who completed 6 week milestone | Posted | Mean | Standard Error | ng/mL | 6 weeks |
|
|
|
|
| Primary | Maximum Plasma Concentration (Cmax) of Atomoxetine | Cmax is the highest concentration of atomoxetine measured following administration of the drug on pharmacokinetic study days occurring at 18 weeks. Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Error | ng/mL | 18 weeks |
|
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|
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| Primary | Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine | AUC is the area under the plasma concentration-time curve following administration of atomoxetine. For the baseline pharmacokinetic study (first dose of atomoxetine) plasma concentrations were measured at 17 timepoints between 0 and 72 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 48, and 72 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) after dose administration for all other participants. The AUC was generated using a mixed log-linear approach and extrapolated to infinity. AUC is compared between responders and non-responders. | 6-week and 18-week responder classifications have different sample sizes, as there are 2 milestones within this study. | Posted | Mean | Standard Deviation | (ng*hours)/mL | Baseline (first dose) |
|
|
|
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| Primary | Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine | For the steady-state pharmacokinetic studies at 6 weeks, plasma concentrations were measured at 15 timepoints between 0 and 24 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and at 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) and extrapolated to 24 hours for all other participants. AUC is compared between responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Error | (ng*hours)/mL | 6 weeks |
|
|
|
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| Primary | Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine | For the steady-state pharmacokinetic studies at 18 weeks, plasma concentrations were measured at 15 timepoints between 0 and 24 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and at 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) and extrapolated to 24 hours for all other participants. AUC is compared between responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Error | (ng*hours)/mL | 18 weeks |
|
|
|
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| Primary | Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG) | DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, absolute baseline and pre-dose concentrations of DHPG will be compared between atomoxetine responders and non-responders. | 6-week and 18-week responder classifications have different sample sizes, as there are 2 milestones within this study. | Posted | Mean | Standard Deviation | ng/mL | Baseline |
|
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|
|
| Primary | Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG) | DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, pre-dose concentration of DHPG at the 6-week pharmacokinetic study visit will be compared between atomoxetine responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Deviation | ng/mL | 6 weeks |
|
|
|
|
| Primary | Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG) | DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, pre-dose concentration of DHPG at the 18-week pharmacokinetic study visit will be compared between atomoxetine responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Deviation | ng/mL | 18 weeks |
|
|
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| Primary | Change in Plasma Concentration of DHPG From Baseline | The change in DHPG will be compared between atomoxetine responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Deviation | ng/mL | 6 weeks |
|
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|
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| Primary | Change in Plasma Concentration of DHPG From Baseline | The change in DHPG will be compared between atomoxetine responders and non-responders. | The overall participants were classified into 2 groups based on responder status. | Posted | Mean | Standard Deviation | ng/mL | 18 weeks |
|
|
|
|
| 0 |
| 42 |
| 0 |
| 42 |
| 37 |
| 42 |
| Decreased Appetite | Gastrointestinal disorders | Non-systematic Assessment |
|
| Diarrhea | Gastrointestinal disorders | Non-systematic Assessment |
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| Cold/Flu | Infections and infestations | Non-systematic Assessment |
|
| Fever | Infections and infestations | Non-systematic Assessment |
|
| Ear Infection | Infections and infestations | Non-systematic Assessment |
|
| Sore Throat | Infections and infestations | Non-systematic Assessment |
|
| Headache | Nervous system disorders | Non-systematic Assessment |
|
| Irritability | Psychiatric disorders | Non-systematic Assessment |
|
| Mood Disturbance | Psychiatric disorders | Non-systematic Assessment |
|
| Self-Injurious Behavior | Psychiatric disorders | Non-systematic Assessment |
|
| Fatigue | General disorders | Non-systematic Assessment |
|
| Foot injury | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
Not provided
Not provided
Not provided
|
| Responder at 18 weeks |
|
|
| Non-Responder at 18 weeks |
|
|
| 0.562 |
| Other |
|
|
|
| Responder at 18 weeks |
|
|
| Non-responder at 18 weeks |
|
|
| 0.955 |
| Other |
|
|
|
| Responder at 18 weeks |
|
|
| Non-responder at 18 weeks |
|
|
| 0.822 |
| Other |
|
|
|
|