Abstract
Ulotaront, a trace amine-associated receptor 1 (TAAR1) and serotonin 5-HT1A receptors agonist, has demonstrated efficacy in the treatment of patients with an acute exacerbation of schizophrenia in a 4-week, double-blind, placebo-controlled study. The aim of this 26-week open-label extension study was to evaluate the safety and effectiveness of ulotaront (25/50/75 mg/d) in patients who completed the initial 4-week study. Of the 193 4-week completers, 157 patients (81.3%) continued into the open-label extension study; 66.9% were completers. Among all extension phase patients, treatment with ulotaront was associated with minimal changes in body weight (mean [SD] change from double-blind baseline: −0.3 [3.7] kg), cholesterol (median change, −2.0 mg/dL), triglycerides (median, −5.0 mg/dL), and prolactin (female, median, −3.4 ng/mL; male, median, −2.7 ng/mL). Movement disorder scales showed no extrapyramidal effects. Twenty-six weeks of extension phase treatment was associated with a mean (95% CI) observed change from open-label baseline in the PANSS total score of −22.6 (−25.6, −19.6; effect size, 1.46), and a mean (95% CI) change in the CGI-Severity score of −1.0 (−1.2, −0.8; effect size, 1.07). Long-term treatment with the TAAR1 agonist ulotaront, in the daily dose range of 25–75 mg, was characterized by a relatively high completion rate, an adverse event profile notable for the absence of extrapyramidal-related adverse effects, a low liability for adverse weight and metabolic effects, and no effect on prolactin levels. Additional studies are needed to further confirm the long-term efficacy and safety of ulotaront.
Highlights
Ulotaront (SEP-363856), one of the first of a new class of CNSactive compounds, is an agonist at trace amine-associated receptor 1 (TAAR1) as well as serotonin 5-HT1A receptors
We report here the results of a multi-regional, open-label study of the safety and effectiveness of 26 weeks of flexible-dose treatment with ulotaront (25, 50, or 75 mg/d) in adults with schizophrenia who had completed an initial 4-week, double-blind, placebo-controlled study[11]
Ulotaront was not associated with clinically meaningful changes in prolactin levels or in movement disorder scales (SAS, Barnes Rating Scale for Drug-Induced Akathisia (BARS), Abnormal Involuntary Movement Scale (AIMS)); and the incidence of Parkinsonlike symptoms and akathisia were low
Summary
Ulotaront (SEP-363856), one of the first of a new class of CNSactive compounds, is an agonist at trace amine-associated receptor 1 (TAAR1) as well as serotonin 5-HT1A receptors. TAAR1 is a G-protein-coupled receptor expressed in cortical, limbic, and midbrain monoaminergic regions that modulate dopaminergic, serotonergic, and glutamatergic activity[1,2,3,4,5,6]. In contrast to first- and second-generation antipsychotics, the efficacy of ulotaront is not mediated by blockade of D2 or 5-HT2A receptors[7]. Ulotaront has been shown to reduce ketamine-induced increases in striatal dopamine synthesis capacity in mice, suggesting the potential to modulate presynaptic dopamine dysfunction observed in schizophrenia patients[9]. Suppression of rapid eye movement sleep has been reported after single doses of ulotaront in both rats and humans and was utilized as a translational pharmacodynamic measure to guide dose selection in subsequent clinical trials in schizophrenia patients[10]
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