AstraZeneca Announces SEROQUEL XR is Now Available to Treat Bipolar Depression
SEROQUEL XR is Now Approved to Treat the Depressive, Manic, and Mixed Episodes of Bipolar Disorder
Once-daily SEROQUEL XR is the only medication FDA-approved for the treatment of acute depressive, manic, and mixed episodes of bipolar disorder.(2)
“Bipolar depression is a serious and debilitating illness with few approved treatment options,” said Dr.
Approximately 8 million American adults may be affected by bipolar disorder, also known as manic-depressive illness, a serious psychiatric condition characterized by recurring episodes of depression and mania.(3,4) For many patients with bipolar disorder, the depressive symptoms are more disruptive than the manic symptoms.(5)
“When symptomatic, people with bipolar disorder experience depressive symptoms more than three times longer than manic symptoms, and this may interfere with daily activities,” said Dr.
Today’s announcement follows the
SEROQUEL XR is now available in 50-mg, 150-mg, 200-mg, 300-mg, and 400-mg tablet strengths. SEROQUEL XR is also approved for the acute and maintenance treatment of schizophrenia.(1) For the full prescribing information, go to www.SEROQUELXR.com.
About Bipolar Disorder
Approximately 8 million American adults may be affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness.(3,4) Bipolar disorder consists of recurring episodes of mania and depression.(6) Bipolar I disorder is characterized by one or more manic or mixed episodes, often with one or more episodes of major depression, whereas bipolar II disorder is distinguished by one or more major depressive episodes accompanied by at least one hypomanic episode.(6)
Patients with bipolar I disorder experience depressive symptoms approximately three times longer than manic symptoms.(7) Similarly, patients with bipolar II disorder spend almost forty times longer in the depressed state than in hypomania.(8) Up to 50 percent of patients with bipolar disorder attempt suicide, and approximately 15 to 20 percent complete suicide.(9)
Bipolar disorder is often misdiagnosed as major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease. In fact, many patients face ten years or more before a correct diagnosis is made.(10) Prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.(1,11)
Bipolar disorder is typically managed through a treatment strategy with several phases – including acute and maintenance phases. In the acute phase, the aim is to improve the acute symptoms of the patient; the maintenance treatment phase aims to reduce the risk of recurrence of future episodes.(12)
Important Safety Information for SEROQUEL XR
SEROQUEL XR is indicated for the treatment of acute depressive episodes associated with bipolar disorder, acute manic or mixed episodes associated with bipolar I disorder as monotherapy and as an adjunct to lithium or divalproex; maintenance treatment of bipolar I disorder as adjunct therapy to lithium or divalproex, and acute and maintenance treatment of schizophrenia. Patients should be periodically reassessed to determine the need for continued treatment and the appropriate dose.
Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk (1.6 to 1.7 times) of death, compared to placebo (4.5% vs. 2.6%, respectively). SEROQUEL XR is not approved for the treatment of patients with dementia-related psychosis. (See Boxed Warning.)
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder and other psychiatric disorders. Patients of all ages started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. SEROQUEL XR is not approved for use in patients under the age of 18 years. (See Boxed Warning.)
Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics, including quetiapine. The relationship of atypical use and glucose abnormalities is complicated by the possibility of increased risk of diabetes in the schizophrenic population and the increasing incidence of diabetes in the general population. However, epidemiological studies suggest an increased risk of treatment-emergent, hyperglycemia-related adverse reactions in patients treated with atypical antipsychotics. Patients starting treatment with atypical antipsychotics who have or are at risk for diabetes should undergo fasting blood glucose testing at the beginning of and periodically during treatment. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing.
In long-term clinical trials of quetiapine, hyperglycemia (fasting glucose greater than or equal to 126 mg/dL) was observed in 10.7% of patients receiving quetiapine (mean exposure 213 days) vs. 4.6% in patients receiving placebo (mean exposure 152 days).
Clinically significant increases in cholesterol (4%-16% for quetiapine vs. 2%-7% for placebo) and triglycerides (8%-23% for quetiapine vs. 6%-16% for placebo) have been observed in clinical trials.
The proportion of patients in clinical trials meeting a weight gain criterion of greater than or equal to 7% of body weight was 5%-23% for quetiapine vs. 0%-7% for placebo.
A potentially fatal symptom complex, sometimes referred to as Neuroleptic Malignant Syndrome (NMS), has been reported in association with administration of antipsychotic drugs, including quetiapine. Rare cases of NMS have been reported with quetiapine. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The management of NMS should include immediate discontinuation of antipsychotic drugs.
Leukopenia, neutropenia, and agranulocytosis (including fatal cases), have been reported temporally related to atypical antipsychotics, including quetiapine. Patients with a pre-existing low white blood cell (WBC) count or a history of drug induced leukopenia/neutropenia should have their complete blood count monitored frequently during the first few months of therapy. In these patients, SEROQUEL XR should be discontinued at the first sign of a decline in WBC absent other causative factors. Patients with neutropenia should be carefully monitored, and SEROQUEL XR should be discontinued in any patient if the absolute neutrophil count is < 1000/cubic mm.
Tardive dyskinesia (TD), a potentially irreversible syndrome of involuntary dyskinetic movements, may develop in patients treated with antipsychotic drugs. The risk of developing TD and the likelihood that it will become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic drugs administered to the patient increase. TD may remit, partially or completely, if antipsychotic treatment is withdrawn. Quetiapine should be prescribed in a manner that is most likely to minimize the occurrence of TD.
Warnings and Precautions also include the risk of orthostatic hypotension, cataracts, seizures, hyperprolactinemia, and possibility of suicide attempts. Examination of the lens by methods adequate to detect cataract formation, such as slit lamp exam or other appropriately sensitive methods, is recommended at initiation of treatment or shortly thereafter, and at 6-month intervals during chronic treatment. The possibility of a suicide attempt is inherent in schizophrenia, and close supervision of high risk patients should accompany drug therapy.
The most commonly reported adverse reactions associated with the use of SEROQUEL XR vs. placebo in clinical trials for schizophrenia and bipolar disorder were somnolence (25%-52% vs. 10%-13%), dry mouth (12%-37% vs. 1%-7%), constipation (6-10% vs. 3-6%), dyspepsia (5-7% vs. 1-4%), dizziness (10-13% vs. 4-11%), orthostatic hypotension (7% vs. 5%), weight gain (7% vs. 1%), increased appetite (12% vs. 6%), fatigue (6-7% vs. 2-4%), dysarthria (5% vs. 0%), and nasal congestion (5% vs. 1%).
Please see full Prescribing Information, including Boxed Warnings, for SEROQUEL XR.
AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of healthcare services. AstraZeneca is one of the world’s leading pharmaceutical companies with global healthcare sales of
The statements contain herein include forward-looking statements. Although we believe our expectations are based on reasonable assumptions, any forward-looking statements, by their very nature, involve risks and uncertainties and may be influenced by factors that could cause actual outcomes and results to be materially different from those predicted. The forward-looking statements reflect knowledge and information available at the date of the preparation of this press release and the Company undertakes no obligation to update these forward-looking statements. Important factors that could cause actual results to differ materially from those contained in forward-looking statements, certain of which are beyond our control, include, among other things, those risk factors identified in the Company’s Annual Report/Form 20-F for 2007. Nothing contained herein should be construed as a profit forecast.
- SEROQUEL XR(R) (quetiapine fumarate) Extended-Release Prescribing Information.
- Data on file, DA-SXR-272661, AstraZeneca Pharmaceuticals LP.
- Hirschfeld RMA, Calabrese JR, Weissman MM, et al. Screening for Bipolar in the Community. J Clin Psychiatry. 2003; 64:53-59.
- US Bureau of the Census. Available at: http://www.census.gov/popest/national/asrh/NC-EST2005/NC-EST2005-02.xls. Accessed
February 12, 2009.
- Calabrese JR, Hirschfeld RMA, et al. Impact of Depressive Symptoms Compared with Manic Symptoms in Bipolar Disorder: Results of a U.S. Community-Based Sample. J Clin Psychiatry. 2004;65(11):1499-1504.
- American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Washington, DC: APA; 2000; 382-397.
- Judd LL, Akiskal HS, Schettler PJ, et al. The Long-term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder. Arch Gen Psychiatry. 2002; 59:530-537.
- Judd LL, Akiskal HS, Schettler PJ, et al. A Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder. Arch Gen Psychiatry. 2003; 60:261 -269.
- Oquendo MA, Chaudhury SR, Mann JJ. Pharmacotherapy of Suicidal Behavior in Bipolar Disorder. Archives of Suicide Research. 2005; 9(3):237-250.
- Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and Impact of Bipolar Disorder: How Far Have We Really Come? Results of the National Depressive and Manic- Depressive Association 2000 Survey of Individuals With Bipolar Disorder. J Clin Psychiatry. 2003; 64:161-174.
- US Food and Drug Administration. Revisions to Product Labeling. http://www.fda.gov/cder/drug/antidepressants/antidepressants_label_change_2007.pdf.Accessed
January 27, 2009.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients With Bipolar Disorder, Second Edition.
April 2002. http://www.psychiatryonline.com/pracGuide/loadGuidelinePdf.aspx?file=Bipolar2ePG_05-15-06.