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Varenicline

Phase 3

Smoking Cessation | Small molecule | Other |Pfizer, Inc.|Last Updated: Apr 5, 2017

Success Probability
Approval Probability 71%
TA Base Rate26%
Adjusted LOA41%
ML RiskLOW_RISK
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Market & Valuation
rNPV $3.2B
Market Size $9.4B
Revenue Basis $1.6B
Competitors 6
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Trial Design
RandomizedDouble-BlindCONTROLLEDDMCBiomarker
Total Trials12
Total Enrollment6,680
FDA Designations
No designations recorded
Clinical Trials (12)
NCT IDTitlePhaseStatusEnrollmentVelocityDesignStartCompletionLast UpdatedSitesCountries
NCT00644969Smoking Cessation Study for Patients With Schizophrenia or Schizoaffective DisorderPHASE3 COMPLETED 128May 1, 2008Apr 1, 2010Apr 15, 201114 United States, Canada
NCT00371813An Investigation of Effectiveness and Safety of Varenicline Tartrate in Helping People Quit SmokingPHASE3 COMPLETED 334Sep 1, 2006Jun 1, 2007Apr 22, 201514 China, Singapore +1
NCT00282984Efficacy and Safety of Varenicline in Smokers With Cardiovascular Disease Who Wish to Quit SmokingPHASE3 COMPLETED 714Feb 1, 2006Aug 1, 2008Apr 5, 201739 United States, Argentina +13
NCT00141167A Twelve-Week Study of Varenicline for Safety and Efficacy in Comparison With Placebo for Smoking CessationPHASE3 COMPLETED 250Feb 1, 2005Jan 1, 2006Sep 6, 201010 South Korea, Taiwan
NCT00143325An Open Label Study That Compares Varenicline to Transdermal Nicotine Patch for Smoking CessationPHASE3 COMPLETED 730Jan 1, 2005Jun 1, 2006Jun 4, 200722 United States, Belgium +3
NCT00143299A 52-Week Placebo-Controlled Study Evaluating the Safety of VareniclinePHASE3 COMPLETED 375Oct 1, 2003Mar 1, 2005Jun 4, 20079 United States, Australia
NCT00143364A Twelve-Week Study of Varenicline for Safety and Efficacy in Comparison With Placebo and Zyban for Smoking CessationPHASE3 COMPLETED 1,005Jun 1, 2003Mar 1, 2005Jun 4, 200715 United States
NCT00141206A Twelve-Week Study of Varenicline for Safety and Efficacy in Comparison With Placebo and Zyban for Smoking CessationPHASE3 COMPLETED 1,005May 1, 2003Apr 1, 2005Jun 4, 200720 United States
NCT00143286A 52-Week Multicenter Study Evaluating the Safety and Efficacy of Varenicline for the Maintenance of Smoking CessationPHASE3 COMPLETED 2,000Apr 1, 2003Mar 1, 2005Jun 4, 200724 United States, Canada +5
NCT00661765A Single Dose Study Investigating the Absorption and Elimination as Well as the Tolerability of Varenicline Transdermal Delivery System (e.g., a Patch) as Compared to Oral Varenicline in Adult Smokers.PHASE1 COMPLETED 18Apr 1, 2008Jun 1, 2008Apr 23, 20091 United States
NCT00527150Multiple Dose, Dose Escalation Study of Varenicline Controlled Release Formulation in Adult SmokersPHASE1 COMPLETED 48Oct 1, 2007Feb 1, 2008Jan 11, 20102 United States
NCT00463918A Phase I Study to Evaluate the Pharmacokinetics of Multiple Doses of Varenicline in Healthy Adolescent SmokersPHASE1 COMPLETED 73May 1, 2007Dec 1, 2007Nov 19, 200816 United States, United Kingdom
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Study Endpoints
Primary Endpoints
Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
Baseline up to 30 days after last dose of study treatment or up to Week 16

AEs are any untoward medical occurrence in a clinical investigation participant administered a product or medical device. The event does not need to be causally related to the study treatment or usage. SAEs include any untoward medical occurrence that results in death, are life threatening, requires hospitalization or prolongation of hospitalization, results in disability or incapacity or are a congenital anomaly or birth defect in the offspring of a study participant. Lack of efficacy was to be reported as an AE when it was associated with an SAE.

Number of Participants With Psychiatric Adverse Events
Baseline up to Week 24

Psychiatric Adverse Event symptoms included, but were not restricted to, depression, anxiety, hostility, perceptual / thinking disturbance, suicidal ideation, or suicidal behavior based on clinical judgment and use of the Positive and Negative Syndrome Scale and Columbia Classification Algorithm of Suicide assessments.

Change From Baseline to Week 12 in Positive and Negative Syndrome Scale (PANSS): Total Score
Baseline to Week 12

PANSS includes 30 items rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme) organized as 7 positive symptom subscale items, 7 negative symptom subscale items and 16 general psychopathology items. Total scores range from 30 to 210 with higher scores indicating more extreme symptoms.

Change From Baseline to Week 24 in Positive and Negative Syndrome Scale (PANSS): Total Score
Baseline to Week 24

PANSS includes 30 items rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme) organized as 7 positive symptom subscale items, 7 negative symptom subscale items and 16 general psychopathology items. Total scores range from 30 to 210 with higher scores indicating more extreme symptoms.

Change From Baseline to Week 12 in Positive and Negative Syndrome Scale (PANSS): Positive Symptoms Score
Baseline to Week 12

PANSS includes 30 items rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme) organized as 7 positive symptom subscale items, 7 negative symptom subscale items and 16 general psychopathology items. Positive symptoms (productive symptoms) associated with schizophrenia (delusions, conceptual disorganization, and hallucinatory behavior) are rated on a scale from 1 (absent) to 7 (extreme); total positive subscale scores range from 7 to 49 with higher scores indicating more extreme symptoms.

Change From Baseline to Week 24 in Positive and Negative Syndrome Scale (PANSS): Positive Symptoms Score
Baseline to Week 24

PANSS includes 30 items rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme) organized as 7 positive symptom subscale items, 7 negative symptom subscale items and 16 general psychopathology items. Positive symptoms (productive symptoms) associated with schizophrenia (delusions, conceptual disorganization, and hallucinatory behavior) are rated on a scale from 1 (absent) to 7 (extreme); total positive subscale scores range from 7 to 49 with higher scores indicating more extreme symptoms.

Change From Baseline to Week 12 in Positive and Negative Syndrome Scale (PANSS): Negative Symptoms Score
Baseline to Week 12

PANSS includes 30 items rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme) organized as 7 positive symptom subscale items, 7 negative symptom subscale items and 16 general psychopathology items. Negative symptoms (deficit features) associated with schizophrenia (blunted affect, emotional withdrawal, poor rapport, and passive / apathetic social withdrawal) are rated on a scale from 1 (absent) to 7 (extreme); total negative subscale scores range from 7 to 49 with higher scores indicating more extreme symptoms.

Change From Baseline to Week 24 in Positive and Negative Syndrome Scale (PANSS): Negative Symptoms Score
Baseline to Week 24

PANSS includes 30 items rated on a 7-point scale (1=absent, 2=minimal, 3=mild, 4=moderate, 5=moderate severe, 6=severe, 7=extreme) organized as 7 positive symptom subscale items, 7 negative symptom subscale items and 16 general psychopathology items. Negative symptoms (deficit features) associated with schizophrenia (blunted affect, emotional withdrawal, poor rapport, and passive / apathetic social withdrawal) are rated on a scale from 1 (absent) to 7 (extreme); total negative subscale scores range from 7 to 49 with higher scores indicating more extreme symptoms.

Change From Baseline to Week 12 in Simpson Angus Rating Scale (SARS)
Baseline to Week 12

10-item rating scale to assess the severity of extrapyramidal symptoms rated on a 5-point scale 0 (normal) to 4 (highest severity). Items measured are gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, glabella tap, tremor, and salivation. Global score calculated by summing individual item scores and dividing by the total number of items; range is 0 to 40 with higher scores indicating greater severity.

Change From Baseline to Week 24 in Simpson Angus Rating Scale (SARS)
Baseline to Week 24

10-item rating scale to assess the severity of extrapyramidal symptoms rated on a 5-point scale 0 (normal) to 4 (highest severity). Items measured are gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, glabella tap, tremor, and salivation. Global score calculated by summing individual item scores and dividing by the total number of items; range is 0 to 40 with higher scores indicating greater severity.

Number of Participants With Suicidal Behavior and / or Ideation ("Yes" Response) on the Columbia Suicide Severity Rating Scale (C-SSRS) During the Treatment Phase
Week 1 to Week 12 (Treatment phase)

C-SSRS is a clinician rated assessment of suicidal behavior and / or intent categorized as: Suicidal behavior=a "yes" response to any of 5 suicidal behavior questions (preparatory acts or behavior, aborted attempt, interrupted attempt, actual attempt, and completed suicide); Suicidal ideation=a "yes" response to any one of 5 suicidal ideation questions which includes wish to be dead, and 4 different categories of active suicidal ideation (thought, thought with method, thought with intent, thought with plan and intent).

Number of Participants With Suicidal Behavior or Suicical Ideation ("Yes" Response ) on the Columbia Suicide-Severity Rating Scale (C-SSRS) During the Post Treatment Phase
Week 13 to Week 24 (Post treatment phase)

C-SSRS is a clinician rated assessment of suicidal behavior and / or intent categorized as: Suicidal behavior=a "yes" response to any of 5 suicidal behavior questions (preparatory acts or behavior, aborted attempt, interrupted attempt, actual attempt, and completed suicide); Suicidal ideation=a "yes" response to any one of 5 suicidal ideation questions which includes wish to be dead, and 4 different categories of active suicidal ideation (thought, thought with method, thought with intent, thought with plan and intent).

Number of Participants With Shift From Baseline to Week 12 in Clinical Global Impressions Scale-Severity (CGI-S) Score
Baseline (Bsl) to Week 12

CGI-S: 7-point clinician rated scale to assess severity of participant's current illness state; range: 1=normal, not ill at all, 2=borderline mentally ill, 3=mildly ill, 4=moderately ill, 5=markedly ill, 6=severely ill, 7=among the most extremely ill patients. Higher scores reflect higher severity of current illness states.

Number of Participants With Shift From Baseline to Week 24 in Clinical Global Impressions Scale-Severity (CGI-S) Score
Baseline to Week 24

CGI-S: 7-point clinician rated scale to assess severity of participant's current illness state; range: 1=normal, not ill at all, 2=borderline mentally ill, 3=mildly ill, 4=moderately ill, 5=markedly ill, 6=severely ill, 7=among the most extremely ill patients. Higher scores reflect higher severity of current illness states.

Number of Participants With Clinical Global Impression of Improvement Scale (CGI-I) Score at Week 1
Baseline, Week 1

CGI-I: 7-point clinician rated scale ranging from 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, to 7=very much worse. Improvement is defined as a score of 1 (very much improved), 2 (much improved), or 3 (minimally improved) on the scale. Scores above 4 reflect worsening of illness state as compared to baseline.

Number of Participants With Clinical Global Impression of Improvement Scale (CGI-I) Score at Week 12
Baseline, Week 12

CGI-I: 7-point clinician rated scale ranging from 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, to 7=very much worse. Improvement is defined as a score of 1 (very much improved), 2 (much improved), or 3 (minimally improved) on the scale. Scores above 4 reflect worsening of illness state as compared to baseline.

Number of Participants With Clinical Global Impression of Improvement Scale (CGI-I) Score at Week 24
Baseline, Week 24

CGI-I: 7-point clinician rated scale ranging from 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, to 7=very much worse. Improvement is defined as a score of 1 (very much improved), 2 (much improved), or 3 (minimally improved) on the scale. Scores above 4 reflect worsening of illness state as compared to baseline.

To compare 12 weeks of treatment with varenicline 1 mg BID to placebo for smoking cessation, and to evaluate continuous abstinence from smoking for 12 weeks after the treatment period.
Number of Responders With Carbon Monoxide (CO) Confirmed 4-week Continuous Quit Rate (CQR) for Last 4 Weeks of Treatment (Trtmt)
weeks 9 through 12

Participants considered Responders (4-week CQR \<=10 parts per million \<ppm\>) through reports of cigarette or other nicotine use since last study visit, confirmed by measurement of end-expiratory exhaled carbon monoxide (CO). If any CO measurement at a particular timepoint was \>10 ppm, subject was considered to be Non-Responder at that timepoint.

4 week continuous quit rate ( 4 week CQR ) for weeks 9 -12
Continuous abstinence for the last 4 weeks of varenicline and NRT (Nicotine Replacement Therapy) treatment period
Summarization of safety data in smokers treated with either varenicline or placebo.
4 week Continuous Quit Rate ( 4 week CQR ) for Weeks 9 -12.
Continuous abstinence Weeks 13 -24.
Rating Scale for Adhesive Residue (e.g., assesses how well the transdermal delivery system remains adhered to subject's skin)
24 hours per Arm
Rating Scale for Assessment of Application Site Dermal-Erythema, Edema, and Irritation (assesses skin irritation associated with varenicline transdermal delivery system)
6 days per Arm
Pharmacokinetic endpoints: plasma varenicline area under the curve (AUClast and AUCinf), maximum plasma concentration (Cmax), terminal half-life (t 1/2) and time of maximum plasma concentration (Tmax)
6 days per Arm
Pharmacokinetic endpoints include varenicline area under the curve from 0-24 hours (AUC24), maximum plasma concentration (Cmax),
Day 1 and Day 14
Safety endpoints include evaluation of clinical safety laboratory tests, supine vital signs, triplicate 12-lead ECGs and adverse events.
up to 14 days
Time of maximum plasma concentration (Tmax) on Day 1 and Day 14
Day 1 and Day 14
Minimum plasma concentration (Cmin), terminal half life (t1/2), observed accumulation ratio (Rac), peak:trough fluctuation (%PTF) on Day 14 only.
Day 14
Pharmacokinetic parameters: Population mean estimate for apparent plasma clearance (CL/F), central volume of distribution (V2/F) and steady-state volume of distribution (Vss/F).
Secondary Endpoints
Number of Participants With 7-day Point Prevalence of Non-smoking at Week 12
Week 12
Number of Participants With 7-day Point Prevalence of Non-smoking at Week 24
Week 24
Number of Participants With at Least a 50 Percent (%) Reduction From Baseline to Week 12 and Week 24 in the Number of Cigarettes Smoked Per Day
Baseline, Week 12, Week 24
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Study Design & Arms
AllocationRANDOMIZED
MaskingDOUBLE
ModelPARALLEL
Treatment Arms
ArmTypeDescription
Placebo ArmPLACEBO_COMPARATORRandomization 2:1 treatment to placebo
Treatment ArmACTIVE_COMPARATOR -
placeboPLACEBO_COMPARATOR -
vareniclineEXPERIMENTAL -
Chantix immediate release tablet formulationACTIVE_COMPARATOR -
Varenicline transdermal delivery systemEXPERIMENTAL -
Cohort 1OTHERSubjects will be randomized to receive either experimental drug (N=9) or matching placebo (N=3).
Cohort 2OTHERSubjects will be randomized to receive either experimental drug (N=9) or matching placebo (N=3).
Cohort 3OTHERSubjects will be randomized to receive either experimental drug (N=9) or matching placebo (N=3).
Optional Cohort 4OTHERSubjects will be randomized to receive either experimental drug (N=9) or matching placebo (N=3).
Optional Cohort 5OTHERSubjects will be randomized to receive either experimental drug (N=9) or matching placebo (N=3).
Interventions
NameTypeDescription
placeboDRUGRandomization 2:1 treatment to placebo
varenicline (CP-526,555)DRUGOne week of titration up to 1mg bid and 11 weeks of dosing at 1mg bid
Varenicline tartrateDRUG -
VareniclineDRUG1 mg twice daily by mouth for 12 weeks
varenicline free baseDRUGA single 2.0 mg dose of varenicline transdermal delivery system applied to the skin for a 24 hour period.
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Eligibility Criteria
Age Range18 Years — 75 Years
SexALL
Healthy VolunteersNo
Study Sites14

Inclusion Criteria: * Have a diagnosis (using the SCID-I/P at screening visit) of schizophrenia or schizoaffective disorder and judged to be stable (without hospitalization or acute exacerbation and functioning in society) on psychiatric treatment for at least the past 6 month. * Current cigarette ...

Countries:United StatesCanadaChinaSingaporeThailandArgentinaAustraliaBrazilCzechiaDenmarkFranceGermanyGreeceMexicoNetherlandsSouth KoreaTaiwanUnited KingdomBelgiumNorwaySweden
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