Molecule Name Asenapine Country of submission US~PRODUCT DETAILS~Test formulation~Drug name: Asenapine Sublingual Tablet EQ 10mg base Manufactured by: Sun Pharmaceutical Industries, Ltd.~Reference formulation~Drug name: SAPHRIS® (Asenapine) sublingual tablets Manufactured by: Schering Corporation, a Subsidiary of Merck & Co., Inc.~STUDY DESIGN~Title An open-label, randomized, two treatment, multi-site, multiple dose, steady state, three-way, reference-replicated crossover, pharmacokinetic study to determine the in-vivo bioequivalence between Asenapine 10 mg sublingual tablet and SAPHRIS® (asenapine) 10 mg sublingual tablet~Study Design Multiple-dose, steady state, three-way reference-replicated crossover study~Type of Study Pharmacokinetic (PK)~Number of subjects 57 randomized to complete 42 subjects~Dosing Test or Reference drug (EQ 10mg) base sublingual tablets are to be taken twice daily, once in the morning and once in the evening, for a period of 7 days before crossing-over to receive the next drug assigned for a period of 7 days, followed by a period of 7 days where the third drug assigned will be received.. There will be a total of three 7-day treatment periods during which each subject will receive the test product in one period and the reference product in two other periods.~To ensure optimal absorption, subjects will be instructed to place the tablet under the tongue and allow it to dissolve completely. The tablet will dissolve in saliva. Tablets will not be crushed, chewed, or swallowed~Housing Subjects will be housed in the clinic or hospital for a multiple days in each period during treatment and the collection of pharmacokinetic samples. Housing will be provided for:~Day 1 and Day 8 or 15 (12-hour confinement)~Days 6-7~Days 13-14~Days 20-21~Investigators may choose to house subjects during the interim days between specified in-patient clinic visits, either in the clinic or at an appropriate off-site facility such as a hotel or motel. Housing offers may be made to each subject population according to the respective Investigator's judgment as to what is best for his/her patients. Such interim housing is not to be considered as study visits, but will be offered at the discretion of the Investigator to all subjects in his/her clinic, at his/her discretion, and simply to improve subject compliance and attempt to reduce variability.~Subjects will be confined for at least 12 hours after initial dosing of either SAPHRIS® (Asenapine) or Asenapine sublingual tablets. Subjects will be required to remain supine for 6 hours following the initial dose. Subjects may get up briefly in order to relieve themselves.~Washout period There will be no washout period~Sampling time points Blood samples will be collected over a dosing interval on day 7, following preliminary sampling on days 5 and 6 to confirm steady-state conditions. The sampling time points are as follows:~Day 5 (1 sample)~Day 6 (1 sample)~Day 7 (15 samples) 0.0(pre-dose), 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0, 8.0, 10.0, 12.0~Dietary Plan Subjects will fast for at least 8 hours prior to and 4 hours after the administration of the morning dose of the test or reference treatment on day 7 of each period (i.e., the days on which blood samples are to be collected to assess the concentration-time curve). All meals on day 7 will be standardized during the study. Water may be allowed, except for 1 hour before and 1 hour after drug administration, when no liquid will be permitted.~Special requirements~Subjects will remain in the supine position for the first 6 hours after the first dose, even if they were previously on a stable dose of asenapine maleate.~Subjects will be adequately hydrated. This may be achieved by administering 240 mL of water before the overnight fast, 240 mL of water one hour before dosing, and beginning no sooner than 1 hour after drug administration, 240 mL of water every 2 hours for 6 hours post-dosing. Subjects will not eat or drink for 10 minutes after drug administration.~Subjects must be adequately informed of possible cardiovascular adverse effects in the consent form.~Safety Parameters~White blood cell (WBC) counts will be monitored and asenapine maleate sublingual tablet treatment modified, if necessary, in accordance with the leukopenia, neutropenia and agranulocytosis warning in the labeling of the reference listed drug product.~Subjects requiring modification of asenapine maleate sublingual tablet treatment will be dropped from the study and provided with prompt medical care.~Blood pressure, heart rate, and body temperature will be monitored during the study and immediate medical care provided for any significant abnormalities.~Subject medical histories, physical examination and laboratory reports, and all incidents of possible adverse reactions will be reported.~Analyte(s) to measure Asenapine in plasma~Pharmacokinetic parameters~Asenapine AUC0-tau, Cmax, Tmax, Cmin and %Fluctuation will be estimated for each subject and period using WinNonlin version 5.2 or higher. The trough samples collected just prior to the morning dose on Days 5, 6 and 7 in each period will be evaluated to demonstrate that steady-state has been achieved by the final morning dose in each period.~Statistical Analysis~The primary pharmacokinetic parameters (Cmax, AUC0-tau,) and Cmin will be natural log-transformed (ln) prior to statistical analyses. Any ln-transformed parameter where the observed intra-subject CV for the reference product is at least 30% (swr ≥ 0.294) will be evaluated using the scaled average bioequivalence (SABE) method. The GLM procedure of SAS will be used to conduct the SABE analyses, as well as to estimate the intra-subject CV for the reference product. The statistical model for the GLM procedure will contain only a term for Sequence*Site. The linearized Scaled Average Bioequivalence statistic and the upper 95% Confidence Bound on the statistic will be estimated. The ratio of geometric means (T/R) will also be calculated.~Plasma concentrations at each time point, Tmax, %Fluctuation, and any ln-transformed pharmacokinetic parameter where the observed intra-subject CV of the reference product is less than 30% (swr < 0.294), will be evaluated using the average (unscaled) bioequivalence (ABE) approach will be used. The MIXED procedure of SAS will be used in this case with a statistical model that includes terms for Sequence, Site, Sequence*Site, Subject nested within Sequence*Site, Period nested within Site, Treatment, and if necessary, Treatment*Site. A separate statistical analysis will be done to determine if the Treatment*Site term is statistically significant (p<0.05) and needs to be retained in the model. If this term is not significant, it will be dropped from the statistical model for the definitive statistical evaluation. The ratio of geometric means (T/R) and 90% confidence intervals for the ratio, based on least-squares means from the analysis of the log-transformed PK Parameter, will be calculated.~Bioequivalence criteria Bioequivalence will be concluded for those primary parameters evaluated by SABE if:~The geometric mean Test-to-Reference ratio falls within the range of 0.800 to 1.250.~The 95% upper confidence bound on the linearized SABE statistic.~Bioequivalence will be concluded for those primary parameters evaluated by ABE if:~The 90% confidence interval on the geometric mean Test-to Reference ratio is contained within the interval 0.800 to 1.250.~Fluctuation for the test product will be evaluated for comparability with the fluctuation of the reference product.~Report format eCTD
This is a Multiple-dose, steady state, three-way reference-replicated crossover study.~The purpose of this Study is to determine the bio-equivalence between SAPHRIS and Asenapine 10mg sublingual tablets.