Otsuka Pharmaceutical Submits New Drug Application to U.S. FDA for Centanafadine for the Treatment of ADHD in Children, Adolescents, and Adults

• Centanafadine is an investigational compound for the treatment of ADHD in children, adolescents, and adults. It is a first-in-class norepinephrine, dopamine, and serotonin reuptake inhibitor (NDSRI).
• In four pivotal Phase 3 clinical trials evaluating the efficacy and safety of centanafadine across pediatric and adult patient populations, centanafadine demonstrated statistically significant efficacy for the core symptoms of inattention and hyperactivity-impulsivity in ADHD.
• Clinical and preclinical data suggest centanafadine showed a favorable safety and tolerability profile and a low potential for abuse and dependence.
• ADHD is a chronic neurodevelopmental disorder characterized primarily by impairments in attention, hyperactivity, and impulsivity.
• Although historically seen as a childhood disorder, research suggests that many individuals diagnosed with ADHD in childhood continue to experience symptoms into adulthood, with some patients experiencing significant impairment.
• ADHD is often not diagnosed until adulthood, with an estimated 15.5 million adults in the U.S. currently diagnosed.

Otsuka Pharmaceutical Development & Commercialization, Inc. and Otsuka Pharmaceutical Co., Ltd. (Otsuka) today announce the filing of a New Drug Application (NDA) with the U.S. Food and Drug Administration (FDA) for centanafadine, once daily extended release capsules, a novel norepinephrine, dopamine, and serotonin reuptake inhibitor (NDSRI), for the treatment of attention-deficit hyperactivity disorder (ADHD) in children, adolescents, and adults. The NDA submission is supported by results from four pivotal Phase 3 clinical trials evaluating the efficacy and safety of centanafadine across patient populations^1,2,3.

“As an innovator in mental health, we are pleased to take this important step forward in the hope of providing a novel treatment option to patients living with ADHD,” said John Kraus, M.D., Ph.D., executive vice president and chief medical officer, Otsuka Pharmaceutical Development & Commercialization, Inc. “Centanafadine represents a first in class mechanism of action among available ADHD therapies, and if approved, may expand the range of options available to those managing this complex condition. We are grateful to the patients and caregivers for their participation in these trials.”

In Phase 3 clinical studies with children, adolescents, and adults, centanafadine demonstrated statistically significant and clinically meaningful improvements in ADHD symptoms compared with placebo, as measured by the ADHD Rating Scale – 5 (ADHD-RS-5) in adolescents and children, and the ADHD Investigator Symptom Rating Scale (AISRS) in adults. Centanafadine was generally well tolerated across studies, with the most common adverse events including decreased appetite, nausea, rash, fatigue, abdominal pain, and somnolence in children and adolescents, and decreased appetite and headache in adults^1,2,3.

About the Phase 3 Clinical Trial Program

The Phase 3 program for centanafadine provides a robust clinical evaluation of the first investigational NDSRI ADHD therapy. The clinical program consists of four different pivotal Phase 3 trials that evaluated the efficacy and safety of centanafadine across children, adolescents, and adults^1,2,3.

The pivotal Phase 3 trial in children (NCT05428033) was a randomized, double-blind, three-arm, fixed-dose study evaluating the efficacy, safety, and tolerability of centanafadine in children aged 4 to 12 years with ADHD. Participants received a weight-based high dose, low dose, or placebo for 6 weeks. The primary endpoint was the change from baseline in ADHD-RS-5 total score at Week 6. The high-dose group demonstrated statistically significant improvement versus placebo, while the low-dose group did not reach statistical significance. Centanafadine showed a favorable safety and tolerability profile and a low potential for abuse and dependence, with the most frequently reported adverse events including decreased appetite, rash, and vomiting¹.

The pivotal Phase 3 trial in adolescents (NCT05257265) was a randomized, double-blind, three-arm, fixed-dose study designed to evaluate the efficacy, safety, and tolerability of centanafadine in adolescents aged 13 to 17 years with ADHD. Participants received either a high dose, low dose, or placebo over a 6-week treatment period. The primary endpoint was change from baseline in the ADHD Rating Scale-5 (ADHD-RS-5) total score at Week 6. The high-dose group achieved statistically significant and clinically meaningful reductions in ADHD symptoms compared with placebo. Centanafadine showed a favorable safety and tolerability profile and a low potential for abuse and dependence, with the most common adverse events including decreased appetite, nausea, headache, and rash².

The two pivotal Phase 3 trials in adults (NCT03605680, NCT03605836) were randomized, double-blind, placebo-controlled studies designed to evaluate the efficacy, safety, and tolerability of centanafadine sustained-release (SR) tablet in adults aged 18 to 55 years with ADHD. Participants received either centanafadine 200 mg/day, 400 mg/day, or placebo over a 6-week treatment period. The primary endpoint was the change from baseline in the Adult ADHD Investigator Symptom Rating Scale (AISRS) total score at Week 6. Both centanafadine dose groups demonstrated statistically significant and clinically meaningful improvements versus placebo. In both studies, centanafadine showed a favorable safety and tolerability profile and a low potential for abuse and dependence, with the most common adverse events including decreased appetite and headache³.

About Attention-Deficit Hyperactivity Disorder (ADHD)

ADHD is a chronic neurodevelopmental disorder characterized primarily by impairments in attention, hyperactivity, and impulsivity⁴. It affects approximately 7 million children in the U.S. and an estimated 15.5 million adults, according to the Centers for Disease Control and Prevention (CDC)^5,6.

About Centanafadine

Centanafadine is a first-in-class norepinephrine, dopamine, and serotonin reuptake inhibitor (NDSRI). Clinical studies have shown that centanafadine significantly reduces core symptoms of ADHD in children, adolescents, and adults, with a favorable safety and tolerability profile and low potential for abuse.

About Otsuka

Otsuka Pharmaceutical Co., Ltd. is a global healthcare company with the corporate philosophy: Otsuka–people creating new products for better health worldwide. Otsuka researches, develops, manufactures, and markets innovative products, with a focus on pharmaceutical products to meet unmet medical needs and nutraceutical products for the maintenance of everyday health.

In pharmaceuticals, Otsuka is a leader in the challenging areas of mental, kidney, and cardiovascular health and has additional research programs in oncology and on several under-addressed diseases including tuberculosis, a significant global public health issue. These commitments illustrate how Otsuka is a “big venture” company at heart, applying a youthful spirit of creativity in everything it does.

Otsuka established a presence in the U.S. in 1973 and today its U.S. affiliates include Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC) and Otsuka America Pharmaceutical, Inc. (OAPI). These two companies’ 2,250 employees in the U.S. develop and commercialize medicines in the areas of mental health and nephrology, using cutting-edge technology to address unmet healthcare needs.

OPDC and OAPI are indirect subsidiaries of Otsuka Pharmaceutical Co., Ltd., which is a subsidiary of Otsuka Holdings Co., Ltd. headquartered in Tokyo, Japan. The Otsuka group of companies employed 35,340 people worldwide and had consolidated sales of approximately USD 14.7 billion in 2024.

All Otsuka stories start by taking the road less traveled. Learn more about Otsuka in the U.S. at www.otsuka-us.com and connect with us on LinkedIn and Twitter at @OtsukaUS. Otsuka Pharmaceutical Co., Ltd.’s global website is accessible at https://www.otsuka.co.jp/en/.

References

1. Ward, Caroline L., et al. “Efficacy and safety of centanafadine for ADHD treatment in children: A randomized clinical trial.” Pediatrics Open Science, vol. 1, no. 3, 1 July 2025, pp. 1–11, https://doi.org/10.1542/pedsos.2024-000349.
2. Ward, Caroline L., Ann C. Childress, et al. “Centanafadine for attention-deficit/hyperactivity disorder in adolescents: A randomized clinical trial.” Journal of the American Academy of Child & Adolescent Psychiatry, July 2025, https://doi.org/10.1016/j.jaac.2025.06.023.
3. Adler, Lenard A., et al. “Efficacy, safety, and tolerability of Centanafadine sustained-release tablets in adults with attention-deficit/hyperactivity disorder.” Journal of Clinical Psychopharmacology, vol. 42, no. 5, 2 June 2022, pp. 429–439, https://doi.org/10.1097/jcp.0000000000001575.
4. American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders (5^th ed., text rev).
5. “Data and Statistics on ADHD.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/adhd/data/index.html.
6. “Facts about ADHD in Adults.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/adhd/php/adults/.

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