Study to Evaluate the Efficacy and Safety of Risperidone ISM® in Patients With Acute Schizophrenia: Open Label Extension

Patients who have completed planned participation in the double-blind segment of the study
PRISMA-3 (NCT03160521) through to the end of the treatment period, may be eligible to enter
into this optional long-term extension segment of the study. During this extension,
open-label Risperidone ISM® (i.e., either 75 or 100 mg) will be administered to all
participating patients once every 4 weeks for approximately 12 months. Patients who enter
into the extension segment of the study will begin participation in the extension segment
immediately upon completion of the end-of-treatment visit assessments and procedures.

In addition to patients continuing from the double-blind segment of the study PRISMA-3
(rollover patients), clinically stable patients not previously enrolled in the study (de novo
patients) may be eligible to enter the long-term extension segment of the study. These
patients will be evaluated for eligibility at a screening visit and, if eligible, will be
allocated to receive either 75 or 100 mg Risperidone ISM every 4 weeks for approximately 12
months.

Approximately 100 de novo patients are planned to be enrolled in the extension segment of the
study, in addition to rollover patients.

The planned total number of randomized patients in this OLE segment of the study is
approximately 479 patients total randomized planned.

Participation in the open-label extension segment of the study PRISMA-3 is optional, and
patients who complete participation in the main segment of the study (double blind segment
of PRISMA-3, NCT03160521) may opt to not participate. Patients who are interested in
participating must meet all eligibility criteria in order to enter into the extension
segment.

Inclusion Criteria (Rollover patients):

To be eligible for entry into the extension segment of the study PRISMA-3, a patient must
meet all of the following criteria at the extension baseline time point (immediately upon
completion of the end-of-treatment visit assessments and procedures for the main part of
the study):

1. Has completed scheduled participation in the double blind segment of the study
PRISMA-3, through to the end of the treatment period and including the
end-of-treatment visit

2. Continues to require long-term treatment with an antipsychotic medication, in the
opinion of the investigator

3. Continues to meet contraceptive requirements of the study PRISMA-3

4. Is willing to participate in the extension segment of the study and remains capable of
providing informed consent

a. A signed informed consent form must be provided before any study assessments are
performed for the extension segment

5. Continues to reside in a stable living situation, in the opinion of the investigator

6. Continues to have an identified reliable informant, in the opinion of the investigator

Exclusion Criteria (Rollover patients):

An individual who meets any of the following criteria at the extension baseline time point
(immediately upon completion of the end-of-treatment visit assessments and procedures for
the double blind segment PRISMA-3) will not be permitted to enter into this extension
segment of the study PRISMA-3:

1. Missed more than 1 scheduled study visit during participation in the double blind
segment of study PRISMA-3

2. Had an abnormal clinical laboratory value, vital sign, or ECG finding during
participation in the main part of the study that, in the opinion of the investigator,
was clinically relevant, related to study drug, and would compromise the well-being of
the patient in the extension segment

3. Had a clinically significant or unstable medical illness/condition/disorder during the
main part of the study that would be anticipated, in the investigator's opinion, to
potentially compromise patient safety in the extension segment

4. Is taking or is anticipated to require any prohibited concomitant medication

5. Pregnant, lactating, or breastfeeding

6. Any contraindication for continued IM injections (e.g., treatment with anticoagulant)

7. Inadequate gluteal or deltoid musculature or excessive fat, as determined by the
investigator, that would interfere with IM study drug injections

8. Study site personnel and/or persons employed by the investigator or study site or is
an immediate family member of such persons

Inclusion Criteria (De Novo Patients):

1. Capable of providing informed consent

2. Age ≥ 18 and ≤ 65 years old

3. On a stable dose of oral risperidone from 4 to 6 mg daily as maintenance therapy for
at least the last 4 weeks prior/before screening/baseline and would potentially
benefit from conversion to an extended release injectable, in the opinion of the
investigator

4. Current diagnosis of schizophrenia, according to the Diagnostic and Statistical Manual
of Mental Disorders, Fifth Edition (DSM-5) criteria that is clinically stable as
evidenced by:

- No hospitalizations for acute exacerbations of schizophrenia and psychiatrically
stable without significant symptom exacerbation over the last 3 months before
screening based on the investigator's judgment

- PANSS total score < 70 at screening

- CGI-S score of ≤ 3 (mild) at screening

5. Has previously had a clinically significant beneficial response (improvement in
schizophrenia symptoms), as determined by the investigator, to treatment with an
antipsychotic medication other than clozapine

6. At least 2 years elapsed since initial onset of active-phase schizophrenia symptoms

7. Subject is outpatient; not hospitalized for worsening of schizophrenia within the last
3 months (hospitalization for social management within this time period is acceptable)

8. Medically stable over the last month prior to screening based on the investigator's
judgment

9. BMI of 18.5 to 40.0 kg/m2 (inclusive) at screening

10. Agrees to discontinue prohibited medications as applicable and as clinically indicated
according to investigator instructions

11. Dosages of all permitted medications are considered to have been stable (with the
exception of medication to be used on an as-needed basis) for ≥ 2 weeks prior to the
baseline visit and to remain stable during participation in this study

12. Resides in a stable living situation, in the opinion of the investigator

13. Has an identified reliable informant, in the opinion of the investigator

14. Meets the contraceptive criteria stablished in the study

15. Agrees not to post any personal medical data related to the study or information
related to the study on any website or social media site during the study duration.

Exclusion Criteria (De Novo Patients):

1. History of proven inadequate clinical response to treatment with therapeutic doses
(with good compliance) of risperidone or paliperidone

2. History of treatment resistance, defined as failure to respond to 2 discrete adequate
trials (≥ 4 weeks with an adequate dose) of 2 different antipsychotic medications;
history of clozapine use (exception: use was not because of treatment resistance or
refractory psychotic symptoms)

3. Known or suspected intolerance of or allergy or hypersensitivity to risperidone,
paliperidone, or any of the excipients in the IM formulations of these

4. History of neuroleptic malignant syndrome, clinically significant tardive dyskinesia
or tardive dystonia

5. History of any other medical condition that is considered to pose any unjustifiable
risk or interfere with study assessments

6. Clinically significant extrapyramidal symptoms at screening or baseline

7. At significant risk of suicidal, homicidal or violent ideation or behavior, by history
or as clinically assessed by the investigator at screening visit

8. Answer of "yes" on item 4 or on item 5 of the Columbia-Suicide Severity Rating Scale
(C-SSRS) (ideation) with the most recent episode occurring within the past 2 months,
or answer "yes" to any of the 5 items (behavior) with an episode occurring within the
last year

9. Current diagnosis or a history of substance use disorder according to DSM-5 criteria
within 6 months prior to the screening visit (with the exception of tobacco, mild
cannabis, or mild alcohol use disorder) or a positive drug screen test (with the
exception of cannabis) verified by repeat testing

10. Lifetime history of diagnosis of schizoaffective disorder or bipolar disorder

11. Clinically significant comorbid neuropsychiatric disorders

12. Clinically significant or unstable medical illness/condition/disorder that would be
anticipated, in the investigator's opinion, to potentially compromise patient safety
or adversely affect the evaluation of efficacy

13. Laboratory abnormality that, in the opinion of the investigator, would compromise the
well-being of the patient, or any of the following laboratory abnormalities at
screening or baseline

14. Pregnant, lactating, or breastfeeding

15. Inadequate gluteal or deltoid musculature or excessive fat, as determined by the
investigator, that would interfere with IM study drug injections

16. Any contraindication for IM injections

17. Receipt of any long-acting antipsychotic medication by IM injection within 60 days
before screening

18. Current involuntary hospitalization or incarceration

19. Hospitalized for more than 30 days during the 90 days before screening

20. Participation in another clinical study in which the patient received an experimental
or investigational drug or agent within 6 months before screening

21. Participation in a clinical study with Risperidone ISM within 12 months before
screening

22. Study site personnel and/or persons employed by the investigator or study site or is
an immediate family member of such persons

23. Patients taking or anticipated to require any prohibited concomitant medication