Depressive Disorder, Treatment-Resistant
Conditions
Brief summary
The objectives of this 10-week study are to evaluate the efficacy, safety, and tolerability of AVP 786 as an adjunctive therapy compared with placebo in patients with major depressive disorder (MDD) who have shown an inadequate response to standard antidepressant treatment. A secondary objective of this study is to assess the pharmacokinetics (PK) of AVP-786 and potential correlations with pharmacodynamic effects.
Detailed description
It is estimated that up to approximately 200 patients will participate in the study at approximately 30 enrolling centers in the US. Eligible patients for this study must have MDD as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria, and have shown an inadequate response to standard antidepressant treatment. This is a multicenter, randomized, double-blind, placebo-controlled, study of 10 weeks duration. Following screening procedures for assessment of inclusion and exclusion criteria, eligible patients will be randomized into the study. Study medication will be administered orally twice a day (BID) (1 capsule in the morning and 1 capsule in the evening, approximately 12 hours apart) throughout the treatment period.
Interventions
DRUGAVP-786 (d6-dextromethorphan hydrobromide and quinidine sulfate combination)
AVP-786 capsules administered twice a day over a 10-week period
DRUGPlacebo
Placebo capsules administered twice a day over a 10-week period
Sponsors
Otsuka Pharmaceutical Development & Commercialization, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Clinical diagnosis of major depressive episode ≤ 24 months in duration * HAM-D17 score ≥ 20. * Documented to not have a significant (25% or greater) change in QIDS-SR16 score between Screening and Baseline visits. * Patients have been deemed to have an inadequate response (less than 50% symptom reduction) to at least 1 but no more than 3 adequate antidepressant trials during the current depressive episode. * Patients must be receiving ongoing treatment with an adequate dose of antidepressants. * Body Mass Index (BMI) of 18-35 kg/m².
Exclusion criteria
* History of myasthenia gravis. * Have cardiovascular concerns such as: * History of complete heart block, QT interval corrected for heart rate (QTc) prolongation, or torsades de pointes. * QTc using the Fridericia's formula (QTcF) at screening \> 450 msec for males and \> 470 msec for females based on central review at the screening visit, unless due to ventricular pacing. * Any family history of congenital QT interval prolongation syndrome. * Known hypersensitivity/intolerance to DM, Q, opiate drugs (codeine, etc.), or any other ingredient of the study medication. * Pose a current suicide risk, as evidenced by any of the following: * It is the judgment of the investigator that the subject may be at risk for suicide. * The subject is rated a "yes" to question 4 or question 5 on the Baseline C-SSRS, if the most recent episode occurred within the past 12 months. * The subject has attempted suicide within the past 6 months * Presence of any other current DSM-IV-TR Axis I disorders with the exception of: generalized anxiety disorder (GAD: 300.02), social anxiety disorder (300.23), dysthymic disorder (300.4), or specific phobia (300.29). Patients with co-morbid GAD, social anxiety disorder, or specific phobia are ineligible if the co-morbid condition is clinically unstable, or has been the primary focus of treatment within the 6 month period prior to screening * Axis I diagnosis of: * Delirium, dementia, amnestic, or other cognitive disorder; * Schizophrenia or other psychotic disorder, based on the M.I.N.I.; * Bipolar I or II disorder, based on the M.I.N.I. * Clinically significant Axis II (DSM-IV-TR) diagnosis of borderline, antisocial, paranoid, schizoid, schizotypal or histrionic personality disorder.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Montgomery-Ǻsberg Depression Rating Scale (MADRS) total score | Visit 5 (Day 70) Week 10 | The MADRS consists of 10 items, each rated based on the structured interview. The dimensions assessed in the MADRS are as follows: 1. Apparent sadness 2. Reported sadness 3. Inner tension 4. Reduced sleep 5. Reduced appetite 6. Concentration difficulties 7. Lassitude 8. Inability to feel 9. Pessimistic thoughts 10. Suicidal thoughts. Each item is rated on a scale from 0 to 6. The MADRS total score is the sum of the scores for the 10 dimensions and can range from 0 to 60, with higher scores indicating a higher severity of depression. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 17-item Hamilton Rating Scale for Depression (HAM-D17) | Visit 5 (Day 70) Week 10 | The HAM-D is a clinician-rated scale that evaluates the level of depression. The HAM-D consists of 17 items (with scale in parentheses) such as Depressed Mood (0-4), Guilt (0-4), Suicide (0-4), Insomnia, initial (0-2), Insomnia, middle (0-2), Insomnia, late (0-2), Work and Interests (0-4), Psychomotor Retardation (0-4), Psychomotor Agitation (0-4), Anxiety, psychic (0-4), Anxiety, somatic (0-4), Gastrointestinal Symptoms (0-2), Somatic Symptoms, general (0-2), Sexual Interest (0-2), Hypochondriasis (0-4), Insight (0-2), and Weight Loss (0-2). Summed subscales are combined to compute a total score. Total score ranges from 0 to 52, with a higher score indicating worse condition. |
| Massachusetts General Hospital Antidepressant Treatment Response Questionnaire (MGH ATRQ) | Visit 5 (Day 70) Week 10 | The MGH ATRQ is given in this study to assess treatment resistance in depression. Participants are to provide information on the questionnaire about the dose level and duration for each medication that has been taken during their current episode/stage of depression. Participants are also to provide the medication that helped them the most and answer a question about the degree of improvement. |
| 16-item Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR16) | Visit 5 (Day 70) Week 10 | The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) is a patient-reported questionnaire used to assess the severity of depressive symptoms over the previous 7 days. The questionnaire assesses sleep, mood, appetite/weight, concentration, self-perception, suicidal thoughts, interest, energy, and psychomotor changes. Each item is scored from 0 to 3, with higher scores indicating greater symptom severity. The total score is calculated using a standard algorithm that sums the highest-rated item within selected symptom domains and individual domain scores, resulting in a total score ranging from 0 to 27, with higher scores indicating more severe depressive symptoms. |
| Sheehan Disability Scale (SDS) | Visit 5 (Day 70) Week 10 | The participant is to assess how disruptive their depression symptoms have been on a 0 to 10 scale, as shown below: 0 Not at all, 1 to 3 Mildly, 4 to 6 Moderately, 7 to 9 Markedly, 10 Extremely. The 3 items will be summed to obtain a measure of global functional impairment that ranges from 0 (unimpaired) to 30 (highly impaired). Higher scores indicate worse conditions. |
| Clinical Global Impression of Severity of Illness (CGI-S) | Visit 5 (Day 70) Week 10 | The CGI-S is clinician's assessment of the participant's illness at the time of the assessment. The CGI-S is scored according to the following 7-point scale, with a higher score indicating a higher severity of illness (0 = not assessed): 1 = normal, not at all ill, 2 = borderline mentally ill, 3 = mildly ill, 4 = moderately ill, 5 = markedly ill, 6 = severely ill, 7 = extremely ill. |
| Clinical Global Impression of Change (CGI-C) | Visit 5 (Day 70) Week 10 | The CGI-C is clinician's assessment of the participant's change in illness at the time of the assessment, using the following 7-point scale (0 = not assessed): 1 = Very much improved, 2 = Much improved, 3 = Minimally improved, 4 = No change, 5 = Minimally worse, 6 = Much worse, 7 = Very much worse. A lower score indicates an improvement in illness. |
| EuroQOL 5 Dimension 5 Level (EQ-5D-5L) | Visit 5 (Day 70) Week 10 | The EQ-5D-5L, a scale used to measure quality of life, is divided into 2 parts, the descriptive system and the visual analog scale (VAS), reported as separate scores. The descriptive system is divided into five categories: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. For each category, the participant selects the one statement that best describes their health on the day of assessment. Each category is scored on a 5-point scale(1=no problems to 5=extreme problems or inability to perform the activity) \[e.g., for mobility: 1 = no problems walking and 5 = unable to walk\]. Missing values for a given category are imputed with a value of 9 and are excluded from the summary for that category. Higher scores for each category= worse health condition. The VAS is a 0 (worst health you can imagine) to 100 (best health you can imagine) vertical scale, where the participant places an X on the scale where they feel their health is today and then writes the number. |
| Patient Global Impression of Change (PGIC) | Visit 5 (Day 70) Week 10 | The PGI-C asks the participant to rate their overall impression of change in their depression symptoms from the time of study entry to the present. The PGI-C is scored on a 7-point scale, where 1 = very much improved, 2 = much improved, 3 = minimally improved, 4 = no change, 5 = minimally worse, 6 = much worse, and 7 = very much worse. Higher scores indicate worsening of depression symptoms. |
| 7-item Generalized Anxiety Disorder (GAD-7) | Visit 5 (Day 70) Week 10 | The GAD-7 is a self-reported questionnaire used to assess symptoms of generalized anxiety disorder. It consists of 7 questions evaluating feelings of nervousness or anxiety, inability to stop or control worrying, excessive worrying, trouble relaxing, restlessness, irritability, and fear that something awful might happen. Each item is scored on a 4-point scale, where 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day. The scores for all seven items are summed to produce a total score ranging from 0 to 21, with higher scores indicating greater severity of anxiety symptoms. |
Countries
United States
Outcome results
None listed