Depression
Conditions
Keywords
treatment resistant, inadequate response
Brief summary
This is a multi-site, double-blind, placebo-controlled study of the acute efficacy of brexpiprazole or placebo in combination with intranasal ketamine added to ongoing, stable, and adequate antidepressant therapy (ADT) in the treatment of adults with Major Depressive Disorder with Treatment Resistant Depression.
Detailed description
This is a five-site, double-blind, placebo-controlled study of the acute efficacy of oral brexpiprazole or placebo combined with intranasal ketamine added to ongoing, stable, and adequate antidepressant therapy (ADT) in the treatment of adults with MDD with TRD. Adequate ADT is defined as a therapeutically sufficient dose for a sufficient treatment period, which would be expected to be effective as listed in the MGH ATRQ.
Interventions
DRUGBrexpiprazole
Administration of up to 3mg brexpiprazole
DRUGKetamine
administration 6 times over two weeks of inhaled ketamine
DRUGPlacebo
Administration of placebo which matches brexpiprazole in size and number of tablets per dose
Sponsors
Massachusetts General Hospital
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 65 Years
Healthy volunteers
No
Inclusion criteria
1. Male or female, 18 to 65 years of age, inclusive, at screening. 2. Able to read, understand, and provide written, dated informed consent prior to screening. Participants will be deemed likely to comply with study protocol and communicate with study personnel about adverse events and other clinically important information. 3. Diagnosed with MDD, single or recurrent, and currently experiencing a major depressive episode (MDE) of at least eight weeks in duration, prior to screening, according to the criteria defined in the Diagnosis and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The diagnosis of MDD will be made by a site psychiatrist and supported by the SCID-5. The diagnosis will be confirmed by remote, independent raters from the MGH CTNI (Massachusetts General Hospital Clinical Trials Network and Institute) with a SAFER interview. 4. Has a history of treatment resistant depression (TRD) during the current MDE, as assessed by the investigator and remote centralized rater using the MGH ATRQ. TRD is defined as failure to achieve a satisfactory response (e.g., less than 50% improvement of depression symptoms), as perceived by the participant, to at least 2 treatment courses during the current episode of a therapeutic dose of an antidepressant therapy (ADT) of at least 8 weeks duration (including the current ADT). The adequacy of dose and duration of the antidepressant therapy will be determined as per the MGH ATRQ criteria. The TRD status will be confirmed by remote, independent raters from the MGH CTNI who will administer the MGH ATRQ, via teleconference, between the screening visit and the baseline visit. Participants must currently be on a stable (for at least 4 weeks) and adequate (according to the MGH ATRQ) dose of ongoing antidepressant therapy (any antidepressant therapy, with the exception of MAOIs), of which total duration must be at least 8 weeks. 5. Meet the threshold on the total MADRS score of \>20 at both the screen visit and the baseline visit (Day -7/-28 and Day 0), and as confirmed by the remote centralized MGH CTNI rater between the screen visit and the baseline visit. 6. In good general health, as ascertained by medical history, physical examination (PE) (including measurement of supine and standing vital signs), clinical laboratory evaluations, and ECG. 7. If female, a status of non-childbearing potential or use of an acceptable form of birth control per the following specific criteria: * Non-childbearing potential (e.g., physiologically incapable of becoming pregnant, i.e., permanently sterilized (status post hysterectomy, bilateral tubal ligation), or is post-menopausal with her last menses at least one year prior to screening); or * Childbearing potential, and meets the following criteria: * Childbearing potential, including women using any form of hormonal birth control, on hormone replacement therapy started prior to 12 months of amenorrhea, using an intrauterine device (IUD), having a monogamous relationship with a partner who has had a vasectomy, or is sexually abstinent. * Negative urinary pregnancy test at screening, confirmed by a negative urinary pregnancy test at randomization prior to receiving study treatment. * Willing and able to continuously use one of the following methods of birth control during the course of the study, defined as those which result in a low failure rate (i.e., less than 1% per year) when used consistently and correctly: implants, injectable or patch hormonal contraception, oral contraceptives, IUD, double-barrier contraception, sexual abstinence. The form of birth control will be documented at screening and baseline. 8. Body mass index between 18-35 kg/m2. 9. Concurrent psychotherapy will be allowed if the type (e.g., supportive, cognitive behavioral, insight-oriented, et al.) and frequency (e.g., weekly or monthly) of the therapy has been stable for at least three months prior to screening and if the type and frequency of the therapy is expected to remain stable during the course of the subject's participation in the study. 10. Concurrent hypnotic therapy (e.g., with zolpidem, zaleplon, melatonin, benzodiazepines or trazodone) will be allowed if the therapy has been stable for at least 4 weeks prior to screening and if it is expected to remain stable during the course of the subject's participation in the study. Patients can also continue treatment with benzodiazepines used for anxiety if therapy has been stable for at least 4 weeks prior to screening and if it is expected to remain stable during the course of the subject's participation in the study.
Exclusion criteria
1. Female of childbearing potential who is not willing to use one of the specified forms of birth control during the study. 2. Female that is pregnant or breastfeeding. 3. Female with a positive pregnancy test at screening or baseline. 4. History during the current MDE of failure to achieve satisfactory response (e.g., less than 50% improvement of depression symptoms) to \>7 treatment courses of a therapeutic dose of an antidepressant therapy of at least 8 weeks duration, according to the MGH ATRQ, as confirmed by the remote, independent MGH CTNI rater. 5. Total MADRS score of \<20 at the screen visit or the baseline visit, or as assessed by the remote, independent MGH CTNI rater and reported to the site. 6. Current diagnosis of a substance use disorder (abuse or dependence, as defined by DSM-IV-TR™), with the exception of nicotine dependence, at screening or within 6 months prior to screening. 7. Current Axis I disorder, diagnosed at screening with the use of the Structured Clinical Interview for DSM-5 AXIS I Disorders (SCID-5), that is the principal focus of treatment and MDD the secondary focus of treatment for the past 6 months or more. 8. History of bipolar disorder, schizophrenia or schizoaffective disorders, or any history of psychotic symptoms in the current or previous depressive episodes. 9. History of anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, within 5 years of screening. 10. Any Axis I or Axis II Disorder, which at screening is clinically predominant to their MDD or has been predominant to their MDD at any time within 6 months prior to screening. 11. In the judgment of the investigator, the subject is considered at significant risk for suicidal behavior during the course of his/her participation in the study. 12. Has failed to respond to ECT during the current depressive episode. 13. Has received VNS at any time prior to screening. 14. Has dementia, delirium, amnestic, or any other cognitive disorder. 15. Has a clinically significant abnormality on the screening physical examination that might affect safety, study participation, or confound interpretation of study results according to the study clinician. 16. Participation in any clinical trial with an investigational drug or device within the past month or concurrent to study participation. 17. Current episode of: * Hypertension, Stage 1 as defined by a systolic blood pressure ≥160 mmHg or diastolic blood pressure ≥100 mHg at the Baseline Visit (Visit 1) within 1.5 hours prior to randomization on two of three measurements (standing and supine) at least 15 minutes apart. * Recent myocardial infarction (within one year) or a history of myocardial infarction. * Syncopal event within the past year. * Congestive heart failure (CHF) New York Heart Association Criteria \>Stage 2 * Angina pectoris. * Heart rate \<45 or \>110 beats per minute at screening or randomization (Baseline Visit). * QTcF (Fridericia-corrected) ≥450 msec at screening or randomization (Baseline Visit). 18. Chronic lung disease excluding asthma. 19. Lifetime history of surgical procedures involving the brain or meninges, encephalitis, meningitis, degenerative central nervous system (CNS) disorder (e.g., Alzheimer's or Parkinson's Disease), epilepsy, mental retardation, or any other disease/procedure/accident/intervention which, according to the screening clinician, is deemed associated with significant injury to or malfunction of the CNS, or history of significant head trauma within the past 2 years. 20. Presents with any of the following lab abnormalities: * Thyroid stimulating hormone (TSH) outside of the normal limits and clinically significant as determined by the investigator. Free thyroxine (T4) levels may be measured if TSH level is high. Subject will be excluded if T4 level is clinically significant. * Patients with diabetes mellitus fulfilling any of the following criteria: * Unstable diabetes mellitus defined as glycosylated hemoglobin (HbA1c) \>8.5% at screening. * Admitted to hospital for treatment of diabetes mellitus or diabetes mellitus-related illness in the past 12 weeks. * Not under physician care for diabetes mellitus. * Has not been on the same dose of oral hypoglycaemic drug(s) and/or diet for the 4 weeks prior to screening. For thiazolidinediones (glitazones) this period should not be less than 8 weeks. * Any other clinically significant abnormal laboratory result (determined as such by the investigator and MGH CTNI medical monitor) at the time of the screening. 21. History of hypothyroidism and has been on a stable dosage of thyroid replacement medication for less than 2 months prior to screening. (Subjects on a stable dosage of thyroid replacement medication for at least 2 months or more prior to screening are eligible for enrollment.) 22. History of hyperthyroidism which was treated (medically or surgically) less than 6 months prior to screening. 23. History of positive screening urine test for drugs of abuse at screening: cannabinoids (if the patient has a legitimate medical prescription for cannabis, patient must agree to abstain during the entirety of the study and to have a negative test at baseline), cocaine, amphetamines, barbiturates, opiates (unless use is in accordance with guidance provided in table of allowed and excluded medications). 24. Patients with exclusionary laboratory values (see Table 1), or requiring treatment with exclusionary concomitant medications (see Appendix 1). 25. Patients on exclusionary concomitant psychotropic medications, the half-life of which would not allow sufficient time for patients to have been free of the medication post-taper for five half-lives within the maximum screening period (28 days). 26. Patients with a history of narrow angle glaucoma. 27. Liver or renal Function tests which meet the
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ was assessed on Days 0, 1, 2, 5, 8, 11, 14, 17, 21, 23, 28 | Superiority will be demonstrated by a statistically significant greater decrease (p\<0.05, 2 sided) on the SDQ total score for participants receiving brexpiprazole versus placebo therapy. Symptoms of Depression Questionnaire (SDQ): This validated self-rating instrument has 44 items on a scale of 1-6, measuring multiple depressive symptom domains, with higher scores indicating worse depression symptoms. Participants reported on their experiences over the past three days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy on Secondary Outcome Variables | These secondary outcome variables were assessed on Days 0, 1 (except for MADRS this day), 2, 5, 8, 11, 14, 17, 21, 23, 28 | Montgomery-Asberg Depression Rating Scale (MADRS):This 10-item clinician-rated instrument measures depression severity. Total score range of 0-60 with higher scores indicating more severity. 6-item Hamilton Rating Scale for Depression (HAM-D6): This instrument is completed with a structured interview guide by the clinician based on his/her assessment of the patient's symptoms, with higher scores indicating worse depression. Scores range from 0-22. Experiences were rated based on the past 3 days. Clinical Global Impressions-Severity (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) scales: These clinician-rated scales rate the severity of the disorder and the global improvement since beginning of the study. Further information is in the baseline measures section. |
| Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Blood Pressure) | Blood pressure was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. This vital sign was measured 6 times following the intranasal administration of ketamine: 15 minutes post dose, 30 minutes post dose, 45 minutes | Blood pressure was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. This vital sign was measured 6 times following the intranasal administration of ketamine: 15 minutes post dose, 30 minutes post dose, 45 minutes post dose, 1 hour post dose, 90 minutes post dose, and 2 hours post dose. Average blood pressure per group was assessed. Medical staff monitoring the ketamine administration were prepared to treat increases in blood pressure greater than 180/110 mm Hg or follow their institutional guidelines if more conservative, if these elevations did not resolve spontaneously within a short time period. Data presented are number of participants with elevated blood pressure at any of the listed time points. |
| Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Heart Rate) | Heart rate was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. | Heart rate was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. This vital sign was measured 6 times following the intranasal administration of ketamine: 15 minutes post dose, 30 minutes post dose, 45 minutes post dose, 1 hour post dose, 90 minutes post dose, and 2 hours post dose. Average heart rate per group was assessed. Medical staff monitoring the ketamine administration were prepared to treat heart rate greater than 110 bpm, or follow their institutional guidelines if more conservative, if these elevations did not resolve spontaneously within a short time period. Data presented are number of participants with elevated heart rate at any of the listed time points. |
| Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Total Number of Abnormal ECGs | ECGs were conducted at baseline and 5, 8, 11, 14, and 21 days after baseline | Electrocardiograms (ECGs) were conducted at baseline, and follow-up visits conducted 5, 8, 11, 14, and 21 days after baseline. Any found to be abnormal were evaluated by a clinician as to the clinical significance of the ECG abnormality. |
| Long-term Sustained Response, as Measured by Achieving a 50% Reduction on the Montgomery-Asberg Depression Rating Scale (MADRS) on Day 28 (Number and Percentage of Participants Achieving Sustained Response Reported) | MADRS was assessed on Days 0, 2, 3, 8, 11, 14, 17, 21, 23, 28; 50% reduction compared Day 28 to Baseline. | The table below compares percentages of participants in each arm who achieved a 50% or greater reduction on the Montgomery-Asberg Depression Rating Scale (MADRS) on Day 28 compared with baseline. This 10- item clinician-rated instrument measures depression severity with higher scores indicating more severity. Each item can be scored from 0 to 6 for a total sore range of 0 to 60. It was administered with a structured interview guide. Experiences over the past 3 days were rated. |
| Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Chemistry and CBC laboratory tests were obtained during screening and on Day 14 and 28 follow-ups | Chemistry and CBC laboratory tests were obtained during the screening visit and on Day 14 and 28 follow-ups. If a test result was abnormal (i.e., outside of the site-specific pre-specified range of expected values), it was evaluated by a clinician as to its clinical significance. |
| Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Number of Participants Reporting) | Adverse events were recorded on a rolling basis from screening through Day 28 | Adverse events were recorded on a rolling basis from screening until the last day of the study (i.e., Day 28). For patients who reported any AEs, the average number of AEs per person per group were recorded. Site investigators rated whether AEs were possibly or probably related to treatment. |
| Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Average Number Per Person Per Group) | The outcome was recorded on a rolling basis from screening through Day 28 | Adverse events were recorded on a rolling basis from screening until the last day of the study (i.e., Day 28). For patients who reported any adverse events, the mean number of adverse events per person per group were calculated and are reported below. |
| Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | The CHRT was used at each study visit through Day 28 | The clinician rated behavioral module of the Concise Health Risk Tracking (CHRT) scale was used at each study visit to identify suicidal ideation and behavior. The first item assesses suicidal ideation. All subsequent items assess suicidal behavior. The below table is for Item 1. |
| Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | ECGs were conducted at baseline and 5, 8, 11, 14, and 21 days after baseline | Electrocardiograms (ECGs) were conducted at baseline, and follow-up visits conducted 5, 8, 11, 14, and 21 days after baseline. Any found to be abnormal were evaluated by a clinician as to the clinical significance of the ECG abnormality. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Ketamine/Brexpiprazole Arm Brexpiprazole up to 3 mg/day for four weeks in combination with bi-weekly administration of intranasal ketamine (40 mg) for two weeks, followed by weekly administration of intranasal ketamine (40 mg) for two weeks | 25 |
| Ketamine/Placebo Arm Placebo for four weeks in combination with bi-weekly administration of intranasal ketamine (40 mg) for two weeks, followed by weekly administration of intranasal ketamine (40 mg) for two weeks | 26 |
| Total | 51 |
Baseline characteristics
| Characteristic | Ketamine/Placebo Arm | Ketamine/Brexpiprazole Arm | Total |
|---|---|---|---|
| Age, Continuous | 44.6 years STANDARD_DEVIATION 13.9 | 40.8 years STANDARD_DEVIATION 12.4 | 42.7 years STANDARD_DEVIATION 13.2 |
| Clinical Severity at Baseline- CGI-I | 4.2 units on a scale STANDARD_DEVIATION 0.5 | 4.2 units on a scale STANDARD_DEVIATION 0.4 | 4.2 units on a scale STANDARD_DEVIATION 0.4 |
| Clinical Severity at Baseline- CGI-S | 4.8 units on a scale STANDARD_DEVIATION 0.7 | 5.0 units on a scale STANDARD_DEVIATION 0.6 | 4.9 units on a scale STANDARD_DEVIATION 0.7 |
| Clinical Severity at Baseline- HAM-D6 | 11.9 units on a scale STANDARD_DEVIATION 2.2 | 12.0 units on a scale STANDARD_DEVIATION 2 | 12.0 units on a scale STANDARD_DEVIATION 2.1 |
| Clinical Severity at Baseline- MADRS | 34.2 units on a scale STANDARD_DEVIATION 5.5 | 33.8 units on a scale STANDARD_DEVIATION 4 | 34.0 units on a scale STANDARD_DEVIATION 4.8 |
| Clinical Severity at Baseline -SDQ | 3.7 units on a scale STANDARD_DEVIATION 0.5 | 3.7 units on a scale STANDARD_DEVIATION 0.6 | 3.7 units on a scale STANDARD_DEVIATION 0.6 |
| Duration of Current Major Depressive Episode | 4.3 years STANDARD_DEVIATION 7 | 4.6 years STANDARD_DEVIATION 6.1 | 4.4 years STANDARD_DEVIATION 6.5 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 3 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 25 Participants | 22 Participants | 47 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Number of comorbid medical conditions | 2.5 Conditions STANDARD_DEVIATION 1.9 | 2.6 Conditions STANDARD_DEVIATION 2 | 2.5 Conditions STANDARD_DEVIATION 1.9 |
| Number of current comorbid psychiatric conditions | 0.2 Conditions STANDARD_DEVIATION 0.5 | 0.1 Conditions STANDARD_DEVIATION 0.3 | 0.1 Conditions STANDARD_DEVIATION 0.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 3 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 23 Participants | 21 Participants | 44 Participants |
| Sex: Female, Male Female | 12 Participants | 14 Participants | 26 Participants |
| Sex: Female, Male Male | 14 Participants | 11 Participants | 25 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 25 | 0 / 26 |
| other Total, other adverse events | 17 / 25 | 18 / 26 |
| serious Total, serious adverse events | 0 / 25 | 0 / 26 |
Outcome results
Primary
Change From Baseline on Symptoms of Depression Questionnaire (SDQ)
Superiority will be demonstrated by a statistically significant greater decrease (p\<0.05, 2 sided) on the SDQ total score for participants receiving brexpiprazole versus placebo therapy. Symptoms of Depression Questionnaire (SDQ): This validated self-rating instrument has 44 items on a scale of 1-6, measuring multiple depressive symptom domains, with higher scores indicating worse depression symptoms. Participants reported on their experiences over the past three days.
Time frame: SDQ was assessed on Days 0, 1, 2, 5, 8, 11, 14, 17, 21, 23, 28
Population: A total of 54 people were randomized, but only 51 received the study drug or placebo and were included in outcome analyses. Of these, 49 (96%) completed study assessments for the primary endpoint, and n=45 (88%) completed the study. See participant flow data for more information.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 5 | 3.4 score on a scale | Standard Deviation 0.6 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 14 | 3.0 score on a scale | Standard Deviation 0.5 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 2 | 3.5 score on a scale | Standard Deviation 0.6 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 17 | 3.1 score on a scale | Standard Deviation 0.6 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 8 | 3.3 score on a scale | Standard Deviation 0.5 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 21 | 3.0 score on a scale | Standard Deviation 0.7 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 1 | 3.5 score on a scale | Standard Deviation 0.6 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 23 | 2.8 score on a scale | Standard Deviation 0.6 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 11 | 3.1 score on a scale | Standard Deviation 0.5 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 28 | 2.9 score on a scale | Standard Deviation 0.6 |
| Ketamine/Brexpiprazole Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 0 | 3.7 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 28 | 3.0 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 0 | 3.7 score on a scale | Standard Deviation 0.5 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 1 | 3.5 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 2 | 3.3 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 5 | 3.3 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 8 | 3.2 score on a scale | Standard Deviation 0.5 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 11 | 3.1 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 14 | 3.2 score on a scale | Standard Deviation 0.7 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 17 | 3.2 score on a scale | Standard Deviation 0.7 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 21 | 3.2 score on a scale | Standard Deviation 0.6 |
| Ketamine/Placebo Arm | Change From Baseline on Symptoms of Depression Questionnaire (SDQ) | SDQ, Day 23 | 3.0 score on a scale | Standard Deviation 0.6 |
Comparison: SDQ total was primary outcome \& Day 14 primary endpoint. Change from baseline was calculated for each person at each follow-up. Change score was the dependent variable in a linear fixed effects model, where a (-)number = less severe depression. For group comparison, treatment was coded as 1 \& placebo as 0, thus a (-)value means treatment doing better. Fixed effects: group(brex v placebo), day(1-28), site(6 sites). All 2-\& 3-way interactions were included, as well as a priori defined covariates.p-value: 0.46Mixed Models Analysis
Comparison: Secondary Aim: To evaluate the short-term effect of brexpiprazole, as measured by the Symptoms of Depression Questionnaire (SDQ), on Day 2. We used the same model as in Aim 1 to test this hypothesis.p-value: 0.04Mixed Models Analysis
Comparison: To evaluate the long-term effect of brexpiprazole as measured by the Symptoms of Depression Questionnaire (SDQ) on Day 28. The same model as was used in Aim 1 was used to test this hypothesis.p-value: 0.92Mixed Models Analysis
Secondary
Efficacy on Secondary Outcome Variables
Montgomery-Asberg Depression Rating Scale (MADRS):This 10-item clinician-rated instrument measures depression severity. Total score range of 0-60 with higher scores indicating more severity. 6-item Hamilton Rating Scale for Depression (HAM-D6): This instrument is completed with a structured interview guide by the clinician based on his/her assessment of the patient's symptoms, with higher scores indicating worse depression. Scores range from 0-22. Experiences were rated based on the past 3 days. Clinical Global Impressions-Severity (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) scales: These clinician-rated scales rate the severity of the disorder and the global improvement since beginning of the study. Further information is in the baseline measures section.
Time frame: These secondary outcome variables were assessed on Days 0, 1 (except for MADRS this day), 2, 5, 8, 11, 14, 17, 21, 23, 28
Population: A total of 54 people were randomized, but only 51 received the study drug or placebo and were included in outcome analyses. Of these, 49 (96%) completed study assessments for the primary endpoint, and n=45 (88%) completed the study. See participant flow data for more information.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 2 | 4.61 score on a scale | Standard Deviation 0.66 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 2 | 3.65 score on a scale | Standard Deviation 0.78 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 5 | 3.5 score on a scale | Standard Deviation 0.78 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 21 | 6.83 score on a scale | Standard Deviation 3.82 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 8 | 3.2 score on a scale | Standard Deviation 0.87 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 5 | 4.33 score on a scale | Standard Deviation 0.92 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 11 | 2.87 score on a scale | Standard Deviation 0.92 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 8 | 9.4 score on a scale | Standard Deviation 2.58 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 14 | 2.8 score on a scale | Standard Deviation 0.96 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 8 | 4.29 score on a scale | Standard Deviation 0.95 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 17 | 2.67 score on a scale | Standard Deviation 1.09 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 23 | 6.68 score on a scale | Standard Deviation 3.41 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 21 | 2.75 score on a scale | Standard Deviation 1.29 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 11 | 3.78 score on a scale | Standard Deviation 1.04 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 23 | 2.41 score on a scale | Standard Deviation 1.18 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 17 | 3.42 score on a scale | Standard Deviation 1.32 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 28 | 2.48 score on a scale | Standard Deviation 1.27 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 14 | 7.36 score on a scale | Standard Deviation 3 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 0 | 33.84 score on a scale | Standard Deviation 4.03 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 14 | 3.48 score on a scale | Standard Deviation 1.08 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 2 | 31.87 score on a scale | Standard Deviation 5.96 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 21 | 3.46 score on a scale | Standard Deviation 1.44 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 5 | 29.46 score on a scale | Standard Deviation 7.56 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 28 | 6.43 score on a scale | Standard Deviation 4.04 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 8 | 27.64 score on a scale | Standard Deviation 7.6 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 5 | 10.08 score on a scale | Standard Deviation 2.53 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 11 | 23.63 score on a scale | Standard Deviation 8.94 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 23 | 3.14 score on a scale | Standard Deviation 1.39 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 14 | 21.28 score on a scale | Standard Deviation 9.53 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 0 | 4.96 score on a scale | Standard Deviation 0.61 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 17 | 20.92 score on a scale | Standard Deviation 10.92 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 28 | 3.17 score on a scale | Standard Deviation 1.56 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 21 | 20.5 score on a scale | Standard Deviation 12.34 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 17 | 6.96 score on a scale | Standard Deviation 3.79 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 23 | 18.36 score on a scale | Standard Deviation 11.29 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 0 | 4.16 score on a scale | Standard Deviation 0.37 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 28 | 18.39 score on a scale | Standard Deviation 11.86 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 1 | 4.56 score on a scale | Standard Deviation 0.77 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 0 | 11 score on a scale | Standard Deviation 3.37 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 11 | 7.96 score on a scale | Standard Deviation 3.03 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 1 | 10.24 score on a scale | Standard Deviation 2.35 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 1 | 3.8 score on a scale | Standard Deviation 0.5 |
| Ketamine/Brexpiprazole Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 2 | 10.48 score on a scale | Standard Deviation 2.45 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 1 | 3.35 score on a scale | Standard Deviation 0.85 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 5 | 9.21 score on a scale | Standard Deviation 3.09 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 8 | 7.64 score on a scale | Standard Deviation 4.13 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 11 | 7.71 score on a scale | Standard Deviation 4.14 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 14 | 7.54 score on a scale | Standard Deviation 4.68 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 17 | 8.09 score on a scale | Standard Deviation 4.33 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 21 | 7.83 score on a scale | Standard Deviation 4.25 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 23 | 7.48 score on a scale | Standard Deviation 4.18 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 28 | 7.58 score on a scale | Standard Deviation 3.69 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 0 | 4.77 score on a scale | Standard Deviation 0.71 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 1 | 4.15 score on a scale | Standard Deviation 0.73 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 2 | 4.12 score on a scale | Standard Deviation 0.59 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 5 | 4 score on a scale | Standard Deviation 1.02 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 8 | 3.68 score on a scale | Standard Deviation 1.22 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 11 | 3.38 score on a scale | Standard Deviation 1.13 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 14 | 3.33 score on a scale | Standard Deviation 1.24 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 17 | 3.48 score on a scale | Standard Deviation 1.34 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 21 | 3.58 score on a scale | Standard Deviation 1.21 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 23 | 3.48 score on a scale | Standard Deviation 1.27 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-S, Day 28 | 3.46 score on a scale | Standard Deviation 1.14 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 0 | 4.15 score on a scale | Standard Deviation 0.46 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 2 | 3.42 score on a scale | Standard Deviation 0.76 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 2 | 8.62 score on a scale | Standard Deviation 3.51 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 5 | 3.29 score on a scale | Standard Deviation 1 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 8 | 2.92 score on a scale | Standard Deviation 1 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 11 | 2.7 score on a scale | Standard Deviation 0.92 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 14 | 2.54 score on a scale | Standard Deviation 0.98 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 17 | 2.83 score on a scale | Standard Deviation 1.19 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 21 | 2.83 score on a scale | Standard Deviation 1.13 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 23 | 2.74 score on a scale | Standard Deviation 1.14 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | CGI-I, Day 28 | 2.54 score on a scale | Standard Deviation 1.18 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 0 | 34.19 score on a scale | Standard Deviation 5.54 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 2 | 28.19 score on a scale | Standard Deviation 6.79 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 5 | 27.42 score on a scale | Standard Deviation 8.75 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 8 | 24.48 score on a scale | Standard Deviation 9.16 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 11 | 21.83 score on a scale | Standard Deviation 9.95 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 14 | 22.08 score on a scale | Standard Deviation 12.1 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 17 | 23.52 score on a scale | Standard Deviation 12.07 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 21 | 23.75 score on a scale | Standard Deviation 10.63 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 23 | 23.57 score on a scale | Standard Deviation 10.53 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | MADRS, Day 28 | 22.13 score on a scale | Standard Deviation 9.98 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 0 | 11.6 score on a scale | Standard Deviation 2.07 |
| Ketamine/Placebo Arm | Efficacy on Secondary Outcome Variables | HAMD6, Day 1 | 9.19 score on a scale | Standard Deviation 3.09 |
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the MADRS change scores, reporting here information for Day 2.p-value: 0.04Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the MADRS change scores, reporting here information for Day 14.p-value: 0.73Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the MADRS change scores, reporting here information for Day 28.p-value: 0.37Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the HAMD6 change scores, reporting here information for Day 2.p-value: 0.06Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the HAMD6 change scores, reporting here information for Day 14.p-value: 0.83Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the HAMD6 change scores, reporting here information for Day 28.p-value: 0.52Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the CGI-S change scores, reporting here information for Day 2.p-value: 0.11Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the CGI-S change scores, reporting here information for Day 14.p-value: 0.98Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the CGI-S change scores, reporting here information for Day 28.p-value: 0.45Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the CGI-I change scores, reporting here information for Day 2.p-value: 0.02Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the CGI-I change scores, reporting here information for Day 14.p-value: 0.07Mixed Models Analysis
Comparison: The same model building approach as used for the primary outcome variable was used for the secondary outcome variables. As per the primary outcome variable, the change scores (i.e., compared to baseline) were the dependent variables of interest. For each secondary outcome variable, non-significant site interaction effects were removed one at a time. This analysis is for the CGI-I change scores, reporting here information for Day 28.p-value: 0.37Mixed Models Analysis
Secondary
Long-term Sustained Response, as Measured by Achieving a 50% Reduction on the Montgomery-Asberg Depression Rating Scale (MADRS) on Day 28 (Number and Percentage of Participants Achieving Sustained Response Reported)
The table below compares percentages of participants in each arm who achieved a 50% or greater reduction on the Montgomery-Asberg Depression Rating Scale (MADRS) on Day 28 compared with baseline. This 10- item clinician-rated instrument measures depression severity with higher scores indicating more severity. Each item can be scored from 0 to 6 for a total sore range of 0 to 60. It was administered with a structured interview guide. Experiences over the past 3 days were rated.
Time frame: MADRS was assessed on Days 0, 2, 3, 8, 11, 14, 17, 21, 23, 28; 50% reduction compared Day 28 to Baseline.
Population: A total of 54 people were randomized, but only 51 received the study drug or placebo and were included in outcome analyses. Of these, 49 (96%) completed study assessments for the primary endpoint, and n=45 (88%) completed the study. See participant flow data for more information.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ketamine/Brexpiprazole Arm | Long-term Sustained Response, as Measured by Achieving a 50% Reduction on the Montgomery-Asberg Depression Rating Scale (MADRS) on Day 28 (Number and Percentage of Participants Achieving Sustained Response Reported) | 10 Participants |
| Ketamine/Placebo Arm | Long-term Sustained Response, as Measured by Achieving a 50% Reduction on the Montgomery-Asberg Depression Rating Scale (MADRS) on Day 28 (Number and Percentage of Participants Achieving Sustained Response Reported) | 8 Participants |
Comparison: We used a Chi-squared test to assess differences between treatment and control in terms of percent of participants achieving a long-term sustained response, as measured by achieving a 50% or greater reduction on the MADRS on Day 28.p-value: 0.47Chi-squared
Comparison: Logistic regression was used to assess a difference in 50% reduction on the MADRS on Day 28 between groups.p-value: 0.3595% CI: [0.52, 6.44]Regression, Logistic
Secondary
Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs
Electrocardiograms (ECGs) were conducted at baseline, and follow-up visits conducted 5, 8, 11, 14, and 21 days after baseline. Any found to be abnormal were evaluated by a clinician as to the clinical significance of the ECG abnormality.
Time frame: ECGs were conducted at baseline and 5, 8, 11, 14, and 21 days after baseline
Population: A total of 54 people were randomized, but only 51 received the study drug or placebo and were included in outcome analyses. Of these, 49 (96%) completed study assessments for the primary endpoint, and n=45 (88%) completed the study. See participant flow data for more information.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 5 | 9 participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 11 | 10 participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Baseline | 12 participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 14 | 10 participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 8 | 11 participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 21 | 8 participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 8 | 12 participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Baseline | 9 participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 5 | 9 participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 21 | 9 participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 11 | 10 participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Number of Participants With Abnormal ECGs | # of participants with abnormal ECGs, Day 14 | 7 participants |
Comparison: This analysis was to assess group differences (drug vs. placebo) in terms of number of abnormal ECGs out of total ECGs assessed.p-value: 0.6Chi-squared
Comparison: This analysis was to assess for group differences (drug vs. placebo) in number/percentage of people with an abnormal ECG at baseline.p-value: 0.33Chi-squared
Comparison: This analysis was to assess for group differences (drug vs. placebo) in number/percentage of people with an abnormal ECG at Visit 4.p-value: 1Chi-squared
Comparison: This analysis was to assess for group differences (drug vs. placebo) in number/percentage of people with an abnormal ECG at Visit 5.p-value: 0.78Chi-squared
Comparison: This analysis was to assess for group differences (drug vs. placebo) in number/percentage of people with an abnormal ECG at Visit 6.p-value: 0.9Chi-squared
Comparison: This analysis was to assess for group differences (drug vs. placebo) in number/percentage of people with an abnormal ECG at Visit 7.p-value: 0.43Chi-squared
Comparison: This analysis was to assess for group differences (drug vs. placebo) in number/percentage of people with an abnormal ECG at Visit 9.p-value: 0.76Chi-squared
Secondary
Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Total Number of Abnormal ECGs
Electrocardiograms (ECGs) were conducted at baseline, and follow-up visits conducted 5, 8, 11, 14, and 21 days after baseline. Any found to be abnormal were evaluated by a clinician as to the clinical significance of the ECG abnormality.
Time frame: ECGs were conducted at baseline and 5, 8, 11, 14, and 21 days after baseline
Population: A total of 54 people were randomized, but only 51 received the study drug or placebo and were included in outcome analyses. Of these, 49 (96%) completed study assessments for the primary endpoint, and n=45 (88%) completed the study. See participant flow data for more information.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Total Number of Abnormal ECGs | 60 Number of abnormal ECGs |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: 12-lead Electrocardiogram (ECG) - Total Number of Abnormal ECGs | 56 Number of abnormal ECGs |
Secondary
Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results
Chemistry and CBC laboratory tests were obtained during the screening visit and on Day 14 and 28 follow-ups. If a test result was abnormal (i.e., outside of the site-specific pre-specified range of expected values), it was evaluated by a clinician as to its clinical significance.
Time frame: Chemistry and CBC laboratory tests were obtained during screening and on Day 14 and 28 follow-ups
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Abnormal lab results at Screening | 1 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Abnormal lab results at Day 14 | 1 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Abnormal lab results at Day 28 | 1 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Abnormal lab results at Screening | 2 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Abnormal lab results at Day 14 | 0 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Laboratory Test Results | Abnormal lab results at Day 28 | 0 Participants |
Secondary
Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Blood Pressure)
Blood pressure was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. This vital sign was measured 6 times following the intranasal administration of ketamine: 15 minutes post dose, 30 minutes post dose, 45 minutes post dose, 1 hour post dose, 90 minutes post dose, and 2 hours post dose. Average blood pressure per group was assessed. Medical staff monitoring the ketamine administration were prepared to treat increases in blood pressure greater than 180/110 mm Hg or follow their institutional guidelines if more conservative, if these elevations did not resolve spontaneously within a short time period. Data presented are number of participants with elevated blood pressure at any of the listed time points.
Time frame: Blood pressure was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. This vital sign was measured 6 times following the intranasal administration of ketamine: 15 minutes post dose, 30 minutes post dose, 45 minutes
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Blood Pressure) | 1 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Blood Pressure) | 0 Participants |
Secondary
Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Heart Rate)
Heart rate was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21. This vital sign was measured 6 times following the intranasal administration of ketamine: 15 minutes post dose, 30 minutes post dose, 45 minutes post dose, 1 hour post dose, 90 minutes post dose, and 2 hours post dose. Average heart rate per group was assessed. Medical staff monitoring the ketamine administration were prepared to treat heart rate greater than 110 bpm, or follow their institutional guidelines if more conservative, if these elevations did not resolve spontaneously within a short time period. Data presented are number of participants with elevated heart rate at any of the listed time points.
Time frame: Heart rate was measured during each administration of ketamine, occurring on days 0, 5, 8, 11, 14, and 21.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Heart Rate) | 1 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Number of Participants With Abnormal Vital Signs (Elevated Heart Rate) | 1 Participants |
Secondary
Safety and Tolerability Outcomes: Suicidal Ideation and Behavior
The clinician rated behavioral module of the Concise Health Risk Tracking (CHRT) scale was used at each study visit to identify suicidal ideation and behavior. The first item assesses suicidal ideation. All subsequent items assess suicidal behavior. The below table is for Item 1.
Time frame: The CHRT was used at each study visit through Day 28
Population: A total of 54 people were randomized, but only 51 received the study drug or placebo and were included in outcome analyses. Of these, 49 (96%) completed study assessments for the primary endpoint, and n=45 (88%) completed the study. See participant flow data for more information.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Screening | 9 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Baseline | 4 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 1 | 5 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 2 | 5 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 5 | 5 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 8 | 5 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 11 | 3 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 14 | 5 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 17 | 4 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 21 | 4 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 23 | 2 Participants |
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 28 | 2 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 23 | 4 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Screening | 4 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 11 | 3 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Baseline | 4 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 21 | 3 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 1 | 5 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 14 | 3 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 2 | 2 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 28 | 4 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 5 | 7 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 17 | 2 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Suicidal Ideation and Behavior | Suicidal Ideation-Day 8 | 8 Participants |
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) throughout the trial.p-value: 0.51Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) at Screening.p-value: 0.09Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) at Baseline.p-value: 0.95Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 1.p-value: 0.94Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 2.p-value: 0.16Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 5.p-value: 0.51Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 8.p-value: 0.33Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 11.p-value: 0.96Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 14.p-value: 0.48Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 17.p-value: 0.41Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 21.p-value: 0.68Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 23.p-value: 0.41Chi-squared
Comparison: This analysis was to compare by group (drug vs. placebo) the occurrence of suicidal ideation (endorsement of item 1 on the CHRT) on Day 28.p-value: 0.41Chi-squared
Secondary
Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Average Number Per Person Per Group)
Adverse events were recorded on a rolling basis from screening until the last day of the study (i.e., Day 28). For patients who reported any adverse events, the mean number of adverse events per person per group were calculated and are reported below.
Time frame: The outcome was recorded on a rolling basis from screening through Day 28
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Average Number Per Person Per Group) | 3.8 Adverse events | Standard Error 3.1 |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Average Number Per Person Per Group) | 3.6 Adverse events | Standard Error 3.5 |
Comparison: This analysis assessed group differences (drug vs. placebo) in terms of mean number of adverse events per person, among those who reported any adverse events.p-value: 0.81t-test, 2 sided
Secondary
Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Number of Participants Reporting)
Adverse events were recorded on a rolling basis from screening until the last day of the study (i.e., Day 28). For patients who reported any AEs, the average number of AEs per person per group were recorded. Site investigators rated whether AEs were possibly or probably related to treatment.
Time frame: Adverse events were recorded on a rolling basis from screening through Day 28
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Ketamine/Brexpiprazole Arm | Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Number of Participants Reporting) | 17 Participants |
| Ketamine/Placebo Arm | Safety and Tolerability Outcomes: Treatment-emergent Adverse Events (Number of Participants Reporting) | 18 Participants |
Comparison: This analysis assessed group differences (drug vs. placebo) in terms of number of participants reporting adverse events.p-value: 0.92Chi-squared