Mirtazapine Treatment of Anxiety in Children and Adolescents With Pervasive Developmental Disorders
Overview
- Phase
- Phase 3
- Intervention
- Mirtazapine
- Conditions
- Autism Spectrum Disorders
- Sponsor
- Massachusetts General Hospital
- Enrollment
- 30
- Locations
- 2
- Primary Endpoint
- Proportion of Participants Who Responded to Treatment at 10 Weeks According to the Improvement Item of the Clinical Global Impression-Scale (Response Defined as CGI-I=1 or CGI-I=2)
- Status
- Completed
- Last Updated
- 7 years ago
Overview
Brief Summary
This study will determine the effectiveness of mirtazapine in reducing anxiety in children with autistic disorder, Asperger's disorder and Pervasive Developmental Disorder.
Detailed Description
One of the areas receiving very little attention in Pervasive Developmental Disorders (PDDs) is that of anxiety. Anxiety is common in PDD, but has not yet been fully characterized. The primary objective of this study is to conduct a preliminary placebo-controlled trial of mirtazapine for the treatment of anxiety associated with PDDs. We hypothesize that mirtazapine will be safe and well tolerated.
Investigators
Christopher John McDougle, M.D.
Director, Lurie Center for Autism
Massachusetts General Hospital
Eligibility Criteria
Inclusion Criteria
- •Ages 5-17 years
- •Diagnosis of autistic disorder, Asperger's disorder or Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS)
- •Clinically significant anxiety as evidenced by a Pediatric Anxiety Rating Scale (PARS) score of 10 or greater
- •Abbreviated intelligence quotient (IQ) greater than 50 on the Stanford Binet 5th Ed.
Exclusion Criteria
- •Diagnosis of Rett's disorder or childhood integrative disorder
- •Diagnosis of obsessive-compulsive disorder (OCD), post-traumatic stress disorder, major mood disorder, psychotic disorder, or substance use disorder
- •Presence of any past or present medical conditions that would make treatment with mirtazapine unsafe
- •Use of other antidepressants or benzodiazepines
- •Use of other psychotropic medications which are ineffective, poorly tolerated, or sub-optimal in terms of dose
- •Previous adequate trial of mirtazapine
Arms & Interventions
Mirtazapine
The starting dose for subjects is 7.5 mg daily. The maximum daily dose will be 45 mg.
Intervention: Mirtazapine
Placebo
Subjects randomized to placebo arm will receive capsules identical in size and appearance to those subjects receiving study drug. Placebo capsules contain inactive ingredients.
Intervention: Placebo
Outcomes
Primary Outcomes
Proportion of Participants Who Responded to Treatment at 10 Weeks According to the Improvement Item of the Clinical Global Impression-Scale (Response Defined as CGI-I=1 or CGI-I=2)
Time Frame: Screen (Visit 1) Baseline (Visit 2) and Endpoint (Week 10)
The Clinical Global Impressions Global Improvement (CGI-I) is designed to take into account all factors to arrive at an assessment of response to treatment. The CGI-I scale ranges from 1 to 7 (1=very much improved; 2= much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse), with lower scores indicating improvement (1=very much improved and 2=much improved). In this study the CGI was focused on the target symptom of anxiety. Participants with a CGI-I score of 1 or 2 were classified as responders. The CGI-I was administered biweekly for 6 weeks and again at 10 weeks during the study. The participant who withdrew from the study before 10 weeks was not included in the calculations.
Mean 10-Week Change in Pediatric Anxiety Rating Scale 5-Item Total Score, Double-blind Phase
Time Frame: Weeks Baseline, 2, 4, 6, and 10
The Pediatric Anxiety Rating Scale (PARS) is a clinician-rated instrument that assesses anxiety symptoms that are commonly associated with social anxiety, separation anxiety, and generalized anxiety disorders. Scaled score ranges form 0-25 with higher scores indicating more severe anxiety symptoms. Means were estimated using a repeated measures linear regression model with treatment group, study week (in categories), and their interaction as covariates, and assuming a common mean between treatment groups at baseline. Confidence intervals reflect a Bonferroni multiple testing correction accounting for the selection of two primary outcomes.