Vortioxetine, 5, 10, and 20 mg, Relapse Prevention Study in Adults With Major Depressive Disorder (MDD)

Phase 4

Completed

Conditions: Major Depressive Disorder

Interventions: Drug: Vortioxetine
Drug: Placebo

Registration Number: NCT02371980

Lead Sponsor: Takeda

Brief Summary: The purpose of this study is to evaluate the efficacy of vortioxetine (5, 10, and 20 mg) versus placebo during the first 28 weeks of the 32-week double-blind treatment period in the prevention of relapse in participants with MDD who responded to acute treatment with vortioxetine 10 mg.

Detailed Description: The drug being tested in this study is called vortioxetine. Vortioxetine is being tested for the prevention of relapse in adults with major depressive disorder (MDD) who respond to daily treatment with vortioxetine. This study will look at relapse rates of MDD in people who take vortioxetine.

The study will enroll approximately 1100 participants. All participants will receive vortioxetine 10 mg open-label for the first 16 weeks of the study. Participants who meet the appropriate MDD response criteria from the Week 8 Visit through Week 16 Visit will be eligible for randomization into the double-blind treatment period. Participants will be randomly assigned (by chance, like flipping a coin) to one of the four treatment groups-which will remain undisclosed to the patient and study doctor during the study (unless there is an urgent medical need):

* Vortioxetine 5 mg

* Vortioxetine 10 mg

* Vortioxetine 20 mg

* Placebo (dummy inactive pill) - this is a capsule that looks like the study drug but has no active ingredient

All participants will be asked to take one capsule at the same time each day throughout the study.

This multi-center trial will be conducted in the United States. The overall time to participate in this study is up to 55 weeks. Participants will make 19 visits to the clinic, and will be contacted by telephone 4 weeks after last dose of study drug for a follow-up assessment.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1106

Inclusion Criteria

In the opinion of the investigator, the participant is capable of understanding and complying with protocol requirements.
The participant or, when applicable, the participant's legally acceptable representative signs and dates a written, informed consent form and any required privacy authorization prior to the initiation of any study procedures.
Suffers from recurrent major depressive disorder (MDD) as the primary diagnosis according to Diagnostic & Statistical Manual of Mental Disorders, 4th Edition - Text Revision (DSM-IV-TR) criteria (classification code 296.3x), and the current episode is confirmed by the Mini International Neuropsychiatric Interview (MINI).
Reported duration of the current episode is ≥8 weeks and ≤18months.
Had at least 2 other major depressive episodes (MDEs) before the current episode.
Has a Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥26 at the Screening and Baseline I visits.
Is a man or woman aged 18 to 75 years, inclusive.
A female participant of childbearing potential who is sexually active with a nonsterilized male partner agrees to routinely use adequate contraception from signing of the informed consent throughout the duration of the study and for 30 days after the last dose.

Exclusion Criteria

Has received any investigational compound within 30 days prior to screening or 5 half-lives prior to screening, whichever is longer.
Has previously or is currently participating in this study.
Has participated in 2 or more clinical studies in the year prior to screening, or has participated in a clinical trial for a psychiatric condition that is exclusionary per this protocol.
Is an immediate family member, study site employee, or is in a dependent relationship with a study site employee who is involved in conduct of this study (eg, spouse, parent, child, sibling) or may consent under duress.
Has one or more of the following:
1. Any current psychiatric disorder which is the primary focus of treatment other than MDD as defined in the DSM-IV-TR, and assessed by the MINI.
2. Current or history of: manic or hypomanic episode, schizophrenia or any other psychotic disorder, including schizoaffective disorder, major depression with psychotic features, bipolar depression with psychotic features, obsessive compulsive disorder (OCD), mental retardation, organic mental disorders, or mental disorders due to a general medical condition as defined in the DSM-IV-TR.
3. Current diagnosis or history of alcohol or other substance abuse or dependence (excluding nicotine or caffeine) as defined in the DSM-IV-TR that has not been in full and sustained remission for at least 3 months from the day of screening (Participant must also have negative urine drug screen at Screening and Baseline I.)
4. Presence or history of a clinically significant neurological disorder (including epilepsy) as determined by the investigator.
5. Neurodegenerative disorder (Alzheimer disease, Parkinson disease, multiple sclerosis, Huntington disease, etc).
6. Any Axis II disorder as defined by DSM-IV-TR that might compromise the study.
The current depressive symptoms of the participant are considered by the investigator to have been resistant to 2 adequate antidepressant treatments of at least 6 weeks duration each.
Has a history of lack of response to previous adequate treatment with vortioxetine for any MDD episode with adequate treatment considered to be known dose of vortioxetine in the approved recommended dose range for at least 6 weeks duration.
Has received electroconvulsive therapy, vagal nerve stimulation, or repetitive transcranial magnetic stimulation within 6 months prior to Screening.
Has started receiving formal cognitive or behavioral therapy, systematic psychotherapy within 30 days from screening or plans to initiate such therapy during the study (supportive therapy, marital therapy and bereavement counseling are allowed).
Has a significant risk of suicide according to the investigator's clinical judgment or has a score ≥5 on item 10 (suicidal thoughts) of the MADRS or has made a suicide attempt in the previous 6 months.
Is required to take excluded medications or it is anticipated that the participant will require treatment with at least 1 of the disallowed concomitant medications during the study.
Has a clinically significant unstable illness, for example hepatic impairment or renal insufficiency, or a cardiovascular, pulmonary, gastrointestinal, endocrine, neurological, rheumatologic, immunologic, hematological, infectious, dermatological disorder or metabolic disturbance.

Note: For the purposes of this protocol fibromyalgia, obstructive sleep apnea, chronic pain diagnosis, and morbid obesity (BMI of > 40) are considered unstable due to the potential impact on assessment of the primary endpoint.
Has a known history of or currently has increased intraocular pressure or is at risk of acute narrow-angle glaucoma.
Has 1 or more laboratory value outside the normal range, based on the blood or urine samples taken at the Screening Visit, that are considered by the investigator to be clinically significant; or the participant has any of the following values at the Screening Visit:
1. A serum creatinine value >1.5 times the upper limits of normal (ULN).
2. A serum total bilirubin value >1.5 xULN.
3. A serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value >2 xULN.
Has glycosylated hemoglobin (HbA1C) ≥7% at screening and no prior diagnosis of diabetes and/or treatment for diabetes. NOTE: Participants with known stable diabetes are not excluded.
Has a thyroid stimulating hormone (TSH) value outside the normal range at the Screening Visit that is deemed clinically significant by the investigator. NOTE: Free T4 will be checked if TSH is out of range. If free T4 is abnormal the participant will be excluded.
Has clinically significant abnormal vital signs as determined by the investigator.
Has an abnormal electrocardiogram (ECG) as determined by the central reader and confirmed as clinically significant by the investigator.
Is positive for Hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV) antibodies, or has a history of human immunodeficiency virus (HIV) infection.
Has a disease or takes medication that, in the opinion of the investigator, could interfere with the assessments of safety, tolerability or efficacy.
The participant, in the opinion of the investigator, is unlikely to comply with the clinical study protocol or is unsuitable for any reason.
Has a history of hypersensitivity or allergies to vortioxetine.
If female, the participant is pregnant or lactating or intending to become pregnant before, during, or within 1 month after participating in this study; or intending to donate ova during such time period.
The participant is considered to be treatment resistant, eg, the participant has not responded to adequate monotherapy treatments of at least 6 weeks' duration, or has only responded to combination or augmentation therapy.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Open-label: Vortioxetine 10 mg	Vortioxetine	Vortioxetine 10 mg, capsules, orally, once, daily (QD) up to 8 weeks. Participants who achieved response (defined as a ≥50% reduction in Montgomery Asberg Depression Rating Scale (MADRS) total score from Baseline) continued to receive vortioxetine 10 mg, capsules, orally, QD for up to Week 16 (stabilization period) in the Open-label Period.
Double-blind: Placebo	Placebo	Following Open-label Period, participants who achieved remission criteria (defined as MADRS total score ≤12 at Weeks 14 and 16) were randomized to receive vortioxetine placebo-matching capsules, orally, QD from Week 17 up to Week 44 in the Double-blind Period.
Double-blind: Vortioxetine 10 mg	Vortioxetine	Following Open-label Period, participants who achieved remission criteria (defined as MADRS total score ≤12 at Weeks 14 and 16) were randomized to receive vortioxetine 10 mg, capsules, orally, QD from Week 17 up to Week 44 in the Double-blind Period.
Double-blind: Vortioxetine 5 mg	Vortioxetine	Following Open-label Period, participants who achieved remission criteria (defined as MADRS total score ≤12 at Weeks 14 and 16) were randomized to receive vortioxetine 5 mg, capsules, orally, QD from Week 17 up to Week 44 in the Double-blind Period.
Double-blind: Vortioxetine 20 mg	Vortioxetine	Following Open-label Period, participants who achieved remission criteria (defined as MADRS total score ≤12 at Weeks 14 and 16) were randomized to receive vortioxetine 20 mg, capsules, orally, QD from Week 17 up to Week 44 in the Double-blind Period.

Primary Outcome Measures

Name	Time	Method
Time From Randomization to Relapse of Major Depressive Disorder During the First 28 Weeks of the 32-Week Double-Blind Treatment Period	From date of double-blind randomization (Week 16) up to relapse or first 28 weeks of Double-blind Period which occurs first (Up to Week 44)	Relapse was defined as either 1) MADRS Score ≥22, 2) lack of efficacy as determined by the investigator or 3) other unsatisfactory treatment response judged by the investigator. Time to relapse was defined as date of relapse - date of randomization + 1 (where date of relapse is the date of last dose, or date of last contact if date of last dose is missing, for participant with a relapse). Participants without relapse were censored at date of withdrawal or date of Week 28 visit, whichever was earliest. MADRS is a 10-item clinician rated scale to measure overall severity of depressive symptoms (i.e., apparent sadness, reported sadness, inner tension, etc.) rated on a 7-point Likert scale from 0 (normal) to 6 (most abnormal) with a total score ranges from 0 to 60. Higher scores indicate greater severity of symptoms. The inter-quartile range (IQR) was 25th percentile to 75th percentile.

Secondary Outcome Measures

Name	Time	Method
Change From Baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) Total Score	Double-blind Baseline (BL) II and Double-blind Period: Weeks 2, 4, 8, 12, 16, 20, 24, 28, and 32	MADRS is a 10-item clinician rated scale to measure overall severity of depressive symptoms (i.e., apparent sadness, reported sadness, inner tension, etc.) rated on a 7-point Likert scale from 0 (normal) to 6 (most abnormal) with a total score range from 0 to 60. Higher score indicates greater severity of symptoms. Baseline II is defined as the last non-missing observation prior to the first dose of double-blind study drug. Mixed model for repeated measures (MMRM) was used for analyses.
Change From Baseline in Clinical Global Impression Scale-Severity (CGI-S) Score at Each Week Assessed	Double-blind Baseline (BL) II and Double-blind Period: Weeks 2, 4, 8, 12, 16, 20, 24, 28, and 32	The CGI-S is a 7-point scale that requires the clinician to rate the severity of the participant's illness at the time of assessment, relative to the clinician's past experience with participant who have the same diagnosis. Considering total clinical experience, a participant was assessed on severity of mental illness on the following scale: 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. Baseline II is defined as the last non-missing observation prior to the first dose of double-blind study drug. MMRM was used for analyses.
Clinical Global Impression Scale-Global Improvement Scale (CGI-I) Score	Week 32	The CGI-I scale assesses the participant's improvement (or worsening) as assessed by the clinician relative to Baseline 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; 7=very much worse.
Time From Randomization to Relapse of Major Depressive Disorder During the Entire 32-Week Double-Blind Treatment Period	From date of double-blind randomization (Week 16) up to relapse or 32 weeks of Double-blind Period which occurs first (Up to Week 44)	Relapse was defined as either 1) MADRS Score ≥22, 2) lack of efficacy as determined by the investigator or 3) other unsatisfactory treatment response judged by the investigator. Time to relapse was defined as date of relapse - date of randomization + 1 (where date of relapse is the date of last dose, or date of last contact if date of last dose is missing, for participant with a relapse). Participants without relapse were censored. MADRS is a 10-item clinician rated scale to measure overall severity of depressive symptoms (i.e., apparent sadness, reported sadness, inner tension, etc.) rated on a 7-point Likert scale from 0 (normal) to 6 (most abnormal) with a total score ranges from 0 to 60. Higher scores indicate greater severity of symptoms. The IQR was 25th percentile to 75th percentile.

Trial Locations

Locations (74): Atlanta Center for Medical Research
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Atlanta, Georgia, United States
Janice L. Miller, M.D., PA d/b/a Janus Center for Psychiatric Reseach
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West Palm Beach, Florida, United States
Collaborative Neuroscience Network, LLC
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Torrance, California, United States
CNRI - Los Angeles, LLC
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Pico Rivera, California, United States
Univ. of Massachussetts Memorial Health Care Systems
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Worcester, Massachusetts, United States
Pharmasite Research, Inc.
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Baltimore, Maryland, United States
Boston Clinical Trials & Medical Research
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Boston, Massachusetts, United States
CNRI - San Diego, LLC
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San Diego, California, United States
Artemis Institute for Clinical Research, LLC
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San Diego, California, United States
Altea Research Institute
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Las Vegas, Nevada, United States
Patient Priority Clinical Sites, LLC
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Cincinnati, Ohio, United States
Heartland Research Associates, LLC
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Wichita, Kansas, United States
Goldpoint Clinical Research, LLC
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Indianapolis, Indiana, United States
CNS Clinical Research Group
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Coral Springs, Florida, United States
Meridien Research
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Maitland, Florida, United States
Pacific Institute of Medical Research
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Los Angeles, California, United States
Research Center for Clinical Studies, Inc.
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Norwalk, Connecticut, United States
iResearch Atlanta, LLC
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Decatur, Georgia, United States
Hassman Research Institute
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Berlin, New Jersey, United States
Phoenix Medical Research, Inc.
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Prairie Village, Kansas, United States
Erie County Medical Center Corporation
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Buffalo, New York, United States
Radiant Research, Inc.
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Murray, Utah, United States
Capstone Clinical Research, Inc.
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Libertyville, Illinois, United States
NoesisPharma
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Phoenix, Arizona, United States
IPS Research Company
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Oklahoma City, Oklahoma, United States
Cutting Edge Research Group, Inc.
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Oklahoma City, Oklahoma, United States
Clinical Trials of Texas, Inc.
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San Antonio, Texas, United States
Summit Research Network (Oregon) Inc.
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Portland, Oregon, United States
University of California San Diego Medical Center
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San Diego, California, United States
Irvine Center for Clinical Research, Inc.
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Irvine, California, United States
CNS Research Science, Inc.
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Jamaica, New York, United States
Synergy Clinical Research of Escondido
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Lemon Grove, California, United States
Pasadena Research Institute
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San Gabriel, California, United States
Indago Research & Health Center, Inc.
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Hialeah, Florida, United States
Sarkis Clinical Trials - Parent
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Ocala, Florida, United States
Alexian Brothers Center for Psychiatric Research
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Arlington Heights, Illinois, United States
Rush St Lukes Presbyterian Medical Center
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Chicago, Illinois, United States
Potomac Grove Clinical Research Center
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Gaithersburg, Maryland, United States
Village Clinical Research, Inc.
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New York, New York, United States
Manhattan Behavioral Medicine, PLLC
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New York, New York, United States
Clinical Trials of America, Inc
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Hickory, North Carolina, United States
Duke University Medical Center
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Durham, North Carolina, United States
NorthCoast Clinical Trials, Inc.
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Beachwood, Ohio, United States
Oregon Center for Clinical Investigations, Inc.
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Portland, Oregon, United States
Keystone Clinical Studies, LLC
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Norristown, Pennsylvania, United States
University of Pennsylvania School of Medicine
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Philadelphia, Pennsylvania, United States
FutureSearch Trials of Dallas, LP
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Dallas, Texas, United States
Bayou City Research, Ltd.
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Houston, Texas, United States
Pillar Clinical Research, LLC
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Richardson, Texas, United States
Neuropsychiatric Associates
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Woodstock, Vermont, United States
Summit Research Network (Seattle), LLC
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Seattle, Washington, United States
SW Biomedical Research, LLC
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Tucson, Arizona, United States
Clinical Neuroscience Solutions, Inc.
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Memphis, Tennessee, United States
MD Clinical
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Hallandale Beach, Florida, United States
Buynak Clinical Research
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Valparaiso, Indiana, United States
Pharmacology Research Institute
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Los Alamitos, California, United States
Lincoln Research
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Lincoln, Rhode Island, United States
Gulfcoast Medical Research Center, LLC
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Fort Myers, Florida, United States
Suburban Research Associates
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Media, Pennsylvania, United States
Lake Charles Clinical Trials, LLC
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Lake Charles, Louisiana, United States
University of Virginia Health System
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Charlottesville, Virginia, United States
Neurobehavioral Research, Inc.
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Cedarhurst, New York, United States
Houston Clinical Trials, LLC
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Houston, Texas, United States
Finger Lakes Clinical Research
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Rochester, New York, United States
Coastal Carolina Research Center, Inc
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Mount Pleasant, South Carolina, United States
Eastside Therapeutic Resource
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Everett, Washington, United States
Frontier Institute
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Spokane, Washington, United States
Stedman Clinical Trials, LLC
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Tampa, Florida, United States
FutureSearch Clinical Trials, L.P.
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Austin, Texas, United States
Medical University of South Carolina (MUSC)
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Charleston, South Carolina, United States
BioBehavioral Research of Austin
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Austin, Texas, United States
Virginia Commonwealth University Medical Center
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Richmond, Virginia, United States
Montefiore Medical Center PRIME
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Bronx, New York, United States
Northbrooke Research Center
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Brown Deer, Wisconsin, United States