Clinical trial NCT02389816: A Phase 3 Study of Lu AA21004 in Patients With Major Depressive Disorder
Official title: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Phase III Study to Evaluate the Efficacy and Safety of Once Daily Oral Lu AA21004 in Patients With Major Depressive Disorder
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Major Depressive Disorder
Keywords: Drug therapy
Lead sponsor: Takeda
Sponsor class: INDUSTRY
First posted: 2015-03-17
Enrollment: 493
Sex: ALL
Minimum age (years): 20
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to evaluate the efficacy of two fixed doses of vortioxetine (Lu AA21004; 10 or 20 mg/day) after 8 weeks of treatment in patients with major depressive disorder (MDD) in Japan.

Detailed description: This is a randomized, double-blind, placebo-controlled, parallel-group, phase III study to assess the efficacy and safety of 8-week treatment of two fixed doses of Vortioxetine (Lu AA21004; 10 or 20 mg/day) in Japanese participants with major depressive disorder (MDD).

Eligibility criteria: Inclusion Criteria:

1. In the opinion of the investigator or sub-investigator, the participant is capable of understanding and complying with protocol requirements.
2. The participant signs and dates a written, informed consent form prior to the initiation of any study procedures.
3. The participant suffers from recurrent MDD as the primary diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria (classification code 296.3x).
4. The participant is a man or a woman aged 20 to 75 years (both inclusive) at the time of informed consent.
5. The reported duration of the current major depressive episode is 3 to 12 months (both inclusive) at the start of screening period.
6. The participant has a MADRS total score ≥26, Hamilton Depression Rating Scale (HAM-D17) total score ≥18, and Clinical global impression scale-Severity (CGI-S) score ≥4 at the start of screening period, at the start of placebo lead-in period and at the start of double-blind treatment period.
7. A female participant of childbearing potential who is sexually active with a nonsterilized male partner agrees to use routinely adequate contraception from signing of informed consent to the end of the follow-up period.

Exclusion Criteria:

1. The participant has any following current or past history of psychiatric disorder and/or neurological disorder:

   * Any current psychiatric disorder other than MDD as defined by DSM-IV-TR (To be assessed by Mini International Neuropsychiatric Interview: MINI). A participant who exhibits symptoms of anxiety is eligible unless the participant fulfills the diagnostic criteria for a current anxiety disorder per DSM-IV-TR.
   * Current diagnosis or history of manic, mixed or hypomanic episode, MDD with psychotic features, schizophrenia or any other psychotic disorder (including substance-related mental disorders, or mental disorders due to a general medical condition) as defined by DSM-IV-TR.
   * Current diagnosis or history of any substance-related disorder (except nicotine and caffeine-related disorders) as defined by DSM-IV-TR.
   * The participant with a positive urine drug screening result at the start of screening period or the start of placebo lead-in period. In case that a participant showed positive test result at the start of screening period because the test was conducted before washout of pretreatment drug, the participant is eligible as long as he/she shows negative result at the start of placebo lead-in period.
   * Presence or history of any clinically significant neurological disorder (including epilepsy).
   * Any neurodegenerative disorder (e.g. Alzheimer's disease, Parkinson's disease, multiple sclerosis, Huntington's disease).
   * Any DSM-IV-TR axis II disorder.
2. The participant has the current or previous major depressive episode which was considered by the investigator or sub-investigator to have been resistant to 2 or more adequate antidepressants treatments of at least 6 weeks duration each at sufficient doses.
3. The participant has received any augmentation therapy (e.g. lithium, T3/T4, lamotrigine, sodium valproate, carbamazepine, additional atypical antipsychotic, or concomitant use of other antidepressant, etc.) for the current major depressive episode.
4. In the opinion of the investigator or sub-investigator, the participant has experienced significant number of major depressive episodes in the past, and is suspected of disease other than MDD.
5. In the opinion of the investigator or sub-investigator, the participant has experienced the first major depressive episode at his/her young age, and is suspected of disease other than MDD.
6. The participant has a MADRS total score at the start of double-blind treatment period that has improved or aggravated by 25% or more from the score at the start of placebo lead-in period.
7. The participant is significantly non-compliant with the study drug in the placebo lead-in period; e.g., not taking the study drug for 6 or more consecutive days.
8. The participant has received electroconvulsive therapy, vagus nerve stimulation, or repetitive transcranial magnetic stimulation therapy within 6 months prior to the screening period, or plans to initiate such therapy during the study.
9. The participant is receiving cognitive-behavioral therapy or psychotherapy at the time of informed consent, or plans to initiate such therapy during the study.
10. The participant is at significant risk of suicide or has a score ≥5 on Item 10 (suicidal thoughts) of the MADRS at the start of screening period, at the start of placebo lead-in period or at the start of double-blind treatment period, or has attempted suicide within 6 months prior to the start of screening period.
11. The participant has experienced any environmental change (e.g. temporary retirement, returnment, change of residence) considered by the investigator or sub-investigator to have the potential to impact on the efficacy evaluation, or plans such environmental changes during the study.
12. The participant is currently receiving drug therapy for thyroid dysfunction.
13. The participant is currently receiving hormonal therapy for gynecological disease.
14. The participant has taken excluded medications during the protocol-specified period, or will require to take excluded medications during the study.
15. The participant has previously received vortioxetine.
16. The participant has received study drug in a previous clinical study of Lu AA21004 (including this study).
17. The participant has a clinically significant chronic liver disease.
18. The participant has a history of severe allergy or hypersensitivity to drugs.
19. The participant has a clinically significant unstable illness, for example, liver disorder or renal insufficiency, or a cardiovascular, pulmonary, gastrointestinal, endocrine, neurological, rheumatologic, immunologic, infectious, neoplastic, skin and subcutaneous tissue disorders, eye disorders, or metabolic disturbance.
20. The participant has clinically significant abnormal vital signs as determined by the investigator or sub-investigator at the start of screening period, placebo lead-in period, or double-blind treatment period.
21. The participant has clinically significant abnormal electrocardiogram (ECG) as determined by the investigator or sub-investigator, at the start of the screening period, at the start of placebo lead-in period, or at the start of double-blind treatment period.
22. The participant has clinically significant abnormal findings of clinical laboratory tests as determined by the investigator or sub-investigator, or has alanine aminotransferase (ALT) or aspartate aminotransferase (AST) \>2 × ULN at the start of screening period or at the start of placebo lead-in period.
23. If female, the participant is pregnant or lactating.
24. The participant has a disease or takes medications that could, in the opinion of the investigator or sub-investigator, interfere with the evaluation of the safety, tolerability, or efficacy.
25. The participant is, in the opinion of the investigator or sub-investigator, unsuitable for this study for any other reason.

Primary outcomes:
measure: Change From Baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) Total Score to Week 8
timeFrame: Baseline (At the start of double-blind treatment period), up to 8 weeks
Secondary outcomes:
measure: MADRS Response at Week 8 (Last Observation Carried Forward (LOCF))
timeFrame: Week 8
measure: MADRS Remission at Week 8 (LOCF)
timeFrame: Week 8
measure: Change From Baseline in Hamilton Depression Scale (HAM-D17) Total Score to Week 8 (LOCF)
timeFrame: Baseline (At the start of double-blind treatment period), up to 8 weeks
measure: Clinical Global Impressions-Improvement (CGI-I) Score at Week 8 (LOCF)
timeFrame: Week 8
measure: Change From Baseline in Clinical Global Impressions-Severity (CGI-S) Score to Week 8 (LOCF)
timeFrame: Baseline (At the start of double-blind treatment period), up to 8 weeks
measure: Change From Baseline in Sheehan Disability Scale (SDS) Total Score to Week 8 (LOCF)
timeFrame: Baseline (At the start of double-blind treatment period), up to 8 weeks
measure: Change From Baseline in Digit Symbol Substitution Test (DSST) Total Score to Week 8 (LOCF)
timeFrame: Baseline (At the start of double-blind treatment period), up to 8 weeks
measure: Change From Baseline in Perceived Deficits Questionnaire (PDQ-5) Total Score to Week 8 (LOCF)
timeFrame: Baseline (At the start of double-blind treatment period), up to 8 weeks
Other outcomes:
Locations:
city: Nagoya
country: Japan
state: Aichi
city: Nagareyama
country: Japan
state: Chiba
city: Noda
country: Japan
state: Chiba
city: Iizuka
country: Japan
state: Fukuoka
city: Kitakyushu
country: Japan
state: Fukuoka
city: Kurume
country: Japan
state: Fukuoka
city: Koriyama
country: Japan
state: Fukushima
city: Shirakawa
country: Japan
state: Fukushima
city: Sapporo
country: Japan
state: Hokkaido
city: Ashiya
country: Japan
state: Hyogo
city: Kanazawa
country: Japan
state: Ishikawa
city: Kawasaki
country: Japan
state: Kanagawa
city: Yokohama
country: Japan
state: Kanagawa
city: Yokosuka
country: Japan
state: Kanagawa
city: Kurashiki
country: Japan
state: Okayama
city: Kadoma
country: Japan
state: Osaka
city: Kita-ku
country: Japan
state: Osaka
city: Osakasayama
country: Japan
state: Osaka
city: Sakai
country: Japan
state: Osaka
city: Karatsu
country: Japan
state: Saga
city: Kawagoe
country: Japan
state: Saitama
city: Kusatsu
country: Japan
state: Shiga
city: Anan
country: Japan
state: Tokushima
city: Arakawa-ku
country: Japan
state: Tokyo
city: Chiyoda-ku
country: Japan
state: Tokyo
city: Hachioji
country: Japan
state: Tokyo
city: Itabashi-ku
country: Japan
state: Tokyo
city: Katsushika-ku
country: Japan
state: Tokyo
city: Koto-ku
country: Japan
state: Tokyo
city: Meguro-ku
country: Japan
state: Tokyo
city: Minato-ku
country: Japan
state: Tokyo
city: Mitaka
country: Japan
state: Tokyo
city: Musashino
country: Japan
state: Tokyo
city: Nakano-ku
country: Japan
state: Tokyo
city: Setagaya-ku
country: Japan
state: Tokyo
city: Shibuya-ku
country: Japan
state: Tokyo
city: Shinagawa-ku
country: Japan
state: Tokyo
city: Shinjuku-ku
country: Japan
state: Tokyo
city: Suginami-ku
country: Japan
state: Tokyo
city: Taito-ku
country: Japan
state: Tokyo
city: Toshima-ku
country: Japan
state: Tokyo
city: Kofu
country: Japan
state: Yamanashi
city: Fukuoka
country: Japan
city: Hiroshima
country: Japan
city: Kumamoto
country: Japan
city: Okayama
country: Japan
city: Saitama
country: Japan
Study officials:
affiliation: Takeda
name: Study Director
role: STUDY_DIRECTOR
References:
citation: Watanabe K, Fujimoto S, Marumoto T, Kitagawa T, Ishida K, Nakajima T, Moriguchi Y, Fujikawa K, Inoue T. Therapeutic Potential of Vortioxetine for Anhedonia-Like Symptoms in Depression: A Post Hoc Analysis of Data from a Clinical Trial Conducted in Japan. Neuropsychiatr Dis Treat. 2022 Feb 19;18:363-373. doi: 10.2147/NDT.S340281. eCollection 2022.
citation: Inoue T, Fujimoto S, Marumoto T, Kitagawa T, Ishida K, Nakajima T, Moriguchi Y, Fujikawa K, Watanabe K. Therapeutic Potential of Vortioxetine for Anxious Depression: A Post Hoc Analysis of Data from a Clinical Trial Conducted in Japan. Neuropsychiatr Dis Treat. 2021 Dec 21;17:3781-3790. doi: 10.2147/NDT.S335028. eCollection 2021.
citation: Inoue T, Fujimoto S, Marumoto T, Kitagawa T, Ishida K, Nakajima T, Moriguchi Y, Fujikawa K, Watanabe K. Early Improvement with Vortioxetine Predicts Response and Remission: A Post Hoc Analysis of Data from a Clinical Trial Conducted in Japan. Neuropsychiatr Dis Treat. 2021 Dec 18;17:3735-3741. doi: 10.2147/NDT.S340309. eCollection 2021.