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BezafibrateTreatment for Bipolar Depression: A Proof of Concept Study

Primary Purpose

Bipolar Disorder, Depressive Episode

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bezafibrate
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bipolar Disorder focused on measuring Bipolar Disorder, Bezafibrate, Depressive Episode

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Men or women between the ages of 18 and 65 (inclusive)
  2. DSM IV diagnosis of Bipolar Disorder Type I or Bipolar Disorder Type II
  3. Ability to sign the Informed Consent Form
  4. Taking an adequate dose of any FDA-approved anti-manic medication for at least two weeks prior to enrollment
  5. Agrees not to change medications during the study
  6. Meets criteria for a current major depressive episode as defined and operationalized by the MINI and by a MADRS score of >18 at screen and baseline (randomization)
  7. Does not meet criteria for current hypomanic or manic episode as defined and operationalized by the MINI

Exclusion Criteria:

  1. The following DSM-IV diagnoses: (1) Bipolar NOS, (2) Cyclothymia, (3) Schizoaffective Disorder, (4) organic mental disorders, (5) substance use disorders, including alcohol, active within the 3 months, (6) schizophrenia, (7) delusional disorder, (8) psychotic disorders not elsewhere classified, (9) acute bereavement, (10) severe borderline or antisocial personality disorder, (11) OCD or OCD-spectrum disorders
  2. Primary diagnosis of anxiety disorders or patients where the anxiety disorder is the primary focus of treatment
  3. Patients with mood congruent or mood incongruent psychotic features
  4. Pregnant women or women of child bearing potential who are not using a medically accepted means of contraception (e.g. oral contraceptives, intrauterine device, barrier methods, or total abstinence from intercourse; Depo Provera is acceptable if it is started 3 months prior to enrollment). Women who are nursing
  5. Patients who are a serious suicide or homicide risk
  6. Suspected or known clinically unstable systemic medical disorder including epilepsy, untreated endocrine disease, unstable angina, recent ulcers or significant esophagitis
  7. Conditions which may be negatively affected by bezafibrate treatment, such as hepatobiliary disease
  8. Clinical or laboratory evidence of hypothyroidism (if maintained on thyroid medication must be euthyroid for at least 1 month before Visit 1)
  9. Subjects having failed two or more trials of somatic therapy (i.e., medications for bipolar depression or FDA-approved devices) during the current bipolar depressive episode
  10. Current use of a fibrate or history of anaphylactic reaction or intolerance to fibrates or any component of the preparation
  11. History of significant treatment non-adherence or situations where the subjects is unlikely to adhere to treatment, in the opinion of the investigator
  12. History of stroke or cerebrovascular disease
  13. Type 1 or Type II Diabetes requiring medication treatment treated with Pioglitazone or any other PPAR agonist medication.
  14. Current use of of MAO Inhibitors, statins, and anticoagulants (e.g. warfarin)

Sites / Locations

  • The Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Bipolar I and Bipolar II Disorder

Arm Description

30 currently depressed patients with DSM-IV bipolar I or bipolar II disorder who are currently taking an adequate dose of an FDA-approved anti-manic medication will receive Bezafibrate treatment.

Outcomes

Primary Outcome Measures

Change from Baseline to Week 8 in Montgomery-Åsberg Depression Rating Scale (MADRS)
The primary efficacy measure will be the change in MADRS score.

Secondary Outcome Measures

Change from Baseline to Week 8 in Clinical Global Impressions Bipolar Scale (CGI-BP-S) score
Secondary efficacy measure will be change in CGI-BP-S score.
Adiponectin Level at Baseline and Week 8
We will measure adiponectin as a well-established biomarker for the effect of bezafibrate on PPAR and examine changes in adiponectin as a mediator of changes in mood symptoms.

Full Information

First Posted
June 23, 2015
Last Updated
November 30, 2021
Sponsor
Massachusetts General Hospital
Collaborators
Brain & Behavior Research Foundation, J Willard and Alice S. Marriott Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT02481245
Brief Title
BezafibrateTreatment for Bipolar Depression: A Proof of Concept Study
Official Title
A Pan-PPAR Agonist Treatment for Bipolar Depression: A Proof of Concept Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2021
Overall Recruitment Status
Recruiting
Study Start Date
September 2015 (undefined)
Primary Completion Date
February 2023 (Anticipated)
Study Completion Date
June 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
Brain & Behavior Research Foundation, J Willard and Alice S. Marriott Foundation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
We propose to test the hypothesis that bezafibrate, a pan-PPAR agonist, may be effective and safe for bipolar depression with the following specific aims: Aim #1. Proof-of-Concept Safety and Tolerability Aim: To assess the safety and tolerability of bezafibrate added to anti-manic medication for bipolar depression, especially with regard to worsening manic symptoms and suicidal ideation. We will conduct a phase IIa, 8-week, open pilot trial of bezafibrate added to FDA-approved anti-manic medication in 30 participants with bipolar depression. We will monitor changes in manic symptoms (Young Mania Rating Scale), suicidal ideation, cognitive functioning specifically in attention and verbal memory, and treatment emergent adverse events (SAFTEE). We will also monitor changes in the Framingham Cardiovascular Risk Score. Aim #2. Preliminary Assessment of Efficacy: To assess the antidepressant efficacy of bezafibrate added to anti-manic medication for acute bipolar I major depressive episodes. Hypothesis: The bezafibrate group will have a statistically significant decrease in the Montgomery Asberg Rating Scale (MADRS) Scores over 8 weeks. The results of this proof-of concept phase IIa study will help us to plan a placebo-controlled randomized trial. In summary, we propose an 8-week, proof-of-concept open pilot trial of an adjunctive pan-PPAR agonist, bezafibrate, for 30 patients with an acute bipolar I major depressive episode. The study may have a profound impact on the development of a novel treatment consistent with the mitochondrial dysregulation hypothesis of bipolar disorder and, to the best of our knowledge, will be the first proof-of-concept trial to assess a pan-PPAR agonist for bipolar disorder.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bipolar Disorder, Depressive Episode
Keywords
Bipolar Disorder, Bezafibrate, Depressive Episode

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Bipolar I and Bipolar II Disorder
Arm Type
Experimental
Arm Description
30 currently depressed patients with DSM-IV bipolar I or bipolar II disorder who are currently taking an adequate dose of an FDA-approved anti-manic medication will receive Bezafibrate treatment.
Intervention Type
Drug
Intervention Name(s)
Bezafibrate
Other Intervention Name(s)
Bezalip
Intervention Description
30 patients with Bipolar I or Bipolar II disorder who are experiencing an acute bipolar depressive episode will be given bezafibrate XR 400 mg daily added on to adequate doses of an FDA-approved anti-manic medication.
Primary Outcome Measure Information:
Title
Change from Baseline to Week 8 in Montgomery-Åsberg Depression Rating Scale (MADRS)
Description
The primary efficacy measure will be the change in MADRS score.
Time Frame
Baseline and Week 8
Secondary Outcome Measure Information:
Title
Change from Baseline to Week 8 in Clinical Global Impressions Bipolar Scale (CGI-BP-S) score
Description
Secondary efficacy measure will be change in CGI-BP-S score.
Time Frame
Baseline and Week 8
Title
Adiponectin Level at Baseline and Week 8
Description
We will measure adiponectin as a well-established biomarker for the effect of bezafibrate on PPAR and examine changes in adiponectin as a mediator of changes in mood symptoms.
Time Frame
Baseline and Week 8

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men or women between the ages of 18 and 65 (inclusive) DSM IV diagnosis of Bipolar Disorder Type I or Bipolar Disorder Type II Ability to sign the Informed Consent Form Taking an adequate dose of any FDA-approved anti-manic medication for at least two weeks prior to enrollment Agrees not to change medications during the study Meets criteria for a current major depressive episode as defined and operationalized by the MINI and by a MADRS score of >18 at screen and baseline (randomization) Does not meet criteria for current hypomanic or manic episode as defined and operationalized by the MINI Exclusion Criteria: The following DSM-IV diagnoses: (1) Bipolar NOS, (2) Cyclothymia, (3) Schizoaffective Disorder, (4) organic mental disorders, (5) substance use disorders, including alcohol, active within the 3 months, (6) schizophrenia, (7) delusional disorder, (8) psychotic disorders not elsewhere classified, (9) acute bereavement, (10) severe borderline or antisocial personality disorder, (11) OCD or OCD-spectrum disorders Primary diagnosis of anxiety disorders or patients where the anxiety disorder is the primary focus of treatment Patients with mood congruent or mood incongruent psychotic features Pregnant women or women of child bearing potential who are not using a medically accepted means of contraception (e.g. oral contraceptives, intrauterine device, barrier methods, or total abstinence from intercourse; Depo Provera is acceptable if it is started 3 months prior to enrollment). Women who are nursing Patients who are a serious suicide or homicide risk Suspected or known clinically unstable systemic medical disorder including epilepsy, untreated endocrine disease, unstable angina, recent ulcers or significant esophagitis Conditions which may be negatively affected by bezafibrate treatment, such as hepatobiliary disease Clinical or laboratory evidence of hypothyroidism (if maintained on thyroid medication must be euthyroid for at least 1 month before Visit 1) Subjects having failed two or more trials of somatic therapy (i.e., medications for bipolar depression or FDA-approved devices) during the current bipolar depressive episode Current use of a fibrate or history of anaphylactic reaction or intolerance to fibrates or any component of the preparation History of significant treatment non-adherence or situations where the subjects is unlikely to adhere to treatment, in the opinion of the investigator History of stroke or cerebrovascular disease Type 1 or Type II Diabetes requiring medication treatment treated with Pioglitazone or any other PPAR agonist medication. Current use of of MAO Inhibitors, statins, and anticoagulants (e.g. warfarin)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Alec P Shannon, B.S.
Phone
6177241858
Email
apshannon@mgh.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew A. Nierenberg, M.D.
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alec P Shannon, B.S.
Phone
617-724-1858
Email
apshannon@mgh.harvard.edu
First Name & Middle Initial & Last Name & Degree
Marina Rakhilin, B.S.
Phone
6176436194
Email
mrakhilin@mgh.harvard.edu

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Identifiable, individual-level data will not be shared. Deidentified group-level data will be published/presented after study completion and analysis.

Learn more about this trial

BezafibrateTreatment for Bipolar Depression: A Proof of Concept Study

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