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XEN1101 for Major Depressive Disorder

Primary Purpose

Major Depressive Disorder

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
XEN1101
Placebo
Sponsored by
James Murrough
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Major Depressive Disorder focused on measuring depression, anhedonia, major depressive disorder, investigational medication, potassium channel, KCNQ

Eligibility Criteria

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

Inclusion Criteria

  1. Written informed consent (and assent when applicable) obtained from subject
  2. Ability for subject to comply with the requirements of the study as determined by the PI;
  3. Men and women, age 18-65 years;
  4. Participants must meet DSM-5 criteria for current depressive disorder (major depressive disorder [MDD]) in a major depressive episode (MDE) as determined by a study psychiatrist and confirmed using the Structured Clinical Interview for DSM-5 Research Version (SCID-5-RV);
  5. Clinically significant anhedonia as determined by a SHAPS score ≥ 20 at screening;
  6. Current illness severity is at least moderate, defined as a score of ≥4 on the CGI-S Scale;
  7. If female of childbearing potential, must agree to use of a medically accepted form of contraception, or else agree to abstinence until 6 months after the last dose of study drug.

Exclusion Criteria

  1. A primary psychiatric diagnosis other than MDD as defined by DSM-5;
  2. Has a history of schizophrenia or other psychotic disorder, major depressive disorder with psychotic features, or bipolar I or II disorder.
  3. History of non-response to >4 adequate antidepressant trials in the current episode as determined by the Antidepressant Treatment Response Questionnaire (ATRQ);
  4. History of non-response to electroconvulsive therapy in the current depressive episode;
  5. A current diagnosis of depression with peripartum onset;
  6. Diagnosis of a major neurocognitive disorder;
  7. Meets criteria for a substance use disorder within the past 6 months, with the exception of nicotine use disorder;
  8. Patient shows signs of retinal macular disease, or retinal pigment epithelium abnormality prior to randomization.
  9. Male patients, if heterosexually active with partner who is female of childbearing potential, pregnant, or breastfeeding, who are unwilling to agree to barrier contraception for the treatment period and for at least 6 months after the last dose of study drug. Female partners of male participants who are unwilling to use at least one form of highly effective contraception starting at least one cycle prior to male patient study drug initiation until 6 months after the last dose of study drug.
  10. Female participants who are pregnant, breastfeeding, or may become pregnant, or unwilling to practice birth control during participation in the study or the 6 months following;
  11. Inability to swallow capsules;
  12. Any contraindication to MRI including claustrophobia, any trauma or surgery which may have left magnetic material in the body, magnetic implants or pacemakers, and inability to lie still for 1 hour or more;
  13. Positive urine toxicology screen for drugs of abuse at the time of screening*;
  14. Use of any dis-allowed medication according to the study protocol**;
  15. Serious and imminent risk of self-harm or violence as determined by the PI;
  16. Extreme illness severity as defined by a CGI-S score >=6;
  17. Any current active suicidal ideation as measured by a Columbia Suicide Severity Rating Scale [C-SSRS] score of greater than 2 during the past month at the time of screening
  18. History of suicide attempt in past 2 years;
  19. Any unstable medical condition, including as follows; 19.1. History of skin or retinal pigment epithelium abnormalities caused by ezogabine; 19.2. Family history of sudden death of unknown cause; 19.3. Clinically significant abnormalities of laboratory tests, physical examination, or ECG; 19.4. History or presence of long QT syndrome; 19.5. QT corrected by Fridericia's formula (QTcF) > 450 msec; 19.6. Alanine transferase (ALT; SGPT) or aspartate transferase (AST; SGOT) levels >3 times the upper limit of normal (ULN) at screening;
  20. Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data.

Sites / Locations

  • Icahn School of Medicine at Mount SinaiRecruiting
  • Baylor College of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

XEN1101

Placebo

Arm Description

Subjects will take two 10 mg capsules of XEN1101 daily for 8 weeks for a total daily dose of 20 mg.

Subjects will take a matching placebo daily for eight weeks.

Outcomes

Primary Outcome Measures

Change in activation within the reward circuit by fMRI
The change in activation within the bilateral ventral striatum (VS) from baseline (week 0) to end of treatment (week 8) as measured by fMRI during an Incentive Flanker Task.

Secondary Outcome Measures

Change in Montgomery-Åsberg Depression Rating Scale Score
The Montgomery-Åsberg Depression Rating Scale (MADARS) is a 10-item instrument used for the evaluation of depressive symptoms in adults and for the assessment of any changes to those symptoms. Each of the 10 items is rated on a scale of 0 to 6, with differing descriptors for each item. These individual item scores are added together to form a total score, which can range between 0 and 60 points, higher score indicating poorer health outcomes. The MADRS provides a measure of the overall level of depression.
Change in Quick Inventory of Depressive Symptomatology, Self-Report [QIDS-SR] Score
The Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR) is a 16-item self-rated instrument designed to assess the severity of depressive symptoms. The 16 items cover the nine symptom domains of major depression and are rated on a scale of 0-3. Total score ranges from 0 to 27, with ranges of 0-5 (normal), 6-10 (mild), 11-15 (moderate), 16-20 (moderate to severe), and 21+ (severe).
Change in Snaith-Hamilton Pleasure Scale (SHAPS)
The Snaith-Hamilton Pleasure Scale (SHAPS) is a well-validated 14-item self-report questionnaire commonly used to assess anhedonia. Each item on the SHAPS is worded so that higher scores indicate greater pleasure capacity. A total score can be derived by summing the responses to each item. Items answered with "strongly agree" are coded as "1", while a "strongly disagree" response was assigned a score of "4." Total scores on the SHAPS can range from 14 to 56, with higher scores corresponding to higher levels of anhedonia.
Change in Temporal Experience of Pleasure Scale
The Temporal Experience of Pleasure Scale (TEPS) is an 18-item self-report measurement of anhedonia which consists of a series of statements that must be rated according to how accurate they are for the individual. The scale produces a sub-score that differentiates the role of anticipatory pleasure ('wanting') and is derived of 10 items. Total scores range is 16-108. Lower scores indicate greater levels of anhedonia.
Change in Clinical Global Impression Scale
This is a widely administered clinician rated scale that assesses the subject overall illness severity and the degree of improvement from the initial assessment. Illness severity is rated on a 1-7 scale where 1 corresponds to "Normal, Not at All Ill", 2 is "Borderline Mentally Ill", the anchor for 3 is "Mildly Ill", the anchor for 4 is "Moderately Ill", 5 is "Markedly Ill", 6 is "Severely Ill", and 7 is "Among the Most Extremely Ill Patients". The degree of improvement is rated on a 1-7 scale where 1 corresponds to "Very Much Improved", 2 is "Much Improved", the anchor for 3 is "Minimally Improved", the anchor for 4 is "No Change", 5 is "Minimally Worse", 6 is "Much Worse", and 7 is "Very Much Worse".

Full Information

First Posted
March 30, 2021
Last Updated
September 14, 2023
Sponsor
James Murrough
Collaborators
Baylor College of Medicine, National Institute of Mental Health (NIMH)
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1. Study Identification

Unique Protocol Identification Number
NCT04827901
Brief Title
XEN1101 for Major Depressive Disorder
Official Title
A Proof of Concept Randomized Controlled Trial of XEN1101 for the Treatment of Major Depressive Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 19, 2021 (Actual)
Primary Completion Date
January 2024 (Anticipated)
Study Completion Date
January 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
James Murrough
Collaborators
Baylor College of Medicine, National Institute of Mental Health (NIMH)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This project is designed to examine the neuronal KCNQ2/3 potassium (K+) channel subtype as a novel treatment target for mood disorders through the administration of the KCNQ-selective channel opener XEN1101 (Xenon Pharmaceuticals).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Major Depressive Disorder
Keywords
depression, anhedonia, major depressive disorder, investigational medication, potassium channel, KCNQ

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
This is a phase II, randomized, parallel-arm, placebo-controlled clinical trial were 60 patients with major depressive disorder will be randomized in 1:1 fashion to XEN1101 (N=30) or matching placebo (N=30).
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
XEN1101
Arm Type
Active Comparator
Arm Description
Subjects will take two 10 mg capsules of XEN1101 daily for 8 weeks for a total daily dose of 20 mg.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subjects will take a matching placebo daily for eight weeks.
Intervention Type
Drug
Intervention Name(s)
XEN1101
Intervention Description
two 10 mg capsules
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
matching placebo
Primary Outcome Measure Information:
Title
Change in activation within the reward circuit by fMRI
Description
The change in activation within the bilateral ventral striatum (VS) from baseline (week 0) to end of treatment (week 8) as measured by fMRI during an Incentive Flanker Task.
Time Frame
Baseline (week 0), End of treatment (week 8)
Secondary Outcome Measure Information:
Title
Change in Montgomery-Åsberg Depression Rating Scale Score
Description
The Montgomery-Åsberg Depression Rating Scale (MADARS) is a 10-item instrument used for the evaluation of depressive symptoms in adults and for the assessment of any changes to those symptoms. Each of the 10 items is rated on a scale of 0 to 6, with differing descriptors for each item. These individual item scores are added together to form a total score, which can range between 0 and 60 points, higher score indicating poorer health outcomes. The MADRS provides a measure of the overall level of depression.
Time Frame
Baseline (week 0), End of treatment (week 8)
Title
Change in Quick Inventory of Depressive Symptomatology, Self-Report [QIDS-SR] Score
Description
The Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR) is a 16-item self-rated instrument designed to assess the severity of depressive symptoms. The 16 items cover the nine symptom domains of major depression and are rated on a scale of 0-3. Total score ranges from 0 to 27, with ranges of 0-5 (normal), 6-10 (mild), 11-15 (moderate), 16-20 (moderate to severe), and 21+ (severe).
Time Frame
Baseline (week 0), End of treatment (week 8)
Title
Change in Snaith-Hamilton Pleasure Scale (SHAPS)
Description
The Snaith-Hamilton Pleasure Scale (SHAPS) is a well-validated 14-item self-report questionnaire commonly used to assess anhedonia. Each item on the SHAPS is worded so that higher scores indicate greater pleasure capacity. A total score can be derived by summing the responses to each item. Items answered with "strongly agree" are coded as "1", while a "strongly disagree" response was assigned a score of "4." Total scores on the SHAPS can range from 14 to 56, with higher scores corresponding to higher levels of anhedonia.
Time Frame
Baseline (week 0), End of treatment (week 8)
Title
Change in Temporal Experience of Pleasure Scale
Description
The Temporal Experience of Pleasure Scale (TEPS) is an 18-item self-report measurement of anhedonia which consists of a series of statements that must be rated according to how accurate they are for the individual. The scale produces a sub-score that differentiates the role of anticipatory pleasure ('wanting') and is derived of 10 items. Total scores range is 16-108. Lower scores indicate greater levels of anhedonia.
Time Frame
Baseline (week 0), End of treatment (week 8)
Title
Change in Clinical Global Impression Scale
Description
This is a widely administered clinician rated scale that assesses the subject overall illness severity and the degree of improvement from the initial assessment. Illness severity is rated on a 1-7 scale where 1 corresponds to "Normal, Not at All Ill", 2 is "Borderline Mentally Ill", the anchor for 3 is "Mildly Ill", the anchor for 4 is "Moderately Ill", 5 is "Markedly Ill", 6 is "Severely Ill", and 7 is "Among the Most Extremely Ill Patients". The degree of improvement is rated on a 1-7 scale where 1 corresponds to "Very Much Improved", 2 is "Much Improved", the anchor for 3 is "Minimally Improved", the anchor for 4 is "No Change", 5 is "Minimally Worse", 6 is "Much Worse", and 7 is "Very Much Worse".
Time Frame
Baseline (week 0), End of treatment (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 Written informed consent (and assent when applicable) obtained from subject Ability for subject to comply with the requirements of the study as determined by the PI; Men and women, age 18-65 years; Participants must meet DSM-5 criteria for current depressive disorder (major depressive disorder [MDD]) in a major depressive episode (MDE) as determined by a study psychiatrist and confirmed using the Structured Clinical Interview for DSM-5 Research Version (SCID-5-RV); Clinically significant anhedonia as determined by a SHAPS score ≥ 20 at screening; Current illness severity is at least moderate, defined as a score of ≥4 on the CGI-S Scale; If female of childbearing potential, must agree to use of a medically accepted form of contraception, or else agree to abstinence until 6 months after the last dose of study drug. Exclusion Criteria A primary psychiatric diagnosis other than MDD as defined by DSM-5; Has a history of schizophrenia or other psychotic disorder, major depressive disorder with psychotic features, or bipolar I or II disorder. History of non-response to >4 adequate antidepressant trials in the current episode as determined by the Antidepressant Treatment Response Questionnaire (ATRQ); History of non-response to electroconvulsive therapy in the current depressive episode; A current diagnosis of depression with peripartum onset; Diagnosis of a major neurocognitive disorder; Meets criteria for a substance use disorder within the past 6 months, with the exception of nicotine use disorder; Patient shows signs of retinal macular disease, or retinal pigment epithelium abnormality prior to randomization. Male patients, if heterosexually active with partner who is female of childbearing potential, pregnant, or breastfeeding, who are unwilling to agree to barrier contraception for the treatment period and for at least 6 months after the last dose of study drug. Female partners of male participants who are unwilling to use at least one form of highly effective contraception starting at least one cycle prior to male patient study drug initiation until 6 months after the last dose of study drug. Female participants who are pregnant, breastfeeding, or may become pregnant, or unwilling to practice birth control during participation in the study or the 6 months following; Inability to swallow capsules; Any contraindication to MRI including claustrophobia, any trauma or surgery which may have left magnetic material in the body, magnetic implants or pacemakers, and inability to lie still for 1 hour or more; Positive urine toxicology screen for drugs of abuse at the time of screening*; Use of any dis-allowed medication according to the study protocol**; Serious and imminent risk of self-harm or violence as determined by the PI; Extreme illness severity as defined by a CGI-S score >=6; Any current active suicidal ideation as measured by a Columbia Suicide Severity Rating Scale [C-SSRS] score of greater than 2 during the past month at the time of screening History of suicide attempt in past 2 years; Any unstable medical condition, including as follows; 19.1. History of skin or retinal pigment epithelium abnormalities caused by ezogabine; 19.2. Family history of sudden death of unknown cause; 19.3. Clinically significant abnormalities of laboratory tests, physical examination, or ECG; 19.4. History or presence of long QT syndrome; 19.5. QT corrected by Fridericia's formula (QTcF) > 450 msec; 19.6. Alanine transferase (ALT; SGPT) or aspartate transferase (AST; SGOT) levels >3 times the upper limit of normal (ULN) at screening; Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sara Hameed, B.A.
Phone
212-585-4622
Email
sara.hameed@mssm.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Amelia Karim
Phone
212-585-4621
Email
amelia.karim@mssm.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James W Murrough, MD, PhD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sara Hameed, B.A.
Phone
212-585-4622
Email
sara.hameed@mssm.edu
First Name & Middle Initial & Last Name & Degree
Amelia Karim
Phone
212-585-4621
Email
amelia.karim@mssm.edu
First Name & Middle Initial & Last Name & Degree
James W Murrough, MD, PhD
Facility Name
Baylor College of Medicine
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andreas Weyland
Phone
713-689-9856
Email
andreas.weyland@bcm.edu
First Name & Middle Initial & Last Name & Degree
Sanjay Mathew, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
All of the individual participant data collected during the trial, after deidentification.
IPD Sharing Time Frame
Immediately following publication. No end date.
IPD Sharing Access Criteria
Investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose. Any purpose. Other NDCT Database
IPD Sharing URL
https://nda.nih.gov

Learn more about this trial

XEN1101 for Major Depressive Disorder

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