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Study to Evaluate the Efficacy, Safety and Tolerability of an Oral Aripiprazole/Escitalopram Combination Therapy in Participants With Major Depressive Disorder (MDD)

Primary Purpose

Major Depressive Disorder (MDD)

Status
Terminated
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Escitalopram
Aripiprazole
Blinded capsule
Sponsored by
Otsuka Pharmaceutical Development & Commercialization, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Major Depressive Disorder (MDD) focused on measuring Major Depressive Disorder, MDD, Depression

Eligibility Criteria

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

Inclusion Criteria:

  • Participants with a current diagnosis of a major depressive episode. The current depressive episode must be ≥8 weeks in duration
  • Participants willing to discontinue all prohibited psychotropic medication starting from the time of signing the informed consent and during the study period
  • Participants with a Hamilton Depression Rating Scale (HAM-D17) Total Score ≥18 at the Baseline Visit for the Prospective Treatment Phase

Exclusion Criteria:

  • Lack of prior treatment with an antidepressant during the current depressive episode
  • Participants who report treatment with adjunctive or monotherapy antipsychotic treatment during the current depressive episode
  • Participants experiencing hallucinations, delusions or any psychotic symptomatology in the current depressive episode
  • Participants with epilepsy or significant history of seizure disorders
  • Participants with a clinically significant current diagnosis of borderline, antisocial, paranoid, schizoid, schizotypal or histrionic personality disorder
  • Participants who have received electroconvulsive therapy (ECT) in the last 10 years

Sites / Locations

  • Study Site 1
  • Study Site 2

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Phase B: Single-blind Prospective Treatment Phase

Phase B+: Single-blind Phase B Responders

Phase C: Aripiprazole/Escitalopram Combination

Phase C: Escitalopram Monotherapy

Phase C: Aripiprazole Monotherapy

Arm Description

Participants received initial dose of escitalopram 10 milligram (mg) blinded capsule (over-encapsulated tablet), orally, once daily, increased to 20 mg/day at the end of Week 1 based upon tolerability profile, for up to maximum of Week 8. No dose reductions were allowed after Week 4 and no dose increments were allowed after Week 3. Participants with incomplete response at the end of the Phase B (Week 8) entered Phase C and the rest of the participants continued to Phase B+.

Participants with response (≥50% reduction in depressive symptom severity in Hamilton Depression Rating Scale {HAM-D17} Total Score; or a HAM-D17 Total Score of <14 at Week 8 or a Clinical Global Impression of Improvement {CGI-I} Score of <3 at the Week 6 or 8) at the end of the Phase B (Week 8) continued treatment with the single-blind escitalopram monotherapy at the dose (10 or 20 mg/day blinded capsules) taken during the final week of Phase B, for up to maximum of Week 14, in Phase B+.

Participants with incomplete response (less than 50% reduction in depressive symptom severity between Baseline and Week 8 measured by the HAM-D17 Total Score and HAM-D17 Total Score of ≥14 at Week 8 and CGI-I Score of ≥3 at Week 6 and 8) at Week 8 received initial dose of aripiprazole 6 mg blinded capsule, orally, once daily at Week 9. Participants were up titrated to aripiprazole target dose of 12 mg/day at Week 10 (if initial 6 mg/day dose was tolerated) or down titrated to 3 mg/day (if significant tolerability issues arise on initial 6 mg/day dose), and thereafter received same dose up to maximum of Week 14. No dose increases were allowed for aripiprazole after end of Week 12, however, doses might be decreased at any visit based upon tolerability. In combination with aripiprazole, participants received escitalopram (10 or 20 mg/day blinded capsules) taken during final week of Phase B for up to maximum Week 14, in Phase C. No dose adjustments allowed for escitalopram during Phase C.

Participants with incomplete response (less than a 50% reduction in depressive symptom severity between the Baseline and Week 8 as measured by the HAM-D17 Total Score and a HAM-D17 Total Score of ≥14 at Week 8 and a CGI-I Score of ≥3 at Week 6 and 8) at Week 8, received escitalopram dose (10 or 20 mg/day blinded capsules) taken during the final week of Phase B for up to maximum Week 14, in Phase C. No dose adjustments were allowed for escitalopram monotherapy during Phase C.

Participants with incomplete response (less than a 50% reduction in depressive symptom severity between the Baseline and Week 8 as measured by the HAM-D17 Total Score and a HAM-D17 Total Score of ≥14 at Week 8 and a CGI-I Score of ≥3 at Week 6 and 8) at Week 8, received initial dose of aripiprazole 6 mg blinded capsule, orally, once daily for Week 9. Participants were up titrated to the aripiprazole target dose of 12 mg/day at Week 10 (if the initial 6 mg/day dose was tolerated) or down titrated to 3 mg/day (if significant tolerability issues arise on the initial 6 mg/day dose), and thereafter received the same dose for up to maximum of Week 14. No dose increases were allowed for aripiprazole after the end of Week 12, however, doses might be decreased at any visit based upon tolerability.

Outcomes

Primary Outcome Measures

Phase C: Mean Change From End of Phase B (Week 8) in the Montgomery-Asberg Depression Rating Scale (MADRS) Total Score to End of Phase C (Week 14)
The MADRS assessed severity of depressive symptoms. It ranges from a minimum of 0 to a maximum of 60 (higher scores indicating a greater severity of depressive symptoms). Participants are rated on 10 items (feelings of sadness, lassitude, pessimism, inner tension, suicidality, reduced sleep or appetite, difficulty concentrating, and a lack of interest) each on a 7-point scale from 0 (no symptoms) to 6 (symptoms of maximum severity). A negative change from Week 8 indicates improvement.

Secondary Outcome Measures

Phase C: Mean Clinical Global Impression - Improvement (CGI-I) Scale Score at the End of Phase C (Week 14)
CGI-I is a 7-point clinician-rated scale ranging from 1 to 7, rated as 1, very much improved; 2, much improved; 3, minimally improved; 4, no change; 5, minimally worse; 6, much worse; or 7, very much worse. A higher score indicates greater impairment.
Phase C: Mean Change From End of Phase B (Week 8) in the Sheehan Disability Scale (SDS) Mean Score to End of Phase C (Week 14)
SDS is a 3-item clinician-rated questionnaire used to evaluate impairments in the domains of work, social life/leisure, and family life/home responsibility. The participant is asked to rate the degree to which their functioning is impaired on an 11-point scale, ranging from 0 (not at all) to 10 (extremely). The scores for the 3 domains are summed into a total score that ranges from 0 (unimpaired) to 30 (highly impaired). A higher score indicates greater impairment. A negative change from Week 8 indicates improvement.

Full Information

First Posted
April 22, 2010
Last Updated
September 28, 2021
Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT01111539
Brief Title
Study to Evaluate the Efficacy, Safety and Tolerability of an Oral Aripiprazole/Escitalopram Combination Therapy in Participants With Major Depressive Disorder (MDD)
Official Title
A Multicenter, Randomized, Double-blind Study to Evaluate the Efficacy, Safety and Tolerability of an Oral Aripiprazole/Escitalopram Combination Therapy in Patients With Major Depressive Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Terminated
Why Stopped
The study was terminated early due to Sponsor decision, closure of this combination therapy program is unrelated to any safety issues, no signals of concern.
Study Start Date
July 13, 2010 (Actual)
Primary Completion Date
September 20, 2011 (Actual)
Study Completion Date
September 20, 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Otsuka Pharmaceutical Development & Commercialization, Inc.

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 will be a multicenter, randomized, double-blind study designed to assess the efficacy, safety and tolerability of an oral Aripiprazole/Escitalopram combination therapy in participants with MDD who have demonstrated an incomplete response to a prospective trial of Escitalopram, and report a treatment history for the current MDD episode of an inadequate response to at least one and no more than three adequate trials of an approved antidepressant other than Escitalopram. An inadequate response is defined as less than a 50% reduction in depressive symptom severity as assessed by the participant's self-report on the Massachusetts General Hospital Antidepressant Treatment Response Questionnaire (ATRQ) and evaluated by the investigator as part of the participant's medical and psychiatric history. An adequate trial is defined as an antidepressant treatment for at least 6 weeks duration (or at least 3 weeks for combination treatments) at an approved dose as specified in the ATRQ.
Detailed Description
The study will be organized as follows: Screening Phase Single-blind Prospective Treatment Phase Single-blind Continuation Phase (Responder) or Double-blind Randomization Phase (non-Responder) 30 day Post Treatment Follow-up Assigned Interventions: Escitalopram monotherapy Aripiprazole/Escitalopram combination therapy Aripiprazole monotherapy

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Major Depressive Disorder (MDD)
Keywords
Major Depressive Disorder, MDD, Depression

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
211 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Phase B: Single-blind Prospective Treatment Phase
Arm Type
Experimental
Arm Description
Participants received initial dose of escitalopram 10 milligram (mg) blinded capsule (over-encapsulated tablet), orally, once daily, increased to 20 mg/day at the end of Week 1 based upon tolerability profile, for up to maximum of Week 8. No dose reductions were allowed after Week 4 and no dose increments were allowed after Week 3. Participants with incomplete response at the end of the Phase B (Week 8) entered Phase C and the rest of the participants continued to Phase B+.
Arm Title
Phase B+: Single-blind Phase B Responders
Arm Type
Experimental
Arm Description
Participants with response (≥50% reduction in depressive symptom severity in Hamilton Depression Rating Scale {HAM-D17} Total Score; or a HAM-D17 Total Score of <14 at Week 8 or a Clinical Global Impression of Improvement {CGI-I} Score of <3 at the Week 6 or 8) at the end of the Phase B (Week 8) continued treatment with the single-blind escitalopram monotherapy at the dose (10 or 20 mg/day blinded capsules) taken during the final week of Phase B, for up to maximum of Week 14, in Phase B+.
Arm Title
Phase C: Aripiprazole/Escitalopram Combination
Arm Type
Experimental
Arm Description
Participants with incomplete response (less than 50% reduction in depressive symptom severity between Baseline and Week 8 measured by the HAM-D17 Total Score and HAM-D17 Total Score of ≥14 at Week 8 and CGI-I Score of ≥3 at Week 6 and 8) at Week 8 received initial dose of aripiprazole 6 mg blinded capsule, orally, once daily at Week 9. Participants were up titrated to aripiprazole target dose of 12 mg/day at Week 10 (if initial 6 mg/day dose was tolerated) or down titrated to 3 mg/day (if significant tolerability issues arise on initial 6 mg/day dose), and thereafter received same dose up to maximum of Week 14. No dose increases were allowed for aripiprazole after end of Week 12, however, doses might be decreased at any visit based upon tolerability. In combination with aripiprazole, participants received escitalopram (10 or 20 mg/day blinded capsules) taken during final week of Phase B for up to maximum Week 14, in Phase C. No dose adjustments allowed for escitalopram during Phase C.
Arm Title
Phase C: Escitalopram Monotherapy
Arm Type
Experimental
Arm Description
Participants with incomplete response (less than a 50% reduction in depressive symptom severity between the Baseline and Week 8 as measured by the HAM-D17 Total Score and a HAM-D17 Total Score of ≥14 at Week 8 and a CGI-I Score of ≥3 at Week 6 and 8) at Week 8, received escitalopram dose (10 or 20 mg/day blinded capsules) taken during the final week of Phase B for up to maximum Week 14, in Phase C. No dose adjustments were allowed for escitalopram monotherapy during Phase C.
Arm Title
Phase C: Aripiprazole Monotherapy
Arm Type
Experimental
Arm Description
Participants with incomplete response (less than a 50% reduction in depressive symptom severity between the Baseline and Week 8 as measured by the HAM-D17 Total Score and a HAM-D17 Total Score of ≥14 at Week 8 and a CGI-I Score of ≥3 at Week 6 and 8) at Week 8, received initial dose of aripiprazole 6 mg blinded capsule, orally, once daily for Week 9. Participants were up titrated to the aripiprazole target dose of 12 mg/day at Week 10 (if the initial 6 mg/day dose was tolerated) or down titrated to 3 mg/day (if significant tolerability issues arise on the initial 6 mg/day dose), and thereafter received the same dose for up to maximum of Week 14. No dose increases were allowed for aripiprazole after the end of Week 12, however, doses might be decreased at any visit based upon tolerability.
Intervention Type
Drug
Intervention Name(s)
Escitalopram
Intervention Description
Escitalopram capsule administered orally, once daily without regard to meals.
Intervention Type
Drug
Intervention Name(s)
Aripiprazole
Intervention Description
Aripiprazole capsule administered orally, once daily without regard to meals.
Intervention Type
Drug
Intervention Name(s)
Blinded capsule
Intervention Description
Blinded capsule administered orally, once daily.
Primary Outcome Measure Information:
Title
Phase C: Mean Change From End of Phase B (Week 8) in the Montgomery-Asberg Depression Rating Scale (MADRS) Total Score to End of Phase C (Week 14)
Description
The MADRS assessed severity of depressive symptoms. It ranges from a minimum of 0 to a maximum of 60 (higher scores indicating a greater severity of depressive symptoms). Participants are rated on 10 items (feelings of sadness, lassitude, pessimism, inner tension, suicidality, reduced sleep or appetite, difficulty concentrating, and a lack of interest) each on a 7-point scale from 0 (no symptoms) to 6 (symptoms of maximum severity). A negative change from Week 8 indicates improvement.
Time Frame
Week 8 to Week 14
Secondary Outcome Measure Information:
Title
Phase C: Mean Clinical Global Impression - Improvement (CGI-I) Scale Score at the End of Phase C (Week 14)
Description
CGI-I is a 7-point clinician-rated scale ranging from 1 to 7, rated as 1, very much improved; 2, much improved; 3, minimally improved; 4, no change; 5, minimally worse; 6, much worse; or 7, very much worse. A higher score indicates greater impairment.
Time Frame
Week 14
Title
Phase C: Mean Change From End of Phase B (Week 8) in the Sheehan Disability Scale (SDS) Mean Score to End of Phase C (Week 14)
Description
SDS is a 3-item clinician-rated questionnaire used to evaluate impairments in the domains of work, social life/leisure, and family life/home responsibility. The participant is asked to rate the degree to which their functioning is impaired on an 11-point scale, ranging from 0 (not at all) to 10 (extremely). The scores for the 3 domains are summed into a total score that ranges from 0 (unimpaired) to 30 (highly impaired). A higher score indicates greater impairment. A negative change from Week 8 indicates improvement.
Time Frame
Week 8 to Week 14

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: Participants with a current diagnosis of a major depressive episode. The current depressive episode must be ≥8 weeks in duration Participants willing to discontinue all prohibited psychotropic medication starting from the time of signing the informed consent and during the study period Participants with a Hamilton Depression Rating Scale (HAM-D17) Total Score ≥18 at the Baseline Visit for the Prospective Treatment Phase Exclusion Criteria: Lack of prior treatment with an antidepressant during the current depressive episode Participants who report treatment with adjunctive or monotherapy antipsychotic treatment during the current depressive episode Participants experiencing hallucinations, delusions or any psychotic symptomatology in the current depressive episode Participants with epilepsy or significant history of seizure disorders Participants with a clinically significant current diagnosis of borderline, antisocial, paranoid, schizoid, schizotypal or histrionic personality disorder Participants who have received electroconvulsive therapy (ECT) in the last 10 years
Facility Information:
City
Cerritos
State/Province
California
ZIP/Postal Code
90703
Country
United States
City
Costa Mesa
State/Province
California
ZIP/Postal Code
92626
Country
United States
City
Irvine
State/Province
California
ZIP/Postal Code
92618
Country
United States
City
San Diego
State/Province
California
ZIP/Postal Code
92102
Country
United States
City
Santa Ana
State/Province
California
ZIP/Postal Code
92705
Country
United States
City
Denver
State/Province
Colorado
ZIP/Postal Code
80204
Country
United States
City
Cromwell
State/Province
Connecticut
ZIP/Postal Code
06416
Country
United States
City
Hartford
State/Province
Connecticut
ZIP/Postal Code
06106
Country
United States
City
Fort Walton Beach
State/Province
Florida
ZIP/Postal Code
32547
Country
United States
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32607
Country
United States
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
City
Libertyville
State/Province
Illinois
ZIP/Postal Code
60048
Country
United States
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
City
Fall River
State/Province
Massachusetts
ZIP/Postal Code
02721
Country
United States
City
Albuquerque
State/Province
New Mexico
ZIP/Postal Code
87109
Country
United States
City
Bronx
State/Province
New York
ZIP/Postal Code
10467
Country
United States
City
Fresh Meadows
State/Province
New York
ZIP/Postal Code
11366
Country
United States
City
Staten Island
State/Province
New York
ZIP/Postal Code
10305
Country
United States
City
Cary
State/Province
North Carolina
ZIP/Postal Code
27518
Country
United States
City
Oklahoma City
State/Province
Oklahoma
ZIP/Postal Code
73112
Country
United States
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38119
Country
United States
City
DeSoto
State/Province
Texas
ZIP/Postal Code
75115
Country
United States
City
Richmond
State/Province
Virginia
ZIP/Postal Code
23230
Country
United States
City
Brown Deer
State/Province
Wisconsin
ZIP/Postal Code
53223
Country
United States
City
Jamejala
ZIP/Postal Code
71024
Country
Estonia
City
Tallinn
ZIP/Postal Code
10617
Country
Estonia
City
Tartu
ZIP/Postal Code
50406
Country
Estonia
City
Tartu
ZIP/Postal Code
50407
Country
Estonia
City
Helsinki
ZIP/Postal Code
00250
Country
Finland
City
Helsinki
ZIP/Postal Code
00260
Country
Finland
City
Kuopio
ZIP/Postal Code
70100
Country
Finland
City
Oulu
ZIP/Postal Code
90100
Country
Finland
City
Berlin
ZIP/Postal Code
10117
Country
Germany
City
Berlin
ZIP/Postal Code
10969
Country
Germany
City
Hamburg
ZIP/Postal Code
20246
Country
Germany
City
Munich
ZIP/Postal Code
80336
Country
Germany
City
Ostfildern
ZIP/Postal Code
73760
Country
Germany
Facility Name
Study Site 1
City
Ahmedabad
State/Province
Gujarat
ZIP/Postal Code
380006
Country
India
Facility Name
Study Site 2
City
Ahmedabad
State/Province
Gujarat
ZIP/Postal Code
380006
Country
India
City
Mangalore
State/Province
Karnataka
ZIP/Postal Code
575001
Country
India
City
Mumbai
State/Province
Maharashtra
ZIP/Postal Code
400026
Country
India
City
Pune
State/Province
Maharashtra
ZIP/Postal Code
411030
Country
India
City
Varanasi
State/Province
Uttar Pradesh
ZIP/Postal Code
221005
Country
India
City
Catania
ZIP/Postal Code
95123
Country
Italy
City
Siena
ZIP/Postal Code
53100
Country
Italy
City
Gwangju
ZIP/Postal Code
501-75
Country
Korea, Republic of
City
Seoul
ZIP/Postal Code
138-736
Country
Korea, Republic of
City
Seoul
ZIP/Postal Code
139-872
Country
Korea, Republic of
City
Seoul
ZIP/Postal Code
150-713
Country
Korea, Republic of
City
Seoul
ZIP/Postal Code
156-755
Country
Korea, Republic of
City
Mexico
State/Province
DF
ZIP/Postal Code
06700
Country
Mexico
City
Tlalnepantla de Baz
State/Province
Estado Do Mexico
ZIP/Postal Code
54050
Country
Mexico
City
Zapopan
State/Province
Jalisco
ZIP/Postal Code
45200
Country
Mexico
City
Monterrey
State/Province
Nuevo Leon
ZIP/Postal Code
64040
Country
Mexico
City
Culiacan
State/Province
Sinaloa
ZIP/Postal Code
80020
Country
Mexico
City
Villahermosa
State/Province
Tabasco
ZIP/Postal Code
86035
Country
Mexico
City
Durango
ZIP/Postal Code
34000
Country
Mexico
City
San Luis Potosi
ZIP/Postal Code
78218
Country
Mexico
City
Changhua
ZIP/Postal Code
500
Country
Taiwan
City
Kaohsiung
ZIP/Postal Code
802
Country
Taiwan
City
Keelung
ZIP/Postal Code
204
Country
Taiwan
City
Taoyuan
ZIP/Postal Code
333
Country
Taiwan

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Anonymized Individual participant data (IPD) that underlie the results of this study will be shared with researchers to achieve aims pre-specified in a methodologically sound research proposal. Small studies with less than 25 participants are excluded from data sharing.
IPD Sharing Time Frame
Data will be available after marketing approval in global markets, or beginning 1-3 years following article publication. There is no end date to the availability of the data.
IPD Sharing Access Criteria
Otsuka will share data on the Vivli data sharing platform which can be found here: https://vivli.org/ourmember/Otsuka/
IPD Sharing URL
https://clinical-trials.otsuka.com

Learn more about this trial

Study to Evaluate the Efficacy, Safety and Tolerability of an Oral Aripiprazole/Escitalopram Combination Therapy in Participants With Major Depressive Disorder (MDD)

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