SUSTAIN-3: A Long-term Safety Study of Esketamine Nasal Spray in Treatment-resistant Depression

Sponsor
Janssen Research & Development, LLC (Industry)
Overall Status
Active, not recruiting
CT.gov ID
NCT02782104
Collaborator
(none)
1,148
177
1
78.7
6.5
0.1

Study Details

Study Description

Brief Summary

The purpose of this study is to assess the safety and tolerability of esketamine nasal spray in participants with treatment-resistant depression (TRD).

Condition or Disease Intervention/Treatment Phase
  • Drug: Esketamine Nasal Spray
Phase 3

Detailed Description

This is an open-label (the researchers and participants know the treatment the participant is receiving) long-term extension study. The study will consist of 2 open-label Phases: 4-week Induction phase (if applicable) and Open-Label Optimization/Maintenance phase (variable). Participants will enter the study Induction Phase from ESKETINTRD3001 (NCT02417064), ESKETINTRD3002 (NCT02418585), ESKETINTRD3003 (NCT02493868), ESKETINTRD3005 (NCT02422186) and ESKETINTRD3006 (US sites only). Participants will enter the study Open-Label Optimization/Maintenance phase from ESKETINTRD3001 (NCT02417064), ESKETINTRD3002 (NCT02418585), ESKETINTRD3003 (NCT02493868) (if appropriate at week 16) or ESKETINTRD3006 (US sites only). In the Open-Label Induction Phase, participants will self-administer flexibly-dosed esketamine nasal spray. During first 4 weeks in Optimization/Maintenance Phase responder participants from the induction phase of study 54135419TRD3008, will continue on the same dose of esketamine nasal spray from the induction phase and have a weekly intranasal treatment session frequency. Participants entering the optimization/maintenance phase from study ESKETINTRD3005 will also have a weekly intranasal treatment session frequency. However, as the ESKETINTRD3005 intranasal study medication is blinded at the time of entry into the current study, the dose of esketamine nasal spray will be administered as outlined in protocol. Participants entering the optimization/maintenance phase from study ESKETINTRD3003 (Direct Entry) or ESKETINTRD3004 who were ongoing in the Optimization, Maintenance, or Optimization/Maintenance phase, respectively, will have the option to have their current intranasal dosing frequency adjusted at the time of entry into 54135419TRD3008 study and should remain on the selected frequency from week 1 to week 4. A one-time dose change will be permitted at study entry. After 4 weeks, esketamine nasal spray treatment sessions will be individualized to either once weekly or once every other week at the fixed 2-week interval (based on clinical global impression - severity [CGI-S] performed at that visit), and every 4 weeks for participants dosed at the 4 week interval. Participants safety will be monitored throughout the study.

Study Design

Study Type:
Interventional
Actual Enrollment :
1148 participants
Allocation:
N/A
Intervention Model:
Single Group Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
An Open-label Long-term Extension Safety Study of Esketamine Nasal Spray in Treatment-resistant Depression
Actual Study Start Date :
Jun 9, 2016
Anticipated Primary Completion Date :
Dec 31, 2022
Anticipated Study Completion Date :
Dec 31, 2022

Arms and Interventions

Arm Intervention/Treatment
Experimental: Esketamine Nasal Spray

Open-Label Induction Phase: Participants will self-administer with esketamine nasal spray twice per week for 4 weeks as a flexible dose regimen (56 milligram [mg] or 84 mg for those < 65 years; 28 mg, 56 mg or 84 mg for those >= 65 years). Participants >= 65 years old will start at a dose of 28 mg on Day 1. Optimization/Maintenance Phase: Participants entering from studies ESKETINTRD3001 (NCT02417064), ESKETINTRD3002 (NCT02418585), ESKETINTRD3003 (NCT02493868), ESKETINTRD3004 (NCT02497287), or ESKETINTRD3006 (US sites only) will self-administer esketamine nasal spray (same dose) once weekly. Participants entering from study ESKETINTRD3005 (NCT02422186) will self-administer esketamine nasal spray (28 mg in week 1; 28 or 56 mg in week 2; and 28, 56 or 84 mg in week 3 and 4) once weekly. After Week 4 (starting at Week 5), based on the Investigator's clinical judgment, the dose of esketamine for all participants can be adjusted based upon efficacy and tolerability.

Drug: Esketamine Nasal Spray
Open-Label Induction Phase: Participants will self-administer with esketamine nasal spray twice per week for 4 weeks as a flexible dose regimen (56 milligram [mg] or 84 mg for those < 65 years; 28 mg, 56 mg or 84 mg for those >= 65 years). Participants >= 65 years old will start at a dose of 28 mg on Day 1. Optimization/Maintenance Phase: Participants entering from studies ESKETINTRD3001 (NCT02417064), ESKETINTRD3002 (NCT02418585) or ESKETINTRD3006 (US sites only) will self-administer esketamine nasal spray (same dose) once weekly. Participants entering from study ESKETINTRD3005 (NCT02422186) will self-administer esketamine nasal spray (28 mg in week 1; 28 or 56 mg in week 2; and 28, 56 or 84 mg in week 3 and 4) once weekly. After Week 4 (starting at Week 5), based on the Investigator's clinical judgment, the dose of esketamine for all participants can be adjusted based upon efficacy and tolerability.
Other Names:
  • JNJ-54135419
  • Outcome Measures

    Primary Outcome Measures

    1. Number of Participants With Treatment Emergent Adverse Events (TEAEs) [Up to End of Study (approximately 5 years 3 months)]

    2. Change From Baseline in Systolic and Diastolic Blood Pressure [Baseline of each dosing session (predose) up to the last post-dose measurement from the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      Change From Baseline (predose) in systolic and diastolic blood pressure will be assessed.

    3. Change From Baseline in Heart Rate [Baseline of each dosing session (predose) up to the last post-dose measurement from the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      Change from Baseline (predose) in heart rate will be assessed.

    4. Change From Baseline in Blood Oxygen Saturation [Baseline of each dosing session (predose) up to the last post-dose measurement from the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      Change From Baseline in Blood oxygen saturation (predose) will be assessed.

    5. Change From Baseline in Modified Observer's Assessment of Alertness/Sedation (MOAAS) Scale Score [1 hour post-dose from the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The MOAA/S will be used to measure treatment-emergent sedation, with correlation to levels of sedation defined by the American Society of Anesthesiologists (ASA) continuum. The MOAA/S scores range from 0=no response to painful stimulus (corresponds to ASA continuum for general anesthesia) to 5=readily responds to name spoken in normal tone (awake; corresponds to ASA continuum for minimal sedation).

    6. Change from Baseline in Electrocardiogram (ECG) intervals [Baseline of each dosing session (predose) up to the last post-dose measurement from the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      Change From Baseline (predose) in Electrocardiogram (ECG) intervals will be assessed.

    7. Change From Baseline in Computerized Cognitive Battery Domain Score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The Change From Baseline in computerized cognitive battery will provide assessment of multiple cognitive domains, including attention, visual learning memory, and executive function.

    8. Change From Baseline in Hopkins Verbal Learning Test-Revised (HVLT-R) Score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The HVLT-R is a measure of verbal learning and memory, is a 12-item word list recall test. Scores include learning, delayed recall, and recognition. The HVLT-R is a well-validated and widely used measure of verbal episodic memory.

    9. Change From Baseline in Columbia-Suicide Severity Rating Scale (C-SSRS) Score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      Change from baseline in suicidal ideation or behavior measured using C-SSRS score will be reported. C-SSRS is a clinician rated assessment of suicidal behavior and / or intent. Scale consists of 28 items in 4 sections: suicide behavior, actual attempts, suicidal ideation, and intensity of ideation. Suicidal ideation consists of 5 'yes/no' items: wish to be dead, non-specific active suicidal thoughts, active suicidal ideation with any methods (not plan) without intention to act, active suicidal ideation with some intent to act without specific plan, active suicidal ideation with specific plan and intent. Only items with yes responses are listed. Worsening of suicidal ideation was an increase in severity of suicidal ideation from baseline.

    10. Changes From Baseline Over Time in Clinical Laboratory Tests [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

    11. Time to Discharge Readiness Using the Clinical Global Assessment of Discharge Readiness (CGADR) [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The CGADR will be used to measure the participant's current clinical status and is the clinician's assessment of the readiness to be discharged from the study site.

    Secondary Outcome Measures

    1. Change From Baseline in Participant-Reported Depressive Symptoms Using the Patient Health Questionnaire - 9 (PHQ-9) Total Score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The PHQ-9 is a 9-item scale used to assess depressive symptoms. The responses for each item are summed to provide a total score (range of 0 to 27) with higher scores indicating greater severity of depressive symptoms.

    2. Change From Baseline in Clinical Global Impression-Severity (CGI-S) score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The CGI-S evaluates the severity of psychopathology on a scale of 0 to 7.

    3. Change From Baseline in days when participants assess disruption of (1) work/school, (2) social life, leisure activities, and (3) family life/home responsibilities as Assessed by the Sheehan Disability Scale (SDS) Total Score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The SDS, a patient-reported outcome measure, is a 5 item questionnaire which has been widely used and accepted for assessment of functional and associated disability impairment. The first three items assess disruption of (1) work/school, (2) social life, and (3) family life/home responsibilities using a 0-10 rating scale. The score for the first three items are summed to create a total score of 0-30 where a higher score indicates greater impairment. It also has one item on days lost from school or work and one item on days when underproductive.

    4. Change From Baseline in days symptoms caused participants to miss school or work or were unable to carry out normal daily responsibilitieswhen participant lost from school or work as as Assessed by the Sheehan Disability Scale (SDS) [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The SDS, a patient-reported outcome measure, is a 5 item questionnaire which has been widely used and accepted for assessment of functional and associated disability. The first three items assess disruption of (1) work/school, (2) social life, and (3) family life/home responsibilities using a 0-10 rating scale. The score for the first three items are summed to create a total score of 0-30 where a higher score indicates greater impairment. It also has one item on days lost from school or work and one item on days when underproductive.

    5. Change From Baseline in days when participant was underproductive as Assessed by the Sheehan Disability Scale (SDS) [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The SDS, a patient-reported outcome measure, is a 5 item questionnaire which has been widely used and accepted for assessment of functional and associated disability. The first three items assess disruption of (1) work/school, (2) social life, and (3) family life/home responsibilities using a 0-10 rating scale. The score for the first three items are summed to create a total score of 0-30 where a higher score indicates greater impairment. It also has one item on days lost from school or work and one item on days when underproductive.

    6. Change From Baseline in Participant-Reported Health-related Quality of Life as Assessed by EuroQol-5 Dimension-5 Level (EQ-5D-5L) ) Valuation Index Score [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The EQ-5D questionnaire is a brief, generic health-related quality of life assessment (HRQOL) that can also be used to incorporate participant preferences into health economic evaluations. The EQ-5D-5L descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression and as overall health using a "thermometer" visual analog scale with response options ranging from 0 (worst imaginable health) to 100 (best imaginable health). Lower scores indicate worsening. EQ-5D scores include EQ-5D valuation index score (a weighted scoring of the 5 dimension scores with a possible range from 0 to 1) and EQ5D descriptive system scores (five scores reflecting each of the 5 EQ-5D health dimensions ranging from 0 [no limitation] to 4 [incapacity]).

    7. Change From Baseline in Participant-Reported Health Status as Assessed by EuroQol-5 Dimension-5 Level (EQ-5D-5L) Visual Analog Scale (VAS) [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      EQ-5D visual analog scale (VAS) is a 20 centimeter (cm) vertical VAS with scores ranging from 0 (worst imaginable health) to 100 (perfect health. A higher score indicates an improvement in health in the Health Status Index. The EuroQol-5 is a five dimensional health state classification. Each dimension is assessed on a 3-point ordinal scale (1=no problems, 2=some problems, 3=extreme problems). The responses to the five EQ-5D dimensions were scored using a utility-weighted algorithm to derive an EQ-5D health status index score between 0 to 1, with 1.00 indicating "full health" and 0 representing dead.

    8. Change From Baseline in Participant- Reported Health Related Quality of Life Using the Quality of Life in Depression Scale (QLDS) [From the start of Induction Phase to End of Optimization/Maintenance Phase (approximately 5 years 3 months)]

      The QLDS is a disease specific PRO designed to assess health related quality of life in patients with Major Depressive Disorder. The instrument has a recall period of "at the moment", contains 34-items with "yes"/"no" response options and takes approximately 5-10 minutes to complete. The score range is from 0 (good quality of life) to 34 (very poor quality of life).

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Based on the prior study the participant is entering 54135419TRD3008 from: a) From ESKETINTRD3001 (NCT02417064) or ESKETINTRD3002 (NCT02418585) study: Participant has completed the induction phase and the 2-weeks follow up phase visit; or Participants completed the induction phase and was a responder and study ESKETINTRD3003 is terminated.; b) From ESKETINTRD3003 (NCT02493868) study: (1) Participant relapsed during the maintenance phase; or (2) Participant was in the induction phase of the ESKETINTRD3003 study when the study was terminated and, after completion of the induction phase, was determined to be a responder; or (3) Participant was in the optimization or maintenance phases at the time the study was terminated; or (4) or (5) Participants was in the induction phase and after completion of induction phase was determined to not meet response criteria (1) Participant completed ESKETINTRD3004 study (optimization/maintenance phase); or (2) Participant was in the induction phase of the ESKETINTRD3004 study when the study was terminated and, after completion of the induction phase, was determined to be a responder; or (3) Participant was in the optimization/maintenance phase at the time the study was terminated; (4) Participant was in the induction phase and did not meet criteria for response may be eligible for to be rolled over into 54135419TRD3008. d) From ESKETINTRD3005 (NCT02422186) study: Participant was in the induction phase of the ESKETINTRD3005 study at the time enrollment into the ESKETINTRD3004 study was closed and, after completion of the induction phase, was determined to be a responder or did not meet the criteria for response. e) From ESKETINTRD3006 study (US Study sites only) (1) Participant completed the induction phase and was a responder.

    • Participant must be medically stable on the basis of physical examination, vital signs, pulse oximetry, and 12-lead Electrocardiogram (ECG) performed predose on the day of the first intranasal treatment session. If there are any abnormalities that are not specified in the inclusion and exclusion criteria, their clinical significance must be determined by the investigator and recorded in the participant's source documents and initialed by the investigator

    • Participant must be medically stable according to the investigator's judgment and knowledge of the subject's medical stability in the parent study. This determination must be documented.

    • A woman of childbearing potential must have a negative serum (beta-human chorionic gonadotropin [b-hCG]) predose on the day of the first intranasal treatment session

    • During the study (that is, from the first intranasal treatment session) and for a minimum of 1 spermatogenesis cycle (defined as approximately 90 days) after receiving the last dose of intranasal study medication, a man who is sexually active with a woman of childbearing potential must be practicing a highly effective method of contraception with his female partner c) must agree not to donate sperm.

    Exclusion Criteria:
    • The evaluation of the benefit versus risk of continued esketamine nasal spray treatment is not favorable for the participant in the opinion of the investigator

    • Since the last study visit in the participant's prior study, participant has suicidal ideation with intent to act per the investigator's clinical judgment or based on the Columbia Suicide Severity Rating Scale (C-SSRS) [corresponding to a response of "Yes" on Item 4 (active suicidal ideation with some intent to act, without specific plan) or Item 5 (active suicidal ideation with specific plan and intent) in the suicidal ideation module of the C-SSRS] or suicidal behavior per the investigator's clinical judgment or based on the C-SSRS (corresponding to any score higher than 0 in the suicidal behavior module of the C-SSRS)

    • Participant has positive test result(s) for drugs of abuse (including barbiturates, methadone, opiates, cocaine, phencyclidine, and amphetamine/methamphetamine) predose on the day of the first intranasal treatment session

    • Participant has any anatomical or medical condition that, per the investigator's clinical judgment based on assessment, may impede delivery or absorption of intranasal study drug

    • Participant has taken any prohibited therapies that would not permit administration of the first intranasal treatment session

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Birmingham Alabama United States
    2 Little Rock Arkansas United States
    3 Garden Grove California United States
    4 Glendale California United States
    5 Oakland California United States
    6 Orange California United States
    7 San Diego California United States
    8 San Rafael California United States
    9 Hartford Connecticut United States
    10 New Haven Connecticut United States
    11 Gainesville Florida United States
    12 Miami Florida United States
    13 Orlando Florida United States
    14 Atlanta Georgia United States
    15 Chicago Illinois United States
    16 Hoffman Estates Illinois United States
    17 Joliet Illinois United States
    18 Maywood Illinois United States
    19 Skokie Illinois United States
    20 Iowa City Iowa United States
    21 Wichita Kansas United States
    22 Lake Charles Louisiana United States
    23 Shreveport Louisiana United States
    24 Baltimore Maryland United States
    25 Gaithersburg Maryland United States
    26 Boston Massachusetts United States
    27 New Bedford Massachusetts United States
    28 Watertown Massachusetts United States
    29 Worcester Massachusetts United States
    30 Rochester Hills Michigan United States
    31 O'Fallon Missouri United States
    32 Saint Charles Missouri United States
    33 Omaha Nebraska United States
    34 Cedarhurst New York United States
    35 New York New York United States
    36 Staten Island New York United States
    37 Hickory North Carolina United States
    38 Cincinnati Ohio United States
    39 Oklahoma City Oklahoma United States
    40 Allentown Pennsylvania United States
    41 Media Pennsylvania United States
    42 Philadelphia Pennsylvania United States
    43 Lincoln Rhode Island United States
    44 Providence Rhode Island United States
    45 Charleston South Carolina United States
    46 Austin Texas United States
    47 Dallas Texas United States
    48 Houston Texas United States
    49 Wichita Falls Texas United States
    50 Charlottesville Virginia United States
    51 Waukesha Wisconsin United States
    52 Banfield Argentina
    53 Ciudad Autonoma de Buenos Aires Argentina
    54 Ciudad Autónoma De Buenos Aires Argentina
    55 Cordoba Argentina
    56 La Plata Argentina
    57 Mendoza Argentina
    58 Rosario Argentina
    59 Caulfield Australia
    60 Elizabeth Vale Australia
    61 Frankston Australia
    62 Vienna Austria
    63 Aalst Belgium
    64 Brugge Belgium
    65 Brussel Belgium
    66 Heusden-Zolder Belgium
    67 Liège Belgium
    68 Yvoir Belgium
    69 Belo Horizonte Brazil
    70 Curitiba Brazil
    71 Fortaleza Brazil
    72 Passo Fundo Brazil
    73 Porto Alegre Brazil
    74 Recife Brazil
    75 Rio de Janeiro Brazil
    76 São Bernardo do Campo Brazil
    77 São Paulo Brazil
    78 Bourgas Bulgaria
    79 Kardzhali Bulgaria
    80 Pazardzhik Bulgaria
    81 Pleven Bulgaria
    82 Plovdiv Bulgaria
    83 Rousse Bulgaria
    84 Sofia Bulgaria
    85 Varna Bulgaria
    86 Vancouver British Columbia Canada
    87 Kingston Ontario Canada
    88 Ottawa Ontario Canada
    89 Toronto Ontario Canada
    90 Brno Czechia
    91 Plzen Czechia
    92 Prague Czechia
    93 Praha 10 Czechia
    94 Praha 2 Czechia
    95 Praha 6 Czechia
    96 Tallinn Estonia
    97 Tartu Estonia
    98 Kuopio Finland
    99 Clermont-Ferrand Cedex 1 France
    100 Douai France
    101 Nantes France
    102 Nîmes France
    103 Paris France
    104 Poitiers Cedex France
    105 Toulon Cedex France
    106 Berlin Germany
    107 Bochum Germany
    108 Mainz Germany
    109 Mittweida Germany
    110 Oranienburg Germany
    111 Pfaffenhofen Germany
    112 Budapest Hungary
    113 Debrecen Hungary
    114 Győr Hungary
    115 Pecs Hungary
    116 Sopron Hungary
    117 Szekszárd Hungary
    118 Vác Hungary
    119 Gwangju Korea, Republic of
    120 Seoul Korea, Republic of
    121 Kaunas Lithuania
    122 Kuala Lumpur Malaysia
    123 Guadalajara Mexico
    124 Leon Mexico
    125 Mexico City Mexico
    126 Mexico Mexico
    127 Monterrey Mexico
    128 San Luis Potosi Mexico
    129 Belchatow Poland
    130 Bialystok Poland
    131 Bydgoszcz Poland
    132 Gdansk Poland
    133 Leszno Poland
    134 Lublin Poland
    135 Warszawa Poland
    136 Bratislava Slovakia
    137 Liptovsky Mikulas Slovakia
    138 Rimavska Sobota Slovakia
    139 Roznava Slovakia
    140 Svidnik Slovakia
    141 Cape Town South Africa
    142 Pretoria South Africa
    143 Welgemoed South Africa
    144 Alcorcón Spain
    145 Barcelona Spain
    146 Bilbao Spain
    147 Madrid Spain
    148 Oviedo Spain
    149 Palma Spain
    150 Pamplona Spain
    151 Sabadell Spain
    152 Salamanca Spain
    153 Sant Boi de Llobregat Spain
    154 Torrevieja Spain
    155 Vitoria-Gasteiz Spain
    156 Zamora Spain
    157 Halmstad Sweden
    158 Lund Sweden
    159 Skövde Sweden
    160 Stockholm Sweden
    161 Kaohsiung Taiwan
    162 New Taipei Taiwan
    163 Taichung Taiwan
    164 Taipei Taiwan
    165 Taoyuan Taiwan
    166 Adana Turkey
    167 Ankara Turkey
    168 Bursa Turkey
    169 Istanbul Turkey
    170 Kucukcekmece/Istanbul Turkey
    171 Oanakkale Turkey
    172 Samsun Turkey
    173 Chesterfield United Kingdom
    174 Derby United Kingdom
    175 London United Kingdom
    176 Northampton United Kingdom
    177 Oxford United Kingdom

    Sponsors and Collaborators

    • Janssen Research & Development, LLC

    Investigators

    • Study Director: Janssen Research & Development, LLC Clinical Trial, Janssen Research & Development, LLC

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Janssen Research & Development, LLC
    ClinicalTrials.gov Identifier:
    NCT02782104
    Other Study ID Numbers:
    • CR108149
    • 54135419TRD3008
    • 2015-003578-34
    First Posted:
    May 25, 2016
    Last Update Posted:
    Aug 18, 2022
    Last Verified:
    Aug 1, 2022
    Studies a U.S. FDA-regulated Device Product:
    No
    Keywords provided by Janssen Research & Development, LLC
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Aug 18, 2022