Safety and Efficacy of Cariprazine As Adjunctive Therapy In Major Depressive Disorder

Sponsor
Forest Laboratories (Industry)
Overall Status
Completed
CT.gov ID
NCT00854100
Collaborator
Gedeon Richter Ltd. (Industry)
231
41
3
17.2
5.6
0.3

Study Details

Study Description

Brief Summary

This is an outpatient study to evaluate the safety, and efficacy of RGH-188 as an add-on therapy to standard antidepressants in patients who did not respond to previous antidepressant therapy.

Condition or Disease Intervention/Treatment Phase
  • Drug: Antidepressant + placebo
  • Drug: Antidepressant + cariprazine (0.1-0.3 mg/day)
  • Drug: Antidepressant + cariprazine (1-2 mg/d)
Phase 2

Study Design

Study Type:
Interventional
Actual Enrollment :
231 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
Double (Participant, Investigator)
Primary Purpose:
Treatment
Official Title:
A Double-Blind, Placebo-Controlled Study of Cariprazine (RGH-188) As Adjunctive Therapy In Major Depressive Disorder
Actual Study Start Date :
Jun 30, 2009
Actual Primary Completion Date :
Dec 6, 2010
Actual Study Completion Date :
Dec 6, 2010

Arms and Interventions

Arm Intervention/Treatment
Placebo Comparator: Placebo

Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo

Drug: Antidepressant + placebo
Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo Oral, once daily for 8 weeks following an 8 week Prospective Treatment (Baseline) Period.

Experimental: Cariprazine 0.1 - 0.3 mg

Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR)+ cariprazine low dose

Drug: Antidepressant + cariprazine (0.1-0.3 mg/day)
Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine (0.1-0.3 mg/d) Oral, once daily for 8 weeks following an 8 week Prospective Treatment (Baseline) Period.

Experimental: Cariprazine 1.0 - 2.0 mg

Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine high dose

Drug: Antidepressant + cariprazine (1-2 mg/d)
Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine (1-2 mg/d) Oral, once daily for 8 weeks following an 8 week Prospective Treatment (Baseline) Period.

Outcome Measures

Primary Outcome Measures

  1. Montgomery-Asberg Depression Rating Scale (MADRS) [Baseline (Week 8) to Week 16]

    The patient is rated on a scale from 0-6 on 10 items. Apparent sadness, reported sadness, lassitude, pessimistic thoughts, inner tension, suicidal thoughts, reduced sleep and appetite, concentration difficulties, inability to feel. The overall MADRS score ranges from 0-60, with 0 meaning no symptoms and score of 60 meaning maximum severity. The primary efficacy parameter was the change in MADRS score totals from the scores taken at Baseline (Week 8) and during at least one more time point up to and including Week 16.

Secondary Outcome Measures

  1. Clinical Global Impression - Improvement (CGI-I) [Week 16]

    The Clinical Global Impression-Improvement (CGI-I) scale is a clinician rated scale that, in this study, will be used to rate total improvement or worsening of mental illness starting at Visit 2 (Week 2) and taken at every visit through Visit 11 (Week 16). The patient will be rated on a scale from 1 to 7, 1 indicating that the patient is very much improved and 7 indicating that the patient is very much worse. The secondary efficacy parameter was the CGI-I total score at Week 16.

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years to 65 Years
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Men and women, 18-65 years old

  • Currently meet the DSM-IV-TR criteria for moderate to severe MDD without psychotic features.

  • Previous failure to respond to adequate trials of one or two ADTs with less than 50% reduction in depressive symptoms during the present episode.

Exclusion Criteria:
  • DSM-IV-TR based diagnosis of an axis I disorder, other than MDD, or any axis I disorder other than MDD that was the primary focus of treatment within 6 months before Visit 1

Contacts and Locations

Locations

Site City State Country Postal Code
1 Forest Investigative Site 040 Phoenix Arizona United States 85050
2 Forest Investigative Site 038 Scottsdale Arizona United States 85254
3 Forest Investigative Site Arcadia California United States 91007
4 Forest Investigative Site Encino California United States 91316
5 Forest Investigative Site Garden Grove California United States 92845
6 Forest Investigative Site Irvine California United States 92618
7 Forest Investigative Site 013 Los Alamitos California United States 90720
8 Forest Investigative Site 041 National City California United States 91950
9 Forest Investigative Site Oceanside California United States 92056
10 Forest Investigative Site 025 Denver Colorado United States 80239
11 Forest Investigative Site Norwich Connecticut United States 06360
12 Forest Investigative Site Washington District of Columbia United States 20016
13 Forest Investigative Site 007 Jacksonville Florida United States 32216
14 Forest Investigative Site 012 West Palm Beach Florida United States 33407
15 Forest Investigative Site 033 Atlanta Georgia United States 30306
16 Forest Investigative Site Roswell Georgia United States 30076
17 Forest Investigative Site Overland Park Kansas United States 66211
18 Forest Investigative Site 042 Fall River Massachusetts United States 02721
19 Forest Investigative Site 034 Pittsfield Massachusetts United States 01267
20 Forest Investigative Site Omaha Nebraska United States 68131
21 Forest Investigative Site Cherry Hill New Jersey United States 08002
22 Forest Investigative Site 001 Bronx New York United States 10467
23 Forest Investigative Site 043 Brooklyn New York United States 11235
24 Forest Investigative Site 020 Mount Kisco New York United States 10549
25 Forest Investigative Site 039 New York New York United States 10003
26 Forest Investigative Site 029 New York New York United States 10021
27 Forest Investigative Site 032 Raleigh North Carolina United States 27607
28 Forest Investigative Site Canton Ohio United States 44718
29 Forest Investigative Site Dayton Ohio United States 45417
30 Forest Investigative Site 015 Portland Oregon United States 97210
31 Forest Investigative Site 006 Media Pennsylvania United States 19063
32 Forest Investigative Site Philadelphia Pennsylvania United States 19104
33 Forest Investigative Site Philadelphia Pennsylvania United States 19107
34 Forest Investigative Site 023 Memphis Tennessee United States 38119
35 Forest Investigative Site 031 Memphis Tennessee United States 38119
36 Forest Investigative Site Nashville Tennessee United States 37212
37 Forest Investigative Site San Antonio Texas United States 78229
38 Forest Investigative Site Woodstock Vermont United States 05091
39 Forest Investigative Site Richmond Virginia United States 23230
40 Forest Investigative Site Bellevue Washington United States 98007
41 Forest Investigative Site Seattle Washington United States 98104

Sponsors and Collaborators

  • Forest Laboratories
  • Gedeon Richter Ltd.

Investigators

  • Study Director: Robert Hayes, PhD, Forest Laboratories

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
Forest Laboratories
ClinicalTrials.gov Identifier:
NCT00854100
Other Study ID Numbers:
  • RGH-MD-71
  • NCT03605784
First Posted:
Mar 2, 2009
Last Update Posted:
Mar 5, 2019
Last Verified:
Feb 1, 2019

Study Results

Participant Flow

Recruitment Details
Pre-assignment Detail The randomized population for RGH-MD-71 totaled 231 participants
Arm/Group Title Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Arm/Group Description Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine low dose Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine high dose
Period Title: Overall Study
STARTED 81 76 74
COMPLETED 72 70 63
NOT COMPLETED 9 6 11

Baseline Characteristics

Arm/Group Title Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg Total
Arm/Group Description Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR)+ cariprazine low dose Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine high dose Total of all reporting groups
Overall Participants 81 76 73 230
Age (Years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [Years]
45.2
(10.2)
46.6
(11.7)
44.2
(12.1)
45.3
(11.3)
Sex: Female, Male (Count of Participants)
Female
61
75.3%
52
68.4%
51
69.9%
164
71.3%
Male
20
24.7%
24
31.6%
22
30.1%
66
28.7%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino
7
8.6%
9
11.8%
9
12.3%
25
10.9%
Not Hispanic or Latino
74
91.4%
67
88.2%
64
87.7%
205
89.1%
Unknown or Not Reported
0
0%
0
0%
0
0%
0
0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native
2
2.5%
0
0%
0
0%
2
0.9%
Asian
0
0%
2
2.6%
1
1.4%
3
1.3%
Native Hawaiian or Other Pacific Islander
0
0%
0
0%
0
0%
0
0%
Black or African American
10
12.3%
15
19.7%
11
15.1%
36
15.7%
White
69
85.2%
57
75%
60
82.2%
186
80.9%
More than one race
0
0%
2
2.6%
1
1.4%
3
1.3%
Unknown or Not Reported
0
0%
0
0%
0
0%
0
0%

Outcome Measures

1. Primary Outcome
Title Montgomery-Asberg Depression Rating Scale (MADRS)
Description The patient is rated on a scale from 0-6 on 10 items. Apparent sadness, reported sadness, lassitude, pessimistic thoughts, inner tension, suicidal thoughts, reduced sleep and appetite, concentration difficulties, inability to feel. The overall MADRS score ranges from 0-60, with 0 meaning no symptoms and score of 60 meaning maximum severity. The primary efficacy parameter was the change in MADRS score totals from the scores taken at Baseline (Week 8) and during at least one more time point up to and including Week 16.
Time Frame Baseline (Week 8) to Week 16

Outcome Measure Data

Analysis Population Description
231 patients were randomized, and of them, 230 received at least 1 dose of treatment (Double-blind Safety Population), and had at least a baseline and 1 post-baseline MADRS assessment (Double-blind Intent To Treat Population). All patients in the Double-blind Intent To Treat Population were included in the efficacy analyses.
Arm/Group Title Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Arm/Group Description Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine low dose Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine high dose
Measure Participants 81 76 73
Least Squares Mean (Standard Error) [Units on a Scale]
-8.0
(1.0)
-7.5
(1.1)
-9.8
(1.1)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Placebo, Cariprazine 0.1 - 0.3 mg
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.746
Comments
Method ANCOVA
Comments
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value 0.5
Confidence Interval (2-Sided) 95%
-2.4 to 3.4
Parameter Dispersion Type:
Value:
Estimation Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Placebo, Cariprazine 1.0 - 2.0 mg
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.227
Comments
Method ANCOVA
Comments
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value -1.8
Confidence Interval (2-Sided) 95%
-4.8 to 1.1
Parameter Dispersion Type:
Value:
Estimation Comments
2. Secondary Outcome
Title Clinical Global Impression - Improvement (CGI-I)
Description The Clinical Global Impression-Improvement (CGI-I) scale is a clinician rated scale that, in this study, will be used to rate total improvement or worsening of mental illness starting at Visit 2 (Week 2) and taken at every visit through Visit 11 (Week 16). The patient will be rated on a scale from 1 to 7, 1 indicating that the patient is very much improved and 7 indicating that the patient is very much worse. The secondary efficacy parameter was the CGI-I total score at Week 16.
Time Frame Week 16

Outcome Measure Data

Analysis Population Description
231 patients were randomized, and of them, 230 received at least 1 dose of treatment (Double-blind Safety Population), and had at least a baseline and 1 post-baseline MADRS assessment (Double-blind Intent To Treat Population). All patients in the Double-blind Intent To Treat Population were included in the efficacy analyses.
Arm/Group Title Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Arm/Group Description Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine low dose Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine high dose
Measure Participants 81 76 73
Least Squares Mean (Standard Error) [Units on a Scale]
2.5
(0.1)
2.5
(0.1)
2.3
(0.1)
Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Placebo, Cariprazine 0.1 - 0.3 mg
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.918
Comments
Method ANCOVA
Comments
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value 0.0
Confidence Interval (2-Sided) 95%
-0.3 to 0.3
Parameter Dispersion Type:
Value:
Estimation Comments
Statistical Analysis 2
Statistical Analysis Overview Comparison Group Selection Placebo, Cariprazine 1.0 - 2.0 mg
Comments
Type of Statistical Test Superiority
Comments
Statistical Test of Hypothesis p-Value 0.167
Comments
Method ANCOVA
Comments
Method of Estimation Estimation Parameter Least Squares Mean Difference
Estimated Value -0.2
Confidence Interval (2-Sided) 95%
-0.6 to 0.1
Parameter Dispersion Type:
Value:
Estimation Comments

Adverse Events

Time Frame Up to 20 weeks
Adverse Event Reporting Description Any AE includes the prospective ADT lead-in, double-blind treatment and 30 -day safety follow up will be considered a treatment-emergent adverse event (TEAE). A TEAE that occurs more than 30 days after the last dose of the investigational product will not be summarized for the safety follow-up period.1 patient left the study after they were randomized to the Cariprazine 1.0-2.0 mg arm, but never took the drug. Therefore, that patient is only captured in the lead in period data.
Arm/Group Title Prospective Antidepressant-Therapy Lead In Period Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Arm/Group Description Interventions included: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) for 8 weeks prior to randomization Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + Placebo for 8 weeks. AE reporting covers this 8 week period plus the 30 day safety follow up that proceeds it. Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine low dose for 8 weeks. AE reporting covers this 8 week period plus the 30 day safety follow up that proceeds it. Drug: Antidepressant (citalopram, duloxetine, escitalopram, sertraline, or venlafaxine XR) + cariprazine high dose for 8 weeks. AE reporting covers this 8 week period plus the 30 day safety follow up that proceeds it.
All Cause Mortality
Prospective Antidepressant-Therapy Lead In Period Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Serious Adverse Events
Prospective Antidepressant-Therapy Lead In Period Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 9/502 (1.8%) 1/81 (1.2%) 0/76 (0%) 1/73 (1.4%)
Cardiac disorders
Angina Unstable 0/502 (0%) 1/81 (1.2%) 0/76 (0%) 0/73 (0%)
Injury, poisoning and procedural complications
Hip Fracture 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Road Traffic Accident 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Upper Limb Fracture 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Intentional Overdose 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Nervous system disorders
Convulsion 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Serotonin Syndrome 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Psychiatric disorders
Anxiety 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Suicidal Ideation 2/502 (0.4%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Depression 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Completed Suicide 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Alcohol Abuse 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Homicidal Ideation 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Suicide Attempt 1/502 (0.2%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Respiratory, thoracic and mediastinal disorders
Chronic Obstructive Pulmanary Disease 0/502 (0%) 0/81 (0%) 0/76 (0%) 1/73 (1.4%)
Other (Not Including Serious) Adverse Events
Prospective Antidepressant-Therapy Lead In Period Placebo Cariprazine 0.1 - 0.3 mg Cariprazine 1.0 - 2.0 mg
Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events Affected / at Risk (%) # Events
Total 262/502 (52.2%) 32/81 (39.5%) 29/76 (38.2%) 35/73 (47.9%)
Gastrointestinal disorders
Nausea 70/502 (13.9%) 5/81 (6.2%) 5/76 (6.6%) 5/73 (6.8%)
Dry Mouth 53/502 (10.6%) 1/81 (1.2%) 2/76 (2.6%) 4/73 (5.5%)
Constipation 35/502 (7%) 1/81 (1.2%) 1/76 (1.3%) 4/73 (5.5%)
Diarrhoea 36/502 (7.2%) 5/81 (6.2%) 4/76 (5.3%) 3/73 (4.1%)
General disorders
Fatigue 36/502 (7.2%) 3/81 (3.7%) 2/76 (2.6%) 5/73 (6.8%)
Infections and infestations
Nasopharyngitis 0/502 (0%) 5/81 (6.2%) 1/76 (1.3%) 6/73 (8.2%)
Upper Respiratory Tract Infection 29/502 (5.8%) 0/81 (0%) 0/76 (0%) 0/73 (0%)
Metabolism and nutrition disorders
Increased appetite 0/502 (0%) 1/81 (1.2%) 1/76 (1.3%) 5/73 (6.8%)
Musculoskeletal and connective tissue disorders
Arthralgia 0/502 (0%) 1/81 (1.2%) 4/76 (5.3%) 1/73 (1.4%)
Nervous system disorders
Headache 73/502 (14.5%) 3/81 (3.7%) 8/76 (10.5%) 6/73 (8.2%)
Dizziness 31/502 (6.2%) 7/81 (8.6%) 4/76 (5.3%) 6/73 (8.2%)
Akathisia 0/502 (0%) 3/81 (3.7%) 2/76 (2.6%) 4/73 (5.5%)
Tremor 0/502 (0%) 4/81 (4.9%) 0/76 (0%) 4/73 (5.5%)
Psychiatric disorders
Insomnia 60/502 (12%) 3/81 (3.7%) 2/76 (2.6%) 7/73 (9.6%)
Anxiety 0/502 (0%) 3/81 (3.7%) 1/76 (1.3%) 4/73 (5.5%)
Restlessness 0/502 (0%) 1/81 (1.2%) 1/76 (1.3%) 7/73 (9.6%)
Skin and subcutaneous tissue disorders
Hyperhidrosis 25/502 (5%) 0/81 (0%) 0/76 (0%) 0/73 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

All data generated in this study will be the property of Forest Research Institute, Inc. An integrated clinical and statistical report will be prepared at the completion of the study. Publication of the results by the Investigator will be subject to mutual agreement between the Investigator and Forest Research Institute, Inc

Results Point of Contact

Name/Title Therapeutic Area Head
Organization Allergan, Inc
Phone 877-277-8566
Email IR-CTRegistration@allergan.com
Responsible Party:
Forest Laboratories
ClinicalTrials.gov Identifier:
NCT00854100
Other Study ID Numbers:
  • RGH-MD-71
  • NCT03605784
First Posted:
Mar 2, 2009
Last Update Posted:
Mar 5, 2019
Last Verified:
Feb 1, 2019