A Study to Evaluate the Efficacy, Safety, and Tolerability of Intranasal Esketamine Plus an Oral Antidepressant in Elderly Participants With Treatment-resistant Depression (TRANSFORM-3)
A Randomized, Double-blind, Multicenter, Active-controlled Study to Evaluate the Efficacy, Safety, and Tolerability of Intranasal Esketamine Plus an Oral Antidepressant in Elderly Subjects With Treatment-resistant Depression
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
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Aalst, Belgium
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Brugge, Belgium
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Brussel, Belgium
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Hasselt, Belgium
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Heusden-Zolder, Belgium
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Liège, Belgium
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Belo Horizonte, Brazil
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Fortaleza, Brazil
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Rio de Janeiro, Brazil
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Santo André, Brazil
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Sao Jose do Rio Preto, Brazil
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Sao Paulo, Brazil
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São Paulo, Brazil
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Bourgas, Bulgaria
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Kardzhali, Bulgaria
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Sofia, Bulgaria
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Varna, Bulgaria
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Helsinki, Finland
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Kuopio, Finland
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Issy-les-Moulineaux, France
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La Tronche, France
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Nice, France
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Nimes Cedex 9, France
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Paris, France
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Poitiers, France
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TOURS cedex 9, France
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Toulon, France
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Toulouse, France
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Kaunas, Lithuania
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Silute, Lithuania
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Vilnius, Lithuania
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Belchatow, Poland
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Bydgoszcz, Poland
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Gdansk, Poland
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Torun, Poland
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Tuszyn, Poland
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Cape Town, South Africa
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Garsfontein, South Africa
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Pretoria, South Africa
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Badajoz, Spain
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Bilbao, Spain
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Madrid, Spain
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Ourense, Spain
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Sant Boi de Llobregat, Spain
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Torrevieja, Spain
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Zamora, Spain
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Goteborg, Sweden
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Halmstad, Sweden
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Lund, Sweden
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Skövde, Sweden
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Solna, Sweden
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Stockholm, Sweden
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Derbyshire, United Kingdom
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Oxford, United Kingdom
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Preston, United Kingdom
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California
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San Diego, California, United States
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Connecticut
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New Haven, Connecticut, United States
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Florida
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Miami, Florida, United States
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Georgia
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Marietta, Georgia, United States
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Iowa
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Iowa City, Iowa, United States
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Maryland
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Baltimore, Maryland, United States
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Massachusetts
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Watertown, Massachusetts, United States
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New York
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New York, New York, United States
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Staten Island, New York, United States
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Ohio
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Cincinnati, Ohio, United States
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Pennsylvania
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Allentown, Pennsylvania, United States
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Texas
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Dallas, Texas, United States
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Wichita Falls, Texas, United States
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Virginia
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Charlottesville, Virginia, United States
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Washington
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Richland, Washington, United States
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- At the time of signing the informed consent form (ICF), participant must be a man or woman 65 years of age or older
- At the start of the Screening/prospective observational Phase, participant must meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for single-episode major depressive disorder (MDD) [if single-episode MDD, the duration must be greater than or equal to (>=) 2 years] or recurrent MDD, without psychotic features, based upon clinical assessment and confirmed by the Mini-International Neuropsychiatric Interview (MINI)
- At the start of the Screening/Prospective observational Phase, participant must have an Inventory of Depressive Symptomatology-Clinician rated (IDS-C30) total score of greater than or equal to (>=) 31
- At the start of the Screening/Prospective observational Phase, participants must have had nonresponse (less than or equal to 25% improvement) to >=1 but less than or equal to (<=) 8 oral antidepressant treatments taken at adequate dosage and for adequate duration, as assessed using the Massachusetts General Hospital - Antidepressant Treatment Response Questionnaire (MGH-ATRQ) and documented records by medical and pharmacy/prescription records, or a letter from the treating physician, for the current episode of depression
- Participant must be taking one of the oral antidepressant treatment with nonresponse that is documented on the MGH-ATRQ at the start of the screening/prospective observational phase
- The participant's current major depressive episode, depression symptom severity (Week 1 MADRS total score greater than or equal to 24 required) and treatment response to antidepressant treatments used in the current depressive episode (retrospectively assessed) must be confirmed for participation in a clinical study based on a Site-Independent Qualification Assessment
- Participant must be medically stable on the basis of clinical laboratory tests performed in the screening/prospective observational phase
Exclusion Criteria:
- The participant's depressive symptoms have previously demonstrated nonresponse to: Esketamine or ketamine in the current major depressive episode per clinical judgment, or all of the 4 oral antidepressant treatment options available for the double-blind induction Phase (Duloxetine, Escitalopram, Sertraline, and Venlafaxine extended release [XR]) in the current major depressive episode (based on MGH-ATRQ), or an adequate course of treatment with electroconvulsive therapy (ECT) in the current major depressive episode, defined as at least 7 treatments with unilateral ECT
- Participants who has received vagal nerve stimulation (VNS) or who has received deep brain stimulation (DBS) in the current episode of depression
- Participant has a current or prior DSM-5 diagnosis of a psychotic disorder or MDD with psychosis, bipolar or related disorders (confirmed by the MINI), obsessive compulsive disorder (current episode only), intellectual disability ( intellectual disability [DSM-5 diagnostic codes 317, 318.0, 318.1, 318.2, 315.8, and 319]), borderline personality disorder, antisocial personality disorder, histrionic personality disorder, or narcissistic personality disorder
- Participant has homicidal ideation/intent, per the Investigator's clinical judgment, or has suicidal ideation with some intent to act within 6 months prior to the start of the Screening/prospective observational Phase, per the Investigator's clinical judgment or based on the Columbia Suicide Severity Rating Scale (C-SSRS) and also includes history of suicidal behavior within the past year prior to start of the screening/prospective observational phase
- Participant has a history (lifetime) of ketamine, phencyclidine (PCP), lysergic acid diethylamide (LSD), or 3, 4-methylenedioxy-methamphetamine (MDMA) hallucinogen-related use disorder\
- Participant has a Mini Mental State Examination (MMSE) < 25 or <22 for those participants with less than an equivalent of high school education
- Participant has neurodegenerative disorder (eg, Alzheimer's Disease, Vascular dementia, Parkinson's disease with clinical evidence of cognitive impairment) or evidence of mild cognitive impairment (MCI)
- Participant has a history of uncontrolled hypertension; current or past history of significant pulmonary insufficiency/condition;clinically significant ECG abnormalities; current or past history of seizures; clinically significant cardiovascular disorders including cerebral and cardiac vascular disease
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
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Experimental: Intranasal Esketamine plus Oral Antidepressant
Participants will self-administer esketamine intranasally twice per week for 4 weeks as a flexible dose regimen in the Double-Blind Induction Phase.
All participants will start with first dose (Day 1 as 28 milligram [mg]); second dose (Day 4) is either 28 or 56 mg.
All subsequent doses may be 28, 56 or 84 mg.
After the first dose, all dosing decisions are determined by the investigator based on efficacy and tolerability.
In addition participants will simultaneously initiate a new, open-label oral antidepressant (Duloxetine, Escitalopram, Sertraline, or Venlafaxine extended release [XR]) on Day 1 that will be continued for the duration of Double-Blind Induction Phase.
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All participants will start with first dose (Day 1 as 28 milligram [mg]); second dose (Day 4) is either 28 or 56 mg.
All subsequent doses may be 28, 56 or 84 mg.
After the first dose, all dosing decisions are determined by the investigator based on efficacy and tolerability.
Duloxetine could be selected as the oral antidepressant medication by the investigator based on review of Massachusetts General Hospital -Antidepressant Treatment Response Questionnaire (MGH-ATRQ) and relevant prior antidepressant medication information.
The minimum therapeutic dose is 60 milligram per day (mg/day).
Escitalopram could be selected as the oral antidepressant medication by the investigator based on review of MGH-ATRQ and relevant prior antidepressant medication information.
Escitalopram will be given at a dose of 10 mg/day throughout the Double-Blind Induction Phase.
This dose (10 mg/day) is the also the minimum therapeutic dose.
Sertraline could be selected as the oral antidepressant medication by the investigator based on review of MGH-ATRQ and relevant prior antidepressant medication information.
Sertraline may be titrated up to a dose of 150 mg/day, but if not tolerated the dose can be reduced to the minimum therapeutic dose of 50 mg/day.
Venlafaxine Extended Release could be selected as the oral antidepressant medication by the investigator based on review of MGH-ATRQ and relevant prior antidepressant medication information.
Venlafaxine Extended Release may be titrated up to a dose of 150 mg/day, but if not tolerated the dose can be reduced to the minimum therapeutic dose of 75 mg/day.
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Active Comparator: Placebo plus Oral Antidepressant
Participants will self-administer matching placebo, intranasally, twice per week for 4 weeks as a flexible dose regimen in Double-Blind Induction Phase using the same titration as Esketamine.
In addition participants will simultaneously initiate a new, open-label oral antidepressant (Duloxetine, Escitalopram, Sertraline, or Venlafaxine XR) on Day 1 that will be continued for the duration of Double-Blind Induction Phase.
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Duloxetine could be selected as the oral antidepressant medication by the investigator based on review of Massachusetts General Hospital -Antidepressant Treatment Response Questionnaire (MGH-ATRQ) and relevant prior antidepressant medication information.
The minimum therapeutic dose is 60 milligram per day (mg/day).
Escitalopram could be selected as the oral antidepressant medication by the investigator based on review of MGH-ATRQ and relevant prior antidepressant medication information.
Escitalopram will be given at a dose of 10 mg/day throughout the Double-Blind Induction Phase.
This dose (10 mg/day) is the also the minimum therapeutic dose.
Sertraline could be selected as the oral antidepressant medication by the investigator based on review of MGH-ATRQ and relevant prior antidepressant medication information.
Sertraline may be titrated up to a dose of 150 mg/day, but if not tolerated the dose can be reduced to the minimum therapeutic dose of 50 mg/day.
Venlafaxine Extended Release could be selected as the oral antidepressant medication by the investigator based on review of MGH-ATRQ and relevant prior antidepressant medication information.
Venlafaxine Extended Release may be titrated up to a dose of 150 mg/day, but if not tolerated the dose can be reduced to the minimum therapeutic dose of 75 mg/day.
Participants will self-administer matching placebo, intranasally, twice per week for 4-weeks as a flexible dose regimen in the Double-Blind Induction Phase.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Change From Baseline in Montgomery Asberg Depression Rating Scale (MADRS) Total Score up to Endpoint (Double-blind Induction Phase [Day 28])- Mixed-Effects Model Using Repeated Measures (MMRM) Analysis
Time Frame: Baseline up to Endpoint (Double-blind Induction Phase[Day 28])
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The MADRS is a clinician-rated scale designed to measure depression severity and to detect changes due to antidepressant treatment.
The scale consists of 10 items (to evaluates apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, inability to feel [interest level], pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of the symptoms), summed for a total possible score range of 0-60.
Higher scores represent a more severe condition.
Negative change in score indicates improvement.
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Baseline up to Endpoint (Double-blind Induction Phase[Day 28])
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Change From Baseline in Montgomery Asberg Depression Rating Scale (MADRS) Total Score to Endpoint (Double-blind Induction Phase [Day 28])- Analysis of Covariance (ANCOVA) Analysis
Time Frame: Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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The MADRS is a clinician-rated scale designed to measure depression severity and to detect changes due to antidepressant treatment.
The scale consists of 10 items (to evaluates apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, inability to feel [interest level], pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item not present or normal) to 6 (severe or continuous presence of the symptoms), summed for a total possible score range of 0-60.
Higher scores represent a more severe condition.
Negative change in score indicates improvement.
Missing data was imputed using Last Observation Carried Forward (LOCF) method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.
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Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Percentage of Participants Who Achieved >=50% Reduction From Baseline in MADRS Total Score at Endpoint (Double-blind Induction Phase [Day 28]) (LOCF Data)
Time Frame: At Endpoint-Double-blind Induction Phase [Day 28]
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Percentage of participants with greater than or equal to (>=50) percent (%) reduction from baseline are reported.
MADRS is clinician-rated scale designed to measure depression severity, and to detect changes due to antidepressant treatment.
Scale consists of 10 items (apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of symptoms), summed for a total possible score of 0 to 60. Higher scores represent more severe condition.
Missing data was imputed using LOCF method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.
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At Endpoint-Double-blind Induction Phase [Day 28]
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Percentage of Participants in Remission (MADRS<=12) at Endpoint (Double-blind Induction Phase [Day 28]) (LOCF Data)
Time Frame: At Endpoint-Double-blind Induction Phase [Day 28]
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Remission was defined as participants who had a MADRS total score of less than or equal to (=<) 12. MADRS is clinician-rated scale designed to measure depression severity, and to detect changes due to antidepressant treatment.
Scale consists of 10 items (apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts), each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of symptoms), summed for a total possible score of 0 to 60. Higher scores represent more severe condition.
Missing data was imputed using LOCF method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.
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At Endpoint-Double-blind Induction Phase [Day 28]
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Change From Baseline in Clinical Global Impression-Severity (CGI-S) Score to Endpoint (Double-blind Induction Phase [Day 28])- ANCOVA Analysis on Ranks
Time Frame: Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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CGI-S provides an overall clinician-determined summary measure of the severity of the participants illness including participants history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the participants ability to function.
The CGI-S evaluates the severity of psychopathology on a scale of 0 to 7. Considering total clinical experience, a participant is assessed on severity of mental illness at the time of rating according to: 0=not assessed; 1=normal (not at all ill); 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients.
Missing data was imputed using LOCF method and last post baseline observation during the double-blind induction phase was carried forward as the "End Point" for that phase.
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Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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Change From Baseline in EuroQol-5 Dimension-5 Level (EQ-5D-5L) to Endpoint (Double-blind Induction Phase [Day 28]): Health Status Index
Time Frame: Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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EQ-5D-5L is a 2-part instrument for use as a measure of health outcome, designed for self-completion by respondents.
It consists of EQ-5D-5L descriptive system and EQ VAS.
EQ-5D-5L descriptive system comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
Each has 5 levels of perceived problems (1-no problem, 2-slight problems, 3-moderate problems, 4-severe problems, 5-extreme problems).
Participant selects answer for each of 5 dimensions considering response that best matches his/her health "today".
Responses were used to generate a health status index (HSI).
HSI ranges from -0.148 (health state value equal to dead) and 0.949 (full health), is anchored at 0 (dead) and 1 (full health).
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Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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Change From Baseline in EuroQol-5 Dimension-5 Level (EQ-5D-5L) to Endpoint (Double-blind Induction Phase [Day 28]): EQ-VAS
Time Frame: Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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EQ-5D-5L is a 2-part instrument for use as a measure of health outcome, designed for self-completion by respondents.
It consists of EQ-5D-5L descriptive system and EQ VAS.
The EQ VAS self-rating records the respondent's own assessment of his or her overall health status at the time of completion, on a scale of 0 (the worst health you can imagine) to 100 (the best health you can imagine).
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Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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Change From Baseline in EuroQol-5 Dimension-5 Level (EQ-5D-5L) to Endpoint (Double-blind Induction Phase [Day 28]): Sum Score
Time Frame: Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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EQ-5D-5L consists of EQ-5D-5L descriptive system and EQ visual analogue scale (EQ VAS).
EQ-5D-5L descriptive system comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
Each has 5 levels of perceived problems (1-no problem, 2-slight problems, 3-moderate problems, 4-severe problems, 5-extreme problems).
Participant selects answer for each of 5 dimensions considering response that best matches his/her health "today".
Responses were used to generate a Health Status Index (HSI).
HSI ranges from -0.148 (health state value equal to dead) and 0.949 (full health).
EQ VAS self-rating records the respondent's own assessment of his/her overall health status at time of completion, on a scale of 0 (worst health you can imagine) to 100 (best health you can imagine).
Sum score ranges from 0 to 100 where, sum score = (sum of the scores from the 5 dimensions minus 5) *5.
Higher score indicates worst health state.
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Baseline and Endpoint (Double-blind Induction Phase [Day 28])
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Director: Janssen Research & Development, LLC Clinical Trial, Janssen Research & Development, LLC
Publications and helpful links
General Publications
- Perez-Ruixo C, Rossenu S, Zannikos P, Nandy P, Singh J, Drevets WC, Perez-Ruixo JJ. Population Pharmacokinetics of Esketamine Nasal Spray and its Metabolite Noresketamine in Healthy Subjects and Patients with Treatment-Resistant Depression. Clin Pharmacokinet. 2021 Apr;60(4):501-516. doi: 10.1007/s40262-020-00953-4. Epub 2020 Oct 31.
- Doty RL, Popova V, Wylie C, Fedgchin M, Daly E, Janik A, Ochs-Ross R, Lane R, Lim P, Cooper K, Melkote R, Jamieson C, Singh J, Drevets WC. Effect of Esketamine Nasal Spray on Olfactory Function and Nasal Tolerability in Patients with Treatment-Resistant Depression: Results from Four Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase III Studies. CNS Drugs. 2021 Jul;35(7):781-794. doi: 10.1007/s40263-021-00826-9. Epub 2021 Jul 7.
- Katz EG, Hough D, Doherty T, Lane R, Singh J, Levitan B. Benefit-Risk Assessment of Esketamine Nasal Spray vs. Placebo in Treatment-Resistant Depression. Clin Pharmacol Ther. 2021 Feb;109(2):536-546. doi: 10.1002/cpt.2024. Epub 2020 Oct 13.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Behavioral Symptoms
- Mood Disorders
- Depression
- Depressive Disorder
- Depressive Disorder, Treatment-Resistant
- Serotonin and Noradrenaline Reuptake Inhibitors
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Sensory System Agents
- Analgesics
- Neurotransmitter Agents
- Membrane Transport Modulators
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Dopamine Agents
- Serotonin Agents
- Selective Serotonin Reuptake Inhibitors
- Antidepressive Agents, Second-Generation
- Duloxetine Hydrochloride
- Esketamine
- Venlafaxine Hydrochloride
- Escitalopram
- Antidepressive Agents
- Sertraline
Other Study ID Numbers
Other Study ID Numbers
- CR107129
- ESKETINTRD3005 (Other Identifier: Janssen Research & Development, LLC)
- 2014-004588-19 (EudraCT Number)
Drug and device information, study documents
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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