Desvenlafaxine in Opioid-Dependent Patients

An Open-Label Pilot Study of Desvenlafaxine for Opioid-Dependent Patients With Comorbid Depression

Background: Although substitution therapy has been shown to be highly effective to retain opioid-dependent patients in treatment and reduce drug use, this population is afflicted by numerous conditions including depression. Unfortunately, studies published thus far have reported inconsistent or no difference in response between placebo therapy and antidepressants such as selective serotonin reuptake inhibitors. Objective: To assess the feasibility of Desvenlafaxine (DESV) administration among opioid-dependent subjects and explore its effect on depressive symptoms. Methods: Open-label pilot trial of 8 weeks of DESV 50-100 mg/day in 20 methadone-maintained individuals with comorbid depressive symptoms at the Centre hospitalier de l'Université de Montréal. Significance: This pilot study will lay down the foundation on which a larger multisite clinical trial could be conducted to examine DESV as new treatment for opioid-dependent population with comorbid depression.

Study Overview

• Status: Completed
• Conditions: Depression; Opioid Dependence; Methadone Treatment
• Intervention / Treatment: Drug: Desvenlafaxine

Detailed Description

To assess the feasibility, tolerability and acceptability of 8 weeks of Desvenlafaxine (DESV) administration among opioid-dependent subjects in a methadone-maintenance program, we will collect detailed information on compliance to DESV treatment, side effects, methadone plasma levels, methadone dose changes and QTc measures.

To explore the effects of DESV on depressive symptoms among opioid-dependent subjects on methadone-maintenance treatment. The severity and symptoms of depression will be evaluated by using the MADRS, the HRDS, and the CGI scale.

To explore the effects of DESV on substance use, anxiety, craving, quality of life and suicidal risk.

• Study Type: Interventional
• Enrollment (Actual): 18
• Phase: Phase 4

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Montréal, Quebec, Canada, H2X0A9
      • Centre de Recherche du Centre Hospitalier de l'Universite de Montreal

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• DSM-IV-TR criteria for opioid dependence;
• Subject is on methadone treatment in the substitution program for at least 4 weeks;
• Subject is aged between 18 and 65 years old;
• subject meets the DSM-V TR criteria for major depressive episode, according to the study psychiatrist and confirmed by the Mini International Neuropsychiatric Interview (MINI);
• Subject reports a score of 20 or higher on the MADRS;
• Subject is eligible for and consents to the study;
• subject is able to give valid, informed consent;
• subject is able to speak and read French or English (grade-nine level of language required)

Exclusion Criteria:

• Unstable medical illness, defined as any medical illness which has not been well-controlled with standard-of-care medications;
• Severe psychiatric condition (e.g., current acute psychosis, past or current hypomania/mania) based on the MINI;
• Pregnancy or breastfeeding;
• Inability to use a medically acceptable form of contraception throughout the study duration. A medically acceptable form of contraception is either: (1) contraceptive pill or intrauterine device or depot hormonal preparation (ring, injection, implant); and/or (2) a barrier method of contraception such as diaphragm, sponge with spermicide or condom;
• Subject currently takes another antidepressant;
• Treatment with Desvenlafaxine at any time in the past;
• Known hypersensitivity to venlafaxine;
• Subject is undergoing psychotherapies for current depression (support therapy or counseling are allowed);
• Subject failed to respond to two or more Health-Canada-approved antidepressants during current episode;
• Unstable Axis-II personality disorder or other Axis-II disorder which has been the primary focus of treatment in the past 3 months, as ascertained by a study psychiatrists;
• Medical diagnosis of kidney and/or liver failure

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Desvenlafaxine; Open-label pilot study; Desvenlafaxine will be administered during 56 consecutive days; Desvenlafaxine will be administered in the morning at a 50 mg dose during weeks 1 and 2, and at 50-100 mg doses (based on the study psychiatrist's judgment) during the 6 following weeks.	Drug: Desvenlafaxine; All subjects will receive 50 mg of the medication during week 1 and 2, then 50-100 mg (based on the psychiatrist judgment) for the following 6 weeks. Subjects who experience significant adverse reactions with the 100mg dose during weeks 2 to 4 could return to the lower dose of 50 mg if judged clinically appropriate by the study psychiatrist.; Other Names: PRISTIQ

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tolerability: Systematic Assessment for Treatment Emergent Events (SAFTEE)	Safety and adverse effects with the Systematic Assessment for Treatment Emergent Events (SAFTEE)	8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
effect of Desvenlafaxine on depressive symptoms	Responders will be determined by a 50% reduction in (Hamilton Depression Rating Scale) HAM-D scores, and remitters will be determined based on scores of ≤7.	8 weeks
effect of Desvenlafaxine on depressive symptoms	Responders will be determined by a 50% reduction in the Montgomery-Asberg Depression Scale (MADRS) scores, and remitters will be determined based on scores of 10.	8 weeks
Response to treatment	A favorable response will be defined as a score of 1 or 2 (very much or much improved) on the Clinical Global Impression CGI-I subscale	8 weeks
Feasibility: Proportion of persons screened who are eligible and enrolled	Proportion of persons screened who are eligible and enrolled	Baseline
Treatment adherence	Compliance will be evaluated at each in-person follow-up visit. Treatment adherence will be calculated as the total number of tablets dispensed minus the number returned, divided by the total number of tablets dispensed	8 weeks
Effect of Desvenlafaxine administration on QT/QTc interval prolongation	It will be assessed by electrocardiograms (upper limit for safety should be 500ms).	4 weeks
Feasibility: Proportion of scheduled study visits completed and biological samples collected	Proportion of scheduled study visits completed and biological samples collected	8 weeks
Potential for drug interactions between methadone and antidepressants - Effect of Desvenlafaxine on methadone serum level (pharmacokinetic variability)	Change from baseline in methadone serum level. We will assessed the methadone serum level at baseline and after a month of treatment.	4 weeks
Methadone dose adjustments	Change from baseline in methadone dose. Each dose adjustment occurring during the trial will be noted at each follow-up visit	2 - 4 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Substance use	number of days of substance use as assessed with The Time Line Follow-Back (TFLB), urine-drug testing and alcohol-breathalyzer testing.	8 weeks
Effect of Desvenlafaxine on anxiety	Change from Baseline in anxiety and mood. It will be assessed with the Hamilton Anxiety Rating Scale (HAM-A)	8 weeks
Effect of Desvenlafaxine on blood pressure and heart rate	Change from Baseline in Systolic Blood Pressure and heart rate	8 weeks
Effect of Desvenlafaxine on opioid craving	Assessed with the abbreviated Heroin Craving Questionnaire (HCQ) - Change from Baseline in Craving.	8 weeks
Effect of Desvenlafaxine on quality of life	Change from baseline in Quality of life. It will be assessed with the World Health Organization Quality of Life questionnaire (WHOQOL-BREF)	8 weeks
Effect of Desvenlafaxine on disability	Change from baseline in disability. It will be assessed with the Sheehan Disability Scale (SDS)	8 weeks
Effect of Desvenlafaxine on suicidal behaviour	Change from Baseline in suicidal behaviour. It will be assessed with the Columbia-Suicide Severity Rating Scale (CSSRS)	8 weeks
Effect of Desvenlafaxine on testosterone level	Change from Baseline in testosterone.	4 weeks

Collaborators and Investigators

• Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)
• Collaborators: Pfizer
• Investigators: Principal Investigator: Didier Jutras-Aswad, M.D., M.Sc., Centre hospitalier de l'Université de Montréal (CHUM); Study Chair: Suzanne Brissette, M.D., M.Sc., Centre hospitalier de l'Université de Montréal (CHUM); Study Chair: Julie Bruneau, M.D., M.Sc., Centre hospitalier de l'Université de Montréal (CHUM); Study Chair: Paul Lespérance, M.D., M.Sc., Centre hospitalier de l'Université de Montréal (CHUM); Study Chair: Clairélaine Ouellet-Plamondon, M.D., Centre hospitalier de l'Université de Montréal (CHUM)

Publications and helpful links

General Publications

• El Hage C, Ghabrash MF, Dubreucq S, Brissette S, Lesperance F, Lesperance P, Ouellet-Plamondon C, Bruneau J, Jutras-Aswad D. A pilot, open-label, 8-week study evaluating desvenlafaxine for treatment of major depression in methadone-maintained individuals with opioid use disorder. Int Clin Psychopharmacol. 2018 Sep;33(5):268-273. doi: 10.1097/YIC.0000000000000223.

Study record dates

Study Major Dates

• Study Start: July 1, 2014
• Primary Completion (Actual): January 1, 2017
• Study Completion (Actual): January 1, 2017

Study Registration Dates

• First Submitted: July 22, 2014
• First Submitted That Met QC Criteria: July 23, 2014
• First Posted (Estimate): July 25, 2014

Study Record Updates

• Last Update Posted (Actual): October 23, 2020
• Last Update Submitted That Met QC Criteria: October 21, 2020
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Keywords: Depression; Methadone; Addiction; Comorbidity; Desvenlafaxine; Opioid-dependent
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders; Mood Disorders; Narcotic-Related Disorders; Depression; Depressive Disorder; Opioid-Related Disorders; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Psychotropic Drugs; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Antidepressive Agents; Serotonin and Noradrenaline Reuptake Inhibitors; Desvenlafaxine Succinate
• Other Study ID Numbers: WI187002; Pfizer Reference Award Number (Other Grant/Funding Number: WI187002)