- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03779789
Vortioxetine in the Elderly vs. Selective Serotonin Reuptake Inhibitors (SSRIs): a Pragmatic Assessment (VESPA)
Assessing Tolerability and Efficacy of Vortioxetine Versus SSRIs in Elderly Patients With Depression: a Pragmatic, Multicenter, Open-label, Parallel-group, Superiority, Randomized Trial
Background. Depression is a highly frequent condition in the elderly, with a huge impact on quality of life, life expectancy, and medical outcomes. SSRIs are commonly prescribed in elderly depressed patients and, although generally safe, they may be associated with tolerability issues. Based on available studies, vortioxetine is likely to have a promising tolerability profile in the elderly, as it does not adversely affect psychomotor or cognitive performance, wakefulness, body weight, and electrocardiogram parameters.
Objectives. Assessing the comparative tolerability, safety and efficacy of vortioxetine compared with the SSRIs as a group (including sertraline, citalopram, escitalopram, paroxetine, fluoxetine, fluvoxamine) in elderly patients affected by major depression. The primary outcome will be the withdrawal rate due to adverse events.
Methods. This is a pragmatic, multicenter, open-label, parallel-group, superiority, randomized trial. Twelve Italian Community Psychiatric Services will consecutively enrol elderly patients suffering from an episode of major depression who get in contact over a period of 12 months. By employing the web-based application RedCap, doctors will be able to randomize patients to vortioxetine or one of the SSRIs, chosen on the basis of clinical judgment, and to collect basic socio-demographic and clinical data. Trained and blinded assessors will administer five validated rating scales: Montgomery-Åsberg Depression Rating Scale (MADRS), Antidepressant Side-Effect Checklist (ASEC), EuroQual 5 Dimensions (EQ-5D), Charlson Age-Comorbidity Index (CACI), and Short Blessed Test (SBT). Patients will be assessed after 1, 3 and 6 months.
Expected results. On the basis of current literature, the investigators hypothesize vortioxetine to be superior to SSRIs as a group in terms of tolerability. As vortioxetine is expected to reduce the withdrawal rates due to adverse events of about 12% compared to SSRIs, and assuming that about 23% of the participants could be lost within 6 months, the investigators aim to enrol 358 patients (179 in each group).
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
-
Catanzaro, Italy
- Azienda Ospedaliera Universitaria Mater Domini, Università Magna Grecia
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Roma, Italy
- Sapienza Università di Roma, Dipartimento di Neurologia e Psichiatria
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Verona, Italy, 37134
- Azienda Ospedaliera Universitaria Verona
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 65 years old or above;
- willing to participate by signing an informed consent;
- suffering from an episode of major depression, based on clinical judgment (guided by DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) criteria);
- treatment with an antidepressant is clinically appropriate, based on clinical/medical judgment;
- agreement between investigator and patient to discontinue any current antidepressant, second generation antipsychotic, or lithium. According to the pragmatic design of the study, the discontinuation will be performed according to common routine practice. No specific protocols for discontinuation will be applied. All other concomitant medications are allowed;
- uncertainty about which trial treatment would be best for the participant.
Exclusion Criteria:
- dementia, of any type and stage, as formally diagnosed by a specialist (geriatrician, neurologist, or others);
- diagnosis of schizophrenia or bipolar disorder;
- clinical conditions or treatments which contraindicate the use of oral vortioxetine or SSRIs, according to clinical/medical judgment (for example conditions or treatments at high risk of bleeding, convulsions, serotoninergic syndrome, hyponatraemia, etc.). All concomitant medications will be prescribed according to routine clinical practice, in compliance with the synthesis of the product characteristics (Riassunto delle Caratteristiche del Prodotto - RCP) registered in the databank of the AIFA (Agenzia Italiana del Farmaco) (available at https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/cerca-farmaco).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: vortioxetine
|
Antidepressant classified under the category "other antidepressants" according to the ATC/DDD index [ATC=Anatomical Therapeutic Chemical Classification System; DDD=Defined Daily Dose].
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 5-20 mg/day).
Other Names:
|
Active Comparator: SSRIs
|
Antidepressant classified under the category "Selective serotonin reuptake inhibitors" according to the ATC/DDD index.
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 50-200 mg/day).
Other Names:
Antidepressant classified under the category "Selective serotonin reuptake inhibitors" according to the ATC/DDD index.
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 10-20 mg/day).
Other Names:
Antidepressant classified under the category "Selective serotonin reuptake inhibitors" according to the ATC/DDD index.
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 5-10 mg/day).
Other Names:
Antidepressant classified under the category "Selective serotonin reuptake inhibitors" according to the ATC/DDD index.
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 20-40 mg/day).
Other Names:
Antidepressant classified under the category "Selective serotonin reuptake inhibitors" according to the ATC/DDD index.
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 20-60 mg/day).
Other Names:
Antidepressant classified under the category "Selective serotonin reuptake inhibitors" according to the ATC/DDD index.
The dose will be flexible according to the clinical evaluation and in accordance with doses reported for elderly in the Summaries of Product Characteristics (available: https://farmaci.agenziafarmaco.gov.it/bancadatifarmaci/home)
(namely: 100-300 mg/day).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants withdrawing from treatment due to adverse events (tolerability)
Time Frame: 6 months
|
Participants withdrawing from allocated treatment due to adverse events on the number of randomized patients.
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants withdrawing from treatment due to any cause (acceptability)
Time Frame: 6 months
|
Participants withdrawing from allocated treatment due to any cause on the number of randomized patients
|
6 months
|
Overall mortality
Time Frame: 6 months
|
The number of deaths on the number of randomized patients
|
6 months
|
Number of participants with at least one episode of self-harm
Time Frame: 6 months
|
Number of participants with at least one episode of self-harm on the number of randomized patients
|
6 months
|
Number of participants died by suicide
Time Frame: 6 months
|
Number of participants died by suicide on the number of randomized patients
|
6 months
|
Treatment-related adverse events as assessed by the ASEC
Time Frame: 6 months
|
The mean change score at the Antidepressant Side-Effect Checklist (ASEC).
ASEC is a validated rating scale, administered by the clinician, measuring the occurrence and severity of 21 adverse events of antidepressants drugs.
For each side effect, a score between 0 (absent) to 3 (severe) is reported.
Also, the likelihood of its association with antidepressants is assessed with a yes/no question.
Single side-effects scores are summed to obtain a total score (ranging from 0 to 63).
|
6 months
|
Number of participants with a reduction of at least 50% of the baseline score of the MADRS (responders)
Time Frame: 6 months
|
The number of participants with a reduction of at least 50% of the baseline score of the Montgomery-Åsberg Depression Rating Scale (MADRS).
The MADRS is a validated rating scale, administered by the clinician, measuring the occurrence and severity of 10 symptomatic dimensions of depression.
For each dimension, a score between 0 (normal, no symptoms) to 6 (severely impaired) is reported.
Single scores for each dimension are summed to obtain a total score (ranging from 0 to 60).
|
6 months
|
Efficacy on depressive symptoms as assessed by the MADRS
Time Frame: 6 months
|
Mean change scores at MADRS.
The MADRS is a validated rating scale, administered by the clinician, measuring the occurrence and severity of 10 symptomatic dimensions of depression.
For each dimension, a score between 0 (normal, no symptoms) to 6 (severely impaired) is reported.
Single scores for each dimension are summed to obtain a total score (ranging from 0 to 60).
|
6 months
|
Quality of life as assessed by the EQ-5D
Time Frame: 6 months
|
Mean change scores at the EQ-5D.
The EQ-5D is a validated rating scale, self-administered, measuring the quality of life according to 5 dimensions.
In addition, the overall health status on the day of the interview is measured on a visual analogue scale ranging from 0 (worst possible health status) to 100 (best possible health status).
When interpreting the scale, dimensions are to be considered separately and not summed in a total score.
|
6 months
|
Cognitive performance as assessed by the SBT
Time Frame: 6 months
|
Mean change scores at the Short Blessed Scale (SBT).
The SBT is a validated rating scale, administered by the clinician, measuring the cognitive performance.
The SBT is a screening tool that aids in detecting early cognitive changes associated with dementia disorders.
Further testing is warranted if dementia is suspected, the SBT should not be used to diagnose dementia.
This is a weighted six-item instrument that evaluates orientation, registration, and attention.
|
6 months
|
Collaborators and Investigators
Collaborators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Mood Disorders
- Depressive Disorder
- Depressive Disorder, Major
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Enzyme Inhibitors
- Tranquilizing Agents
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Serotonin Agents
- Antidepressive Agents
- Serotonin 5-HT1 Receptor Agonists
- Serotonin Receptor Agonists
- Serotonin Antagonists
- Anti-Anxiety Agents
- Cytochrome P-450 Enzyme Inhibitors
- Antidepressive Agents, Second-Generation
- Cytochrome P-450 CYP2D6 Inhibitors
- Serotonin 5-HT3 Receptor Antagonists
- Cytochrome P-450 CYP1A2 Inhibitors
- Cytochrome P-450 CYP2C19 Inhibitors
- Selective Serotonin Reuptake Inhibitors
- Sertraline
- Citalopram
- Paroxetine
- Vortioxetine
- Fluoxetine
- Fluvoxamine
- Escitalopram
Other Study ID Numbers
- 2016-0234923
- 2018-001444-66 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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