A 6-Month Open-Label Extension Study of Vortioxetine in Pediatric Patients with Depressive or Anxiety Disorders

Abstract

Objectives: In this 6-month open-label extension (OLE) of NCT01491035 (a 14-day, open-label, pharmacokinetic/safety lead-in study), the long-term safety and tolerability of vortioxetine (5-20 mg/day) were investigated in children and adolescents with a DSM-IV-TR™ diagnosis of depressive or anxiety disorder in the United States or Germany. The study also was designed to provide data to inform dose selection and titration in future pediatric studies with vortioxetine.

Methods: Safety evaluations included spontaneously reported adverse events (AEs), the Columbia Suicide Severity Rating Scale (C-SSRS), and the Pediatric Adverse Events Rating Scale (PAERS; clinician administered). Clinical effectiveness was determined by Clinical Global Impressions. Comorbid attention-deficit/hyperactivity disorder was permitted, including concomitant use of stimulant medication (US sites only).

Results: Of the 47 patients who completed the lead-in period, 41 continued into the OLE. Most patients (n = 39 [95%]) continued their previous dose regimen. Twenty-one patients (51%) withdrew during the OLE; the most common primary reasons were administrative [n = 8], AEs [n = 4], and lack of efficacy [n = 3]. Thirty-five patients (85%) had ≥1 AE, 86% of which were mild or moderate in severity. Five patients (12%) reported a severe AE, none of which was considered related to study medication. The most common AEs (≥10%) were headache (27%), nausea (20%), dysmenorrhea (females; 19%), and vomiting (15%), with no relationship between AE intensity and age or dose. Five patients reported instances of suicidal ideation during the OLE, one of whom also reported this during the lead-in period. Two patients had nonsuicidal self-injurious behavior; one had a nonfatal suicide attempt. Throughout the study, there was a decrease over time in the incidence and intensity of AEs collected using the PAERS. Effectiveness assessment indicated a trend toward improvement based on numeric results.

Conclusion: This OLE confirms the findings from the lead-in study, which concluded that a dosing strategy of 5-20 mg/day is safe, well tolerated, and suitable for future clinical studies of vortioxetine in pediatric patients.

Keywords: adolescents; antidepressant; anxiety; children; depression; dosing; long-term safety; pediatric patients; vortioxetine.

Figures

FIG. 1.

Distribution of patients according to highest intensity of any PAERS symptom by visit (OC). Patients affected by ≥1 PAERS symptom: baseline, n = 38; week 2 (end of lead-in treatment period), n = 37; and week 26 (end of OLE treatment period), n = 15. PAERS, Pediatric Adverse Events Rating Scale; OC, observed cases; OLE, open-label extension.

FIG. 2.

Mean CGI-S score during the lead-in period (days 1–14) and extension period (days 14–182) in children and adolescents (OC). LOCF reported for day 182. CGI-S, Clinical Global Impressions–Severity of Illness; LOCF, last observation carried forward; OC, observed cases.

FIG. 3.

Mean CGI-I score during the lead-in period (days 1–14) and extension period (days 14–182) in children and adolescents (OC). LOCF reported for day 182. *CGI-I is scored based on change; therefore, no score can be reported for day 1. CGI-I, Clinical Global Impressions–Improvement; LOCF, last observation carried forward; OC, observed cases.