E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Major depressive disorder |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10025453 |
E.1.2 | Term | Major depressive disorder NOS |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
This study has two primary objectives: (1) to test the hypothesis that time to confirmed response is shorter in the early intervention strategy vs. the delayed intervention strategy, among patients identified as suffering from MDD with a lack of improvement after 4 weeks of escitalopram treatment (2) to test the hypothesis that time to confirmed remission will be shorter in the early compared with the delayed strategy. |
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E.2.2 | Secondary objectives of the trial |
To compare the efficacy of both intervention strategies as measured by time to: oConfirmed response as defined by ≥50% reduction in baseline QIDS-SR oConfirmed remission as defined by a QIDS-SR score of ≤5 that is maintained for two consecutive visits •To compare the efficacy throughout the study as measured by the CGI-S rating scale. •To compare the improvement of painful symptoms as measured by the VAS score for overall pain severity. •To identify clinical and demographic predictors of earlier time to response and remission as measured by the HAMD17 •To compare the functional improvement as measured by the SDS •To compare the improvement as measured by the CPFQ •To compare the direct and indirect costs by collecting resource utilisation data •To compare the quality of life changes as measured by the EQ-5D •To compare the safety of early intervention strategy with delayed intervention strategy as measured by both unsolicited TEAE and SAEs
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
(1] Male or female outpatients of at least 18 years of age who meet criteria for MDD, single or recurrent episode according to the DSM-IV®-TR disease diagnostic criteria. [2] Patients (receiving or not antidepressant treatment) who, based on investigator criteria, initiate treatment with escitalopram or change their current AD treatment to escitalopram for this current MDD episode, at Visit 1. [3] Must have a baseline score of ≥19 on the HAM-D17 at visit 1. [4] Must have a baseline score of ≥ 4 in the Clinical Global Impression- Severity (CGI-S) at visit 1. [5] Have a level of understanding sufficient to provide ICD, and to communicate with the investigators and site personnel. [6] Are judged to be reliable and agree to keep all appointments for clinic visits and procedures required by the protocol.
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E.4 | Principal exclusion criteria |
[7] Have any current primary Axis I disorder other than MDD [8] Have a diagnosis of dementia, Alzheimer’s disease, or organic brain syndrome; or who are cognitively impaired or who have language problems that prevent them from understanding and/or providing valid answers to the rating scale contents. [9] Concomitant participation in other studies with investigational or marketed products. [10] Are not expected to be able to be monitored throughout the entire study period for reasons unrelated to their illness [11] Are demonstrating a response or demonstrated a response to the AD treatment for the current depression episode previous to baseline visit [12] Are investigator site personnel directly affiliated with this study and/or their immediate families [13] Are employed by Lilly or Boehringer Ingelheim (BI) [14] Women of childbearing potential who are not using a medically accepted means of contraception. Women who are pregnant or breast-feeding may not participate in the study. [15] Have received treatment within the last 30 days with a drug that has not received regulatory approval for any indication at the time of study entry. [16] Are judged to be at serious suicidal risk in the opinion of the investigator, and/or if the patient’s baseline (visit 1) HAMD17 scores on item 3 suicide are 3. [17] Have been treated with a MAOI within 14 days prior to visit 1 or potential need to use an MAOI during the study or within 5 days after discontinuation of study drug. [18] Require initiation or discontinuation of psychotherapy within 6 weeks prior to enrollment [19] Have any contraindication for the use of duloxetine or escitalopram based on Duloxetine and Escitalopram SPC. [20] Have a history of lack of response to duloxetine or escitalopram at a clinically appropriate dose for a minimum of 4 weeks, or have previously completed or withdrawn from this study or any other study investigating duloxetine or escitalopram. [21] Have any previous diagnosis of psychotic disorders. [22] Have DSM-IV-defined history of substance abuse or dependence within the past year, excluding nicotine and caffeine [23] Have serious or unstable cardiovascular, hepatic, renal, respiratory or hematological illness; symptomatic peripheral vascular disease; or other medical or psychological conditions that, in the opinion of the investigator, would compromise participation or be likely to require hospitalization during the course of the study. [24] Have had ECT or Transcranial Magnetic Stimulation within the past year
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E.5 End points |
E.5.1 | Primary end point(s) |
Time to confirmed response is defined as the time from the day of study randomization (visit 2) to the date of first observation of confirmed response defined as a >or=50% baseline score reduction on the HAMD17 for two consecutive visits. Time to confirmed remission is defined as the time from the day of study randomization (visit 2) to the date of first observation of confirmed remission defined as a score on the HAMD17 of ≤7 for two consecutive visits.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
early intervention strategy vs late intervention strategy |
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E.8.3 |
The trial involves single site in the Member State concerned
| Information not present in EudraCT |
E.8.4 | The trial involves multiple sites in the Member State concerned | Information not present in EudraCT |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 59 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Last visit of the last subject undergoing the trial |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 7 |