E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Major Depressive Disorder |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Psychiatry and Psychology [F] - Mental Disorders [F03] |
MedDRA Classification |
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 |
The primary objective is to demonstrate the efficacy of SPD489 when used as augmentation therapy in the treatment of major depressive disorder (MDD) in inadequate responders following an 8-week course of treatment with an antidepressant, as measured by the mean change in Montgomery-Ǻsberg Depression Rating Scale (MADRS) total scores. |
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E.2.2 | Secondary objectives of the trial |
The key secondary objective is to demonstrate the effect of SPD489, when used as augmentation therapy in the treatment of MDD in inadequate responders following an 8-week course of treatment with an antidepressant, on quality of life (QoL) as measured by the Sheehan Disability Scale (SDS).
Additional secondary objectives are described in the Protocol. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subject has a primary diagnosis of non-psychotic major depressive disorder (single or recurrent) as defined by the Structured Clinical Interview for DSM-IV-TR disorders – Axis-I (SCID-CT) that has lasted ≥8 weeks prior to the Screening Visit (Visit 1).
Subject has a Montgomery Asburg Depression Rating Scale (MADRS) total score ≥24 at the Lead-in Baseline Visit (Visit 2). |
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E.4 | Principal exclusion criteria |
- Subject whose current episode of MDD has not responded to an adequate treatment regimen (at least 6 weeks of treatment at the maximum tolerated adult dose approved for the indication) with 2 or more approved single antidepressant agents. Any subject whose current episode of MDD has not responded to an approved adjunctive treatment strategy is to be excluded.
- Subject who has a lifetime history of treatment-resistant depression, defined as having not responded to adequate treatment (at least 8 weeks of treatment at the maximum tolerated adult dose approved for the indication) with 2 or more treatment regimens, including, distinct classes of approved single antidepressant agents and adjunctive treatment strategies.
- Subject is considered a suicide risk in the opinion of the Investigator, has previously made a suicide attempt within the past 3 years, or is currently demonstrating active suicidal ideation.
- Subject has any current co-morbid psychiatric disorder that is either controlled with medications prohibited in this study or is uncontrolled and associated with significant symptoms. Excluded are: any significant Axis II disorders, any bipolar disorder, any current or lifetime psychosis, post-traumatic stress disorder, anorexia nervosa, and bulimia nervosa.
A history of serious cardiac problems that may place them at increased vulnerability to the sympathomimetic effects of a stimulant medication, a history of moderate to severe hypertension or an average (of 3 readings) resting sitting systolic blood pressure >139mmHg or an average (of 3 readings) diastolic blood pressure >89mmHg at the Screening Visit (Visit 1) and/or Lead-in Baseline Visit (Visit 2), or a concurrent chronic or acute illness or unstable medical condition that may deteriorate that could confound the results of safety assessments, increase risk to the subject, or lead to difficulty complying with the protocol. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Change from Augmentation Baseline Visit (Visit 8 [Week 8]) to Visit 14 (Week 16/Any) in Montgomery-Asberg Depression Rating Scale (MADRS) total score. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
• Randomized Subjects: Week -4 to -1, 0, 6, 8, 9, 10, 11, 12, 14, 16/Any
• Non-Randomized Subjects: Week -4 to -1, 0, 6, 8, 10, 12, 16/Any
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E.5.2 | Secondary end point(s) |
1) Change from the Augmentation Baseline Visit (Visit 8 [Week 8]) to Visit 14 (Week 16/Any) in Sheehan Disabillity Scale (SDS) total score.
2) Safety and tolerability as based on a) occurrence of treatment-emergent adverse events (TEAEs), b) response to Columbia Suicide Severity Rating Scale (C-SSRS), evaluations of blood pressure and pulse, c) clinical laboratory evalutions, and d) electrocardiograms (ECG)
3) Percent of Participants Achieving a 25% Response on the MADRS at Visit 14 (Week 16/Any)
4) Percent of Participants Achieving a 50% Response on the MADRS at Visit 14 (Week 16/Any)
5) Percent of Participants Achieving Remission on the MADRS at Visit 14 (Week 16/Any)
6) Change from Augmentation Baseline Visit (Visit 8 [Week 8]) over time in MADRS total score.
7) Change in Abbreviated Brief Assessment of Cognition Affective Disorders (ABAC-A)
8) Change from the Augmentation Baseline Visit (Visit 8 [Week 8]) to Visit 14 (Week 16/Any) in Short Form-12 Health Survey V2 (SF-12V2)
9) Change from the Augmentation Baseline Visit (Visit 8 [Week 8]) to Visit 14 (Week 16/Any) in EuroQoL Group 5-Dimension Self-Report Questionnaire (EQ-5D-5L index score)
10) Change from the Augmentation Baseline Visit (Visit 8 [Week 8]) to Visit 14 (Week 16/Any) in Changes in Sexual Functioning Questionnaire - 14 item Scale (CSFQ-14)
11) Clinical Global Impressions - Severity of Illness (CGI-S) at Visit 2 (Week 0) and Visit 8 (Week 8)
12) Change in Clinical Global Impressions - Global Improvement (CGI-I) at Visit 14 (Week 16/Any)
13) Change from the Augmentation Baseline Visit (Visit 8 [Week 8]) to Visit 14 (Week 16/Any) in Global Fatigue Index (GFI) in the Multidimensional Assessment of Fatigue (MAF)
14) Amphetamine Cessation Symptom Assessment (ACSA) at Visit 15 (Week 17/Any)
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1 )
• Randomized (R): Week (Wk) 0, 8, 9, 10, 11, 12, 14, 16/Any
• Non-randomized (NR): 0, 8, 10, 12, 16/Any
2a)
• R: Wk 8, 9, 10, 11, 12, 14, 16/Any, 17/Any
• NR: 8, 10, 12, 16/Any, 17/Any
2b)
• R: Wk -1 to -4, 0, 1, 2, 3, 4, 6, 8, 9, 10, 11, 12, 14, 16/Any, 17/Any
• NR: Wk -1 to -4, 0, 1, 2, 3, 4, 6, 8, 10, 12, 16/Any, 17/Any
2c)
• R & NR: Wk -4 to -1, 0, 8, 12, 16/Any
2d)
• R & NR: Wk -4 to -1, 0, 8, 16/Any
3-6)
• R: Wk -4 to -1, 0, 6, 8, 9, 10, 11, 12, 14, 16/Any
• NR: Wk -4 to -1, 0, 6, 8, 10, 12, 16/Any
7-10+13) R & NR: Wk 0, 8, 16/Any
11) R & NR: Wk 0 and 8
12)
• R: Wk 1, 2, 3, 4, 6, 8, 9, 10, 11, 12, 14, 16/Any
• NR: Wk 1, 2, 3, 4, 6, 8, 10, 12, and 16/Any
14) R & NR: Wk 17/Any
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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 | No |
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 | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
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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) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
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 | Yes |
E.8.1.7.1 | Other trial design description |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 39 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Czech Republic |
Germany |
Hungary |
Poland |
Romania |
South Africa |
United States |
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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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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 | |
E.8.9.1 | In the Member State concerned days | 14 |
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 | 8 |