Clinical Trial Results:
A Phase IIa, Multicenter, Randomized, Placebo-Controlled Clinical Trial to Evaluate the Safety and Efficacy of MK-6096 for Treatment Augmentation in Patients with Major Depressive Disorder
Summary
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EudraCT number |
2011-005200-15 |
Trial protocol |
DE FI SE NO |
Global end of trial date |
03 Sep 2013
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Results information
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Results version number |
v2 |
This version publication date |
10 Jun 2016
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First version publication date |
21 Jan 2015
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Other versions |
v1 , v3 |
Version creation reason |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
6096-022
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT01554176 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Merck Sharp & Dohme Corp.
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Sponsor organisation address |
2000 Galloping Hill Road, Kenilworth, NJ, United States, 07033
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Public contact |
Clinical Trials Disclosure, Merck Sharp & Dohme Corp., ClinicalTrialsDisclosure@merck.com
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Scientific contact |
Clinical Trials Disclosure, Merck Sharp & Dohme Corp., ClinicalTrialsDisclosure@merck.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
03 Sep 2013
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
03 Sep 2013
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Global end of trial reached? |
Yes
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Global end of trial date |
03 Sep 2013
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
The purpose of this study is to evaluate the safety and efficacy of filorexant (MK-6096) versus placebo as adjunctive treatment for major depressive disorder (MDD), in participants who are partial responders to antidepressant monotherapy with one of identified selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), or bupropion. The primary hypothesis of the study is that filorexant is superior to placebo as augmentation therapy with respect to change from baseline to Week 6 in the Montgomery Asberg Depression Rating Scale (MADRS) total score. Participants will be randomized to receive filorexant or placebo for a 6-week treatment phase. After completion of the treatment phase, during a 2-week run-out phase participants who received placebo in the treatment phase will continue to receive placebo and those who received filorexant in the treatment phase will receive either filorexant or placebo.
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Protection of trial subjects |
This study was conducted in conformance with Good Clinical Practice standards and applicable country and/or local statutes and regulations regarding ethical committee review, informed consent, and the protection of human subjects participating in biomedical research.
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Background therapy |
Participants will continue to take their pretrial antidepressant medication as prescribed throughout the trial. | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
18 May 2012
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Norway: 3
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Country: Number of subjects enrolled |
Sweden: 6
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Country: Number of subjects enrolled |
Finland: 15
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Country: Number of subjects enrolled |
France: 19
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Country: Number of subjects enrolled |
Germany: 34
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Country: Number of subjects enrolled |
United States: 52
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Worldwide total number of subjects |
129
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EEA total number of subjects |
77
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
129
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
- | ||||||||||||||||||||||||||||||||||||
Pre-assignment
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Screening details |
During the 1-2 week screening period participants will be evaluated to determine if they meet study entry criteria. The screening period will serve as a wash-out period for participants taking prohibited medications. | ||||||||||||||||||||||||||||||||||||
Period 1
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Period 1 title |
Treatment Phase
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||||||||||||||||||||
Roles blinded |
Subject, Investigator | ||||||||||||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Filorexant 10 mg (Treatment Phase) | ||||||||||||||||||||||||||||||||||||
Arm description |
Treatment Phase: Participants in this group were administered filorexant 10 mg once daily at bedtime for 6 weeks. | ||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
filorexant
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Investigational medicinal product code |
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Other name |
MK-6096
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Filorexant, one 10 mg tablet, orally, once daily at bedtime
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Arm title
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Placebo (Treatment Phase) | ||||||||||||||||||||||||||||||||||||
Arm description |
Treatment Phase: Participants in this group were administered placebo once daily at bedtime for 6 weeks. | ||||||||||||||||||||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Placebo, one tablet, orally, once daily at bedtime
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Period 2
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Period 2 title |
Run-out Phase
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Is this the baseline period? |
No | ||||||||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | ||||||||||||||||||||||||||||||||||||
Roles blinded |
Subject, Investigator | ||||||||||||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Filorexant 10 mg/Filorexant 10 mg (Run-out Phase) | ||||||||||||||||||||||||||||||||||||
Arm description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered filorexant 10 mg once daily at bedtime for 2 weeks. Participants in this group had received filorexant 10 mg once daily during the treatment phase. | ||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
filorexant
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Investigational medicinal product code |
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Other name |
MK-6096
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Filorexant, one 10 mg tablet, orally, once daily at bedtime
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Arm title
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Filorexant 10 mg/Placebo (Run-out Phase) | ||||||||||||||||||||||||||||||||||||
Arm description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered placebo once daily at bedtime for 2 weeks. Participants in this group had received filorexant 10 mg once daily during the treatment phase. | ||||||||||||||||||||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Placebo, one tablet, orally, once daily at bedtime
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Arm title
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Placebo/Placebo (Run-out Phase) | ||||||||||||||||||||||||||||||||||||
Arm description |
Run-out Phase: Following completion of the 6-week Treatment Phase, participants in this group were administered placebo once daily at bedtime for 2 weeks. Participants in this group had received placebo once daily during the Treatment Phase. | ||||||||||||||||||||||||||||||||||||
Arm type |
Placebo | ||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Tablet
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Routes of administration |
Oral use
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Dosage and administration details |
Placebo, one tablet, orally, once daily at bedtime
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Baseline characteristics reporting groups
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Reporting group title |
Filorexant 10 mg (Treatment Phase)
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Reporting group description |
Treatment Phase: Participants in this group were administered filorexant 10 mg once daily at bedtime for 6 weeks. | ||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo (Treatment Phase)
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Reporting group description |
Treatment Phase: Participants in this group were administered placebo once daily at bedtime for 6 weeks. | ||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Filorexant 10 mg (Treatment Phase)
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Reporting group description |
Treatment Phase: Participants in this group were administered filorexant 10 mg once daily at bedtime for 6 weeks. | ||
Reporting group title |
Placebo (Treatment Phase)
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Reporting group description |
Treatment Phase: Participants in this group were administered placebo once daily at bedtime for 6 weeks. | ||
Reporting group title |
Filorexant 10 mg/Filorexant 10 mg (Run-out Phase)
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Reporting group description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered filorexant 10 mg once daily at bedtime for 2 weeks. Participants in this group had received filorexant 10 mg once daily during the treatment phase. | ||
Reporting group title |
Filorexant 10 mg/Placebo (Run-out Phase)
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Reporting group description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered placebo once daily at bedtime for 2 weeks. Participants in this group had received filorexant 10 mg once daily during the treatment phase. | ||
Reporting group title |
Placebo/Placebo (Run-out Phase)
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Reporting group description |
Run-out Phase: Following completion of the 6-week Treatment Phase, participants in this group were administered placebo once daily at bedtime for 2 weeks. Participants in this group had received placebo once daily during the Treatment Phase. |
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End point title |
Change from Baseline to Week 6 in MADRS Total Score | ||||||||||||||||||
End point description |
The MADRS is a 10-item clinician-rated instrument for evaluating severity of symptoms of depression. Each item is rated on a scale from 0 to 6, with higher scores indicating greater symptom severity. The MADRS total score for each participant was calculated as the sum of the rating assigned to each of the 10 MADRS items, and ranged from 0 to 60 with a higher score indicating greater severity of symptoms. A MADRS total score >30 or 35 indicates severe depression, while a total score ≤10 indicates remission. The reported measure is the change from baseline to Week 6; improvement in symptoms is represented by negative values.
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End point type |
Primary
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End point timeframe |
Baseline and Week 6
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Notes [1] - Includes participants who took ≥1 dose of study drug and had baseline and Week 6 value [2] - Includes participants who took ≥1 dose of study drug and had baseline and Week 6 value |
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Statistical analysis title |
Change from Baseline in MADRS Total Score - Week 6 | ||||||||||||||||||
Statistical analysis description |
Number of participants included for calculation of mean ± SD baseline and mean ± SD change from baseline MADRS Total Score is 119. Constrained longitudinal data analysis (cLDA) model uses efficacy Full Analysis Set (FAS) population (number of participants: filorexant 10 mg – 64, placebo – 64; total number of participants in cLDA analysis – 128). FAS includes participants who took ≥1 dose of study drug and had ≥1 evaluable efficacy measurement, including those who had only a baseline measurement.
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Comparison groups |
Filorexant 10 mg (Treatment Phase) v Placebo (Treatment Phase)
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Number of subjects included in analysis |
119
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Analysis specification |
Pre-specified
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Analysis type |
superiority | ||||||||||||||||||
P-value |
= 0.679 [3] | ||||||||||||||||||
Method |
Constrained longitudinal data analysis | ||||||||||||||||||
Parameter type |
Difference in least squares means | ||||||||||||||||||
Point estimate |
-0.7
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Confidence interval |
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level |
95% | ||||||||||||||||||
sides |
2-sided
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lower limit |
-3.8 | ||||||||||||||||||
upper limit |
2.5 | ||||||||||||||||||
Notes [3] - cLDA model included terms for treatment, time, the interaction of time by treatment, severity of disease (Hamilton Depression Rating Scale, 17-items [HAM-D17] ≤20, >20) and insomnia severity index (ISI ≤14, >14). |
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End point title |
Number of Participants With an Adverse Event (AE) During Treatment Phase | |||||||||
End point description |
An AE is any unfavorable and unintended change in the structure, function or chemistry of the body temporally associated with study drug administration, whether or not considered related to the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with study drug administration, is also an AE. Participants with one or more AEs during the treatment phase (up to study Week 6) are counted once in this summary.
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End point type |
Primary
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End point timeframe |
Up to Week 6
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Notes [4] - Includes participants who took ≥1 dose of study drug [5] - Includes participants who took ≥1 dose of study drug |
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Statistical analysis title |
Participants with AEs During Treatment Phase | |||||||||
Statistical analysis description |
Estimated parameter is between-group difference in percentage of participants with an AE = percentage (filorexant 10 mg) − percentage (placebo)
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Comparison groups |
Filorexant 10 mg (Treatment Phase) v Placebo (Treatment Phase)
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Number of subjects included in analysis |
128
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Analysis specification |
Pre-specified
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Analysis type |
other [6] | |||||||||
Method |
Miettinen & Nurminen | |||||||||
Parameter type |
Difference in percentage incidence | |||||||||
Point estimate |
15.6
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
-0.9 | |||||||||
upper limit |
31.4 | |||||||||
Notes [6] - Between-group comparison of AE incidence rate |
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End point title |
Number of Participants Who Discontinued Study Drug Due to an AE During Treatment Phase | |||||||||
End point description |
An AE is any unfavorable and unintended change in the structure, function or chemistry of the body temporally associated with study drug administration, whether or not considered related to the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with study drug administration, is also an AE. Participants who discontinued study drug treatment due to an AE during the treatment phase (up to study Week 6) are counted once in this summary.
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End point type |
Primary
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End point timeframe |
Up to Week 6
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Notes [7] - Includes participants who received ≥1 dose of study drug [8] - Includes participants who received ≥1 dose of study drug |
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Statistical analysis title |
Drug Discontinuation Due to AE (Treatment Phase) | |||||||||
Statistical analysis description |
Estimated parameter is between-group difference in percentage of participants discontinued from study drug due to an AE = percentage (filorexant 10 mg) − percentage (placebo)
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Comparison groups |
Filorexant 10 mg (Treatment Phase) v Placebo (Treatment Phase)
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Number of subjects included in analysis |
128
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Analysis specification |
Pre-specified
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Analysis type |
other [9] | |||||||||
Method |
Miettinen & Nurminen | |||||||||
Parameter type |
Difference in percentage incidence | |||||||||
Point estimate |
0
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Confidence interval |
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level |
95% | |||||||||
sides |
2-sided
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lower limit |
-7 | |||||||||
upper limit |
7 | |||||||||
Notes [9] - Between-group comparison of incidence rate of drug discontinuation due to AE |
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End point title |
Number of Participants With an AE During Run-out Phase [10] | ||||||||||||
End point description |
An AE is any unfavorable and unintended change in the structure, function or chemistry of the body temporally associated with study drug administration, whether or not considered related to the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with study drug administration, is also an AE. Participants with one or more AEs during the 2-week run-out phase and/or during the 2-week follow up after the last dose of study drug, are counted once in this summary.
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End point type |
Primary
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End point timeframe |
From first run-out dose (following Week 6 visit) up to 14 days after last dose of study drug (approximately 4 weeks)
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Notes [10] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Statistical analysis was not performed for this endpoint (number of participants with AEs) in run-out phase, as the principal time frame of interest for this measure is the 6-week treatment phase. A statistical analysis is reported for number of participants with AEs in treatment phase. |
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Notes [11] - Includes participants who took ≥1 dose of study drug in run-out phase [12] - Includes participants who took ≥1 dose of study drug in run-out phase [13] - Includes participants who took ≥1 dose of study drug in run-out phase |
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No statistical analyses for this end point |
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End point title |
Number of Participants Who Discontinued Study Drug Due to an AE During Run-out Phase [14] | ||||||||||||
End point description |
An AE is any unfavorable and unintended change in the structure, function or chemistry of the body temporally associated with study drug administration, whether or not considered related to the study drug. Any worsening (i.e., any clinically significant adverse change in frequency and/or intensity) of a preexisting condition which is temporally associated with study drug administration, is also an AE. Participants who discontinued study drug treatment due to an AE during the 2-week run-out phase are counted once in this summary.
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End point type |
Primary
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End point timeframe |
From first run-out dose (following Week 6 visit) up to Week 8 (2 weeks)
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Notes [14] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Statistical analysis was not performed for this endpoint (number of participants with study drug discontinuations due to AEs) in run-out phase, as the principal time frame of interest for this measure is the 6-week treatment phase. A statistical analysis is reported for number of participants with study drug discontinuations due to AEs in treatment phase. |
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Notes [15] - Includes participants who took ≥1 dose of study drug in run-out phase [16] - Includes participants who took ≥1 dose of study drug in run-out phase [17] - Includes participants who took ≥1 dose of study drug in run-out phase |
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No statistical analyses for this end point |
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End point title |
Change from Baseline to Week 6 in MADRS Total Score Excluding the Sleep Item | ||||||||||||
End point description |
The MADRS is a 10-item clinician-rated instrument for evaluating severity of symptoms of depression. Each item is rated on a scale from 0 to 6, with higher scores indicating greater symptom severity. The MADRS total score excluding the sleep item for each participant was calculated as the sum of the rating assigned to 9 of the 10 MADRS items (rating for the item “Reduced Sleep” was excluded), and ranged from 0 to 54 with a higher score indicating greater severity of symptoms. The reported measure is the change from baseline to Week 6; improvement in symptoms is represented by negative values.
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End point type |
Secondary
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End point timeframe |
Baseline and Week 6
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Notes [18] - Not analyzed: primary efficacy not positive; study ended early with enrollment less than planned [19] - Not analyzed: primary efficacy not positive; study ended early with enrollment less than planned |
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No statistical analyses for this end point |
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End point title |
Change from Baseline to Week 6 in the Hamilton Depression Rating Scale, 17-item Version (HAM-D17) Bech Subscale Score | ||||||||||||
End point description |
The HAM-D, an instrument for evaluating severity of symptoms of depression, was completed by the participant. The instrument used in this study was the 17-item version (HAM-D17). Each item is rated on either a 3-point (0 to 2) or a 5-point scale (0 to 4), with higher scores indicating greater symptom severity. The Bech subscale of the HAM-D17 is composed of 6 identified items out of the 17 items rated. The Bech subscale score is the sum for a participant of the 6 items in the subscale, and ranged from 0 to 22 with a higher score indicating greater severity of symptoms. The reported measure is the change from baseline to Week 6; improvement in symptoms is represented by negative values.
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End point type |
Secondary
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End point timeframe |
Baseline and Week 6
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Notes [20] - Not analyzed: primary efficacy not positive; study ended early with enrollment less than planned [21] - Not analyzed: primary efficacy not positive; study ended early with enrollment less than planned |
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No statistical analyses for this end point |
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End point title |
Percentage of Participants with HAM-D17 Remission (HAM-D17 Total Score ≤7) at Week 6 | |||||||||
End point description |
The HAM-D, an instrument for evaluating severity of symptoms of depression, was completed by the participant. The instrument used in this study was the 17-item version (HAM-D17). Each item is rated on either a 3-point (0 to 2) or a 5-point scale (0 to 4), with higher scores indicating greater symptom severity. The HAM-D17 total score for each participant was calculated as the sum of the rating assigned to each of the 17 HAM-D items, and ranged from 0 to 54 with a higher score indicating greater severity of symptoms. A participant with HAM-D17 total score ≤7 at Week 6 was defined to have achieved HAM-D17 remission.
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End point type |
Secondary
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End point timeframe |
Week 6
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Notes [22] - Not analyzed: primary efficacy not positive; study ended early with enrollment less than planned [23] - Not analyzed: primary efficacy not positive; study ended early with enrollment less than planned |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
Treatment Phase: Up to Week 6 Run-out Phase: From first run-out dose (following Week 6 visit) up to 14 days after last dose of study drug (approximately 4 weeks)
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Adverse event reporting additional description |
The 2 treatment phase reporting groups include the total treated study population. The 3 run-out phase groups present those in total treated study population by their randomized assignment during the run-out phase.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
16.0
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Reporting groups
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Reporting group title |
Placebo (Treatment Phase)
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Reporting group description |
Treatment Phase: Participants in this group were administered placebo once daily at bedtime for 6 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Filorexant 10 mg (Treatment Phase)
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Reporting group description |
Treatment Phase: Participants in this group were administered filorexant 10 mg once daily at bedtime for 6 weeks. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Filorexant 10 mg/Filorexant 10 mg (Run-out Phase)
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Reporting group description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered filorexant 10 mg once daily at bedtime for 2 weeks. Participants in this group had received filorexant 10 mg once daily during the treatment phase. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Filorexant 10 mg/Placebo (Run-out Phase)
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Reporting group description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered placebo once daily at bedtime for 2 weeks. Participants in this group had received filorexant 10 mg once daily during the treatment phase. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo/Placebo (Run-out Phase)
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Reporting group description |
Run-out Phase: Following completion of the 6-week treatment phase, participants in this group were administered placebo once daily at bedtime for 2 weeks. Participants in this group had received placebo once daily during the treatment phase. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||||||
Date |
Amendment |
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18 Jun 2012 |
Amendment 02: Primary reason for amendment was to incorporate revisions to eligibility criteria and timing of HAM-D assessment at screening. |
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14 Dec 2012 |
Amendment 03: Primary reason for amendment was to incorporate revisions to eligibility criteria, which were intended to address issue of slow rate of enrollment of participants in the study. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? Yes | |||||||
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Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||||||
None reported |