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    Clinical Trial Results:
    A Phase 3 Multicenter Study of the Long-term Safety and Tolerability of ALKS 5461 for the Adjunctive Treatment of Major Depressive Disorder in Adults who Have an Inadequate Response to Antidepressant Therapy (the FORWARD-2 Study)

    Summary
    EudraCT number
    2014-000380-41
    Trial protocol
    HU   DE   SK   BG   PL  
    Global end of trial date
    20 Nov 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    06 Dec 2018
    First version publication date
    06 Dec 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ALK5461-208
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02141399
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Alkermes, Inc.
    Sponsor organisation address
    852 Winter Street, Waltham, United States, 02451
    Public contact
    Eva Stroynowski, Alkermes, Inc., +1 781-609-7000, eva.stroynowski@alkermes.com
    Scientific contact
    Eva Stroynowski, Alkermes, Inc., +1 781-609-7000, eva.stroynowski@alkermes.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    15 Oct 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    20 Nov 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    20 Nov 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the long-term safety and tolerability of ALKS 5461 for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD)
    Protection of trial subjects
    All subjects received ALKS 5461 during the course of the study as an adjunctive treatment for major depressive disorder. All subjects took ALKS 5461 along with antidepressant therapy (ADT) prescribed by the investigator.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    14 May 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Canada: 54
    Country: Number of subjects enrolled
    United States: 1204
    Country: Number of subjects enrolled
    Australia: 35
    Country: Number of subjects enrolled
    Poland: 33
    Country: Number of subjects enrolled
    Bulgaria: 88
    Country: Number of subjects enrolled
    Germany: 66
    Country: Number of subjects enrolled
    Hungary: 5
    Worldwide total number of subjects
    1485
    EEA total number of subjects
    192
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    1403
    From 65 to 84 years
    82
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects were entered into the study in one of 3 ways, based upon their previous experience with ALKS 5461: Subjects continuing from an ALKS 5461 lead-in study; Subjects who participated in the prospective lead-in for an ALKS 5461 lead-in study, but did not meet the entrance criteria; Subjects who were not randomized in a lead-in study.

    Pre-assignment
    Screening details
    All subjects received ALKS 5461 during the course of the study as an adjunctive treatment for major depressive disorder. All subjects took ALKS 5461 along with antidepressant therapy (ADT) prescribed by the investigator.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    This was an open-label study; no blinding occurred.

    Arms
    Arm title
    ALKS 5461
    Arm description
    ALKS 5461 adjunctive treatment
    Arm type
    Experimental

    Investigational medicinal product name
    ALKS 5461
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    2 mg buprenorphine:2 mg samidorphan, taken once daily (in addition to open-label treatment with a commercially available antidepressant)

    Number of subjects in period 1
    ALKS 5461
    Started
    1485
    Completed
    741
    Not completed
    744
         Adverse event, serious fatal
    2
         Consent withdrawn by subject
    238
         Physician decision
    17
         Adverse event, non-fatal
    156
         Failure to meet eligibility criteria
    14
         Not specified
    45
         Pregnancy
    3
         Non-compliance with study drug
    18
         Lost to follow-up
    151
         Lack of efficacy
    62
         Protocol deviation
    38

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    ALKS 5461
    Reporting group description
    ALKS 5461 adjunctive treatment

    Reporting group values
    ALKS 5461 Total
    Number of subjects
    1485 1485
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    1403 1403
        From 65-84 years
    82 82
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    46.5 ( 12.27 ) -
    Gender categorical
    Units: Subjects
        Female
    964 964
        Male
    521 521

    End points

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    End points reporting groups
    Reporting group title
    ALKS 5461
    Reporting group description
    ALKS 5461 adjunctive treatment

    Primary: Incidence of adverse events

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    End point title
    Incidence of adverse events [1]
    End point description
    Safety and tolerability were assessed by the incidence of adverse events.
    End point type
    Primary
    End point timeframe
    Up to 56 weeks
    Notes
    [1] - 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: No statistical analysis was conducted for this measure
    End point values
    ALKS 5461
    Number of subjects analysed
    1485
    Units: Incidence of Adverse Events
    1124
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Up to 56 weeks
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    ALKS 5461
    Reporting group description
    Subjects who received at least 1 dose of study drug.

    Serious adverse events
    ALKS 5461
    Total subjects affected by serious adverse events
         subjects affected / exposed
    47 / 1485 (3.16%)
         number of deaths (all causes)
    2
         number of deaths resulting from adverse events
    2
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Uterine leiomyoma
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Breast cancer
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Oesophageal adenocarcinoma
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Seminoma
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Phlebitis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Abortion spontaneous
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Abortion missed
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ectopic pregnancy
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Chest pain
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Reproductive system and breast disorders
    Endometriosis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Menometrorrhagia
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Menorrhagia
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Uterine prolapse
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vaginal prolapse
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pulmonary oedema
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory arrest
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    1 / 1
    Psychiatric disorders
    Depression
         subjects affected / exposed
    3 / 1485 (0.20%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Suicidal ideation
         subjects affected / exposed
    3 / 1485 (0.20%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Major depression
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Conversion disorder
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mental status changes
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychotic disorder
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Suicide attempt
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Alcohol poisoning
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ankle fracture
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Ligament sprain
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Post procedural complication
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Wrist fracture
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Myocardial infarction
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac failure congestive
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sinus tachycardia
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Colitis
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Duodenal ulcer
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastric ulcer haemorrhage
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholelithiasis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Tubulointerstitial nephritis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Lumbar spinal stenosis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 1485 (0.13%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Appendicitis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cellulitis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Meningitis viral
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteomyelitis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Otitis media
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pyelonephritis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Diabetic ketoacidosis
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Malnutrition
         subjects affected / exposed
    1 / 1485 (0.07%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    ALKS 5461
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    1124 / 1485 (75.69%)
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    150 / 1485 (10.10%)
         occurrences all number
    179
    Headache
         subjects affected / exposed
    156 / 1485 (10.51%)
         occurrences all number
    198
    Somnolence
         subjects affected / exposed
    124 / 1485 (8.35%)
         occurrences all number
    142
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    85 / 1485 (5.72%)
         occurrences all number
    91
    Gastrointestinal disorders
    Constipation
         subjects affected / exposed
    151 / 1485 (10.17%)
         occurrences all number
    173
    Dry mouth
         subjects affected / exposed
    87 / 1485 (5.86%)
         occurrences all number
    95
    Nausea
         subjects affected / exposed
    322 / 1485 (21.68%)
         occurrences all number
    409
    Vomiting
         subjects affected / exposed
    116 / 1485 (7.81%)
         occurrences all number
    134
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    81 / 1485 (5.45%)
         occurrences all number
    90
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    80 / 1485 (5.39%)
         occurrences all number
    88
    Upper respiratory tract infection
         subjects affected / exposed
    83 / 1485 (5.59%)
         occurrences all number
    98

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Apr 2014
    Clarified study procedures to avoid ambiguity and improve acceptability in a global setting.
    12 May 2015
    Adjusted the number of subjects to be enrolled in the study, and clarified procedures and requirements.
    03 Mar 2016
    Adjusted the requirements for pharmacokinetic sampling

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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