E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Form of mental illness where patients experience major depressive episodes and at least one hypomania episode. |
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E.1.1.2 | Therapeutic area | Psychiatry and Psychology [F] - Mental Disorders [F03] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 26.1 |
E.1.2 | Level | HLGT |
E.1.2 | Classification code | 10026753 |
E.1.2 | Term | Manic and bipolar mood disorders and disturbances |
E.1.2 | System Organ Class | 10037175 - Psychiatric disorders |
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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 |
To determine the onset and 7-day durability of anti-depressive effects of a single-day IDR of 6 mg, 12 mg and 18 mg of GH001 in patients with bipolar II disorder and a current major episode of depression. |
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E.2.2 | Secondary objectives of the trial |
• To determine: o the effect on depressive symptoms and global clinical status; o the safety and tolerability; o the intensity and duration of the psychoactive effects (PsE); o the impact on sleep quality; o the impact on cognitive outcomes
Of a single-day IDR of 6 mg, 12 mg and 18 mg of GH001 in patients with bipolar II disorder and a current major episode of depression.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
4. Has a body mass index (BMI) in the range of 18.5 and 40 kg/m2 (inclusive) at screening. 5. Meets the trial criteria for bipolar II disorder and is experiencing a major depressive episode, as assessed by a trial psychiatrist or registered clinical psychologist: -Meets the DSM-5 diagnostic criteria for bipolar II disorder with a current major depressive episode confirmed by the Mini-International Neuropsychiatric Interview (MINI) v7.0.2 -Has a Montgomery-Asberg Depression Rating Scale (MADRS) total score of ≥ 24 at screening and prior to first dose on Day 0 8. Female patients must be either surgically sterile (hysterectomy, tubal ligation, or bilateral oophorectomy) or postmenopausal with amenorrhea for the last 2 years or remain completely abstinent (complete avoidance of heterosexual intercourse) or use a highly effective (failure rate <1%) medically accepted contraceptive method, including, but not limited to, hormone contraceptives that inhibit ovulation, intrauterine device (including hormone-releasing intrauterine device/systems) for 30 days before and 90 days after GH001 dosing and must have a negative serum pregnancy test at screening and a negative urine pregnancy test on the pre-test day (Day -1). 10. Is able to inhale 3 liters of air from the test balloon within a single breath at screening, on the pre-test day (Day -1) and prior to first dose (Day 0). An incentive spirometer will be given to patients following screening. They will be encouraged to practice deep inhalations prior to the first dose on the test day (Day 0). Patients failing the test inhalation at screening may have the test inhalations repeated within 14 days of the original screening date. |
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E.4 | Principal exclusion criteria |
2. Has, based on history, psychiatric assessment, and evaluation of the MINI, a current or prior diagnosis of bipolar I disorder, a manic episode, a psychotic disorder, major depressive disorder (MDD) or other mood disorder with psychotic features, obsessive compulsive disorder, post-traumatic stress disorder (PTSD), autism spectrum disorder, borderline personality disorder, schizophrenia, delusional disorder, paranoid personality disorder, schizoaffective disorder, clinically significant intellectual disability, or any other psychiatric comorbidity that renders the patient unsuitable for the trial according to the investigator’s judgment. 3. Has one or more first degree relatives with a current or previously diagnosed psychotic disorder, bipolar I disorder, or MDD with psychotic features. 4. Has significant suicide risk as defined by: (a) suicidal ideation as endorsed on items 4 or 5 on the C-SSRS within the past year, during the screening period, or at Baseline; or (b) suicidal behaviors within the past year; or (c) clinical assessment of significant suicidal risk during clinical interview; or (d) non-suicidal self-injury within the past year. 6. Has taken anti-depressive medication e.g., a selective serotonin reuptake inhibitor (SSRI) such as paroxetine, fluoxetine (including in combination with olanzapine) or citalopram, a serotonin and norepinephrine reuptake inhibitor (SNRI) such as venlafaxine or duloxetine, a tricyclic antidepressant (TCA) such as amitriptyline or imipramine, an antipsychotic such as quetiapine, an atypical antidepressant such as bupropion or vortioxetine, or an N-methyl-D-aspartate (NMDA) receptor antagonist such as esketamine, within 7 days or 5 half-lives (whichever is longer) prior to dosing (exception: within the last 5 weeks in the case of fluoxetine). Patients who at screening are on such medication and are willing to discontinue and observe a wash-out period of 7 days or 5 half-lives (whichever is longer) prior to GH001 dosing (5 weeks for fluoxetine), can still be included, but the wash-out must be implemented, completed and documented before study drug administration. Gradual dose reduction before discontinuation and wash-out should be performed as per the investigator’s judgement and applicable medical guidelines. To ascertain patient safety during the potential taper and washout of anti-depressive medication, patients undergoing such taper and washout will be contacted weekly by the site. 8. Is taking mood stabilizer therapy other than lamotrigine at screening or is, by the investigator, considered to be in the need of mood stabilizer treatment other than lamotrigine during the study. A period of at least 6 months without receipt of Lithium or Valproate and without an occurrence of a hypomanic episode is required prior to dosing. A period of at least 2 weeks or 5 half-lives (whichever is longer) without receipt of atypical anti-psychotics (e.g., aripiprazole, olanzapine, risperidone) and without an occurrence of a hypomanic episode is required prior to dosing. 18. Has any current or past clinically significant condition (e.g., severe infection, severe pulmonary disease, uncontrolled hypertension, uncontrolled diabetes, severe cardiovascular disease, severe hepatic or renal failure, severe brain disorder (including seizure disorder, stroke, dementia, degenerative neurologic diseases, meningitis, encephalitis, and head injury with loss of consciousness) that may interfere with the interpretation of the trial results, constitutes a health risk for the patient, or that otherwise renders the patient unsuitable for the trial according to the investigator’s judgment. 24. Patients with DSM-5 alcohol or substance use disorder (excluding tobacco and caffeine use disorders) within 6 months prior to screening. 25. If a smoker, is unwilling or unable to abstain from cigarette smoking or vaping on the day of study drug administration (nicotine replacement therapy is permitted). 28. A positive Coronavirus Disease 2019 (COVID-19) test during the screening, on the pre-test day (Day -1), or on Day 0 as confirmed by an antigen or polymerase chain reaction test. Subjects with a positive test result for COVID-19 during the screening period or on the scheduled trial dosing day may be rescreened, or attend their rescheduled Day -1/Day 0 visit a minimum of 5 days after initially testing positive, with/without a negative COVID-19 test result, provided that they are clinically recovered, and at the discretion of the investigator. |
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E.5 End points |
E.5.1 | Primary end point(s) |
•The anti-depressive effects of GH001 evaluated by: o Change from baseline in MADRS
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
• Prior to first dose on Day 0; • Day 7. |
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E.5.2 | Secondary end point(s) |
The anti-depressive effects of GH001 evaluated by: • The proportion of patients in remission (MADRS ≤10); •Change from baseline in MADRS assessed; • The proportion of responders (≥50% reduction from baseline in MADRS total score); • Change from baseline in Clinical Global Impression – Severity scale (CGI-S); • Change from baseline in Bipolar Depression Rating Scale (BDRS);
The safety and tolerability of GH001 evaluated by: • Reporting of Treatment Emergent Adverse Events (TEAEs); • Clinically significant changes from baseline in ECG, vital signs, safety laboratory assessments, spirometry assessments; • Assessment of sedation (Modified Observer'’s Assessment of Alertness and Sedation scale [MOAA/S]); • The incidence of AEs of mania or hypomania (as assessed using the DSM-5 criteria for mania/hypomania); • Change from baseline in YMRS; • Change from baseline in Clinician Administered Dissociative States Scale (CADSS); • Assessment of patient discharge readiness using the Clinical Assessment of Discharge Readiness (CADR); • Change from baseline in Brief Psychiatric Rating Scale (BPRS); • C-SSRS categorization based on the Columbia Classification Algorithm of Suicide Assessment (C-CASA).
The PsE experienced by the patients when the PsE has subsided: • PsE assessment using the Peak Experience (PE) scale (PES) to assess the achievement of a PE (PES total score ≥75); • Challenging Experience Questionnaire (CEQ); • Mystical Experience Questionnaire (MEQ30);
Duration of the PsEs defined as the time from study drug dosing to the time when the PsE have subsided;
The impact on sleep quality as evaluated by change from pre-test day (Day -1) to Day 1 and to Day 7 in the Pittsburgh Sleep Quality Index (PSQI)
The impact on cognitive outcomes as evaluated by: • Rapid Visual Information Processing Test; • Verbal Recognition Memory Test; • Spatial Working Memory Test; • Digit Symbol Substitution Test.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
• 2 hours after the final study drug dosing on Day 0, and at Day 1 and Day 7; • 2 hours after the final study drug dosing on Day 0, and at Day 1; • at 2 hours after the final study drug dosing on Day 0, and at Day 1 and Day 7; • at 2 hours after the final study drug dosing on Day 0, and at Day 1 and Day 7; • Day 1 and Day 7; • 60 min after each dosing and at discharge on Day 0; • Day 0, Day 1, and Day 7; • Day 0, Day 1, and Day 7; • Day 0, Day 1, and Day 7; • 30-60 min after each dosing; • 30-60 min after each dosing; • Day -1, Day 1, Day 7; • Day -1, Day 0, Day 1, Day 7; |
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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 | Yes |
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 | 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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Open-label, non-randomized, single arm |
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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 | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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 | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 6 |
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 |
United Kingdom |
Germany |
Netherlands |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 16 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 16 |