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    Summary
    EudraCT Number:2022-003743-10
    Sponsor's Protocol Code Number:BPL-003-201
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2023-02-14
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2022-003743-10
    A.3Full title of the trial
    A Quadruple Masked, Dose-Finding Study to Evaluate the Efficacy and Safety of Intranasal BPL-003, with Open Label Extension, in Patients with Treatment Resistant Depression
    Estudio cuádruple ciego de determinación de la dosis para evaluar la eficacia y la seguridad de BPL-003 intranasal, con extensión abierta, en pacientes con depresión resistente al tratamiento
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to Evaluate the Efficacy and Safety of Intranasal BPL-003 in Patients with Treatment Resistant Depression
    Estudio para evaluar la eficacia y la seguridad de BPL-003 intranasal en pacientes con depresión resistente al tratamiento
    A.4.1Sponsor's protocol code numberBPL-003-201
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorBeckley Psytech Ltd.
    B.1.3.4CountryUnited Kingdom
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportBeckley Psytech Ltd.
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationBeckley Psytech Ltd.
    B.5.2Functional name of contact pointMedical Information
    B.5.3 Address:
    B.5.3.1Street AddressBeckley Park
    B.5.3.2Town/ cityOxford
    B.5.3.3Post codeOX39SY
    B.5.3.4CountryUnited Kingdom
    B.5.6E-mailMedinfo@beckleypsytech.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product name5-MeO-DMT.Benzoate Dry Powder
    D.3.2Product code BPL-003
    D.3.4Pharmaceutical form Nasal powder in single-dose container
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPNasal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNot applicable
    D.3.9.2Current sponsor codeBPL-003
    D.3.9.3Other descriptive name5-Methoxy-N,N-dimethyltryptamine benzoate
    D.3.9.4EV Substance CodeSUB299297
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number18.7
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Yes
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product name5-MeO-DMT.Benzoate Dry Powder
    D.3.2Product code BPL-003
    D.3.4Pharmaceutical form Nasal powder in single-dose container
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPNasal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNot applicable
    D.3.9.2Current sponsor codeBPL-003
    D.3.9.3Other descriptive name5-Methoxy-N,N-dimethyltryptamine benzoate
    D.3.9.4EV Substance CodeSUB299297
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number0.47
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Yes
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product name5-MeO-DMT.Benzoate Dry Powder
    D.3.2Product code BPL-003
    D.3.4Pharmaceutical form Nasal powder in single-dose container
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPNasal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNot applicable
    D.3.9.2Current sponsor codeBPL-003
    D.3.9.3Other descriptive name5-Methoxy-N,N-dimethyltryptamine benzoate
    D.3.9.4EV Substance CodeSUB299297
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number12.5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Yes
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 4
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product name5-MeO-DMT.Benzoate Dry Powder
    D.3.2Product code BPL-003
    D.3.4Pharmaceutical form Nasal powder in single-dose container
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPNasal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNNot applicable
    D.3.9.2Current sponsor codeBPL-003
    D.3.9.3Other descriptive name5-Methoxy-N,N-dimethyltryptamine benzoate
    D.3.9.4EV Substance CodeSUB299297
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6.2
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Yes
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Treatment-Resistant Depression (TRD)
    Depresión resistente al tratamiento
    E.1.1.1Medical condition in easily understood language
    Depression that has not improved with other treatments.
    Depresión que no ha mejorado con otros tratamientos
    E.1.1.2Therapeutic area Psychiatry and Psychology [F] - Mental Disorders [F03]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10057840
    E.1.2Term Major depression
    E.1.2System Organ Class 10037175 - Psychiatric disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    CORE study:
    To determine the efficacy of 12 mg of BPL-003 given with psychological support to participants with treatment--resistant depression (TRD)

    Open label extension (OLE):
    To determine the safety of a second dose of BPL-003 given with psychological support to participants with TRD
    Estudio principal (CORE):
    Determinar la eficacia de 12 mg de BPL-003 administrados con apoyo psicológico a participantes con depresión resistente al tratamiento (DRT)

    Extensión sin enmascaramiento (OLE):
    Determinar la seguridad de una segunda dosis de BPL-003 administrada con apoyo psicológico a participantes con DRT
    E.2.2Secondary objectives of the trial
    CORE:
    - To determine the efficacy, including early onset, of BPL-003 given with psychological support to participants with TRD
    - To determine the safety of 0.3 mg, 8 mg, or 12 mg of BPL-003 given with psychological support to participants with TRD
    - To evaluate the pharmacokinetics (PK) of 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) and its active metabolite (bufotenine) in participants with TRD after nasal administration of BPL-003
    - To determine the effects on depression and disability of 0.3 mg, 8 mg, or 12 mg of BPL-003 given with psychological support to participants with TRD
    OLE:
    - To determine the efficacy of a second dose of BPL-003 given with psychological support to participants with TRD
    - To evaluate the PK of 5-MeO-DMT and its active metabolite (bufotenine) in participants with TRD after nasal administration of BPL-003
    - To determine the effects of a second dose of BPL-003 on depression and disability, given with psychological support to participants with TRD
    CORE:
    -Determinar la eficacia, incluido el inicio temprano, de BPL-003 administrado con apoyo psicológico a participantes con DRT
    -Determinar la seguridad de 0,3 mg, 8 mg o 12 mg de BPL-003 administrados con apoyo psicológico a participantes con DRT
    -Evaluar la farmacocinética (FC) de 5-metoxi-N,N-dimetiltriptamina (5-MeO-DMT) y su metabolito activo (bufotenina) en participantes con DRT tras la administración nasal de BPL-003
    -Determinar los efectos sobre la depresión y la discapacidad de 0,3 mg, 8 mg o 12 mg de BPL-003 administrados con apoyo psicológico a participantes con DRT

    OLE:
    -Determinar la eficacia de una segunda dosis de BPL-003 administrada con apoyo psicológico a participantes con DRT
    -Evaluar la FC de 5-MeO-DMT y su metabolito activo (bufotenina) en participantes con DRT tras la administración nasal de BPL-003
    -Determinar los efectos de una segunda dosis de BPL-003 sobre la depresión y la discapacidad, administrada con apoyo psicológico a participantes con DRT
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    CORE:
    1. Willing and able to give informed consent.
    2. Male and female participants, age 18 to 75 years at the time of informed consent.
    3. At least moderate major depressive disorder (MDD), (single or recurrent episode as informed by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] criteria; if single episode, duration of ≥3 months and ≤ 2 years) based on medical records, clinical assessment, and documented completion of the version 7.0.2 Mini International Neuropsychiatric Interview (MINI).
    4. Diagnosed with TRD defined as failure to respond to an adequate dose and duration of at least 2 pharmacological treatments based on the MGH ATRQ assessment. Augmentation with an add-on treatment counts as a second treatment. Participants must not have failed more than 5 prior pharmacological treatments current episode (psychotherapy is not counted towards treatment failure).
    5. Hamilton Depression Rating Scale (HDRS) (17 item) score ≥19 at Screening (Visit 1) and baseline (Day -3).
    6. CGI-S ≥4 at Screening and baseline (Day -3).
    7. QIDS-SR-16 ≥13 at baseline (Day -3).
    8. If currently taking antidepressant medications, willing and able to
    discontinue current antidepressants including selective serotonin reuptake inhibitor, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, and any augmentation medication such as antipsychotics or lithium.
    9. Able (in the investigator’s opinion) and willing to undertake and comply with all study requirements, including ability to complete all protocol required assessment tools and to comply with all study visits in language used by study site.
    10. Willing to abstain from alcohol for 48 hours before Day 1.
    11. Willing to abstain from recreational drugs from Screening until the end of the study.
    • Intermittent use of cannabinoids prior to Screening is not exclusionary as long as the participant does not meet the criteria for substance use disorder, as assessed using the DSM-5.
    12. Willing to allow their own general practitioner, and consultant if appropriate, to be informed of study participation.
    OLE:
    1. Participants who complete the CORE study.
    2. Willing and able to give informed consent for the OLE.
    3. Willing to abstain from alcohol for 48 hours before OLE Day 1.
    4. Willing to abstain from recreational drugs throughout the duration of the study.
    CORE:
    1. Estar dispuesto y ser capaz de dar el consentimiento informado.
    2. Hombres y mujeres de 18 a 75 años en el momento del consentimiento informado.
    3. Trastorno depresivo mayor (TDM) al menos moderado (episodio único o recurrente según los criterios del Manual diagnóstico y estadístico de los trastornos mentales, quinta edición [DSM-5]; si es un episodio único, duración de ≥3 meses y ≤2 años) basado en la historia clínica, la evaluación clínica y la cumplimentación documentada de la versión 7.0.2 de la Entrevista Neuropsiquiátrica Internacional Reducida (Mini International Neuropsychiatric Interview, MINI).
    4. Diagnóstico de DRT, definida como la falta de respuesta a una dosis adecuada y duración de al menos 2 tratamientos farmacológicos según el cuestionario ATRQ del MGH. El refuerzo con un tratamiento suplementario cuenta como segundo tratamiento. Los participantes no deben haber presentado fracasos terapéuticos en más de 5 tratamientos farmacológicos previos en el episodio actual (la psicoterapia no cuenta para los fracasos terapéuticos).
    5. Puntuación de la escala de evaluación de la depresión de Hamilton (Hamilton Depression Rating Scale, HDRS) (17 ítems) ≥19 en la selección (visita 1) y al inicio (día −3).
    6. CGI-S ≥4 en la selección y al inicio (día −3).
    7. QIDS-SR-16 ≥13 al inicio (día −3).
    8. Si actualmente toma medicamentos antidepresivos; estar dispuesto y ser capaz de suspender los antidepresivos actuales, incluidos los inhibidores selectivos de la recaptación de serotonina, los inhibidores de la recaptación de serotonina y norepinefrina, los antidepresivos tricíclicos, los inhibidores de la monoaminooxidasa y cualquier medicamento de refuerzo, como los antipsicóticos o el litio.
    9. Estar dispuesto y ser capaz (en opinión del investigador) de emprender y cumplir con todos los requisitos del estudio, incluida la capacidad de completar todas las herramientas de evaluación requeridas por el protocolo y cumplir con todas las visitas del estudio en el idioma utilizado por el centro del estudio.
    10. Estar dispuesto a abstenerse del alcohol durante 48 horas antes del día 1.
    11. Estar dispuesto a abstenerse de las drogas desde la selección hasta el final del estudio.
    • El uso intermitente de cannabinoides antes de la selección no es excluyente, siempre que el participante no cumpla con los criterios de trastornos relacionados con el consumo de sustancias, según lo evaluado mediante el DSM-5.
    12. Estar dispuesto a permitir que su propio médico general y psicoterapeuta, si corresponde, sean informados sobre la participación en el estudio.
    OLE:
    1. Participantes que completen el estudio CORE.
    2. Estar dispuesto y ser capaz de dar el consentimiento informado para la OLE.
    3. Estar dispuesto a abstenerse del alcohol durante 48 horas antes del día 1 de la OLE.
    4. Estar dispuesto a abstenerse de las drogas a lo largo de todo el estudio.
    E.4Principal exclusion criteria
    CORE:
    1. Positive test for cannabinoids pre-dose on Day 1.
    2. Current or past history of schizophrenia, psychotic disorder including psychotic depression, bipolar disorder, delusional disorder, schizoaffective disorder, or any other severe psychiatric disorder as assessed by medical history and a structured clinical interview (MINI).
    3. Current personality disorders: Cluster A (paranoid, schizoid, schizotypal), Cluster B (antisocial, borderline, histrionic, narcissistic), or Cluster C (avoidant, dependent, -obsessive compulsive) assessed via McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), MINI, and clinical judgement.
    4. First-degree family history of schizophrenia, bipolar disorder, delusional disorder, or schizoaffective disorder.
    5. Current (within the last year) alcohol or substance use disorder (other than caffeine or nicotine) according to DSM-5 and assessed by the MINI at Screening that the investigator and/or medical monitor judge to be a safety concern for enrollment in the study or that could interfere with the therapeutic process or with other aspects of study participation. Any participant who is not able to agree or adhere to a plan to reduce and manage use will be excluded.
    6. A participant who at any time has been unresponsive to ketamine or esketamine, unresponsive to an adequate course of treatment with electroconvulsive therapy (ECT) defined as at least 7 treatments with unilateral/bilateral ECT, or has received vagal nerve stimulation or has received deep brain stimulation.
    7. Currently receiving prohibited medications or therapy.
    8. Suicidal ideation with some intent to act within 12 months prior to the start of Screening, per the investigator’s clinical judgement or based on the C-SSRS, corresponding to a response of “Yes” on Item 4 (active suicidal ideation with some intent to act, without specific plan) or Item 5 (active suicidal ideation with specific plan and intent) for suicidal ideation on the C-SSRS, or any suicidal behavior within the 12 months prior to the start of Screening. Participants reporting suicidal ideation with intent to act or suicidal behavior as assessed on Day 1 should be excluded.
    9. Suicide attempt and/or self-injurious behavior within the last 12 months prior to Screening.
    10. Depression is secondary to other severe medical conditions according to the investigator’s opinion.
    11. Other personal circumstances and behavior judged to be incompatible with establishment of rapport or safe exposure to the study medication.
    12. Any other clinically significant psychiatric condition that, in the opinion of the investigator, may interfere with the interpretation of the study results or constitute a health risk for the participant if he/she takes part in the study.
    Further medical exclusion criteria are listed in the protocol.
    OLE:
    1. Currently taking antidepressant medication.
    2. Currently taking any other prohibited medication.
    3. Participants who, in the opinion of the investigator, are not suitable to participate in the OLE.
    1. Prueba positiva para cannabinoides antes de la administración de la dosis del día 1.
    2. Episodios actuales o antecedentes de esquizofrenia, trastorno psicótico que incluye depresión psicótica, trastorno bipolar, trastorno delirante, trastorno esquizoafectivo o cualquier otro trastorno psiquiátrico grave según lo evaluado por la anamnesis y una entrevista clínica estructurada (MINI).
    3. Trastornos de personalidad actuales: grupo A (paranoide, esquizoide, esquizotípico), grupo B (antisocial, límite, histriónico, narcisista) o grupo C (evitativo, dependiente, obsesivo-compulsivo), evaluados a través del instrumento de cribado de McLean para el trastorno límite de la personalidad (McLean Screening Instrument for Borderline Personality Disorder, MSI- BPD), la MINI y el razonamiento clínico.
    4. Antecedentes familiares de primer grado de esquizofrenia, trastorno bipolar, trastorno delirante o trastorno esquizoafectivo.
    5. Trastorno actual (en el último año) por consumo de alcohol o de sustancias (que no sean cafeína o nicotina) según el DSM-5 y evaluado por la MINI en la selección, y que el investigador y/o el monitor médico considere que es un problema de seguridad para la inclusión en el estudio o que puede interferir en el proceso terapéutico o en otros aspectos de la participación en el estudio. Se excluirá a los participantes que no acepten seguir un plan para reducir y controlar el consumo, o no puedan cumplirlo.
    6. Participantes que, en algún momento, no hayan respondido a la ketamina o a la esketamina; no hayan respondido a una tanda adecuada de tratamiento con terapia electroconvulsiva (TEC), definida como al menos 7 tratamientos con TEC unilateral/bilateral; hayan recibido estimulación del nervio vago; o hayan recibido estimulación cerebral profunda.
    7. Participantes que actualmente reciban medicamentos o tratamientos prohibidos .
    8. Ideas de suicidio con alguna intención de actuar en los 12 meses anteriores al inicio de la selección, según el razonamiento clínico del investigador o con base en la escala C-SSRS, correspondiente a una respuesta de "Sí" en el ítem 4 (ideas activas de suicidio con alguna intención de actuar, sin plan específico) o en el ítem 5 (ideas activas de suicidio con intención y plan específico) en relación con las ideas de suicidio en la C‑SSRS, o cualquier comportamiento suicida en los 12 meses anteriores al inicio de la selección. Los participantes que notifiquen ideas de suicidio con intención de actuar o comportamiento suicida según lo evaluado el día 1 deben ser excluidos.
    9. Intento de suicidio y/o conducta autolesiva en los 12 meses anteriores a la selección.
    10. Depresión que sea secundaria a otras enfermedades graves según la opinión del investigador.
    11. Otras circunstancias personales y conductas que se consideren incompatibles con el establecimiento de una relación o exposición segura al medicamento del estudio.
    12. Cualquier otra enfermedad psiquiátrica clínicamente significativa que, en opinión del investigador, pueda interferir en la interpretación de los resultados del estudio o constituir un riesgo para la salud del participante si participa en el estudio.
    Otros criterios de exclusión médica se enumeran en el protocolo.
    OLE:
    1. Tomar actualmente medicamentos antidepresivos.
    2. Tomar actualmente cualquier otro medicamento prohibido.
    3. Participantes que, a juicio del investigador, no sean aptos para participar en la OLE.
    E.5 End points
    E.5.1Primary end point(s)
    CORE:
    Change from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) for 12 mg compared to 0.3 mg of BPL-003
    OLE:
    • Number of events and percentage of participants with TEAEs
    • Percentage of participants with clinically significant abnormal laboratory tests compared to OLE and CORE baseline
    • Percentage of participants with clinically significant abnormal vital sign measurements (heart rate, blood pressure, and body temperature) compared to OLE and CORE baseline
    • Percentage of participants with clinically significant ECG parameters compared to OLE and CORE baseline
    • Incidence of suicidal ideation or behavior, as assessed by the C-SSRS compared to OLE and CORE baseline
    CORE:
    Cambio desde el inicio en la escala de valoración de la depresión de Montgomery-Asberg (Montgomery-Asberg Depression Rating Scale, MADRS) con 12 mg en comparación con 0,3 mg de BPL-003

    OLE:
    Número de acontecimientos y porcentaje de participantes con AADT
    • Porcentaje de participantes con resultados anómalos de pruebas analíticas clínicamente significativos en comparación con el inicio del estudio principal (CORE) y la extensión sin enmascaramiento (OLE) del estudio
    • Porcentaje de participantes con mediciones anómalas de constantes vitales clínicamente significativas (frecuencia cardíaca, presión arterial y temperatura corporal) en comparación con el inicio del CORE y la OLE del estudio
    • Porcentaje de participantes con parámetros de ECG clínicamente significativos en comparación con el inicio del CORE y la OLE del estudio
    Incidencia de ideas de suicidio o comportamiento suicida, evaluada por la escala C-SSRS en comparación con el inicio del CORE y la OLE del estudio
    E.5.1.1Timepoint(s) of evaluation of this end point
    CORE:
    At Day 29
    OLE:
    Up to 9 weeks following CORE period completion
    CORE:
    -En el día 29
    OLE:
    Hasta 9 semanas tras la finalización del periodo CORE
    E.5.2Secondary end point(s)
    CORE:
    1. Change from baseline in MADRS for 12 mg compared to 0.3 mg of BPL-003
    2. Change from baseline in MADRS for 8 mg compared to 0.3 mg of BPL-003
    3. Change from baseline in MADRS for 8 mg compared to 0.3 mg of BPL-003
    4. Number of events and percentage of participants with treatment -emergent adverse events (TEAEs)
    5. Percentage of participants with clinically significant abnormal laboratory tests compared to baseline
    6. Percentage of participants with clinically significant abnormal vital sign measurements (heart rate, blood pressure, and body temperature) compared to baseline
    7. Percentage of participants with clinically significant electrocardiogram (ECG) parameters compared to baseline
    8. Incidence of suicidal ideation or behavior, as assessed by the Columbia-Suicide Severity Rating Scale (C-SSRS) compared to baseline
    9. Impairment in cognitive performance, assessed by Cognitive Test Battery compared to baseline
    10. Plasma levels of 5-MeO-DMT and its metabolite (bufotenine) after nasal administration of BPL-003
    11. Change from baseline in MADRS for 8 mg and 12 mg of BPL-003 compared to 0.3 mg of BPL-003
    12. Percentage of responders (defined as 50% reduction in MADRS total score) by dose group compared to baseline
    13. Percentage of participants in remission (defined as MADRS total score ≤ 10) by dose group
    14. Change in 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR-16) score by dose group compared to baseline, by dose group
    15. Change in Quality of Life in Depression Scale (QLDS) score by dose group compared to baseline, by dose group
    16. Change in Sheehan Disability Scale (SDS) total score by dose group compared to baseline, by dose group
    17. Change in Clinical Global Impression-Severity (CGI-S) score by dose group compared to baseline, by dose group
    OLE:
    1. Change in MADRS compared to OLE and CORE baseline
    2. Percentage of responders (defined as 50% reduction in MADRS total score) compared to OLE and CORE baseline
    3. Percentage of participants in remission (defined as MADRS total score ≤ 10) compared to OLE and CORE baseline
    4. Plasma levels of 5-MeO-DMT and its metabolite (bufotenine) after nasal administration of BPL-003
    5. Change in QIDS-SR-16 score compared to OLE and CORE baseline
    6. Change in QLDS score compared to OLE and CORE baseline
    7. Change in SDS total score compared to OLE and CORE baseline
    8. Change in CGI-S score compared to OLE and CORE baseline
    CORE:
    1. Cambio desde el inicio en la escala MADRS con 12 mg en comparación con 0,3 mg de BPL-003
    2. Cambio desde el inicio en la escala MADRS con 8 mg en comparación con 0,3 mg de BPL-003
    3. Cambio desde el inicio en la escala MADRS con 8 mg en comparación con 0,3 mg de BPL-003
    4. Número de acontecimientos y porcentaje de participantes con acontecimientos adversos aparecidos durante el tratamiento (AADT)
    5. Porcentaje de participantes con resultados anómalos de pruebas analíticas clínicamente significativos en comparación con el inicio del estudio
    6. Porcentaje de participantes con mediciones anómalas de constantes vitales clínicamente significativas (frecuencia cardíaca, presión arterial y temperatura corporal) en comparación con el inicio del estudio
    7. Porcentaje de participantes con parámetros del electrocardiograma (ECG) clínicamente significativos en comparación con el inicio del estudio
    8. Incidencia de ideas de suicidio o comportamiento suicida, evaluada por la escala de evaluación del riesgo de suicidio de Columbia (Columbia-Suicide Severity Rating Scale, C-SSRS) en comparación con el inicio del estudio
    9. Deterioro en el rendimiento cognitivo, evaluado mediante una serie de pruebas cognitivas en comparación con el inicio del estudio
    10. Niveles plasmáticos de 5-MeO-DMT y su metabolito (bufotenina) hasta 60 minutos después de la administración nasal de BPL-003
    11.Cambio desde el inicio en la escala MADRS con 8 mg y 12 mg de BPL-003 en comparación con 0,3 mg de BPL-003
    12.Porcentaje de participantes que responden al tratamiento (definido como una reducción del 50 % en la puntuación total de la escala MADRS) en comparación con el inicio del estudio, por grupo de dosis
    13. Porcentaje de participantes en remisión (definida como una puntuación total de la escala MADRS ≤10) por grupo de dosis
    14. Cambio en la puntuación del inventario rápido de autoinforme de sintomatología depresiva de 16 ítems (16-item Quick Inventory of Depressive Symptomatology-Self-Report, QIDS-SR-16) en comparación con el inicio del estudio, por grupo de dosis
    15. Cambio en la puntuación de la escala de calidad de vida para la depresión (Quality of Life in Depression Scale, QLDS) en comparación con el inicio del estudio, por grupo de dosis
    16. Cambio en la puntuación total de la escala de discapacidad de Sheehan (Sheehan Disability Scale, SDS) en comparación con el inicio del estudio, por grupo de dosis
    17. Cambio en la puntuación de la escala de impresión global clínica de gravedad (Clinical Global Impression-Severity, CGI-S) en comparación con el inicio del estudio, por grupo de dosis

    OLE:
    1. Cambio en la escala MADRS en comparación con el inicio del CORE y la OLE del estudio
    2. Porcentaje de participantes que responden al tratamiento (definido como una reducción del 50 % en la puntuación total de la escala MADRS) en comparación con el inicio del CORE y la OLE del estudio
    3. Porcentaje de participantes en remisión (definida como una puntuación total de la escala MADRS ≤10) en comparación con el inicio del CORE y la OLE del estudio
    4. Niveles plasmáticos de 5-MeO-DMT y su metabolito (bufotenina) hasta 60 minutos después de la administración nasal de BPL-003
    5.Cambio en la puntuación de QIDS-SR-16 en comparación con el inicio del CORE y la OLE del estudio
    6. Cambio en la puntuación de QLDS en comparación con el inicio del CORE y la OLE del estudio
    7. Cambio en la puntuación total de SDS en comparación con el inicio del CORE y la OLE del estudio
    8. Cambio en la puntuación de CGI-S en comparación con el inicio del CORE y la OLE del estudio
    E.5.2.1Timepoint(s) of evaluation of this end point
    CORE:
    1. at Day 8
    2. at Day 29
    3. at Day 8
    8. at Days 2, 8, 29, 43, and 57
    9. at Days 8 and 29
    10. up to 60 minutes after administration
    11. at Days 2 and 57
    12. at Days 2, 8, 29, and 57
    13. at Days 2, 8, 29, and 57
    14. at Days 2, 8, 29, and 57
    15. at Days 2, 8, 29, and 57
    16. at Days 29, and 57
    17. at Days 2, 8, 29, and 57
    OLE:
    4. up to 60 minutes after administration
    For additional details on remaining endpoints please refer to Schedule of Events
    CORE:
    1. en el día 8
    2. en el día 29
    3. en el día 8
    8. en los días 2, 8, 29, 43 y 57
    9. en los días 8 y 29
    10. hasta 60 minutos después de la administración
    11. en los días 2 y 57
    12. en los días 2, 8, 29 y 57
    13. en los días 2, 8, 29 y 57
    14. en los días 2, 8, 29 y 57
    15. en los días 2, 8, 29 y 57
    16. en los días 29 y 57
    17. en los días 2, 8, 29 y 57

    OLE:
    4. hasta 60 minutos después de la administración
    Para más información sobre los criterios de valoración restantes, consulte la agenda de programación.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group No
    E.8.1.6Cross over Yes
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Quadruple Masked
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    0.3 mg BPL-003
    E.8.2.4Number of treatment arms in the trial3
    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.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA17
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    United States
    Poland
    Spain
    Czechia
    Germany
    United Kingdom
    E.8.7Trial has a data monitoring committee Yes
    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
    LVLS
    UVUP
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months4
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months6
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 200
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 25
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state29
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 98
    F.4.2.2In the whole clinical trial 225
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    After the patients have ended their participation in the clinical trial, they will be treated by their physician according to their medical condition in line with standard therapy.
    Una vez que los/las pacientes hayan finalizado la participación en el ensayo clínico, su médico/a les tratará según el estado de salud de acuerdo con la terapia habitual.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2023-05-24
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-05-16
    P. End of Trial
    P.End of Trial StatusOngoing
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