Trial Outcomes & Findings for Levomilnacipran ER vs. Adjunctive Quetiapine for Adults With Inadequate Relief With SSRIs in MDD (NCT NCT02720198)

NCT ID: NCT02720198

Last Updated: 2019-08-14

Results Overview

A ten-item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders. Total scores will range from 0 to 60. Higher scores indicate greater severity of depressive episodes.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

60 participants

Primary outcome timeframe

Baseline to Week 8

Results posted on

2019-08-14

Participant Flow

Potential participants were identified by self-referral via the printed ad, phone script, the patients' physicians, local health providers, mental health providers, or Duke providers. Others were recommended by PI or Study Coordinator. They assessed and screened at 2 sites, an university hospital and a clinic of the research institute.

One subject was lost to follow up after screening.

Participant milestones

Participant milestones
Measure
Levomilnacipran
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Overall Study
STARTED
29
31
Overall Study
COMPLETED
29
30
Overall Study
NOT COMPLETED
0
1

Reasons for withdrawal

Reasons for withdrawal
Measure
Levomilnacipran
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Overall Study
Withdrawal by Subject
0
1

Baseline Characteristics

Levomilnacipran ER vs. Adjunctive Quetiapine for Adults With Inadequate Relief With SSRIs in MDD

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=31 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Total
n=60 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Age, Categorical
Between 18 and 65 years
28 Participants
n=99 Participants
30 Participants
n=107 Participants
58 Participants
n=206 Participants
Age, Categorical
>=65 years
1 Participants
n=99 Participants
1 Participants
n=107 Participants
2 Participants
n=206 Participants
Age, Continuous
45.34 years
STANDARD_DEVIATION 14.28 • n=99 Participants
46.13 years
STANDARD_DEVIATION 11.17 • n=107 Participants
45.75 years
STANDARD_DEVIATION 12.67 • n=206 Participants
Sex: Female, Male
Female
20 Participants
n=99 Participants
20 Participants
n=107 Participants
40 Participants
n=206 Participants
Sex: Female, Male
Male
9 Participants
n=99 Participants
11 Participants
n=107 Participants
20 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=99 Participants
1 Participants
n=107 Participants
1 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
29 Participants
n=99 Participants
30 Participants
n=107 Participants
59 Participants
n=206 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Asian
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Black or African American
20 Participants
n=99 Participants
25 Participants
n=107 Participants
45 Participants
n=206 Participants
Race (NIH/OMB)
White
9 Participants
n=99 Participants
4 Participants
n=107 Participants
13 Participants
n=206 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=99 Participants
0 Participants
n=107 Participants
0 Participants
n=206 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=99 Participants
2 Participants
n=107 Participants
2 Participants
n=206 Participants
Region of Enrollment
United States
29 participants
n=99 Participants
31 participants
n=107 Participants
60 participants
n=206 Participants
Baseline SSRI
Escitalopram
9 Participants
n=99 Participants
3 Participants
n=107 Participants
12 Participants
n=206 Participants
Baseline SSRI
Fluoxetine
3 Participants
n=99 Participants
10 Participants
n=107 Participants
13 Participants
n=206 Participants
Baseline SSRI
Sertraline
5 Participants
n=99 Participants
6 Participants
n=107 Participants
11 Participants
n=206 Participants
Baseline SSRI
Citalopram
8 Participants
n=99 Participants
5 Participants
n=107 Participants
13 Participants
n=206 Participants
Baseline SSRI
Paroxetine
3 Participants
n=99 Participants
7 Participants
n=107 Participants
10 Participants
n=206 Participants
Baseline SSRI
Unknown
1 Participants
n=99 Participants
0 Participants
n=107 Participants
1 Participants
n=206 Participants
Baseline Dose of SSRI
mg(Escitalopram)
18.89 dose of medication, mg
STANDARD_DEVIATION 3.333 • n=99 Participants
16.67 dose of medication, mg
STANDARD_DEVIATION 5.774 • n=107 Participants
18.33 dose of medication, mg
STANDARD_DEVIATION 3.892 • n=206 Participants
Baseline Dose of SSRI
mg(Fluoxetine)
53.33 dose of medication, mg
STANDARD_DEVIATION 23.094 • n=99 Participants
42.00 dose of medication, mg
STANDARD_DEVIATION 6.325 • n=107 Participants
44.62 dose of medication, mg
STANDARD_DEVIATION 11.983 • n=206 Participants
Baseline Dose of SSRI
mg(Sertraline)
170.00 dose of medication, mg
STANDARD_DEVIATION 27.386 • n=99 Participants
150.00 dose of medication, mg
STANDARD_DEVIATION 31.623 • n=107 Participants
159.09 dose of medication, mg
STANDARD_DEVIATION 30.151 • n=206 Participants
Baseline Dose of SSRI
mg(Citalopram)
21.25 dose of medication, mg
STANDARD_DEVIATION 8.345 • n=99 Participants
28.00 dose of medication, mg
STANDARD_DEVIATION 10.954 • n=107 Participants
23.85 dose of medication, mg
STANDARD_DEVIATION 9.608 • n=206 Participants
Baseline Dose of SSRI
mg(Paroxetine)
40.00 dose of medication, mg
STANDARD_DEVIATION 0.000 • n=99 Participants
51.43 dose of medication, mg
STANDARD_DEVIATION 15.736 • n=107 Participants
48.00 dose of medication, mg
STANDARD_DEVIATION 13.984 • n=206 Participants

PRIMARY outcome

Timeframe: Baseline to Week 8

Population: Data not available on some participants.

A ten-item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders. Total scores will range from 0 to 60. Higher scores indicate greater severity of depressive episodes.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=26 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes of Montgomery-Åsberg Depression Rating Scale (MADRS) Total Score
-5.81 score on a scale
Standard Deviation 6.080
-6.97 score on a scale
Standard Deviation 7.632

SECONDARY outcome

Timeframe: Week 8

Population: Data not available on some participants.

Remission was defined as \[\>or=50% reduction in MADRS score with MADRS \<or=10\] and response was defined as \[\>or=50% reduction in MADRS with MADRS \>10\]. Response rate included remission and response.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=26 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Response Rate
3 Participants
7 Participants

SECONDARY outcome

Timeframe: Week 8

Population: Data not available on some participants.

Remission was defined as \[\>or=50% reduction in MADRS score with MADRS \<or=10\]

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=26 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Remission Rate
2 Participants
3 Participants

SECONDARY outcome

Timeframe: Baseline to Week 8

Number of words correctly recalled by the respondent is recorded. 1 point for each word correctly recalled. Total score range of 0-40. Higher scores mean better cognitive function.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes in Neurocognition by Changes in Scores on Reyes Verbal Learning Test
2.28 score on a scale
Standard Deviation 5.694
2.90 score on a scale
Standard Deviation 5.255

SECONDARY outcome

Timeframe: Baseline to Week 8

DSST measures working memory and visuospatial processing. 1 point for each object correctly substituted from number to each matched symbol. Total score range of 0-89. Higher scores mean better cognitive function.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes in Neurocognition by Changes in Scores on Scores on Digit Symbol Substitution Test (DSST)
3.21 score on a scale
Standard Deviation 9.321
0.87 score on a scale
Standard Deviation 7.431

SECONDARY outcome

Timeframe: Baseline to Week 8

CGI-S is a 7 point scale that assess the severity of illness and requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention. It is used to assess the clinician's view of the patient's global functioning. Total score range of 0-7.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Number of Subjects With Global Improvement in Scores on Clinical Global Impression Scale- Severity (CGI-S)
13 Participants
13 Participants

SECONDARY outcome

Timeframe: Baseline to Week 8

Population: Data not available for some participants.

CGI-I a 7 point scale that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention. It is used to assess the clinician's view of the patient's global functioning. Total score range of 0-7.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=27 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Number of Subjects With General Improvement in Scores on Clinical Global Impression Scale- Improvement (CGI-I)
21 Participants
24 Participants

SECONDARY outcome

Timeframe: Baseline to Week 8

Population: Data not available for all subjects.

A questionnaire used by clinicians to rate the severity of a patient's anxiety. Total score range of 0-48. A higher score indicates greater anxiety.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=28 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes of Anxiety Symptoms in Scores on Hamilton Anxiety Rating Scale (HAM-A)
-3.89 score on a scale
Standard Deviation 4.969
-5.53 score on a scale
Standard Deviation 5.859

SECONDARY outcome

Timeframe: Baseline to Week 8

A self-reported brief scale to assess impairment of work/school, social life and family and home. Total score range of 0-30. A higher score indicates greater impairment.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes of Quality of Life in Scores on Sheehan Disability Scale (SDS) Total
-3.79 score on a scale
Standard Deviation 6.477
-0.10 score on a scale
Standard Deviation 8.126

SECONDARY outcome

Timeframe: Baseline to Week 8

Self-Administered assessment measuring lack of motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Total scores range from 0-54. Higher scores indicate greater apathy.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes in Scores on Apathy Evaluation Scale (AES).
-2.07 score on a scale
Standard Deviation 8.689
-1.83 score on a scale
Standard Deviation 7.852

SECONDARY outcome

Timeframe: Baseline to Week 8

ASEX is scale for sexual dysfunction to assess safety and tolerability of medication. Total scores range from 5-30. Higher scores indicate greater sexual dysfunction.

Outcome measures

Outcome measures
Measure
Levomilnacipran
n=29 Participants
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=30 Participants
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Changes in Sexual Dysfunction by Changes in Scores on Arizona Sexual Experience Scale (ASEX)
-0.76 score on a scale
Standard Deviation 2.923
-0.30 score on a scale
Standard Deviation 4.829

Adverse Events

Levomilnacipran

Serious events: 0 serious events
Other events: 16 other events
Deaths: 0 deaths

Quetiapine

Serious events: 0 serious events
Other events: 22 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Levomilnacipran
n=29 participants at risk
Levomilnacipran ER is switched from SSRI. Levomilnacipran ER: A flexible dose regime of levomilnacipran ER 20-120 mg/d mg per day, starting at 20 mg/d on Days 1-2, increasing to 40 mg/d on Days 3-7 in week 1, then flexibly dosed between 40 mg/d -120 mg/d during weeks 2 through 8.
Quetiapine
n=31 participants at risk
Quetiapine XR was added in addition to current SSRI. Quetiapine XR: Quetiapine XR was started at 50 mg/d on Day 1-2, increasing to 150 mg/d on Days 3-7 in Week 1 and then flexibly dosed between 150-300 mg/d during Weeks 1 through 8 along with their current SSRI.
Gastrointestinal disorders
Nausea
13.8%
4/29 • Screening to Week 9
12.9%
4/31 • Screening to Week 9
General disorders
Increase Appetite
0.00%
0/29 • Screening to Week 9
9.7%
3/31 • Screening to Week 9
General disorders
Weight Gain
3.4%
1/29 • Screening to Week 9
9.7%
3/31 • Screening to Week 9
General disorders
Weight Loss
3.4%
1/29 • Screening to Week 9
0.00%
0/31 • Screening to Week 9
Nervous system disorders
Headache
20.7%
6/29 • Screening to Week 9
6.5%
2/31 • Screening to Week 9
Nervous system disorders
Drowsiness
6.9%
2/29 • Screening to Week 9
38.7%
12/31 • Screening to Week 9
Nervous system disorders
Dizziness
0.00%
0/29 • Screening to Week 9
3.2%
1/31 • Screening to Week 9
Nervous system disorders
Confusion
0.00%
0/29 • Screening to Week 9
6.5%
2/31 • Screening to Week 9
Renal and urinary disorders
Dysuria
6.9%
2/29 • Screening to Week 9
0.00%
0/31 • Screening to Week 9
General disorders
Dry Mouth
0.00%
0/29 • Screening to Week 9
3.2%
1/31 • Screening to Week 9
General disorders
Sweating
10.3%
3/29 • Screening to Week 9
0.00%
0/31 • Screening to Week 9

Additional Information

Dr. Narei Hong

Duke University Medical Center

Phone: 984-215-8493

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place