Efficacy and Safety of Paroxetine Controlled Release for Major Depressive Disorder in Irritable Bowel Syndrome Patients

Depressive Disorder Clinical Trial

Official title:

Efficacy and Safety of Paroxetine Controlled Release for Major Depressive Disorder in Irritable Bowel Syndrome Patients: An Open-label, Randomized, add-on Study

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT01916200
• Other study ID #: 117049
• Status: Withdrawn
• Phase: Phase 4
• First received: August 1, 2013
• Last updated: July 14, 2014
• Start date: January 2014
• Est. completion date: September 2014

Study information

• Verified date: July 2014
• Source: GlaxoSmithKline
• Contact: n/a
• Is FDA regulated: No
• Health authority: China: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

This is an open label, randomized, add-on, 8 weeks multicentre study to evaluate the efficacy and safety of paroxetine Controlled Release (CR) in patients with Major Depressive Disorder (MDD) comorbid Irritable Bowel Syndrome (IBS).

Subjects will be patients who are referred to the outpatient or inpatient clinic of gastroenterology departments of province level general hospitals in China. All subjects present with irritable bowel syndrome according to ROME III, and also are diagnosed with MDD by Mini-International Neuropsychiatric Interview (MINI). All subjects will provide written informed consent prior to participating in the study. Subjects will be assessed for eligibility at a screening visit, with eligible patients returning for a assessment within 1 week, at which time they will randomly enter into paroxetine CR (12.5mg/d, flexible dose: 12.5-50mg/d) plus IBS regular treatment or IBS regular treatment only. Subjects will be evaluated at weeks 2 (Day 14), 4 (Day 28), 6 (Day 42) and 8 (Day 56), for a total of 5 study treatment visits.

Description:

This is an open label, randomized, add-on, 8 weeks multicentre study to evaluate the efficacy and safety of paroxetine CR in patients with MDD comorbid IBS.

This study is designed with a 1-week screening period, followed by 8 weeks of treatment and 1 week follow up period, 7 visits totally; the calculation of visit date is base on the real date of random date.

Study Screening:

Visit 1: a screening period for within 7 days to determine eligibility for the study, subjects aged ≥ 18 and ≤ 65 years at the time of screening, must have a diagnosis of IBS and MDD. After giving their informed consent to participate in the study, patients will undergo screening assessments, including demographic data (birth, race, gender, height, weight), medical history, disease history, therapy history, concomitant medication, physical examination, vital signs, 12-lead ECG and laboratory assessments.

Treatment Phase:

The treatment phase will last for 8 weeks. The visit (except baseline) will have ±3 days.

Visit 2 (Day 0, baseline visit): Patients who fulfil all the study inclusion and exclusion criteria will accept baseline assessment (including concomitant medication, vital signs and scale assessment) and be randomised into paroxetine CR plus IBS regular treatment group or IBS regular treatment only group at baseline visit. The day after randomizing (Day 1), patients will receive paroxetine CR 12.5mg/d plus IBS regular treatment or IBS regular treatment only (patients who have received IBS regular treatment before can continue their treatment). On Day 8, following 1 weeks of treatment, paroxetine CR should be titrated to 25mg/d.

Visit 3-5 (Day 14, Day 28, Day 42): Efficacy and safety assessments will be performed at these visits, including vital signs and HDRS-17 (Hamilton Depression Rating Scale 17 items), CGI-S (Clinical Global Impression- Severity), CGI-I (Clinical Global Impression- Improvement), WHOQOL (World Health Organization Quality of Life Assessment), IBSSS (The Irritable Bowel Severity Scoring System). From Week 3 to 6, the investigator can titrate the subject's dose upwards according to clinical response and tolerability, at a maximum rate of paroxetine CR 12.5mg every 14 days. For example, if CGI-I is ≥3 based on the assessment at scheduled clinic visit, and the patient is able to tolerate an increased dose, the dose increment to the next dose level shall be considered. The highest dose that may be administered is paroxetine CR 50 mg and dose titration may only occur at scheduled visits.

Visit 6 (Day 56): Efficacy and safety assessments will be performed at these visits, including vital signs, physical examination, laboratory assessments and HDRS-17, CGI-S, CGI-I, WHOQOL, IBSSS.

If the patient experiences an adverse event (AE) and the investigator deems that a reduction in dose is required then the patient may be administered a dose one level (paroxetine CR 12.5 mg) lower than they were taking previously. Upon resolution of the AE, the investigator may return to patient's pre-AE dose level.

Follow-Up:

After treatment phase, the investigator should communicate with all the subjects about the follow-up choice: reduce or continuing paroxetine CR treatment/ other antidepressants treatment/ transferring to psychiatric clinics. It is not recommend to reduce drug dosage during the treatment period of MDD.

For those subjects who decide to discontinue paroxetine CR treatment: a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. The dosage should be reduced weekly, the daily dose reduction is 12.5mg per week, and once a week. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.

Visit 7 (Day 63): the investigator should conduct safety follow up by phone call to all participants to investigate the medication situation and safety related information.

Withdraw:

Patients withdrawn from the study prior to Visit 6 (Week 8) will have all end-of-study procedures performed. Patients withdrawn from the study for any reason are to attend an early withdrawal visit on withdrawal from the study. In addition, patients have to taper the study drug if they end the study on a dose level higher than dose level 1 (paroxetine CR 12.5 mg). The dosage should be reduced weekly, the daily dose reduction is 12.5mg per week, and once a week.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: September 2014
• Est. primary completion date: September 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

1. Meet the diagnostic for IBS according to ROME III;

2. Meet the diagnostic for MDD according to MINI;

3. Age=18 and = 65;

4. Patients or their guardian have the ability to understand and to provide informed consent to the examination, observation, and evaluation; processes specified in this protocol, and have signed the informed consent from based on a full understanding of the trial.

Exclusion Criteria:

1. Patients were also excluded if they had any medical condition that would contraindicate the use of paroxetine CR [Seroxat CR®];

2. History of alcohol / drug dependence and schizophrenia; history of serious mental illness;

3. Major neurological deficits that interfere with the patient's ability to understand the study procedures and provide a written informed consent;

4. Patients were also excluded if their current episode of depression had failed to respond to two or more adequate trials of antidepressants, benzodiazepines, or other anxiolytics at a clinically appropriate dose for a minimum of 4 weeks;

5. Suicide ideation;

6. Use monoamine oxidase inhibitors (MAOIs), benzodiazepines or other antidepressants within at least 14 days before study begin;

7. Other medical and psychological conditions prevent patients from participating in the study or signing informed consent;

8. Pregnant or lactating females, or anyone who plan to become pregnant during the study period;

9. Those who are known to currently participate a clinical trial;

10. Those patients with significant organ disease. GI disorders that are infectious;

11. Ischemic, radiation-induced, or medication-induced; inflammatory bowel disease (Cohn's disease and ulcerative colitis);

12. Recent gastrointestinal surgery (within 6 months).

13. Has received electroconvulsive therapy (ECT) or psychotherapy in the 3 months prior to screening.

14. Presents with clinically significant abnormalities in haematology, clinical chemistry, electrocardiogram (ECG) or physical examination at screening which have not resolved prior to the baseline visit or has clinically significant conditions, which in the opinion of the investigator, will render the patient unsuitable for the study and pose a safety concern or interfere with the accurate safety and efficacy assessments (e.g., severe cardiovascular disease, hepatic or renal failure etc).

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Depression
• Depressive Disorder
• Depressive Disorder, Major
• Irritable Bowel Syndrome

Intervention

Drug:
• Paroxetine CR
Paroxetine CR will be provided by GlaxoSmithKline (GSK) and be available as 12.5 mg over-encapsulated tablets with the research use only label outside the package. Paroxetine CR should be administered as a single daily dose, with or without food. The recommended initial dose is 25 mg/day. Patients were dosed in a range of 25 mg to 62.5 mg/day in the clinical trials demonstrating the effectiveness of paroxetine CR in the treatment of major depressive disorder. As with all drugs effective in the treatment of major depressive disorder, the full effect may be delayed. Some patients not responding to a 25-mg dose may benefit from dose increases, in 12.5 mg/day increments, up to a maximum of 62.5 mg/day. Dose changes should occur at intervals of at least 1 week.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
GlaxoSmithKline

References & Publications (22)

Boyce PM, Talley NJ, Balaam B, Koloski NA, Truman G. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol. 2003 Oct;98(10):2209-18. — View Citation

Cho HS, Park JM, Lim CH, Cho YK, Lee IS, Kim SW, Choi MG, Chung IS, Chung YK. Anxiety, depression and quality of life in patients with irritable bowel syndrome. Gut Liver. 2011 Mar;5(1):29-36. doi: 10.5009/gnl.2011.5.1.29. Epub 2011 Mar 16. — View Citation

Creed F, Fernandes L, Guthrie E, Palmer S, Ratcliffe J, Read N, Rigby C, Thompson D, Tomenson B; North of England IBS Research Group. The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology. 2003 Feb;124(2):303-17. — View Citation

Creed F, Ratcliffe J, Fernandez L, Tomenson B, Palmer S, Rigby C, Guthrie E, Read N, Thompson D. Health-related quality of life and health care costs in severe, refractory irritable bowel syndrome. Ann Intern Med. 2001 May 1;134(9 Pt 2):860-8. — View Citation

Cremonini F, Talley NJ. Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors. Gastroenterol Clin North Am. 2005 Jun;34(2):189-204. Review. — View Citation

Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002 Dec;123(6):2108-31. Review. — View Citation

Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, Whitehead WE, Janssens J, Funch-Jensen P, Corazziari E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993 Sep;38(9):1569-80. — View Citation

Francis CY, Morris J, Whorwell PJ. The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress. Aliment Pharmacol Ther. 1997 Apr;11(2):395-402. — View Citation

Friedrich M, Grady SE, Wall GC. Effects of antidepressants in patients with irritable bowel syndrome and comorbid depression. Clin Ther. 2010 Jul;32(7):1221-33. doi: 10.1016/j.clinthera.2010.07.002. Review. — View Citation

Gros DF, Antony MM, McCabe RE, Swinson RP. Frequency and severity of the symptoms of irritable bowel syndrome across the anxiety disorders and depression. J Anxiety Disord. 2009 Mar;23(2):290-6. doi: 10.1016/j.janxdis.2008.08.004. Epub 2008 Aug 27. — View Citation

Guthrie E, Creed F, Fernandes L, Ratcliffe J, Van Der Jagt J, Martin J, Howlett S, Read N, Barlow J, Thompson D, Tomenson B. Cluster analysis of symptoms and health seeking behaviour differentiates subgroups of patients with severe irritable bowel syndrome. Gut. 2003 Nov;52(11):1616-22. — View Citation

Hillilä MT, Siivola MT, Färkkilä MA. Comorbidity and use of health-care services among irritable bowel syndrome sufferers. Scand J Gastroenterol. 2007 Jul;42(7):799-806. — View Citation

Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006 Apr;130(5):1480-91. Review. Erratum in: Gastroenterology. 2006 Aug;131(2):688. — View Citation

Masand PS, Kaplan DS, Gupta S, Bhandary AN, Nasra GS, Kline MD, Margo KL. Major depression and irritable bowel syndrome: is there a relationship? J Clin Psychiatry. 1995 Aug;56(8):363-7. — View Citation

Mertz HR. Irritable bowel syndrome. N Engl J Med. 2003 Nov 27;349(22):2136-46. Review. — View Citation

Mitchell CM, Drossman DA. Survey of the AGA membership relating to patients with functional gastrointestinal disorders. Gastroenterology. 1987 May;92(5 Pt 1):1282-4. — View Citation

Park JM, Choi MG, Cho YK, Lee IS, Kim JI, Kim SW, Chung IS. Functional Gastrointestinal Disorders Diagnosed by Rome III Questionnaire in Korea. J Neurogastroenterol Motil. 2011 Jul;17(3):279-86. doi: 10.5056/jnm.2011.17.3.279. Epub 2011 Jul 13. — View Citation

Russo MW, Gaynes BN, Drossman DA. A national survey of practice patterns of gastroenterologists with comparison to the past two decades. J Clin Gastroenterol. 1999 Dec;29(4):339-43. — View Citation

Sandler RS. Epidemiology of irritable bowel syndrome in the United States. Gastroenterology. 1990 Aug;99(2):409-15. — View Citation

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57. Review. — View Citation

Thompson W, Longstreth G, Drossman Deds. Functional bowel disorders and functional abdominal pain. In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE, eds. Rome II. The Functional Gastrointestinal Disorders, 2nd edn. McLean, VA: Degnon Associates, 2000: 351-432.

Vandvik PO, Lydersen S, Farup PG. Prevalence, comorbidity and impact of irritable bowel syndrome in Norway. Scand J Gastroenterol. 2006 Jun;41(6):650-6. — View Citation

* Note: There are 22 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	HDRS-17		8 weeks	No
Secondary	HDRS-17 item 10		8 weeks	No
Secondary	CGI-I		8 weeks	No
Secondary	CGI-S		8 weeks	No
Secondary	WHOQOL		8 weeks	No
Secondary	IBSSS		8 weeks	No