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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04338321
Other study ID # CR108787
Secondary ID 2019-002992-3354
Status Completed
Phase Phase 3
First received
Last updated
Start date August 21, 2020
Est. completion date July 15, 2022

Study information

Verified date October 2023
Source Janssen-Cilag International NV
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The primary purpose of this study is to evaluate the efficacy of flexibly dosed esketamine nasal spray compared with quetiapine extended-release (XR), both in combination with a continuing selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI), in achieving remission in participants who have treatment-resistant major depressive disorder (MDD) with a current moderate to severe depressive episode.


Description:

A depressive state with classical symptoms such as low (depressive/sad) mood, markedly diminished interest in activities, significant weight loss/gain, insomnia or hypersomnia, psychomotor agitation/retardation, excessive fatigue, inappropriate guilt, diminished concentration, and recurrent thoughts of death, persisting for more than 2 weeks is classified as major depressive disorder (MDD). The mechanism of action of ketamine is distinct from conventional antidepressants (ADs), which target the monoamines (serotonin, norepinephrine, and/or dopamine). Esketamine, the S-enantiomer of ketamine, is approved and widely used for the induction and maintenance of anesthesia via intramuscular or intravenous (IV) administration. There is a significant unmet need to develop novel AD treatments based on the relevant psychophysiological pathways underlying MDD. The goal of any novel treatment would be the rapid and long-lasting relief of depressive symptoms, especially in participants with treatment-resistant depression (TRD), who lack a sufficient response to the currently available treatment strategies. The study consists of a Screening Phase (up to 14 days), an Acute Phase (8 Weeks), a Maintenance Phase (24 Weeks) and a Safety Follow-up Phase (2 Weeks). Safety assessment includes adverse event, serious adverse events, physical examination, vital signs, electrocardiogram, clinical safety laboratory assessments, suicidal risk monitoring. The total duration of the study is approximately 36 Weeks for all participants.


Recruitment information / eligibility

Status Completed
Enrollment 676
Est. completion date July 15, 2022
Est. primary completion date January 20, 2022
Accepts healthy volunteers No
Gender All
Age group 18 Years to 74 Years
Eligibility Inclusion Criteria: - At screening, each participant must meet Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria for single-episode major depressive disorder (MDD) or recurrent MDD, without psychotic features, based on clinical assessment and confirmed by the Mini International Neuropsychiatric Interview (MINI) - At screening and baseline, each participant must have an Inventory of Depressive Symptomatology - Clinician-rated, 30 item (IDS-C30) total score of greater than or equal to (>=) 34 - Must be on a current antidepressive treatment that includes an selective serotonin reuptake inhibitor (SSRI)/ serotonin-norepinephrine reuptake inhibitor (SNRI) at screening that resulted in nonresponse (less than 25% improvement of symptoms) after having been given at an adequate dosage (based on antidepressive dosages from SmPC [or local equivalent, if applicable]) for an adequate duration of at least 6 weeks and having been uptitrated to the maximum tolerated dose; however, at screening the participant must show signs of minimal clinical improvement to be eligible for the study. Clinical improvement of a participant on their current AD treatment will be retrospectively evaluated in a qualified psychiatric interview performed by an experienced clinician. At baseline (Day 1) prior to randomization, the investigator will evaluate any changes in the participant's signs/symptoms of depression since the screening assessment and confirm that the inclusion criteria for the current AD treatment are still met (that is nonresponse and minimal clinical improvement) - The current antidepressive treatment, was immediately preceded by nonresponse to at least 1 but not more than 5 different, consecutive treatments (all within the current moderate to severe antidepressive episode) with anti-depressants (ADs) taken at an adequate dosage for an adequate duration of at least 6 weeks and must be documented - Must have been treated with at least 2 different antidepressive substance classes among the treatments taken at an adequate dosage for an adequate duration of at least 6 weeks resulting in nonresponse in the current moderate to severe depressive episode (including the current treatment with an selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor [SSRI/SNRI]) - Must be on a single oral SSRI/SNRI on Day 1 prior to randomization Exclusion Criteria: - Received treatment with esketamine or ketamine in the current moderate to severe depressive episode - Received treatment with quetiapine extended- or immediate-release in the current moderate to severe depressive episode of a dose higher than 50 milligram per day (mg/day) - Had depressive symptoms in the current moderate to severe depressive episode that previously did not respond to an adequate course of treatment with electroconvulsive therapy (ECT), defined as at least 7 treatments with unilateral/bilateral ECT - Has no signs of clinical improvement at all or with a significant improvement on their current AD treatment that includes an SSRI/SNRI as determined at screening by an experienced clinician during the qualified psychiatric interview - Received vagal nerve stimulation or has received deep brain stimulation in the current episode of depression - has a current or prior DSM-5 diagnosis of a psychotic disorder or MDD with psychotic features, bipolar or related disorders (confirmed by the Mini International Neuropsychiatric Interview [MINI]), obsessive compulsive disorder (current only), intellectual disability (DSM-5 diagnostic codes 317, 318.0, 318.1, 318.2, 315.8, and 319), autism spectrum disorder, borderline personality disorder, or antisocial personality disorder, histrionic personality disorder, or narcissistic personality disorder - age at onset of first episode of MDD was more than or equal to (>=) 55 years - has homicidal ideation or intent, per the investigator's clinical judgment; or has suicidal ideation with some intent to act within 1 month prior to screening, per the investigator's clinical judgment; or based on the Columbia-Suicide Severity Rating Scale (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, or a history of suicidal behavior within the past year prior to screening. Participants reporting suicidal ideation with intent to act or suicidal behavior prior to the start of the acute phase should also be excluded

Study Design


Intervention

Drug:
Esketamine 28 mg
Esketamine will be self-administered at a dose of 28 mg as nasal spray.
Esketamine 56 mg
Esketamine will be self-administered at a dose of 56 mg as nasal spray.
Esketamine 84 mg
Esketamine will be self-administered at a dose of 84 mg (maximum uptitrated dose) as nasal spray.
Quetiapine XR 50 mg
Quetiapine XR will be administered at an initial dose of 50 mg/day and may be further increased to 300 mg/day based on individual participant evaluation.
Quetiapine XR 100 mg
Quetiapine XR will be administered at a dose of 100 mg/day and may be further increased to 300 mg/day based on individual participant evaluation.
Quetiapine XR 150 mg
Quetiapine XR will be administered at a dose of 150 mg/day and may be further increased to 300 mg/day based on individual participant evaluation.
SSRI/SNRI
Participants will continue to take SSRI/SNRI that is approved for use in depression in their country of participation; off-label use of any SSRI/SNRI is not permitted. The continuing SSRI/SNRI dosage may be optimized throughout the study, at the investigator's discretion and based on the SmPC (or local equivalent, if applicable).

Locations

Country Name City State
Argentina FunDaMos Ciudad Autonoma de Buenos Aires
Argentina Fundacion para el Estudio y Tratamiento de las Enfermedades Mentales Ciudad Autónoma De Buenos Aires
Argentina CEN-Consultorios Especializados en Neurociencias Cordoba
Argentina Fundacion Lennox Cordoba
Argentina Instituto Médico DAMIC Cordoba
Argentina Sanatorio Prof. Leon S. Morra S.A Cordoba
Argentina Instituto de Neurociencias San Agustín La Plata
Argentina C.I.A.P. (Centro de investigación y Asistencia en Psiquiatría) Rosario
Austria Medical University Graz Graz
Austria Medical University Vienna, MUV Vienna
Austria Schmitz and Schmitz Vienna
Belgium Anima Alken
Belgium Pz Duffel Duffel
Belgium Clinique Psychiatrique des Frères Alexiens Henri-Chapelle
Belgium Sint-Franciskusziekenhuis Heusden-Zolder
Belgium ARIADNE Lede
Belgium CHU de Liège Liege
Brazil CPN - Centro de Pesquisa em Neurociências Ltda Belo Horizonte
Brazil Trial Tech Tecnologia em Pesquisas com Medicamentos Curitiba
Brazil Ruschel Medicina e Pesquisa Clínica Ltda Rio de Janeiro
Brazil BR Trials São Paulo
Brazil C.J.S. Carvalho & Carvalho LTDA (Viver - Centro De Desospitalizacao Humana) São Paulo
Bulgaria State Psychiatric Hospital Kardzhali Kardzhali
Bulgaria UMHAT 'Dr. Georgi Stranski', EAD Pleven
Bulgaria Mental Health Center - Plovdiv Plovdiv
Bulgaria Mental Health Center - Rousse Rousse
Bulgaria Centre for Mental Health Prof.N.Shipkovenski EOOD Sofia
Bulgaria MHC - Sofia, EOOD Sofia
Bulgaria Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum Sofia
Bulgaria University Multiprofile Hospital for Active Treatment - UMHAT Alexandrovska EAD Sofia
Czechia Psychiatricka ambulance Saint Anne s.r.o. Brno
Czechia Psychiatricka ambulance, MUDr. Marta Holanova Brno
Czechia NeuropsychiatrieHK, s.r.o. Hradec Kralove-Vekose
Czechia A-Shine s.r.o. Plzen
Czechia Institut Neuropsychiatricke pece Prague
Czechia AD71 s.r.o. Praha 10
Czechia Clintrial s.r.o. Praha 10
Czechia Medical Services Prague s.r.o. Praha 6
Denmark Aalborg University Hospital Aalborg
Denmark Psykiatrien i Region Syddanmark Esbjerg N
Finland Mederon LTD at ARTES Helsinki
Finland Psykiatrinen Palvelukeskus Solvum Oy Helsinki
Finland Savon Psykiatripalvelu Kuopio
Germany Universitaetsklinikum der RWTH Aachen Aachen
Germany Rheinhessen Fachklinik Alzey Alzey
Germany Alexander Schulze - Germany Berlin
Germany Charite Campus Benjamin Franklin Berlin
Germany Emovis GmbH Berlin
Germany Medizinisches Versorgungszentrum LiO GmbH Berlin
Germany Praxis Dr. med. Kirsten Hahn Berlin
Germany Vivantes Klinikum Spandau Berlin
Germany Universitatsklinikum Bonn Bonn
Germany Klinikum Chemnitz gGmbH Chemnitz
Germany Carl-Thiem-Klinikum Cottbus gGmbH Cottbus
Germany Klinikum Dortmund gGmbH Dortmund
Germany Universitatsklinikum Carl Gustav Carcus Dresden Dresden
Germany Universitatsklinikum Frankfurt Frankfurt Am Main
Germany Universitätsklinikum Freiburg - Abteilung für Psychiatrie u. Psychotherapie mit Poliklinik Freiburg
Germany SRH Waldklinikum Gera GmbH Gera
Germany Georg-August Universität, Universitätsmedizin Göttingen Gottingen
Germany Evangelisches Krankenhaus Bethanien gGmbH Greifswald
Germany Klinische Forschung Hamburg Hamburg
Germany Universitaetsklinik Hamburg-Eppendorf Hamburg
Germany Klinische Forschung Hannover-Mitte GmbH Hannover
Germany Medizinische Hochschule Hannover Hannover
Germany Universität Heidelberg Heidelberg
Germany Oberhavel Kliniken GmbH Hennigsdorf
Germany Universitätsklinikum des Saarlandes Homburg
Germany Universitätsklinikum Jena Jena
Germany Panakeia - Arzneimittelforschung GmbH Leipzig
Germany Universitaetsklinikum Magdeburg A.oe.R Magdeburg
Germany Universitätsmedizin der Johannes Gutenberg-Universität Mainz Mainz
Germany Pharmakologisches Studienzentrum Chemnitz GmbH Mittweida
Germany Universitätsklinikum Münster Munster
Germany Ruppiner Kliniken Neuruppin
Germany Praxis Prof. Steinwachs Nurnberg
Germany Johanniter Krankenhaus Oberhausen Oberhausen
Germany Danuvius Klinik Pfaffenhofen Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik Pfaffenhofen
Germany Klinische Forschung Schwerin GmbH Schwerin
Germany Somni Bene GmbH Schwerin
Germany Klinikum der Hansestadt Stralsund GmbH-Ambulanz-Klinik für Psychiatrie und Psychotherapie - Germany Stralsund
Greece 'Dafni' Psychiatric Hospital of Attica Athens
Greece Aiginition Hospital of Athens Athens
Greece Venizeleio General Hospital Crete
Greece Psychiatric Clinic 'Agios Charalampos' Heraklion
Greece University General Hospital of Ioannina Ioannina
Greece University General Hospital of Rio Patras Patras
Greece 'G. Papanikolaou' Hospital of Thessaloniki Thessaloniki
Greece 424 Military Hospital of Thessaloniki Thessaloniki
Greece Psychiatric Hospital of Thessaloniki Thessaloniki
Hungary Észak-Közép-budai Centrum, Új Szent János Kórház és Szakrendelo Budai Családközpontú Budapest
Hungary Processus Kft. Budapest
Hungary Semmelweis Egyetem Budapest
Hungary Debreceni Egyetem, Kenézy Gyula Egyetemi Oktatókórház Debrecen
Hungary Bugat Pal Korhaz Gyongyos
Hungary Petz Aladar Megyei Oktato Korhaz Gyor
Hungary Bács-Kiskun Megyei Kórház a Szegedi Tudományegyetem Általános Orvostudományi Kar Oktató Kórháza Kalocsa
Hungary Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktatokorhaz Nyiregyhaza
Hungary Pecsi Tudomanyegyetem Klinikai Kozpont Pecs
Israel Rambam Medical Center Haifa
Israel Shalvata Mental Health Center Hod Hasharon
Israel Beer Yaakov Mental Health Center Lod
Israel Geha Mental Health Center Petach Tikva
Israel Sheba Medical Center Ramat Gan
Israel Tel Aviv Sourasky Medical Center Telaviv
Kazakhstan Republican Scientific and Practical Center of Mental Health Almaty
Kazakhstan Medical Center for Psychological Healt SME Nur-Sultan
Kazakhstan East-Kazakhstan Regional Centre of Mental Health Ust'-Kamenogorsk
Korea, Republic of Chonnam National University Hospital Gwangju
Korea, Republic of Wonkwang University Hospital Iksan
Korea, Republic of Korea University Anam Hospital Seoul
Korea, Republic of KyungHee University Hospital Seoul
Korea, Republic of Samsung Medical Center Seoul
Korea, Republic of Severance Hospital, Yonsei University Health System Seoul
Malaysia Hospital Raja Permaisuri Bainun Ipoh
Malaysia Hospital Kuala Lumpur Kuala Lumpur
Malaysia University Malaya Medical Centre Kuala Lumpur
Malaysia Hospital Pengajar Universiti Putra Malaysia Serdang
Malaysia Hospital Tuanku Jaafar Seremban
Netherlands AMC Amsterdam
Netherlands Brain Research Center Amsterdam
Netherlands LUMC Leiden
Norway Haukeland University Hospital Hordaland
Norway Sykehuset Ostfold Moss
Norway St Olav University Hospital Trondheim
Poland Mlynowamed Specjalistyczny Psychiatryczny Gabinet Lekarski Joanna Lazarczyk Bialystok
Poland Osrodek Badan Klinicznych CLINSANTE S.C. Bydgoszcz
Poland Centrum Badan Klinicznych PI-House sp. z o.o. Gdansk
Poland Uniwersyteckie Centrum Kliniczne Gdansk
Poland Centrum Medyczne Care Clinic Katowice Katowice
Poland Niepubliczny Zaklad Opieki Psychiatrycznej MENTIS Leszno
Poland Specjalistyczny Psychiatryczny Zespol Opieki Zdrowotnej w Lodzi Szpital im. J. Babinskiego Lodz
Poland SPZOZ CSK UM w Lodzi Klinika Zaburzen Afektywnych i Psychotycznych Lodz
Poland Centrum Medyczne Luxmed Sp z o o Lublin
Poland Osrodek Badan Klinicznych CLINSANTE S.C. Torun
Portugal Hospital de Braga Braga
Portugal Centro Hospitalar do Tâmega e Sousa, EPE - Hospital Padre Americo, Vale do Sousa Guilhufe - Penafiel
Portugal Centro Hospitalar de Lisboa Norte - Hospital Santa Maria Lisboa
Portugal Fundação Champalimaud Lisboa
Portugal Hospital CUF Tejo Lisbon
Portugal Hospital Beatriz Angelo Loures
South Africa Cape Town Clinical Research Centre Cape Town
South Africa Flexivest 14 Research Cape Town
South Africa Gert Bosch - Pretoria South Africa Garsfontein
Sweden Psykiatriska kliniken Goteborg
Sweden Affecta Pskyiatrimottagning Halmstad
Sweden Psykiatriska kliniken Lulea
Sweden ProbarE i Lund AB Lund
Sweden ONE LIFETIME Läkarmottagning Skovde
Sweden ProbarE i Stockholm AB Stockholm
Taiwan Changhua Christian Hospital ChangHua
Taiwan Hualien Tzu Chi Hospital Hualien
Taiwan Chang Gung Memorial Hospital Kaohsiung
Taiwan Kai-Syuan Psychiatric Hospital Kaohsiung
Taiwan National Cheng Kung University Hospital Tainan
Taiwan Mackay Memorial Hospital Taipei
Taiwan National Taiwan University Hospital Taipei
Taiwan Taipei Veterans General Hospital Taipei
Taiwan Taipei Medical University Taipei City
Taiwan Chang Gung Memorial Hospital Taoyuan
Turkey Hacettepe University Medical Faculty Ankara
Turkey Bursa Yuksek Ihtisas Training and Research Hospital Bursa
Turkey Uludag University Medical Faculty Bursa
Turkey Bakirkoy Mental Health Training and Research Hospital Istanbul
Turkey Erenkoy Mental Health Hospital Istanbul
Turkey Uskudar University Neuropsychiatry Hospital Istanbul
Turkey Ege Universitesi Tip Fakultesi Izmir
Turkey Selcuk University Medical Faculty Konya
Turkey Liv Hospital Samsun
Turkey Namik Kemal University Tekirdag
United Arab Emirates American Center for Psychiatry and Neurology Abu Dhabi

Sponsors (1)

Lead Sponsor Collaborator
Janssen-Cilag International NV

Countries where clinical trial is conducted

Argentina,  Austria,  Belgium,  Brazil,  Bulgaria,  Czechia,  Denmark,  Finland,  Germany,  Greece,  Hungary,  Israel,  Kazakhstan,  Korea, Republic of,  Malaysia,  Netherlands,  Norway,  Poland,  Portugal,  South Africa,  Sweden,  Taiwan,  Turkey,  United Arab Emirates, 

Outcome

Type Measure Description Time frame Safety issue
Primary Percentage of Participants With Remission as Assessed by the Montgomery-Asberg Depression Rating Scale (MADRS) Score at Week 8 Percentage of participants with remission as assessed by the MADRS at Week 8 was reported. The MADRS is a clinician-rated scale designed to measure depression severity and to detect changes due to antidepressant treatment. The scale consists of 10 items, each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of the symptoms), for a total possible score of 60. Higher scores represent a more severe condition. The MADRS evaluates apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts. A participant was defined as being in remission if the MADRS total score was less than or equal to (<=)10 and no treatment or study discontinuation before Week 8. Week 8
Secondary Percentage of Participants With Both Remission at Week 8 and Relapse-free Until Week 32 Percentage of participants with both remission at Week 8 and relapse-free until Week 32 were reported. A participant was defined as being in remission if the MADRS total score was <= 10 and no treatment or study discontinuation before Week 8. A relapse was defined by any of following: a) Worsening of depressive symptoms as indicated by MADRS total score greater than or equal to (>=) 22 confirmed by 1 additional assessment of MADRS total score >= 22 within the next 5 to 15 days. The date of the second MADRS assessment was used for the date of relapse; b) Any psychiatric hospitalization for: worsening of depression, suicide prevention or suicide attempt, the start date of hospitalization was the date of relapse; c) Suicide attempt, completed suicide, or any other clinically relevant event determined by investigator's judgment to be indicative of a relapse of depressive illness, but without hospitalized. The onset of the event was used for the date of relapse. Week 32
Secondary Change From Baseline in Clinician-rated Overall MADRS Score Change from baseline in clinician-rated overall MADRS score was reported. The MADRS is a clinician-rated scale designed to measure depression severity and to detect changes due to antidepressant treatment. The scale consists of 10 items, each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of the symptoms), summed up for a total possible score range of 0 to 60. Higher scores represent a more severe condition. The MADRS evaluates apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts. Baseline, Weeks 1, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32
Secondary Change From Baseline in Clinician-rated Overall MADRS Score at Last Observation Carried Forward (LOCF) Change from baseline in clinician-rated overall MADRS score at LOCF was reported. The MADRS is a clinician-rated scale designed to measure depression severity and to detect changes due to antidepressant treatment. The scale consists of 10 items, each of which is scored from 0 (item is not present or is normal) to 6 (severe or continuous presence of the symptoms), summed up for a total possible score range of 0 to 60. Higher scores represent a more severe condition. The MADRS evaluates apparent sadness, reported sadness, inner tension, sleep, appetite, concentration, lassitude, interest level, pessimistic thoughts, and suicidal thoughts. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32
Secondary Change From Baseline in Clinician-rated Overall Severity of Depressive Illness as Assessed by Clinical Global Impression - Severity (CGI-S) Scale Score Change from baseline in clinician-rated overall severity of depressive illness as assessed by CGI-S scale score was reported. The CGI-S provides an overall clinician-determined summary measure of the severity of the participant's illness that takes into account all available information, including knowledge of the participant's history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the participant's ability to function. The CGI-S evaluates the severity of psychopathology on a scale of 1 to 7. Considering total clinical experience, a participant is assessed on severity of mental illness at the time of rating according to: 1 = normal (not at all ill); 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; 7 = among the most extremely ill participants. Negative change in score indicates improvement. Baseline, Weeks 1, 2, 3, 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Clinician-rated Overall Severity of Depressive Illness as Assessed by CGI-S Scale Score at LOCF Change from Baseline in clinician-rated overall severity of depressive illness as assessed by CGI-S scale score at LOCF was reported. The CGI-S provides an overall clinician-determined summary measure of the severity of the participant's illness that takes into account all available information, including knowledge of the participant's history, psychosocial circumstances, symptoms, behavior, and the impact of the symptoms on the participant's ability to function. The CGI-S evaluates the severity of psychopathology on a scale of 1 to 7. A participant is assessed on severity of mental illness at the time of rating according to: 1 = normal (not at all ill); 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; 7 = among the most extremely ill participants. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 2, 3, 4, 8, 12, 16, 20, 24, 28, 32
Secondary Clinician-rated Overall Severity of Depressive Illness as Assessed by Clinical Global Impression - Change (CGI-C) Scale Score Clinician-rated overall severity of depressive illness as assessed by CGI-C scale score was reported. The CGI-C evaluates the total improvement whether or not entirely due to drug treatment on a scale of 1 to 7. Compared to the condition at baseline, a participant is assessed on how much he/she has changed, according to: 1 = very much improved; 2 = much improved; 3 = minimally improved; 4 = no change; 5 = minimally worse; 6 = much worse; 7 = very much worse. Higher scores indicate more severity. Baseline, Weeks 1, 2, 3, 4, 8, 12, 16, 20, 24, 28, 32
Secondary Number of Participants With Clinician-rated Overall Severity of Depressive Illness as Assessed by CGI-C Scale Score at LOCF Number of participants with clinician-rated overall severity of depressive illness as assessed by CGI-C scale score at LOCF was reported. The CGI-C evaluates the total improvement whether or not entirely due to drug treatment on a scale of 1 to 7. Compared to the condition at baseline, a participant is assessed on how much he/she has changed, according to: 1 = very much improved; 2 = much improved; 3 = minimally improved; 4 = no change; 5 = minimally worse; 6 = much worse; 7 = very much worse. Higher scores indicate more severity. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 2, 3, 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Depressive Symptoms as Assessed by Patient Health Questionnaire (PHQ) 9-item Total Score Change from baseline in participant-reported depressive symptoms as assessed by PHQ 9-item total score was reported. The PHQ-9 is a validated 9-item, patient-reported outcome (PRO) measure to assess depressive symptoms. Each item is rated on a 4-point scale (0=not at all, 1=several days, 2=more than half the days, and 3=nearly every day). The participant's item responses are summed to provide a total score (range of 0 to 27), with higher scores indicating greater severity of depressive symptoms. The severity of the PHQ-9 is categorized as follows: None-minimal (0-4), Mild (5-9), Moderate (10-14), Moderately Severe (15-19) and Severe (20-27). Baseline, Weeks 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32
Secondary Change From Baseline in Participant-reported Depressive Symptoms as Assessed by PHQ 9-item Total Score at LOCF Change from baseline in participant-reported depressive symptoms as assessed by PHQ 9-item total score at LOCF was reported. The PHQ-9 is a validated 9-item, PRO measure to assess depressive symptoms. Each item is rated on a 4-point scale (0=not at all, 1=several days, 2=more than half the days, and 3=nearly every day). The participant's item responses are summed to provide a total score (range of 0 to 27), with higher scores indicating greater severity of depressive symptoms. The severity of the PHQ-9 is categorized as follows: None-minimal (0-4), Mild (5-9), Moderate (10-14), Moderately Severe (15-19) and Severe (20-27). LOCF is defined as participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32
Secondary Change From Baseline in Participant-reported Functional Impairment and Associated Disability as Assessed by Sheehan Disability Scale (SDS) Total Score Change from baseline in participant-reported functional impairment and associated disability as assessed by SDS total score was reported. The SDS is a validated PRO measure consisting of a 5-item questionnaire that has been widely used and accepted for assessment of functional impairment and associated disability. The first 3 items assess disruption of (1) work/school, (2) social life, and (3) family life/home responsibilities using a rating scale from 0 to 10. It also has 1 item assessing days lost from school or work and 1 item assessing days of underproductivity. The scores for the first 3 items are summed to create a total score of 0 to 30, where higher score indicates greater impairment. Scores <=2 for each item and <= 6 for the total score are considered functional remission. Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Functional Impairment and Associated Disability as Assessed by SDS Total Score at LOCF Change from baseline in participant-reported functional impairment and associated disability as assessed by SDS total score at LOCF was reported. The SDS is a validated PRO measure consisting of a 5-item questionnaire for assessment of functional impairment and associated disability. The first 3 items assess disruption of (1) work/school, (2) social life, and (3) family life/home responsibilities using a rating scale from 0 to 10. It also has 1 item assessing days lost from school or work and 1 item assessing days of underproductivity. The scores for the first 3 items are summed to create a total score of 0 to 30, where higher score indicates greater impairment. Scores <=2 for each item and <= 6 for the total score are considered functional remission. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Health-related Quality of Life (HRQoL) and Health Status as Assessed by 36-item Short-Form Health Survey (SF-36) Scale Score Change from baseline in participant-reported HRQoL and health status as assessed by SF-36 scale score was reported. The SF-36 consists of 8 subscales (physical function, role limitations due to physical problems, pain, general health perception, vitality, social function, role limitations due to emotional problems, and mental health). Participants self-report on items in a subscale that have between 2-6 choices per item using likert-type responses (for example: none of the time, some of the time, etc.). Summations of item scores of the same subscale give the subscale scores, which are transformed into a range from 0 to 100; 0= worst HRQoL, 100=best HRQoL. Higher scores indicate better health status. Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported HRQoL and Health Status as Assessed by SF-36 Scale Score at LOCF Change from baseline in participant-reported HRQoL and health status as assessed by SF-36 domain scores at LOCF was reported. The SF-36 consists of 8 subscales (physical function, role limitations due to physical problems, pain, general health perception, vitality, social function, role limitations due to emotional problems, and mental health). Participants self-report on items in a subscale that have between 2-6 choices per item using likert-type responses (for example: none of the time, some of the time, etc.). Summations of item scores of the same subscale give the subscale scores, which are transformed into a range from 0 to 100; 0= worst HRQoL, 100=best HRQoL. Higher scores indicate better health status. LOCF is defined as participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Quality of Life as Assessed by Quality of Life in Depression Scale (QLDS) Total Score Change from baseline in participant-reported quality of life as assessed by QLDS total score was reported. The QLDS is a disease-specific validated PRO measure which assesses the impact that depression has on a participant's quality of life. It is a 34-item self-rated questionnaire which consists of dichotomous response questions, with the response being either True/Not True. Each statement on the QLDS is given a score of "1" or "0". A score of "1" is indicative of adverse quality of life. All item scores are summed to give a total score that ranges from 0 (good quality of life) to 34 (very poor quality of life). A higher score indicates a more severe condition. Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Quality of Life as Assessed by QLDS Total Score at LOCF Change from baseline in participant-reported quality of life as assessed by QLDS total score at LOCF was reported. The QLDS is a disease-specific validated PRO measure which assesses the impact that depression has on a participant's quality of life. It is a 34-item self-rated questionnaire which consists of dichotomous response questions, with the response being either True/Not True. Each statement on the QLDS is given a score of "1" or "0". A score of "1" is indicative of adverse quality of life. All item scores are summed to give a total score that ranges from 0 (good quality of life) to 34 (very poor quality of life). A higher score indicates a more severe condition. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Health-related Quality of Life as Assessed by EuroQol-5 Dimension-5 Level (EQ-5D-5L) Score: Health Status Index Change from baseline in participant-reported health-related quality of Life as assessed by EQ-5D-5L score: health status index was reported. The EQ-5D-5L is a standardized 2-part instrument used to measure health outcomes, primarily designed for self-completion by respondents. It consists of the EQ-5D-5L descriptive system and the EQ Visual Analogue Scale (EQ-VAS). The EQ-5D-5L descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each of the 5 dimensions is divided into 5 levels of perceived problems (level 1 = no problem, level 2 = slight problems, level 3 = moderate problems, level 4 = severe problems, level 5 = extreme problems). The participant selects an answer for each of the 5 dimensions considering the response that best matches his or her health "today." Responses were used to generate health status index which ranges from 0 (dead) and 1 (full health), a lower score indicates worse health. Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Health-related Quality of Life Group, as Assessed by EQ-5D-5L Score: Health Status Index at LOCF Change from baseline in participant-reported health-related quality of Life as assessed by EQ-5D-5L score: health status index at LOCF was reported. The EQ-5D-5L is a standardized 2-part instrument used to measure health outcomes, primarily designed for self-completion by respondents. It consists of the EQ-5D-5L descriptive system and the EQ-VAS. The EQ-5D-5L descriptive system comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each of the 5 dimensions is divided into 5 levels of perceived problems (level 1 = no problem, level 2 = slight problems, level 3 = moderate problems, level 4 = severe problems, level 5 = extreme problems). The participant selects an answer for each of the 5 dimensions considering the response that best matches his or her health "today." LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Health Status as Assessed by EQ-5D-5L Score: VAS Change from baseline in participant-reported health status as assessed by EQ-5D-5L Score: VAS was reported. The EQ-5D-5L is a standardized 2-part instrument for use as a measure of health outcome, primarily designed for self-completion by respondents. It essentially consists of the EQ-5D-5L descriptive system and the EQ-VAS. EQ-VAS self-rating records the respondent's own assessment of his/her overall health status at time of completion, on a scale of 0 (worst health you can imagine) to 100 (best health you can imagine). Positive change in score indicates improvement. Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Health Status as Assessed by EQ-5D-5L Score: VAS at LOCF Change from baseline in participant-reported health status as assessed by EQ-5D-5L score: VAS at LOCF was reported. The EQ-5D-5L is a standardized 2-part instrument for use as a measure of health outcome, primarily designed for self-completion by respondents. It essentially consists of the EQ-5D-5L descriptive system and the EQ-VAS. EQ-VAS self-rating records the respondent's own assessment of his/her overall health status at time of completion, on a scale of 0 (worst health you can imagine) to 100 (best health you can imagine). Positive change in score indicates improvement. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Work Productivity as Assessed by Work Productivity and Activity Impairment (WPAI): Depression Questionnaire Change from baseline in participant-reported work productivity as assessed by WPAI: depression questionnaire was reported. The WPAI-D questionnaire is a validated short instrument that assesses impairment in work and other regular activities over the past 7 days. The WPAI yields four types of scores: (a) Absenteeism (work time missed); (b) Presenteeism (impairment at work / reduced on-the-job effectiveness); (c) Work productivity loss (overall work impairment / absenteeism plus presenteeism); (d) Activity Impairment. The first three scores were derived only for respondents who were working (should be missing for non-working), but the last score was applicable for all respondents. Each score ranges from 0 to 100 with higher scores indicating greater impairment and less productivity. Baseline, Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Change From Baseline in Participant-reported Work Productivity as Assessed by WPAI: Depression Questionnaire at LOCF Change from baseline in participant-reported work productivity as assessed by WPAI: depression questionnaire at LOCF was reported. The WPAI-D questionnaire is a validated short instrument that assesses impairment in work and other regular activities over the past 7 days. The WPAI yields four types of scores: (a) Absenteeism (work time missed); (b) Presenteeism (impairment at work / reduced on-the-job effectiveness); (c) Work productivity loss (overall work impairment / absenteeism plus presenteeism); (d) Activity Impairment. The first three scores were derived only for respondents who were working (should be missing for non-working), but the last score was applicable for all respondents. Each score ranges from 0 to 100 with higher scores indicating greater impairment and less productivity. LOCF is defined as the participants who had a missing value or who stopped treatment at a specific time point had their last non-missing value carried forward. Baseline, LOCF at Weeks 4, 8, 12, 16, 20, 24, 28, 32
Secondary Number of Participants With Treatment-emergent Adverse Events (TEAEs) An AE is any untoward medical occurrence in a participant participating in a clinical study that does not necessarily have a causal relationship with the pharmaceutical/ biological agent under study. TEAEs were those events if they started after administration of the first dose until 14 days after the last dose of study medication for other TEAEs except serious; and first dose until 30 days after the last dose of study medication for serious TEAEs. Up to Week 35
Secondary Number of Participants With TEAEs of Special Interest Number of participants with TEAEs of special interest were reported. It included significant TEAEs that were judged to be of special interest because of clinical importance, known or suspected class effects, or based on nonclinical signals. Events such as sedation, depersonalization/derealization disorder, depression suicidal, aggression, allergic cystitis, cholestasis and jaundice of hepatic origin, and many more were considered as TEAEs of special interest. Up to Week 35
Secondary Number of Participants With Suicidal Ideation or Behavior as Assessed by Columbia-Suicide Severity Rating Scale (C-SSRS) Score Number of participants with suicidal ideation or behavior as assessed by C-SSRS score was reported. The C-SSRS is an assessment tool that evaluates suicidal ideation and behavior. Suicidal ideation consists of 5 items: wish to be dead, non-specific active suicidal thoughts, active suicidal ideation with any methods (not plan) without intention to act, active suicidal ideation with some intent to act without specific plan, and active suicidal ideation with specific plan and intent. Suicidal behavior consists of 5 items: preparatory acts or behavior, aborted attempt, interrupted attempt, actual attempt (non-fatal), and completed suicide. The maximum score (from the 10 categories) assigned for each participant was summarized into one of three broad categories: No suicidal ideation or behavior (0), Suicidal ideation (1 - 5), Suicidal behavior (6 - 10). Total score ranges from 1 to 10. Higher scores indicate more severe suicidal ideation and behavior. Weeks 1, 2, 3, 4, 8, 12, 16, 20, 24, 28, 32
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