Esketamine Adjuvant Therapy for Patients With Chronic Visceral Pain Comorbid Major Depressive Disorder

Major Depressive Disorder Clinical Trial

Official title:

A Randomized Controlled, Single-blind, Esketamine Adjuvant Therapy for the Efficacy and Safety of Patients With Chronic Visceral Pain Comorbid Major Depressive Disorder

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04847245
• Other study ID #: Esketamine20210221
• Status: Not yet recruiting
• Phase: N/A
• Start date: May 1, 2021
• Est. completion date: March 1, 2023

Study information

• Verified date: April 2021
• Source: Peking University
• Contact: Tianmei SI, PhD., MD
• Phone: 86-1062723748
• Email: si.tian-mei[@]163.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Ketamine is a dissociative anesthetic and powerful analgesic. At low doses, ketamine can desensitize the central pain pathway and modulate opioid receptors. Studies have generally found that preoperative use of ketamine can reduce opioid consumption by approximately 50% and sub-anaesthetic doses of it have a rapid antidepressant effect, especially refractory depression. Studies have confirmed that esketamine, the S(+) enantiomer of ketamine, has a stronger affinity for NMDA receptors, which can achieve the same effect at smaller doses. While the incidence of neuropsychiatric side effects is significantly lower. On March 4, 2019, the U.S. Food and Drug Administration (FDA) first approved esketamine nasal spray with a new mechanism of action for the treatment of adult patients with refractory depression. Based on the analgesic and antidepressant effects of ketamine, the investigators speculate that esketamine may be effective for patients with chronic visceral pain comorbid depression. At present, the research evidence in this area is relatively lacking. Therefore, this study aims to explore the difference in the efficacy and safety of esketamine as an adjuvant therapy and positive control drug-pregabalin in patients with chronic visceral pain comorbid depression.

Detailed Description: According to the inclusion criteria and exclusion criteria, select patients with chronic visceral pain comorbid depression.

Filtering and grouping period: During this phase, the patient will sign an informed consent form, and then conduct a structured clinical evaluation to determine whether it meets the "depressive disorder" in the DSM-IV-TR diagnostic criteria. According to the ICD-11, determine whether the patients have chronic visceral pain.

Acute treatment period: Randomize patients into the following treatment groups: intravenous administration of esketamine (3 groups, 0.125, 0.25, 0.50 mg/kg)， and duloxetine is co- administered orally. Pregabalin capsules were administered combined with duloxetine orally.

observation period: After 2 weeks, esketamine treatment was discontinued, and observation was continued for 2 weeks. Maintain duloxetine and pregabalin treatment.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 80
• Est. completion date: March 1, 2023
• Est. primary completion date: December 31, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 55 Years

Eligibility

Inclusion Criteria:

1. aged 18 to 55

2. Those who can understand and obey the research plan

3. Sign the informed consent form voluntarily

4. Those who meet the DSM-IV-TR depression diagnostic criteria and have first or second episodes of depression

5. Hamilton Depression Scale score = 14 points

6. Those who meet the ICD-11 pain diagnostic criteria, and visual analogue scale score = 7 points. Those who have chronic visceral pain instead of cancer pain.

7. No systemic use of antidepressants and analgesics within 2 weeks after enrollment.

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Exclusion Criteria:

1. Female patients who are pregnant, breastfeeding, or preparing to conceive

2. Allergic to duloxetine or pregabalin in the past.

3. A history of serious or unstable physical diseases, such as cardiovascular/liver/kidney/respiratory/ endocrine/nervous/ blood system disease.

4. A history of epileptic seizures or brain injury, or any neurological disease (including multiple sclerosis, degenerative diseases such as acute lateral sclerosis, Parkinson's disease and movement disorders, etc.);

5. In the last 12 months, the patient has the following medical history or its main diagnosis (DSM-IV-TR) is organic mental disorder, schizophrenia, schizoaffective mental disorder, delusional mental disorder, indeterminate mental disorder, Bipolar disorder, psychotic characteristics that are coordinated or uncoordinated with the mood, and history of substance abuse (including alcohol, psychoactive substances, etc.).

6. Patients with a history of adverse reactions to multiple drugs.

7. The patient is taking psychotropic drugs, including benzodiazepines, sleeping pills, anticonvulsants, etc.

8. During the depressive episode, treatment with at least 2 antidepressants in a sufficient course of treatment or at least one SSRI antidepressant treatment is ineffective. A sufficient dose of treatment means treatment with fluoxetine =40 mg/day (or sertraline =100 mg/day, paroxetine> 40 mg/day, fluvoxamine> 100 mg/day, citalopram> 40 mg /Day, escitalopram> 20 mg/day, venlafaxine> 150 mg/day, duloxetine> 80 mg/day)

9. Received electroconvulsive therapy within 6 months before enrollment.

10. Those who are currently at serious risk of suicide, and a score of 3 or higher in item 3 of the 17-HAMD .

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Related Conditions & MeSH terms

• Chronic Visceral Pain
• Depression
• Depressive Disorder
• Depressive Disorder, Major
• Disease
• Major Depressive Disorder
• Visceral Pain

Intervention

Drug:
• Pregabalin 75mg tid + Duloxetine
Pregabalin capsules were administered orally (75 mg, 3 times a day), combined administration of duloxetine (60-120 mg/day).
• Intravenous administration of esketamine 0.125 mg/kg+Duloxetine
Intravenous administration of esketamine 0.125 mg/kg (2 times per week), combined oral administration of duloxetine (60-120 mg/day)
• Intravenous administration of esketamine 0.25 mg/kg +Duloxetine
Intravenous administration of esketamine 0.25 mg/kg (2 times per week), combined oral administration of duloxetine (60-120 mg/day)
• Intravenous administration of esketamine 0.50 mg/kg+Duloxetine
Intravenous administration of esketamine 0.50 mg/kg (2 times per week), combined oral administration of duloxetine (60-120 mg/day)

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Peking University

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Visual Analogue Scale (VAS)	The pain VAS is a unidimensional measure of pain intensity, which has been widely used in diverse adult populations, including those with chronic visceral pain. The minimus value is 0 and the maximum value is 10. Higher scores mean a worse outcome.	Day 0 to Day 28
Secondary	Hamilton Depression Rating Scale (HAMD)	The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms. The minimum value is 0 and the maximum value is 52. Higher scores mean a worse outcome.	Day 0 to Day 28
Secondary	Short Form 12 Health Survey (SF-12)	SF-12 is a 12-item, patient-reported survey of patient health, and is widely used since it produces similar results for physical and mental health scores with far less respondent burden for producing scores of overall mental and physical well-being. The SF-12 yields an eight-scale profile of scores as well as physical and mental health summary measures. Answers to questions of these subscales are combined (weighted) with Physical Component Summary (PCS-12) and Mental Component Summary (MCS-12) scale scores. SF-12 scales and summary measures are scored so that a higher score indicates a better health state. After recoding raw scores for some items (BP, GH, VT, and one item from MH), the raw scores could be transformed to provide scores for eight scales, each ranging from 0 (the worst) to 100 (the best).	Day 0 to Day 28
Secondary	Hamilton Anxiety Scale (HAMA)	The HAMA is a psychological questionnaire used by clinicians to rate the severity of a patient's anxiety. The scale consists of 14 items designed to assess the severity of a patient's anxiety. Each of the 14 items contains a number of symptoms, and each group of symptoms is rated on a scale of zero to four, with four being the most severe. The minimum value is 0 and the maximum value is 56. Higher scores mean a worse outcome.	Day 0 to Day 28
Secondary	Changes in serum inflammatory factors	Explore the action mechanism of esketamine on patients with chronic visceral pain comorbid depression from the level of blood inflammatory factors, including cytokines IL-1beta, IL-6, IL-8, IL-10, IL-12p70, TNF-alpha, etc.	Day 0 to Day 28
Secondary	Electroencephalogram (EEG)	Calculate the time-frequency characteristics of EEG data in each frequency band (delta wave, <4 Hz; theta wave, 4-8 Hz; alpha wave, 8-12 Hz and beta wave, 12-30 Hz) during the study period.	Day 0 to Day 28
Secondary	Functional magnetic resonance imaging (fMRI)	The regional brain activity, including fractional amplitude of low frequency fluctuation (fALFF) and regional homogeneity (ReHo) values, will be computed and assessed. In addtion, the large-scale brain networks and edge-wise connections in patients will be explored based on the theory of brain networks during the study period.	Day 0 to Day 28