Efficacy, Safety and Pharmacokinetic Study of Inhaled Esketamine in Treatment-resistant Bipolar Depression

NCT ID: NCT03965871

Last Updated: 2021-03-19

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 88 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-03-28
• Study Completion Date: 2021-02-19

Brief Summary

The purpose of the study is to determine the efficacy, safety and pharmacokinetics of inhaled Esketamine in participants with treatment-resistant bipolar depression (TRBD). The study is to determine the efficacy and dose response of three Esketamine doses, compared with placebo.

Detailed Description

This is a randomized, multiple dose, placebo-controlled, double-blind, multicentre study of Esketamine DPI, inhalation powder delivered via dry powder inhaler (DPI) in participants with TRBD. There are 3 study phases: Screening phase, a two weeks double-blind treatment phase and a 6-week follow-up phase. Participants are to be randomized in 1:1:1:1 ratio to receive placebo or one of the three doses of Esketamine DPI. Participants from each group will receive different dosing sequences, consider as a single dose, corresponding to low, medium, high Esketamine dose or placebo. Participants will undergo one cycle of treatment consisting of four doses of Esketamine DPI or placebo over 14-day period. Participants safety will be monitored throughout the study.

Conditions

Bipolar Depression

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Esketamine low dose

Participants are to receive four doses of Esketamine DPI administered over 14-day period (on Day 1, 4, 8 and 11).

Group Type: EXPERIMENTAL

Esketamine DPI - low dose

Intervention Type: DRUG

Esketamine DPI is to be administered via dry powder inhaler. Each dose correspond to low Esketamine dose.

Esketamine medium dose

Participants are to receive four doses of Esketamine DPI administered over 14-day period (on Day 1, 4, 8 and 11).

Group Type: EXPERIMENTAL

Esketamine DPI - medium dose

Intervention Type: DRUG

Esketamine DPI is to be administered via dry powder inhaler. Each dose correspond to medium Esketamine dose.

Esketamine high dose

Participants are to receive four doses of Esketamine DPI administered over 14-day period (on Day 1, 4, 8 and 11).

Group Type: EXPERIMENTAL

Esketamine DPI - high dose

Intervention Type: DRUG

Esketamine DPI is to be administered via dry powder inhaler. Each dose correspond to high Esketamine dose.

Placebo

Participants are to receive four doses of Placebo DPI administered over 14-day period (on Day 1, 4, 8 and 11).

Group Type: PLACEBO_COMPARATOR

Placebo DPI

Intervention Type: DRUG

Placebo DPI is to be administered via dry powder inhaler.

Interventions

Esketamine DPI - low dose

Esketamine DPI is to be administered via dry powder inhaler. Each dose correspond to low Esketamine dose.

Intervention Type: DRUG

Esketamine DPI - medium dose

Esketamine DPI is to be administered via dry powder inhaler. Each dose correspond to medium Esketamine dose.

Intervention Type: DRUG

Esketamine DPI - high dose

Esketamine DPI is to be administered via dry powder inhaler. Each dose correspond to high Esketamine dose.

Intervention Type: DRUG

Placebo DPI

Placebo DPI is to be administered via dry powder inhaler.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. Gender: female or male,

2. Age: 18 - 65 years old, inclusive, on the day of Screening,

3. Participant must meet Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria for depressive episode in Bipolar Disorder (BD) type I or II, without psychotic features, confirmed by the Mini International Neuropsychiatric Interview (MINI),

4. Participant must have in Montgomery-Asberg Depression Rating Scale (MADRS) total score of >= 24 at Screening and predose on Day 1,

5. Participant is treatment resistant in the current episode of depression, defined as having an inadequate response to at least 2 adequate mood stabilizing treatment regimens administered for the sufficient duration and dose and administered in the current episode of depression,

6. Participant in the last mood stabilizing treatment regimen is to be administered at least one of the medication listed in the protocol,

7. Participant's last mood stabilizing treatment regimen is to be without antidepressant drugs from the class: SSRI, SNRI, TCA, MAOI or NaSSA,

8. Participant must be on stable mood stabilizing treatment regimen (listed in the protocol), remain non-responsive to it and continue the treatment from Screening to at least the duration of the double-blind treatment phase,

9. Participant's other drugs taken as a standard treatment for bipolar disorder, but not for depressive episode treatment, are to be allowed and may be continued through the study and it's administration is up to Investigator discretion,

10. Participant agrees to be hospitalized voluntarily for a period of 12 h before first administration and until the end of treatment phase on Day 14,

11. Participant must be medically stable on the basis of clinical laboratory tests, physical examination, vital signs, 12-lead ECG,

12. Participant agrees to blood sample collection for DNA analysis,

13. Participant of childbearing potential willing to use acceptable forms of contraception.

Exclusion Criteria

1. Participant has a current DSM-5 diagnosis, according to MINI, of any other than BD disorder,

2. Participant has a BD with a rapid-cycling course (≥ 4 episodes per year),

3. Participant has in Young Mania Rating Scale (YMRS) total score of greater than 12 at Screening and every other assessment,

4. Participant has suicidal ideation in MADRS 'suicidal thoughts' subscale score greater or equal to 2 and/or in C-SSRS score greater or equal to 4 at Screening and/or has a history of suicidal thoughts within 6 months prior to Screening and/or history of suicidal attempt within 1 year prior to Screening,

5. Participant has a history or current signs and symptoms of chronic obstructive pulmonary disease (COPD), asthma, liver or renal insufficiency, significant cardiac, vascular, pulmonary, gastrointestinal, endocrine, hematologic, neurologic, rheumatologic or metabolic disturbances that are uncontrolled with medication change during last three months before Screening and/or that could influence the present general health condition at the Investigator's discretion,

6. Participant has uncontrolled hypertension,

7. Upper respiratory tract and/or chest infection and/or inflammation within 2 weeks preceding the first administration and during the treatment phase,

8. Participant took part in other clinical trial within 90 days preceding the Screening,

9. Known allergy or hypersensitivity, intolerance or contraindication to Esketamine/ketamine or its derivatives and/or to any study product excipients,

10. Blood drawn within 30 days prior to inclusion to the study,

11. History of drug, alcohol, chemical, sedatives or sleeping medications abuse or dependence (except nicotine or caffeine) within 2 years prior to Screening,

12. Lifetime abuse or dependence on ketamine or phencyclidine,

13. Positive results from pregnancy test for female participants,

14. Lactation in female participants,

15. Positive drug screen (except benzodiazepines evaluation during follow-up) or alcohol breath test.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Center for Research and Development, Poland

OTHER

Sponsor Role: collaborator

Celon Pharma SA

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Wojewodzki Szpital im. Jana Pawła II

Bełchatów, , Poland

Wojewodzki Szpital dla Nerwowo i Psychicznie Chorych

Bolesławiec, , Poland

Samodzielny Publiczny Psychiatryczny Zaklad Opieki Zdrowotnej

Choroszcz, , Poland

Szpital Miejski

Elblag, , Poland

Uniwersyteckie Centrum Kliniczne

Gdansk, , Poland

Wojewodzki Szpital dla Nerwowo i Psychicznie Chorych

Gmina Świecie, , Poland

Gornoslaskie Centrum Medyczne

Katowice, , Poland

Specjalistyczny Psychiatryczny Zespol Opieki Zdrowotnej

Lodz, , Poland

Pabianickie Centrum Medyczne

Pabianice, , Poland

Mazowieckie Specjalistyczne Centrum Zdrowia

Pruszków, , Poland

Mazowiecki Szpital i Centrum Diagnostyczne Allenort

Warsaw, , Poland

Uniwersytecki Szpital Kliniczny

Wroclaw, , Poland

Countries

Poland

References

Dean RL, Hurducas C, Hawton K, Spyridi S, Cowen PJ, Hollingsworth S, Marquardt T, Barnes A, Smith R, McShane R, Turner EH, Cipriani A. Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder. Cochrane Database Syst Rev. 2021 Sep 12;9(9):CD011612. doi: 10.1002/14651858.CD011612.pub3.

Reference Type: DERIVED

PMID: 34510411 (View on PubMed)

Other Identifiers

03KET2018

Identifier Type: -

Identifier Source: org_study_id