PCORI Comparative Effectiveness Study-Esketamine (Spravato) vs. Ketamine-Equivalence Study
NCT ID: NCT06713616
Last Updated: 2025-05-20
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
PHASE3
400 participants
INTERVENTIONAL
2025-01-27
2030-12-31
Brief Summary
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* How well the treatment helps with symptoms of depression (effectiveness),
* How comfortable and willing people are to use the treatment (acceptability), and
* How well people can deal with any side effects from the treatment (tolerability).
The study will also examine factors that may predict which treatment works better for certain patients.
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Racemic Ketamine
Ketamine will be given intravenously. Per FDA guidance, the max dose of ketamine will be 60mg per day, with a total lifetime limit of 8 doses. Ketamine will be infused over 40 minutes.
Racemic ketamine
Ketamine will be given intravenously. Per FDA guidance, the max dose of ketamine will be 60mg per day, with a total lifetime limit of 8 doses. Ketamine will be infused over 40 minutes.
Spravato (Esketamine)
Spravato® (Esketamine) will be given intranasally. For esketamine, the dose will be between 56 and 84mg, according to the FDA label for the drug. Allowances will be made for patients who have difficulty tolerating these doses to be dosed at 28mg in subsequent treatment sessions.
Spravato (Esketamine)
Spravato® (Esketamine) will be given intranasally. For esketamine, the dose will be between 56 and 84mg, according to the FDA label for the drug. Allowances will be made for patients who have difficulty tolerating these doses to be dosed at 28mg in subsequent treatment sessions.
Interventions
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Racemic ketamine
Ketamine will be given intravenously. Per FDA guidance, the max dose of ketamine will be 60mg per day, with a total lifetime limit of 8 doses. Ketamine will be infused over 40 minutes.
Spravato (Esketamine)
Spravato® (Esketamine) will be given intranasally. For esketamine, the dose will be between 56 and 84mg, according to the FDA label for the drug. Allowances will be made for patients who have difficulty tolerating these doses to be dosed at 28mg in subsequent treatment sessions.
Eligibility Criteria
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Inclusion Criteria
* Stated willingness to comply with all study procedures and availability for the duration of the study
* Adults ages 18 or older
* Diagnosis of major depressive disorder that is refractory to two or more antidepressant trials
* Moderate or severe depression based on an initial MADRS score ≥ 25
* Judged appropriate for ketamine or esketamine by clinician, independent of potential study participation
* A female participant must be:
a. Not of childbearing potential\*, OR b. Of childbearing potential and practicing a highly effective method of contraception (failure rate of \<1% per year when used consistently and correctly) and agrees to remain on a highly effective method while receiving study intervention and until 1 week after last dose - the end of relevant systemic exposure. The investigator will evaluate the potential for contraceptive method failure (e.g., noncompliance, recently initiated) in relationship to the first dose of drug. Acceptable methods of contraception are: i. combined (estrogen and progestogen containing) hormonal or progestogen-only hormonal contraception associated with inhibition of ovulation (oral, transdermal, or intravaginal) ii. intrauterine device (IUD) iii. intrauterine hormone-releasing system (IUS) iv. bilateral tubal occlusion/ligation v. male partner with a bilateral vasectomy with documented aspermia or a bilateral orchiectomy vi. male or female condom with spermicide, diaphragm, or sponge with spermicide (Note: Use of condom as the sole method of contraception is not considered to be a highly effective method of contraception).
* A female participant must agree not to donate eggs (ova, oocytes) or freeze for future use for the purposes of assisted reproduction during the study \* We will consider women to be of childbearing potential if they are within 2 years of menopause (within 3 years since last menstrual period) and have not had a hysterectomy, bilateral oophorectomy, or other definitive surgical intervention.
Exclusion Criteria
* Other psychiatric comorbidities are permitted so long as depression is the predominant diagnosis
* Active or recent (within 12 months) substance use disorder (other than nicotine)
* Pregnant or lactating women
* Intracerebral hemorrhage or aneurysmal vascular disease
* Hypersensitivity to ketamine, esketamine or any of the excipients
* Known family history of ketamine use disorder
* Prior known ketamine use disorder as well as subjects for whom study participations will result in more than 8 lifetime exposures to ketamine (e.g., prior exposure to ketamine, prior recreational use with ketamine)
* Uncontrolled hypertension, as demonstrated by a blood pressure of greater than 145 / 90 at screening visit. (Pre-treatment blood pressure will be permitted to be 150 / 95 to allow for "whitecoat" hypertension on treatment visits 1-8.)
* Known cardiovascular and cerebrovascular conditions that are associated with an increased risk related to ketamine or esketamine administration (including space-occupying CNS lesions). This includes those prospective participants who undergo EKG and are shown to have an abnormality that would put them at increased risk related to treatment.
* Known condition for which an acute rise in blood pressure would pose a serious risk.
* Arteriovenous malformation
* Positive urine toxicology at screening visit, except for substances that are prescribed (i.e., benzodiazepines, stimulants). Given the extended length of time between exposure and negative toxicology screen, a positive screen for THC will not be exclusionary unless the pattern of use and clinical evaluation are indicative of cannabis use disorder. Cannabis used within 24 hours of dosing is exclusionary.
* Positive alcohol breathalyzer at screening or clinical signs of intoxication
* The patient is unable to arrange for someone to drive them home after each treatment session; patients who are unwilling to refrain from driving and operating machinery on treatment days until the next day following sleep will be excluded.
18 Years
ALL
No
Sponsors
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Patient-Centered Outcomes Research Institute
OTHER
Yale University
OTHER
Responsible Party
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Samuel Wilkinson
Associate Professor of Psychiatry
Principal Investigators
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Locations
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Mood Institute
Milford, Connecticut, United States
Yale School of Medicine
New Haven, Connecticut, United States
Emory University
Atlanta, Georgia, United States
University of Michigan
Ann Arbor, Michigan, United States
LifeStance Health
Moore, Oklahoma, United States
Houston Center for Advanced Psychiatric Treatment
Bellaire, Texas, United States
Countries
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Central Contacts
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Facility Contacts
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Brandon Kitay, MD
Role: primary
Sagar Parikh, MD
Role: primary
Sandhya Prashad, MD
Role: primary
Other Identifiers
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23-005287
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
2000037121
Identifier Type: -
Identifier Source: org_study_id
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