INDIANAPOLIS and INGELHEIM, Germany, December 10 /PRNewswire/ --
-- Longest controlled duloxetine trial to-date showed significant advantages over placebo
Duloxetine hydrochloride (Cymbalta(R)/Xeristar(R)), administered at 60 to 120 mg once daily, delayed the onset of a new episode of depression in patients with recurrent depressive disorder, compared with placebo (p<.001), according to new data from an international study presented at a meeting of a major scientific society. Up to 85 percent of patients with depression experience depressive recurrences(1).
Duloxetine is currently approved in Europe for the treatment of major depressive episodes.
Results from the longest controlled duloxetine study to-date showed that, during the trial's 52-week placebo-controlled maintenance phase, duloxetine-treated patients (n=288) had a longer time to a depressive recurrence, and were less likely to experience a new episode of depression than the patients (n=226) who received placebo (recurrence rates were 14.4 percent vs. 33.1 percent, respectively).
A depressive episode is defined when a patient experiences at least five (or more) of the following symptoms that have been present during the same 2-week period and represent a change from previous functioning including depressive mood, markedly diminished interest in activities most of the day, significant weight loss, insomnia and increased tiredness in accordance with the DSM-IV criteria for major depressive disorder (MDD)(2). The purpose of the study was to understand whether the long-term use of duloxetine would prevent the onset of new depressive episodes in patients with MDD who are at a high risk of experiencing a depressive recurrence. Patients had to have experienced at least 3 episodes of depression over the previous 5 years in order to be eligible for the study.
Previous research has shown that many patients with depression will suffer from multiple depressive episodes.(3) The number of episodes,(4) their duration(5) and the presence of lingering depressive symptoms increase the risk of recurrence, or future episodes of depression.(6) For those who experience depression multiple times in their life, studies have shown that the illness may cause structural changes in the brain,(7) making it more difficult to treat over time.(7)
"Recurrent depressive episodes are detrimental to long-term health and well being of patients," said Dr. Giuseppe Maina, University of Turin, Italy, an investigator and an author on the study.
In the maintenance phase, which followed up to 34 weeks of open-label treatment, the most common adverse events (those occurring in at least 5 percent of patients in any treatment group) were headache, insomnia, dizziness, fatigue, back pain, common cold and flu. The results of the study were similar between duloxetine and placebo-treated patients in the incidence of any individual adverse event.
In addition to being approved for the treatment of major depressive episodes, duloxetine is also approved in Europe for the treatment of generalised anxiety disorder (GAD), diabetic peripheral neuropathic pain (DPNP), and stress urinary incontinence (SUI).
Notes to Editors:
Additional Study Findings
-- Time to worsening of depressive symptoms was significantly longer in
the duloxetine treated group compared with the placebo-treated group.
This was defined as a 50 percent increase from baseline on the 17-item
Hamilton Rating Scale for Depression (HAMD17) total score and a
Clinical Global Impressions of Severity (CGI-S) score of 3 or more at
anytime during the maintenance phase.
-- Patients taking duloxetine experienced less worsening symptom severity
during the 52-week maintenance phase as measured by efficacy measures
including the HAMD17 total score and subscales, the CGI-S, and the
Patient's Global Impression of Improvement (PGI-I) scales, compared
with those taking placebo (p< .01).
-- Patients taking duloxetine experienced a similar worsening in somatic
symptom severity during the 52-week maintenance phase as measured by
Visual Analog Scales (VAS) for pain and the Symptom
Questionnaire-Somatic Subscale (SQ-SS), compared with those taking
placebo (p> .05).
Adverse Events
The proportion of duloxetine-treated patients who discontinued the study due to adverse events during the acute, continuation and maintenance phases was 6.6 percent, 6.1 percent and 4.1 percent, respectively. The following were the most common treatment-emergent adverse events:
-- Acute phase: nausea, headache, dry mouth and excessive sweating
-- In addition, there was one person who did not complete the acute
phase due to a completed suicide, which was determined by study
investigators not to be attributed to treatment
-- Continuation phase: headache, common cold and excessive sweating
-- Maintenance phase: headache, back pain and common cold
Methods
The 52-week maintenance phase was preceded by up to 34-weeks of open-label treatment with duloxetine 60-120 mg once daily. Of the 514 patients initially entered into the study, 288 patients met response criteria at the end of up to 34 weeks treatment and entered the 52-week, double-blind, maintenance phase of the study. Patients were randomly assigned to receive either duloxetine at the dose to which they had previously responded or placebo during the maintenance phase.
The primary endpoint of the study was time to recurrence of a major depressive episode during 52 weeks of maintenance treatment, as assessed by any of the following recurrence criteria: a CGI-S score greater than or equal to 4 and meeting DSM-IV criteria for MDD; three consecutive visits meeting re-emergence criteria or 10 total re-emergence visits; or study discontinuation due to lack of efficacy. Secondary measures included the HAMD17 total score and subscales, CGI-S and PGI-I scales, SQ-SS and VAS for pain. Safety and tolerability were assessed via analysis of treatment-emergent adverse events, vital signs, weight, ASEX for sexual functioning, and laboratory measures. The primary study manuscript has already been submitted for review with a view to publication in a peer-reviewed medical journal.
About Major Depressive Disorder
Major Depressive Disorder (MDD) affects approximately 121 million people worldwide.(8) The World Health Organization estimates depression will be among the highest-ranking causes of disability in developed countries by 2020, second only to ischemic heart disease worldwide.(8) It can happen to anyone of any age, race or ethnicity; however, women are nearly twice as likely to experience depression as men.(9) Complete elimination of symptoms, or remission, is the primary goal of depression treatment. Treating the full spectrum of emotional and physical symptoms to remission decreases a patient's risk of relapse.(10)
About Duloxetine
While duloxetine's mechanism of action in humans is not fully known, it is believed to affect both serotonin and norepinephrine/noradrenaline-mediated nerve signaling in the brain and the spinal cord. Based on pre-clinical studies, duloxetine is a reuptake inhibitor of serotonin and norepinephrine/noradrenaline. Scientists believe its effect on mood and pain perception is due to increasing the activity of serotonin and norepinephrine in the central nervous system.
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