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Study in Major Depressive Disorder With BTRX-335140 vs Placebo

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ClinicalTrials.gov Identifier: NCT04221230
Recruitment Status : Recruiting
First Posted : January 9, 2020
Last Update Posted : October 13, 2021
Sponsor:
Information provided by (Responsible Party):
BlackThorn Therapeutics, Inc.

Brief Summary:
A proof of concept (POC) study evaluating the impact of BTRX-335140 relative to placebo on symptoms of major depressive disorder (MDD) in adult subjects with MDD and symptoms of anhedonia and anxiety following 8 weeks of double-blind treatment as assessed by the HAMD-17 Scale.

Condition or disease Intervention/treatment Phase
Major Depressive Disorder Drug: BTRX-335140 Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 180 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: A Phase 2a, Randomized, Double-blind, Placebo-controlled Proof of Concept Study to Evaluate the Effects of Oral BTRX-335140 Versus Placebo in Subjects With Major Depressive Disorder
Actual Study Start Date : December 14, 2019
Estimated Primary Completion Date : June 2022
Estimated Study Completion Date : July 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: BTRX-335140
BTRX-335140
Drug: BTRX-335140
Active Drug

Placebo Comparator: Placebo
Placebo
Drug: Placebo
Placebo




Primary Outcome Measures :
  1. Hamilton Depression Rating Scale (HAMD-17) [ Time Frame: 8 weeks ]
    Change in baseline to Week 8 on the HAMD-17 score; Minimum 0, Maximum 52; Higher scores mean a worse outcome


Secondary Outcome Measures :
  1. Clinical Global Impression of Improvement (CGI-I) score [ Time Frame: 8 weeks ]
    The CGI-I is a clinician rating of how much the subject's illness has improved or worsened relative to a baseline state, a 7-point scale is used from 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, 7=very much worse.

  2. Change from baseline in Snaith-Hamilton Pleasure Scale (SHAPS) score [ Time Frame: 8 weeks ]
    The SHAPS is a self-report 14-item, instrument, developed for the assessment of hedonic capacity. Participants score whether they experience pleasure in performing a list of activities or experiences. Participants can rate the answers as "definitely/strongly agree", "agree", "disagree" or "strongly disagree". "Definitely agree" will be rated 1, "Agree" will be rated 2, "Disagree" will be rated 3, and "Definitely disagree" will be rated 4. The participant's item responses are summed to provide a total score ranging from 14 to 56. A higher total SHAPS score indicates higher levels of current anhedonia.

  3. Change from baseline in Hospital Anxiety and Depression Scale (HADS) subscales (ie, anxiety subscale [HADS-A] and depression subscale [HADS-D]) scores [ Time Frame: 8 weeks ]
    The Hospital Anxiety and Depression Scale (HADS) is a 14-item self-report questionnaire with 2 subscales: anxiety and depression. Each item is rated on a 4-point scale (0-3), giving maximum scores of 21 for anxiety and depression with higher scores indicating more severe symptoms.

  4. Change from baseline in Hamilton Anxiety Rating Scale (HAM-A) score [ Time Frame: 8 weeks ]
    The HAM-A is a 14-item scale to measure severity of different anxiety-related symptoms in participants. Each of the 14 items is rated by the clinician on a 5-point scale ranging from 0 (not present) to 4 (maximum degree) with a total score range of 0 to 52 where higher score indicates greater symptom severity.

  5. Change from baseline in Sheehan Disability Scale (SDS) score [ Time Frame: 8 weeks ]
    The Sheehan Disability Scale (SDS) is a 3-item self-report questionnaire used to assess the effect of the participant's symptoms on their work (work/school impairment score), social life (social life/leisure activities impairment score), and family life (family life/home responsibilities impairment score). Each item is measured on a 0 (not at all) to 10 (extremely) point scale with higher values indicating greater disruption.

  6. 6. Assessment of safety through the occurrence of TEAEs, SAEs, and adverse events of special interest (AESIs) [ Time Frame: 8 weeks ]
    Change from baseline in vital signs measurements, body weights, body mass index (BMI), clinical laboratory test results, C SSRS scores, Clinical Opiate Withdrawal Scale (COWS) scores; physical examination findings, ECG results, and ophthalmologic examination findings.



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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Subjects are eligible to be included in the study only if they meet all the following criteria:

  1. Are adult men or women 18 to 65 years of age (inclusive) at informed consent
  2. Have a primary DSM-5 diagnosis of MDD, with prominent symptoms of anhedonia confirmed by Structured Clinical Interview for DSM-5 Disorders, Clinical Trials Version (SCID-5-CT)

    1. The current episode must have started at least 3 weeks prior to screening but no more than 12 months before the screening visit.
    2. Have not failed 2 or more courses of antidepressant treatment in the current episode
    3. No more than a 3-point change in HAMD 17 between screening and baseline
    4. Have sufficient history or an independent report to confirm that symptoms are causing functional impairment or clinically significant distress
  3. Meet the blinded rule list based on clinical scale criteria
  4. Body mass index (BMI) between 18-40 kg/m2 (inclusive)
  5. Medically stable (in the opinion of the investigator and Sponsor/Sponsors delegate) based on medical history, vital signs, clinical laboratory tests, and 12-lead electrocardiogram (ECG) performed at screening and baseline
  6. Agree to the following birth control:

    1. Nonvasectomized men must agree to use a condom with spermicide, if sexually active during the study, until 90 days after the last dose of study drug administration. No restrictions are required for a vasectomized man, provided his vasectomy was performed 4 months or more prior to the first dose of study drug. A man who has been vasectomized less than 4 months prior to the first dose of study drug must follow the same restrictions as a nonvasectomized man. Additionally, men must refrain from sperm donation during study treatment and for at least 90 days following the last dose of study drug.
    2. Women of child-bearing potential (women not surgically sterilized and between menarche and 2 years postmenopausal) must have a negative serum pregnancy test at screening and a negative urine pregnancy test at enrollment and agree to use reliable birth control (eg, oral contraceptives or Norplant®; a reliable double barrier method of birth control [diaphragms with contraceptive jelly; cervical caps with contraceptive jelly; condoms with contraceptive foam]; intrauterine devices; partner with vasectomy; or abstinence) during the study and for 10 days following the last dose of the study drug (BTRX-335140 or placebo). Women will be considered surgically sterile, if they have had tubal ligation, bilateral salpingo oophorectomy, or a hysterectomy.

      Note: Abstinence will be allowed if, in the investigator's judgement, it is determined that the subject is reliable, that abstinence is the preferred and usual lifestyle of the subject, and that abstinence will be continued for the duration of the study including the 10 days (women) or 90-day period (men) following last dose of study drug as noted above.

    3. Or engaged exclusively in a non-heterosexual relationship
  7. Willing and able to give written informed consent to participate
  8. Able to understand and comply with instructions in English
  9. Are judged by the investigator to be reliable and agree to keep all appointments for clinic visits, tests, and procedures, including venipuncture, and examinations required by the protocol

Exclusion Criteria:

Subjects will be excluded from the study if they meet any of the following criteria:

  1. Have a history of any of the following DSM-5 disorders within the specified timeframe:

    1. Currently or in the past year: diagnosis of personality disorder, attention deficit disorder/attention deficit hyperactivity disorder, anorexia nervosa, or bulimia nervosa. Subjects with comorbid generalized anxiety disorder, social anxiety disorder, or panic disorder for whom MDD is considered the primary diagnosis are not excluded.
    2. Lifetime: diagnosis of bipolar 1 or 2, schizophrenia, obsessive compulsive disorder, or post-traumatic stress disorder
  2. Have a history of substance or alcohol use disorder (AUD), per DSM-5 criteria, within the past year
  3. Are actively suicidal (eg, any suicide attempts within the past 12 months) or are at serious suicidal risk as indicated by any current suicidal intent, including a plan, as assessed by the Columbia Suicide Severity Rating Scale (C-SSRS) (score of "YES" on suicidal ideations item 4 or 5 within 3 months prior to Visit 1 [Screening]) and/or based on clinical evaluation by the investigator; or are homicidal, in the opinion of the investigator
  4. Have a history or signs of Cushing's disease, Addison's Disease, primary amenorrhea or other evidence of significant disorders of the hypothalamus-pituitary-adrenal axis
  5. Have any other clinically significant medical or psychiatric condition or circumstance prior to randomization that, in the opinion of the investigator, or Sponsor could affect subject safety, preclude evaluation of response, interfere with the ability to comply with study procedures, or prohibit completion of the study, such as acute stress disorder, adjustment disorder, impulse control disorder, uncontrolled diabetes mellitus, renal or hepatic impairment, coronary artery disease, evidence of significant active cardiac, respiratory, or hematologic disease, cancer with <5 year remission (basal cell carcinoma is not excluded), chronic pain, fibromyalgia, gastric bypass, lap band placement, or any other significant gastrointestinal condition
  6. Have had prior seizures (other than remote history of childhood febrile seizure) or other condition that would place the subject at increased risk of seizures or is taking anticonvulsants for seizure control
  7. Have a history of serious head injury (eg, skull fracture, cerebral contusion, or trauma resulting in prolonged unconsciousness), intracranial neoplasm, or hemorrhage
  8. Have ever had electroconvulsive treatment, vagal nerve stimulation, or treatment with ketamine or esketamine for MDD
  9. Have initiated transcranial magnetic stimulation, psychotherapy (such as Cognitive Behavioral Therapy) or have had a change in psychotherapy, or other non-drug therapies (such as acupuncture or hypnosis) within 4 weeks prior to Visit 1 (Screening) or at any time during the acute phase of the study
  10. Have a visual or physical motor impairment that could interfere with subject's ability to perform study assessments, as assessed by the investigator
  11. Have alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels ≥2 x upper limit of normal (ULN) or a bilirubin level 1.5 x ULN unless due to a documented history of Gilbert's syndrome
  12. Estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73m2 as calculated by the Chronic Kidney Disease Epidemiology Collaboration [CKD EPI] 2009 creatinine equation at Visit 1 (Screening)
  13. Positive hepatitis C virus (HCV) antibody (Ab), hepatitis B surface antigen (HBs Ag), hepatitis A virus (HAV) IgM antibody (HAV-Ab [IgM]) or human immunodeficiency virus (HIV) test at Visit 1 (Screening)
  14. Have a thyroid-stimulating hormone (TSH) level of <0.9 x lower limit of normal (LLN) or >1.2 x ULN on or off stable treatment for hyperthyroidism or hypothyroidism; if TSH is abnormal, evaluate reflex Free T3 and Free T4. If reflex testing is normal, the assessment of normal thyroid function will be determined based on the judgement of the investigator, following discussion with the medical monitor.
  15. Have any other clinically significant abnormalities (significant would include laboratory deviations requiring acute medical intervention or further medical evaluation) in laboratory results at screening, including clinical chemistries, hematology, and urinalysis, and any clinical information that, in the judgment of the investigator or Sponsor, should preclude a subject's participation at study entry
  16. Exclusionary ECG abnormalities obtained at Visit 1 (Screening) or Visit 2 (Baseline) are QT interval corrected using Fridericia's formula (QTcF) >450 msec in males or >470 msec in females, complete bundle branch block, evidence of myocardial infarction or ischemia, and predominantly nonsinus conducted rhythms. Other abnormalities can be exclusionary at the discretion of the principal investigator or medical monitor. See Section 6.3.5 of protocol for guidance on ECG interpretations.
  17. Have a positive urine drug screen for amphetamines, barbiturates, cocaine, methadone, opioids, propoxyphene, tetrahydrocannabinol (THC), phencyclidine, or a positive blood alcohol level assessed by breathalyzer at Visit 1 (Screening) and Visit 2 (Baseline). For occasional (1 to 2 times per month maximum) cannabis users only, 1 retest is allowed and subject must agree to abstain from use for the duration of the study; a positive second test is exclusionary.
  18. Have any use, by history, of Salvinorin A
  19. Use of the following concomitant medications (contact the Sponsor-designated medical monitor to determine eligibility when in doubt):

    1. Psychoactive medication including stimulants, benzodiazepines and anxiolytics, oral antipsychotics, mood stabilizers/anticonvulsants (carbamazepine, lamotrigine, etc.), lithium, antidepressants, S adenosylmethionine, melatonin, agomelatine, and hypnotics/sedatives within 5 half-lives or 14 days (whichever is longer) of Visit 2 (Baseline)
    2. Fluoxetine and irreversible monoamine oxidase inhibitors within 4 weeks of Visit 2 (Baseline) depot antipsychotics within 2 months of Visit 2 (Baseline)
    3. Opioid agonists and antagonists
  20. Are currently taking or have taken within 5 half-lives of Visit 2 (Baseline) any medications or supplements that are moderate or strong inhibitors or inducers of cytochrome P450 (CYP) 3A4 (non-comprehensive list in protocol), on a diet likely to modulate CYP3A4 activity (eg, food/juice of grapefruit, Seville oranges), or are taking substrates of P-glycoprotein (P gp) with narrow therapeutic windows (eg, digoxin).
  21. Are women who are either pregnant or breastfeeding
  22. Have participated (received study treatment) in a clinical study or any other type of medical research judged by the investigator or Sponsor to be scientifically or medically incompatible with this study within 30 days prior to Visit 1 (Screening). Contact the Sponsor-designated medical monitor to determine eligibility when in doubt.
  23. Have participated in multiple interventional clinical studies, such that, in the opinion of the investigator, the subject is not a suitable candidate for participation
  24. Have previously completed or withdrawn from this study or any other study investigating BTRX 335140
  25. Are investigator site personnel directly affiliated with this study, and/or their immediate families. Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted.
  26. Are employees of the Sponsor or are employees of any third-party organizations (TPOs) (eg, laboratory staff, study vendors and transportation providers) involved in study who require exclusion of their employees
  27. Has any of the following: 1) useful vision in only 1 eye from a pre-existing ophthalmic disease or amblyopia; 2) a corneal transplant in either eye; 3) corneal dystrophy or family history of corneal dystrophy; 4) severe dry eye syndrome [keratitis sicca]; 5) will not or cannot cooperate with ophthalmic examination requiring pupillary dilation (includes history of severe adverse reaction to mydriatic agents or untreated narrow angle glaucoma). Note: The following ocular disorders are allowed: cataracts, prior cataract surgery, glaucoma (narrow angle glaucoma is allowed if definitively treated with laser peripheral iridectomy), macular degeneration, or ocular changes associated with diabetes mellitus or multiple sclerosis.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04221230


Contacts
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Contact: Louis Wong (415) 912-9482 Louis.Wong@BlackThornrx.com

Locations
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Sponsors and Collaborators
BlackThorn Therapeutics, Inc.
Investigators
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Study Director: Jane Tiller, MBChB BlackThorn Therapeutics
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Responsible Party: BlackThorn Therapeutics, Inc.
ClinicalTrials.gov Identifier: NCT04221230    
Other Study ID Numbers: K2-MDD-201
First Posted: January 9, 2020    Key Record Dates
Last Update Posted: October 13, 2021
Last Verified: October 2021

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Depressive Disorder
Depression
Depressive Disorder, Major
Mood Disorders
Mental Disorders
Behavioral Symptoms