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对选择性5-羟色胺再摄取抑制剂耐药的强迫症患者使用mavoglurant增强治疗:一项概念验证性、随机、安慰剂对照的2期研究。

Mavoglurant Augmentation in OCD Patients Resistant to Selective Serotonin Reuptake Inhibitors: A Proof-of-Concept, Randomized, Placebo-Controlled, Phase 2 Study.

作者信息

Rutrick Daniel, Stein Dan J, Subramanian Ganesan, Smith Brian, Fava Maurizio, Hasler Gregor, Cha Jang-Ho, Gasparini Fabrizio, Donchev Toni, Ocwieja Magdalena, Johns Donald, Gomez-Mancilla Baltazar

机构信息

Adams Clinical Trials, Watertown, MA, 02472, USA.

MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Groote Schuur Hospital, University of Cape Town, Cape Town, 7925, South Africa.

出版信息

Adv Ther. 2017 Feb;34(2):524-541. doi: 10.1007/s12325-016-0468-5. Epub 2017 Jan 2.

Abstract

INTRODUCTION

To determine if mavoglurant (modified release) as an augmentation therapy to selective serotonin reuptake inhibitors (SSRIs) could have beneficial effects reducing Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score in patients with obsessive-compulsive disorder (OCD) resistant to SSRI treatment.

METHODS

This was a multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 2 study. Patients remained on their SSRI treatment and mavoglurant or placebo was added on. Non-smoking men and women aged 18-65 years primarily diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria were randomized (1:1) to mavoglurant or placebo groups. After 50 patients were randomized, an interim analysis was conducted to determine whether the study should be continued. The primary outcome measure was absolute change in Y-BOCS from baseline at week 17. Safety was assessed by recording adverse events (AEs) and serious adverse events (SAEs).

RESULTS

Interim analysis led to a decision to terminate the study. In total 38 (76.0%) participants completed 17 weeks of treatment and 37 (74.0%) completed the study. There was no significant difference in least squares (LS) mean change from baseline at week 17 in Y-BOCS total score for mavoglurant compared with placebo groups [-6.9 (1.75) vs. -8.0 (1.78), respectively; LS mean difference 1.1; 95% CI -3.9, 6.2; p = 0.671]. The incidence of AEs was higher in the mavoglurant compared with the placebo group (80.8% vs. 70.8%, respectively).

CONCLUSION

This study of mavoglurant in OCD was terminated because of the lack of efficacy at interim analysis. The study did not support the use of an antagonist of mGluR5 receptors for OCD treatment.

TRIAL REGISTRATION

The study was registered with ClinicalTrials.gov: NCT01813019.

FUNDING

This study was sponsored by Novartis Pharma AG, Basel, Switzerland.

摘要

简介

为了确定作为选择性5-羟色胺再摄取抑制剂(SSRI)增效疗法的吗氯贝胺控释剂,对SSRI治疗无效的强迫症(OCD)患者降低耶鲁-布朗强迫症量表(Y-BOCS)总分是否有有益效果。

方法

这是一项多中心、随机、双盲、安慰剂对照、平行组2期研究。患者继续接受SSRI治疗,并添加吗氯贝胺或安慰剂。根据《精神疾病诊断与统计手册》(第4版,修订版;DSM-IV-TR)标准,年龄在18-65岁的非吸烟男性和女性,主要诊断为强迫症,随机(1:1)分为吗氯贝胺组或安慰剂组。随机分组50例患者后,进行中期分析以确定研究是否应继续。主要结局指标是第17周时Y-BOCS相对于基线的绝对变化。通过记录不良事件(AE)和严重不良事件(SAE)评估安全性。

结果

中期分析导致决定终止研究。总共38例(76.0%)参与者完成了17周的治疗,37例(74.0%)完成了研究。与安慰剂组相比,吗氯贝胺组在第17周时Y-BOCS总分相对于基线的最小二乘(LS)均值变化无显著差异[-6.9(1.75)对-8.0(1.78);LS均值差异1.1;95%CI -3.9,6.2;p = 0.671]。吗氯贝胺组AE的发生率高于安慰剂组(分别为80.8%对70.8%)。

结论

由于中期分析时缺乏疗效,这项关于吗氯贝胺治疗OCD的研究被终止。该研究不支持使用mGluR5受体拮抗剂治疗OCD。

试验注册

该研究已在ClinicalTrials.gov注册:NCT01813019。

资金

本研究由瑞士巴塞尔的诺华制药公司赞助。

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