Title

Phase IV:Safety and Efficacy of EMSAM in Adolescents With Major Depression
A Phase IV, Double-Blind, Placebo-Controlled, Randomized, Flexible Dose Study of the Safety and Efficacy of EMSAM in Adolescents With Major Depression
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Intervention/Treatment

    selegiline ...
  • Study Participants

    308
The primary purpose of your participation in this study is to help answer the following research question: Whether 12-week administration of EMSAM (selegiline transdermal system) is safe and effective for the treatment of adolescents (aged 12 through 17 years) with Major Depressive Disorder (MDD).
• Assess the safety and efficacy of EMSAM (selegiline transdermal system) versus placebo in adolescents (aged 12 through 17 years) who meet criteria for Major Depressive Disorder (MDD) without psychotic features, single or recurrent
Study Started
Jul 31
2007
Primary Completion
Oct 31
2010
Study Completion
Oct 31
2010
Results Posted
Jun 26
2013
Estimate
Last Update
Jan 15
2014
Estimate

Drug Selegiline Transdermal System

EMSAM 6mg, 9mg, or 12mg Flexible Dose- 1 patch/24 hours- 12 Week Study

  • Other names: EMSAM

Drug Placebo

Matching Placebo for EMSAM 6mg, 9mg, or 12mg Flexible Dose- 1 patch/24 hours- 12 Week Study

  • Other names: Matching Placebo Transdermal System

EMSAM Experimental

Approved Medication for Major Depressive Disorder: EMSAM (Selegiline Transdermal System) 6mg, 9mg, or 12mg

Placebo Placebo Comparator

Placebo Selegiline Transdermal System 6, 9 or 12

Criteria

Inclusion Criteria:

Male / Female outpatients 12 to 17 years of age diagnosed with Major Depressive Disorder (MDD). (Must have a Children's Depression Rating Scale-Revised [CDRS-R] with a total score of at least 45 at screening.)
Female patients must test negative on a pregnancy at visit 1.
Weight and height must be greater than the 10th percentile according to age and height,
Assent and consent must be given.

Exclusion Criteria:

Have a serious or unstable medical illness, psychological condition, clinically significant laboratory or ECG result, hypersensitivity to selegiline, or any other condition that in the opinion of the investigator would compromise participation in the study or be likely to lead to hospitalization during the course of the study.
Have a current or previous diagnosis of bipolar disorder, psychotic depression, schizophrenia or other psychotic disorder, anorexia, bulimia, obsessive compulsive disorder, pervasive development disorder or borderline personality disorder, as determined by the investigator.
Have a risk of suicide
Female patients who are either pregnant, nursing or have recently given birth.
Use of any protocol prohibited medications or substances.

Summary

Placebo

EMSAM

All Events

Event Type Organ System Event Term Placebo EMSAM

CDRS-R Total Score (Child) (mITT w/LOCF Population) Week 12

A summary of the primary efficacy outcome measure, Children's Depression Rating Scale (CDRS-R) Total Score, as reported by the Child, at Week 12 (EOS), by treatment assigned, is shown for the modified intent-to-treat (mITT) population, with the last observation carried forward (LOCF) in time. CDRS-R total raw scores range from 17(minimum) 113(maximum). A lower score indicates a lower likelihood of a depressive disorder, a higher score indicates a higher likelihood of a depressive disorder. Two subscales are summed to calculate a total score: Evaluated Symptom Area and Ratings of Observed Nonverbal Behavior.

Placebo

Baseline - Observed

57.9
units on a scale (Mean)
Standard Deviation: 12.57

Week 12 - Change From Baseline

-21.5
units on a scale (Mean)
Standard Deviation: 16.47

Week 12 - Observed

36.4
units on a scale (Mean)
Standard Deviation: 15.91

EMSAM

Baseline - Observed

56.7
units on a scale (Mean)
Standard Deviation: 12.34

Week 12 - Change From Baseline

-21.4
units on a scale (Mean)
Standard Deviation: 16.61

Week 12 - Observed

35.4
units on a scale (Mean)
Standard Deviation: 15.30

CGI-C - Week 12 (mITT w/LOCF Population)

A summary of the Clinicians Global Impression of Change (CGI-C) Score at Week 12 (EOS), by treatment assigned, is shown for the mITT population with LOCF. The CGI-c assesses the overall change in the severity of illness (depression). The clinician rates the subject's change based on a bipolar scale from 1(minimum; "Very much improved") to 7(maximum; "Very much worse"). A lower score indicates lower levels of depression as compared to baseline, a higher score indicates higher levels of depression as compared to baseline. A score of 4 ("Unchanged") indicates no change in illness compared to baseline. The scale is not calculated as a statistical change score; the clinician rates their impression of change overall.

Placebo

2.387
units on a scale (Mean)
Standard Deviation: 1.208

EMSAM

2.386
units on a scale (Mean)
Standard Deviation: 1.138

CGI-C Percent Responders (mITT w/LOCF Population)

A summary of the CGI-C percent responders at Week 12 (EOS), by treatment assigned, is shown for the mITT population with LOCF. CGI-C responders were defined as a score of 1 or 2 at the end of the study. A non-responder was defined as a score of ≥3 at end of study. Maximum score is 100%.

Placebo

Percent Non-Responder

40.7
Percent Responder

Percent Responder

59.3
Percent Responder

EMSAM

Percent Non-Responder

41.4
Percent Responder

Percent Responder

58.6
Percent Responder

CDRS-R Total Score (Parent/Other) Week 12 (mITT w/LOCF Population)

A summary of a secondary efficacy outcome measure, Children's Depression Rating Scale (CDRS-R) Total Score (Scored by Parent/Other), at Week 12 (EOS), by treatment assigned, is shown for the modified intent-to-treat (mITT) population, with the last observation carried forward (LOCF) in time. CDRS-R (Parent/Other) total raw scores range from 14 (minimum) 94 (maximum). A lower score indicates a lower likelihood of a depressive disorder, a higher score indicates a higher likelihood of a depressive disorder. One subscale is summed to calculate a total score: Evaluated Symptom Area. Ratings of Observed Nonverbal Behavior subscale is not included in Parent/Other total calculation.

Placebo

Baseline- Observed

49.4
units on a scale (Mean)
Standard Deviation: 11.27

Week 12 - Change From Baseline

-18.7
units on a scale (Mean)
Standard Deviation: 14.09

Week 12- Observed

30.7
units on a scale (Mean)
Standard Deviation: 13.55

EMSAM

Baseline- Observed

48.8
units on a scale (Mean)
Standard Deviation: 10.1

Week 12 - Change From Baseline

-18.3
units on a scale (Mean)
Standard Deviation: 14.27

Week 12- Observed

30.5
units on a scale (Mean)
Standard Deviation: 13.36

CDRS-R Total Score (Best Description) Week 12 (mITT w/LOCF Population)

A summary of a secondary efficacy outcome measure, Children's Depression Rating Scale (CDRS-R) Total Score (Best Description), at Week 12 (EOS), by treatment assigned, is shown for the modified intent-to-treat (mITT) population, with the last observation carried forward (LOCF) in time. Best Description ratings are used when ratings based on interviews with different sources (e.g., child, parent, other ratings) differ for a particular symptom. The evaluator must determine which of these ratings most accurately represents the current affective functioning of the child, and circle that rating in the Best Description of Child Column. CDRS-R (Best Description)total raw scores range from 17(minimum) 113(maximum). A lower score indicates a lower likelihood of a depressive disorder, a higher score indicates a higher likelihood of a depressive disorder. Two subscales are summed to calculate a total score: Evaluated Symptom Area and Ratings of Observed Nonverbal Behavior.

Placebo

Baseline - Observed

60.7
units on a scale (Mean)
Standard Deviation: 12.26

Week 12 - Change From Baseline

-22.7
units on a scale (Mean)
Standard Deviation: 16.54

Week 12 - Observed

38.0
units on a scale (Mean)
Standard Deviation: 16.62

EMSAM

Baseline - Observed

59.5
units on a scale (Mean)
Standard Deviation: 11.05

Week 12 - Change From Baseline

-22.5
units on a scale (Mean)
Standard Deviation: 16.97

Week 12 - Observed

37.0
units on a scale (Mean)
Standard Deviation: 15.73

CDRS-R Total Score (Child) Week 12 (mITT w/OC Population)

A summary of the secondary efficacy outcome measure, Children's Depression Rating Scale (CDRS-R) Total Score (Scored by Child), at Week 12 (EOS), by treatment assigned, is shown for the modified intent-to-treat (mITT) population with observed cases (w/OC). CDRS-R (Child) total raw scores range from 17(minimum) 113(maximum). A lower score indicates a lower likelihood of a depressive disorder, a higher score indicates a higher likelihood of a depressive disorder. Two subscales are summed to calculate a total score: Evaluated Symptom Area and Ratings of Observed Nonverbal Behavior.

Placebo

Baseline - Observed

58.1
units on a scale (Mean)
Standard Deviation: 12.64

Week 12 - Change From Baseline

-25.5
units on a scale (Mean)
Standard Deviation: 15.07

Week 12 - Observed

30.8
units on a scale (Mean)
Standard Deviation: 12.41

EMSAM

Baseline - Observed

56.6
units on a scale (Mean)
Standard Deviation: 12.39

Week 12 - Change From Baseline

-25.3
units on a scale (Mean)
Standard Deviation: 15.16

Week 12 - Observed

31.1
units on a scale (Mean)
Standard Deviation: 12.38

CDRS-R Total Score (Parent/Other) Week 12 (mITT w/OC Population)

A summary of a secondary efficacy outcome measure, Children's Depression Rating Scale (CDRS-R) Total Score (Scored by Parent/Other), at Week 12 (EOS), by treatment assigned, is shown for the modified intent-to-treat (mITT) population with observed cases (w/OC). CDRS-R (Parent/Other) total raw scores range from 14 (minimum) 94 (maximum). A lower score indicates a lower likelihood of a depressive disorder, a higher score indicates a higher likelihood of a depressive disorder. One subscale is summed to calculate a total score: Evaluated Symptom Area. Ratings of Observed Nonverbal Behavior subscale is not included in Parent/Other total calculation.

Placebo

Baseline - Observed

49.6
units on a scale (Mean)
Standard Deviation: 11.43

Week 12 - Change From Baseline

-22.6
units on a scale (Mean)
Standard Deviation: 12.97

Week 12 - Observed

25.5
units on a scale (Mean)
Standard Deviation: 10.70

EMSAM

Baseline - Observed

48.9
units on a scale (Mean)
Standard Deviation: 10.21

Week 12 - Change From Baseline

-22.2
units on a scale (Mean)
Standard Deviation: 12.66

Week 12 - Observed

25.8
units on a scale (Mean)
Standard Deviation: 9.59

CDRS-R Total Score (Best Description) Week 12 (mITT w/OC Population)

A summary of a secondary efficacy outcome measure, Children's Depression Rating Scale (CDRS-R) Total Score (Best Description), at Week 12 (EOS), by treatment assigned, is shown for the modified intent-to-treat (mITT) population, with observed cases (w/OC). Best Description ratings are used when ratings based on interviews with different sources (e.g., child, parent, other ratings) differ for a particular symptom area. The evaluator must determine which of these ratings most accurately represents the current affective functioning of the child, and circle that rating in the Best Description of Child Column. CDRS-R (Best Description) total raw scores range from 17(minimum) 113(maximum). A lower score indicates a lower likelihood of a depressive disorder, a higher score indicates a higher likelihood of a depressive disorder. Two subscales are summed to calculate a total score: Evaluated Symptom Area and Ratings of Observed Nonverbal Behavior.

Placebo

Baseline - Observed

60.7
units on a scale (Mean)
Standard Deviation: 12.34

Week 12 - Change From Baseline

-27.0
units on a scale (Mean)
Standard Deviation: 14.93

Week 12 - Observed

32.1
units on a scale (Mean)
Standard Deviation: 13.18

EMSAM

Baseline - Observed

59.4
units on a scale (Mean)
Standard Deviation: 11.10

Week 12 - Change From Baseline

-26.6
units on a scale (Mean)
Standard Deviation: 15.18

Week 12 - Observed

32.4
units on a scale (Mean)
Standard Deviation: 12.75

Physical Examination (Screening vs. EOS)

Number of physical examination findings that were normal at screening, but abnormal at end of study are presented. Four subjects receiving placebo and four subjects receiving EMSAM had abnormal findings on physical examination at the end of study that were normal at screening.

Placebo

4.0
Number of Abnormal Exams

EMSAM

4.0
Number of Abnormal Exams

Urinalysis (Change From Baseline)

A summary of a secondary safety outcome measure, Urinalysis (Change from Baseline), by treatment assigned, is shown for the safety population. Mean changes from baseline are provided for PH and specific gravity.

Placebo

PH

-0.02
units on a scale (Mean)
Standard Deviation: 0.906

Specific Gravity

EMSAM

PH

-0.11
units on a scale (Mean)
Standard Deviation: 1.052

Specific Gravity

Vital Signs-Heart Rate (Change From Baseline)

Summary mean change in heart rate measured in beats per minute (beats/min or BPM) (supine, standing, and orthostatic change)results for all subjects are presented.

Placebo

Orthostatic Change in Heart Rate

-0.8
BPM (Mean)
Standard Deviation: 11.70

Standing Heart Rate

-0.6
BPM (Mean)
Standard Deviation: 14.26

Supine Heart Rate

0.2
BPM (Mean)
Standard Deviation: 11.90

EMSAM

Orthostatic Change in Heart Rate

2.8
BPM (Mean)
Standard Deviation: 13.8

Standing Heart Rate

2.6
BPM (Mean)
Standard Deviation: 15.12

Supine Heart Rate

-0.1
BPM (Mean)
Standard Deviation: 9.91

Vital Signs-Blood Pressure (Change From Baseline)

Summary mean change in blood pressure (systolic/diastolic) measured in millimeters of mercury (mmHg) (supine, standing, and orthostatic change)results for all subjects are presented.

Placebo

Orthostatic Change in Diastolic Blood Pressure

-0.4
mmHg (Mean)
Standard Deviation: 7.84

Orthostatic Change in Systolic Blood Pressure

-2.1
mmHg (Mean)
Standard Deviation: 9.32

Standing Diastolic Blood Pressure

0.8
mmHg (Mean)
Standard Deviation: 8.5

Standing Systolic Blood Pressure

-1.2
mmHg (Mean)
Standard Deviation: 10.29

Supine Diastolic Blood Pressure

1.1
mmHg (Mean)
Standard Deviation: 8.21

Supine Systolic Blood Pressure

0.9
mmHg (Mean)
Standard Deviation: 8.94

EMSAM

Orthostatic Change in Diastolic Blood Pressure

-1.5
mmHg (Mean)
Standard Deviation: 7.85

Orthostatic Change in Systolic Blood Pressure

-2.3
mmHg (Mean)
Standard Deviation: 11.30

Standing Diastolic Blood Pressure

-0.1
mmHg (Mean)
Standard Deviation: 9.11

Standing Systolic Blood Pressure

-2.5
mmHg (Mean)
Standard Deviation: 11.63

Supine Diastolic Blood Pressure

1.4
mmHg (Mean)
Standard Deviation: 8.52

Supine Systolic Blood Pressure

-0.3
mmHg (Mean)
Standard Deviation: 11.8

12 Lead ECG (Change From Baseline)

A summary of a secondary safety outcome measure, 12 Lead electrocardiogram (ECG) (Change from Baseline) measured in milliseconds (msec), by treatment assigned, is shown for the safety population. Mean change from Baseline in PR interval, QRS duration, QT interval, and QTc (Bazett and Fridericia corrections) interval are presented.

Placebo

PR Interval

0.7
msec (Mean)
Standard Deviation: 10.47

QRS Duration

QTc (Bazett Correction) Interval

-4.1
msec (Mean)
Standard Deviation: 19.20

QTc (Fridericia Correction) Interval

-2.3
msec (Mean)
Standard Deviation: 16.06

QT Interval

1.3
msec (Mean)
Standard Deviation: 24.86

EMSAM

PR Interval

-0.9
msec (Mean)
Standard Deviation: 11.04

QRS Duration

1.1
msec (Mean)
Standard Deviation: 8.21

QTc (Bazett Correction) Interval

-2.9
msec (Mean)
Standard Deviation: 20.23

QTc (Fridericia Correction) Interval

-0.6
msec (Mean)
Standard Deviation: 15.27

QT Interval

3.8
msec (Mean)
Standard Deviation: 21.51

12 Lead ECG (Change From Baseline)Ventricular Heart Rate

A summary of a secondary safety outcome measure, 12 Lead electrocardiogram (ECG) (Change from Baseline)Ventricular Heart Rate measured in beats per minute(beats/min or BPM), by treatment assigned, is shown for the safety population. Mean change from baseline is presented.

Placebo

-1.7
BPM (Mean)
Standard Deviation: 10.40

EMSAM

-2.4
BPM (Mean)
Standard Deviation: 10.43

Hematology - White Blood Cell (WBC) (Change From Baseline)

A summary of a secondary safety outcome measure, Hematology (Change from Baseline), by treatment assigned, is shown for the safety population. Mean change from Baseline in ABS BASOPHILS (X10^9/L), ABS EOSINOPHILS (X10^9/L), ABS LYMPHOCYTES (X10^9/L), ABS MONOCYTES (X10^9/L), and ABS NEUTROPHILS (X10^9/L) are presented.

Placebo

ABS BASOPHILS (X10^9/L)

ABS EOSINOPHILS (X10^9/L)

-0.01
(X10^9/L) (Mean)
Standard Deviation: 0.1

ABS LYMPHOCYTES (X10^9/L)

-0.09
(X10^9/L) (Mean)
Standard Deviation: 0.535

ABS MONOCYTES (X10^9/L)

0.01
(X10^9/L) (Mean)
Standard Deviation: 0.134

ABS NEUTROPHILS (X10^9/L)

0.01
(X10^9/L) (Mean)
Standard Deviation: 1.542

PLATELETS (X10^9/L)

-0.01
(X10^9/L) (Mean)
Standard Deviation: 44.126

WBC (X10^9/L)

-0.09
(X10^9/L) (Mean)
Standard Deviation: 1.813

EMSAM

ABS BASOPHILS (X10^9/L)

ABS EOSINOPHILS (X10^9/L)

0.01
(X10^9/L) (Mean)
Standard Deviation: 0.115

ABS LYMPHOCYTES (X10^9/L)

-0.03
(X10^9/L) (Mean)
Standard Deviation: 0.538

ABS MONOCYTES (X10^9/L)

ABS NEUTROPHILS (X10^9/L)

-0.1
(X10^9/L) (Mean)
Standard Deviation: 1.346

PLATELETS (X10^9/L)

1.82
(X10^9/L) (Mean)
Standard Deviation: 54.452

WBC (X10^9/L)

-0.12
(X10^9/L) (Mean)
Standard Deviation: 1.614

Hematology - Hematocrit (Change From Baseline)

A summary of a secondary safety outcome measure, Hematology - Hematocrit(HCT)(Change from Baseline), by treatment assigned, is shown for the safety population.

Placebo

-0.58
percent (Mean)
Standard Deviation: 2.294

EMSAM

-1.13
percent (Mean)
Standard Deviation: 3.093

Hematology - Hemoglobin (Change From Baseline)

A summary of a secondary safety outcome measure, Hematology - Hemoglobin(HGB)(Change from Baseline), by treatment assigned, is shown for the safety population.

Placebo

-0.18
g/dL (Mean)
Standard Deviation: 0.694

EMSAM

-0.36
g/dL (Mean)
Standard Deviation: 0.854

CGI-S - Week 12 (mITT w/LOCF Population)

A summary of the Clinical Global Impression of Severity (CGI-S) at baseline and Week 12 (EOS), by treatment assigned, is shown for the mITT population with LOCF. The CGI-s is the clinician's assessment of severity of illness (depression). Scores range from 1(minimum) to 7(maximum). A lower score indicates lower illness severity, a higher score indicates higher levels of illness severity.

Placebo

Baseline CGI-S Scale

4.494
units on a scale (Mean)
Standard Deviation: 0.659

Week 12 CGI-S Scale

3.0
units on a scale (Mean)
Standard Deviation: 1.333

EMSAM

Baseline CGI-S Scale

4.527
units on a scale (Mean)
Standard Deviation: 0.662

Week 12 CGI-S Scale

3.007
units on a scale (Mean)
Standard Deviation: 1.250

Hematology - Red Blood Cell (Change From Baseline)

A summary of a secondary safety outcome measure, Hematology - Red Blood Cell (RBC)(Change from Baseline), by treatment assigned, is shown for the safety population.

Placebo

-0.04
x10^12/L (Mean)
Standard Deviation: 0.234

EMSAM

-0.12
x10^12/L (Mean)
Standard Deviation: 0.313

Total

308
Participants

Age, Continuous

14.8
years (Mean)
Standard Deviation: 1.61

Age, Categorical

Race/Ethnicity, Customized

Sex: Female, Male

Overall Study

Placebo

EMSAM

Drop/Withdrawal Reasons

Placebo

EMSAM