A Randomised, Controlled Trial to Investigate the Effect of a Six Week Intensified Pharmacological Treatment for Bipolar Depression Compared to Treatment as Usual in Subjects Who Had a First-time Treatment Failure on Their First-line Treatment.

Status: Recruiting
Location: See all (13) locations...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 3
SUMMARY

Bipolar disorders affect approximately 4.5 million people across the European Union (EU) and are associated with high annual healthcare and societal costs. Bipolar disorder I and II represent disorders that cause extreme fluctuation in a person's mood, energy, and ability to function, in which symptoms of (hypo)mania and depression alternate. The depressive episodes of bipolar disorders are often referred to as bipolar depression (BD). In other words: it is a phase/state of the disorder. For many patients with BD, the depressive polarity is often more pervasive and more debilitating than manic states, with estimates that depressed mood accounts for up to two-thirds of the time spent unwell, even with treatment. The burden of not received an effective treatment for BD is high: more severe psychopathology, higher rates of unemployment, more hospitalisations, lower quality of life, lower cognitive functioning, risk of suicide, comorbidities and poorer social and occupational functioning and thus more carer burden. For BD, the treatment guidelines are very heterogeneous, amongst other reasons because the disease is heterogeneous and treatments should be tailored to the patients. There is no clear treatment algorithm and it cannot yet be predicted which treatment will be effective. Especially the place of adjunctive antidepressants is under debate. Usually, for psychiatric disorders (including bipolar disorder), a patient is considered to be treatment-resistant is two medicinal treatments have been tried (in sufficient duration and dosage) without sufficient success. For BD, there is no consensus on when to consider a patient as treatment-resistant, but the most common definition is after one prior treatment failure. This raises the research question whether adjunctive antidepressants to treat BD should be introduced earlier in the treatment. Additionally, The INTENSIFY trial is part of the larger Horizon 2021 project, with the central goal of paving the way for a shift towards a treatment decision-making process tailored for the individual at risk for treatment resistance. To that end, we aim to establish evidence-based criteria to make decisions of early intense treatment in individuals at risk for treatment resistance across the major psychiatric disorders of schizophrenia, bipolar disorder and major depression.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• In- or out patients, at least 18 years of age.

• Being willing and able to provide written informed consent. Having a legal guardian to cosign is allowed. Informed consent will be signed at visit 1, before any study procedure.

• Female subjects of child bearing potential must use effective contraception during the trial as per the requirements of the applicable SmPCs and should have a negative pregnancy test at visit 1 or 2 (before randomisation). Male subjects that will use valproate acid during the trial must use effective contraceptive measures during the trial (see section 8.2.1).

• Meeting diagnostic criteria for a primary diagnosis of bipolar depression (bipolar disorder type I and II currently in a depressive episode), according to DSM-5. The primary diagnosis will be confirmed by the Mini International Neuropsychiatric Interview (MINI v7.0.2).

• Subject experiences a treatment failure due to lack of efficacy in the current episode, as confirmed by a CGI-I ≥3; preferably, this treatment is a first-line pharmacotherapeutic agent for the primary DSM-5 diagnosis, and was prescribed for at least 4 weeks within an effective dose range as specified in the Summary of Product Characteristics (SmPCs). However, other lines of treatment are accepted as well.

• Subject and clinician intend to change pharmacotherapeutic treatment.

• A minimum symptom severity threshold needs to be present (moderate leve) and subject needs to experience functional impairment.

‣ The minimum symptom severity threshold is a score of ≥20 on the Montgomery Åsberg Depression Rating Scale (MADRS)

⁃ Functional impairment is defined as a score of 5 or higher on any of the three scales of the Sheehan Disability Scale (SDS).

Locations
Other Locations
Austria
Medical University Innsbruck
RECRUITING
Innsbruck
Germany
Universitätsklinik für Psychiatrie und Psychotherapie Bielefeld
RECRUITING
Bielefeld
LWL-Klinik Dortmund, Bereich Forschung & Wissenschaft
RECRUITING
Dortmund
University Hospital Frankfurt am Main - Goethe University
RECRUITING
Frankfurt Am Main
Klinik für Psychiatrie und Psychotherapie der Universitätsmedizin Mainz
RECRUITING
Mainz
Westfälische Wilhelms-Universität Münster
RECRUITING
Münster
Greece
Eginition hospital, department of psychiatry
NOT_YET_RECRUITING
Athens
Italy
Universita degli Studi di Brescia
RECRUITING
Brescia
University of Cagliari
RECRUITING
Cagliari
Università degli studi della Campania Luigi Vanvitelli
RECRUITING
Naples
Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino
RECRUITING
Turin
Spain
Fundació Clínic per a la Recerca Biomèdica
RECRUITING
Barcelona
United Kingdom
King's College London, Psychiatry & Cognitive Neuroscience
NOT_YET_RECRUITING
London
Contact Information
Primary
Inge Winter, Dr.
i.winter@umcutrecht.nl
+31875553227
Backup
Cynthia Okhuijsen-Pfeifer, Dr.
c.pfeifer@umcutrecht.nl
+31875553227
Time Frame
Start Date: 2025-02-11
Estimated Completion Date: 2028-06-30
Participants
Target number of participants: 418
Treatments
Experimental: Bipolar Depression EIPT: Switch to one of the following combinations:
Bipolar Depression randomized to EIPT: Switch to 1. one of the following: escitalopram, sertraline, bupropion or venlafaxine plus 2. two of the following: lithium, valproate acid or quetiapine
Active_comparator: Bipolar Depression TAU: Switch to quetiapine plus lithium or valproate acid
Bipolar Depression randomized to TAU: Switch to quetiapine plus lithium or valproate acid Compound, brand, dosage, frequency and duration up to the investigator's discretion (in accordance with SmPC).
Related Therapeutic Areas
Sponsors
Collaborators: Universität Münster
Leads: Dr. Inge Winter

This content was sourced from clinicaltrials.gov