Safety and efficacy of Placida® (fixed dose combination of flupentixol 0.5 mg and melitracen 10 mg) in comparison to escitalopram 10 mg and clonazepam 0.5 mg in patients with comorbid anxiety and depression: a randomized, double blind, double dummy, parallel group clinical trial
DOI:
https://doi.org/10.18203/2349-3259.ijct20232501Keywords:
Anxiety, Flupentixol, Melitracen, Escitalopram, Clonazepam, DepressionAbstract
Background: Individuals with major depressive disorder (MDD) commonly present with comorbid anxiety and have greater depressive illness severity and chronicity, more suicide attempts, and completions. This randomized, double blind, double dummy, parallel-group clinical phase IV trial (CTRI/2022/11/047050) is aimed to compare the safety and efficacy of Placida® (FDC of flupentixol 0.5 mg + melitracen 10 mg) versus escitalopram + clonazepam in patients with comorbid anxiety and depression.
Methods: This is a randomized, controlled, double blind, double dummy, parallel-group, phase IV trial. A total of 440 patients was enrolled across 11 sites in India who fulfilled the inclusion and exclusion criteria. All the subjects will be followed up for 2, 4, 6, 8, 10, 12, 16, 20, and 24 weeks with a buffer period of 1 week in each visit. The patient will be checked for severity of adverse events (AEs) and serious adverse events (SAEs). Efficacy will be assessed using the Hamilton depression rating scale (HAM-D), Hamilton anxiety rating scale (HAM-A) at baseline, weeks 4, 8 and 16, 24 score-reduction rate from baseline to end of treatment and extrapyramidal symptom rating scale (ESRS) at week 16 and end of the study. The first enrolment was done on 26 November 2022 and presently the subjects are under follow-up stage. The anticipated completion date for the study is March 2024.
Conclusions: Outcomes of this trial will provide valuable information on safety and efficacy of Placida® as compared to escitalopram and clonazepam in treating patients with comorbid anxiety and depression.
Trial Registration: The trial is registered with clinical trial registry India (CTRI/2022/11/047050) prospectively.
Metrics
References
Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72(3):341-8.
Scott KM, Oakley Browne MA, McGee MA, Wells JE, New Zealand Mental Health Survey Research Team. Mental-physical comorbidity in Te Rau Hinengaro: the New Zealand Mental Health Survey. Aust N Z J Psychiatry. 2006;40(10):882-8.
Bhattacharya R, Shen C, Sambamoorthi U. Excess risk of chronic physical conditions associated with depression and anxiety. BMC Psychiatry. 2014;14:10.
Sagna A, Gallo JJ, Pontone GM. Systematic review of factors associated with depression and anxiety disorders among older adults with Parkinson’s disease. Parkinsonism Relat Disord. 2014;20(7):708-15.
Doyle T, Palmer S, Johnson J, Babyak MA, Smith P, Mabe S, et al. Association of anxiety and depression with pulmonary-specific symptoms in chronic obstructive pulmonary disease. Int J Psychiatry Med. 2013;45(2):189-202.
Kretchy IA, Owusu-Daaku FT, Danquah SA. Mental health in hypertension: assessing symptoms of anxiety, depression and stress on anti-hypertensive medication adherence. Int J Ment Health Syst. 2014;8:25.
Ganasegeran K, Renganathan P, Manaf RA, Al-Dubai SA. Factors associated with anxiety and depression among type 2 diabetes outpatients in Malaysia: a descriptive cross-sectional singlecentre study. BMJ Open. 2014;4(4):e004794.
Belzer K, Schneier FR. Comorbidity of anxiety and depressive disorders: Issues in conceptualization, assessment, and treatment. J Psychiatr Pract. 2004;10:296-306.
Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG. Comorbidity of DSM-III-R major depressive disorder in the general population: Results from the US National comorbidity survey. Br J Psychiatry Suppl. 1996:17-30.
Baldwin DS, Lopes AT. The influence of comorbid anxiety disorders on outcome in major depressive disorder. Medicographia. 2009;31:126-31.
Keller MB, Krystal JH, Hen R, Neumeister A, Simon NM. Untangling depression and anxiety: Clinical challenges. J Clin Psychiatry. 2005;66:1477-84.
Ballenger JC. Overview of different pharmacotherapies for attaining remission in generalized anxiety disorder. J Clin Psychiatry. 2001;62(19):11-9.
Papakostas GI, Trivedi MH, Alpert JE. Efficacy of bupropion and the selective serotonin reuptake inhibitors in the treatment of anxiety symptoms in major depressive disorder: A meta-analysis of individual patient data from 10 double-blind randomized clinical trials. J Psychiatry Res. 2008;42:134-40.
ClinCalc. Clonazepam - Drug Usage Statistics. Available at: https://clincalc.com/DrugStats/Drugs/ Clonazepam. Accessed on 23 March 2023.
Martino D, Cavanna A. Advances in the neurochemistry and neuropharmacology of Tourette syndrome. Academic Press. 2013.
Fisher GL, Roget NA, editors. Encyclopedia of substance abuse prevention, treatment, and recovery. Sage. 2009.
Joint Formulary Committee. British National Formulary (BNF), 65th edition. London, UK: Pharmaceutical Press. 2013.
Rossi S. Australian Medicines Handbook. Adelaide: The Australian Medicines Handbook Unit Trust. 2013.
"Fluanxol® (flupentixol) Tablets Registration Certificate". Russian State Register of Medicinal Products.
Ahmed A, Molvi KI, Nazim S, Baig I, Memon T, Rahil M. The importance of six membered saturated nitrogen containing ring in psychological disorders. J Chem Pharm Res. 2012;4(1):872.
Budavari S, O’Neil MJ, Smith A, Heckelman PE. In: The Merck Index, 13th Edition. Merck & Co. Inc., Whitehouse Station, NJ. 2001;1294.
Buschmann H, Holenz J, Párraga A, Torrens A, Vela JM, Díaz JL, editors. Antidepressants, antipsychotics, anxiolytics, 2 volume set: From chemistry and pharmacology to clinical application. John Wiley & Sons. 2007.
World Health Organization. The World Health Report 2004: Changing History. Geneva, Switzerland: WHO; Annex Table 3: Burden of Disease in DALYs by Cause, Sex, and Mortality Stratum in WHO Regions, Estimates for 2002. 2004.
Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593-602.
NASMHPD (National Association of State Mental Health Program Directors), Medical Directors Council. Morbidity and Mortality in People with Serious Mental Illness. 2006.
Broich K. Committee for Medicinal Products for Human Use (CHMP) assessment on efficacy of antidepressants. Eur Neuropsychopharmacol. 2009;19(5):305-8.
Hunt SM, McKenna SP. The QLDS: a scale for the measurement of quality of life in depression. Health Policy. 1992;22(3):307-19.
Jakobsen JC, Wetterslev J, Winkel P, Lange T, Gluud C. Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods. BMC Med Res Methodol. 2014;14(1):120.
Jakobsen JC, Gluud C. The necessity of randomized clinical trials. Br J Med Res. 2013;3(4):1453-68.
Grover S, Avasth A, Kalita K, Dalal PK, Rao GP, Chadda RK, et al. IPS multicentric study: Antidepressant prescription patterns. Indian J Pscychiatry. 2013;55(1):41.
Kaur H, Sidana A, Singh TK. Comparison of efficacy and tolerability of escitalopram and venlafaxine in treatment-naïve patients with unipolar nonpsychotic depression: Is there a need to revisit the prescription patterns? JMHIB. 2019;24(1):15.
Higgins A, Nash M, Lynch AM. Antidepressant-associated sexual dysfunction: Impact, effects, and treatment. Drug Healthc Patient Saf. 2010;2:141-50.
Lane RM. A critical review of selective serotonin reuptake inhibitor-related sexual dysfunction; Incidence, possible aetiology, and implications for management. J Psychopharmacol. 1997;11:72-82.
Mahapatra J, Quraishi SN, David A, Sampson S, Adams CE. Flupenthixol decanoate (depot) for schizophrenia or other similar psychotic disorders. CDSR. 2014(6).
Lundbeck Canada Inc. Product Monograph: FLUANXOL (Flupentixol), as oral tablets or intramuscular injection. Available at: https://www.lundbeck.com/content/dam/lundbeck-com/americas/canada/products/files/fluanxol_product_monograph_english.pdf. Accessed on 21 July 2023.
EMC. Access the most comprehensive and up to date medicine database in the UK. Available at: https://www.medicines.org.uk/emc/files/pil.998.pdf. Accessed on 21 July 2023.
Summary of Product characteristics. Available at: https://www.papaloizou.com/PublicDocsPDF/SPCs/Deanxit_SPC.pdf. Accessed on 21 July 2023.
Buschmann H, Holenz J, Párraga A, Torrens A, Vela JM, Díaz JL, editors. Antidepressants, antipsychotics, anxiolytics, 2 volume set: From chemistry and pharmacology to clinical application. John Wiley & Sons. 2007.
Greenstein GR. The Merck index: An encyclopedia of chemicals, drugs, and biologicals. Reference Reviews. 2007;21(6):40.