Optimized Predictive Treatment In Medications for Unipolar Major Depression (OPTIMUM-D)

NCT05017311 | Recruiting Phase 4

• 1 other identifier: 1027397
• Study Type: interventional
• Target: 400
• Locations: 1 country
• Sites: 7

Brief Summary

This is a study that will test a predictive biomarker algorithm based on results from a previous study. The goal of this study is to integrate clinical, imaging, EEG, and molecular data across 8 sites to predict treatment outcome for patients experiencing a major depressive episode (MDE).

Conditions

Major Depressive Disorder

Keywords

major depression; major depressive disorder; MDD; escitalopram; brexpiprazole; neuroimaging; genomics; proteomics; metabolomics

Outcome Measures

Primary Outcomes (1)

• Change in Montgomery Asberg Depression Rating Scale (MADRS) scores from baseline

  Measured as clinical response, defined as a decrease in Montgomery Asberg Depression Rating Scale (MADRS) score at the Week 8 visit, by 50% or greater, from MADRS score at Baseline visit (i.e., lower MADRS scores = better outcome)

  Baseline to Week 8

Secondary Outcomes (3)

• Clinical response

  Baseline to Week 8

• Time to clinical response

  Baseline to Week 8

• Remission at Week 8

  Week 8

Other Outcomes (2)

• Week 12 clinical outcome - Response

  Baseline to Week 8 and Week 8 to Week 12

• Week 12 clinical outcome - Remission

  Week 12

Study Arms (4)

Allocation by Predictive Biomarker Algorithm; Escitalopram + Brexpiprazole

ACTIVE COMPARATOR

Patients are randomly assigned to the Allocation by Predictive Biomarker Algorithm group. Based on the outcome result from the personalized predictive biomarker algorithm, patients predicted as non-responders to escitalopram monotherapy will receive open-label escitalopram (10-20 mg/d) and blinded brexpiprazole (0.5-2 mg/d) for the first 8 weeks of the study. For the final 4 weeks of the study, patients will continue to receive both medications but the brexpiprazole will no longer be blinded.

Drug: Escitalopram; Drug: Brexpiprazole

Allocation by Predictive Biomarker Algorithm; Placebo

PLACEBO COMPARATOR

Patients are randomly assigned to the Allocation by Predictive Biomarker Algorithm group. Based on the outcome result from the personalized predictive biomarker algorithm, patients predicted to respond to escitalopram monotherapy will receive open-label escitalopram (10-20 mg/d) and blinded placebo for the first 8 weeks of the study. For the final 4 weeks of the study, responders will continue to receive open-label escitalopram without the placebo and non-responders will receive a combination of open-label escitalopram and open-label brexpiprazole.

Drug: Escitalopram

Random Allocation; Escitalopram + Brexpiprazole

ACTIVE COMPARATOR

Patients are randomly assigned to the Random Allocation group and then randomly assigned to receive open-label escitalopram (10-20 mg/d) and blinded brexpiprazole (0.5-2 mg/d) for the first 8 weeks of the study. For the final 4 weeks of the study, patients will continue to receive both medications but the brexpiprazole will no longer be blinded.

Drug: Escitalopram; Drug: Brexpiprazole

Random Allocation; Placebo

PLACEBO COMPARATOR

Patients are randomly assigned to the Random Allocation group and then randomly assigned to receive open-label escitalopram (10-20 mg/d) and blinded placebo for the first 8 weeks of the study. For the final 4 weeks of the study, responders will continue to receive open-label escitalopram without the placebo and non-responders will receive a combination of open-label escitalopram and open-label brexpiprazole.

Drug: Escitalopram

Interventions

Escitalopram DRUG

All patients will receive open-label escitalopram (10-20 mg/d) for the entire study duration (12 weeks).

Also known as: Cipralex

Allocation by Predictive Biomarker Algorithm; Escitalopram + Brexpiprazole; Allocation by Predictive Biomarker Algorithm; Placebo; Random Allocation; Escitalopram + Brexpiprazole; Random Allocation; Placebo

Brexpiprazole DRUG

Depending on the initial randomization process, patients will either receive blinded brexpiprazole (0.5-2 mg/d) for the entire study duration (12 weeks) or for the last 4 weeks of the study if they received the placebo during the first 8 weeks of the study and were non-responders.

Also known as: Rexulti

Allocation by Predictive Biomarker Algorithm; Escitalopram + Brexpiprazole; Random Allocation; Escitalopram + Brexpiprazole

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Outpatients 18 to 65 years of age.
• Meet DSM-5 criteria for MDE in MDD as determined by SCID-5.
• Free of psychotropic medications for at least 5 half-lives (e.g. 1 week for most antidepressants, 5 weeks for fluoxetine) before baseline Visit 1 (exceptions: stable use of hypnotics; stable use of stimulants for attention-deficit/hyperactive disorder).
• MADRS score ≥ 24.
• Fluency in English, sufficient to complete the interviews and self-report questionnaires.

You may not qualify if:

• Any diagnosis, other than MDD, that is considered the primary diagnosis.
• Bipolar I or Bipolar-II diagnosis.
• Presence of a significant Axis II diagnosis (borderline, antisocial).
• High suicidal risk, defined by clinician judgment.
• Substance dependence/abuse in the past 6 months.
• Presence of significant neurological disorders, head trauma, or other unstable medical conditions.
• Pregnant or breastfeeding.
• Failure of 4 or more adequate pharmacologic interventions (as determined by the Antidepressant Treatment History Form).
• Started psychological treatment within the past 3 months with the intent of continuing treatment.
• Patients who have previously failed escitalopram or showed intolerance to escitalopram or brexpiprazole, and patients at risk for hypomanic switch (i.e. with a history of antidepressant induced hypomania).
• Healthy Comparison (HC) Participants
• to 65 years of age.
• No history of psychiatric disorders (as determined by SCID-5) or significant physical conditions (e.g. arthritis, fibromyalgia).
• Fluency in English, sufficient to complete the interviews and self-report questionnaires.

Sponsors & Collaborators

• Unity Health Toronto: collaborator
• McMaster University: collaborator
• Queen's University: collaborator
• University of Ottawa: collaborator
• University of British Columbia: collaborator
• University of Calgary: collaborator
• McGill University: collaborator
• Dalhousie University: collaborator
• University of Michigan: collaborator
• Simon Fraser University: collaborator
• Nova Scotia Health Authority: lead
• Centre for Addiction and Mental Health: collaborator

Study Sites (7)

University of Calgary

Calgary, Alberta, T2N 2T9, Canada

NOT YET RECRUITING

University of British Columbia

Vancouver, British Columbia, V6T2A1, Canada

NOT YET RECRUITING

Nova Scotia Health Authority

Halifax, Nova Scotia, B3H 2E2, Canada

RECRUITING

McMaster University

Hamilton, Ontario, L8P3B6, Canada

NOT YET RECRUITING

Queen's University

Kingston, Ontario, K7L4X3, Canada

NOT YET RECRUITING

University Health Network

Toronto, Ontario, M5T2S8, Canada

NOT YET RECRUITING

Centre for Addiction and Mental Health

Toronto, Ontario, M6J1H4, Canada

NOT YET RECRUITING

Related Publications (17)

• Lam RW, Milev R, Rotzinger S, Andreazza AC, Blier P, Brenner C, Daskalakis ZJ, Dharsee M, Downar J, Evans KR, Farzan F, Foster JA, Frey BN, Geraci J, Giacobbe P, Feilotter HE, Hall GB, Harkness KL, Hassel S, Ismail Z, Leri F, Liotti M, MacQueen GM, McAndrews MP, Minuzzi L, Muller DJ, Parikh SV, Placenza FM, Quilty LC, Ravindran AV, Salomons TV, Soares CN, Strother SC, Turecki G, Vaccarino AL, Vila-Rodriguez F, Kennedy SH; CAN-BIND Investigator Team. Discovering biomarkers for antidepressant response: protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort. BMC Psychiatry. 2016 Apr 16;16:105. doi: 10.1186/s12888-016-0785-x.

  PMID: 27084692 BACKGROUND

• Kennedy SH, Lam RW, Rotzinger S, Milev RV, Blier P, Downar J, Evans KR, Farzan F, Foster JA, Frey BN, Giacobbe P, Hall GB, Harkness KL, Hassel S, Ismail Z, Leri F, McInerney S, MacQueen GM, Minuzzi L, Muller DJ, Parikh SV, Placenza FM, Quilty LC, Ravindran AV, Sassi RB, Soares CN, Strother SC, Turecki G, Vaccarino AL, Vila-Rodriguez F, Yu J, Uher R; CAN-BIND Investigator Team. Symptomatic and Functional Outcomes and Early Prediction of Response to Escitalopram Monotherapy and Sequential Adjunctive Aripiprazole Therapy in Patients With Major Depressive Disorder: A CAN-BIND-1 Report. J Clin Psychiatry. 2019 Feb 5;80(2):18m12202. doi: 10.4088/JCP.18m12202.

  PMID: 30840787 BACKGROUND

• Farzan F, Atluri S, Frehlich M, Dhami P, Kleffner K, Price R, Lam RW, Frey BN, Milev R, Ravindran A, McAndrews MP, Wong W, Blumberger D, Daskalakis ZJ, Vila-Rodriguez F, Alonso E, Brenner CA, Liotti M, Dharsee M, Arnott SR, Evans KR, Rotzinger S, Kennedy SH. Standardization of electroencephalography for multi-site, multi-platform and multi-investigator studies: insights from the canadian biomarker integration network in depression. Sci Rep. 2017 Aug 7;7(1):7473. doi: 10.1038/s41598-017-07613-x.

  PMID: 28785082 BACKGROUND

• Lopez JP, Fiori LM, Cruceanu C, Lin R, Labonte B, Cates HM, Heller EA, Vialou V, Ku SM, Gerald C, Han MH, Foster J, Frey BN, Soares CN, Muller DJ, Farzan F, Leri F, MacQueen GM, Feilotter H, Tyryshkin K, Evans KR, Giacobbe P, Blier P, Lam RW, Milev R, Parikh SV, Rotzinger S, Strother SC, Lewis CM, Aitchison KJ, Wittenberg GM, Mechawar N, Nestler EJ, Uher R, Kennedy SH, Turecki G. MicroRNAs 146a/b-5 and 425-3p and 24-3p are markers of antidepressant response and regulate MAPK/Wnt-system genes. Nat Commun. 2017 May 22;8:15497. doi: 10.1038/ncomms15497.

  PMID: 28530238 BACKGROUND

• Uher R, Frey BN, Quilty LC, Rotzinger S, Blier P, Foster JA, Muller DJ, Ravindran AV, Soares CN, Turecki G, Parikh SV, Milev R, MacQueen G, Lam RW, Kennedy SH; CAN-BIND Investigator Team. Symptom Dimension of Interest-Activity Indicates Need for Aripiprazole Augmentation of Escitalopram in Major Depressive Disorder: A CAN-BIND-1 Report. J Clin Psychiatry. 2020 Jun 16;81(4):20m13229. doi: 10.4088/JCP.20m13229.

  PMID: 32558407 BACKGROUND

• Allen TA, Harkness KL, Lam RW, Milev R, Frey BN, Mueller DJ, Uher R, Kennedy SH, Quilty LC. Interactions between neuroticism and stressful life events predict response to pharmacotherapy for major depression: A CAN-BIND 1 report. Personal Ment Health. 2021 Nov;15(4):273-282. doi: 10.1002/pmh.1514. Epub 2021 May 18.

  PMID: 34008342 BACKGROUND

• Nogovitsyn N, Muller M, Souza R, Hassel S, Arnott SR, Davis AD, Hall GB, Harris JK, Zamyadi M, Metzak PD, Ismail Z, Downar J, Parikh SV, Soares CN, Addington JM, Milev R, Harkness KL, Frey BN, Lam RW, Strother SC, Rotzinger S, Kennedy SH, MacQueen GM. Hippocampal tail volume as a predictive biomarker of antidepressant treatment outcomes in patients with major depressive disorder: a CAN-BIND report. Neuropsychopharmacology. 2020 Jan;45(2):283-291. doi: 10.1038/s41386-019-0542-1. Epub 2019 Oct 14.

  PMID: 31610545 BACKGROUND

• Chakrabarty T, McInerney SJ, Torres IJ, Frey BN, Milev RV, Muller DJ, Rotzinger S, Kennedy SH, Lam RW; CAN-BIND Investigator Team. Cognitive Outcomes with Sequential Escitalopram Monotherapy and Adjunctive Aripiprazole Treatment in Major Depressive Disorder: A Canadian Biomarker Integration Network in Depression (CAN-BIND-1) Report. CNS Drugs. 2021 Mar;35(3):291-304. doi: 10.1007/s40263-021-00793-1. Epub 2021 Mar 8.

  PMID: 33683582 BACKGROUND

• Morton E, Bhat V, Giacobbe P, Lou W, Michalak EE, McInerney S, Chakrabarty T, Frey BN, Milev RV, Muller DJ, Parikh SV, Rotzinger S, Kennedy SH, Lam RW; CAN-BIND Investigator Team. Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report. CNS Drugs. 2021 Apr;35(4):439-450. doi: 10.1007/s40263-021-00803-2. Epub 2021 Apr 16.

  PMID: 33860922 BACKGROUND

• Ayyash S, Davis AD, Alders GL, MacQueen G, Strother SC, Hassel S, Zamyadi M, Arnott SR, Harris JK, Lam RW, Milev R, Muller DJ, Kennedy SH, Rotzinger S, Frey BN, Minuzzi L, Hall GB; CAN-BIND Investigator Team. Exploring brain connectivity changes in major depressive disorder using functional-structural data fusion: A CAN-BIND-1 study. Hum Brain Mapp. 2021 Oct 15;42(15):4940-4957. doi: 10.1002/hbm.25590. Epub 2021 Jul 23.

  PMID: 34296501 BACKGROUND

• Caspani G, Turecki G, Lam RW, Milev RV, Frey BN, MacQueen GM, Muller DJ, Rotzinger S, Kennedy SH, Foster JA, Swann JR. Metabolomic signatures associated with depression and predictors of antidepressant response in humans: A CAN-BIND-1 report. Commun Biol. 2021 Jul 22;4(1):903. doi: 10.1038/s42003-021-02421-6.

  PMID: 34294869 BACKGROUND

• Allen TA, Lam RW, Milev R, Rizvi SJ, Frey BN, MacQueen GM, Muller DJ, Uher R, Kennedy SH, Quilty LC. Early change in reward and punishment sensitivity as a predictor of response to antidepressant treatment for major depressive disorder: a CAN-BIND-1 report. Psychol Med. 2019 Jul;49(10):1629-1638. doi: 10.1017/S0033291718002441. Epub 2018 Sep 17.

  PMID: 30220263 BACKGROUND

• Alders GL, Davis AD, MacQueen G, Strother SC, Hassel S, Zamyadi M, Sharma GB, Arnott SR, Downar J, Harris JK, Lam RW, Milev R, Muller DJ, Ravindran A, Kennedy SH, Frey BN, Minuzzi L, Hall GB; CAN-BIND Investigator Team. Escitalopram ameliorates differences in neural activity between healthy comparison and major depressive disorder groups on an fMRI Emotional conflict task: A CAN-BIND-1 study. J Affect Disord. 2020 Mar 1;264:414-424. doi: 10.1016/j.jad.2019.11.068. Epub 2019 Nov 13.

  PMID: 31757619 BACKGROUND

• Chakrabarty T, Harkness KL, McInerney SJ, Quilty LC, Milev RV, Kennedy SH, Frey BN, MacQueen GM, Muller DJ, Rotzinger S, Uher R, Lam RW. Childhood maltreatment and cognitive functioning in patients with major depressive disorder: a CAN-BIND-1 report. Psychol Med. 2020 Nov;50(15):2536-2547. doi: 10.1017/S003329171900268X. Epub 2019 Oct 4.

  PMID: 31583989 BACKGROUND

• Dunlop K, Rizvi SJ, Kennedy SH, Hassel S, Strother SC, Harris JK, Zamyadi M, Arnott SR, Davis AD, Mansouri F, Schulze L, Ceniti AK, Lam RW, Milev R, Rotzinger S, Foster JA, Frey BN, Parikh SV, Soares CN, Uher R, Turecki G, MacQueen GM, Downar J. Clinical, behavioral, and neural measures of reward processing correlate with escitalopram response in depression: a Canadian Biomarker Integration Network in Depression (CAN-BIND-1) Report. Neuropsychopharmacology. 2020 Jul;45(8):1390-1397. doi: 10.1038/s41386-020-0688-x.

  PMID: 32349119 BACKGROUND

• Yrondi A, Fiori LM, Frey BN, Lam RW, MacQueen GM, Milev R, Muller DJ, Foster JA, Kennedy SH, Turecki G. Association Between Side Effects and Blood microRNA Expression Levels and Their Targeted Pathways in Patients With Major Depressive Disorder Treated by a Selective Serotonin Reuptake Inhibitor, Escitalopram: A CAN-BIND-1 Report. Int J Neuropsychopharmacol. 2020 Feb 1;23(2):88-95. doi: 10.1093/ijnp/pyz066.

  PMID: 31819986 BACKGROUND

• McInerney SJ, Chakrabarty T, Maciukiewicz M, Frey BN, MacQueen GM, Milev RV, Ravindran AV, Rotzinger S, Kennedy SH, Lam RW; CAN-BIND Investigator Team. Cognition and Its Association with Psychosocial and Occupational Functioning during Treatment with Escitalopram in Patients with Major Depressive Disorder: A CAN-BIND-1 Report: La Cognition Et Son Association Avec Le Fonctionnement Psychosocial Et Professionnel Durant Le Traitement Par Escitalopram Chez Des Patients Souffrant De Trouble Depressif Majeur: Une Etude Can-Bind-1. Can J Psychiatry. 2021 Sep;66(9):798-806. doi: 10.1177/0706743720974823. Epub 2020 Dec 23.

  PMID: 33353384 BACKGROUND

MeSH Terms

Conditions

Depressive Disorder, Major

Interventions

Escitalopram; Dexetimide; brexpiprazole

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Propylamines; Amines; Organic Chemicals; Nitriles; Benzofurans; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Piperidones; Piperidines; Heterocyclic Compounds, 1-Ring

Study Officials

• Rudolf Uher, MD

  Nova Scotia Health Authority

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Nicole Stinson, BSc

CONTACT

9024735313; nicole.stinson@nshealth.ca

Jill M Cumby, MSc

CONTACT

9024731780; jill.cumby@nshealth.ca

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Staff Psychiatrist, Independent Investigator, Professor

Study Record Dates

• First Submitted: August 16, 2021
• First Posted: August 23, 2021
• Study Start: January 20, 2023
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): April 30, 2029
• Last Updated: February 27, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: Within 12 months of study completion.
• Access Criteria: By application.

Locations

CA (7)