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Weiss F, Pacciardi B, D’Alessandro G, Caruso V, Maremmani I, Pini S, Perugi G. The Role of Vortioxetine in the Treatment of Depressive Symptoms in General Hospital Psychiatry: A Case-Series and PRISMA-Compliant Systematic Review of the Literature. J Clin Med 2024; 13:531. [PMID: 38256665 PMCID: PMC10816732 DOI: 10.3390/jcm13020531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
Depressive symptoms are a customary finding in hospitalized patients, particularly those who are undergoing long hospitalizations, underwent major surgical procedures or suffer from high levels of multimorbidity and frailty. The patients included in this case series shared high degrees of frailty-complexity and were evaluated within the ordinary consultation and liaison psychiatry service of the University Hospital in Pisa, Italy, from September 2021 to June 2023. Patients were administered at least one follow-up evaluation after a week and before discharge. To relate this case series to the extant literature, a comprehensive systematic review of vortioxetine safety and efficacy was performed. None of the six patients included developed serious safety issues, but one patient complained of mild-to-moderate nausea for some days after the vortioxetine introduction. Five out of six patients exhibited at least a slight clinical benefit as measured by the clinical global impression scale. Of the 858 entries screened via Scopus and Medline/PubMed, a total of 134 papers were included in our review. The present case series provides preliminary evidence for vortioxetine's safety in this healthcare domain. The literature reviewed in this paper seems to endorse a promising safety profile and a very peculiar efficacy niche for vortioxetine in consultation and liaison psychiatry.
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Affiliation(s)
- Francesco Weiss
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Bruno Pacciardi
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Giulia D’Alessandro
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Valerio Caruso
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Icro Maremmani
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
- G. De Lisio Institute of Behavioural Sciences, 56121 Pisa, Italy
| | - Stefano Pini
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
| | - Giulio Perugi
- Psychiatric Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (F.W.); (B.P.); (G.D.); (V.C.); (S.P.); (G.P.)
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Öztürk S, Demir M, Koçkaya EA, Karaaslan C, Süloğlu AK. Establishment of a 3D multicellular placental microtissues for investigating the effect of antidepressant vortioxetine. Reprod Toxicol 2024; 123:108519. [PMID: 38043629 DOI: 10.1016/j.reprotox.2023.108519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/23/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023]
Abstract
The placenta is a unique organ with an active metabolism and dynamically changing physiology throughout pregnancy. It is difficult to elucidate the structure of cell-cell and cell-extracellular matrix interactions of the placenta in in vivo studies due to interspecies differences and ethical constraints. In this study, human umbilical cord vein cells (HUVEC) and human placental choriocarcinoma cells (BeWo) were co-cultured for the first time to form spheroids (microtissues) on a three-dimensional (3D) Petri Dish® mold and compared with a traditional two-dimensional (2D) system. Vortioxetine is an antidepressant with a lack of literature on its use in pregnancy in established cultures, the toxicity of vortioxetine was studied to investigate the response of spheroids representing placental tissue. Spheroids were characterised by morphology and exposed to vortioxetine. Cell viability and barrier integrity were then measured. Intercellular junctions and the localisation of serotonin transporter (SERT) proteins were demonstrated by immunofluorescence (IF) staining in BeWo cells. Human chorionic gonadotropin (beta-hCG) hormone levels were also measured. In the 3D system, cell viability and hormone production were higher than in the 2D system. It was observed that the barrier structure was impaired, the structure of intracellular skeletal elements was altered and SERT expression decreased depending on vortioxetine exposure. These results demonstrate that the multicellular microtissue placenta model can be used to obtain results that more closely resemble in vivo toxicity studies of various xenobiotics than other 2D and mono-culture spheroid models in the literature. It also describes the use of 3D models for soft tissues other than the placenta.
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Affiliation(s)
- Selen Öztürk
- Hacettepe University, Faculty of Science, Department of Biology, Zoology Section, Beytepe Campus, Ankara, Türkiye
| | - Merve Demir
- Hacettepe University, Faculty of Science, Department of Biology, Zoology Section, Beytepe Campus, Ankara, Türkiye
| | - E Arzu Koçkaya
- Gazi University, The Higher Vocational School of Health Services, Gölbaşı Campus, Ankara, Türkiye
| | - Cagatay Karaaslan
- Hacettepe University, Faculty of Science, Department of Biology, Molecular Biology Section, Beytepe Campus, Ankara, Türkiye
| | - Aysun Kılıç Süloğlu
- Hacettepe University, Faculty of Science, Department of Biology, Zoology Section, Beytepe Campus, Ankara, Türkiye.
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Bai W, Song H, Hu Y, Zhang X, Wang X, Guo C, Qiu B, Dong Z. Bioequivalence Study of Vortioxetine Hydrobromide Tablets in Healthy Chinese Subjects Under Fasting and Fed Conditions. Drug Des Devel Ther 2023; 17:3035-3046. [PMID: 37795495 PMCID: PMC10547006 DOI: 10.2147/dddt.s428771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023] Open
Abstract
Objective This study compared the pharmacokinetic and safety profiles of generic and original vortioxetine hydrobromide tablets under fasting and fed conditions, and evaluated the bioequivalence of two vortioxetine formulations to obtain sufficient evidence for abbreviated new drug application. Methods A randomized, open-label, two-formulation, single-dose, two-period crossover bioequivalence study was conducted under fasting and fed conditions (n = 32 per study). Eligible healthy Chinese subjects received a single 10-mg dose of the test or reference vortioxetine hydrobromide tablet, followed by a 28-day washout interval between periods. Serial blood samples were collected up to 72 h after administration in each period, and the plasma concentrations of vortioxetine were detected using a validated method. The primary pharmacokinetic (PK) parameters were calculated using the non-compartmental method. The geometric mean ratios for the PK parameters of the test drug to the reference drug and the corresponding 90% confidence intervals were acquired for bioequivalence analysis. A safety evaluation was performed throughout the study. Results Under fasting and fed conditions, the PK parameters of the test drug were similar to those of the reference drug. The 90% confidence intervals (CIs) of the geometric mean ratios of the test to reference formulations were 96.44-105.81% for peak concentration (Cmax), 97.94-105.05% for the area under the curve truncated at 72 hours (AUC0-72 h) under fasting conditions, 93.92-104.15% for Cmax, and 96.67-102.55% for AUC0-72 h under fed conditions, all of which were within the accepted bioequivalence range of 80.00-125.00%. Both the test and reference formulations were well-tolerated, and no serious adverse events related to the study drug were reported during the study. Conclusion The PK bioequivalence of the test and reference vortioxetine hydrobromide tablets in healthy Chinese subjects was established under fasting and fed conditions, which met the predetermined regulatory criteria. Both formulations were safe and well tolerated.
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Affiliation(s)
- Wanjun Bai
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Haojing Song
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Yiting Hu
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Xueyuan Zhang
- Shanghai Innovstone Therapeutics Limited, Shanghai, People’s Republic of China
| | - Xiaoru Wang
- CSPC Zhongqi Pharmaceutical Technology (Shijiazhuang) Co., Ltd, Shijiazhuang, People’s Republic of China
| | - Caihui Guo
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Bo Qiu
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
| | - Zhanjun Dong
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, Hebei, People’s Republic of China
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Zuccarello P, Carnazza G, Barbera N. Development and validation of a LC-MS/MS method for analysis of vortioxetine in postmortem specimens. First data from an authentic case. J Forensic Sci 2023; 68:578-585. [PMID: 36637045 DOI: 10.1111/1556-4029.15198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
Vortioxetine is an antidepressant recently licensed in USA and EU for the treatment of major depressive disorder. Neither fatal case due to overdose nor data about postmortem concentrations on blood or other specimens have been reported. The aims of this study were the development and validation of a method for vortioxetine analysis by Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) in postmortem samples and its application in an authentic case. The method was validated and applied on blood, vitreous humor, bile, brain, liver, kidney, and gastric content. After protein precipitation, the supernatant was directly injected into LC-MS/MS. Analysis was carried out by Multiple Reaction Monitoring (MRM) mode. The authentic case concerned a 38 years-old woman, affected by depression, who was found hanged at home. The method determined an acceptable sensitivity, selectivity, linearity, precision, and accuracy for all matrices. No interference was shown for all matrices. The matrices do not significantly reduce the peak intensity of vortioxetine. No carryover was shown. Toxicological analysis of the authentic case showed vortioxetine in blood (234 ng/ml), vitreous humor (10.5 ng/ml), brain (490 ng/g), lung (479 ng/g), liver (3751 ng/g), kidney (798 ng/g), bile (2267 ng/ml) and gastric content (253 ng/ml). Our case suggests that even at blood concentrations of vortioxetine equal to 234 ng/ml, the subject was able to stage and carry out the hanging. Vortioxetine concentrations found in the other cadaveric samples (biological fluids, organs, and gastric content) may be helpful to evaluate further similar comparable cases.
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Affiliation(s)
- Pietro Zuccarello
- Laboratory of Forensic Toxicology, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Giulia Carnazza
- Laboratory of Forensic Toxicology, Department "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Nunziata Barbera
- Laboratory of Forensic Toxicology, Department "G.F. Ingrassia", University of Catania, Catania, Italy
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Danielak D. Vortioxetine in management of major depressive disorder - a favorable alternative for elderly patients? Expert Opin Pharmacother 2021; 22:1167-1177. [PMID: 33650935 DOI: 10.1080/14656566.2021.1880567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Depressive disorders are common in older patients, and their prevalence may reach up to 17.1%. Though for older adults, the initial recommended treatment is either life-review treatment or group cognitive-behavioral therapy, a combination of pharmacotherapy with interpersonal psychotherapy is also an option. There are many classes of antidepressants, and some meta-analyses suggest that the efficacy of different antidepressant groups is similar. Therefore, depression treatment in an elderly patient should consider preference, safety, and tolerability. Most reports suggest that SSRIs, such as citalopram, escitalopram, or sertraline, should be proposed as first-time medications.Areas covered: This article discusses the pharmacokinetic and pharmacodynamic properties of vortioxetine, emphasizing the observed differences, benefits, and risks for older patients. Vortioxetine - a multimodal antidepressant drug - was shown to be effective against major depressive disorders in both double-blinded, placebo-controlled trials and open-label studies.Expert opinion: Compared with commonly used antidepressants, vortioxetine appears to have unique properties that may be beneficial for elderly patients. Not only does it enhance cognitive function, but it also has a favorable safety profile.
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Affiliation(s)
- Dorota Danielak
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
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Adamo D, Pecoraro G, Aria M, Favia G, Mignogna MD. Vortioxetine in the Treatment of Mood Disorders Associated with Burning Mouth Syndrome: Results of an Open-Label, Flexible-Dose Pilot Study. PAIN MEDICINE 2021; 21:185-194. [PMID: 31343684 DOI: 10.1093/pm/pnz120] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy of a new multimodal antidepressant, vortioxetine (VO), in the management of burning mouth syndrome (BMS). DESIGN Longitudinal single-assessment open-label pilot study. SETTING University hospital. Subjects. Thirty BMS patients were enrolled. METHODS BMS patients were treated with topical clonazepam and a flexible dose of VO (10 mg, 15 mg, or 20 mg). The visual analog scale (VAS), the Total Pain Rating Index (T-PRI), the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A), and the Pittsburgh Sleep Quality Index (PSQI) were performed at baseline (time 0) and after two (time 1), four (time 2), six (time 3), and 12 months (time 4) of treatment. Descriptive statistics and the Wilcoxon nonparametric test for two paired samples were used. RESULTS The BMS patients showed a statistically significant improvement in VAS and T-PRI scores from baseline (median [interquartile range {IQR}] = 10.0 [10-10] and 22.0 [20-24], respectively) to time 4 (median [IQR] = 0.0 [0-0] and 8.0 [7-9], P < 0.001, respectively). Similarly, the HAM-A and HAM-D and PSQI scores showed an improvement from time 0 (median [IQR] = 20 [15.8-22], 19 [16-20.3], and 4.0 [4-7.3], respectively) to time 4 (median [IQR] = 6.0 [6-7], 6.0 [6-7], and 3.0 [3-4], respectively, P < 0.001). CONCLUSIONS VO is efficacious and well tolerated in the treatment of BMS in firstline therapy on account of its better receptor pharmacological profile and in second-line treatment for patients who have only partially responded or have reported adverse effects to previous treatments.
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Affiliation(s)
- Daniela Adamo
- Departments of *Neurosciences, Reproductive and Odontostomatological Sciences
| | - Giuseppe Pecoraro
- Departments of *Neurosciences, Reproductive and Odontostomatological Sciences
| | - Massimo Aria
- Economics and Statistics, University Federico II of Naples, Naples, Italy
| | - Gianfranco Favia
- Oro- Maxillofacial Pathology and Surgery Unit, University Hospital Policlinico Bari, Bari, Italy
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Adamo D, Calabria E, Coppola N, Pecoraro G, Mignogna MD. Vortioxetine as a new frontier in the treatment of chronic neuropathic pain: a review and update. Ther Adv Psychopharmacol 2021; 11:20451253211034320. [PMID: 34497709 PMCID: PMC8419528 DOI: 10.1177/20451253211034320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Chronic neuropathic pain (CNP) is a disabling medical condition that impairs the health-related quality-of-life of affected patients. A high prevalence of anxiety, depression, sleep disturbance and cognitive impairment has frequently been reported in association with CNP, making the management of this disease complex and often multidisciplinary. Dual-acting agents such as selective serotonin and noradrenalin reuptake inhibitors (SNRIs) are considered particularly useful in the modulation of pain and in treatment of the mood disorders frequently associated with CNP. Recent evidence suggests that the top-down inhibitory control of pain involves the engagement and enhancement of descending endogenous opioidergic, cannabinoid and serotonergic systems, with the effect of serotonin being particularly related to the receptor subtypes that are preferentially activated; indeed serotonin induces analgesia via activation of 5-HT7 receptors and hyperalgesia via activation of 5-HT3 receptors. Vortioxetine (VO) is a novel multimodal serotonergic antidepressant with a unique mechanism of action. It has been demonstrated recently in experimental and clinical studies to have efficacy on pain hypersensitivity and on mood disorders. This drug inhibits the serotonin transporter with a high affinity, antagonises the 5-HT3, 5-HT1D and 5HT7 serotonin receptors, and activates the 5-HT1A and 5-HT1B receptors. In clinical studies, VO has proved effective at a dose of 10-20 mg/daily in short- and long-term treatment of patients with chronic orofacial pain, demonstrating a higher rate of clinical response and remission, a better acceptability, safety rate and tolerability, and a lower latency of action compared with other antidepressants. In the light of these recent findings, VO may be considered as a new pharmacological treatment also in relation to various types of CNP, particularly in elderly patients with concomitant mood disorders and cognitive impairment. The purpose of this review is to provide an up-to-date overview of the pharmacology and clinical applications of VO and to highlight its potential therapeutic properties and advantages in the management of CNP.
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Affiliation(s)
- Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Elena Calabria
- Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, via Pansini no.5, Naples, 80131, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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8
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Adamo D, Pecoraro G, Coppola N, Calabria E, Aria M, Mignogna M. Vortioxetine versus other antidepressants in the treatment of burning mouth syndrome: An open-label randomized trial. Oral Dis 2020; 27:1022-1041. [PMID: 32790904 DOI: 10.1111/odi.13602] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This randomized open-label trial compared the efficacy and tolerability of vortioxetine (15 mg/daily) with different antidepressants in the treatment of patients with burning mouth syndrome (BMS). METHODS One and hundred fifty BMS patients were randomized into five groups and treated with either vortioxetine, paroxetine (20 mg/daily), sertraline (50 mg/daily), escitalopram (10 mg/daily) or duloxetine (60 mg/daily). The Visual Analogue Scale (VAS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A), and Clinical Global Impression Improvement (CGI-I) and Efficacy scales (CGI-E) were performed at baseline and after 2, 4, 6, and 12 months of treatment. Any adverse events (AEs) were tabulated for each group. Descriptive statistics, including the Kruskal-Wallis non-parametric test and the Friedman non-parametric test for median comparisons between different times, were used. RESULTS All the antidepressants (AD) were associated with a significant decrease in the VAS, T-PRI, HAM-A, HAM-D, CGI-I, and CGI-E scores in the long-term (p < .001). However, the response rate of the vortioxetine group showed a significant reduction after six months. The medians, after 6 months, were as follows: VAS 0.0; T-PRI 2.0; HAM-A 7.0; HAM-D 7.0; CGI-I 1.0; and CGI-E 1.0 with a lower incidence of AEs (p < .019). CONCLUSION Vortioxetine was efficacious with a shorter latency of action and fewer AEs compared with other ADs.
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Affiliation(s)
- Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University Federico II of Naples, Naples, Italy
| | - Michele Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
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De Berardis D, Fornaro M, Anastasia A, Vellante F, Olivieri L, Rapini G, Serroni N, Orsolini L, Valchera A, Carano A, Tomasetti C, Ventriglio A, Bustini M, Pompili M, Serafini G, Perna G, Iasevoli F, Martinotti G, Di Giannantonio M. Adjunctive vortioxetine for SSRI-resistant major depressive disorder: a "real-world" chart review study. ACTA ACUST UNITED AC 2020; 42:317-321. [PMID: 32159712 PMCID: PMC7236167 DOI: 10.1590/1516-4446-2019-0690] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/09/2019] [Indexed: 11/21/2022]
Abstract
Objective: Selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of treatment of major depressive disorder (MDD). However, non-response is common, often necessitating combination strategies. The present study assessed the efficacy of vortioxetine as an add-on therapy in patients with SSRI-resistant MDD. Methods: The charts of 36 adult outpatients with DSM-IV-TR MDD who had not achieved a response after at least 8 weeks of treatment with an SSRI were reviewed retrospectively. Subjects were treated with vortioxetine (5-20 mg/day) for 8 weeks added to the current SSRI. The main outcome measures were change from baseline in total Hamilton Scale for Depression (HAM-D) score and the rate of response (a 50% or greater reduction in HAM-D score and a Clinical Global Impression ‐ Improvement module [CGI-I] score of 1 or 2 at endpoint). HAM-D scores ≤ 7 were considered as remission. Additional outcome measures included the Snaith-Hamilton Pleasure Scale (SHAPS) and the Scale for Suicide Ideation (SSI). Results: 32 patients completed the 8 weeks of treatment. At 8 weeks, a significant reduction in HAM-D score was observed (p ≤ 0.001), with response obtained by 41.7% and remission by 33.3% of patients. Significant reductions in SHAPS and SSI were also observed (p ≤ 0.001 for both scales). Conclusions: Adjunctive vortioxetine may be useful and well-tolerated in stage I treatment-resistant depression. However, the limitations of this study (such as small sample size, absence of randomization and control group, retrospective design, etc.) must be considered.
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Affiliation(s)
- Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," National Health Service (NHS), ASL 4 Teramo, Italy.,Department of Neurosciences and Imaging, University "G. D'Annunzio" Chieti, Italy
| | - Michele Fornaro
- Department of Psychiatry, Federico II University, Naples, Italy.,Polyedra, Teramo, Italy
| | - Annalisa Anastasia
- Department of Psychiatry, Federico II University, Naples, Italy.,Polyedra, Teramo, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, University "G. D'Annunzio" Chieti, Italy
| | - Luigi Olivieri
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," National Health Service (NHS), ASL 4 Teramo, Italy
| | - Gabriella Rapini
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," National Health Service (NHS), ASL 4 Teramo, Italy
| | - Nicola Serroni
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini," National Health Service (NHS), ASL 4 Teramo, Italy
| | - Laura Orsolini
- Polyedra, Teramo, Italy.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, UK
| | - Alessandro Valchera
- Polyedra, Teramo, Italy.,Hermanas Hospitalarias, Villa S. Giuseppe Hospital, Ascoli Piceno, Italy
| | - Alessandro Carano
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso" NHS, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Carmine Tomasetti
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "SS. Annunziata" NHS, ASL 4 Giulianova, Italy
| | | | - Massimiliano Bustini
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "San Camillo de Lellis" NHS, ASL Rieti, Italy
| | - Maurizio Pompili
- Suicide Prevention Center, Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Section of Psychiatry, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, Villa San Benedetto Menni Hospital, FoRiPsi, Albese con Cassano, Como, Italy.,Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, Miami University, Miami, USA
| | - Felice Iasevoli
- Department of Psychiatry, Federico II University, Naples, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, University "G. D'Annunzio" Chieti, Italy
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Inoue T, Sasai K, Kitagawa T, Nishimura A, Inada I. Randomized, double-blind, placebo-controlled study to assess the efficacy and safety of vortioxetine in Japanese patients with major depressive disorder. Psychiatry Clin Neurosci 2020; 74:140-148. [PMID: 31725942 PMCID: PMC7027855 DOI: 10.1111/pcn.12956] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/04/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022]
Abstract
AIM The burden of major depressive disorder (MDD) in Japan is high. This study aimed to evaluate the efficacy and safety of the multimodal antidepressant vortioxetine in Japanese patients with MDD. METHODS Japanese patients aged 20-75 years with recurrent MDD and a Montgomery-Åsberg Depression Rating Scale (MADRS) score ≥ 26 were randomized to vortioxetine 10 or 20 mg or placebo in a phase-3, double-blind, 8-week study. The primary end-point was change in MADRS total score from baseline. Secondary end-points included MADRS response and remission rates, change in Hamilton Rating Scale for Depression-17 item (HAM-D17) score, and other measures of depressive symptoms, including Clinical Global Impression of Severity (CGI-S), Clinical Global Impression of Improvement (CGI-I), and Sheehan Disability Scale (SDS). Cognitive function was assessed using Digit Symbol Substitution Test (DSST) score and Perceived Deficits Questionnaire-5 item (PDQ-5) score. RESULTS Vortioxetine 10 mg (n = 165) and 20 mg (n = 163) reduced MADRS total score by 2.66 and 3.07 points versus placebo (n = 161) after 8 weeks (P < 0.01 for each dose), respectively. MADRS response and remission rates were also significantly greater with vortioxetine than with placebo (P < 0.05 for both doses). Vortioxetine 10 and 20 mg significantly improved HAM-D17 score, CGI-I score, and SDS total score after 8 weeks. PDQ-5 score was significantly improved in subjects administered vortioxetine, while DSST scores showed no significant difference. Vortioxetine was generally well tolerated. CONCLUSION Vortioxetine at both the 10- and 20-mg/day doses demonstrated robust antidepressant efficacy in Japanese patients with MDD, and was well tolerated over the 8-week treatment period.
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Affiliation(s)
- Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | | | | | | | - Isao Inada
- Takeda Pharmaceutical Company Ltd, Osaka, Japan
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Miao J, Wang G, Hou J, Areberg J, Zhao Y, Højer AM, Ettrup A. Pharmacokinetics and Safety of Vortioxetine in the Chinese Population. Adv Ther 2019; 36:3134-3146. [PMID: 31552551 PMCID: PMC6822801 DOI: 10.1007/s12325-019-01092-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 02/05/2023]
Abstract
Introduction Major depressive disorder (MDD) is associated with a significant burden of disease in China. Awareness and better access to treatments could help alleviate the burden associated with MDD. Because variations have been observed in the pharmacokinetics (PK) of antidepressants across different races and ethnicities, evaluation of the clinical pharmacology of vortioxetine in diverse populations remains important to assess the potential need for dose adjustments. Methods Data were pooled from two phase I open-label PK studies in healthy Chinese subjects, and one phase III double-blind noninferiority study in Chinese patients with MDD to describe the PK and safety data for vortioxetine. Doses in these studies ranged from 10 mg (single dose) to 10 and 20 mg (multiple daily doses). A population PK analysis of vortioxetine in the Chinese population was conducted using nonlinear mixed-effect modeling. Results In total, 186 individuals were included in the PK analysis: 79 healthy Chinese subjects and 107 Chinese patients with MDD. No clinically significant differences in the PK of vortioxetine were observed between the Chinese population and the previous data in non-Chinese populations. Because of a generally lower weight in the Chinese population compared with the non-Chinese population, exposures were 19% and 18% higher in the Chinese population than in the non-Chinese population (for maximum observed plasma concentration and area under the plasma concentration–time curve, respectively), which is not considered clinically relevant. A high prevalence of pruritus was observed in one phase I PK study (56% overall); however, this was not reflected in the phase III study in Chinese patients with MDD (0.8%). Conclusions The PK parameters of vortioxetine in Chinese subjects were comparable to previous data in non-Chinese subjects. Overall, no new safety concerns were raised among the Chinese population. On the basis of this analysis, the tolerability profile of vortioxetine in Chinese healthy subjects and in patients with MDD is expected to be comparable to that in the non-Chinese population. Funding H. Lundbeck A/S, Valby, Denmark. Trial Registration NCT01676571. Electronic supplementary material The online version of this article (10.1007/s12325-019-01092-4) contains supplementary material, which is available to authorized users.
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Adamo D, Pecoraro G, Fortuna G, Amato M, Marenzi G, Aria M, Mignogna MD. Assessment of oral health‐related quality of life, measured by OHIP‐14 and GOHAI, and psychological profiling in burning mouth syndrome: A case‐control clinical study. J Oral Rehabil 2019; 47:42-52. [DOI: 10.1111/joor.12864] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Giulio Fortuna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Massimo Amato
- Dentistry Unit, Department of Medicine, Surgery and Dentistry University of Salerno Fisciano Italy
| | - Gaetano Marenzi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
| | - Massimo Aria
- Department of Economics and Statistics Federico II University Naples Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences Federico II University Naples Italy
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Abstract
BACKGROUND Obesity and depression are common comorbid conditions. The objective of the study was to evaluate the effect of obesity on the pharmacokinetics of the serotonergic antidepressant vortioxetine. METHODS Vortioxetine pharmacokinetics were evaluated in 16 otherwise healthy obese volunteers (mean weight, 119 kg; mean body mass index (BMI) 41.8 kg/m) and in 14 normal-weight subjects (mean weight, 68 kg; mean BMI, 23.0 kg/m) matched for age. All subjects received a single 5-mg oral dose of vortioxetine once daily for 29 days. Pre-dose plasma vortioxetine concentrations were measured during the 29 days of dosing, and during a 4-week washout period after the last dose. Full 24-hour profiles were obtained after the first and last doses. RESULTS Vortioxetine accumulated extensively over the 29 days; the accumulation ratio was not significantly different between obese and control groups (means: 5.24 and 4.46, respectively). Steady-state concentration (Css) and steady-state clearance also did not differ between groups. However mean washout half-life (T1/2) was significantly prolonged in obese vs. control subjects (3.26 days vs. 2.21 days, P < 0.01). Up to 89% of the individual variability in T1/2 was explained by the product of Css and numeric indicators of the degree of obesity. CONCLUSIONS The half-life of vortioxetine washout after discontinuation of therapy is significantly prolonged in obese individuals compared to normal weight controls. To avoid a potential risk of serotonin syndrome, obese patients who plan to change their medication from vortioxetine to a monoamine oxidase inhibitor (MAOI) should extend the time between vortioxetine discontinuation and MAOI initiation beyond what is recommended in the product label.
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