1
|
Vasiliu O. Efficacy, Tolerability, and Safety of Toludesvenlafaxine for the Treatment of Major Depressive Disorder-A Narrative Review. Pharmaceuticals (Basel) 2023; 16:411. [PMID: 36986510 PMCID: PMC10051807 DOI: 10.3390/ph16030411] [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: 01/23/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/12/2023] Open
Abstract
The estimated rate of treatment-resistant major depressive disorder (TRD) remains higher than 30%, even after the discovery of multiple classes of antidepressants in the last 7 decades. Toludesvenlafaxine (ansofaxine, LY03005, or LPM570065) is a first-in-class triple monoaminergic reuptake inhibitor (TRI) that has reached clinical use. The objective of this narrative review was to summarize clinical and preclinical evidence about the efficacy, tolerability, and safety of toludesvenlafaxine. Based on the results of 17 reports retrieved in the literature, the safety and tolerability profiles of toludesvenlafaxine were good in all clinical trials, and the pharmacokinetic parameters were well described in the phase 1 trials. The efficacy of toludesvenlafaxine was demonstrated in one phase 2 and one phase 3 trial, both on primary and secondary outcomes. In conclusion, this review highlights the favorable clinical results of toludesvenlafaxine in only two short-term trials that enrolled patients with major depressive disorder (MDD) (efficacy and tolerability were good for up to eight weeks), indicating the need for more good quality, larger-sample, and longer-term trials. Exploring new antidepressants, such as TRI, can be considered a priority for clinical research due to the high rates of TRD, but also due to the significant percentages of relapse in patients with MDD.
Collapse
Affiliation(s)
- Octavian Vasiliu
- Department of Psychiatry, Dr. Carol Davila University Emergency Central Military Hospital, 010825 Bucharest, Romania
| |
Collapse
|
2
|
Castricum J, Birkenhager TK, Kushner SA, Elgersma Y, Tulen JHM. Cortical Inhibition and Plasticity in Major Depressive Disorder. Front Psychiatry 2022; 13:777422. [PMID: 35153873 PMCID: PMC8825489 DOI: 10.3389/fpsyt.2022.777422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a severe psychiatric disorder that is associated with various cognitive impairments, including learning and memory deficits. As synaptic plasticity is considered an important mechanism underlying learning and memory, deficits in cortical plasticity might play a role in the pathophysiology of patients with MDD. We used Transcranial Magnetic Stimulation (TMS) to assess inhibitory neurotransmission and cortical plasticity in the motor cortex of MDD patients and controls. METHODS We measured the cortical silent period (CSP) and short interval cortical inhibition (SICI), as well as intermittent theta-burst stimulation (iTBS), in 9 drug-free MDD inpatients and 18 controls. RESULTS The overall response to the CSP, SICI, and iTBS paradigms was not significantly different between the patient and control groups. iTBS induction resulted in significant potentiation after 20 mins in the control group (t (17) = -2.8, p = 0.01), whereas no potentiation was observed in patients. CONCLUSIONS Potentiation of MEP amplitudes was not observed within the MDD group. No evidence was found for medium-to-large effect size differences in CSP and SICI measures in severely depressed drug-free patients, suggesting that reduced cortical inhibition is unlikely to be a robust correlate of the pathophysiological mechanism in MDD. However, these findings should be interpreted with caution due to the high inter-subject variability and the small sample size. SIGNIFICANCE These findings advance our understanding of neurophysiological functioning in drug-free severely depressed inpatients.
Collapse
Affiliation(s)
- Jesminne Castricum
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, Netherlands
| | - Tom K Birkenhager
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Steven A Kushner
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ype Elgersma
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, Netherlands
| | - Joke H M Tulen
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands.,ENCORE Expertise Center for Neurodevelopmental Disorders, Erasmus Medical Center, Rotterdam, Netherlands
| |
Collapse
|
3
|
Borbély É, Simon M, Fuchs E, Wiborg O, Czéh B, Helyes Z. Novel drug developmental strategies for treatment-resistant depression. Br J Pharmacol 2021; 179:1146-1186. [PMID: 34822719 PMCID: PMC9303797 DOI: 10.1111/bph.15753] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/17/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022] Open
Abstract
Major depressive disorder is a leading cause of disability worldwide. Because conventional therapies are ineffective in many patients, novel strategies are needed to overcome treatment‐resistant depression (TRD). Limiting factors of successful drug development in the last decades were the lack of (1) knowledge of pathophysiology, (2) translational animal models and (3) objective diagnostic biomarkers. Here, we review novel drug targets and drug candidates currently investigated in Phase I–III clinical trials. The most promising approaches are inhibition of glutamatergic neurotransmission by NMDA and mGlu5 receptor antagonists, modulation of the opioidergic system by κ receptor antagonists, and hallucinogenic tryptamine derivates. The only registered drug for TRD is the NMDA receptor antagonist, S‐ketamine, but add‐on therapies with second‐generation antipsychotics, certain nutritive, anti‐inflammatory and neuroprotective agents seem to be effective. Currently, there is an intense research focus on large‐scale, high‐throughput omics and neuroimaging studies. These results might provide new insights into molecular mechanisms and potential novel therapeutic strategies.
Collapse
Affiliation(s)
- Éva Borbély
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Hungary.,Molecular Pharmacology Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary
| | - Mária Simon
- Department of Psychiatry and Psychotherapy, Clinical Centre, Medical School, University of Pécs, Hungary
| | - Eberhard Fuchs
- German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany
| | - Ove Wiborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Boldizsár Czéh
- Neurobiology of Stress Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary.,Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, Hungary.,Molecular Pharmacology Research Group, Szentágothai János Research Centre, University of Pécs, Pécs, Hungary
| |
Collapse
|
4
|
Schneider C, Breilmann J, Reuter B, Becker T, Kösters M. Systematic evaluation of the 'efficacy-effectiveness gap' in the treatment of depression with venlafaxine and duloxetine. Acta Psychiatr Scand 2021; 144:113-124. [PMID: 33661520 DOI: 10.1111/acps.13293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Evidence of larger drug effects in highly standardized studies (efficacy) compared to clinical routine (effectiveness) is discussed as efficacy-effectiveness gap. This study aimed to quantify effect size differences of RCTs and non-RCTs in the treatment of depression with venlafaxine and duloxetine and to identify effect modifying predictors. METHODS A comprehensive systematic review and meta-analysis was conducted, including all prospective trials, which evaluated the treatment effects of duloxetine or venlafaxine in patients with depression. The primary outcome was the pre-post effect size after acute therapy, which were compared between RCTs and non-RCTs. Moreover, an exploratory analysis of predictors in a mixed meta-regression model within an information-theoretic approach was performed. RESULTS 171 RCTs and 74 non-RCTs were included. The pre-post effect size differed significantly between RCTs and non-RCTs (-3.04 vs. -2.62, Δ = 0.41, p = 0.012, high heterogeneity). Study characteristics were very similar between RCTs and non-RCTs. Most important variables to predict effect sizes were 'depression severity', 'dose' and 'number of participants'. CONCLUSION Despite differences in effect sizes between RCTs and non-RCTs, study design is not clearly an important predictor for the effect sizes. Our results question the common assumption that non-RCTs are generally better suited to describe a drug's effectiveness in clinical practice than RCTs. Future studies and their reporting should put more emphasis on the description of external validity, in order to allow better assessments of clinical relevance.
Collapse
Affiliation(s)
- Carolin Schneider
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanna Breilmann
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| | - Markus Kösters
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Germany
| |
Collapse
|
5
|
Jiang JL, El Mansari M, Blier P. Triple reuptake inhibition of serotonin, norepinephrine, and dopamine increases the tonic activation of α 2-adrenoceptors in the rat hippocampus and dopamine levels in the nucleus accumbens. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109987. [PMID: 32474007 DOI: 10.1016/j.pnpbp.2020.109987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 01/03/2023]
Abstract
Clinical studies have shown the therapeutic efficacy of an increase in dopamine (DA) transmission in treatment of major depressive disorder (MDD). In the present study, we investigated whether blockade of DA transporters in addition to serotonin (5-HT) and norepinephrine (NE) produced additional adaptations of monoaminergic systems. In vivo electrophysiological recordings were carried out in male anesthetized rats. Vehicle, the 5-HT reuptake inhibitor escitalopram, the NE/DA reuptake blocker nomifensine and their combination (triple reuptake inhibition; TRI) were delivered for 2 or 14 days. Firing activity of NE, 5-HT and DA neurons was assessed. Tonic activation of 5-HT1A receptors and α1- and α2-adrenoceptors was determined in the hippocampus and extracellular DA levels in the nucleus accumbens (NAc). Unlike escitalopram, nomifensine and TRI administration increased the tonic activation of α2-adrenoceptors in the hippocampus despite decreasing NE neuronal firing activity after 2 and 14 days of administration. The firing activity of 5-HT neurons was increased after prolonged nomifensine and TRI regimens, while addition of nomifensine to escitalopram prevented the early 2-day suppression of firing by 5-HT reuptake inhibition. The tonic activation of 5-HT1A receptors was enhanced only with escitalopram. Whereas escitalopram and nomifensine decreased firing activity of DA neurons after a 2-day administration, their combination normalized it to baseline level after 14 days; this was accompanied by a robust increase in extracellular DA levels in the NAc. In summary, these results indicate that TRI increases NE and DA but not 5-HT transmission, suggesting a differential efficacy profile in MDD patients.
Collapse
Affiliation(s)
- Jojo L Jiang
- University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
| | - Mostafa El Mansari
- University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
| | - Pierre Blier
- University of Ottawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
| |
Collapse
|
7
|
Witkin JM, Monn JA, Schoepp DD, Li X, Overshiner C, Mitchell SN, Carter G, Johnson B, Rasmussen K, Rorick-Kehn LM. The Rapidly Acting Antidepressant Ketamine and the mGlu2/3 Receptor Antagonist LY341495 Rapidly Engage Dopaminergic Mood Circuits. J Pharmacol Exp Ther 2016; 358:71-82. [PMID: 27189960 DOI: 10.1124/jpet.116.233627] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/10/2016] [Indexed: 11/22/2022] Open
Abstract
Ketamine is a rapidly acting antidepressant in patients with treatment-resistant depression (TRD). Although the mechanisms underlying these effects are not fully established, inquiry to date has focused on the triggering of synaptogenesis transduction pathways via glutamatergic mechanisms. Preclinical data suggest that blockade of metabotropic glutamate (mGlu2/3) receptors shares many overlapping features and mechanisms with ketamine and may also provide rapid efficacy for TRD patients. Central dopamine circuitry is recognized as an end target for mood regulation and hedonic valuation and yet has been largely neglected in mechanistic studies of antidepressant-relevant effects of ketamine. Herein, we evaluated the changes in dopaminergic neurotransmission after acute administration of ketamine and the mGlu2/3 receptor antagonist LY341495 [(2S)-2-amino-2-[(1S,2S)-2-carboxycycloprop-1-yl]-3-(xanth-9-yl) propanoic acid ] in preclinical models using electrophysiologic, neurochemical, and behavioral endpoints. When given acutely, both ketamine and LY341495, but not the selective serotonin reuptake inhibitor (SSRI) citalopram, increased the number of spontaneously active dopamine neurons in the ventral tegmental area (VTA), increased extracellular levels of dopamine in the nucleus accumbens and prefrontal cortex, and enhanced the locomotor stimulatory effects of the dopamine D2/3 receptor agonist quinpirole. Further, both ketamine and LY341495 reduced immobility time in the tail-suspension assay in CD1 mice, which are relatively resistant to SSRI antidepressants. Both the VTA neuronal activation and the antidepressant phenotype induced by ketamine and LY341495 were attenuated by the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo- (9CI)-benzo[f]quinoxaline-7-sulfonamide, indicating AMPA-dependent effects. These findings provide another overlapping mechanism of action of ketamine and mGlu2/3 receptor antagonism that differentiates them from conventional antidepressants and thus support the potential rapidly acting antidepressant actions of mGlu2/3 receptor antagonism in patients.
Collapse
Affiliation(s)
- J M Witkin
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - J A Monn
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - D D Schoepp
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - X Li
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - C Overshiner
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - S N Mitchell
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - G Carter
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - B Johnson
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - K Rasmussen
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| | - L M Rorick-Kehn
- Departments of Neuroscience and Discovery Chemistry, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana (J.M.W., J.A.M., D.D.S., X.L., C.O., B.J., K.R., L.M.R.-K.), and Windlesham, Surrey, UK (S.N.M., G.C.)
| |
Collapse
|