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Bunting E, Cooper R, Seral M, Manji H, Rossor A, Reilly MM, Lunn MP, Bennett D, Hadden R, Carr AS. 099 High relapse rate with steroid monotherapy in non-systemic vasculitic neuropathy. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionHistorically, single tissue vasculitis has been managed with steroid monotherapy. Recent data from large longitudinal databases on systemic vasculitis suggest Non-Systemic Vasculitic Neuropathy (NSVN) has higher rates of relapse, recommending that more aggressive immunotherapy is employed.AimTo investigate the relapse rate in NSVN in response to steroid monotherapy.MethodsA retrospective case note review of clinically and/or pathologically defined cases of (Systemic Vasculitic Neuropathy) SVN and NSVN in two London specialist peripheral nerve centres, between 2005- 2012 and 2015 - 2019.Results32 cases of SVN and 34 cases of NSVN were identified. In each group 14 individuals were treated first-line with steroid monotherapy, and 8 with cyclophosphamide. 8 SVN and 9 NSVN cases received steroids plus azathioprine. 15/32 SVN and 13/34 NSVN relapsed after first-line therapy (10/14 and 9/14 on steroid monotherapy, 3/8 and 3/9 on steroids and azathioprine, 2/8 and 1/8 on cyclophosphamide). 10 individuals stabilised with the addition of azathioprine, 13 with cyclophosphamide and 4 with Rituximab.ConclusionThis representative case series suggests that steroid monotherapy is inadequate in the treatment of NSVN and supports an approach akin to that recommended in SVN, even if nerve is the only tissue clinically involved.e.bunting@nhs.net
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Keh R, Khalil A, Nihoyannopoulos L, Compton L, Kapoor M, Gosal D, Manji H, Rossor A, Reilly M, Lunn M, Lavin T, Carr A. Corrigendum to Routine blood monitoring in maintenance Immunoglobulin treatment of inflammatory neuropathy: Is it clinically relevant? [Journal of the Neurological Sciences 408 (2020) 116527]. J Neurol Sci 2020; 417:116988. [DOI: 10.1016/j.jns.2020.116988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ionescu DF, Fu DJ, Qiu X, Lane R, Lim P, Kasper S, Hough D, Drevets WC, Manji H, Canuso CM. Esketamine Nasal Spray for Rapid Reduction of Depressive Symptoms in Patients With Major Depressive Disorder Who Have Active Suicide Ideation With Intent: Results of a Phase 3, Double-Blind, Randomized Study (ASPIRE II). Int J Neuropsychopharmacol 2020; 24:22-31. [PMID: 32861217 PMCID: PMC7816667 DOI: 10.1093/ijnp/pyaa068] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/10/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with major depressive disorder (MDD) having active suicidal ideation with intent require immediate treatment. METHODS This double-blind study (ASPIRE II) randomized adults (aged 18-64 years) with MDD having active suicidal ideation with intent to esketamine 84 mg or placebo nasal spray twice weekly for 4 weeks, given with comprehensive standard of care (hospitalization ≥5 days and newly initiated or optimized oral antidepressant[s]). Change from baseline to 24 hours post-first dose in Montgomery-Asberg Depression Rating Scale total score (primary efficacy endpoint) was analyzed using ANCOVA. Clinical Global Impression-Severity of Suicidality-revised (key secondary endpoint) was analyzed using ANCOVA on ranks of change. RESULTS Of 230 patients who were randomized (115 per arm), 227 received study drug and were included in efficacy/safety analyses; 184 (80.0%) completed double-blind treatment. Greater improvement in Montgomery-Asberg Depression Rating Scale total score was observed with esketamine (mean [SD]: -15.7 [11.56]) vs placebo (-12.4 [10.43]), each with standard of care, at 24 hours (least-squares mean difference [SE]: -3.9 [1.39], 95% CI: -6.60, -1.11; 2-sided P = .006). This was also noted at the earlier (4-hour) timepoint (least-squares mean difference -4.2, 95% CI: -6.38, -1.94). Patients in both treatment groups experienced rapid reduction in Clinical Global Impression-Severity of Suicidality-revised score; the between-group difference was not statistically significant. The most common adverse events among esketamine-treated patients were dizziness, dissociation, nausea, dysgeusia, somnolence, headache, and paresthesia. CONCLUSION This study confirmed rapid and robust reduction of depressive symptoms with esketamine nasal spray in severely ill patients with MDD who have active suicidal ideation with intent. Trial Registration: Clinical Trials.gov identifier: NCT03097133.
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Affiliation(s)
- Dawn F Ionescu
- Department of Neuroscience, Janssen Research and Development, LLC, San Diego, CA,Correspondence: Dawn Ionescu, MD, Senior Director, Neuroscience Clinical Development, Janssen Research and Development, LLC, 3210 Merryfield Row, San Diego, CA 92121 ()
| | - Dong-Jing Fu
- Department of Neuroscience, Janssen Research and Development, LLC, Titusville, NJ
| | - Xin Qiu
- Department of Statistics, Janssen Research and Development, LLC, Raritan, NJ
| | - Rosanne Lane
- Department of Statistics, Janssen Research and Development, LLC, Titusville, NJ
| | - Pilar Lim
- Department of Statistics, Janssen Research and Development, LLC, Titusville, NJ
| | - Siegfried Kasper
- Center of Brain Research, Medical University of Vienna, Vienna, Austria
| | - David Hough
- Department of Neuroscience, Janssen Research and Development, LLC, Titusville, NJ
| | - Wayne C Drevets
- Department of Neuroscience, Janssen Research and Development, LLC, San Diego, CA
| | - Husseini Manji
- Department of Neuroscience, Janssen Research and Development, LLC, Titusville, NJ
| | - Carla M Canuso
- Department of Neuroscience, Janssen Research and Development, LLC, Titusville, NJ
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Izmailova ES, Wagner JA, Ammour N, Amondikar N, Bell‐Vlasov A, Berman S, Bloomfield D, Brady LS, Cai X, Calle RA, Campbell M, Cerreta F, Clay I, Foschini L, Furlong P, Goldel R, Goldsack JS, Groenen PM, Folarin A, Heemskerk J, Honig P, Hotopf M, Kamphaus T, Karlin DR, Leptak C, Liu Q, Manji H, Mather RJ, Menetski JP, Narayan VA, Papadopoulos E, Patel B, Patrick‐Lake B, Podichetty JT, Pratap A, Servais L, Stephenson D, Tenaerts P, Tromberg BJ, Usdin S, Vasudevan S, Zipunnikov V, Hoffmann SC. Remote Digital Monitoring for Medical Product Development. Clin Transl Sci 2020. [PMCID: PMC7877824 DOI: 10.1111/cts.12851] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The use of digital health products has gained considerable interest as a new way to improve therapeutic research and development. Although these products are being adopted by various industries and stakeholders, their incorporation in clinical trials has been slow due to a disconnect between the promises of digital products and potential risks in using these new technologies in the absence of regulatory support. The Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium hosted a public workshop to address challenges and opportunities in this field. Important characteristics of tool development were addressed in a series of presentations, case studies, and open panel sessions. The workshop participants endorsed the usefulness of an evidentiary criteria framework, highlighted the importance of early patient engagement, and emphasized the potential impact of digital monitoring tools and precompetitive collaborations. Concerns were expressed about the lack of real‐life validation examples and the limitations of legacy standards used as a benchmark for novel tool development and validation. Participants recognized the need for novel analytical and statistical approaches to accommodate analyses of these novel data types. Future directions are to harmonize definitions to build common methodologies and foster multidisciplinary collaborations; to develop approaches toward integrating digital monitoring data with the totality of the data in clinical trials, and to continue an open dialog in the community. There was a consensus that all these efforts combined may create a paradigm shift of how clinical trials are planned, conducted, and results brought to regulatory reviews.
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Affiliation(s)
| | | | - Nadir Ammour
- Sanofi Research & Development Chilly‐Mazarin France
| | - Ninad Amondikar
- The Michael J. Fox Foundation for Parkinson's Research New York New York USA
| | - Andrea Bell‐Vlasov
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | - Steven Berman
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | | | - Linda S. Brady
- National Institute of Mental Health National Institutes of Health Bethesda Maryland USA
| | | | | | - Michelle Campbell
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | | | - Ieuan Clay
- Evidation Health San Mateo California USA
| | | | - Pat Furlong
- Parent Project Muscular Dystrophy Hackensack New Jersey USA
| | - Rob Goldel
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | | | | | | | - Jill Heemskerk
- National Institute of Biomedical Imaging and Bioengineering National Institutes of Health Bethesda Maryland USA
| | | | | | - Tania Kamphaus
- Foundation for the National Institutes of Health North Bethesda Maryland USA
| | | | - Christopher Leptak
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Qi Liu
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Husseini Manji
- Janssen Research and Development LLC Titusville New Jersey USA
| | | | - Joseph P. Menetski
- Foundation for the National Institutes of Health North Bethesda Maryland USA
| | | | - Elektra Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration Silver Spring Maryland USA
| | - Bakul Patel
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | | | | | | | - Laurent Servais
- University of Liège Neuromuscular Reference Center Disease Liege Belgium
- MDUK Neuromuscular Center University of Oxford Oxford UK
| | | | - Pam Tenaerts
- Clinical Trials Transformation Initiative Durham North Carolina USA
| | - Bruce J. Tromberg
- National Institute of Biomedical Imaging and Bioengineering National Institutes of Health Bethesda Maryland USA
| | - Steve Usdin
- BioCentury Publications Washington District of Columbia USA
| | - Srikanth Vasudevan
- Center for Devices and Radiological Health, US Food and Drug Administration Silver Spring Maryland USA
| | - Vadim Zipunnikov
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Steven C. Hoffmann
- Foundation for the National Institutes of Health North Bethesda Maryland USA
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Fu DJ, Ionescu DF, Li X, Lane R, Lim P, Sanacora G, Hough D, Manji H, Drevets WC, Canuso CM. Esketamine Nasal Spray for Rapid Reduction of Major Depressive Disorder Symptoms in Patients Who Have Active Suicidal Ideation With Intent: Double-Blind, Randomized Study (ASPIRE I). J Clin Psychiatry 2020; 81. [PMID: 32412700 DOI: 10.4088/jcp.19m13191] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare esketamine to placebo, each in addition to standard-of-care treatment, for rapidly reducing major depressive disorder symptoms, including suicidal ideation. METHODS This phase 3, double-blind, multicenter study (ASPIRE I), conducted between June 2017 and December 2018, enrolled 226 adults having major depressive disorder based on Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) criteria, active suicidal ideation with intent, and need for psychiatric hospitalization. Patients were randomized 1:1 to esketamine 84 mg or placebo nasal spray twice-weekly for 4 weeks, each with comprehensive standard-of-care treatment (initial psychiatric hospitalization and newly initiated or optimized oral antidepressant[s] therapy). Change from baseline to 24 hours post-first dose in Montgomery-Asberg Depression Rating Scale (MADRS) total score (primary endpoint) was analyzed using analysis of covariance (ANCOVA), and change in Clinical Global Impression of Severity of Suicidality Revised version (CGI-SS-r; key secondary endpoint) score was analyzed using ANCOVA on ranks with treatment difference estimated using the Hodges-Lehmann estimate. RESULTS Greater improvement in MADRS total score was observed with esketamine + standard-of-care versus placebo + standard-of-care at 24 hours (least-squares mean difference [SE]: -3.8 [1.39]; 95% CI, -6.56 to -1.09; 2-sided P = .006), as well as at earlier (4 hours) and later time points during 4-week double-blind treatment. The difference between groups in the severity of suicidality was not statistically significant (median of treatment difference [95% CI]: 0.0 [-1.00 to 0.00]; 2-sided P = .107). The most common adverse events among esketamine-treated patients were dizziness, dissociation, headache, nausea, and somnolence. CONCLUSIONS These findings demonstrate rapid and robust efficacy of esketamine nasal spray in reducing depressive symptoms in severely ill patients with major depressive disorder who have active suicidal ideation with intent. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03039192.
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Affiliation(s)
- Dong-Jing Fu
- Director, Neuroscience Clinical Development, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560. .,Neuroscience Clinical Development, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Dawn F Ionescu
- Neuroscience Clinical Development, Janssen Research & Development, LLC, San Diego, California, USA
| | - Xiang Li
- Department of Quantitative Sciences, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Rosanne Lane
- Department of Quantitative Sciences, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Pilar Lim
- Department of Quantitative Sciences, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Hough
- Neuroscience Clinical Development, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Husseini Manji
- Neuroscience Clinical Development, Janssen Research & Development, LLC, Titusville, New Jersey, USA
| | - Wayne C Drevets
- Neuroscience Clinical Development, Janssen Research & Development, LLC, San Diego, California, USA
| | - Carla M Canuso
- Neuroscience Clinical Development, Janssen Research & Development, LLC, Titusville, New Jersey, USA
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Wajs E, Aluisio L, Holder R, Daly EJ, Lane R, Lim P, George JE, Morrison RL, Sanacora G, Young AH, Kasper S, Sulaiman AH, Li CT, Paik JW, Manji H, Hough D, Grunfeld J, Jeon HJ, Wilkinson ST, Drevets WC, Singh JB. Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression: Assessment of Long-Term Safety in a Phase 3, Open-Label Study (SUSTAIN-2). J Clin Psychiatry 2020; 81. [PMID: 32316080 DOI: 10.4088/jcp.19m12891] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/28/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate long-term safety and efficacy of esketamine nasal spray plus a new oral antidepressant (OAD) in patients with treatment-resistant depression (TRD). METHODS This phase 3, open-label, multicenter, long-term (up to 1 year) study was conducted between October 2015 and October 2017. Patients (≥ 18 years) with TRD (DSM-5 diagnosis of major depressive disorder and nonresponse to ≥ 2 OAD treatments) were enrolled directly or transferred from a short-term study (patients aged ≥ 65 years). Esketamine nasal spray (28-mg, 56-mg, or 84-mg) plus new OAD was administered twice a week in a 4-week induction (IND) phase and weekly or every-other-week for patients who were responders and entered a 48-week optimization/maintenance (OP/MAINT) phase. RESULTS Of 802 enrolled patients, 86.2% were direct-entry and 13.8% were transferred-entry; 580 (74.5%) of 779 patients who entered the IND phase completed the phase, and 150 (24.9%) of 603 who entered the OP/MAINT phase completed the phase. Common treatment-emergent adverse events (TEAEs) were dizziness (32.9%), dissociation (27.6%), nausea (25.1%), and headache (24.9%). Seventy-six patients (9.5%) discontinued esketamine due to TEAEs. Fifty-five patients (6.9%) experienced serious TEAEs. Most TEAEs occurred on dosing days, were mild or moderate in severity, and resolved on the same day. Two deaths were reported; neither was considered related to esketamine. Cognitive performance generally either improved or remained stable postbaseline. There was no case of interstitial cystitis or respiratory depression. Treatment-emergent dissociative symptoms were transient and generally resolved within 1.5 hours postdose. Montgomery-Åsberg Depression Rating Scale total score decreased during the IND phase, and this reduction persisted during the OP/MAINT phase (mean [SD] change from baseline of respective phase to endpoint: IND, -16.4 [8.76]; OP/MAINT, 0.3 [8.12]). CONCLUSIONS Long-term esketamine nasal spray plus new OAD therapy had a manageable safety profile, and improvements in depression appeared to be sustained in patients with TRD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02497287.
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Affiliation(s)
- Ewa Wajs
- Director Neuroscience R&D, Janssen Research & Development BE, Turnhoutseweg 30, 2340 Beerse, Belgium. .,Janssen Research & Development, Beerse, Belgium
| | - Leah Aluisio
- Janssen Research & Development, San Diego, California, USA
| | | | - Ella J Daly
- Janssen Research & Development, Titusville, New Jersey, USA
| | - Rosanne Lane
- Janssen Research & Development, Titusville, New Jersey, USA
| | - Pilar Lim
- Janssen Research & Development, Pennington, New Jersey, USA
| | - Joyce E George
- Janssen Research & Development, Pennington, New Jersey, USA
| | | | - Gerard Sanacora
- The Yale Depression Research Program, Yale University, New Haven, Connecticut, USA
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London, London, United Kingdom.,Maudsley NHS Foundation Trust, London, United Kingdom
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University, Vienna, Austria
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine and Institute of Brain Science, National Yang-Ming University, Taiwan
| | - Jong-Woo Paik
- Department of Psychiatry/Kyung Hee University College of Medicine, Seoul, South Korea
| | - Husseini Manji
- Janssen Research & Development, Titusville, New Jersey, USA
| | - David Hough
- Janssen Research & Development, Pennington, New Jersey, USA
| | - Jennifer Grunfeld
- Peninsula Therapeutic and Research Group, Frankston, Victoria, Australia
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Samuel T Wilkinson
- The Yale Depression Research Program, Yale University, New Haven, Connecticut, USA
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Ochs-Ross R, Daly EJ, Zhang Y, Lane R, Lim P, Morrison RL, Hough D, Manji H, Drevets WC, Sanacora G, Steffens DC, Adler C, McShane R, Gaillard R, Wilkinson ST, Singh JB. Efficacy and Safety of Esketamine Nasal Spray Plus an Oral Antidepressant in Elderly Patients With Treatment-Resistant Depression-TRANSFORM-3. Am J Geriatr Psychiatry 2020; 28:121-141. [PMID: 31734084 DOI: 10.1016/j.jagp.2019.10.008] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Elderly patients with major depression have a poorer prognosis, are less responsive to treatment, and show greater functional decline compared with younger patients, highlighting the need for effective treatment. METHODS This phase 3 double-blind study randomized patients with treatment-resistant depression (TRD) ≥65 years (1:1) to flexibly dosed esketamine nasal spray and new oral antidepressant (esketamine/antidepressant) or new oral antidepressant and placebo nasal spray (antidepressant/placebo). The primary endpoint was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to day 28. Analyses included a preplanned analysis by age (65-74 versus ≥75 years) and post-hoc analyses including age at depression onset. RESULTS For the primary endpoint, the median-unbiased estimate of the treatment difference (95% CI) was -3.6 (-7.20, 0.07); weighted combination test using MMRM analyses z = 1.89, two-sided p = 0.059. Adjusted mean (95% CI) difference for change in MADRS score between treatment groups was -4.9 (-8.96, -0.89; t = -2.4, df = 127; two-sided nominal p = 0.017) for patients 65 to 74 years versus -0.4 (-10.38, 9.50; t = -0.09, two-sided nominal p = 0.930) for those ≥75 years, and -6.1 (-10.33, -1.81; t = -2.8, df = 127; two-sided nominal p = 0.006) for patients with depression onset <55 years and 3.1 (-4.51, 10.80; t = 0.8, two-sided nominal p = 0.407) for those ≥55 years. Patients who rolled over into the long-term open-label study showed continued improvement with esketamine following 4 additional treatment weeks. CONCLUSIONS Esketamine/antidepressant did not achieve statistical significance for the primary endpoint. Greater differences between treatment arms were seen for younger patients (65-74 years) and patients with earlier onset of depression (<55 years).
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Affiliation(s)
- Rachel Ochs-Ross
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ.
| | - Ella J Daly
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ
| | - Yun Zhang
- Janssen Research & Development, LLC (YZ), Fremont, CA
| | - Rosanne Lane
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ
| | - Pilar Lim
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ
| | - Randall L Morrison
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ
| | - David Hough
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ
| | - Husseini Manji
- Janssen Research & Development, LLC (RO-R, EJD, RL, PL, RLM, DH, HM), Titusville, NJ
| | - Wayne C Drevets
- Janssen Research & Development, LLC (WCD, JBS), San Diego, CA
| | | | - David C Steffens
- University of Connecticut School of Medicine (DCS), Farmington, CT
| | - Caleb Adler
- University of Cincinnati College of Medicine (CA), Cincinnati, OH
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Keh R, Kahlil A, Nihoyannopoulos L, Compton L, Kapoor M, Gosal D, Manji H, Rossor A, Reilly M, Lunn M, Lavin T, Carr A. Routine blood monitoring in maintenance immunoglobulin treatment of inflammatory neuropathy: Is it clinically relevant? J Neurol Sci 2020; 408:116527. [DOI: 10.1016/j.jns.2019.116527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/21/2019] [Accepted: 10/08/2019] [Indexed: 01/01/2023]
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Doraiswamy PM, London E, Varnum P, Harvey B, Saxena S, Tottman S, Campbell SP, Ibáñez AF, Manji H, Al Olama MAAS, Chou IH, Herrman H, Jeong SJ, Le T, Montojo C, Reve B, Rommelfanger KS, Stix C, Thakor N, Chow KHM, Welchman AE, Candeias V. Empowering 8 Billion Minds: Enabling Better Mental Health for All via the Ethical Adoption of Technologies. NAM Perspect 2019; 2019:201910b. [PMID: 34532674 PMCID: PMC8406599 DOI: 10.31478/201910b] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health (Australia)
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Affiliation(s)
- Wayne C Drevets
- Janssen Research and Development, San Diego (Drevets, Singh); Titusville, N.J. (Hough, Daly, Manji); and Beerse, Belgium (Popova)
| | - Jaskaran B Singh
- Janssen Research and Development, San Diego (Drevets, Singh); Titusville, N.J. (Hough, Daly, Manji); and Beerse, Belgium (Popova)
| | - David Hough
- Janssen Research and Development, San Diego (Drevets, Singh); Titusville, N.J. (Hough, Daly, Manji); and Beerse, Belgium (Popova)
| | - Ella J Daly
- Janssen Research and Development, San Diego (Drevets, Singh); Titusville, N.J. (Hough, Daly, Manji); and Beerse, Belgium (Popova)
| | - Vanina Popova
- Janssen Research and Development, San Diego (Drevets, Singh); Titusville, N.J. (Hough, Daly, Manji); and Beerse, Belgium (Popova)
| | - Husseini Manji
- Janssen Research and Development, San Diego (Drevets, Singh); Titusville, N.J. (Hough, Daly, Manji); and Beerse, Belgium (Popova)
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11
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Daly EJ, Trivedi MH, Janik A, Li H, Zhang Y, Li X, Lane R, Lim P, Duca AR, Hough D, Thase ME, Zajecka J, Winokur A, Divacka I, Fagiolini A, Cubała WJ, Bitter I, Blier P, Shelton RC, Molero P, Manji H, Drevets WC, Singh JB. Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:893-903. [PMID: 31166571 PMCID: PMC6551577 DOI: 10.1001/jamapsychiatry.2019.1189] [Citation(s) in RCA: 274] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Controlled studies have shown short-term efficacy of esketamine for treatment-resistant depression (TRD), but long-term effects remain to be established. OBJECTIVE To assess the efficacy of esketamine nasal spray plus an oral antidepressant compared with an oral antidepressant plus placebo nasal spray in delaying relapse of depressive symptoms in patients with TRD in stable remission after an induction and optimization course of esketamine nasal spray plus an oral antidepressant. DESIGN, SETTING, AND PARTICIPANTS In this phase 3, multicenter, double-blind, randomized withdrawal study conducted from October 6, 2015, to February 15, 2018, at outpatient referral centers, 705 adults with prospectively confirmed TRD were enrolled; 455 entered the optimization phase and were treated with esketamine nasal spray (56 or 84 mg) plus an oral antidepressant. After 16 weeks of esketamine treatment, 297 who achieved stable remission or stable response entered the randomized withdrawal phase. INTERVENTIONS Patients who achieved stable remission and those who achieved stable response (without remission) were randomized 1:1 to continue esketamine nasal spray or discontinue esketamine treatment and switch to placebo nasal spray, with oral antidepressant treatment continued in each group. MAIN OUTCOMES AND MEASURES Time to relapse was examined in patients who achieved stable remission, as assessed using a weighted combination log-rank test. RESULTS Among the 297 adults (mean age [SD], 46.3 [11.13] years; 197 [66.3%] female) who entered the randomized maintenance phase, 176 achieved stable remission; 24 (26.7%) in the esketamine and antidepressant group and 39 (45.3%) in the antidepressant and placebo group experienced relapse (log-rank P = .003, number needed to treat [NNT], 6). Among the 121 who achieved stable response, 16 (25.8%) in the esketamine and antidepressant group and 34 (57.6%) in the antidepressant and placebo group experienced relapse (log-rank P < .001, NNT, 4). Esketamine and antidepressant treatment decreased the risk of relapse by 51% (hazard ratio [HR], 0.49; 95% CI, 0.29-0.84) among patients who achieved stable remission and 70% (HR, 0.30; 95% CI, 0.16-0.55) among those who achieved stable response compared with antidepressant and placebo treatment. The most common adverse events reported for esketamine-treated patients after randomization were transient dysgeusia, vertigo, dissociation, somnolence, and dizziness (incidence, 20.4%-27.0%), each reported in fewer patients (<7%) treated with an antidepressant and placebo. CONCLUSIONS AND RELEVANCE For patients with TRD who experienced remission or response after esketamine treatment, continuation of esketamine nasal spray in addition to oral antidepressant treatment resulted in clinically meaningful superiority in delaying relapse compared with antidepressant plus placebo. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02493868.
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Affiliation(s)
- Ella J. Daly
- Department of Neuroscience, Janssen Research and Development LLC, Titusville, New Jersey
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Adam Janik
- Department of Neuroscience, Janssen Research and Development LLC, San Diego, California
| | - Honglan Li
- Department of Neuroscience, Janssen Research and Development LLC, Titusville, New Jersey
| | - Yun Zhang
- Department of Clinical Biostatistics, Janssen Research and Development LLC, Fremont, California
| | - Xiang Li
- Department of Clinical Biostatistics, Janssen Research and Development LLC, Raritan, New Jersey
| | - Rosanne Lane
- Department of Clinical Biostatistics, Janssen Research and Development LLC, Titusville, New Jersey
| | - Pilar Lim
- Department of Clinical Biostatistics, Janssen Research and Development LLC, Titusville, New Jersey
| | - Anna R. Duca
- Department of Neuroscience, Janssen Research and Development LLC, Titusville, New Jersey
| | - David Hough
- Department of Neuroscience, Janssen Research and Development LLC, Titusville, New Jersey
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - John Zajecka
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
| | - Andrew Winokur
- Department of Psychiatry, University of Connecticut Health, Farmington,Institute of Living, Hartford, Connecticut
| | | | - Andrea Fagiolini
- Department of Molecular Medicine, Division of Psychiatry, University of Siena, Siena, Italy
| | - Wiesław J. Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Pierre Blier
- Departments of Psychiatry and Cellular/Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard C. Shelton
- Department of Psychiatry, University of Alabama School of Medicine, Birmingham
| | - Patricio Molero
- Department of Psychiatry, Clinica Universidad de Navarra, Pamplona, Spain
| | - Husseini Manji
- Department of Neuroscience, Janssen Research and Development LLC, Titusville, New Jersey
| | - Wayne C. Drevets
- Department of Neuroscience, Janssen Research and Development LLC, San Diego, California
| | - Jaskaran B. Singh
- Department of Neuroscience, Janssen Research and Development LLC, San Diego, California
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Fedgchin M, Trivedi M, Daly EJ, Melkote R, Lane R, Lim P, Vitagliano D, Blier P, Fava M, Liebowitz M, Ravindran A, Gaillard R, Ameele HVD, Preskorn S, Manji H, Hough D, Drevets WC, Singh JB. Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined With a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1). Int J Neuropsychopharmacol 2019; 22:616-630. [PMID: 31290965 PMCID: PMC6822141 DOI: 10.1093/ijnp/pyz039] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/11/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND About one-third of patients with depression fail to achieve remission despite treatment with multiple antidepressants and are considered to have treatment-resistant depression. METHODS This Phase 3, double-blind, multicenter study enrolled adults with moderate-to-severe depression and nonresponse to ≥2 antidepressants in the current depression episode. Eligible patients (N = 346) were randomized (1:1:1) to twice-weekly nasal spray treatment (esketamine [56 or 84 mg] or placebo) plus a newly initiated, open-label, oral antidepressant taken daily for 4 weeks. The primary efficacy endpoint was change from baseline to day 28 in the Montgomery-Asberg Depression Rating Scale total score, performed by blinded, remote raters. Based on the predefined statistical testing sequence, esketamine 84 mg/antidepressant had to be significant for esketamine 56 mg/antidepressant to be formally tested. RESULTS Statistical significance was not achieved with esketamine 84 mg/antidepressant compared with antidepressant/placebo (least squares [LS] means difference [95% CI]: -3.2 [-6.88, 0.45]; 2-sided P value = .088). Although esketamine 56 mg/antidepressant could not be formally tested, the LS means difference was -4.1 [-7.67, -0.49] (nominal 2-sided P value = .027). The most common (>20%) adverse events reported for esketamine/antidepressant were nausea, dissociation, dizziness, vertigo, and headache. CONCLUSIONS Statistical significance was not achieved for the primary endpoint; nevertheless, the treatment effect (Montgomery-Asberg Depression Rating Scale) for both esketamine/antidepressant groups exceeded what has been considered clinically meaningful for approved antidepressants vs placebo. Safety was similar between esketamine/antidepressant groups and no new dose-related safety concerns were identified. This study provides supportive evidence for the safety and efficacy of esketamine nasal spray as a new, rapid-acting antidepressant for patients with treatment-resistant depression. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02417064.
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Affiliation(s)
- Maggie Fedgchin
- Janssen Research and Development, Department of Neuroscience, Titusville, New Jersey,Correspondence: Maggie Fedgchin, PharmD, Director, Department of Neuroscience, Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560 ()
| | - Madhukar Trivedi
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, Texas
| | - Ella J Daly
- Janssen Research and Development, Department of Neuroscience, Titusville, New Jersey
| | - Rama Melkote
- Janssen Research and Development, Clinical Biostatistics, Titusville, New Jersey
| | - Rosanne Lane
- Janssen Research and Development, Clinical Biostatistics, Titusville, New Jersey
| | - Pilar Lim
- Janssen Research and Development, Clinical Biostatistics, Titusville, New Jersey
| | - Dawn Vitagliano
- Janssen Research and Development, Department of Neuroscience, Titusville, New Jersey
| | - Pierre Blier
- University of Ottawa, Departments of Psychiatry and Cellular & Molecular Medicine, Ottawa, Ontario, Canada
| | - Maurizio Fava
- Clinical Trials Network and Institute, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Arun Ravindran
- Institute of Medical Sciences, University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Raphael Gaillard
- Centre Hospitalier Sainte Anne, Service Hospitalo-Universitaire, Paris, France
| | | | - Sheldon Preskorn
- University of Kansas School of Medicine-Wichita, Wichita, Kansas
| | - Husseini Manji
- Janssen Research and Development, Department of Neuroscience, Titusville, New Jersey
| | - David Hough
- Janssen Research and Development, Department of Neuroscience, Titusville, New Jersey
| | - Wayne C Drevets
- Janssen Research and Development, Department of Neuroscience, San Diego, California
| | - Jaskaran B Singh
- Janssen Research and Development, Department of Neuroscience, San Diego, California
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Stroud C, Onnela JP, Manji H. Harnessing digital technology to predict, diagnose, monitor, and develop treatments for brain disorders. NPJ Digit Med 2019; 2:44. [PMID: 31304390 PMCID: PMC6550158 DOI: 10.1038/s41746-019-0123-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/06/2019] [Indexed: 11/09/2022] Open
Abstract
Digital technologies-including smartphones, wearables, and social media data-show great potential for helping to alleviate suffering from brain disorders such as Parkinson's disease, Alzheimer's disease, depression, and schizophrenia. However, as researchers, technology developers, disease-focused groups, and others forge forward to take advantage of the tremendous opportunities in this domain, it is important to avoid hype and overpromising, and to ensure that this work is done rigorously and collaboratively. In June 2018, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders hosted a workshop that brought together a wide range of experts and stakeholders. The workshop provided an opportunity to take stock of the rapidly-evolving landscape and discuss how to work together to address both scientific and practical challenges, so that the potential of digital technologies can be translated into meaningful contributions toward the health of individuals and society. Workshop presentations and discussions focused on four key challenges: transforming data into insight, navigating regulatory pathways, designing user-centered tools, and building partnerships across a complex ecosystem. This article highlights the many issues, challenges, and opportunities discussed by individual participants at the workshop.
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Affiliation(s)
- Clare Stroud
- 1The National Academies of Sciences, Engineering, and Medicine, 500 Fifth Street NW, Washington, DC 20001 USA
| | - Jukka-Pekka Onnela
- 2Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115 USA
| | - Husseini Manji
- 3Janssen Research and Development, LLC, Raritan, NJ 08869 USA
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Popova V, Daly EJ, Trivedi M, Cooper K, Lane R, Lim P, Mazzucco C, Hough D, Thase ME, Shelton RC, Molero P, Vieta E, Bajbouj M, Manji H, Drevets WC, Singh JB. Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study. Am J Psychiatry 2019; 176:428-438. [PMID: 31109201 DOI: 10.1176/appi.ajp.2019.19020172] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE About one-third of patients with depression fail to achieve remission despite treatment with multiple antidepressants. This study compared the efficacy and safety of switching patients with treatment-resistant depression from an ineffective antidepressant to flexibly dosed esketamine nasal spray plus a newly initiated antidepressant or to a newly initiated antidepressant (active comparator) plus placebo nasal spray. METHODS This was a phase 3, double-blind, active-controlled, multicenter study conducted at 39 outpatient referral centers. The study enrolled adults with moderate to severe nonpsychotic depression and a history of nonresponse to at least two antidepressants in the current episode, with one antidepressant assessed prospectively. Confirmed nonresponders were randomly assigned to treatment with esketamine nasal spray (56 or 84 mg twice weekly) and an antidepressant or antidepressant and placebo nasal spray. The primary efficacy endpoint, change from baseline to day 28 in Montgomery-Åsberg Depression Rating Scale (MADRS) score, was assessed by a mixed-effects model using repeated measures. RESULTS Of 435 patients screened, 227 underwent randomization and 197 completed the 28-day double-blind treatment phase. Change in MADRS score with esketamine plus antidepressant was significantly greater than with antidepressant plus placebo at day 28 (difference of least square means=-4.0, SE=1.69, 95% CI=-7.31, -0.64); likewise, clinically meaningful improvement was observed in the esketamine plus antidepressant arm at earlier time points. The five most common adverse events (dissociation, nausea, vertigo, dysgeusia, and dizziness) all were observed more frequently in the esketamine plus antidepressant arm than in the antidepressant plus placebo arm; 7% and 0.9% of patients in the respective treatment groups discontinued study drug because of an adverse event. Adverse events in the esketamine plus antidepressant arm generally appeared shortly after dosing and resolved by 1.5 hours after dosing. CONCLUSIONS Current treatment options for treatment-resistant depression have considerable limitations in terms of efficacy and patient acceptability. Esketamine is expected to address an unmet medical need in this population through its novel mechanism of action and rapid onset of antidepressant efficacy. The study supports the efficacy and safety of esketamine nasal spray as a rapidly acting antidepressant for patients with treatment-resistant depression.
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Affiliation(s)
- Vanina Popova
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Ella J Daly
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Madhukar Trivedi
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Kimberly Cooper
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Rosanne Lane
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Pilar Lim
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Christine Mazzucco
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - David Hough
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Michael E Thase
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Richard C Shelton
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Patricio Molero
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Eduard Vieta
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Malek Bajbouj
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Husseini Manji
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Wayne C Drevets
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
| | - Jaskaran B Singh
- Janssen Research and Development, Beerse, Belgium (Popova); Janssen Research and Development, Titusville, N.J. (Daly, Lane, Lim, Hough, Manji, Drevets); the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Trivedi); Janssen Research and Development, Spring House, Pa. (Cooper); Janssen Canada, Toronto (Mazzucco); the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase); the Department of Psychiatry, University of Alabama School of Medicine, Birmingham (Shelton); Clínica Universidad de Navarra, Pamplona, Spain (Molero); Institute of Neuroscience, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain (Vieta); Charité Universitätsmedizin Berlin, Berlin (Bajbouj); Janssen Research and Development, San Diego (Singh)
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Bharucha T, Brown R, Bamford A, Kaliakatsos M, Hoskote C, Breuer J, Manji H, Zandi M. P58 Setting up an encephalitis multidisciplinary meeting in a tertiary neurology centre. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesTo improve the outcome of encephalitis in the region.DesignService evaluation of the introduction of monthly encephalitis meetings attended by specialist neuroradiologists, neurologists and infection doctors.SubjectsPatient referred at the discretion of the clinician from local hospitals and the tertiary referral centre.MethodsDiagnosis confirmed at the MDT or as a direct result of the MDT discussion.ResultsTo be presented.ConclusionsEncephalitis is a rare and complex clinical syndrome that requires close communication between neurologists and infection doctors. Setting up an MDT established this interaction, and streamlines patient care. Further, it provides access to novel technologies such as metagenomic diagnostic approaches.
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Canuso CM, Singh JB, Fedgchin M, Alphs L, Lane R, Lim P, Pinter C, Hough D, Sanacora G, Manji H, Drevets WC. Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. Focus (Am Psychiatr Publ) 2019; 17:55-65. [PMID: 32015715 DOI: 10.1176/appi.focus.17105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
(Reprinted with permission from AmJ Psychiatry 2018; 175:620-630).
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Canuso CM, Singh JB, Fedgchin M, Alphs L, Lane R, Lim P, Pinter C, Hough D, Sanacora G, Manji H, Drevets WC. Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study. Am J Psychiatry 2018; 175:620-630. [PMID: 29656663 DOI: 10.1176/appi.ajp.2018.17060720] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors compared the efficacy of standard-of-care treatment plus intranasal esketamine or placebo for rapid reduction of symptoms of major depression, including suicidality, among individuals at imminent suicide risk. METHOD In a double-blind, multicenter, proof-of-concept study, 68 participants were randomly assigned to receive esketamine (84 mg) or placebo twice weekly for 4 weeks, in addition to comprehensive standard-of-care treatment. The primary efficacy endpoint was change in score from baseline to 4 hours after initial dose on the Montgomery-Åsberg Depression Rating Scale (MADRS). Clinician global judgment of suicide risk (from the Suicide Ideation and Behavior Assessment Tool) was also assessed. Secondary endpoints included these measures at 24 hours and double-blind endpoint at day 25. RESULTS A significantly greater improvement in MADRS score was observed in the esketamine group compared with the placebo group at 4 hours (least-square mean difference=-5.3, SE=2.10; effect size=0.61) and at ∼24 hours (least-square mean difference=-7.2, SE=2.85; effect size=0.65), but not at day 25 (least-square mean difference=-4.5, SE=3.14; effect size=0.35). Significantly greater improvement was also observed in the esketamine group on the MADRS suicidal thoughts item score at 4 hours (effect size=0.67), but not at 24 hours (effect size=0.35) or at day 25 (effect size=0.29). Between-group reductions in clinician global judgment of suicide risk scores were not statistically different at any time point. The most common adverse events among participants in the esketamine group were nausea, dizziness, dissociation, unpleasant taste, and headache. CONCLUSIONS These preliminary findings indicate that intranasal esketamine compared with placebo, given in addition to comprehensive standard-of-care treatment, may result in significantly rapid improvement in depressive symptoms, including some measures of suicidal ideation, among depressed patients at imminent risk for suicide.
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Affiliation(s)
- Carla M Canuso
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Jaskaran B Singh
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Maggie Fedgchin
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Larry Alphs
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Rosanne Lane
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Pilar Lim
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Christine Pinter
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - David Hough
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Gerard Sanacora
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Husseini Manji
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
| | - Wayne C Drevets
- From Janssen Research and Development, Titusville, N.J., and San Diego; Janssen Scientific Affairs, Titusville, N.J.; and the Department of Psychiatry, Yale School of Medicine, New Haven, Conn
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Groves J, Compton L, Kapoor M, Rossor A, Manji H, Reilly M, Lunn M, Carr A. Immunoglobulin dosing in inflammatory neuropathy: an induction, maintenance and cessation algorithm. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Daly EJ, Singh JB, Fedgchin M, Cooper K, Lim P, Shelton RC, Thase ME, Winokur A, Van Nueten L, Manji H, Drevets WC. Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry 2018; 75:139-148. [PMID: 29282469 PMCID: PMC5838571 DOI: 10.1001/jamapsychiatry.2017.3739] [Citation(s) in RCA: 388] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022]
Abstract
Importance Approximately one-third of patients with major depressive disorder (MDD) do not respond to available antidepressants. Objective To assess the efficacy, safety, and dose-response of intranasal esketamine hydrochloride in patients with treatment-resistant depression (TRD). Design, Setting, and Participants This phase 2, double-blind, doubly randomized, delayed-start, placebo-controlled study was conducted in multiple outpatient referral centers from January 28, 2014, to September 25, 2015. The study consisted of 4 phases: (1) screening, (2) double-blind treatment (days 1-15), composed of two 1-week periods, (3) optional open-label treatment (days 15-74), and (4) posttreatment follow-up (8 weeks). One hundred twenty-six adults with a DSM-IV-TR diagnosis of MDD and history of inadequate response to 2 or more antidepressants (ie, TRD) were screened, 67 were randomized, and 60 completed both double-blind periods. Intent-to-treat analysis was used in evaluation of the findings. Interventions In period 1, participants were randomized (3:1:1:1) to placebo (n = 33), esketamine 28 mg (n = 11), 56 mg (n = 11), or 84 mg (n = 12) twice weekly. In period 2, 28 placebo-treated participants with moderate-to-severe symptoms were rerandomized (1:1:1:1) to 1 of the 4 treatment arms; those with mild symptoms continued receiving placebo. Participants continued their existing antidepressant treatment during the study. During the open-label phase, dosing frequency was reduced from twice weekly to weekly, and then to every 2 weeks. Main Outcomes and Measures The primary efficacy end point was change from baseline to day 8 (each period) in the Montgomery-Åsberg Depression Rating Scale (MADRS) total score. Results Sixty-seven participants (38 women, mean [SD] age, 44.7 [10.0] years) were included in the efficacy and safety analyses. Change (least squares mean [SE] difference vs placebo) in MADRS total score (both periods combined) in all 3 esketamine groups was superior to placebo (esketamine 28 mg: -4.2 [2.09], P = .02; 56 mg: -6.3 [2.07], P = .001; 84 mg: -9.0 [2.13], P < .001), with a significant ascending dose-response relationship (P < .001). Improvement in depressive symptoms appeared to be sustained (-7.2 [1.84]) despite reduced dosing frequency in the open-label phase. Three of 56 (5%) esketamine-treated participants during the double-blind phase vs none receiving placebo and 1 of 57 participants (2%) during the open-label phase had adverse events that led to study discontinuation (1 event each of syncope, headache, dissociative syndrome, and ectopic pregnancy). Conclusions and Relevance In this first clinical study to date of intranasal esketamine for TRD, antidepressant effect was rapid in onset and dose related. Response appeared to persist for more than 2 months with a lower dosing frequency. Results support further investigation in larger trials. Trial Registration clinicaltrials.gov identifier: NCT01998958.
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Affiliation(s)
- Ella J. Daly
- Department of Neuroscience, Janssen Research & Development LLC, Titusville, New Jersey
| | - Jaskaran B. Singh
- Department of Neuroscience, Janssen Research & Development LLC, San Diego, California
| | - Maggie Fedgchin
- Department of Neuroscience, Janssen Research & Development LLC, Titusville, New Jersey
| | - Kimberly Cooper
- Department of Neuroscience, Janssen Research & Development LLC, Spring House, Pennsylvania
| | - Pilar Lim
- Department of Quantitative Sciences, Janssen Research & Development LLC, Titusville, New Jersey
| | - Richard C. Shelton
- Department of Psychiatry, University of Alabama School of Medicine, Birmingham
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Andrew Winokur
- Institute of Living, Hartford, Connecticut
- Department of Psychiatry, UConn Health, Farmington, Connecticut
| | - Luc Van Nueten
- Department of Neuroscience, Janssen Research & Development, Beerse, Belgium
| | - Husseini Manji
- Department of Neuroscience, Janssen Research & Development LLC, Titusville, New Jersey
| | - Wayne C. Drevets
- Department of Neuroscience, Janssen Research & Development LLC, Titusville, New Jersey
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Spillane J, Englezou C, Sarri-Gonzalez S, Rossor A, Lunn MP, Manji H, Reilly MM, Carr AS. PO207 Thromboembolic risk in inflammatory neuromuscular disease patients on long-term ivig. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Breen G, Li Q, Roth BL, O'Donnell P, Didriksen M, Dolmetsch R, O'Reilly PF, Gaspar HA, Manji H, Huebel C, Kelsoe JR, Malhotra D, Bertolino A, Posthuma D, Sklar P, Kapur S, Sullivan PF, Collier DA, Edenberg HJ. Translating genome-wide association findings into new therapeutics for psychiatry. Nat Neurosci 2017; 19:1392-1396. [PMID: 27786187 DOI: 10.1038/nn.4411] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Genome-wide association studies (GWAS) in psychiatry, once they reach sufficient sample size and power, have been enormously successful. The Psychiatric Genomics Consortium (PGC) aims for mega-analyses with sample sizes that will grow to >1 million individuals in the next 5 years. This should lead to hundreds of new findings for common genetic variants across nine psychiatric disorders studied by the PGC. The new targets discovered by GWAS have the potential to restart largely stalled psychiatric drug development pipelines, and the translation of GWAS findings into the clinic is a key aim of the recently funded phase 3 of the PGC. This is not without considerable technical challenges. These approaches complement the other main aim of GWAS studies, risk prediction approaches for improving detection, differential diagnosis, and clinical trial design. This paper outlines the motivations, technical and analytical issues, and the plans for translating PGC phase 3 findings into new therapeutics.
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Affiliation(s)
- Gerome Breen
- MRC Social, Genetic &Developmental Psychiatry Centre, Institute of Psychiatry, Psychology &Neuroscience, King's College London, London, UK.,UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Qingqin Li
- Neuroscience Therapeutic Area, Janssen Research &Development, LLC, Titusville, New Jersey, USA
| | - Bryan L Roth
- Department of Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,National Institute of Mental Health Psychoactive Drug Screening Program (NIMH PDSP), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Michael Didriksen
- H. Lundbeck A/S, Synaptic Transmission, Neuroscience Research DK, Valby, Denmark
| | - Ricardo Dolmetsch
- Department of Neuroscience, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Paul F O'Reilly
- MRC Social, Genetic &Developmental Psychiatry Centre, Institute of Psychiatry, Psychology &Neuroscience, King's College London, London, UK
| | - Héléna A Gaspar
- MRC Social, Genetic &Developmental Psychiatry Centre, Institute of Psychiatry, Psychology &Neuroscience, King's College London, London, UK.,UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - Husseini Manji
- Neuroscience Therapeutic Area, Janssen Research &Development, LLC, Titusville, New Jersey, USA
| | - Christopher Huebel
- MRC Social, Genetic &Developmental Psychiatry Centre, Institute of Psychiatry, Psychology &Neuroscience, King's College London, London, UK.,UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, and Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Dheeraj Malhotra
- Neuroscience Discovery and Translational Area, Pharma Research &Early Development, F. Hoffmann - La Roche, Basel, Switzerland
| | - Alessandro Bertolino
- Institute of Psychiatry, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Danielle Posthuma
- Department of Complex Trait Genetics, Centre for Neurogenomics and Cognitive Research/VU University Amsterdam, Amsterdam, the Netherlands.,Department of Clinical Genetics, VU University Medical Centre Amsterdam, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Pamela Sklar
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shitij Kapur
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David A Collier
- MRC Social, Genetic &Developmental Psychiatry Centre, Institute of Psychiatry, Psychology &Neuroscience, King's College London, London, UK.,UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley Hospital, London, UK.,Discovery Neuroscience Research, Eli Lilly and Company Ltd, Windlesham, Surrey, UK
| | - Howard J Edenberg
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Nastasi L, Desikan M, Turner C, Parton M, Morrow J, Carr A, Manji H, Hanna M, Quinlivan R. Quality of care in the first neuromuscular complex care centre in the UK from the patients' perspective. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Singh JB, Fedgchin M, Daly EJ, De Boer P, Cooper K, Lim P, Pinter C, Murrough JW, Sanacora G, Shelton RC, Kurian B, Winokur A, Fava M, Manji H, Drevets WC, Van Nueten L. A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression. Am J Psychiatry 2016; 173:816-26. [PMID: 27056608 DOI: 10.1176/appi.ajp.2016.16010037] [Citation(s) in RCA: 322] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Ketamine, an N-methyl-d-aspartate glutamate receptor antagonist, has demonstrated a rapid-onset antidepressant effect in patients with treatment-resistant depression. This study evaluated the efficacy of twice- and thrice-weekly intravenous administration of ketamine in sustaining initial antidepressant effects in patients with treatment-resistant depression. METHOD In a multicenter, double-blind study, adults (ages 18-64 years) with treatment-resistant depression were randomized to receive either intravenous ketamine (0.5 mg/kg of body weight) or intravenous placebo, administered over 40 minutes, either two or three times weekly, for up to 4 weeks. Patients who discontinued double-blind treatment after at least 2 weeks for lack of efficacy could enter an optional 2-week open-label phase to receive ketamine with the same frequency as in the double-blind phase. The primary outcome measure was change from baseline to day 15 in total score on the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS In total, 67 (45 women) of 68 randomized patients received treatment. In the twice-weekly dosing groups, the mean change in MADRS score at day 15 was -18.4 (SD=12.0) for ketamine and -5.7 (SD=10.2) for placebo; in the thrice-weekly groups, it was -17.7 (SD=7.3) for ketamine and -3.1 (SD=5.7) for placebo. Similar observations were noted for ketamine during the open-label phase (twice-weekly, -12.2 [SD=12.8] on day 4; thrice-weekly, -14.0 [SD=12.5] on day 5). Both regimens were generally well tolerated. Headache, anxiety, dissociation, nausea, and dizziness were the most common (≥20%) treatment-emergent adverse events. Dissociative symptoms occurred transiently and attenuated with repeated dosing. CONCLUSIONS Twice-weekly and thrice-weekly administration of ketamine at 0.5 mg/kg similarly maintained antidepressant efficacy over 15 days.
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Affiliation(s)
- Jaskaran B Singh
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Maggie Fedgchin
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Ella J Daly
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Peter De Boer
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Kimberly Cooper
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Pilar Lim
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Christine Pinter
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - James W Murrough
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Gerard Sanacora
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Richard C Shelton
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Benji Kurian
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Andrew Winokur
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Maurizio Fava
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Husseini Manji
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Wayne C Drevets
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Luc Van Nueten
- From Janssen Research and Development, Titusville, N.J., and Beerse, Belgium; the Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, N.Y.; the Department of Psychiatry, Yale University, New Haven, Conn.; the Department of Psychiatry and Behavioral Neurobiology, School of Medicine, University of Alabama at Birmingham; the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas; the Institute of Living, Hartford, Conn.; University of Connecticut Health Center, Farmington; the Department of Psychiatry, Massachusetts General Hospital, Boston
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25
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Grover D, Newsholme W, Brink N, Manji H, Miller R. Herpes simplex virus infection of the central nervous system in human immunodeficiency virus-type 1-infected patients. Int J STD AIDS 2016; 15:597-600. [PMID: 15339367 DOI: 10.1258/0956462041724163] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report clinical, radiological and virological data from nine consecutive HIV-infected patients with herpes simplex virus (HSV) infection of the central nervous system (CNS). Three patients presented with confusion, two with fever and headache, two with anxiety and depression, one with slow mentation and memory loss and one with expressive dysphasia. Five patients had previous AIDS-defining diagnoses: four of these five patients had previous cutaneous HSV infection. HSV DNA was detected by the polymerase chain reaction (PCR) on cerebrospinal fluid (CSF) in seven patients. HSV infection was diagnosed by brain biopsy (after negative PCR on CSF) in one patient and at autopsy in one patient (after negative CSF PCR and brain biopsy). Seven patients received specific anti-viral therapy; two died of unrelated causes and the other five recovered. Two patients were not treated, in one the diagnosis was made at autopsy and the other recovered spontaneously. HIV-infected patients with CNS HSV infection have a varied presentation. Diagnosis by PCR on CSF identified the majority of cases. With specific treatment the outcome was good.
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Affiliation(s)
- D Grover
- Department of Genitourinary Medicine, Mortimer Market Centre, Camden PCT, London WC1E 6AU, UK
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26
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Evans MRB, Manji H. Neurology in Africa: Howlett. Journal of Neurology, Neurosurgery & Psychiatry 2015. [DOI: 10.1136/jnnp-2014-308919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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27
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Lekman M, Hössjer O, Andrews P, Källberg H, Uvehag D, Charney D, Manji H, Rush JA, McMahon FJ, Moore JH, Kockum I. The genetic interacting landscape of 63 candidate genes in Major Depressive Disorder: an explorative study. BioData Min 2014; 7:19. [PMID: 25279001 PMCID: PMC4181757 DOI: 10.1186/1756-0381-7-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/28/2014] [Indexed: 12/17/2022] Open
Abstract
Background Genetic contributions to major depressive disorder (MDD) are thought to result from multiple genes interacting with each other. Different procedures have been proposed to detect such interactions. Which approach is best for explaining the risk of developing disease is unclear. This study sought to elucidate the genetic interaction landscape in candidate genes for MDD by conducting a SNP-SNP interaction analysis using an exhaustive search through 3,704 SNP-markers in 1,732 cases and 1,783 controls provided from the GAIN MDD study. We used three different methods to detect interactions, two logistic regressions models (multiplicative and additive) and one data mining and machine learning (MDR) approach. Results Although none of the interaction survived correction for multiple comparisons, the results provide important information for future genetic interaction studies in complex disorders. Among the 0.5% most significant observations, none had been reported previously for risk to MDD. Within this group of interactions, less than 0.03% would have been detectable based on main effect approach or an a priori algorithm. We evaluated correlations among the three different models and conclude that all three algorithms detected the same interactions to a low degree. Although the top interactions had a surprisingly large effect size for MDD (e.g. additive dominant model Puncorrected = 9.10E-9 with attributable proportion (AP) value = 0.58 and multiplicative recessive model with Puncorrected = 6.95E-5 with odds ratio (OR estimated from β3) value = 4.99) the area under the curve (AUC) estimates were low (< 0.54). Moreover, the population attributable fraction (PAF) estimates were also low (< 0.15). Conclusions We conclude that the top interactions on their own did not explain much of the genetic variance of MDD. The different statistical interaction methods we used in the present study did not identify the same pairs of interacting markers. Genetic interaction studies may uncover previously unsuspected effects that could provide novel insights into MDD risk, but much larger sample sizes are needed before this strategy can be powerfully applied.
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Affiliation(s)
- Magnus Lekman
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Ola Hössjer
- Department of Mathematics, Stockholm University, Stockholm, Sweden
| | - Peter Andrews
- Institute of Quantitative Biomedical Science, Department of Genetics and Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Henrik Källberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Uvehag
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Dennis Charney
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
| | - Husseini Manji
- Laboratory of Molecular Pathophysiology, NIMH, NIH, Department of Health & Human Services (DHHS), Bethesda, USA
| | - John A Rush
- Academic Medical Research Institute, Duke-National University of Singapore, Singapore, Singapore
| | - Francis J McMahon
- Genetic Basis of Mood & Anxiety Disorders Section, Human Genetic Branch, NIMH, NIH, Department of Health & Human Services (DHHS), Bethesda, USA
| | - Jason H Moore
- Institute of Quantitative Biomedical Science, Department of Genetics and Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Neuroimmunology Unit, Karolinska Institutet, Stockholm, Sweden
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28
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Svenningsson P, Berg L, Matthews D, Ionescu DF, Richards E, Niciu M, Malinger A, Toups M, Manji H, Trivedi MH, Zarate CA, Greengard P. Preliminary evidence that early reduction in p11 levels in natural killer cells and monocytes predicts the likelihood of antidepressant response to chronic citalopram. Mol Psychiatry 2014; 19:962-4. [PMID: 24614495 PMCID: PMC4161667 DOI: 10.1038/mp.2014.13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The prediction of treatment response in many neuropsychiatric disorders would be facilitated by easily accessible biomarkers. Using flow cytometry, we herein demonstrate correlations between early reductions of p11 levels in Natural Killer (NK) cells and monocytes and antidepressant response to citalopram in patients with major depressive disorder (MDD).
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Affiliation(s)
- P Svenningsson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - L Berg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - D Matthews
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - DF Ionescu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - E Richards
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - M Niciu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - A Malinger
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - M Toups
- Department of Psychiatry and the Mood Disorders Research Program and Clinic, University of Texas Southwestern Medical Center, Dallas, USA
| | - H Manji
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - MH Trivedi
- Department of Psychiatry and the Mood Disorders Research Program and Clinic, University of Texas Southwestern Medical Center, Dallas, USA
| | - CA Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - P Greengard
- Laboratory of Molecular and Cellular Neuroscience, The Rockefeller University, New York, USA
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29
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Waddell B, Heath CA, Manji H, Smith C, Davenport R. Progressive cognitive decline and neuropathy in a sailor. Pract Neurol 2013; 14:110-8. [PMID: 24226093 DOI: 10.1136/practneurol-2013-000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- B Waddell
- Department of Neurology, Ninewells Hospital, , Dundee, UK
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30
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Nugent AC, Carlson PJ, Bain EE, Eckelman W, Herscovitch P, Manji H, Zarate CA, Drevets WC. Mood stabilizer treatment increases serotonin type 1A receptor binding in bipolar depression. J Psychopharmacol 2013; 27:894-902. [PMID: 23926239 PMCID: PMC3784836 DOI: 10.1177/0269881113499204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abnormal serotonin type 1A (5-HT1A) receptor function and binding have been implicated in the pathophysiology of mood disorders. Preclinical studies have consistently shown that stress decreases the gene expression of 5-HT1A receptors in experimental animals, and that the associated increase in hormone secretion plays a crucial role in mediating this effect. Chronic administration of the mood stabilizers lithium and divalproex (valproate semisodium) reduces glucocorticoid signaling and function in the hippocampus. Lithium has further been shown to enhance 5-HT1A receptor function. To assess whether these effects translate to human subject with bipolar disorder (BD), positron emission tomography (PET) and [18F]trans-4-fluoro-N-(2-[4-(2-methoxyphenyl) piperazino]-ethyl)-N-(2-pyridyl) cyclohexanecarboxamide ([(18)F]FCWAY) were used to acquire PET images of 5-HT1A receptor binding in 10 subjects with BD, before and after treatment with lithium or divalproex. Mean 5-HT1A binding potential (BPP) significantly increased following mood stabilizer treatment, most prominently in the mesiotemporal cortex (hippocampus plus amygdala). When mood state was also controlled for, treatment was associated with increases in BPP in widespread cortical areas. These preliminary findings are consistent with the hypothesis that these mood stabilizers enhance 5-HT1A receptor expression in BD, which may underscore an important component of these agents' mechanism of action.
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Affiliation(s)
- Allison C Nugent
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - Paul J Carlson
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, USA
| | - Earle E Bain
- Neuroscience and Anesthesia Development, Abbott Laboratories, Abbott Park, USA
| | - William Eckelman
- University of California, San Diego Medical Center, San Diego, USA
| | | | - Husseini Manji
- Johnson & Johnson Pharmaceutical Research & Development, Titusville, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, USA
| | - Wayne C Drevets
- Johnson & Johnson Pharmaceutical Research & Development, Titusville, USA,Laureate Institute for Brain Research, Tulsa, USA; Department of Psychiatry, The University of Oklahoma College of Medicine, Tulsa, USA
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31
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Davidson GL, Murphy SM, Polke JM, Laura M, Salih MAM, Muntoni F, Blake J, Brandner S, Davies N, Horvath R, Price S, Donaghy M, Roberts M, Foulds N, Ramdharry G, Soler D, Lunn MP, Manji H, Davis MB, Houlden H, Reilly MM. Frequency of mutations in the genes associated with hereditary sensory and autonomic neuropathy in a UK cohort. J Neurol 2013; 259:1673-85. [PMID: 22302274 DOI: 10.1007/s00415-011-6397-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/21/2011] [Accepted: 12/23/2011] [Indexed: 12/25/2022]
Abstract
The hereditary sensory and autonomic neuropathies (HSAN, also known as the hereditary sensory neuropathies) are a clinically and genetically heterogeneous group of disorders, characterised by a progressive sensory neuropathy often complicated by ulcers and amputations, with variable motor and autonomic involvement. To date, mutations in twelve genes have been identified as causing HSAN. To study the frequency of mutations in these genes and the associated phenotypes, we screened 140 index patients in our inherited neuropathy cohort with a clinical diagnosis of HSAN for mutations in the coding regions of SPTLC1, RAB7, WNK1/HSN2, FAM134B, NTRK1 (TRKA) and NGFB. We identified 25 index patients with mutations in six genes associated with HSAN (SPTLC1, RAB7, WNK1/HSN2, FAM134B, NTRK1 and NGFB); 20 of which appear to be pathogenic giving an overall mutation frequency of 14.3%. Mutations in the known genes for HSAN are rare suggesting that further HSAN genes are yet to be identified. The p.Cys133Trp mutation in SPTLC1 is the most common cause of HSAN in the UK population and should be screened first in all patients with sporadic or autosomal dominant HSAN.
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Affiliation(s)
- G L Davidson
- Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, London, UK.
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Haddow LJ, Accoroni A, Cartledge JD, Manji H, Benn P, Gilson RJC. Routine detection and management of neurocognitive impairment in HIV-positive patients in a UK centre. Int J STD AIDS 2013; 24:217-9. [PMID: 23535355 PMCID: PMC4138002 DOI: 10.1177/0956462412472452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2–4.7%) had documented HAD. Eleven patients (7.3%; CI 3.7–12.7%) reported recent symptoms suggesting NCI; most of these individuals were diagnosed with a psychiatric or substance-use disorder. Among specialist referrals with symptoms suggesting NCI, 11 were diagnosed with HAD from a clinic population of 3129 individuals (annual incidence 0.4%; CI 0.2–0.6%). No patients with mildly symptomatic or asymptomatic HAND were identified in either sample, suggesting that such patients remain undetected in current clinical practice. Evidence-based screening for HAND in HIV clinics may be needed.
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Affiliation(s)
- L J Haddow
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London
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33
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Arthur-Farraj P, Murphy S, Laura M, Lunn MP, Manji H, Blake J, Ramdharry G, Fox Z, Reilly M. HAND WEAKNESS IN CHARCOT-MARIE-TOOTH DISEASE 1X. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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34
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Berger GE, Wood SJ, Ross M, Hamer CA, Wellard RM, Pell G, Phillips L, Nelson B, Amminger GP, Yung AR, Jackson G, Velakoulis D, Pantelis C, Manji H, McGorry PD. Neuroprotective effects of low-dose lithium in individuals at ultra-high risk for psychosis. A longitudinal MRI/MRS study. Curr Pharm Des 2012; 18:570-5. [PMID: 22239590 DOI: 10.2174/138161212799316163] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/17/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate if low-dose lithium may counteract the microstructural and metabolic brain changes proposed to occur in individuals at ultra-high risk (UHR) for psychosis. METHODS Hippocampal T2 relaxation time (HT2RT) and proton magnetic resonance spectroscopy ((1)H-MRS) measurements were performed prior to initiation and following three months of treatment in 11 UHR patients receiving low-dose lithium and 10 UHR patients receiving treatment as usual (TAU). HT2RT and (1)H-MRS percentage change scores between scans were compared using repeated measures ANOVA and correlated with behavioural change scores. RESULTS Low-dose lithium significantly reduced HT2RT compared to TAU (p=0.018). No significant group by time effects was seen for any brain metabolites as measured with (1)H-MRS, although myo-inositol, creatine, choline-containing compounds and NAA increased in the group receiving low-dose lithium and decreased or remained unchanged in subjects receiving TAU. CONCLUSIONS This pilot study suggests that low-dose lithium may protect the microstructure of the hippocampus in UHR states as reflected by significantly decreasing HT2RT. Larger scale replication studies in UHR states using T2 relaxation time as a proxy for emerging brain pathology seem a feasible mean to test neuroprotective strategies such as low-dose lithium as potential treatments to delay or even prevent the progression to full-blown disorder.
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Affiliation(s)
- Gregor E Berger
- ORYGEN Youth Health Research Centre, Locked Bag 10, Parkville, Victoria, 3052, Australia.
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35
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Arthur-Farraj P, Murphy S, Laura M, Lunn M, Manji H, Blake J, Ramdharry G, Fox Z, Reilly M. Hand weakness in Charcot-Marie-Tooth disease 1X. Neuromuscul Disord 2012; 22:622-6. [PMID: 22464564 PMCID: PMC3657175 DOI: 10.1016/j.nmd.2012.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 02/14/2012] [Accepted: 02/27/2012] [Indexed: 11/28/2022]
Abstract
There have been suggestions from previous studies that patients with Charcot-Marie-Tooth disease (CMT) have weaker dominant hand muscles. Since all studies to date have included a heterogeneous group of CMT patients we decided to analyse hand strength in 43 patients with CMT1X. We recorded handedness and the MRC scores for the first dorsal interosseous and abductor pollicis brevis muscles, median and ulnar nerve compound motor action potentials and conduction velocities in dominant and non-dominant hands. Twenty-two CMT1X patients (51%) had a weaker dominant hand; none had a stronger dominant hand. Mean MRC scores were significantly higher for first dorsal interosseous and abductor pollicis brevis in non-dominant hands compared to dominant hands. Median nerve compound motor action potentials were significantly reduced in dominant compared to non-dominant hands. We conclude that the dominant hand is weaker than the non-dominant hand in patients with CMT1X.
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Affiliation(s)
- P.J. Arthur-Farraj
- MRC Centre for Neuromuscular Diseases, Department of Molecular Neuroscience, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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36
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Bargiela D, Mullin S, Kalluvya S, Manji H. 1218 HIV distal sensory polyneuropathy in Sub-Saharan Africa: an evolving epidemic. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Evans M, Lunn MP, Steidel K, Stam J, Day JL, Manji H. 026 Universidade Catholica de Mozambique (UCM), Beira: the second medical school in Mozambique. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mullin S, Temu A, Kalluvya S, Grant A, Manji H. High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania. Trop Med Int Health 2011; 16:1291-6. [PMID: 21707880 DOI: 10.1111/j.1365-3156.2011.02825.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. METHODS We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART-naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. RESULTS Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2-3.3) and older participants (aOR 2.7, 95% CI 1.1-6.2 for age 40 + vs. <30 years). CONCLUSION Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV-infected patients to an additional avoidable risk of DSP. Access to non-neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.
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Affiliation(s)
- S Mullin
- North Middlesex University Hospital NHS Trust, London, UK.
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40
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Mullin S, Temu A, Kalluvya S, Grant A, Manji H. PAF63 High prevalence of distal sensory polyneuropathy in treated and untreated Tanzanians with HIV. A cross-sectional survey. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Murphy S, Brandner S, Polke J, Manji H, Houlden H, Reilly MM. POG11 A novel mutation in the nerve-specific 5'-UTR of the Cx32 gene causing CMTX1. J Neurol Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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42
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Saifee T, Schwingenschuh P, Katschnig P, Aguirregomozcorta M, Bhatia K, Rothwell J, Manji H, Lunn M, Reilly M, Edwards M. P55 Neurophysiological evidence for cerebellar dysfunction in neuropathic tremor. Neuromuscul Disord 2010. [DOI: 10.1016/s0960-8966(10)70070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Murphy S, Polke J, Manji H, Brandner S, Houlden H, Reilly M. P59 A novel mutation in the nerve-specific 5 UTR of the Cx32 gene causing CMTX1. Neuromuscul Disord 2010. [DOI: 10.1016/s0960-8966(10)70074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Michell AW, Laura M, Blake J, Lunn MP, Cox A, Gibbons VS, Davis MB, Wood NW, Manji H, Houlden H, Murray NMF, Reilly MM. GJB1 gene mutations in suspected inflammatory demyelinating neuropathies not responding to treatment. J Neurol Neurosurg Psychiatry 2009; 80:699-700. [PMID: 19448103 DOI: 10.1136/jnnp.2008.150557] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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45
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Lekman M, Laje G, Charney D, Rush AJ, Wilson AF, Sorant AJM, Lipsky R, Wisniewski SR, Manji H, McMahon FJ, Paddock S. The FKBP5-gene in depression and treatment response--an association study in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Cohort. Biol Psychiatry 2008; 63:1103-10. [PMID: 18191112 PMCID: PMC2587308 DOI: 10.1016/j.biopsych.2007.10.026] [Citation(s) in RCA: 200] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 10/30/2007] [Accepted: 10/30/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND In a recent study of several antidepressant drugs in hospitalized, non-Hispanic White patients, Binder et al. reported association of markers located within the FKBP5 gene with treatment response after 2 and 5 weeks. Individuals homozygous for the TT-genotype at one of the markers (rs1360780) reported more depressive episodes and responded better to antidepressant treatment. There was no association between markers in FKBP5 and disease. The present study aimed at studying the associated FKBP5 markers in the ethnically diverse Sequenced Treatment Alternatives to Relieve Depression (STAR*D) sample of non-hospitalized patients treated with citalopram. METHODS We used clinical data and DNA samples from 1809 outpatients with non-psychotic major depressive disorder (DSM-IV criteria), who received up to 14 weeks of citalopram. A subset of 1523 patients of White non-Hispanic or Black race was matched with 739 control subjects for a case-control analysis. The markers rs1360780 and rs4713916 were genotyped on the Illumina platform. TaqMan-assay was used for marker rs3800373. RESULTS In the case-control analysis, marker rs1360780 was significantly associated with disease status in the White non-Hispanic sample after correction for multiple testing. A significant association was also found between rs4713916 and remission. Markers rs1360780 and rs4713916 were in strong linkage disequilibrium in the White non-Hispanic but not in the Black population. There was no significant difference in the number of previous episodes of depression between genotypes at any of the three markers. CONCLUSIONS These results indicate that FKBP5 is an important target for further studies of depression and treatment response.
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Affiliation(s)
- Magnus Lekman
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gonzalo Laje
- Genetic Basis of Mood & Anxiety disorders, Mood & Anxiety program, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Dept. of Health & Human Services (DHHS), Bethesda, MD
| | - Dennis Charney
- Department of Psychiatry, Neuroscience, and Pharmacology & Biological Chemistry, Mount Sinai School of Medicine, New York, NY
| | - A. John Rush
- Departments of Clinical Sciences and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alexander F. Wilson
- Genometrics Section, Inherited Disease Research Branch, National Human Genome Research Institute, NIH, DHHS, Baltimore, MD
| | - Alexa J. M. Sorant
- Genometrics Section, Inherited Disease Research Branch, National Human Genome Research Institute, NIH, DHHS, Baltimore, MD
| | - Robert Lipsky
- Section of Molecular Genetics, Laboratory of Neurogenetics, National Institute on Alcohol Abuse & Alcoholism, NIH, DHHS, Rockville, MD
| | | | - Husseini Manji
- Laboratory of Molecular Pathophysiology, Mood & Anxiety Program, NIMH, NIH, DHHS, Bethesda, MD
| | - Francis J. McMahon
- Genetic Basis of Mood & Anxiety disorders, Mood & Anxiety program, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Dept. of Health & Human Services (DHHS), Bethesda, MD
| | - Silvia Paddock
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden,Genetic Basis of Mood & Anxiety disorders, Mood & Anxiety program, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Dept. of Health & Human Services (DHHS), Bethesda, MD
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Abstract
The 'neurotrophin hypothesis of depression' is based largely on correlations between stress or antidepressant treatment and down- or upregulation, respectively, of brain-derived neurotrophic factor (BDNF). Genetic disruption of the signaling pathways involving BDNF and its receptor, the tyrosine kinase TrkB, does not seem to cause depressive behaviors, but does hamper the effect of antidepressant drugs. Thus, BDNF may be a target of antidepressants, but not the sole mediator of depression or anxiety. Advances in BDNF cell biology, including its transcription through multiple promoters, trafficking and secretion, may provide new insights into its role in mood disorders. Moreover, as the precursor proBDNF and the mature protein mBDNF can elicit opposite effects on cellular functions, the impact of proBDNF and its cleavage on mood should be considered. Opposing influences of mBDNF and proBDNF on long-term potentiation and long-term depression might contribute to the dichotomy of BDNF actions on behaviors mediated by the brain stress and reward systems.
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Affiliation(s)
- Keri Martinowich
- Mood and Anxiety Program, National Institute of Mental Health, Building 35, Room 1C1004, 35 Convent Drive, MSC 3714, Bethesda, Maryland 20892-3714, USA
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Brennan AR, Yuan P, Dickstein DL, Rocher AB, Hof PR, Manji H, Arnsten AFT. Protein kinase C activity is associated with prefrontal cortical decline in aging. Neurobiol Aging 2007; 30:782-92. [PMID: 17919783 DOI: 10.1016/j.neurobiolaging.2007.08.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 07/16/2007] [Accepted: 08/22/2007] [Indexed: 11/17/2022]
Abstract
Aging is associated with deficiencies in the prefrontal cortex, including working memory impairment and compromised integrity of neuronal dendrites. Although protein kinase C (PKC) is implicated in structural plasticity, and overactivation of PKC results in working memory impairments in young animals, the role of PKC in prefrontal cortical impairments in the aged has not been examined. This study provides the first evidence that PKC activity is associated with prefrontal cortical dysfunction in aging. Pharmacological inhibition of PKC with chelerythrine rescued working memory impairments in aged rats and enhanced working memory in aged rhesus monkeys. Improvement correlated with age, with older monkeys demonstrating a greater degree of improvement following PKC inhibition. Furthermore, PKC activity within the prefrontal cortex was inversely correlated with the length of basal dendrites of prefrontal cortical neurons, as well as with working memory performance in aged rats. Together these findings indicate that PKC is dysregulated in aged animals and that PKC inhibitors may be useful in the treatment of cognitive deficits in the elderly.
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Affiliation(s)
- Avis R Brennan
- Yale University School of Medicine, Department of Neurobiology, 333 Cedar Street, New Haven, CT 06511, USA.
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Abstract
OBJECTIVE Suicidal ideation is an uncommon symptom than can emerge during antidepressant treatment. The biological basis of treatment-emergent suicidal ideation is unknown. Genetic markers may shed light on the causes of treatment-emergent suicidal ideation and help identify individuals at high risk who may benefit from closer monitoring, alternative treatments, or specialty care. METHOD A clinically representative cohort of outpatients with major depressive disorder who enrolled in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were treated with citalopram under a standard protocol for up to 14 weeks. DNA samples from 1,915 participants were genotyped for 768 single-nucleotide polymorphisms in 68 candidate genes. Allele and genotype frequencies were compared between the 120 participants who developed treatment-emergent suicidal ideation and those who did not. RESULTS Two markers were significantly associated with treatment-emergent suicidal ideation in this sample (marker rs4825476, p=0.0000784, odds ratio=1.94; permutation p=0.01; marker rs2518224, p=0.0000243, odds ratio=8.23; permutation p=0.003). These markers reside within the genes GRIA3 and GRIK2, respectively, both of which encode ionotropic glutamate receptors. CONCLUSIONS Markers within GRIK2 and GRIA3 were associated with treatment-emergent suicidal ideation during citalopram therapy. If replicated, these findings may shed light on the biological basis of this potentially dangerous adverse event and help identify patients at increased risk.
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Affiliation(s)
- Gonzalo Laje
- Genetic Basis of Mood and Anxiety Disorders, NIMH, 35 Convent Dr., Rm. 1A207, Bethesda, MD 20892-3719, USA.
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Paddock S, Laje G, Charney D, Rush AJ, Wilson AF, Sorant AJM, Lipsky R, Wisniewski SR, Manji H, McMahon FJ. Association of GRIK4 with outcome of antidepressant treatment in the STAR*D cohort. Am J Psychiatry 2007; 164:1181-8. [PMID: 17671280 DOI: 10.1176/appi.ajp.2007.06111790] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An initial pharmacogenetic study of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial reported an association between genetic variation in the HTR2A gene and outcome of citalopram treatment. By design, the study analyzed only those markers that showed reproducible association in the first wave of genotypes (comprising 1,297 patients) in the complete cohort of patients. The purpose of the present study was to utilize a second wave of genotype results, for a more powerful analysis, in the complete cohort of patients with available deoxyribonucleic acid (DNA) samples. METHOD The authors tested the association between treatment response and 768 markers that were genotyped in the full set of 1,816 eligible patients from the STAR*D cohort. In order to control for multiple testing, the subjects were divided into two study groups: discovery and replication. RESULTS In addition to the previously identified marker in the HTR2A gene, a new marker (rs1954787) in the GRIK4 gene, which codes for the kainic acid-type glutamate receptor KA1, was observed. The effect size of the GRIK4 marker alone was modest, but homozygote carriers of the treatment-response-associated marker alleles of both the GRIK4 and HTR2A genes were 23% less likely to experience nonresponse to treatment relative to participants who did not carry any of these marker alleles. CONCLUSIONS The findings demonstrate that genetic variation in a kainic acid-type glutamate receptor is reproducibly associated with response to the antidepressant citalopram. This finding suggests that the glutamate system plays an important role in modulating response to selective serotonin reuptake inhibitors (SSRIs).
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MESH Headings
- Adult
- Black or African American/genetics
- Antidepressive Agents/pharmacology
- Antidepressive Agents/therapeutic use
- Base Sequence
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 13/genetics
- Citalopram/pharmacology
- Citalopram/therapeutic use
- Cohort Studies
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/drug therapy
- Depressive Disorder, Major/genetics
- Female
- Genetic Markers
- Genotype
- Humans
- Male
- Pharmacogenetics
- Psychiatric Status Rating Scales/statistics & numerical data
- Quantitative Trait Loci/genetics
- ROC Curve
- Receptor, Serotonin, 5-HT2A/drug effects
- Receptors, Kainic Acid/drug effects
- Receptors, Kainic Acid/genetics
- Receptors, N-Methyl-D-Aspartate/genetics
- Selective Serotonin Reuptake Inhibitors/pharmacology
- Selective Serotonin Reuptake Inhibitors/therapeutic use
- Treatment Outcome
- White People/genetics
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Affiliation(s)
- Silvia Paddock
- Genetic Basis of Mood and Anxiety Disorders, Mood and Anxiety Program, NIMH, NIH, Department of Health and Human Services, Bethesda, MD, USA.
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Hu XZ, Rush AJ, Charney D, Wilson AF, Sorant AJM, Papanicolaou GJ, Fava M, Trivedi MH, Wisniewski SR, Laje G, Paddock S, McMahon FJ, Manji H, Lipsky RH. Association between a functional serotonin transporter promoter polymorphism and citalopram treatment in adult outpatients with major depression. ACTA ACUST UNITED AC 2007; 64:783-92. [PMID: 17606812 DOI: 10.1001/archpsyc.64.7.783] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The HTTLPR, a functional polymorphism of the serotonin transporter gene solute carrier family 6 (neurotransmitter transporter, serotonin), member 4 (SLC6A4), promoter, affects transcription and may be involved in antidepressant drug treatment outcome, although response rates with antidepressants can be lower in patients who experience adverse effects. OBJECTIVE To test the hypothesis that HTTLPR is associated with treatment outcome to citalopram. DESIGN A clinical effectiveness trial, Sequenced Treatment Alternatives to Relieve Depression, collected DNA samples from outpatients with nonpsychotic major depressive disorder who received citalopram in the first treatment step. The triallelic HTTLPR locus was genotyped in 1775 samples to discriminate between long (L) and short (S) alleles, followed by the A > G substitution. The low-expression S and L(G) alleles were grouped together compared with the high-expression L(A) allele. SETTING Eighteen primary care and 23 psychiatric care sites across the United States. PARTICIPANTS Ages 18 to 75 years, meeting criteria for single or recurrent nonpsychotic major depression. MAIN OUTCOME MEASURES Categorical response, remission, tolerance, and adverse effect burden. RESULTS Expression-based grouping produced a significant finding of association between the L(A) allele and adverse effect burden in the entire sample (P = .004 [genotype frequency]; P < .001 [allele frequency]). To control for bias from population stratification, a white American subsample was analyzed. A lesser adverse effect burden was associated with L(A)L(A) genotype frequency (P = .03) or L(A) allele frequency (P = .007). These findings in white patients did not hold when the L allele was undifferentiated. No association was observed between treatment outcome phenotypes and HTTLPR. Development of diarrhea and the presence of the low-expression S or L(G) alleles were the strongest risk factors associated with adverse effect burden. CONCLUSIONS The HTTLPR polymorphism is associated with citalopram adverse effects. Because the L(A) allele confers increased SLC6A4 transcription, increased serotonin transporter levels in brain and other tissues may lead to fewer adverse effects for antidepressant medications that target the transporter.
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Affiliation(s)
- Xian-Zhang Hu
- Section on Molecular Genetics, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892, USA
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