Adjunctive Brexpiprazole for Patient Life Engagement in Major Depressive Disorder: A Canadian, Phase 4, Open-Label, Interventional Study: Brexpiprazole d'appoint pour l'engagement dans la vie des patients souffrant de trouble dépressif majeur: une étude interventionnelle canadienne ouverte de phase 4.

OBJECTIVES: To characterize the effects of adjunctive brexpiprazole on patient life engagement and depressive symptoms in patients with major depressive disorder (MDD) using patient-reported outcomes.

METHODS: An 8-week, Phase 4, open-label, interventional study was conducted at 15 Canadian trial sites between April 2021 and May 2022. Adult outpatients with MDD (at least moderately severe) and inadequate response to 1-2 antidepressants continued their current antidepressant and received oral adjunctive brexpiprazole 0.5-2 mg/day. Co-primary endpoints were change from baseline to Week 8 in Inventory of Depressive Symptomatology Self-Report (IDS-SR) 10-item Life Engagement subscale score, and IDS-SR 30-item total score. Safety was assessed by standard variables.

RESULTS: Of 122 enrolled patients, 120 (98.4%) were treated (mean [ SD ] dose: 1.2 [0.4] mg/day) and analyzed, and 111 (91.0%) completed the study. Statistically significant least squares mean improvements to Week 8 were observed on IDS-SR10 Life Engagement subscale score (baseline mean [ SD ]: 16.1 [4.7]; change [95% confidence interval]: -8.11 [-9.34, -6.88]; p  < 0.001) and IDS-SR total score (baseline mean [ SD ]: 41.3 [9.8]; change [95% confidence interval]: -17.38 [-20.08, -14.68]; p  < 0.001). Improvements were observed from Week 2, onwards. Treatment-emergent adverse events with incidence ≥5% were fatigue ( n  = 13, 10.8%), headache ( n  = 13, 10.8%), insomnia ( n  = 12, 10.0%), nausea ( n  = 9, 7.5%), tremor ( n  = 8, 6.7%), and weight increase ( n  = 7, 5.8%). Six patients (5.0%) discontinued due to adverse events. Mean ( SD ) change in body weight from baseline to last visit was +1.9 (3.4) kg.

CONCLUSIONS: Using an exploratory patient-reported outcome measure, patients with MDD and inadequate response to antidepressants who received open-label adjunctive brexpiprazole showed early and clinically meaningful improvement in patient life engagement, which should be further assessed in a prospective randomized controlled trial. Patient-rated depressive symptoms (on the validated 30-item IDS-SR) also improved. Adjunctive brexpiprazole was well tolerated, and no new safety signals were observed.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04830215.