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Major Depressive DisorderPhase 3INSTA-MDNCT05644301

INflammation-based Stratification for Immune-Targeted Augmentation in Major Depressive Disorder

A Phase 3 study testing Celecoxib and Minocyclin in people with Major Depressive Disorder and Inflammation, run by Universiteit Antwerpen at 3 sites in Belgium.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This is a randomised, double-blind, placebo-controlled clinical trial in which patients with major depressive disorder will receive augmentation through minocycline (MCO), celecoxib (CXB) or placebo. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Major Depressive Disorder, Inflammation
What is being tested?
Celecoxib and Minocyclin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
240 participants
Where
3 sitesBelgium
Study dates
21 Sep 2023to Sep 2026
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Male or female, 18-65 years inclusive.
  • Able and willing to give informed consent and take oral medication.
  • Physically healthy.
  • Diagnosis of Major Depressive Disorder by DSM-5 criteria, confirmed by the Mini International Neuropsychiatric Interview (MINI).
  • The current episode of depression has failed to remit to the current antidepressant treatment at the adequate dose (as defined in the Maudsley Prescribing guidelines). Relapse while taking an antidepressant is also considered a treatment failure.
  • Tolerant to the current antidepressant and having no planned changes in their current therapy for the duration of the study.
  • Stable on current treatment for a minimum of 4 weeks (6 weeks for fluoxetine) prior to baseline.
  • If female and of childbearing age, willing to use adequate contraceptive precautions and willing to take a pregnancy test at baseline.

Who cannot join

  • Primary diagnosis of a bipolar disorder, psychotic spectrum disorder, obsessive-compulsive disorder, eating disorder, post-traumatic stress disorder, or alcohol and/or substance use disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (< 4 weeks before screening, excl. nicotine and caffeine).
  • Use of immunosuppressant or immunostimulant drugs within 21 days of screening (e.g., glucocorticoid treatment, methotrexate, etc.).
  • History of peptic ulcer disease or gastrointestinal (GI) bleeding.
  • Having an acute infection or inflammatory bowel disorder.
  • Current severe cardiovascular disease, congestive heart failure (NYHA-class II-IV), ischemic or thrombotic events or unstable coronary artery (incl. coronary artery bypass graft (CABG) surgery),
  • Liver impairment (alanine aminotransferase > 2x upper limit, serum albumin < 25 g/l or Child-Pugh Score ≥ 10)
Show all 14Show fewer
  • Renal impairment (creatinine clearance < 30 mL/min).
  • Having received >14 days of tetracycline or non-steroidal anti-inflammatory medication within the previous 2 months, or having a history of sensitivity or intolerance to these classes of drugs.
  • Chronic severe hypertension (systolic BP > 170 mmHg).
  • Serology positive for hepatitis-B surface antigen, hepatitis-C antibodies or HIV antibodies.
  • Received electroconvulsive therapy < 2 months prior to screening.
  • Blood donation in 30 days prior to screening.
  • Pregnancy or breastfeeding.
  • Currently enrolled in an intervention study.

Trial locations and contacts

3 sites in 1 country.

Jonas Janssens, MD contact

015304643

jonas.janssens@emmaus.be

Celine Wessa, MD contact

Celine.wessa@emmaus.be

Belgium3 sites, 3 recruiting
  • UZ Brussel

    Brussels

    Chris Baeken, PhD MD

    Recruiting
  • UPC Duffel

    Duffel, Antwerpen, 2570

    Manuel Morrens, manuel.morrens@uantwerpen.be

    Tim Rietberg

    Recruiting
  • Katholiek Universiteit Leuven Campus Kortenberg

    Leuven

    Elfi Vergaelen, MD PhD

    Emma Saillart

    Recruiting

Other trials in Belgium

About this study

Official title: INflammation-based Stratification for Immune-Targeted Augmentation in Major Depressive

This is a randomised, double-blind, placebo-controlled clinical trial in which patients with major depressive disorder will receive augmentation through minocycline (MCO), celecoxib (CXB) or placebo.

Read the detailed description

This project aims to repurpose two established anti-inflammatory compounds as adjuvant therapy for immune-mediated depression, in line with state-of-the-art research of the last 10 years. Immune-mediated depression represents a subtype which accounts for approximately 30% of depressive disorders. Patients with this immunosubtype are more likely to have a higher severity of depression, a lower quality of life and more somatic symptoms. Furthermore it is accompanied by a high incidence of treatment resistance. While their mechanisms of action completely differ from those of existing antidepressant treatment options, immunomodulatory drugs celecoxib and minocycline have proven their merit as add-on treatment in depressive episodes. They have been on the Belgian market for years and come with a known pharmacological and safety profile. Patient stratification at baseline based on inflammatory status will reveal which inflammatory subpopulation benefits most from each of the two investigated anti-inflammatory compounds. Additionally, our distinctive study design allows head-to-head comparison of both add-on therapies and will as such provide the last stepping stones towards clinical implementation of individualised treatment strategies in depression.

Being tested
Celecoxib, Minocyclin, Placebo
Keywords
Immunopsychiatry, Celecoxib, Minocyclin, Inflammation, Randomised Controlled Clinical Trial
Medical subject headings
Depressive Disorder, Major, Inflammation, cyclopia sequence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CelecoxibDrug

    Oral capsule, 200 mg, twice daily, for 12 weeks

  • MinocyclinDrug

    Oral capsule, 100 mg, twice daily, for 12 weeks

  • PlaceboDrug

    Oral capsule, no active substance, twice daily, for 12 weeks

Study groups in NCT05644301
Study groupRoleWhat they receive
High Sensitive C-reactive Protein (hs-CRP) < 3mg/L: Minocyclin + Treatment As Usual (TAU)Active comparatorNot described
Receives: Drug: Minocyclin
High Sensitive C-reactive Protein (hs-CRP) < 3mg/L: Celecoxib + Treatment As Usual (TAU)Active comparatorNot described
Receives: Drug: Celecoxib
High Sensitive C-reactive Protein (hs-CRP) < 3mg/L: Placebo + Treatment As Usual (TAU)Placebo comparatorNot described
Receives: Drug: Placebo
High Sensitive C-reactive Protein (hs-CRP) > 3mg/L: Minocyclin + Treatment As Usual (TAU)Active comparatorNot described
Receives: Drug: Minocyclin
High Sensitive C-reactive Protein (hs-CRP) > 3mg/L: Celecoxib + Treatment As Usual (TAU)Active comparatorNot described
Receives: Drug: Celecoxib
High Sensitive C-reactive Protein (hs-CRP) > 3mg/L: Placebo + Treatment As Usual (TAU)Placebo comparatorNot described
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in depressive symptom severity (HDRS-17)

    Change in severity of depression measured as the change in the 17-point scale of the Hamilton Depression Rating Scale (HDRS-17; score is ranging from 0 to 52, higher scores indicate higher severity of depressive symptoms) between baseline and endpoint

    Measured: T0 -> T6 (12 weeks)

  2. Remission rate of depression (HDRS-17)

    Rates of remission measured as a score of ≤7 on the 17-point scale of the Hamilton Depression Rating Scale (HDRS-17; score is ranging from 0 to 52, higher scores indicate higher severity of depressive symptoms and scores 0-7 are considered as being normal) at endpoint

    Measured: T0 -> T6 (12 weeks)

Secondary outcomes (11)
  1. Change in depressive symptom severity (IDS-30SR)

    Change in severity of depression measured as the change in the Inventory of Depressive Symptomatology - Self Report (IDS-SR; score is ranging from 0 to 84, higher scores indicate higher severity of depressive symptoms)

    Measured: T0 -> T6 (12 weeks)

  2. Response rate of depressive symptoms (HDRS-17)

    Response rates of the depressive symptoms measured on the 17-point scale of the Hamilton Depression Rating Scale (HDRS-17; score is ranging from 0 to 52, higher scores indicate higher severity of depressive symptoms), with response being defined as a 50% reduction in HDRS-17-score from baseline and partial response as a 25% reduction.

    Measured: T0 -> T6 (12 weeks)

  3. Change in night-time sleep (PSQI)

    Change in night-time sleep quality and/or quantity measured on the Pittsburgh Sleep Quality Index (PSQI; score is ranging from 0 to 21, higher scores indicate more sleep disturbances)

    Measured: T0 -> T6 (12 weeks)

  4. Change in anxiety (STAI)

    Change in anxiety measured on the Stait Trait Anxiety Inventory-Self Report (STAI; score is ranging from 20 tot 80, higher scores indicate higher levels of anxiety intensity)

    Measured: T0 -> T6 (12 weeks)

  5. Change in core assessment of psychomotor change (CORE)

    Change in the degree of psychomotor disturbance (which is as an integral component of melancholia) measured on the Core Assessment Of Psychomotor Change (CORE; score is ranging from 0-54, higher scores indicate higher levels of psychomotor disturbances)

    Measured: T0 -> T6 (12 weeks)

  6. Depressive symptom profiles (IDS-SR)

    Profile of the depression measured on the Inventory of Depressive Symptomatology - Self Report (IDS-SR; score is ranging from 0 to 84, higher scores indicate higher severity of depressive symptoms)

    Measured: T0 -> T6 (12 weeks)

  7. Therapy compliance (MARS)

    Therapy compliance measured on the Medication Adherence Scale (MARS; score is ranging from 0-10, higher scores indicate better medication adherence)

    Measured: T0 -> T6 (12 weeks)

  8. Adverse effects

    Side effects measured with a questionnaire based on the list as used in the Antidepressant Side-Effect Checklist (ASEC-21) and the known side effects of Minocycline and Celecoxib

    Measured: T0 -> T6 (12 weeks)

  9. Metabolic blood markers

    Cholesterol (mg/dl), High Density Lipoprotein (HDL) (mg/dl), Low Density Lipoprotein (LDL) (mg/dl), fasting glucose (mg/dl), triglycerides (mg/dl)

    Measured: T0 -> T6 (12 weeks)

  10. Other metabolic measures

    Waist circumference (cm), height (cm) will be measured to calculate the BMI (kg/m^2)

    Measured: T0 -> T6 (12 weeks)

  11. Other metabolic measures

    Weight (kg) will be measured to calculate the BMI (kg/m^2)

    Measured: T0 -> T6 (12 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Dec 2022
  2. Study start21 Sep 2023
  3. Primary completionSep 2026 (estimated)
  4. Study completionSep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
240 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05644301
Sponsor's protocol ID
T001222N
Acronym
INSTA-MD
Status last verified
Oct 2024
First submitted
24 Nov 2022
Last updated
15 Oct 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Osimo EF, Baxter LJ, Lewis G, Jones PB, Khandaker GM. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med. 2019 Sep;49(12):1958-1970. doi: 10.1017/S0033291719001454. Epub 2019 Jul 1.

    PubMed 31258105
  • Foley EM, Parkinson JT, Kappelmann N, Khandaker GM. Clinical phenotypes of depressed patients with evidence of inflammation and somatic symptoms. Compr Psychoneuroendocrinol. 2021 Aug 5;8:100079. doi: 10.1016/j.cpnec.2021.100079. eCollection 2021 Nov.

    PubMed 34729541
  • Carvalho LA, Torre JP, Papadopoulos AS, Poon L, Juruena MF, Markopoulou K, Cleare AJ, Pariante CM. Lack of clinical therapeutic benefit of antidepressants is associated overall activation of the inflammatory system. J Affect Disord. 2013 May 15;148(1):136-40. doi: 10.1016/j.jad.2012.10.036. Epub 2012 Nov 27.

    PubMed 23200297
  • Wessa C, Janssens J, Coppens V, El Abdellati K, Vergaelen E, van den Ameele S, Baeken C, Zeeuws D, Milaneschi Y, Lamers F, Penninx B, Claes S, Morrens M, De Picker L. Efficacy of inflammation-based stratification for add-on celecoxib or minocycline in major depressive disorder: Protocol of the INSTA-MD double-blind placebo-controlled randomised clinical trial. Brain Behav Immun Health. 2024 Sep 19;41:100871. doi: 10.1016/j.bbih.2024.100871. eCollection 2024 Nov.

    PubMed 39350954

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Celecoxib and Minocyclin in people with Major Depressive Disorder and Inflammation, run by Universiteit Antwerpen at 3 sites in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 15 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Jonas Janssens, MD (015304643, jonas.janssens@emmaus.be), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in depressive symptom severity (HDRS-17) (time frame: T0 -> T6 (12 weeks)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05644301, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Oct 2024.

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