Randomized, Double-Blind Study of the Efficacy and Tolerability of Extended Release Quetiapine Fumarate (Quetiapine XR) Monotherapy in Elderly Patients with Major Depressive Disorder

Abstract

This study assessed the efficacy and tolerability of once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in elderly patients with major depressive disorder (MDD). An 11-week (9-week randomized; 2-week posttreatment phase), double-blind, placebo-controlled, Phase III study (D1448C00014). A total of 53 centers in Argentina, Estonia, Finland, Russia, Ukraine, and the United States. A total of 338 patients (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD, age≥66 years, Hamilton Rating Scale for Depression [HAM-D] total score≥22, HAM-D Item 1 [depressed mood] score≥2) were randomized (mean age: 71.3 years). Patients were randomized to quetiapine XR (n= 166; flexible-dosing 50-300 mg/day) or placebo (n= 172). Primary outcome was Montgomery Åsberg Depression Rating Scale (MADRS) total score change from randomization at Week9. At Week 9, quetiapine XR (least squares [LS] means:-16.33, standard error [SE]: 0.95; mean change:-16.0, standard deviation [SD]: 9.3) significantly reduced MADRS total score from randomization versus placebo (LS means [SE]:-8.79 [0.94]; mean [SD]:-9.0 [9.9]); significant improvements were also seen at Week 1 (LS means [SE]:-4.65 [0.53] versus-2.56 [0.53], respectively; mean [SD]:-4.3 [5.1] versus-2.4 [3.7], respectively). At Week 9, secondary outcome variables significantly improved with quetiapine XR versus placebo, including MADRS response (≥50% reduction in total score); MADRS remission (total score≤8); HAM-D total, HAM-A total, HAM-A psychic and somatic cluster, and Clinical Global Impressions-Severity of Illness (CGI-S) total scores; proportion of patients with CGI-Improvement score of 2 or less; Q-LES-Q-SF% maximum total, Pittsburgh Sleep Quality Index global, and pain Visual Analog Scale scores. Common adverse events (>10% patients with quetiapine XR) were somnolence, headache, dry mouth, and dizziness. In elderly patients with MDD, quetiapine XR monotherapy (50-300 mg/day, flexibly dosed) is effective at improving depressive symptoms, with symptom improvement observed as early as Week 1. Overall tolerability and safety were consistent with the known profile of quetiapine.