Efficacy and Safety of Daridorexant in Patients With Major Depressive Disorder and Insomnia

Phase 4Not Yet RecruitingNCT07555743

Institut d'Investigació Biomèdica de Bellvitge134 enrolled

Overview

The goal of this clinical trial is to evaluate the efficacy and safety of Daridorexant in major depressive disorder (MDD) patients with comorbid insomnia. The main questions to answer are: 1. Does Daridorexant improve the severity of insomnia as measured by the Insomnia Severity Index (ISI)? 2. Does Daridorexant have an impact on depressive symptoms? In order to address these questions, researchers will compare Daridorexant with a placebo to evaluate its impact on both insomnia and MDD-related symptoms. Participants will: * Receive Daridorexant or placebo for a duration of three months * Complete a Sleep Diary and other questionnaires assessing sleep and depressive symptoms. * Undergo polysomnography to obtain objective measurements of sleep parameters.

Insomnia is an extensively studied condition, yet its interactions with major depressive disorder (MDD) remain insufficiently understood. This study aims to evaluate the efficacy and safety of Daridorexant in MDD patients with comorbid insomnia. The primary objective is to determine whether Daridorexant improves the severity of insomnia, as measured by the Insomnia Severity Index (ISI), while assessing its impact on depressive symptoms will be considered the secondary objective. A prospective, double-blind, randomized, multicenter, placebo-controlled trial will be conducted in major depressive disorder outpatient clinic of the psychiatry department. Eligible patients will be randomized to Daridorexant versus placebo. Neither participants nor investigators will be aware of the treatment allocation. Standardized procedures for blinding and emergency unblinding will be implemented across all centers. The main outcome will be the improvement of Insomnia Severity Index (ISI) but additionally total sleep time, wake after sleep onset time, sleep latency and sleep efficiency will be measured. Data collection will include the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms measured by the Montgomery-Åsberg Depression Rating Scale (MADRS), suicidal thoughts measured by the MINI-Neuropsychiatry Scale, quality of life measured by EuroQol, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Polysomnography at baseline and 3 months. The study aims to demonstrate improvements in patient's subjective experience of insomnia, and additionally objective quantifiable improvements of objective sleep measurements via polysomnography, without an associated increase in depressive symptoms.

Study Type

INTERVENTIONAL

Allocation

Eligibility

Sex: ALLMin age: 18 YearsMax age: 99 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age Range: 18-99 years old. * Patients with a current major depressive episode according to DSM-5, in a stable phase (defined as at least 4 weeks without significant changes in antidepressant treatment and no psychiatric hospitalizations in the previous 8 weeks) and with moderate or greater severity, as indicated by a total score of * 20 on the Montgomery-Åsberg Depression Rating Scale (MADRS). * Insomnia disorder confirmed according to DSM-5 * Insomnia Severity: Insomnia Severity Index (ISI) score = o \>15. * Medication Stability defined by : * Stable doses of antidepressants, mood stabilizers, or antipsychotics for at least 1 month prior to baseline (T0). * Melatonin, Benzodiacepines, sedative antidepressants or sedative antipsychotics use for insomnia should follow a wash out protocol described below. * Informed Consent: Ability and willingness to provide written informed consent. * Acceptance of Protocol Requirements: Agreement to adhere to all scheduled visits, treatment plans, and study procedures. Exclusion Criteria: * Other Current Psychiatric Disorders: Any current psychiatric disorder other than major depressive disorder (e.g., active psychotic disorders, mania, hypomania, acute schizophrenia, schizoaffective disorder). * Use of Non-Permitted Sleep Medications: Concurrent use of melatonin, benzodiazepines, sedative antidepressants or sedative antipsychotics use for insomnia not allowed by the protocol and unwillingness to follow the slow- taper schedule constitutes an exclusion criterion. * No concurrent sleep medications at least 30 days prior to baseline. Exclusion criteria if the patient has withdrawal symptoms and/or sleep disturbances measured by BWSQ prior to baseline. * Uncontrolled Severe Medical Conditions: Any condition that could interfere with study procedures, safety, or outcome measures (e.g., unstable cardiovascular, respiratory, neurological, or endocrine disorders). * Pregnancy or breastfeeding * Cognitive Impairments: Significant impairments that prevent the comprehension or completion of study questionnaires or procedures. * Hypersensitivity: Known allergy or hypersensitivity to daridorexant or any of its excipients. * Specific Sleep Disorders: Sleep apnea or hypopnea index ≥ 15 events/hour (based on American Academy of Sleep Medicine criteria) or any event associated with oxygen saturation \< 80% (as measured by polysomnography). * Periodic limb movement index ≥ 15 events/hour (as measured by polysomnography). Restless legs syndrome, circadian rhythm sleep-wake disorders, REM behavior disorder, or narcolepsy. * Concomitant Use with Moderate and potent CYP3A4 Inhibitors: Prohibited due to potential drug interaction (refer to protocol section 4.5 for specifics). * Moderate and severe hepatic Impairment: Any hepatic condition deemed unsafe for daridorexant use. * Relapse or Worsening of the Main Diagnosis: Relapse of depression whose severity precludes continued participation according to the investigator's judgment. * Substance Use Disorder: History of substance use disorder without sustained remission. Exception: past sedative abuse may be permissible if remission criteria are clearly met, as determined by the investigator. * Excessive Caffeine Intake: Daily consumption of \>400 mg of caffeine (e.g., \>4 standard cups of coffee). * High-Risk Alcohol Consumption: Alcohol intake above recommended risk thresholds in accordance with the guidelines of the Spanish Ministry of Health: i.e., \>4 standard drinks/day (\>40g/d) for men, \>2 standard drinks/day (\>20g/d) for women.

Outcomes

Primary Outcomes

Insomnia Severity Index (ISI)

The Insomnia Severity Index is a widely used, self-reported questionnaire designed to assess the nature, severity, and impact of insomnia symptoms. Each item is rated on a 5-point Likert scale from 0 to 4. The total score ranges from 0 to 28, with higher scores indicating greater insomnia severity. According to the results insomnia will be classified as follows: 0-7: absence of clinical insomnia; 8-14: subclinical insomnia; 15-21: clinical insomnia; 22-28: severe insomnia.

Time frame: ISI will be administered to all patients at baseline, and at months 1 and 3.

Secondary Outcomes

Sleep Efficiency (polysomnography)

•Sleep Efficiency (%): Total Sleep Time (minutes) / time in bed (minutes).

Time frame: Polysomnography will be performed at baseline and at month 3.

Total Sleep Time (Polysomnography)

Total Sleep Time (TST): measured in minutes.

Time frame: PSG will be performed at baseline and at month 3.

Wake After Sleep Onset (polysomnography)

Total number of minutes that a patient is awake after having initially fallen asleep.

Time frame: Polysomnography will be performed at baseline and at month 3.

Arousal Index (polysomnography)

Number of arousals per hour of sleep.

Time frame: Polysomnography will be performed at baseline and at month 3.

Cumulative time spent under 90% oxygen saturation (polysomnography)

\[time under 90% oxygen saturation (min) / total sleep time (min)\] · 100 (%)

Time frame: Polysomnography will be performed at baseline and at month 3.

Periodic Leg Movement Index (Polysomnography)

number of leg movements per hour of sleep.

Time frame: Polysomngraphy will be performed at baseline and at month 3.

Apnea-Hypopnea Index (polysomnography)

number of apneas and hypopneas per hour of sleep.

Time frame: Polysomnography will be performed at baseline and at month 3.

Pittsburg Sleep Quality Index (PSQI)

Each item is rated on a 4-point Likert scale from 0 to 3. The total score varies between 0 and 21, with higher scores indicating greater difficulties with sleep.

Time frame: PSQI will be administered to all patients at baseline, and at months 1 and 3.

Dysfunctional Beliefs and Attitudes about Sleep (DBAS)

Each item is rated on a 5-point Likert scale from 1 to 5. The total score ranges from 30 to 150, with lower scores indicating a greater presence of dysfunctional beliefs and attitudes about sleep.

Time frame: The DBAS will be administered to all patients at baseline, and at months 1 and 3.

Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ)

The IDSIQ is a patient-reported outcome measure assessing daytime functioning impairments associated with insomnia. It comprises 14 items, each rated on a 0-10 scale. Items are summed to obtain a total score (range: 0-140). Interpretation: Higher scores indicate greater daytime impairment related to insomnia.

Time frame: The IDSIQ will be administered daily to all patients from baseline through month 3.

Montgomery-Åsberg Depression Rating Scale (MADRS)

The assessment should be based on a clinical interview that ranges from general questions about symptoms to more detailed questions that allow for a precise evaluation of severity. The evaluator must decide whether the assessment corresponds to the responses defined at the levels of the scale (0, 2, 4, 6) or to those between them (1, 3, 5). The total score ranges from 0 to 60. Interpretation: No depression (0-6); mild (7-19); moderate (20-34); severe (35-60).

Time frame: MADRS will be administered to all patients at baseline, and at months 1 and 3.

Suicidal Scale of the Mini-International Neuropsychiatric Interview (MINI)

Only the suicide item of the MINI will be administered. Each item is scored dichotomously (Yes/No). Points are assigned to "Yes" responses and summed to yield a total score: Wish to be dead: 1 point Self-harm desire: 2 points Suicidal ideation: 6 points Suicide plan: 10 points Suicide attempt (past month): 10 points Lifetime suicide attempt: 4 points Total score range: 0-33 Risk categories: 0: No risk 1-5: Low risk 6-9: Moderate risk ≥10: High risk

Time frame: Will be administered to all patients at baseline and at months 1 and 3.

EuroQol-5D-5L

The EQ-5D-5L comprises 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each rated on ordered levels. Each item is rated on a 5-point Likert scale from 1 to 5. The total score ranges from 5 to 25, with higher scores indicating poorer health status. The instrument also includes a visual analogue scale, where pacients rate their overall health from 0 (worst imaginable health) to 100 (best imaginable health).

Time frame: Will be administered at baseline and at month 3.

Sleep onset (Sleep diary)

Time in minutes between attempting to fall asleep and the onset of sleep.