title: A Randomized, Double-blind, Placebo-controlled Trial of the Efficacy and Safety of Levomilnacipran ER 40-120mg/day for Prevention of Relapse in Patients with Major Depressive Disorder.
abstract: OBJECTIVE
  Major depressive disorder is often chronic, with relapse and recurrence common. Levomilnacipran extended-release is a potent and selective serotonin and reuptake inhibitor approved in the United States for treatment of major depressive disorder in adults. The objective of this study (NCT01085812) was to evaluate the efficacy, safety, and tolerability of levomilnacipran extended-release in the prevention of relapse in patients with major depressive disorder.
  
  
  METHODS
  A 24-week Phase III randomized, double-blind, controlled trial comparing levomilnacipran extended-release 40-120mg/day with placebo for relapse prevention in patients with major depressive disorder who had responded to 12-week, open-label treatment with levomilnacipran extended-release. Statistical power was calculated on the assumption that 38 percent of placebo and 20 percent of levomilnacipran extended-release patients would relapse.
  
  
  METHODS
  Thirty-six outpatient study centers throughout the United States and Canada.
  
  
  METHODS
  Of 348 patients who met randomization criteria and entered double-blind treatment, three discontinued prior to treatment, 112 were randomized to placebo, and 233 to levomilnacipran extended-release.
  
  
  METHODS
  
  
  
  METHODS
  Time to relapse was analyzed using the Cox proportional hazard-regression model with treatment group and baseline Montgomery-Åsberg Depression Rating Scale score as explanatory variables. Safety was also evaluated.
  
  
  RESULTS
  Time to relapse was longer for levomilnacipran extended-release versus placebo (hazard ratio [95% confidence interval] = 0.68 [0.40][1.17]), but the treatment difference was not statistically significant (P=0.165). A relatively low percentage of patients from either group relapsed (placebo=20.5%, levomilnacipran extended-release=13.9%).
  
  
  CONCLUSIONS
  This study did not detect between-treatment group differences, potentially due to lower than expected relapse rates in the placebo group. Levomilnacipran extended-release was generally well tolerated.
authors.affiliation: Dr. Shiovitz with the California Neuroscience Research Medical Group Inc, Sherman Oaks, California; and Dr. Greenberg, Mr. Chen, Ms. Forero, and Mr. Gommoll are from Forest Research Institute, Jersey City, New Jersey.
authors.forename: Thomas
authors.initials: T
authors.lastname: Shiovitz
authors.affiliation: Dr. Shiovitz with the California Neuroscience Research Medical Group Inc, Sherman Oaks, California; and Dr. Greenberg, Mr. Chen, Ms. Forero, and Mr. Gommoll are from Forest Research Institute, Jersey City, New Jersey.
authors.forename: William M
authors.initials: WM
authors.lastname: Greenberg
authors.affiliation: Dr. Shiovitz with the California Neuroscience Research Medical Group Inc, Sherman Oaks, California; and Dr. Greenberg, Mr. Chen, Ms. Forero, and Mr. Gommoll are from Forest Research Institute, Jersey City, New Jersey.
authors.forename: Changzheng
authors.initials: C
authors.lastname: Chen
authors.affiliation: Dr. Shiovitz with the California Neuroscience Research Medical Group Inc, Sherman Oaks, California; and Dr. Greenberg, Mr. Chen, Ms. Forero, and Mr. Gommoll are from Forest Research Institute, Jersey City, New Jersey.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Forero
authors.affiliation: Dr. Shiovitz with the California Neuroscience Research Medical Group Inc, Sherman Oaks, California; and Dr. Greenberg, Mr. Chen, Ms. Forero, and Mr. Gommoll are from Forest Research Institute, Jersey City, New Jersey.
authors.forename: Carl P
authors.initials: CP
authors.lastname: Gommoll
keywords: Levomilnacipran; antidepressants; major depressive disorder; major depressive disorder relapse; serotonin and norepinephrine reuptake inhibitor (SNRI)