Safety and Efficacy of Levomilnacipran Extended Release in Pediatric Patients Aged 7–17 Years with Major Depressive Disorder: Results of Two Phase 3, Randomized, Double-Blind Studies

Objective: Major depressive disorder (MDD) presents a significant psychosocial burden, and there is an unmet need for additional treatment options in pediatric patients. Here, we report the results of two phase 3 multicenter, randomized, double-blind, placebo- and active-controlled, parallel-group studies evaluating the efficacy and safety of levomilnacipran extended release in children and adolescents with MDD. Methods: In the first study, LVM-MD-11, patients aged 12–17 years received daily doses of levomilnacipran 40 mg ( n = 134), levomilnacipran 80 mg ( n = 138), fluoxetine 20 mg ( n = 134), or placebo ( n = 141). In the second study, LVM-MD-14, patients aged 7–17 years received levomilnacipran 40 to 80 mg ( n = 166), fluoxetine 20 mg ( n = 166), or placebo ( n = 160) daily. Primary and secondary efficacy endpoints were changes in Children's Depression Rating Scale-Revised (CDRS-R) total score and Clinical Global Impressions-Severity (CGI-S) score, respectively. Results: In LVM-MD-11, there were no significant differences in change in CDRS-R total score between patients treated daily with placebo (least squares mean [LSM] change in CDRS-R total score −22.9) versus levomilnacipran 40 mg (−23.3; p = 0.8035) or 80 mg (−22.6; p = 0.8681). Similarly, in LVM-MD-14, there were no significant differences in LSM change in CDRS-R total score with placebo (−21.3) versus levomilnacipran 40 to 80 mg daily (−23.0; p = 0.2215). There were also no significant differences between the fluoxetine and placebo groups in either study for changes in CDRS-R total score. Changes in CGI-S score were not significant between placebo and levomilnacipran 40 to 80 mg daily or between placebo and fluoxetine. Levomilnacipran was generally well tolerated. Conclusions: The high placebo response in this study prevented the detection of an effect of levomilnacipran in children and adolescents. Clinical Trial Registration numbers: NCT02431806 and NCT03569475.