In the overall COMET trial, AXS-05 treatment resulted in rapid, substantial, and durable improvement in depressive symptoms, measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), which was sustained or increased with long-term treatment. Patients experienced mean reductions from baseline in the MADRS total score of 14.0 points at Week 2 and 21.1 points at Week 6 (primary timepoint). Reductions from baseline at 6 and 12 months were 23.9 points and 23.0 points, respectively.
Clinical response on the MADRS (defined as ≥50% reduction from baseline) after treatment with AXS-05 was achieved by 39.7% of patients at Week 2 and 73.2% of patients at Week 6. This rate of response was sustained or increased with long-term treatment, with 84.6% and 82.8% of patients achieving a clinical response at 6 and 12 months, respectively. Remission from depression (defined as MADRS ≤10) after treatment with AXS-05 was achieved by 21.5% of patients at Week 2 and 52.5% of patients at Week 6. This rate of remission was sustained or increased with long-term treatment, with 68.7% and 69.0% of patients in remission at 6 and 12 months, respectively.
Clinicians reported rapid, substantial, and durable global improvement in depressive symptoms, measured by the Clinical Global Impression of Improvement (CGI-I) scale, in patients treated with AXS-05. Marked or moderate improvement in depressive symptoms was achieved after treatment with AXS-05 by 50.4% of patients at Week 2 and 83.1% of patients at Week 6. This improvement on the CGI-I was sustained or increased with long-term treatment, as evidenced by marked or moderate improvement being achieved by 86.7% and 93.1% of patients at 6 and 12 months, respectively.
Patients experienced rapid, substantial, and durable improvement in functional impairment, as measured by the Sheehan Disability Scale (SDS) with AXS-05 treatment. The SDS is a patient-rated scale that was designed to assess functioning in work, social life, and family life, and is among the most commonly used functional impairment scales in depression clinical trials. Clinical response on the SDS (defined as a total score of ≤12) was achieved after treatment with AXS-05 by 55.1% of patients at Week 2 and 70.7% of patients at Week 6. This improvement in functioning was maintained or increased with long-term treatment with AXS-05, as evidenced by clinical response on the SDS being achieved by 80.6% and 75.9% of patients at 6 months and at 12 months, respectively.
Results of the COMET-AU trial were similar to those of the overall COMET study, demonstrating rapid, substantial, and durable improvements in depressive symptoms and functional impairment with AXS-05 treatment in patients who had failed one prior antidepressant treatment. Mean reductions from baseline in the MADRS total score were 13.1 points at Week 2 and 19.1 points at Week 6. Clinical response on the MADRS was achieved by 33.3% of patients at Week 2 and 64.6% of patients at Week 6. Remission from depression was achieved by 15.7% of patients at Week 2 and 40.4% of patients at Week 6. Marked or moderate improvement in depressive symptoms, assessed by the CGI-I scale, was achieved by 40.7% of patients at Week 2 and 70.0% of patients at Week 6. Clinical response on the SDS was achieved by 48.1% of patients at Week 2 and 63.4% of patients at Week 6. The improvements in depressive symptoms and functioning were sustained with long-term treatment.
AXS-05 was well tolerated with long-term dosing. The safety profile of AXS-05 over the 12-month treatment period was consistent with what was previously reported in short-term controlled trials, with no new safety signals detected. The most commonly reported adverse events in the COMET trial were dizziness (12.7%), nausea (11.9%), headache (8.8%), dry mouth (7.1%), and decreased appetite (6.1%). These adverse events occurred at rates that were similar to those observed in the previously reported controlled trials with AXS-05. During the 12-month trial, 8.4% of patients discontinued due to adverse events, with no individual adverse event in more than 1.5% of patients. Treatment with AXS-05 was not associated with psychotomimetic effects, cognitive impairment, weight gain, or increased sexual dysfunction.
COMET Efficacy Results Summary
A total of 611 de novo patients with MDD were enrolled and treated with AXS-05 twice daily for up to 12 months. Efficacy results for these patients are summarized below:
| ● | The mean MADRS total score was 32.7 at baseline. |
| ● | Treatment with AXS-05 was associated with a mean reduction from baseline in the MADRS total score of 9.1 points at Week 1, 14.0 points at Week 2, and 21.1 points at Week 6. Mean MADRS total score reductions from baseline after 6 and 12 months of treatment with AXS-05 were 23.9 points and 23.0 points, respectively. |