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VAL66MET (SNP rs6265) GENOTYPE SPECIFIC DOSING REGIMENS AND METHODS FOR THE TREATMENT OF DEPRESSION

a genotype-specific, depression-specific technology, applied in the direction of biochemical apparatus and processes, drug compositions, biocide, etc., can solve the problems of clinically significant distress or impairment in social, occupational or other important areas of functioning, psychological distress, and the onset of suicidal ideation

Inactive Publication Date: 2016-03-17
JANSSEN PHARMA NV
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Benefits of technology

The present invention is a method for treating depression, particularly treatment-resistant depression, in a patient who is also a suicidal ideator. The method involves genetic testing to determine the patient's Val66Met rs6265 polymorphism in the BDNF gene, and then administering an esketamine dosing regimen for a period of between 2 and 8 weeks. The esketamine is administered intranasally, with a dosage ranging from 28 mg to 84 mg, depending on the patient's genotype. The method may also involve a maintenance phase for an additional 6 to 10 weeks. The invention is based on the discovery that patients with the Val / Val homozygote or the Val / Met heterozygote or the Met / Met homozygote have a higher response to esketamine treatment compared to patients with other genotypes.

Problems solved by technology

Further, the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
They may also cause psychological distress, which is another symptom associated with suicidal ideation.
Symptoms like these related with psychological inflexibility, recurring patterns, or psychological distress may in some cases lead to the onset of suicidal ideation.
However, there are several circumstances in which individuals can be hospitalized involuntarily, per state law including circumstances where an individual poses danger to self or others and where an individual is unable to care for one's self.
However, prescribing medication to treat suicidal ideation can be difficult.
This puts them at greater risk of following through with attempting suicide.
Additionally, if a patient has a co-morbid psychiatric disorder, it may be difficult to find a medication that addresses both the psychiatric disorder and suicidal ideation.
This has caused the Food and Drug Administration (FDA) to issue a warning stating that sometimes the use of antidepressants may actually increase the thoughts of suicidal ideation.
In addition, individuals who carry the Met polymorphism have been reported to have an increased risk of stress-related major depression.

Method used

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  • VAL66MET (SNP rs6265) GENOTYPE SPECIFIC DOSING REGIMENS AND METHODS FOR THE TREATMENT OF DEPRESSION
  • VAL66MET (SNP rs6265) GENOTYPE SPECIFIC DOSING REGIMENS AND METHODS FOR THE TREATMENT OF DEPRESSION
  • VAL66MET (SNP rs6265) GENOTYPE SPECIFIC DOSING REGIMENS AND METHODS FOR THE TREATMENT OF DEPRESSION

Examples

Experimental program
Comparison scheme
Effect test

example 1

Effect of Val66Met rs6265 Polymorphism in BDNF; Retrospective Analysis of Esketamine (ESKETIVTRD2001) and Ketamine (KETIVTRD2002) Clinical Trials

ESKETIVTRD2001 Clinical Trial Design and Objectives:

[0144]This was a double-blind, double-randomization, placebo-controlled, multiple dose titration study in 30 adult subjects with TRD. The study consisted of 3 phases: a screening phase of up to 2 weeks, a 7-day double-blind (DB) treatment phase (Day 1 to Day 7), and a 4-week post-treatment (with optional open label [OL] esketamine 0.40 mg / kg during follow-up [FU]: administered on Days 7, 10, 14 and 17.). The interval between the first and last dose of study medication was 3 days. Approximately 30 adult subjects with TRD were randomized to treatment (esketamine 0.40 mg / kg, esketamine 0.20 mg / kg, or placebo i.v. infusion) in a 1:1:1 ratio on Day 1.

[0145]If esketamine 0.40 mg / kg dose was not well tolerated on Day 1 and / or Day 4 the dose may be reduced to 0.3 mg / kg. Subjects who were responder...

formulation example 1

Prophetic Example

[0200]An aqueous formulation of S-ketamine hydrochloride is prepared by mixing S-ketamine hydrochloride (at a concentration of 161.4 mg / mL) in water and then adding 1N NaOH(aq) to pH 5.0.

formulation example 2

Prophetic Example

[0201]Aqueous formulation of S-ketamine hydrochloride is prepared by mixing S-ketamine hydrochloride (at a concentration of 161.4 mg / mL) in water and then adding 10 mg / mL tauroursodeoxycholic acid (TUDCA). To the resulting mixture is added 1N NaOH(aq) to pH 4.5.

[0202]While the foregoing specification teaches the principles of the present invention, with examples provided for the purpose of illustration, it will be understood that the practice of the invention encompasses all of the usual variations, adaptations and / or modifications as come within the scope of the following claims and their equivalents.

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PUM

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Abstract

The present invention is directed to methods and dosing regimens for the treatment of depression (preferably, treatment resistant depression), for the treatment of depression in a suicidal patient, and / or for the treatment and / or prevention of suicidality (e.g. suicidal ideations) comprising genotyping a patient to determine their Val66Met rs6265 polymorphism in BDNF and administering a ketamine, preferably esketamine, preferably intranasal esketamine, according to a dosing regimen matched to the patient's genotype.

Description

CROSS REFERENCE TO RELATED APPLICATIONS[0001]This application claims the benefit of priority under 35 U.S.C. §119(e) to U.S. Provisional Application 62 / 050,439, filed Sep. 15, 2014, the disclosure of which is herein incorporated by reference in its entirety.SEQUENCE LISTING[0002]The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on Aug. 14, 2015, is named PRD3353USNP_SL.txt and is 2,526 bytes in size.FIELD OF THE INVENTION[0003]The present invention is directed to methods and dosing regimens for the treatment of depression (preferably treatment resistant depression), for the treatment of depression in a suicidal patient, and / or for the treatment and / or prevention of suicidality (e.g. suicidal ideations) comprising genotyping a patient to determine their Val66Met rs6265 polymorphism in BDNF and administering a ketamine, preferably esketamine, pref...

Claims

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Application Information

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Patent Type & Authority Applications(United States)
IPC IPC(8): A61K31/135A61K9/00C12Q1/68
CPCA61K31/135A61K9/0043C12Q2600/106C12Q2600/156C12Q1/6883A61P25/24
Inventor CAERS, LODEWIJK IVOSALVADORE, GIACOMOSINGH, JASKARAN
Owner JANSSEN PHARMA NV
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