Major Depressive Disorder
Depression is a Global Public Health Concern
Depression is a serious medical illness and a global public health concern that can occur at any time over a person's life. While most people will experience depressed mood at some point during their lifetime, major depressive disorder (MDD) is different. MDD is the chronic, pervasive feeling of utter unhappiness and suffering, which impairs daily functioning. Symptoms of MDD include diminished pleasure in activities, changes in appetite that result in weight changes, insomnia or oversleeping, psychomotor agitation, loss of energy or increased fatigue, feelings of worthlessness or inappropriate guilt, difficulty thinking, concentrating or making decisions, and thoughts of death or suicide and attempts at suicide. Close to 800,000 people die due to suicide every year, and it is the second leading cause of death in individuals 15-29 years old. For many people, depression cannot be controlled for any length of time without treatment. Standard FDA-approved medications available in the multi-billion-dollar global antidepressant market include commonly prescribed selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as atypical antipsychotics used adjunctively to augment them.
1World Health Organization. Preventing suicide: a global imperative. Available at: http://www.who.int/mental_health/suicideprevention/world_report_2014/en/
Shortcomings of Standard Antidepressants (SSRIs and SNRIs)
While current FDA-approved antidepressants are widely used, about two-thirds of patients with MDD do not respond to their initial antidepressant treatment. Inadequate response to current antidepressants is among the key reasons MDD is one of the leading public health concerns in the United States, creating a significant unmet medical need for new agents with fundamentally different mechanisms of action.
ELEVATE is our ongoing Phase 2, randomized, double-blind, multi-center, placebo-controlled clinical trial designed to evaluate the efficacy and safety of adjunctive use of oral AV-101 for MDD in patients with an inadequate response to standard antidepressant therapy with either an FDA-approved SSRI or SNRI. We are developing AV-101, initially, as a new generation adjunctive treatment to replace the widespread use of atypical antipsychotics, such as aripiprazole, for tens of millions of patients with MDD worldwide suffering from an inadequate response to standard SSRIs and SNRIs. Paradigm-shifting clinical studies performed by Dr. Carlos Zarate, Jr. and others at the U.S. National Institute of Mental Health (NIMH), Yale University and several other academic research centers have demonstrated that, when given intravenously, a single low dose intravenous infusion of the NMDA receptor antagonist ketamine can produce robust and rapid antidepressant effects in patients with treatment-resistant MDD. AV-101’s mechanism of action is functionally similar to ketamine in that both are NMDA receptor antagonists. However, ketamine is a classic channel-blocking NMDA receptor antagonist. AV-101 is a NMDA receptor GlyB antagonist. It inhibits NMDA receptor function rather than blocking it. We believe this difference (modulating NMDA receptor activity rather than blocking it), together with the activation of AMPA receptor pathways, can potentially bypass the adverse side effects that occur with ketamine while still achieving ketamine-like antidepressant effects.
Our Goal: Displace Adjunctive Atypical Antipsychotics in the Depression Drug Treatment Paradigm