{"id":15552,"date":"2011-10-31T15:06:10","date_gmt":"2011-10-31T19:06:10","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=15552"},"modified":"2011-11-01T13:26:32","modified_gmt":"2011-11-01T17:26:32","slug":"viibryd-i","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/10\/31\/viibryd-i\/","title":{"rendered":"Viibryd I&#8230;"},"content":{"rendered":"<br \/>\n<blockquote>\n<div align=\"center\"><u><strong><a href=\"http:\/\/carlatpsychiatry.blogspot.com\/2011\/10\/fda-slams-viibryd-better-sexual-profile.html\"><font color=\"#200020\">FDA Slams Viibryd: Better Sexual Profile Claim &ldquo;Not Supported by the Data&rdquo;<\/font><\/a><\/strong><\/u><br \/>                   <strong><font color=\"#200020\">The Carlat Psychiatry Blog<\/font><\/strong><br \/>                   by Danny Carlat<br \/>                   October 26, 2011<\/div>\n<p align=\"justify\"><sup>The September 2011 issue of the <em>Journal of Clinical Psychiatry<\/em> created history in two ways. First, the journal published this <strong><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21951984\"><font color=\"#200020\">article<\/font><\/a><\/strong> written by FDA staff critically reviewing the efficacy and safety data of <a href=\"https:\/\/www.viibryd.com\/\"><font color=\"#200020\">Viibryd<\/font><\/a>, a new antidepressant that the same FDA staff had just <em>approved<\/em>. Second, it was not just <em>any <\/em>journal that published the article, but the <em>Journal of Clinical Psychiatry<\/em>.  Why is this so historic? Anybody who has followed this blog over the  years has noticed a certain&hellip;shall we say, skepticism&#8230;toward many of  the articles published in <em>JCP<\/em>, especially those published in its  industry-funded supplements. But in this case I&#8217;m happy to give the  journal kudos for having the courage to publish an article critical of  an antidepressant made by a company that pays for drug ads. <\/sup><\/p>\n<p align=\"justify\"><sup>Not that any of this information is truly new. Back in April of 2011, my own <em>Carlat Psychiatry Report<\/em> actually scooped <em>JCP<\/em> on this issue, when Jim Phelps and I reported in this <strong><a target=\"_blank\" href=\"http:\/\/thecarlatreport.com\/four-%E2%80%9Cnew%E2%80%9D-antidepressants-or-are-they-free-article\"><font color=\"#200020\">article<\/font><\/a><\/strong>  that Viibryd-funded authors had tweaked sexual side effect data to make  the drug appear &ldquo;cleaner&rdquo; than its SSRI competitors.&nbsp; [Some of this  tweaking, interestingly enough, occurred in the pages of the Journal of Clinical Psychiatry]. In fact, as we reported and as this new  paper elaborates, the studies proved nothing at all about Viibryd&rsquo;s side  effects, because they artfully omitted a crucial element&mdash;the inclusion  of a comparator SSRI known to cause sexual dysfunction.<\/sup><\/p>\n<div align=\"justify\"><sup>The other claim put to bed by the FDA is  the idea that Viibryd is quicker to work than other antidepressants.  This was based on one of Forest&rsquo;s trials which showed that Viibryd  separated from placebo by week one. The FDA&rsquo;s article pointed out two  problems. First, this data was from Trial 04, which was only one of two  large trials submitted as part of the new drug application. In the other  trial, Trial 07, Viibryd did not separate from placebo until week 4.  Second, neither trial compared Viibryd with an already approved SSRI,  meaning that no statements can be made about the new drug working faster  than any other drug.<\/sup><\/div>\n<\/p>\n<div align=\"justify\"><sup>It&rsquo;s nice to see the FDA stepping up to  the plate and proactively publishing articles that dispel company-spread  rumors about drug effectiveness. And it&rsquo;s also great that a usually  industry-friendly journal like JCP would publish this.<\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">Along with having a name like a <em>World of Warcraft<\/em> Character, <strong><font color=\"#200020\">Viibryd<\/font><\/strong> [Vilazodone] has a long confusing history. The <a href=\"http:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/nda\/2011\/022567Orig1s000MedR.pdf\" target=\"_blank\"><u><strong><font color=\"#200020\">FDA Medical Report<\/font><\/strong><\/u><\/a> lists 5 previous Phase 2 Clinical Trials by Merck and GSK:<\/div>\n<div align=\"center\"><img decoding=\"async\" vspace=\"3\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/viibryd-1.gif\" \/><\/div>\n<div align=\"justify\">In that FDA Report, they mention those studies as not supportive, and consider two subsequent studies:<\/div>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" vspace=\"3\" height=\"230\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/viibryd-2.gif\" \/><\/div>\n<div align=\"justify\">Here are the references:<\/div>\n<ul>\n<div align=\"justify\"><strong><font color=\"#660033\">Trial 4: GNSC-04-DP-02<\/font><\/strong> <\/div>\n<ol>\n<div align=\"justify\"><strong><font color=\"#660033\">PubMed:<\/font><\/strong> <u><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19284933\"><strong><font color=\"#200020\">Evidence for efficacy and tolerability of vilazodone in the  treatment of major depressive disorder: a randomized, double-blind,  placebo-controlled trial.<\/font><\/strong><\/a><\/u><\/div>\n<div align=\"justify\"><strong><font color=\"#660033\">Clinical Trial<\/font><\/strong> [<strong><font color=\"#200020\">NCT00285376<\/font><\/strong>]: <a target=\"_blank\" href=\"http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00285376?term=NCT00285376&#038;rank=1\"><u><strong><font color=\"#200020\">Effectiveness Study of Vilazodone to Treat Depression and to Discover Genetic Markers Associated With Response<\/font><\/strong><\/u><\/a><\/div>\n<\/ol>\n<div align=\"justify\"><strong><font color=\"#660033\">Trial 7: CLDa-07-DP-02<\/font><\/strong><\/div>\n<ol>\n<div align=\"justify\"><strong><font color=\"#660033\">PubMed:<\/font><\/strong> <strong><font><u><a target=\"_blank\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21527122?dopt=Abstract\"><strong><font color=\"#200020\">A randomized, double-blind, placebo-controlled, 8-week study of vilazodone, a serotonergic agent for the treatment of major depressive disorder.<\/font><\/strong><\/a><\/u><\/font><\/strong><\/div>\n<div align=\"justify\"><strong><font color=\"#660033\">Clinical Trial<\/font><\/strong> [<strong><font color=\"#200020\">NCT00683592<\/font><\/strong>]: <a target=\"_blank\" href=\"http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00683592?term=Vilazodone&#038;rank=2\"><u><strong><font color=\"#200020\">Randomized, Double-Blind, Placebo Controlled Study of Vilazodone&#8217;s Efficacy, Safety, and Biomarkers of Response in Major Depressive Disorder (MDD)<\/font><\/strong><\/u><\/a><\/div>\n<\/ol>\n<\/ul>\n<div align=\"justify\">And the results as reported in the <a href=\"http:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/nda\/2011\/022567Orig1s000MedR.pdf\" target=\"_blank\"><u><strong><font color=\"#200020\">FDA Medical Report<\/font><\/strong><\/u><\/a>:         <\/div>\n<div align=\"center\"><img decoding=\"async\" vspace=\"3\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/viibryd-3.gif\" \/><\/div>\n<p align=\"justify\">I don&#8217;t take or have access to the <em>Journal of Clinical Psychiatry<\/em>, so I had to look elsewhere for the timeline data for the Viibryd Trials and found it <a href=\"http:\/\/www.viibrydhcp.com\/Efficacy.aspx\" target=\"_blank\"><u><strong><font color=\"#660033\">here<\/font><\/strong><\/u><\/a> on their web-site. My new hobby is re-displaying the industry generated data on graphs that start with zero, so here for your perusal is their graphically reformatted data from the two trials to compare with their versions:<\/p>\n<div align=\"center\"><img decoding=\"async\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/viibryd-6.gif\" \/><br \/>    <sup>Trial 4: Graphic Rescaled<br \/> <\/sup><\/div>\n<p>   <\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"453\" vspace=\"3\" height=\"272\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/viibryd-4.gif\" \/><br \/>     <sup>Trial 7: Graphic Rescaled<\/sup><\/div>\n<p align=\"justify\">So what&#8217;s this all about? Just another SSRI with a lightweight drug effect on depression, some way overblown advantages like less sexual side effects and rapid onset that probably aren&#8217;t real [see <a target=\"_blank\" href=\"http:\/\/thecarlatreport.com\/four-%E2%80%9Cnew%E2%80%9D-antidepressants-or-are-they-free-article\"><u><strong><font color=\"#200020\">Carlat<\/font><\/strong><\/u><\/a>]. But there are some other things: five failed Phase 2 studies with <strong>Merck<\/strong> and <strong>GSK<\/strong>; Clinical Trials financed by <strong>Genaissance<\/strong> Pharmaceuticals and<strong> Forest<\/strong> Laboratories; a Study Director [Carol Reed MD] who is working for <strong>Genaissance<\/strong> on one study and then <strong>Forest<\/strong> for the next one; along the way, she&#8217;s also listed with <strong>Clinical Data <\/strong>and <strong>PGxHealth LLC<\/strong> as well. Whose drug is this after all? Is the entire Pharmaceutical Industry involved in marketing this drug? So I started trying to figure that out and things got even more confusing. The drug is now being sold by <u><strong><font color=\"#004400\">Forest Laboratories<\/font><\/strong><\/u>, but that turns out to be a very long story deserving another post of its own.  <\/p>\n<div align=\"justify\">But before moving on to the corporate intrigue involved in this drug being released, let me reiterate something you may have missed along the way, the legend under the data for Trial 7:<\/div>\n<div align=\"center\"><img decoding=\"async\" vspace=\"3\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/viibryd-7.gif\" \/><\/div>\n<div align=\"justify\">What can a person take from that? Two subjects <em>double dipping<\/em> in Clinical Trials? What does that say about the modern Clinical Research Industry? Nothing good I would think&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>FDA Slams Viibryd: Better Sexual Profile Claim &ldquo;Not Supported by the Data&rdquo; The Carlat Psychiatry Blog by Danny Carlat October 26, 2011 The September 2011 issue of the Journal of Clinical Psychiatry created history in two ways. First, the journal published this article written by FDA staff critically reviewing the efficacy and safety data of [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15552","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/15552","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=15552"}],"version-history":[{"count":30,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/15552\/revisions"}],"predecessor-version":[{"id":15645,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/15552\/revisions\/15645"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=15552"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=15552"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=15552"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}