Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
  • A61K38/07—Tetrapeptides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/33—Heterocyclic compounds
  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/4025—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil not condensed and containing further heterocyclic rings, e.g. cromakalim
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/24—Antidepressants
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D403/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00
  • C07D403/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings
  • C07D403/06—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, not provided for by group C07D401/00 containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms

Definitions

• Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It is estimated that 50% or more of patients with depression do not experience an adequate therapeutic response to known administered drugs. In most instances, 2 or more weeks of drug therapy are need before meaningful improvement is observed, as noted in an open-label study on pharmacological treatment of depression. (Rush et al, Am. J. Psychiatry 2006, 163 : 1905). There currently is no single effective treatment for depression, anxiety, and other related diseases.
• N-methyl-d-aspartate (NMDA) receptor is a postsynaptic, ionotropic receptor that is responsive to, inter alia, the excitatory amino acids glutamate and glycine and the synthetic compound NMDA.
• the NMDA receptor controls the flow of both divalent and monovalent ions into the postsynaptic neural cell through a receptor associated channel (Foster et al, Nature 1987, 329:395-396; Mayer et al, Trends in Pharmacol. Sci. 1990, 1 1 :254-260).
• the NMDA receptor has been implicated during development in specifying neuronal architecture and synaptic connectivity, and may be involved in experience-dependent synaptic modifications.
• NMDA receptors are also thought to be involved in long term potentiation and central nervous system disorders.
• the NMDA receptor is believed to consist of several protein chains embedded in the postsynaptic membrane.
• the first two types of subunits discovered so far form a large extracellular region, which probably contains most of the allosteric binding sites, several transmembrane regions looped and folded so as to form a pore or channel, which is permeable to Ca , and a carboxyl terminal region.
• the opening and closing of the channel is regulated by the binding of various ligands to domains (allosteric sites) of the protein residing on the extracellular surface.
• the binding of the ligands is thought to affect a conformational change in the overall structure of the protein which is ultimately reflected in the channel opening, partially opening, partially closing, or closing.
• the NMDA receptor plays a major role in the synaptic plasticity that underlies many higher cognitive functions, such as memory acquisition, retention and learning, as well as in certain cognitive pathways and in the perception of pain (Collingridge et ah, The NMDA Receptor, Oxford University Press, 1994). In addition, certain properties of NMDA receptors suggest that they may be involved in the information-processing in the brain that underlies consciousness itself.
• the NMDA receptor has drawn particular interest since it appears to be involved in a broad spectrum of CNS disorders. For instance, during brain ischemia caused by stroke or traumatic injury, excessive amounts of the excitatory amino acid glutamate are released from damaged or oxygen deprived neurons. This excess glutamate binds to the NMDA receptors which opens their ligand-gated ion channels; in turn the calcium influx produces a high level of intracellular calcium which activates a biochemical cascade resulting in protein degradation and cell death. This phenomenon, known as excitotoxicity, is also thought to be responsible for the neurological damage associated with other disorders ranging from hypoglycemia and cardiac arrest to epilepsy.
• NMDA receptors have also been implicated in certain types of spatial learning.
• GLYX-13 is exemplified by the following structure:
• GLYX-13 exhibits nootropic, neuroprotective and antinociceptive activity, and enhances learning, memory and cognition in vivo. GLYX-13, has also been shown to exhibit rapid-acting, robust, and sustained antidepressant activity and to lack the pyschotomimetic side effects associated with other drugs and mechanisms that target the NMDA receptor.
• This disclosure provides methods and regimens for treating depression (e.g., treatment-resistant depression) in a patient (e.g., a patient in need of such treatment), for example, a patient being treated for depression by another anti-depressant without achieving significantly full response or effectiveness to treatment on the other anti-depressant alone.
• depression e.g., treatment-resistant depression
• a patient e.g., a patient in need of such treatment
• another anti-depressant for depression by another anti-depressant without achieving significantly full response or effectiveness to treatment on the other anti-depressant alone.
• Candidate patient(s) can include, without limitation, individual(s) that (i) have self-reported one or more symptoms of depression; and/or (ii) have been diagnosed as suffering from depression (e.g., untreated depression, e.g., untreated for 4, 5, 6, 7, 8 or more weeks), e.g., received a score greater than 7 on the Hamilton Depression Rating Scale ("HDRS") and/or a score greater than 10 on the Montgomery-Asberg Depression Rating Scale (MADRS); and/or (iii) have undergone, or are currently undergoing, treatment for depression with at least one other antidepressant; and/or (iv) are predisposed to, or at risk of, depression.
• depression e.g., untreated depression, e.g., untreated for 4, 5, 6, 7, 8 or more weeks
• HDRS Hamilton Depression Rating Scale
• MADRS Montgomery-Asberg Depression Rating Scale
• iii have undergone, or are currently undergoing, treatment for depression with at least one other antidepress
• the methods and regimens disclosed herein include administering a particular dose (or a range of doses) of GLYX-13 (or a composition containing GLYX-13) at a particular frequency (or a range of frequencies, e.g., weekly or once every two weeks) over a time period that is sufficient so as to provide the patient with two or more (e.g., two, three, four, five, six, seven, eight, nine, ten, eleven, twelve) doses of GLYX-13 over said time period.
• the period of time during which the patient receives the two or more doses is sometimes referred to herein as an "induction period of time" (also sometimes referred to herein as "repeat” or “repeated” dosing).
• the methods and regimens described herein can further include a "rest period of time,” during which time the patient does not receive GLYX-13 (or a composition containing the same).
• the methods and regimens include two or more treatment cycles (e.g. continuous cycles), in which each cycle includes an induction period of time and a rest period of time.
• each of the treatment cycles can be independently varied from one another in terms of dosage, frequency, duration of induction period of time, duration of rest period of time, etc.
• the methods and regimens described herein can further include administering one or more other anti-depressants at any point before, during, or after any induction period of time and/or any rest period of time.
• this disclosure features regimens for treating depression in a human patient, which include delivering to the patient GLYX-13 in a cycle of treatment, said cycle comprising intravenously administering a dosage of about 5 mg/kg to about 10 mg/kg of GLYX-13 (or about 2.5 mg/kg to about 10 mg/kg of GLYX-13, or for example, about 225mg to about 900 mg of GLYX-13) per week or every other week for at least four weeks in the cycle followed by at least one week, two weeks, three weeks, four weeks, two months or more where no GLYX-13 is administered.
• FIG. 1 is a graph showing improvements (based on HDRS scale) achieved during an induction period of time (identified as “stabilization” on the graph) are generally maintained throughout the rest period of time (identified as “randomized withdrawal” on the graph), although HDRS scores did vary with dosage frequency.
• FIG. 2 is a graph showing a sub-set of data from the graph shown in FIG. 1 and shows that data for subject with drug withdrawn appear to show long-lasting effect of GLYX- 13.
• FIG. 3 is a series of graphs showing that GLYX-13 metaplasticity enhances long- term potentiation ("LTP") 24 hours and one week following a single dose, and persistently enhances LTP following multiple bi-weekly doses.
• LTP long- term potentiation
• FIG. 5 is a graph showing improvements (based on CGI-S scale) achieved during an induction period of time are generally maintained throughout the rest period of time (identified as "Week 7" and "Week 13" on the graph), although CGI-S scores did vary with dosage frequency.
• FIG. 6 is a graph indicated an example of stabilization phase of GLYX-13 if reestablished following forced relapse. Repeated crossover can demonstrate repeated response to GLYX-13 and relapse to placebo.
• FIGS. 7 A and 7B show typical design of randomized withdrawal maintenance study.
• This disclosure provides methods and regimens for treating depression (e.g., treatment-resistant depression) in a patient (e.g., a patient in need of such treatment).
• depression e.g., treatment-resistant depression
• a patient e.g., a patient in need of such treatment.
• Candidate patient(s) can include, without limitation, individual(s) that (i) have self-reported one or more symptoms of depression; and/or (ii) have been diagnosed as suffering from depression (e.g., untreated depression, e.g., untreated for 4, 5, 6, 7, 8 or more weeks), e.g., received a score greater than 7 on the Hamilton Depression Rating Scale ("HDRS") and/or a score greater than 10 on the Montgomery-Asberg Depression Rating Scale (MADRS); and/or (iii) have undergone, or are currently undergoing, treatment for depression with at least one other antidepressant; and/or (iv) are predisposed to, or at risk of, depression.
• depression e.g., untreated depression, e.g., untreated for 4, 5, 6, 7, 8 or more weeks
• HDRS Hamilton Depression Rating Scale
• MADRS Montgomery-Asberg Depression Rating Scale
• iii have undergone, or are currently undergoing, treatment for depression with at least one other antidepress
• the methods and regimens disclosed herein include administering a particular dose (or a range of doses) of GLYX-13 (or a composition containing GLYX-13) at a particular frequency (or a range of frequencies, e.g., weekly or once every two weeks) over a time period that is sufficient so as to provide the patient with two or more (e.g., two, three, four, five, six, seven, eight, nine, ten, eleven, twelve) doses of GLYX-13 over said time period.
• the period of time during which the patient receives the two or more doses is sometimes referred to herein as an "induction period of time" (also sometimes referred to herein as "repeat” or “repeated” dosing).
• the methods and regimens described herein can further include a "rest period of time,” during which time the patient does not receive GLYX-13 (or a composition containing the same).
• the methods and regimens include two or more treatment cycles (e.g. continuous cycles), in which each cycle includes an induction period of time and a rest period of time.
• each of the treatment cycles can be independently varied from one another in terms of dosage, frequency, duration of induction period of time, duration of rest period of time, etc.
• the methods and regimens described herein can further include administering one or more other anti-depressants at any point before, during, or after any induction period of time and/or any rest period of time.
• Depression is a common psychiatric disorder and refers to a mental state of low mood and aversion to activity.
• Various symptoms associated with depression include persistent anxious or sad feelings, feelings of helplessness, hopelessness, pessimism, and/or worthlessness, low energy, restlessness, irritability, fatigue, loss of interest in pleasurable activities or hobbies, excessive sleeping, overeating, appetite loss, insomnia, thoughts of suicide, and suicide attempts.
• the presence, severity, frequency, and duration of the above mentioned symptoms vary on a case to case basis.
• a patient may have at least one, at least two, at least three, at least four, or at least five of these symptoms.
• the most common depression conditions include Major Depressive Disorder and Dysthymic Disorder. Other depression conditions develop under unique circumstances. Such depression conditions include but are not limited to Psychotic depression, Postpartum depression, Seasonal affective disorder (SAD), mood disorder, depressions caused by chronic medical conditions such as cancer or chronic pain, chemotherapy, chronic stress, post-traumatic stress disorders, and Bipolar disorder (or manic depressive disorder).
• SAD Seasonal affective disorder
• mood disorder depressions caused by chronic medical conditions such as cancer or chronic pain, chemotherapy, chronic stress, post-traumatic stress disorders, and Bipolar disorder (or manic depressive disorder).
• Treatment resistant depression occurs in patients suffering from depression who are resistant to standard pharmacological treatments, including tricyclic antidepressants, MAOIs, SSRIs, esketamine or other NMDA modulators, double and triple uptake inhibitors and/or anxiolytic drugs, and antipsychotic treatments, as well non-pharmacological treatments such as psychotherapy, electroconvulsive therapy, vagus nerve stimulation and/or transcranial magnetic stimulation.
• standard pharmacological treatments including tricyclic antidepressants, MAOIs, SSRIs, esketamine or other NMDA modulators, double and triple uptake inhibitors and/or anxiolytic drugs, and antipsychotic treatments, as well non-pharmacological treatments such as psychotherapy, electroconvulsive therapy, vagus nerve stimulation and/or transcranial magnetic stimulation.
• a treatment resistant-patient may be identified as one who fails to experience alleviation of one or more symptoms of depression (e.g., persistent anxious or sad feelings, feelings of helplessness, hopelessness, pessimism) despite undergoing one or more standard pharmacological or non- pharmacological treatment.
• a treatment-resistant patient is one who fails to experience alleviation of one or more symptoms of depression despite undergoing treatment with two different antidepressant drugs.
• a treatment-resistant patient is one who fails to experience alleviation of one or more symptoms of depression despite undergoing treatment with three or four different antidepressant drugs.
• a treatment- resistant patient may also be identified as one who is unwilling or unable to tolerate the side effects of one or more standard pharmacological or non-pharmacological treatment.
• Treating includes any effect, e.g., lessening, reducing, modulating, or eliminating, that results in the improvement of the condition, disease, disorder and the like.
• “Individual,” “patient,” or “subject” are used interchangeably and include any animal, including mammals, preferably mice, rats, other rodents, rabbits, dogs, cats, swine, cattle, sheep, horses, or primates, and most preferably humans.
• an effective amount can be an amount effective to treat any of the diseases, disorders, and conditions described herein (e.g., treatment-resistant depression).
• an effective amount can refer the quantity needed to achieve a desired therapeutic and/or prophylactic effect, e.g., during an ensuing rest period of time, the patient substantially maintains a level of improvement of depression symptoms as compared to a level of improvement achieved after an induction period of time as indicated by one or more of the following scales or measures: HDRS, MADRS, or % reduction in symptoms from baseline (e.g., as determined immediately after the induction period and during the rest period of time).
• the patient substantially maintains a HDRS-17 score of less than or about 7; and/or maintains a MADRS score of less than or about 10; and/or maintains a greater than or equal to about 50% reduction in depression symptoms from baseline.
• Achieving and maintaining improvement of depression symptoms in a patient e.g., achieving and maintaining a HDRS-17 score of less than or about 7; and/or a MADRS score of less than or about 10; and/or a greater than or equal to about 50% reduction in depression symptoms from baseline
• stabilizing a patient.
• GLYX-13 is represented by the following formula:
• GLYX-13 may be obtained by recombinant or synthetic methods such as those described in US Patents 5,763,393 and 4,086, 196 herein incorporated by reference. Also contemplated are polymorphs, hydrates, homologs, solvates, free bases, and/or suitable salt forms of GLYX 13 such as, but not limited to, the acetate salt.
• the peptide may be in cyclized or non-cyclized form as further described in US 5,763,393.
• a GLYX-13 analog may include an insertion or deletion of a moiety on one or more of the Thr or Pro groups such as a deletion of CH 2 , OH, or H 2 moiety.
• GLYX-13 may be optionally substituted with one or more halogens, C1-C3 alkyl (optionally substituted with halogen or amino), hydroxyl, and/or amino.
• Other compounds contemplated for use herein include Glycine-site partial agonists of the NMDAR disclosed in US 5,763,393, US 6, 107,271, and Wood et al, Neuro. Report, 19, 1059-1061, 2008, the entire contents of which are herein incorporated by reference.
• each induction period of time is, independently, from about three weeks to about sixteen weeks, from about three weeks to about twelve weeks, from about three weeks to about ten weeks, from about three weeks to about eight weeks, from about three weeks to about six weeks; from about four weeks to about sixteen weeks, from about four weeks to about twelve weeks, from about four weeks to about ten weeks, from about four weeks to about eight weeks, from about four weeks to about six weeks; from about five weeks to about sixteen weeks, from about five weeks to about twelve weeks, from about five weeks to about ten weeks, from about five weeks to about eight weeks, from about five weeks to about six weeks; from about six weeks to about sixteen weeks, from about six weeks to about twelve weeks, from about six weeks to about ten weeks, or from about six weeks to about eight weeks.
• each induction period of time is, independently, from about three weeks to about twelve weeks, e.g., from about four weeks to about twelve weeks, from about six weeks to about twelve weeks, from about five weeks to about eight weeks. In certain embodiments, each induction period of time is, independently, about three weeks, about four weeks, about five weeks, about six weeks, about seven weeks, about eight weeks, about ten weeks, or about twelve weeks, e.g., about six weeks.
• a therapeutically effective amount of GLYX-13 for adult human treatment administered, for example, during an induction period of time are in the range of about 0.01 mg/kg to about 1000 mg/kg per administration (e.g., about 0.01 mg/kg to about 100 mg/kg, about 0.01 mg/kg to about 50 mg/kg, about 0.01 mg/kg to about 25 mg/kg, about 0.01 mg/kg to about 10 mg/kg, about 0.1 mg/kg to about 100 mg/kg, about 0.1 mg/kg to about 50 mg/kg, about 0.1 mg/kg to about 50 mg/kg, about 0.1 mg/kg to about 10 mg/kg, about 1 mg/kg to about 100 mg/kg, about 1 mg/kg to about 50 mg/kg, about 1 mg/kg to about 50 mg/kg per day, about 1 mg/kg to about 10 mg/kg, or about 1 mg/kg to about 10 mg/kg per administration, e.g., once a week, twice a week or three times a week and/or
• the GLYX-13 is administered weekly or every other week for a first period of time (i.e., an induction period of time) of about three weeks to about twelve weeks (e.g., sequentially administering about 5 mg/kg or about 10 mg/kg weekly or every other week for three to twelve weeks, five to ten weeks, three to six weeks, six to twelve weeks or more), and wherein the rest period of time is about one to about six weeks (or more), e.g. one, two three, four, five, six, seven or eight weeks or more.
• a first period of time i.e., an induction period of time
• a first period of time i.e., an induction period of time
• the rest period of time is about one to about six weeks (or more), e.g. one, two three, four, five, six, seven or eight weeks or more.
• the methods and regimens include two or more treatment cycles (e.g. continuous cycles), in which each cycle includes an induction period of time and a rest period of time.
• each of the treatment cycles can be independently varied from one another in terms of dosage, frequency, duration of induction period of time, duration of rest period of time, etc.
• Combination therapy is intended to embrace administration of multiple therapeutic agents in a sequential manner, that is, wherein each therapeutic agent is administered at a different time, as well as administration of these therapeutic agents, or at least two of the therapeutic agents, in a substantially simultaneous manner.
• Substantially simultaneous administration can be accomplished, for example, by administering to the subject a single tablet or capsule or i.v. solution having a fixed ratio of each therapeutic agent or in multiple, single tablets, capsules, or i.v. solutions for each of the therapeutic agents.
• Sequential or substantially simultaneous administration of each therapeutic agent can be effected by any appropriate route including, but not limited to, oral routes, intravenous routes, intramuscular routes, and direct absorption through mucous membrane tissues.
• the therapeutic agents can be administered by the same route or by different routes.
• the NMDAR antagonist is selected from the group consisting of ketamine, esketamine, memantine, lanicemine (AZD6765), CERC-301, dextromethorphan, dextrorphan, phencyclidine, dizocilpine (MK-801), amantadine, ifenprodil, and riluzole, or a pharmaceutically acceptable salt or prodrug thereof. Also contemplated are derivatives of the aforementioned NMDAR antagonists.
• Also contemplated herein are methods of treating depression that include administering GLYX-13 in combination with ( e.g. simultaneously or sequentially) other non- pharmacological treatments such as psychotherapy, electroconvulsive therapy, vagus nerve stimulation and/or transcranial magnetic stimulation.
• wetting agents such as sodium lauryl sulfate and magnesium stearate, as well as coloring agents, release agents, coating agents, sweetening, flavoring and perfuming agents, preservatives and antioxidants may be present in the formulated agents.
• Formulations suitable for oral administration may be in the form of capsules, cachets, pills, tablets, lozenges (using a flavored basis, usually sucrose and acacia or tragacanth), powders, granules, or as a solution or a suspension in an aqueous or non-aqueous liquid, or as an oil-in-water or water-in-oil liquid emulsion, or as an elixir or syrup, or as pastilles (using an inert base, such as gelatin and glycerin, or sucrose and acacia), each containing a predetermined amount of a subject composition thereof as an active ingredient.
• Compositions of the present invention may also be administered as a bolus, electuary, or paste.
• compositions of this invention suitable for parenteral administration comprise a subject composition in combination with one or more pharmaceutically-acceptable sterile isotonic aqueous or non-aqueous solutions, dispersions, suspensions or emulsions, or sterile powders which may be reconstituted into sterile injectable solutions or dispersions just prior to use, which may contain antioxidants, buffers, bacteriostats, solutes which render the formulation isotonic with the blood of the intended recipient or suspending or thickening agents.
• Emulsifying agents include, but are not limited to, lecithin, sorbitan monooleate, and acacia.
• Nonaqueous vehicles include, but are not limited to, edible oils, almond oil, fractionated coconut oil, oily esters, propylene glycol, and ethyl alcohol.
• Preservatives include, but are not limited to, methyl or propyl hydroxybenzoate and sorbic acid.
• Contemplated compounds may also be formulated for parenteral administration including, but not limited to, by injection or continuous infusion. Formulations for injection may be in the form of suspensions, solutions, or emulsions in oily or aqueous vehicles, and may contain formulation agents including, but not limited to, suspending, stabilizing, and dispersing agents.
• the composition may also be provided in a powder form for reconstitution with a suitable vehicle including, but not limited to, sterile, pyrogen- free water.
• the present invention has multiple aspects, illustrated by the following non-limiting examples.
• FIG. 6 is a graph showing that efficacy of GLYX-13 was reestablished following forced relapse. Repeated crossover demonstrated repeated response to GLYX-13 and relapse to placebo.
• Example 2 Repeat Dose Study A repeat dose study, as reflected in Example 1 was conducted on human subjects using adjunctive dosing (patients were currently taking another antidepressant medication).
• subjects who had achieved response to GLYX-13 at some visit were assigned to weekly or biweekly dosing based on time to relapse during placebo administration and randomized to continue receiving GLYX-13 or placebo (randomized withdrawal) for a subsequent 6 weeks of dosing.
• Subjects were blind to the treatments.
• Third party evaluators blind to treatment and protocol were utilized. Treatment dose and interval were calculated by an interactive web-based response system based on a mathematical algorithm; site personnel were blinded to treatment.
• Adjunctive GLYX-13 caused reduction in HDRS-17 scores in subjects with MDD that had responded inadequately to another antidepressant agent. Following the first few doses, response relapsed over a week or more but as treatment continued, decrease in HDRS-17 in response to each dose of GLYX-13 progressively decreased such that following 6 weeks of dosing scores were reduced from 23.5+0.34 at baseline to 10.3+0.65 in responders. Maximum reduction of HDRS-17 scores in all dosing groups was apparent by week 10 (week 3 of randomized withdrawal). Following 6 weeks of dosing, withdrawal of GLYX-13 was not associated with return of HDRS-17 score toward baseline for up to 10 weeks.

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