Infliximab treatment for cognitive dysfunction in depressed individuals with inflammation
The Role of Inflammation in Cognitive Dysfunction in Acute Depression as Determined by Experimental Inhibition of Tumor Necrosis Factor-alpha Signaling in a Randomized Controlled Trial.
This study is testing if infliximab can help improve thinking and memory in adults with depression who also have signs of inflammation.
Quick facts
| Phase | Phase 2 |
|---|---|
| Study type | Interventional |
| Enrollment | 100 (estimated) |
| Ages | 25 Years to 50 Years |
| Sex | All |
| Sponsor | Massachusetts General Hospital Academic / other |
| Drugs / interventions | infliximab |
| Locations | 1 site (Boston, Massachusetts) |
| Trial ID | NCT06136546 on ClinicalTrials.gov |
What this trial studies
This mechanistic randomized controlled trial investigates the effects of infliximab, a tumor necrosis factor inhibitor, on cognitive dysfunction in adults with Major Depressive Disorder who exhibit an inflammatory phenotype. Participants will be randomly assigned to receive either infliximab or a placebo, and their cognitive functions, including psychomotor speed and executive functioning, will be assessed through daily mobile-based evaluations and in-person clinician assessments over a two-week period. Blood samples will be collected to measure immune biomarkers, providing insights into the relationship between inflammation and cognitive impairment in depression.
Who should consider this trial
Good fit: Ideal candidates are adults aged 25-50 with Major Depressive Disorder and elevated C reactive protein levels indicating inflammation.
Not a fit: Patients who do not exhibit an inflammatory phenotype or have not been off antidepressant treatment for the required duration may not benefit from this study.
Why it matters
Potential benefit: If successful, this study could lead to improved cognitive functioning in depressed patients with inflammation, enhancing their overall quality of life.
How similar studies have performed: While the approach of using infliximab for cognitive dysfunction in depression is novel, previous studies have explored the role of inflammation in depression with varying results.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria:
1. Aged 25-50 years
2. Able to read and understand English and willing to provide informed consent/comply with the study protocol
3. Willingness to complete intravenous infusion and have blood drawn
4. Exhibit circulating blood level of C reactive protein ≥ 3mg/L
5. Diagnosed with Major Depressive Disorder
6. Moderate depressive symptom severity, as indicated by score ≥15 on the Hamilton Depression Rating Scale
7. Antidepressant treatment free for at least 4 weeks prior to study entry or be on a fixed treatment regimen for at least 4 weeks; willingness to continue treatment status (i.e., change/begin new treatment) until study termination
8. Willingness not to begin/change therapies until study termination (maximum of three weeks following screening)
9. Be of non-childbearing potential per the following specific criteria:
a. Non-childbearing potential (e.g., physiologically incapable of becoming pregnant, i.e., permanently sterilized (status post hysterectomy, bilateral tubal ligation), or is post-menopausal with her last menses at least one year prior to screening); or b. Childbearing potential and meets the following criteria: i. A negative serum pregnancy test within thirty days of infusion (may be repeated closer to infusion date at the discretion of the PI or study staff) and abstinent after the negative serum pregnancy test and prior to infusion; or ii. Using any form of hormonal birth control, on hormone replacement therapy started prior to 12 months of amenorrhea, using an intrauterine device (IUD), having a monogamous relationship with a partner who has had a vasectomy, or is sexually abstinent; iii. Continuously use one of the following methods of birth control over the last six months: implants, injectable or patch hormonal contraception, oral contraceptives, IUD, double-barrier contraception, sexual abstinence.
Exclusion Criteria:
1. Medical conditions that could confound interpretation or increase participant risk, as indicated via medical history or laboratory testing; exclusionary medical conditions will include:
i. acute injury/infection within one week of study initiation or infection within one month of study initiation that required antibiotic/antiviral treatment ii. chronic infection (e.g., hepatitis B or C or HIV) or history of Covid 19 infection within the past 6 months or with persisting symptoms.
iii. latent infection (e.g., tuberculosis, fungal infections), or history of recurrent infections, iv. uncontrolled cardiovascular, endocrine, hematologic, hepatic, renal or neurologic disease (as determined by medical history, physical exam and laboratory testing) v. cancer history vi. autoimmune conditions; neurologic conditions (controlled) that are known to substantially impact cognitive function (e.g., stroke).
Of note, stable medical conditions such as diabetes and cardiovascular disease, will be allowed in the study as they can contribute to endogenous inflammation.
2. Active antipsychotic and anticonvulsant medication use (that interact with infliximab)
3. Prior use of a TNF antagonist or use of systemic corticosteroids or anti-proliferative agents within one year of study entry
4. History of liver abnormalities
5. Major cognitive impairment as determined by study investigators
6. Active restrictive eating disorder or obsessive compulsive disorder deemed by study investigators to be primary cause of depressive disorder
7. History of a psychotic disorder or Bipolar disorder type I/II
8. Current substance use disorder (i.e., present in last six months), of greater than mild severity
9. Suicidal ideation based on a score ≥3 on the Columbia-Suicide Severity Rating Scale
10. Electroconvulsive therapy (ECT)/deep brain stimulation (DBS) within the last year, or report of persistent negative cognitive effects of ECT/DBS
11. Presence of a transplanted solid organ
12. Medication use affecting immune or cognitive function:
i. Chronic use (\>1 month) of a benzodiazepine more than the equivalent of 2 mg of lorazepam ii. Use of anti-inflammatory agents during the study: non-steroidal anti-inflammatory agents (NSAIDs) (excluding 81mg of aspirin), glucocorticoid containing medicines or statins, or cyclooxygenase-2 (COX-2) inhibitors
13. Considered by the study investigators to be inappropriate for the study due to safety concerns or to be unlikely to complete the protocol
14. History of allergic response to murine products
Where this trial is running
Boston, Massachusetts
- Massachusetts General Hospital — Boston, Massachusetts, United States (Recruiting)
Study contacts
- Study coordinator: Naoise Mac Giollabhui, PhD
- Email: nmacgiollabhui@mgh.harvard.edu
- Phone: 6177241000
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.