{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT05017311","title":"Optimized Predictive Treatment In Medications for Unipolar Major Depression (OPTIMUM-D)","sponsor":"Nova Scotia Health Authority","phases":["PHASE4"],"status":"RECRUITING","indication":null,"disease":"major depressive disorder"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of SLC6A4, DRD2, HTR1A, HTR2A has somatic-mutation evidence in major depressive disorder","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: SLC6A4 in major depressive disorder","url":"https://platform.opentargets.org/evidence/ENSG00000108576/MONDO_0002009","date":"2026-11-12T04:06:10.032Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"yes","detail":"DRD2: germline; HTR2A: germline","rule":"Any germline or somatic human genetic evidence for the target in this cancer, counted apart from animal-model and literature evidence","source":{"label":"Open Targets: DRD2 in major depressive disorder","url":"https://platform.opentargets.org/evidence/ENSG00000149295/MONDO_0002009","date":"2026-11-12T04:06:10.032Z"},"context":[{"figure":"2.6× relative probability of success, phase 1 to launch, with human genetic support","dataset":"Minikel et al., Nature 2024","years":"drug programs to 2023","caveat":"All therapy areas, mostly germline evidence; not a probability for this program."}]},{"id":"pediatric_target","label":"Pediatric target","value":"no","detail":"Not on the FDA list","rule":"Target is on FDA's Pediatric Molecular Target List (relevant targets); membership alone neither requires nor waives a study","source":{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"},"context":[]},{"id":"haematologic","label":"Haematologic cancer","value":"no","detail":"Solid tumour","rule":"From the indication, or the registry conditions when no indication matches","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"},"context":[{"figure":"Likelihood of approval from phase 1: 7.5% haematologic vs 4.6% solid","dataset":"BIO / Informa / QLS 2021","years":"2011–2020","caveat":"Population-level, not a prediction."}]}],"facts":[{"label":"SLC6A4 (via Escitalopram)","text":"Evidence types in major depressive disorder: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: SLC6A4 in major depressive disorder","url":"https://platform.opentargets.org/evidence/ENSG00000108576/MONDO_0002009","date":"2026-11-12T04:06:10.032Z"}},{"label":"DRD2 (via Brexpiprazole)","text":"Evidence types in major depressive disorder: literature, genetic_association, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, gwas_credible_sets, europepmc.","source":{"label":"Open Targets: DRD2 in major depressive disorder","url":"https://platform.opentargets.org/evidence/ENSG00000149295/MONDO_0002009","date":"2026-11-12T04:06:10.032Z"}},{"label":"HTR1A (via Brexpiprazole)","text":"Evidence types in major depressive disorder: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: HTR1A in major depressive disorder","url":"https://platform.opentargets.org/evidence/ENSG00000178394/MONDO_0002009","date":"2026-11-12T04:06:10.032Z"}},{"label":"HTR2A (via Brexpiprazole)","text":"Evidence types in major depressive disorder: literature, animal_model, genetic_association, clinical; literature and animal_model listed separately from human genetics. Datasources: clinical_precedence, eva, europepmc, impc.","source":{"label":"Open Targets: HTR2A in major depressive disorder","url":"https://platform.opentargets.org/evidence/ENSG00000102468/MONDO_0002009","date":"2026-11-12T04:06:10.032Z"}}],"pending":[{"what":"Normal-tissue expression in vital organs","source":"Human Protein Atlas (ticket 36)"},{"what":"Pan-essential in cell lines","source":"DepMap (ticket 36)"},{"what":"Approved drug on this target","source":"Drugs@FDA (ticket 30)"}]},{"n":2,"question":"Can the result be trusted?","flags":[{"id":"randomised","label":"Randomised","value":"yes","detail":"Randomised allocation","rule":"Registry allocation field","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"400 planned; each patient moves a rate by 100 ÷ 400 = 0.3 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Change in Montgomery Asberg Depression Rating Scale (MADRS) scores from baseline","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"},"context":[{"figure":"Non-OS primary endpoint: odds ratio 2.79 for a positive phase 3","dataset":"Otsuka 2021, 400 phase 3 oncology trials","years":"to 2020","caveat":"Shown with the next figure: a surrogate is easier to hit, and often a weak guide to survival."},{"figure":"52% of surrogate-to-OS correlations are low","dataset":"Prasad 2015","years":"published to 2014","caveat":"Shown with the figure above."}]},{"id":"results_overdue","label":"Results overdue","value":"no","detail":"Primary completion expected 2028-12-31; not yet due","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"},"context":[]}],"facts":[],"pending":[{"what":"Treated and evaluable counts, assessor, confirmed response, follow-up and data cutoff","source":"Readout extraction (ticket 32)"},{"what":"Primary endpoint changed between registry versions","source":"Registry versions in the store (ticket 32)"}]},{"n":3,"question":"What must it beat?","flags":[],"facts":[],"pending":[{"what":"Control-arm result and approved therapies for the same segment, with label links","source":"Drugs@FDA, FDA labels and readouts (tickets 30, 32)"}]},{"n":4,"question":"Too crowded, or too late?","flags":[],"facts":[{"label":"Stopped on this target","text":"190 terminated, withdrawn or suspended trials of drugs against SLC6A4; 24 give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"SLC6A4: what already stopped","url":"/target/ENSG00000108576#stopped","date":"2026-11-12T04:06:10.077Z"}}],"pending":[{"what":"Programs on the target by phase and months behind the leader","source":"Programs and Drugs@FDA (ticket 33)"}]},{"n":5,"question":"Can it be approved, and stay approved?","flags":[{"id":"single_country","label":"Single-country","value":"yes","detail":"All 10 sites in Canada","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311?tab=locations","date":"2026-11-12T04:06:10.032Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMA/PE/0000183866 (brexpiprazole, Treatment of schizophrenia): PM: decision on the application for modification of an agreed PIP, 5 Dec 2024","rule":"An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name","source":{"label":"EMA EMA/PE/0000183866","url":"https://www.ema.europa.eu/en/medicines/human/paediatric-investigation-plans/ema-pe-0000183866","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_orphan","label":"EU orphan designation","value":"no","detail":"No EU orphan designation names Escitalopram, Brexpiprazole","rule":"An EU orphan designation lists the drug as its active substance (exact name) or belongs to a medicine that does; withdrawn and expired designations are listed with their status","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-orphan_designations-json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_authorised","label":"Authorised in the EU","value":"yes","detail":"Rxulti: authorised since 26 Jul 2018","rule":"An EMA medicine record lists the drug as its active substance or INN, exact name; national-only authorisations are not in this file","source":{"label":"EMA EPAR Rxulti","url":"https://www.ema.europa.eu/en/medicines/human/EPAR/rxulti","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"fda_orphan","label":"FDA orphan designation","value":"not published","detail":"FDA's orphan designation database turns away automated requests, so this app does not read it; search it by hand at the link","rule":"Would be: an FDA orphan designation names the drug","source":{"label":"FDA orphan designations search","url":"https://www.accessdata.fda.gov/scripts/opdlisting/oopd/","date":""},"context":[]},{"id":"fda_ped_approval","label":"FDA pediatric oncology approval","value":"no","detail":"FDA's table lists no pediatric approval of Escitalopram, Brexpiprazole","rule":"FDA's Pediatric Oncology Drug Approvals table names the drug","source":{"label":"FDA Pediatric Oncology Drug Approvals (content current as of 2026-03-03)","url":"https://www.fda.gov/about-fda/oncology-center-excellence/pediatric-oncology-drug-approvals","date":"2026-11-12T04:06:10.106Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"58 interventional studies of Escitalopram, Brexpiprazole include patients under 18; 8 are recruiting, not yet recruiting or active","rule":"The registry's age group includes Child (birth to 17 years), which also counts studies that set no minimum age","source":{"label":"ClinicalTrials.gov search","url":"https://clinicaltrials.gov/search?intr=%22Escitalopram%22+OR+%22Brexpiprazole%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-12T04:06:10.130Z"},"context":[]}],"facts":[{"label":"Caveat","text":"Site counts are not patients per country, and trials registered only outside ClinicalTrials.gov are not covered. Where the sites are is a fact about the record, not a judgement of its quality."},{"label":"Cited case","text":"In February 2022 FDA asked its Oncologic Drugs Advisory Committee whether sintilimab's application, resting on ORIENT-11, a phase 3 run only in China, needed further trials showing it applies to US patients and US practice. One case, not a rule.","source":{"label":"FDA, ODAC 10 Feb 2022, draft questions","url":"https://www.fda.gov/media/156017/download","date":"2022-02-10"}},{"label":"Rare pediatric disease voucher","text":"FDA, content current as of 29 Apr 2026: “As of February 3, 2026, enactment of the Consolidated Appropriations Act, 2026, the rare pediatric disease PRV program will sunset after September 30, 2029. FDA may not award any PRVs under this program after September 30, 2029.” Voucher sale prices are not shown here; they appear only as company-reported news.","source":{"label":"FDA: Rare Pediatric Disease Designation and Priority Review Voucher Programs","url":"https://www.fda.gov/industry/medical-products-rare-diseases-and-conditions/rare-pediatric-disease-designation-and-priority-review-voucher-programs","date":"2026-11-11"}}],"pending":[{"what":"Precedent approvals for target, modality and endpoint; accelerated-approval status","source":"Drugs@FDA and FDA accelerated-approval tables (ticket 30)"}]},{"n":6,"question":"Can the sponsor finish?","flags":[],"facts":[{"label":"Sponsor","text":"Nova Scotia Health Authority (academic or other)","source":{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"}},{"label":"principal investigator","text":"Rudolf Uher, MD, PhD, Nova Scotia Health Authority","source":{"label":"Person page","url":"/person/Rudolf%20Uher%2C%20MD%2C%20PhD","date":"2026-11-12T04:06:10.032Z"}}],"pending":[{"what":"Filed cash, quarterly spend and the runway arithmetic","source":"SEC XBRL company facts (ticket 37)"},{"what":"Sponsor's completed vs stopped oncology trials and results-reporting record","source":"Registry, by company (ticket 37)"}]}],"limits":"Public records cannot show: sales forecasts; a probability of success for this asset; full deal terms and net prices; FDA designations and action dates before approval (shown only as company-reported); clinical holds unless the company disclosed them; manufacturing; patents on unapproved drugs; whether preclinical findings have been replicated.","sources":[{"label":"ClinicalTrials.gov NCT05017311","url":"https://clinicaltrials.gov/study/NCT05017311","date":"2026-11-12T04:06:10.032Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-12T04:06:10.032Z"},{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"}]},"source":"ClinicalTrials.gov + Open Targets","fetchedAt":"2026-11-12T04:06:10.021Z"}