Help your patients feel rapid symptom relief in just 3 days1,2

In a 6-week study, ZURZUVAE® (zuranolone) demonstrated clinically meaningful improvement
of postpartum depression (PPD) symptoms at primary and key secondary endpoints shown below1,2

LS mean change from baseline in HAMD-17 total score across the study period1,2

ZURZUVAE 50 mg

Placebo

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Mean baseline HAMD-17 scores (SD): ZURZUVAE 50 mg, 28.6 (2.49); Placebo, 28.8 (2.34).1
HAMD-17, 17-item Hamilton Depression Rating Scale; LS, least squares; SD, standard deviation.

For more information on the HAMD-17, please see the study design below.

The study included 195 adult patients in the full analysis set (N=98 ZURZUVAE 50 mg and N=97 placebo).1,2

ZURZUVAE 50 mg

Placebo

ZURZUVAE clinical trial design

SKYLARK was a 6-week, phase 3, randomized, placebo-controlled, double-blind, multicenter study that evaluated the efficacy and safety of ZURZUVAE 50 mg in women diagnosed with postpartum depression1,2

Primary endpoint​

Change from baseline in HAMD-17 total score at Day 151

Key secondary endpoints included

Change from baseline in HAMD-17 total score at Days 3, 28, and 451

Selected inclusion criteria

  • 18–45 years of age2
  • Baseline HAMD-17 total score ≥261
  • Met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR®) criteria for a major depressive episode with symptom onset in the third trimester or within 4 weeks of delivery and were ≤12 months postpartum1,2

Concomitant oral antidepressant use allowed for patients taking a stable dose ≥30 days before baseline1

85% of patients received ZURZUVAE
or placebo​ as monotherapy1

15% of patients added ZURZUVAE or
placebo to another oral antidepressant1

The HAMD-17 is a gold-standard tool used by psychiatrists to measure depression severity in clinical trials3

17-item, clinician-rated scale used to assess severity of depressive symptoms, including4:

  • Depressed mood
  • Sleep disturbance
  • Anxiety
  • Agitation
  • Loss of interest in activities
  • Loss of energy/fatigue
  • Feelings of guilt
  • Weight loss
  • Suicidal thoughts/action
See the ZURZUVAE HAMD-17 individual item results compared to placebo5

Change from baseline in HAMD-17 individual items at Day 155

(full analysis set, n=183)

SKYLARK was not adequately powered to determine a treatment effect based on change from baseline in individual
items at Day 15. Type 1 error (false positive rate) was not controlled, therefore no conclusions of benefit can be drawn.

HAMD-17, 17-item Hamilton depression rating scale; LS, least squares; SE, standard error; GI, gastrointestinal.
Clinical efficacy of ZURZUVAE

Drs. Greg Mattingly, Bassem Maximos, and Danielle Johnson break down the SKYLARK trial results and discuss what this FDA-approved oral 14-day treatment could mean for patients with PPD.

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Review ZURZUVAE safety data established in clinical studies
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treatment choice for women like these with PPD

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References: 1. ZURZUVAE Prescribing Information. Cambridge, MA: Biogen and Sage Therapeutics, Inc.  2. Deligiannidis KM, Meltzer-Brody S, Maximos B, et al. Zuranolone for the Treatment of Postpartum Depression. Am J Psych. 2023;180(9):668-675. 
3. Gerbasi ME, Eldar-Lissai A, Acaster S, et al. Associations between commonly used patient-reported outcome tools in postpartum depression clinical practice and the Hamilton Rating Scale for Depression. Arch Women’s Ment Health. 2020;23:727-735 
4. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psych. 1960;23:56-62. 5. Deligiannidis KM, Meltzer-Brody S, Maximos B, et al. Zuranolone for the Treatment of Postpartum Depression. Am J Psych. 2023;(Suppl):1-16.

INDICATION

ZURZUVAE® (zuranolone) is indicated for the treatment of postpartum depression (PPD) in adults.

 

IMPORTANT SAFETY INFORMATION

WARNING: IMPAIRED ABILITY TO DRIVE OR ENGAGE IN OTHER POTENTIALLY HAZARDOUS ACTIVITIES

ZURZUVAE causes driving impairment due to central nervous system (CNS) depressant effects.

Advise patients not to drive or engage in other potentially hazardous activities until at least 12 hours after ZURZUVAE administration for the duration of the 14-day treatment course. Inform patients that they may not be able to assess their own driving competence, or the degree of driving impairment caused by ZURZUVAE.

 

WARNINGS AND PRECAUTIONS

Impaired Ability to Drive or Engage in Other Potentially Hazardous Activities

  • ZURZUVAE causes driving impairment due to central nervous system (CNS) depressant effects
  • Advise patients not to drive a motor vehicle or engage in other potentially hazardous activities requiring complete mental alertness, such as operating machinery, until at least 12 hours after ZURZUVAE administration for the duration of the 14-day treatment course. Inform patients that they may not be able to assess their own driving competence or the degree of driving impairment caused by ZURZUVAE

Central Nervous System Depressant Effects

  • ZURZUVAE can cause CNS depressant effects such as somnolence and confusion
  • Somnolence developed in 36% of patients who received ZURZUVAE (50 mg) and in 6% of patients who received placebo daily. Some ZURZUVAE-treated patients developed confusional state. One of these cases was severe, and was also associated with somnolence, dizziness, and gait disturbance
  • A higher percentage of ZURZUVAE-treated patients, compared to placebo-treated patients, experienced somnolence, dizziness, or confusion that required dosage reduction, interruption, or discontinuation
  • Because ZURZUVAE can cause CNS depressant effects, patients may be at higher risk of falls
  • Other CNS depressants such as alcohol, benzodiazepines, opioids, tricyclic antidepressants, or drugs that increase zuranolone concentration, may increase impairment of psychomotor performance or CNS depressant effects such as somnolence, cognitive impairment, and the risk of respiratory depression in ZURZUVAE-treated patients
  • To reduce the risk of CNS depressant effects and/or mitigate CNS depressant effects that occurs with ZURZUVAE treatment:
    • If patients develop CNS depressant effects, consider dosage reduction or discontinuation of ZURZUVAE
    • If use with another CNS depressant is unavoidable, consider dosage reduction
    • Reduce the ZURZUVAE dosage in patients taking strong CYP3A4 inhibitors

Suicidal Thoughts and Behavior

  • In pooled analyses of placebo-controlled trials of chronically administered antidepressant drugs (SSRIs and other antidepressant classes) that included approximately 77,000 adult patients and 4,500 pediatric patients, the incidence of suicidal thoughts and behaviors in antidepressant-treated patients age 24 years and younger was greater than in placebo-treated patients. There was considerable variation in risk of suicidal thoughts and behaviors among drugs, but there was an increased risk identified in young patients for most drugs studied. There were differences in absolute risk of suicidal thoughts and behaviors across the different indications, with the highest incidence in patients with major depressive disorder (MDD)
  • ZURZUVAE does not directly affect monoaminergic systems. Consider changing the therapeutic regimen, including discontinuing ZURZUVAE, in patients whose depression becomes worse or who experience emergent suicidal thoughts and behaviors

Embryo-fetal Toxicity

  • Based on findings from animal studies, ZURZUVAE may cause fetal harm when administered to a pregnant woman
  • Advise a pregnant woman of the potential risk to an infant exposed to ZURZUVAE in utero. Advise females of reproductive potential to use effective contraception during treatment with ZURZUVAE and for one week after the final dose
 

ADVERSE REACTIONS

  • The most common adverse reactions (≥5% and greater than placebo) in ZURZUVAE-treated patients were somnolence, dizziness, diarrhea, fatigue, nasopharyngitis, and urinary tract infection
 

DRUG INTERACTIONS

CNS Depressant Drugs and Alcohol

  • Caution should be used when ZURZUVAE is administered in combination with other CNS drugs or alcohol. If use with another CNS depressant is unavoidable, consider dosage reduction

Strong CYP3A4 Inhibitors

  • Reduce the ZURZUVAE dosage when used with a strong CYP3A4 inhibitor

CYP3A4 Inducers

  • Avoid concomitant use of ZURZUVAE with CYP3A4 inducers
 

USE IN SPECIFIC POPULATIONS

Pregnancy

  • There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, including ZURZUVAE, during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://womensmentalhealth.org/research/pregnancyregistry/antidepressants/
  • Based on findings from animal studies, ZURZUVAE may cause fetal harm. Advise pregnant women of the potential risk to a fetus. Available data on ZURZUVAE use in pregnant women from the clinical development program are insufficient to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

Lactation

  • Available data from a clinical lactation study in 14 women indicate that zuranolone is present in low levels in human milk. There are no data on the effects of zuranolone on a breastfed infant and limited data on the effects on milk production
  • The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ZURZUVAE and any potential adverse effects on the breastfed child from ZURZUVAE or from the underlying maternal condition

Hepatic Impairment

  • The recommended ZURZUVAE dosage in patients with severe hepatic impairment (Child-Pugh C) is lower than patients with normal hepatic function

Renal Impairment

  • The recommended ZURZUVAE dosage in patients with moderate and severe renal impairment is lower than those with normal renal function
 

DRUG ABUSE AND DEPENDENCE

  • ZURZUVAE contains zuranolone, a Schedule IV controlled substance
  • Zuranolone has abuse potential with associated risks of misuse, abuse, and substance use disorder including addiction
  • ZURZUVAE may produce physical dependence
 

Please see full Prescribing Information, including Boxed Warning.

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