ZURZUVAE™ (zuranolone) demonstrated rapid improvement
of postpartum depression (PPD) symptoms1,2

Statistically significant improvement vs placebo at Day 15
with treatment effect seen as early as
Day 31

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

ZURZUVAE 50 mg

Placebo

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Statistically significant improvements in depressive symptoms were observed for the primary and all key secondary endpoints1,2

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.

ZURZUVAE clinical trial design

The pivotal SKYLARK phase 3 study evaluated the efficacy and safety of ZURZUVAE in women with PPD1,2

  • SKYLARK was a 6-week, randomized, placebo-controlled, double-blind, multicenter study1
  • ZURZUVAE 50 mg or placebo was taken orally once daily in the evening with fat-containing food for 14 days, after which patients were off ZURZUVAE or placebo and were followed through Day 451
  • Concomitant use of existing oral antidepressants was allowed during the treatment course for patients taking stable oral antidepressants for at least 30 days before baseline1
    • Baseline use of stable oral antidepressants was reported in 15% of patients. The remaining 85% received ZURZUVAE or placebo as monotherapy1
  • The study included 195 adult patients with PPD in the full analysis set (N=98 ZURZUVAE 50 mg and N=97 placebo) who met the DSM-5 criteria for a major depressive episode with onset of symptoms in the third trimester or within 4 weeks of delivery and had a baseline HAMD-17 total score of ≥261
    • HAMD-17 (Hamilton Rating Scale for Depression) is a 17-item, clinician-rated scale used to assess severity of depressive symptoms3
    • Scores on the HAMD-17 range from 0 to 52; a score of 17–23 indicates moderate depression and a score of ≥24 indicates severe depression3,4
  • The primary endpoint was change from baseline in depressive symptoms as measured by the HAMD-17 total score at Day 151
  • The key secondary endpoints included change from baseline in HAMD-17 total score at Days 3, 28, and 451
Review safety results
Explore 14-day dosing

References: 1. ZURZUVAE Prescribing Information. Cambridge, MA: Biogen and Sage Therapeutics, Inc; 11/2023. 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. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psych. 1960;23:56-62. 4. Zimmerman M, Martinez JH, Young D, et al. Severity classification on the Hamilton depression rating scale. J Affect Disord. 2013;150:384-388.

INDICATION

ZURZUVAE 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 under the Controlled Substances Act
  • 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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