Desvenlafaxine
| Evidence Level: L4 | Predicted Indications: 10 |
Table of Contents
Desvenlafaxine: From Major Depressive Disorder to Obsessive-Compulsive Disorder
One-Sentence Summary
Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) and the active metabolite of venlafaxine. It is used as an antidepressant. The TxGNN model predicts it may be effective for obsessive-compulsive disorder (OCD), but no trial in the provided data tests desvenlafaxine in OCD. Support comes from 2 off-target clinical trials and 4 publications, of which only one, on the parent drug venlafaxine, is a controlled trial in OCD.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the US license entries; trial descriptions indicate major depressive disorder |
| Predicted New Indication | Obsessive-compulsive disorder |
| TxGNN Prediction Score | 99.91% |
| Evidence Level | L4 |
| US Market Status | ✓ Marketed |
| Number of NDAs | 4 license entries (all under NDA204150) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism-of-action data for desvenlafaxine is not available in the Evidence Pack. Desvenlafaxine is known to inhibit serotonin and norepinephrine reuptake. Serotonergic reuptake inhibition is the established pharmacological basis of OCD treatment (SSRIs and clomipramine).
Depression and OCD are both treated with serotonergic drugs, which makes the prediction plausible at the class level. The direct support is indirect, however. A double-blind comparison of the parent compound venlafaxine against paroxetine in 150 OCD patients exists, but it had no placebo arm. Class-level reviews of serotonergic antidepressants in OCD add further context.
The very high score (0.999) is a model output, not clinical confirmation. Its rank among all predictions is 3,094.
Clinical Trial Evidence
Neither registered trial tests desvenlafaxine in OCD.
| Trial Number | Phase | Status | Enrollment | Key Findings |
|---|---|---|---|---|
| NCT01527786 | Phase 3 | Completed | 25 | Pilot of desvenlafaxine in postpartum depression. The drug matches but the disease does not, so it gives no OCD evidence. |
| NCT03299166 | Phase 2/3 | Completed | 426 | Placebo-controlled trial of adjunctive troriluzole in OCD patients with inadequate response to SSRI, clomipramine, venlafaxine, or desvenlafaxine. It shows a feasible OCD trial design but tests a different drug. |
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 14624187 | 2003 | RCT (parent compound) | J Clin Psychopharmacol | First double-blind comparison of an SNRI (venlafaxine) vs paroxetine in 150 OCD patients. There was no placebo arm. |
| 24766145 | 2014 | Review | Expert Opin Pharmacother | Review of double-blind studies of serotonergic antidepressants in OCD. |
| 36686097 | 2022 | Review | Cureus | Review of postpartum depression. It notes that OCD and anxiety can develop later in life, and is only indirectly relevant. |
| 40224942 | 2025 | Clinical study | Psychiatry Clin Psychopharmacol | Risperidone augmentation in antidepressant-resistant somatic symptom disorder. This is off-target for desvenlafaxine in OCD. |
US Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| NDA204150 | Desvenlafaxine (Alembic Pharmaceuticals Limited) | Tablet, extended release | Not listed in the record |
| NDA204150 | Desvenlafaxine (Sun Pharmaceutical Industries, Inc.) | Tablet, extended release | Not listed in the record |
| NDA204150 | Desvenlafaxine (Sun Pharmaceutical Industries, Inc.) | Tablet, extended release | Not listed in the record |
| NDA204150 | Desvenlafaxine (Alembic Pharmaceuticals Limited) | Tablet, extended release | Not listed in the record |
Safety Considerations
Please refer to the package insert for safety information. No warnings, contraindications, or drug interaction records were retrieved.
Conclusion and Next Steps
Decision: Hold
Rationale: No trial tests desvenlafaxine in OCD. Support consists of one small venlafaxine comparison without placebo, class-level reviews, and a model score. The safety label data has also not been retrieved, which blocks safety screening.
To proceed, the following is needed:
- The current US package insert (warnings, contraindications, approved indications)
- Detailed mechanism-of-action data from DrugBank
- Desvenlafaxine-specific OCD data, such as a controlled trial or a review of SNRI evidence in OCD
- Consideration of other predictions for this drug: dysthymic disorder and melancholia have far stronger evidence (L2), including direct desvenlafaxine trials. The personality disorder entries and other rare-disease entries (ranks 2–7) have no evidence (L5) and share tied scores, which suggests a knowledge-graph artifact.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.