- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00621946
Treatment of Outpatients With Severe Asthma and Moderate or Severe Major Depressive Disorder
Escitalopram in the Treatment of Outpatients With Severe Asthma and Moderate or Severe Major Depressive Disorder: A Randomized, Double-Blind, Placebo-Controlled Trial
Study Overview
Status
Intervention / Treatment
Detailed Description
Primary Aim
1) Determine if escitalopram treatment is associated with less oral corticosteroid use for asthma symptom control than placebo in asthma outpatients with moderate or MDD.
Secondary Aims
- Determine if escitalopram treatment is associated with greater improvement in asthma symptoms than placebo in outpatients with severe asthma and moderate or severe MDD.
- Determine if escitalopram treatment is associated with greater depressive symptom remission rates than placebo in outpatients with severe asthma and moderate or severe MDD.
Background/Significance
Asthma is a common, chronic general medical condition characterized by inflammation and variable, but usually reversible, airflow obstruction. Approximately 7.2% of people in the United States have a history of asthma. Asthma is common with an increasing prevalence and mortality especially in low-income and minority populations.
The course of asthma appears to be influenced by mood and emotions. It has been reported that there is a high prevalence of depression or depressive symptoms in both children and adults with asthma.
Depression is associated with increased use of asthma-related urgent care services, as well as a variety of unfavorable asthma outcomes. In addition to the possible associations between depression and asthma medication nonadherence and even death, depression appears to be associated with increased use of emergency rooms, hospitals, and unscheduled appointments for asthma.
Despite data on the frequency of depression in asthma and its adverse consequences, it is generally not recognized or treated.
Our proposed study is different. We observed a modest difference between antidepressant and placebo in a prior trial. However, in a subgroup with more severe asthma (based on frequent corticosteroid use) and more severe depression (based on higher depressive symptoms scores) we saw a much larger effect size. The proposed study will target this subgroup. The sample size is based on the effect size we observed in this subgroup in our previous pilot study.
A placebo controlled trial is needed because 1) the primary outcome in our previous trial was not significant. Therefore, it is not clear that antidepressant treatment is effective in depressed asthma patients. 2) We identified a subgroup with greater depressive symptom and asthma severity that based on a post-hoc analysis appeared to show a favorable response to the antidepressant. Thus, we want to confirm these post-hoc findings with a targeted prospective study. In the clinical population we will study, very few patients have ever received assessment or treatment for depression. Therefore, we would not be withholding clearly effective treatment that they would otherwise receive.
Standard of care for severe asthma is aggressive asthma treatment. Our study does not require any changes in the patient's asthma treatment. No guidelines are currently available on the treatment of depression in asthma patients. Standard care for depression would be antidepressants.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Texas
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Dallas, Texas, United States, 75390
- The UT Southwestern Medical Center at Dallas
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Current HAM-D score of ≥ 20
- Patients with severe asthma (defined as asthma requiring three or more course of oral corticosteroids in the past year).
- No changes in asthma medications, oral corticosteroid use, or treatment for respiratory tract infections in the past week
- Needs to have taken ≥ 3 courses of oral corticosteroids, for asthma, in the past 12 months.
- Both male and female
- English- or Spanish-speaking
Exclusion Criteria:
- Current substance or alcohol abuse/dependence
- MDD with psychotic features (delusions, hallucinations, disorganized thought processes)
- Bipolar disorder
- Schizophrenia or schizoaffective disorder
- Substance-induced mood disorder and mood disorder secondary to a general medical condition
- Mental retardation or other severe cognitive impairment
- Prison or jail inmates
- Pregnant or nursing women or women of childbearing age who will not use The University of Texas Southwestern Medical Center - Institutional Review Board (UTSW IRB) approved methods of birth control or abstinence during the study
- Treatment-resistant depressed persons defined as having failed two adequate trials of antidepressants
- Current antipsychotic or antidepressant therapy or psychotherapy
- Initiation of other psychotropic medications or psychotherapy within past 2 weeks (e.g., anxiolytics, hypnotics)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Placebo Matching Escitalopram given orally daily (for a 12-week duration).
|
Placebo Matching Escitalopram
Other Names:
|
Active Comparator: Escitalopram
Once daily oral administration (for a 12-week duration) of 10 mg escitalopram tablets with an increase to 20 mg in those with a less than 30% decrease in HAM-D scores at week 4.
|
Active Escitalopram
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
HAM-D (Hamilton Rating Scale for Depression)
Time Frame: Baseline
|
The HAM-D is a 17 item questionnaire (a clinician-administered depression scale) designed to evaluate severity of depressive symptoms.
Scores can range from 0 to 52.
The higher the score, the worse the depressive symptoms (worse outcome).
|
Baseline
|
ACQ (Asthma Control Questionnaire)
Time Frame: Baseline
|
The ACQ is a questionnaire used to assess symptoms pertinent to asthma management.
Scores range from 0 to 42.
The higher the score, the worse the asthma symptoms (worse outcome).
The total ACQ score is obtained by dividing the raw score by the total number of items (in this case 7 items).
|
Baseline
|
IDS-SR (Inventory of Depressive Symptomatology - Self-Report)
Time Frame: Baseline
|
The IDS-SR is a 30 item (self-report questionnaire) designed to assess symptoms of depression.
Scores range from 0 to 90.
The higher the score, the worse the depressive symptoms (worse outcome).
|
Baseline
|
HAM-D (Hamilton Rating Scale for Depression)
Time Frame: Up to 12 weeks
|
The HAM-D is a 17 item questionnaire (a clinician-administered depression scale) designed to evaluate severity of depressive symptoms.
Scores can range from 0 to 52.
The higher the score, the worse the depressive symptoms (worse outcome).
|
Up to 12 weeks
|
ACQ (Asthma Control Questionnaire)
Time Frame: Up to 12 weeks
|
The ACQ is a questionnaire used to assess symptoms pertinent to asthma management.Scores range from 0 to 42.
The higher the score, the worse the asthma symptoms (worse outcome).
The total ACQ score is obtained by dividing the raw score by the total number of items (in this case 7 items).
|
Up to 12 weeks
|
IDS-SR (Inventory of Depressive Symptomatology - Self-Report)
Time Frame: Up to 12 weeks
|
The IDS-SR is a 30 item (self-report questionnaire) designed to assess symptoms of depression.
Scores range from 0 to 90.
The higher the score, the worse the depressive symptoms (worse outcome).
|
Up to 12 weeks
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: E. Sherwood Brown, Ph.D, M.D., UT Southwestern Medical Center at Dallas
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Behavioral Symptoms
- Mental Disorders
- Respiratory Tract Diseases
- Mood Disorders
- Immune System Diseases
- Lung Diseases
- Hypersensitivity, Immediate
- Bronchial Diseases
- Lung Diseases, Obstructive
- Respiratory Hypersensitivity
- Hypersensitivity
- Depression
- Depressive Disorder
- Asthma
- Depressive Disorder, Major
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Parasympatholytics
- Autonomic Agents
- Peripheral Nervous System Agents
- Muscarinic Antagonists
- Cholinergic Antagonists
- Cholinergic Agents
- Psychotropic Drugs
- Serotonin Uptake Inhibitors
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Serotonin Agents
- Antidepressive Agents
- Antidepressive Agents, Second-Generation
- Antiparkinson Agents
- Anti-Dyskinesia Agents
- Citalopram
- Dexetimide
Other Study ID Numbers
- 092007-057
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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