- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01610063
Evaluation of an Antidepressant Pharmacogenomic Algorithm in an Outpatient Clinical Setting
February 10, 2017 updated by: Daniel K. Hall-Flavin, Mayo Clinic
A Pilot Study for the Evaluation of the Clinic-wide Impact of the Antidepressant Pharmacogenomic Algorithm in an Outpatient Clinical Setting
This was a study of a genotyping tool that reported on how subjects responded to medications and could be used in a community psychiatry practice to improve medication choice for depression.
After the DNA test, an interpretive report was provided to the subjects' physicians.
The hypothesis of this pilot study was that it was feasible to use this pharmacogenomic algorithm in a new setting to treat depressed subjects..
Study Overview
Detailed Description
Antidepressant medications are among the most widely prescribed medications.
However, only 35% to 45% of depressed patients have a complete remission of their illness when initially treated with these medications.
Consequently, the Mayo Clinic psychiatric pharmacogenomic team developed a pharmacogenomic algorithm designed to improve the effectiveness and safety of antidepressant medications by providing guidance in medication selection and appropriate dosing.
This algorithm has been incorporated into a new genotyping interpretative report.
The pharmacogenomic algorithm is based on genotyping both copies of four informative genes.
These four genes are: 1) the Cytochrome (P450 2D6) gene; 2) the Cytochrome (P450 2C19) gene; 3) the Serotonin Transporter gene (SLC6A4); and 4) the Serotonin 2A receptor gene (5HTR2A).
The trial took place at the Franciscan Skemp Healthcare System in La Crosse, Wisconsin over the course of 12 months.
Study Type
Interventional
Enrollment (Actual)
227
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Wisconsin
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La Crosse, Wisconsin, United States, 54601
- Franciscan Skemp Healthcare
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 80 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Patient is between the ages of 18 and 80.
- Major depressive disorder or depressive disorder not otherwise specified as ascertained by a physician or mental health professional licensed to diagnose.
- Patient is an outpatient and not in imminent need of inpatient hospitalization, or a discharging inpatient with scheduled follow-up with a Behavioral Health psychiatrist.
- Patient has been referred to see a psychiatrist for optimum medication management.
- Patient's Hamilton Depression Rating score is >14
- Ability to read, understand and sign an informed consent document
Exclusion Criteria:
- Serious medical illness (as ascertained via the initial triage screening process)
- Patients with a diagnosis of Bipolar I disorder
- Patients with a diagnosis of Schizophrenia or Schizoaffective disorder
- Patients who are legally unable to consent to enrollment in the study (i.e. patients with legal guardians)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Guided
A pharmacogenomic algorithm (GeneSight) guided treatment decisions for antidepressant medication selection and appropriate dosing.
|
Genetic test results for 4 genes were put through algorithm and provided to physician for guidance prescribing medication.
Other Names:
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No Intervention: Unguided
Treatment as usual
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage Change in Quick Inventory of Depressive Symptomatology (QIDS-C16) Score From Baseline
Time Frame: baseline, 8-week visit
|
The QIDS-C16 is a 16-item scale that is clinician-rated; it is designed to assess the severity of depressive symptoms.
The QIDS-C16 total score ranges from 0-27.
Scores ranging from 0 to 10 correspond with no to mild depression, while scores >/= 11 correspond to moderate to severe depression.
A negative change indicates improvement in the subject's depression, and a positive change indicates a worsening of the subject's depression.
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baseline, 8-week visit
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage Change in Hamilton Depression Rating Scale (HAMD-17) Score From Baseline
Time Frame: baseline, 8-week visit
|
The HAMD-17 is a 17-item scale that evaluates depressed mood, vegetative and cognitive symptoms of depression, and co-morbid anxiety symptoms.
The 17 items are rated on either a 5-point (0-4) or a 3-point (0-2) scale.
In general, the 5 point scale items use a rating of 0=absent; 1=doubtful to mild; 2=mild to moderate; 3=moderate to severe; 4=very severe.
The 3-point scale items use a rating of 0=absent; 1=probable or mild; 2=definite.
The total HAMD-17 score ranges from 0 (not ill) to 52 (severely ill).
A negative change indicates improvement in the subject's depression/anxiety symptoms, and a positive change indicates a worsening of the subject's depression/anxiety symptoms.
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baseline, 8-week visit
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Percentage Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline
Time Frame: baseline, 8-week visit
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The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire.
The PHQ-9 is based directly on the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual Fourth Edition (DSM-IV).
Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 (no symptoms) and 27 (severe symptoms) for depression.
A negative change indicates improvement in the subject's depression symptoms, and a positive change indicates a worsening of the subject's depression symptoms.
|
baseline, 8-week visit
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Percentage Change in Outcome by Bin Status and Treatment Group
Time Frame: baseline, 8-week visit
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The Genesight algorithm presents recommendations for antidepressants and antipsychotics in "bin status" associated with colors.
Green indicates "Use as Directed."
Yellow indicates "Use with Caution."
Red indicates "Use with Increased Caution and with More Frequent Monitoring."
Definitions of the depression questionnaires are found in previous outcome measures.
A negative change indicates improvement in the subject's depression/anxiety symptoms, and a positive change indicates a worsening of the subject's depression/anxiety symptoms.
|
baseline, 8-week visit
|
Pharmacogenomic Report Utilization
Time Frame: baseline, 8-week visit
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Physicians were directed to complete a survey for each participant detailing their experiences during the study period.
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baseline, 8-week visit
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Physicians' Perception of Participant's Satisfaction With Their Care
Time Frame: 8-week visit
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Physicians reported on their perception of each participant's satisfaction with their care only for patients who completed the 8-week study.
Physicians were directed to complete a survey for each participant detaining their experience during the study period.
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8-week visit
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Responders at Week 8
Time Frame: baseline, 8 weeks
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Definitions of the depression questionnaires are found in previous outcome measures.
Definition of responder: a participant who had 50% or higher reduction in psychiatric score from baseline.
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baseline, 8 weeks
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Remitters at Week 8
Time Frame: baseline, 8 weeks
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Definitions of the depression questionnaires are found in previous outcome measures.
Definition of remitter: a participant with score less than or equal to certain value (HAMD-17 <=7, QIDS-C16<=5, PHQ-9<5).
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baseline, 8 weeks
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Daniel K. Hall-Flavin, Mayo Clinic
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 1, 2009
Primary Completion (Actual)
November 1, 2011
Study Completion (Actual)
May 1, 2013
Study Registration Dates
First Submitted
May 25, 2012
First Submitted That Met QC Criteria
May 30, 2012
First Posted (Estimate)
June 1, 2012
Study Record Updates
Last Update Posted (Actual)
March 30, 2017
Last Update Submitted That Met QC Criteria
February 10, 2017
Last Verified
February 1, 2017
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 08-005610
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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