- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02335307
Implementing Genomics in Practice (IGNITE) Proof of Concept Study: Genotyping in Family Medicine Clinics (IGNITE)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Codeine and tramadol are opioid analgesics that depend on cytochrome P450 2D6 (CYP2D6) for bioactivation to morphine and O-desmethyltramadol, respectively. Morphine and O-desmethyltramadol have much greater affinity for the opioid receptor and thus are more powerful analgesics.
Individuals with genotypes associated with low CYP2D6 activity (poor metabolizers) are unable to convert sufficient amounts of codeine or tramadol to their active metabolites and may fail to derive sufficient pain relief. At the opposite extreme, individuals with genotypes associated with increased CYP2D6 activity (ultra-rapid metabolizers) are at risk for serious toxicity with usual codeine or tramadol doses.
The CYP2D6 genotype also has implications for response to other drugs, such as tricyclic antidepressants (TCAs), which are commonly used for neuropathic pain.
Patients will be recruited from family medicine clinics, serving as either implementation sites or control sites. Patients from implementation sites will undergo CYP2D6 genotyping, with results placed in the medical record to assist with prescribing of pain medications. Pain medications prescribed from baseline to 3 months will be assessed through medical record review. A pain assessment questionnaire will be administered to patients enrolled from both sites at baseline and 3 months.
At the end of the study, a 20-item survey will be administered to physicians at the implementation sites. We will assess whether having CYP2D6 genotype results is useful to inform prescribing decisions for pain medication from the physician's perspective.
We will also assess medicines prescribed to patients enrolled from both sites over the 12-month period after enrollment from medical record review and determine the number of patients who were prescribed a medication that has genetic information in its FDA-approved label.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
Florida
-
Archer, Florida, United States, 32618
- Archer Family Health Care
-
Gainesville, Florida, United States, 32606
- UF Health Spring Hill Pain Management
-
Gainesville, Florida, United States, 32607
- UF Health Family Medicine: Hampton Oaks
-
Gainesville, Florida, United States, 32607
- UF Health Internal Medicine - Tower Hill
-
Gainesville, Florida, United States, 32608
- UF Health Family Medicine: Haile Plantation
-
Gainesville, Florida, United States, 32609'
- UF Health Family Medicine: Main Street
-
Gainesville, Florida, United States, 32610
- UF Health Internal Medicine-Medical Plaza
-
Gainesville, Florida, United States, 32641
- UF Health Family Medicine: Eastside
-
Old Town, Florida, United States, 32680
- UF Health Family Medicine - Old Town
-
Oviedo, Florida, United States, 32765
- Oviedo Family Health Center
-
Saint Cloud, Florida, United States, 34769
- ProHealth Family Physicians
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Treated in family medicine clinic
- History of pain for at least 3 months
- Prescribed medication for pain relief
Exclusion Criteria:
- Pain for less than 3 months
- Not currently prescribed any medication for pain
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Control
Patients will continue to receive their current pain management therapy.
In addition, a pain assessment questionnaire will be administered at baseline and 3 months.
|
A pain assessment questionnaire will be administered at baseline and 3 months.
Other Names:
|
Implementation
Patients will undergo CYP2D6 genotyping, with results entered into the medical record to assist the physician with prescribing pain medication.
In addition, a pain assessment questionnaire will be administered at baseline and 3 months.
|
A pain assessment questionnaire will be administered at baseline and 3 months.
Other Names:
CYP2D6 genotype results and an interpretive report will be placed in the electronic medical record to assist the physician with prescribing medication for pain management.
|
Physician assessment
At the end of the study, a 20-item survey will be administered to physicians who treated patients enrolled in the study.
The survey will assess whether having CYP2D6 genotype results is useful to inform prescribing decisions for pain medication from the physician's perspective.
|
20-item survey administered to physicians treating patients enrolled in the study
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in overall pain score (Patient Reported Outcomes Measurement Information System (PROMIS)
Time Frame: Change from baseline to 3 months
|
Patient Reported Outcomes Measurement Information System (PROMIS) measures will be used to assess pain intensity, physical functioning, and emotional functioning.
There are 10 subscales on the PROMIS questionnaire that address the domains of pain, pain functioning, and emotional functioning.
At least 4 (and up to 30) items are used to derive a score for each subscale.
A computer adaptive version of the questionnaire based on item response theory will be used to administer the survey.
A score of 0 to 100 based on survey responses will be resulted for each subscale.
|
Change from baseline to 3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in pain medication
Time Frame: Change from baseline to 3 months
|
Change in pain medication will be evaluated in several manners: change in the opiate prescribed, change from an opiate to a non-opiate; and change in dose of the opiate prescribed
|
Change from baseline to 3 months
|
Change in pain score of pain intensity (Patient Reported Outcomes Measurement Information System (PROMIS) subscale)
Time Frame: Change from baseline to 3 months
|
Patient Reported Outcomes Measurement Information System (PROMIS) subscale for pain intensity, with the score ranging from 0 to 100 resulting.
|
Change from baseline to 3 months
|
Change in pain score of physical functioning (Patient Reported Outcomes Measurement Information System (PROMIS) subscale)
Time Frame: Change from baseline to 3 months
|
Patient Reported Outcomes Measurement Information System (PROMIS) subscales for physical functioning include pain function, pain interference, pain behavior, sleep disturbance, and sleep-related impairment.
A score of 0 to 100 based on survey responses will be resulted for each subscale.
|
Change from baseline to 3 months
|
Change in pain score of emotional functioning
Time Frame: Change from baseline to 3 months
|
Patient Reported Outcomes Measurement Information System (PROMIS) subscales for emotional functioning include fatigue, anxiety, depression, and anger.
A score of 0 to 100 based on survey responses will be resulted for each subscale.
|
Change from baseline to 3 months
|
Physician perceived usefulness of genetic information (survey)
Time Frame: 3 months
|
Survey will be administered to physicians with patients in the study to assess the effect of having genotype information on their prescribing decisions.
|
3 months
|
Medications prescribed with pharmacogenetic implications (Percent of patients with at least one other drug (besides an opioid) where genotype information might be useful for prescribing)
Time Frame: 12 months
|
Percent of patients with at least one other drug (besides an opioid) where genotype information might be useful for prescribing
|
12 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Larisa Cavallari, PharmD, University of Florida
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- IRB201400501 - N
- U01HG007269-02 (U.S. NIH Grant/Contract)
- OCR14741 (Other Identifier: Universiy of Florida)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Pain
-
Flowonix MedicalApproved for marketingBack Pain | Leg Pain | Trunk Pain | Intractable Pain | Arm Pain
-
University Hospital Schleswig-HolsteinZealand University Hospital; European Regional Development Fund; Design School...CompletedPain, Acute | Pain, Chronic | Pain Measurement | Pain, CancerGermany
-
Universitat Jaume ICompletedPain, Acute | Pain, Chronic | OncologySpain
-
Dow University of Health SciencesRecruitingLow Back Pain | Chronic Low-back Pain | Low Back Pain, Mechanical | Mechanical Low Back Pain | Pain, Chronic | Pain, Back | Lower Back Pain Chronic | CLBP - Chronic Low Back PainPakistan
-
Dr. Negrin University HospitalCompletedPostoperative Pain, Acute | Postoperative Pain, ChronicSpain
-
University of Campinas, BrazilCompletedPREGNANCY | LUMBAR BACK PAIN | PELVIC PAIN
-
George Washington UniversityRecruitingCervical Fusion | Pain, Back | Pain, Neck | Myofacial PainUnited States
-
Atatürk Chest Diseases and Chest Surgery Training...RecruitingPostoperative Pain | Postoperative Pain, Acute | Postoperative Pain, Chronic | VATSTurkey
-
Atatürk Chest Diseases and Chest Surgery Training...RecruitingPostoperative Pain | Thoracotomy | Postoperative Pain, Acute | Postoperative Pain, ChronicTurkey
-
Janssen Research & Development, LLCCompletedPain, Radiating | Pain, Burning | Pain, Crushing | Pain, Migratory | Pain, SplittingUnited States, France, Spain, Poland, Portugal
Clinical Trials on Pain assessment questionnaire
-
M.D. Anderson Cancer CenterCompletedMalignant Solid Neoplasm | Gastric Carcinoma | Malignant Peritoneal Neoplasm | Colorectal Carcinoma | Carcinomatosis | Appendix CarcinomaUnited States
-
Mayo ClinicNational Cancer Institute (NCI)CompletedPain | Unspecified Adult Solid Tumor, Protocol Specific | Metastatic CancerUnited States
-
Centre hospitalier de l'Université de Montréal...Completed
-
University Hospital Center of MartiniqueInstitut National de la Santé Et de la Recherche Médicale, France; Clinique...RecruitingFever | Dengue | Chikungunya | Zika VirusFrance, French Guiana, Guadeloupe, Martinique, Réunion
-
Centre Hospitalier Intercommunal de Toulon La Seyne...RecruitingCirrhosis | Pain, Acute | Hepatic Fibrosis | Pain, Chronic | Pain, NeuropathicFrance
-
British University In EgyptCompleted
-
University of California, Los AngelesCompletedThymectomy and Cardiothoracic SurgeryUnited States
-
KK Women's and Children's HospitalDuke UniversityActive, not recruitingBreast Cancer | Chronic Pain | Acute Pain | Depression, AnxietyUnited States, Singapore
-
Centre Hospitalier Universitaire de NīmesCompleted
-
University Hospital, BordeauxCompletedChronic Pain | Postoperative Pain