- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03531268
Prospective Study to Evaluate the Clinical Utility of Perioperative Pharmacogenomic Testing
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Potential subjects will participate in screening with a minimum of 4 days prior to their planned surgery. The study involves obtaining mouth swab samples for genetic testing and employing standardized measures for PGx testing of subjects preoperatively.
Study staff will pre-screen potential subjects scheduled at the preoperative center or on surgeons' operative schedules. The study team member will ask the treating clinician involved with the care of a patient for permission to speak to the patient. The physician or a member of the research staff will describe the study to potentially eligible patients and a study investigator will obtain consent. After meeting inclusion and exclusion criteria, subjects who agree to participate in the study will complete study questionnaires and provide a swab sample for PGx analysis.
Trained members of the research staff will obtain a buccal swab sample from each subject who has given informed consent to participate in study procedures. The buccal swab will be packaged and shipped to an outside laboratory for processing and the conduct of the PGx testing. The results of the PGx testing will be provided in a standardized report and sent back to the research staff conducting the study. Typically, the turn-around for shipping the sample and obtaining the results will be 4 days. The results will be available to the anesthesiologist prior to the patient's surgery.
Prior to the initiation of the scheduled surgery, the anesthesiologist will be asked to complete a questionnaire about the clinical utility of PGx testing for that subject. In the perioperative group of subjects for whom clinicians find clinical utility for PGx testing (experimental group), outcomes will be compared to the remaining subjects (control group) for whom PGx testing was felt not to have any clinical utility.
After surgery, there will be two assessment periods. Clinical outcomes and the quality of the subject's recovery from surgery will be assessed postoperatively at 24 hours +/-4 hours after surgery by directly interviewing each study subject and reviewing the electronic medical record. Additional assessments of subjects will be conducted by review of the electronic medical record at 30 days +/- 3 days postoperatively.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02115
- Brigham and Women's Hospital
-
Boston, Massachusetts, United States, 02110
- Massachusetts General Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adults 18 years of age or older at screening.
- Adults with qualifying insurance coverage.
- Subjects scheduled to undergo elective surgery with an expected hospitalization 24 hrs =/- 4 hrs after surgery.
- American Society of Anesthesiology (ASA) physical status 1, 2, or 3.
One or more of the following:
- Subjects prescribed 4 or more medications at time of surgery.
- Any subject prescribed any one of the following medication categories: opioid, benzodiazepine, antidepressant, antipsychotic, stimulant, mood stabilizer, NSAIDs, anti-epileptic drugs.
- Any subject prescribed any one of the following medication categories: antiplatelet therapy, anticoagulant drugs.
- Able to provide informed consent, adhere to the study protocol, and complete all study assessments.
Exclusion Criteria:
- Subjects who do not have insurance coverage for PGx testing.
- Subjects who are expected to have surgery prior to the ability to obtain the results of the pharmacogenomic testing (generally it takes 4 days to obtain the results of testing).
- Subjects who are not being prescribed 4 or more medications, or who are not receiving any of the medication categories noted in the inclusion criteria.
- Planned multiple surgical procedures within the 30-day study follow up period.
- Clinically significant medical or psychiatric disease that, in the opinion of the investigator, would make participation in a clinical study inappropriate. This includes any psychiatric or other disease that would cause the subject to be unable to comply with the study requirements.
- Administration of an investigational drug within 30 days prior to providing PGx testing, or planned administration of an investigational product during the subject's participation in this study
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Screening
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: PGx testing has clinical utility
These are subjects whose PGx testing is judged to have clinical utility and whose clinical care may be modified.
Modifications may include altering doses or types of drugs given based on metabolic profile of the patient.
|
Pharmacogenomic (PGx) testing will be administered to all subjects.
The results of PGx testing will be evaluated for clinical utility.
Subjects will be evaluated based on whether PGx testing has clinical utility or has no clinical utility.
|
No Intervention: PGx testing has no clinical utility
These are subjects whose PGx testing is judged to have no clinical utility.
Care "as usual" is provided, and there are no changes in drug selection or dosing based on the results of PGx testing.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical Utility
Time Frame: The day of surgery or the day prior
|
The anesthesiologist will be shown the results of PGx testing and will complete a "Clinical Utility Questionnaire" regarding the clinical utility of PGx testing for the subject.
The responses will be rated: 0 = no utility; 1 = some utility; 2 = significant utility.
The larger value (2) is considered as having a higher utility for this scale.
|
The day of surgery or the day prior
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Intraoperative and postoperative use of opioids
Time Frame: 24 hrs +/- 4 hrs after surgery
|
The use of intraoperative and postoperative use of opioids will be measured (morphine mg equivalents)
|
24 hrs +/- 4 hrs after surgery
|
Duration times (surgery, anesthesia, length of stay in PACU)
Time Frame: 24 hrs +/- 4 hrs after surgery
|
Surgical duration and anesthesia duration times, length of stay in PACU (duration will be measured in minutes)
|
24 hrs +/- 4 hrs after surgery
|
Pain Assessment
Time Frame: 24 hrs +/- 4 hrs after surgery
|
Pain Numeric Rating Scale, 0 - 10 (0 = no pain, 10 = maximum pain) (lower values = better outcome)
|
24 hrs +/- 4 hrs after surgery
|
Postoperative Nausea and Vomiting
Time Frame: 24 hrs +/- 4 hrs after surgery
|
Postoperative Nausea and Vomiting Scale (0 = no nausea/vomiting, 200 = maximal nausea/vomiting) (lower values = better outcome)
|
24 hrs +/- 4 hrs after surgery
|
Sedation and Delirium Assessment
Time Frame: 24 hrs +/- 4 hrs after surgery
|
Richmond Agitation and Sedation Scale (-5 = unarousable, 0 = alert and calm, +4 = combative) (values = 0 are best outcome)
|
24 hrs +/- 4 hrs after surgery
|
Subject Satisfaction
Time Frame: 24 hrs +/- 4 hrs after surgery
|
Subject Satisfaction Questionnaire (1 = extremely dissatisfied, 5 = extremely satisfied) (higher values = best outcome)
|
24 hrs +/- 4 hrs after surgery
|
Quality of Recovery
Time Frame: 24 hrs +/- 4 hrs after surgery
|
Quality of Recovery Questionnaire (0 = poor, 150 = excellent) (higher values = best outcome)
|
24 hrs +/- 4 hrs after surgery
|
Length of stay in hospital after surgery
Time Frame: 30 days
|
Length of stay in the hospital after surgery (days)(lower number = best outcome)
|
30 days
|
Opioid Prescriptions
Time Frame: 30 days
|
Amount of opioids prescribed after surgery (morphine mg equivalents) (lower amount = best outcome)
|
30 days
|
Hospital Readmissions
Time Frame: 30 days
|
Number of times readmitted to hospital within 30 days after surgery (lower number = best outcome)
|
30 days
|
Emergency Room Visits
Time Frame: 30 days
|
Number of emergency room visits within 30 days after surgery (lower number = best outcome)
|
30 days
|
Unscheduled Phone Calls
Time Frame: 30 days
|
Number of unscheduled phone calls to the doctor's office within 30 days after surgery (lower number = best outcome)
|
30 days
|
Unscheduled Office Visits
Time Frame: 30 days
|
Number of unscheduled visits to the doctor's office within 30 days after surgery (lower number = best outcome)
|
30 days
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Director: Srdjan S Nedeljkovic, MD, Brigham and Women's Hospital
Publications and helpful links
General Publications
- Cregg R, Russo G, Gubbay A, Branford R, Sato H. Pharmacogenetics of analgesic drugs. Br J Pain. 2013 Nov;7(4):189-208. doi: 10.1177/2049463713507439.
- Jannetto PJ, Bratanow NC. Utilization of pharmacogenomics and therapeutic drug monitoring for opioid pain management. Pharmacogenomics. 2009 Jul;10(7):1157-67. doi: 10.2217/pgs.09.64.
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2018P000454
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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 Perioperative/Postoperative Complications
-
Lawson Health Research InstituteWithdrawnPerioperative/Postoperative ComplicationsCanada
-
Wake Forest University Health SciencesTerminatedPerioperative/Postoperative ComplicationsUnited States
-
Technical University of MunichHealth Information Management, BelgiumActive, not recruitingPerioperative/Postoperative Complications
-
Atatürk Chest Diseases and Chest Surgery Training...CompletedPerioperative/Postoperative ComplicationsTurkey
-
Namigar TurgutCompletedPerioperative/Postoperative ComplicationsTurkey
-
TC Erciyes UniversityCompletedPerioperative/Postoperative ComplicationsTurkey
-
COPAL - My JourneyRecruiting
-
Queen Mary University of LondonThe London ClinicRecruitingPerioperative/Postoperative ComplicationsUnited Kingdom
-
Mayo ClinicCompletedPerioperative/Postoperative ComplicationsUnited States
-
Technical University of MunichCompletedPerioperative/Postoperative Complications | OutcomeGermany
Clinical Trials on PGx Testing
-
Duke UniversityNational Institute of General Medical Sciences (NIGMS)Completed
-
Mayo ClinicCompletedGastrointestinal DiseasesUnited States
-
AltheaDxInnovis LLCCompletedDepression | AnxietyUnited States
-
AltheaDxCarolina Partners in Mental HealthcareCompletedDepression | AnxietyUnited States
-
Northwell HealthGenomind, LLCCompletedPsychotic Disorders | Schizophrenia | Schizoaffective Disorder | Schizophreniform Disorder | Bipolar DisorderUnited States
-
InSource DiagnosticsSyntactxUnknownTarget Drug-related Adverse EventsUnited States
-
AltheaDxOchsner Health SystemTerminatedSurgery | Acute PainUnited States
-
AltheaDxUniversity Hospitals Cleveland Medical CenterCompleted
-
University of MichiganCompletedAntidepressants Causing Adverse Effects in Therapeutic UseUnited States
-
Glycemic Index Laboratories, IncCanadian Center for Functional Medicine; InovoBiologic Inc.CompletedBlood Glucose, PostprandialCanada