- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05965401
Pharmacogenetic-Guided Antidepressant Prescribing in Adolescents (PGx-GAP)
Pharmacogenetic-Guided Antidepressant Prescribing (PGx-GAP) in Adolescents
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Goal: To test the efficacy of pharmacogenetic-guided antidepressant prescribing for adolescents with depression.
Background: For an adolescent with moderate to severe depression, antidepressant medication is prescribed, often in combination with psychotherapy. The class of antidepressants recommended for use is selective serotonin reuptake inhibitors (SSRIs) with fluoxetine recommended as the first-line medication, and four other SSRIs recommended for consideration (sertraline, citalopram, escitalopram, fluvoxamine) if the adolescent does not respond or tolerate fluoxetine. For most adolescents, medication prescribing, and monitoring will be managed by a primary care physician or community pediatrician rather than by a mental health care provider, and guidelines exist to support this management (Guidelines for Adolescent Depression in Primary Care, GLAD-PC). However, GLAD-PC does not account for SSRI metabolism phenotypes that could change whether the SSRI selected is efficacious or tolerated. Our team of researchers, clinician scientists, patient partners, and primary care providers has designed a trial to test the impact of accounting for metabolism phenotypes, through pharmacogenetic-guided antidepressant prescribing, on adolescent outcomes, experiences, and health care utilization.
Principal Question: Compared to GLAD-PC informed prescribing, does pharmacogenetic-guided prescribing for depressed adolescents who have not responded or tolerated first-line fluoxetine therapy, have superior efficacy following 12-weeks of therapy with an alternative SSRI?
The Trial: This is a parallel arm randomized controlled trial. Adolescents aged 12-17 years (n=452) that did not respond or tolerate first-line fluoxetine therapy will be randomly allocated to receive pharmacogenetic-guided antidepressant therapy (experimental intervention) or GLAD-PC guided prescribing (control intervention). Participants and prescribing physicians will be blinded to which intervention was received. The primary outcome is depressive symptom remission at 12 weeks measured using the Quick Inventory of Depressive Symptomatology - Adolescent (17-item) (QIDS-A17). Secondary outcomes include side effects, role functioning, medication adherence, and health-related quality of life measured 4-, 8-, and 12-weeks after intervention initiation as well as cost-effectiveness.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Laina McAusland, MSc
- Phone Number: 403-210-6353
- Email: gap@ucalgary.ca
Study Locations
-
-
Alberta
-
Calgary, Alberta, Canada, T2N 4N1
- Recruiting
- University of Calgary
-
Principal Investigator:
- Chad Bousman
-
Contact:
- Laina McAusland, MSc
- Email: gap@ucalgary.ca
-
Principal Investigator:
- Amanda Newton
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 12-17
- Depression as the primary concern, confirmed by the treating physician
- QIDS-A17 score greater than or equal to 11 indicating moderate-to-severe symptoms
- Prior failure of fluoxetine therapy due to inefficacy or intolerance
- Intention to start a new SSRI
- English fluency
Exclusion Criteria:
- Co-occurring psychosis, bipolar disorder, eating disorder, autism spectrum disorder, fetal alcohol spectrum disorder, or intellectual disability
- A score of 2 or 3 on suicide item 13 of the QIDS-A17
- High-risk alcohol or substance use (excluding cannabis and tobacco) as indicated by a score of monthly or more on the S2BI
- History of non-response to 3 or more antidepressants (including fluoxetine, i.e. failure of fluoxetine and two other agents) as confirmed by the treating physician
- Psychotherapy or brain stimulation-based therapy initiated within 8 weeks of referral, or plans to initiate/change these therapies during study participation
- History of liver or hematopoietic cell transplant
- History of CYP2B6, CYP2C19, or CYP2D6 testing
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Pharmacogenetic (PGx)-Guided
Participants and their physician will receive a one-time prescribing report after completing baseline for second-line selective serotonin reuptake inhibitors with dosing information based on CYP2B6, CYP2C19, and CYP2D6 genotype data.
|
SSRI dosing based on Clinical Pharmacogenetics Implementation Consortium's SSRI dosing guidelines.
|
Active Comparator: Guidelines for Adolescent Depression in Primary Care (GLAD-PC)-Guided
Participants and their physician will receive a one-time prescribing report after completing baseline for second-line selective serotonin reuptake inhibitors based on GLAD-PC dosing guidelines.
|
SSRI dosing based on GLAD-PC clinical practice guidelines
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with depression remission
Time Frame: Baseline to 12 weeks
|
Quick Inventory of Depressive Symptomatology - Adolescent - 17-item (QIDS-A17) total score < 6. Scores range from 0-27, with higher scores indicative of more severe depression.
|
Baseline to 12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with side effects and adverse drug reactions
Time Frame: Baseline to 12 weeks
|
Frequency, Intensity, Burden of Side Effects Rating (FIBSER) scale.
Total scores range from 0-6 (3 items); cut-points are used to indicate moderate (score of 3) or severe (score of 5) adverse drug reaction/side effect interference with activities.
|
Baseline to 12 weeks
|
Percent Change in Role functioning
Time Frame: Baseline to 12 weeks
|
WHO Disability Assessment Schedule.
Scores range from 0 to 48, with higher scores indicative of worse role functioning.
|
Baseline to 12 weeks
|
Percent Change in Depressive Symptom Severity
Time Frame: Baseline to 12 weeks
|
Quick Inventory of Depressive Symptomatology - Adolescent - 17-item (QIDS-A17).
Scores range from 0-27, with higher scores indicative of more severe depression.
|
Baseline to 12 weeks
|
Percent Change in clinician assessment of depressive symptom severity
Time Frame: Baseline to 12 weeks
|
Change in Clinical Global Impression Severity (CGI-S) scale.
Scores range from 0-7, with higher scores indicative of more severe illness.
|
Baseline to 12 weeks
|
Change in self-report health care resource use
Time Frame: Baseline to 12 weeks
|
Resource use questionnaire that captures number of visits and out-of-pocket costs for various mental health services.
|
Baseline to 12 weeks
|
Change in health care utilization
Time Frame: Baseline to 12 weeks
|
Administrative data will be obtained on medication information (agent, dose, duration) and health care utilization (doctor visits, hospitalizations, emergency room visits).
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Baseline to 12 weeks
|
Change in health-related quality of life
Time Frame: Baseline to 12 weeks
|
EuroQoL 5 Dimension - Youth (EQ-5D-Y).
Five descriptive items code level of perceived problems in health states and a visual analog scale has a score from 0-100, with higher scores indicative of better health.
|
Baseline to 12 weeks
|
Change in medication adherence
Time Frame: 4 to 12 weeks
|
Medication Adherence Report Scale (MARS-5) scores.
Scores range from 5-25 with higher scores indicative of better medication adherence.
|
4 to 12 weeks
|
Change in behavioral activation
Time Frame: Baseline to 12 weeks
|
Emergence of activation based on Treatment-Emergent Activation and Suicidality Assessment Profile.
Total scores range from 0-114 (38 items) with higher scores indicating greater behavioral activation.
|
Baseline to 12 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Minimally clinically important differences
Time Frame: 12 weeks
|
Participant-reported, Global Rating of Change Scale (GRCS) (11-point Likert scale ranging from +5 to -5) to indicate the degree to which symptoms and role functioning changed for the better, for the worse, or no change was experienced.
|
12 weeks
|
Blinding fidelity
Time Frame: 12 weeks
|
Physician-reported, 1-item survey about the perceived allocation of each of their participating patients; response options are 'PGx-guided prescribing', 'don't know' or 'GLAD-PC prescribing'
|
12 weeks
|
Intervention fidelity
Time Frame: 12 weeks
|
Physician-reported, two questions on use of recommendations in the dosing report.
|
12 weeks
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Amanda Newton, PhD, University of Alberta
- Principal Investigator: Chad Bousman, PhD, University of Calgary
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- REB23-0532
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Anonymized, individual participant PGx-GAP data will be shared using a controlled-access model. Under this model, the data will be released to a researcher if access criteria are met.
All requests for data sharing should be made to the Co-Principal Investigators who will be responsible for reviewing and granting requests. Requestors should provide a research proposal for review. In the event that a data sharing request is declined, reasons will be provided to the requestor. If the data sharing request is granted, a data-sharing agreement will be initiated by the Co-Principal Investigators alongside the University of Calgary (lead institution). This agreement will include information on the individual data to be shared; if other documents will be available (e.g., statistical codes, data dictionary), when the data will be available and for how long, and how data access will be provided (e.g., file transfer).
IPD Sharing Access Criteria
- The requestor is affiliated with an academic institution as an independent investigator or trainee of an independent investigator;
- The proposed research question(s) and hypothesis(es) are specific, measurable, and achievable;
- The proposed research project will be governed/overseen by a local legal/regulatory body;
- The proposed research project poses no risk of invasion of privacy or breaches of confidentiality for trial participants;
- A member of the proposed research team has sufficient statistical skills to carry out the proposed analytic plan;
- The requestor has sufficient financial and/or human resources to see the proposed research project to completion;
- The proposed research question(s) and hypothesis(es) do not conflict with active or planned studies of the Co-Principal Investigators.
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.
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