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Implementing Genomics in Practice (IGNITE) Proof of Concept Study: Genotyping in Family Medicine Clinics (IGNITE)

5 juni 2019 bijgewerkt door: University of Florida
This study will examine the effect of having genotype information on pain management and pain control for patients treated in family medicine clinics. This study will also examine physician-perceived usefulness of genotype information. Patients will be enrolled from family medicine clinics serving as either implementation sites or control sites. Patients from implementation sites will undergo genotyping, while those from control sites will not by genotyped.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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.

Studietype

Observationeel

Inschrijving (Werkelijk)

505

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Verenigde Staten
    • Florida
      • Archer, Florida, Verenigde Staten, 32618
        • Archer Family Health Care
      • Gainesville, Florida, Verenigde Staten, 32606
        • UF Health Spring Hill Pain Management
      • Gainesville, Florida, Verenigde Staten, 32607
        • UF Health Family Medicine: Hampton Oaks
      • Gainesville, Florida, Verenigde Staten, 32607
        • UF Health Internal Medicine - Tower Hill
      • Gainesville, Florida, Verenigde Staten, 32608
        • UF Health Family Medicine: Haile Plantation
      • Gainesville, Florida, Verenigde Staten, 32609'
        • UF Health Family Medicine: Main Street
      • Gainesville, Florida, Verenigde Staten, 32610
        • UF Health Internal Medicine-Medical Plaza
      • Gainesville, Florida, Verenigde Staten, 32641
        • UF Health Family Medicine: Eastside
      • Old Town, Florida, Verenigde Staten, 32680
        • UF Health Family Medicine - Old Town
      • Oviedo, Florida, Verenigde Staten, 32765
        • Oviedo Family Health Center
      • Saint Cloud, Florida, Verenigde Staten, 34769
        • ProHealth Family Physicians

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar tot 80 jaar (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Bemonsteringsmethode

Niet-waarschijnlijkheidssteekproef

Studie Bevolking

Patients will be enrolled from family medicine clinics serving as either implementation sites or control sites for pain mangement.

Beschrijving

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Cohorten en interventies

Groep / Cohort
Interventie / Behandeling
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.
Ander: Pain assessment questionnaire
A pain assessment questionnaire will be administered at baseline and 3 months.
Andere namen:
  • PROMIS questionnaire
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.
Ander: Pain assessment questionnaire
A pain assessment questionnaire will be administered at baseline and 3 months.
Andere namen:
  • PROMIS questionnaire
Genetisch: CYP2D6 genotyping
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.
Ander: Physician assessment
20-item survey administered to physicians treating patients enrolled in the study

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Change in overall pain score (Patient Reported Outcomes Measurement Information System (PROMIS)
Tijdsspanne: 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

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Change in pain medication
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 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
Tijdsspanne: 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)
Tijdsspanne: 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)
Tijdsspanne: 12 months
Percent of patients with at least one other drug (besides an opioid) where genotype information might be useful for prescribing
12 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

University of Florida

Medewerkers

National Human Genome Research Institute (NHGRI)

Onderzoekers

  • Hoofdonderzoeker: Larisa Cavallari, PharmD, University of Florida

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

1 juni 2015

Primaire voltooiing (Werkelijk)

12 juni 2017

Studie voltooiing (Werkelijk)

25 oktober 2017

Studieregistratiedata

Eerst ingediend

7 januari 2015

Eerst ingediend dat voldeed aan de QC-criteria

8 januari 2015

Eerst geplaatst (Schatting)

9 januari 2015

Updates van studierecords

Laatste update geplaatst (Werkelijk)

6 juni 2019

Laatste update ingediend die voldeed aan QC-criteria

5 juni 2019

Laatst geverifieerd

1 juni 2019

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Andere studie-ID-nummers

  • IRB201400501 - N
  • U01HG007269-02 (Subsidie/contract van de Amerikaanse NIH)
  • OCR14741 (Andere identificatie: Universiy of Florida)

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Beschrijving IPD-plan

The consent form has an addendum for NIH dbGaP. Participants who agree will have their deidentified results shared to dbGaP. Those who do not agree will not have their results shared.

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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