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

5. juni 2019 oppdatert av: 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.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

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

Observasjonsmessig

Registrering (Faktiske)

505

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

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

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år til 80 år (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

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

Beskrivelse

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

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Kohorter og intervensjoner

Gruppe / Kohort
Intervensjon / Behandling
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.
Annen: Pain assessment questionnaire
A pain assessment questionnaire will be administered at baseline and 3 months.
Andre navn:
  • 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.
Annen: Pain assessment questionnaire
A pain assessment questionnaire will be administered at baseline and 3 months.
Andre navn:
  • PROMIS questionnaire
Genetisk: 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.
Annen: Physician assessment
20-item survey administered to physicians treating patients enrolled in the study

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Change in overall pain score (Patient Reported Outcomes Measurement Information System (PROMIS)
Tidsramme: 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

Sekundære resultatmål

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

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University of Florida

Samarbeidspartnere

National Human Genome Research Institute (NHGRI)

Etterforskere

  • Hovedetterforsker: Larisa Cavallari, PharmD, University of Florida

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

1. juni 2015

Primær fullføring (Faktiske)

12. juni 2017

Studiet fullført (Faktiske)

25. oktober 2017

Datoer for studieregistrering

Først innsendt

7. januar 2015

Først innsendt som oppfylte QC-kriteriene

8. januar 2015

Først lagt ut (Anslag)

9. januar 2015

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

6. juni 2019

Siste oppdatering sendt inn som oppfylte QC-kriteriene

5. juni 2019

Sist bekreftet

1. juni 2019

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Andre studie-ID-numre

  • IRB201400501 - N
  • U01HG007269-02 (U.S. NIH-stipend/kontrakt)
  • OCR14741 (Annen identifikator: Universiy of Florida)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

JA

IPD-planbeskrivelse

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.

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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