Trial of Citalopram for the Prevention of Depression (PICCO)

This study has been completed.
Sponsor:
Collaborators:
Ontario HIV Treatment Network
Schering-Plough
CIHR Canadian HIV Trials Network
Information provided by (Responsible Party):
Marina Klein, McGill University Health Center
ClinicalTrials.gov Identifier:
NCT00317746
First received: April 21, 2006
Last updated: April 4, 2014
Last verified: April 2014
  Purpose

With the improved prognosis of human immunodeficiency virus (HIV) infection, end stage liver disease due to hepatitis C (HCV) now represents a major cause of morbidity and mortality in people with HIV. Treatment for HCV has become increasingly important as a means of preventing the consequences of chronic HCV infection. Paradoxically, co-infected patients have low rates of treatment initiation and completion in large part because they have a high risk of developing neuropsychiatric symptoms while receiving PEG-interferon (PEG-IFN). There are a large number of co-infected individuals in Canada who could benefit from HCV therapy if tolerability could be improved. This trial will address whether prophylactic use of antidepressants in HIV-HCV infected patients initiating HCV therapy can prevent the development of neuropsychiatric side effects and thus permit more patients to receive full treatment for HCV.


Condition Intervention Phase
Depression
HIV Infections
Hepatitis C
Drug: Citalopram
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: A Randomized, Placebo Controlled Trial of Citalopram for the Prevention of Depression and Its Consequences in HIV-Hepatitis C Co-infected Individuals Initiating Pegylated Interferon/Ribavirin Therapy

Resource links provided by NLM:


Further study details as provided by McGill University Health Center:

Primary Outcome Measures:
  • The primary outcome is the average proportion of PEG-IFN and ribavirin doses received in participants receiving citalopram compared with placebo [ Time Frame: week 24 ] [ Designated as safety issue: No ]
  • A second major objective is to compare arms with respect to the rate of moderate-to-severe depressive symptoms during the first 24 weeks of therapy. [ Time Frame: week 12 and week 24 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Secondary measures will assess impact of citalopram versus placebo on anxiety, neurocognitive function, quality of life and adherence to therapy. HCV and HIV control will also be examined. [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
  • Substudies aimed at understanding the pathogenesis of neuropsychiatric side effects and neurocognitive function in this population will be performed. [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]

Enrollment: 76
Study Start Date: November 2006
Study Completion Date: March 2012
Primary Completion Date: March 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Placebo Comparator: Placebo
Placebo + PEG-interferon-alfa2b + ribavirin
Experimental: Citalopram
Citalopram + PEG-interferon-alpha2b + ribavirin
Drug: Citalopram

Detailed Description:

Trial design:

This study is a Canadian multicentre randomized, double-blind placebo controlled trial. We will evaluate whether prophylactic citalopram compared to symptomatic treatment of depression can significantly increase the amount of HCV therapy received in co-infected patients during the first 24 weeks. Post study follow-up will extend until 6 months after cessation of HCV therapy (up to 72 weeks) to capture information on SVR (sustained virologic response) for HCV. 76 patients will be randomized in a 1:1 ratio to citalopram or placebo. Patients will be stratified by study centre and HCV genotype. Citalopram (or placebo) will begin 3 weeks before HCV treatment at an initial dose of 10 mg per day then be increased to 20 mg per day after one week and continued throughout treatment with PEG-IFN/ribavirin (up to 48 weeks) and then tapered to discontinuation at completion of HCV therapy. The management of depression emerging in study participants is mandated in the protocol to ensure that the original treatment assignments remain blinded while allowing for all subjects to remain in the study and mimics what would take place in clinical practice.

Analysis:

The analyses will follow the intention-to-treat approach. Random regression modelling will be employed to analyse longitudinal data on adherence to prescribed PEG-IFN and ribavirin dosage at weeks 12 and 24. Survival analyses will be used to compare the two treatment groups with respect to the time to the development of depressions.

Implications:

Prophylactic antidepressants may not only prevent overt depression but may also diminish the development of sub-clinical depressed mood. Effective prevention of a broad range of neuropsychiatric symptoms by use of citalopram has the potential to diminish morbidity associated with PEG-IFN treatment and consequently allow a greater number of patients to complete full therapy. In addition, such an approach may help patients remain adherent to their HIV therapy during the course of HCV treatment which could have long-term personal and public health implications by preventing the emergence of HIV resistance. Furthermore, if shown to be an effective strategy for preventing neuropsychiatric symptoms, treatment for HCV may become more accessible to the large number of patients who may not have ready access to the frequent and intensive psychiatric monitoring, necessary for the early detection and treatment of depression that manifests on PEG-IFN.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • HIV+ adults with chronic HCV infection requiring therapy and with no contraindications to PEG-IFN/ribavirin will be enrolled.

Exclusion Criteria:

  • Subjects with prior suicide attempt, active depression, treatment with antidepressants within 6 months of study entry or with other psychiatric disorders will be excluded.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00317746

Locations
Canada, Quebec
Immunodeficiency Service Montreal Chest Institute McGill University Health Centre
Montreal, Quebec, Canada, H2X 2P4
Sponsors and Collaborators
Marina Klein
Ontario HIV Treatment Network
Schering-Plough
CIHR Canadian HIV Trials Network
Investigators
Principal Investigator: Marina B Klein, MD Immunodeficiency Service Montreal Chest Institute
  More Information

Additional Information:
No publications provided by McGill University Health Center

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Marina Klein, Study Principal Investigator, McGill University Health Center
ClinicalTrials.gov Identifier: NCT00317746     History of Changes
Other Study ID Numbers: CTN194, Schering #2229
Study First Received: April 21, 2006
Last Updated: April 4, 2014
Health Authority: Canada: Health Canada

Keywords provided by McGill University Health Center:
HIV/HCV Co-infection
Depression
Citalopram

Additional relevant MeSH terms:
Acquired Immunodeficiency Syndrome
Depression
Depressive Disorder
Hepatitis
Hepatitis A
Hepatitis C
HIV Infections
Infection
Behavioral Symptoms
Digestive System Diseases
Enterovirus Infections
Flaviviridae Infections
Hepatitis, Viral, Human
Immune System Diseases
Immunologic Deficiency Syndromes
Lentivirus Infections
Liver Diseases
Mental Disorders
Mood Disorders
Picornaviridae Infections
Retroviridae Infections
RNA Virus Infections
Sexually Transmitted Diseases
Sexually Transmitted Diseases, Viral
Slow Virus Diseases
Virus Diseases
Citalopram
Dexetimide
Anti-Dyskinesia Agents
Antidepressive Agents

ClinicalTrials.gov processed this record on October 22, 2014