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PREemptive Pharmacogenomic Testing for Preventing Adverse Drug REactions (PREPARE)

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ClinicalTrials.gov Identifier: NCT03093818
Recruitment Status : Recruiting
First Posted : March 28, 2017
Last Update Posted : September 13, 2018
Sponsor:
Collaborators:
University of Liverpool
Medical University of Vienna
Centro di Riferimento Oncologico - Aviano
Andaluz Health Service
University of Patras
University of Ljubljana
Karolinska Institutet
The Golden Helix Foundation
Royal Dutch Pharmacists Association (KNMP)
Bio.Logis Genetic Information Management
Paul Sabatier University
Uppsala University
Robert Bosch Gesellschaft für Medizinische Forschung mbH
Federal Institute for Drugs and Medical Devices
St. Antonius Hospital
Information provided by (Responsible Party):
J.J.Swen, Leiden University Medical Center

Brief Summary:
PREPARE is an international, prospective, multi-center, open, randomized, cross-over implementation study assessing the impact of pre-emptive pharmacogenomic testing, of a panel of actionable pharmacogenomic variants, on adverse event incidence. Additional outcomes include, healthcare expenditure, process indicators for implementation and provider adoption of pharmacogenomics.

Condition or disease Intervention/treatment Phase
Adverse Drug Reaction Other: Pharmacogenomic testing Not Applicable

Detailed Description:

Pre-emptive pharmacogenomic testing will be implemented in clinical sites across seven European countries (United Kingdom, The Netherlands, Austria, Greece, Slovenia, Italy and Spain). The 35-month study is split into two time-blocks. The participating countries are randomized to start with either implementing pharmacogenomics guided prescribing or with standard of care in the first block. In the pharmacogenomics guided prescribing arm, results of the pharmacogenomic test will be incorporated in the (electronic) medical record and may be used by physicians and pharmacists to guide drug and dose selection for 39 routinely prescribed drugs, as per the Dutch Pharmacogenomics Working Group guidelines. In the standard of care arm, patients will not receive pharmacogenomic testing. After this time-block, the countries switch to implementing the opposite strategy and will recruit new patients.

Patients are eligible for participation when they receive a first prescription for one or more of 39 drugs for which a Dutch Pharmacogenomic Working Group guideline is available (acenocoumarol, amitriptyline, aripiprazole, atomoxetine, atorvastatin,azathioprine ,capecitabine, citalopram, clomipramine, clopidogrel, codeine, doxepin, efavirenz, escitalopram, flecainide, flucloxacillin, fluorouracil, haloperidol, imipramine, irinotecan, mercaptopurine, metoprolol, nortryptiline, paroxetine, phenprocoumon, phenytoin, pimozide, propafenon, sertraline, simvastatin, tacrolimus, tamoxifen, tegafur, thioguanine, tramadol, venlafaxine, voriconazole, warfarin or zuclopenthixol). All patients will be followed for a minimum of three months and a maximum of 19 months. In total, 6,892 patients will be recruited; 3,446 will receive pharmacogenomic testing, and 3,446 will receive standard of care. Each implementation site will concentrate on, but is not limited to, recruiting patients within a specific therapeutic area. Therapeutic areas include primary care, general medicine, cardiology, oncology, psychiatry, neurology, and transplantation. It is hypothesized that implementing pharmacogenomics guided drug and dose selection will decrease incidence of clinically relevant adverse drug reactions by 30% (from 4% to 2.8%).


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 6892 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single (Outcomes Assessor)
Masking Description:

A random 10% sample of causality and severity of recorded ADE will be assessed by a 2nd independent, blinded (unaware of patient allocation) assessor.

Drug-genotype association of the ADE as per the Dutch Pharmacogenomics Working Group guideline will be assessed by a blinded review committee.

Primary Purpose: Prevention
Official Title: PREemptive Pharmacogenomic Testing for Preventing Adverse Drug REactions
Actual Study Start Date : March 20, 2017
Estimated Primary Completion Date : May 2020
Estimated Study Completion Date : May 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Drug Reactions

Arm Intervention/treatment
Experimental: Pharmacogenomic testing arm
3,446 patients will provide a DNA sample. A pharmacogenomic test is performed. Results of this test are incorporated in the (electronic) medical record and combined with a clinical decision support system. Physicians and pharmacists may choose to use these results to guide drug and dose selection as per the Dutch Pharmacogenomics Working Group guidelines. Patients will receive a "Safety-Code card" containing their personal pharmacogenomics results, which can be used by other physicians or pharmacists during subsequent prescriptions.
Other: Pharmacogenomic testing
The pharmacogenomic panel to be used incorporates 44 genetic variants for the following 12 "pharamacogenes": CYP1A2 (cytochrome P450), CYP2B6, CYP2C19, CYP2C9, CYP2D6,CYP3A4, DPYD (dihydropyrimidine dehydrogenase), FVL (factor five Leiden), HLA-B (human leukocyte antigen), SLCO1B1 (solute carrier organic anion transporter), TPMT (thiopurine methyltransferase), UGT1A1 (UDP-glucuronosyltransferase), and VKORC1 (vitamin K epoxide reductase complex).

No Intervention: Standard of care arm
3,446 patients will provide a DNA sample. However, no pharmacogenomic test is performed until the study is completed. Physicians and pharmacists will prescribe and dispense drugs routinely, without using pharmacogenomic test results to guide drug and dose selection. Patients will receive a mock "Safety-Code card", which does not contain personal pharmacogenomics results.



Primary Outcome Measures :
  1. Experience of at least one clinically relevant adverse drug reaction which is caused by the drug of inclusion [ Time Frame: 12 weeks ]
    Defined as an adverse drug reaction which is causally related to the drug of inclusion (definite, probable or possible), clinically relevant (CTCAE Grade 2,3,4 or 5) and associated with a drug-genotype interaction (as per the Dutch Pharmacogenomics Working Group guidelines). For oncology patients receiving 5-FU, capecitabine, tegafur or irinotecan, only hematological toxicities of NCI-CTCAE grade 4-5 and non-hematological toxicities of NCI-CTCAE grade 3-5 will be considered clinically relevant.


Secondary Outcome Measures :
  1. Physician and pharmacist adherence to Dutch Pharmacogenomics Working Group guidelines [ Time Frame: 18 months ]
    Defined as adhering to the guidelines or not adhering to the guidelines

  2. Healthcare expenditure related to adverse events [ Time Frame: 18 months ]
    Any costs made as a result of an adverse event

  3. Incidence of drug discontinuation due to an adverse event [ Time Frame: 18 months ]
    Related to the drug of inclusion

  4. Incidence of discontinuation due to lack of efficacy [ Time Frame: 18 months ]
    Related to the drug of inclusion

  5. Quality of life [ Time Frame: 18 months ]
    Time trade-off question

  6. Incidence of dose adjustments [ Time Frame: 18 months ]
    Related to the drug of inclusion

  7. Attitudes towards and knowledge of pharmacogenomics [ Time Frame: 18 months ]
    Composite outcome: a list of seven questions regarding pharmacogenomics



Information from the National Library of Medicine

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, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Subject must be ≥ 18 years old
  • Subject must receive a first prescription (meaning no known prescription for this drug in the preceding 12 months) for one or more of 39 drugs, for which a Dutch Pharmacogenomic Working Group guideline is available, which is prescribed to them in routine care
  • Subject is able and willing to take part and be followed-up for at least 12 weeks
  • Subject is able to donate blood or saliva
  • Subject has signed informed consent
  • The study limit of enrolment (172 per arm, per time-block) for that drug has not been reached

Exclusion Criteria:

  • Subject has previous (direct-to-consumer, or clinical) genetic testing for a gene important to the drug of inclusion
  • Subject is pregnant or lactating
  • Subject has a life expectancy estimated to be less than three months by treating clinical team
  • Duration of the drug of inclusion total treatment length is planned to be less than seven consecutive days. A drug whose route of administration changes during the first seven days (e.g. intravenous to oral flucloxacillin) but whose total treatment duration is seven days or longer, is still eligible.
  • For inpatients: hospital admission is expected to be less than 72 hours
  • Subject is unable to consent to the study
  • Subject is unwilling to take part
  • Subject has no fixed address
  • Subject has no current general practitioner
  • Subject is, in the opinion of the Investigator, not suitable to participate in the study
  • Subject has existing impaired hepatic or renal function for which a lower dose or alternate drug selection are already part of current routine care. This would not apply to any drugs specifically given to manage liver/renal impairment/transplantation.
  • Subject has an estimated glomerular filtration rate (MDRD) of less than 15 ml/min per 1,73m2 in a subject with a functioning graft
  • Subject has advanced liver failure (stage Child-Pugh C)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03093818


Contacts
Contact: Cathelijne H van der Wouden, PharmD +31 (0)70 5265879 c.h.van_der_wouden@lumc.nl

Locations
Austria
Medical University of Vienna Recruiting
Vienna, Austria
Contact: Gere Sunder-Plassmann, MD       gere.sunder-plassmann@meduniwien.ac.at   
Principal Investigator: Gere Sunder-Plassmann, MD         
Greece
University of Patras Recruiting
Patras, Greece
Contact: George P. Patrinos, PhD       gpatrinos@upatras.gr   
Principal Investigator: George P. Patrinos, PhD         
Italy
Centro di Riferimento Oncologico Recruiting
Aviano, Italy
Contact: Erika Cecchin, PharmD PhD       ececchin@cro.it   
Principal Investigator: Giuseppe Toffoli, MD         
Netherlands
Leiden University Medical Center Recruiting
Leiden, Netherlands
Contact: Cathelijne van der Wouden, PharmD       c.h.van_der_wouden@lumc.nl   
Principal Investigator: Jesse J. Swen, PharmD PhD         
Slovenia
University of Ljubljana Recruiting
Ljubljana, Slovenia
Contact: Vita Dolzan, MD PhD       vita.dolzan@mf.uni-lj.si   
Principal Investigator: Vita Dolzan, MD PhD         
Spain
Servicio Andaluz de Salud Recruiting
Granada, Spain
Contact: Cristina L. Dávila Fajardo, PharmD PhD       cldf28@hotmail.com   
Principal Investigator: Cristina L. Dávila Fajardo, PharmD PhD         
United Kingdom
University of Liverpool Recruiting
Liverpool, United Kingdom
Contact: Richard Turner, MD       Richard.Turner@liverpool.ac.uk   
Principal Investigator: Munir Pirmohamed, MB ChB(Hons) PhD         
Sponsors and Collaborators
J.J.Swen
University of Liverpool
Medical University of Vienna
Centro di Riferimento Oncologico - Aviano
Andaluz Health Service
University of Patras
University of Ljubljana
Karolinska Institutet
The Golden Helix Foundation
Royal Dutch Pharmacists Association (KNMP)
Bio.Logis Genetic Information Management
Paul Sabatier University
Uppsala University
Robert Bosch Gesellschaft für Medizinische Forschung mbH
Federal Institute for Drugs and Medical Devices
St. Antonius Hospital
Investigators
Principal Investigator: Jesse J. Swen, PharmD PhD Leiden University Medical Center
Principal Investigator: Munir Pirmohamed, MB ChB(Hons) PhD University of Liverpool
Principal Investigator: Gere Sunder-Plassmann, MD Medical University of Vienna
Principal Investigator: Giuseppe Toffoli, MD Centro di Riferimento Oncologico
Principal Investigator: Cristina Lucía Dávila Fajardo, PharmD PhD Andaluz Health Service
Principal Investigator: George P. Patrinos, PhD University of Patras
Principal Investigator: Vita Dolzan, MD PhD University of Ljubljana

Additional Information:
Responsible Party: J.J.Swen, Associate Professor of Pharmacogenetics, Section Chair Laboratory, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center
ClinicalTrials.gov Identifier: NCT03093818     History of Changes
Other Study ID Numbers: 668353 (U-PGx)
First Posted: March 28, 2017    Key Record Dates
Last Update Posted: September 13, 2018
Last Verified: September 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
Drug-Related Side Effects and Adverse Reactions
Chemically-Induced Disorders