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Genomic Medicine for Ill Neonates and Infants (The GEMINI Study) (GEMINI)

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ClinicalTrials.gov Identifier: NCT03890679
Recruitment Status : Recruiting
First Posted : March 26, 2019
Last Update Posted : March 10, 2021
Sponsor:
Collaborators:
Rady Children's Hospital, San Diego
Children's Hospital Medical Center, Cincinnati
MOUNT SINAI HOSPITAL
N.C. Children's Hospital
University of Pittsburgh
Information provided by (Responsible Party):
Tufts Medical Center

Study Description
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Brief Summary:

The Genomic Medicine for Ill Neonates and Infants (The GEMINI Study) is a research study aimed at comparing the clinical and economic utility of performing rapid whole genomic sequencing versus a targeted genomic sequencing panel on neonates and infants suspected of having a genetic disorder. This study is funded by the National Institutes of Health.

This multicenter, prospective clinical trial will enroll 400 subjects at the Floating Hospital for Children at Tufts Medical Center (Boston, MA), Cincinnati Children's Hospital Medical Center (Cincinnati, OH), Mount Sinai Kravis Children's Hospital (New York, NY), North Carolina Children's Hospital (Chapel Hill, NC), Children's Hospital of Pittsburgh (Pittsburgh, PA), and Rady Children's Hospital (San Diego, CA).


Condition or disease Intervention/treatment Phase
Pediatric: Genetic Syndrome Diagnostic Test: rapid whole genomic sequencing (rWGS) Not Applicable

Detailed Description:
This multicenter, prospective clinical trial will examine the diagnostic yield and clinical utility of NewbornDx, a targeted genomic sequencing panel for use in the neonate, and rapid whole genomic sequencing (rWGS) testing in high-risk infants with signs/symptoms consistent with a possible genetic disorder. Infants will undergo NewbornDx and rWGS (proband) testing. The biological parent(s), when available, will undergo NewbornDx testing at the same time as the infant. For rWGS,the infant will undergo testing first. If a specific diagnosis that is consistent with the phenotype is not made with rWGS proband analysis alone, the parent(s) will undergo rWGS. The study will also evaluate the cost effectiveness of each test as well as standard of care (SOC) testing. A retrospective chart review of infants with suspected genetic disorders will be done to understand 1-year cost and health outcomes that would have been incurred in the absence of the advanced testing. The resulting data from the trial will be used in the economic evaluation comparing NewbornDx, rWGS, and SOC over a 1-year period and used as basis to simulate the lifetime cost-effectiveness of these testing strategies. A web-based clinical reference database to provide references, clinical management guidelines, opportunities for clinical trial participation, and support groups for each condition will be developed with separate interfaces for the parent/guardian(s) and medical provider. The clinical reference database will be qualitatively assessed by a survey of medical providers.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 400 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Genomic Medicine for Ill Neonates and Infants (The GEMINI Study)
Actual Study Start Date : May 24, 2019
Estimated Primary Completion Date : April 1, 2023
Estimated Study Completion Date : August 1, 2023
Arms and Interventions
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Intervention Details:
  • Diagnostic Test: rapid whole genomic sequencing (rWGS)
    rWGS and NewbornDx are genomic sequencing platforms
    Other Name: NewbornDx

Outcome Measures
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Primary Outcome Measures :
  1. The number of subjects with a confirmed genetic disorder detected by NewbornDx [ Time Frame: 1-2 weeks ]
    If NewbornDx diagnoses a genetic disorder

  2. The number of subjects with a confirmed genetic disorder detected by rWGS [ Time Frame: 1-2 weeks ]
    If rWGS diagnoses a genetic disorder

  3. Time in hours to a positive result by NewbornDx [ Time Frame: 1-2 weeks ]
    Duration of time (hours) to determine diagnosis by NewbornDx

  4. Time in hours to a positive result by rWGS [ Time Frame: 1-2 weeks ]
    Duration of time (hours) to determine diagnosis by rWGS

  5. Perception of the clinical utility of genomic sequencing [ Time Frame: 1 week ]
    The Clinician Assessment of Clinical Utility assessed by physician survey using units on a likert scale with 1 meaning not useful at all and 5 meaning very useful

  6. Clinical utility of genomic sequencing as assessed by changes in clinical care management [ Time Frame: 1 week ]
    The Clinician Assessment of Clinical Utility assessed by physician survey selecting the specific types of 35 possible management changes (i.e. surgical intervention implemented, medication changed, etc.)


Secondary Outcome Measures :
  1. One year cost-effectiveness of standard of care (SOC), NewbornDx and rWGS testing [ Time Frame: 5 years ]
    All three care platforms will be assessed for their cost-effectiveness based on Quality-Adjusted-Life Year. Qualities are assessed on a scale ranging from 0 (deceased) to 1 (perfect health).

  2. Lifetime cost-effectiveness of SOC, NewbornDx and rWGS testing [ Time Frame: 5 years ]
    All three care platforms will be assessed for their cost-effectiveness based on Quality-Adjusted-Life Year. Qualities are assessed on a scale ranging from 0 (deceased) to 1 (perfect health).

  3. User satisfaction with the clinical reference database providing physician-specific information about treatments, resources and ongoing clinical trials regarding the genetic disorder diagnosed: likert scale [ Time Frame: 5 years ]
    The Clinician Satisfaction with Return of Genomic Testing Information survey assessed by physicians using units on a likert scale with 1 meaning not useful at all and 5 meaning very useful


Eligibility Criteria
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Ages Eligible for Study:   up to 1 Year   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Documented informed consent from the parent/guardian
  • Signs/symptoms consistent with a possible genetic disorder
  • Admitted to a hospital participating in this study at the time of enrollment
  • Less than one year corrected gestational age

Exclusion Criteria:

  • A known genetic diagnosis (e.g. prenatal testing)
  • Major congenital anomaly associated with a chromosomal anomaly detected on prenatal testing
  • Presence of documented congenital infection
  • Infants considered non-viable due to prematurity (< 23 0/7 weeks GA)
Contacts and Locations
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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): NCT03890679


Contacts
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Contact: Anne Kurfiss, MPH 617-636-7134 akurfiss@tuftsmedicalcenter.org
Contact: Jill Maron, MD, MPH 617-636-0766 jmaron@tuftsmedicalcenter.org

Locations
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United States, California
Rady Children's Hospital - San Diego Recruiting
San Diego, California, United States, 92123
Contact: Michele Feddock       mfeddock@rchsd.org   
Sub-Investigator: Kristen Wigby, MD         
Principal Investigator: Stephen Kingsmore, MD, DSc         
United States, Massachusetts
Tufts Medical Center Recruiting
Boston, Massachusetts, United States, 02111
Contact: Anne Kurfiss, MPH    617-636-7134    akurfiss@tuftsmedicalcenter.org   
Contact: Jill Maron, MD    617-636-0766    jmaron@tuftsmedicalcenter.org   
Principal Investigator: Jill Maron, MD, MPH         
Principal Investigator: Jonathan Davis, MD         
United States, New York
Icahn School of Medicine at Mount Sinai Recruiting
New York, New York, United States, 10029
Contact: Emily Spear       emily.spear@mssm.edu   
Principal Investigator: Annemarie Stroustrup, MD, MPH         
United States, North Carolina
University of North Carolina at Chapel Hill Recruiting
Chapel Hill, North Carolina, United States, 27599
Contact: Jennifer Talbert, MS, RN       jlhamm@email.unc.edu   
Principal Investigator: Andrea Trembath, MD, MPH         
United States, Ohio
Cincinnati Children's Hospital Medical Center Recruiting
Cincinnati, Ohio, United States, 45229
Contact: Farrah Jackson       farrah.jackson@cchmc.org   
Principal Investigator: Kristen Suhrie, MD         
United States, Pennsylvania
University of Pittsburgh Medical Center Recruiting
Pittsburgh, Pennsylvania, United States, 15213
Contact: Mark Tumblin       mark.tumblin2@chp.edu   
Principal Investigator: Tom Diacovo, MD         
Principal Investigator: Gerard Vockley, MD, MPH         
Sponsors and Collaborators
Tufts Medical Center
Rady Children's Hospital, San Diego
Children's Hospital Medical Center, Cincinnati
MOUNT SINAI HOSPITAL
N.C. Children's Hospital
University of Pittsburgh
Investigators
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Principal Investigator: Jill L Maron, MD, MPH Floating Hospital for Children at Tufts Medical Center
Principal Investigator: Jonathan M Davis, MD Floating Hospital for Children at Tufts Medical Center
More Information
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Responsible Party: Tufts Medical Center
ClinicalTrials.gov Identifier: NCT03890679    
Other Study ID Numbers: JHUSIRB00000007
First Posted: March 26, 2019    Key Record Dates
Last Update Posted: March 10, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Sequencing data that relates genomic data to phenotype or other biological states will be generated and released in accordance to the NIH GDS Policy. Data, including genome sequences (fastq files), variants (vcf files), and associated HIPAA compliant clinical metadata will be deposited in the Longitudinal Pediatric Data Resource (LPDR; https://www.nbstrn.org/research-tools/longitudinal-pediatric-data-resource). The LPDR, in turn, will deposit data in the NCBI dbGAP. Variants with ACMG recommended pathogenicity assessments will be deposited in ClinVar. Novel disorder gene assertions will be deposited in ClinGen (https://clinicalgenome.org/).
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: Annual data submissions supplemented by specific dataset deposits as manuscripts arising from this work are submitted for publication.
Access Criteria: Individual level data will be made available through controlled access. Genomic Summary Results will be made available through unrestricted access.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No