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Evaluation of an Antidepressant Pharmacogenomic Algorithm in an Outpatient Clinical Setting

This study has been completed.
Sponsor:
Collaborator:
Assurex Health Home
Information provided by (Responsible Party):
Daniel K. Hall-Flavin, Mayo Clinic
ClinicalTrials.gov Identifier:
NCT01610063
First received: May 25, 2012
Last updated: February 10, 2017
Last verified: February 2017
  Purpose
This was a study of a genotyping tool that reported on how subjects responded to medications and could be used in a community psychiatry practice to improve medication choice for depression. After the DNA test, an interpretive report was provided to the subjects' physicians. The hypothesis of this pilot study was that it was feasible to use this pharmacogenomic algorithm in a new setting to treat depressed subjects..

Condition Intervention
Depression
Other: Pharmacogenomic algorithm

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Diagnostic
Official Title: A Pilot Study for the Evaluation of the Clinic-wide Impact of the Antidepressant Pharmacogenomic Algorithm in an Outpatient Clinical Setting

Resource links provided by NLM:


Further study details as provided by Mayo Clinic:

Primary Outcome Measures:
  • Percentage Change in Quick Inventory of Depressive Symptomatology (QIDS-C16) Score From Baseline [ Time Frame: baseline, 8-week visit ]
    The QIDS-C16 is a 16-item scale that is clinician-rated; it is designed to assess the severity of depressive symptoms. The QIDS-C16 total score ranges from 0-27. Scores ranging from 0 to 10 correspond with no to mild depression, while scores >/= 11 correspond to moderate to severe depression. A negative change indicates improvement in the subject's depression, and a positive change indicates a worsening of the subject's depression.


Secondary Outcome Measures:
  • Percentage Change in Hamilton Depression Rating Scale (HAMD-17) Score From Baseline [ Time Frame: baseline, 8-week visit ]
    The HAMD-17 is a 17-item scale that evaluates depressed mood, vegetative and cognitive symptoms of depression, and co-morbid anxiety symptoms. The 17 items are rated on either a 5-point (0-4) or a 3-point (0-2) scale. In general, the 5 point scale items use a rating of 0=absent; 1=doubtful to mild; 2=mild to moderate; 3=moderate to severe; 4=very severe. The 3-point scale items use a rating of 0=absent; 1=probable or mild; 2=definite. The total HAMD-17 score ranges from 0 (not ill) to 52 (severely ill). A negative change indicates improvement in the subject's depression/anxiety symptoms, and a positive change indicates a worsening of the subject's depression/anxiety symptoms.

  • Percentage Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline [ Time Frame: baseline, 8-week visit ]
    The PHQ-9 is the nine item depression scale of the Patient Health Questionnaire. The PHQ-9 is based directly on the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual Fourth Edition (DSM-IV). Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 (no symptoms) and 27 (severe symptoms) for depression. A negative change indicates improvement in the subject's depression symptoms, and a positive change indicates a worsening of the subject's depression symptoms.

  • Percentage Change in Outcome by Bin Status and Treatment Group [ Time Frame: baseline, 8-week visit ]
    The Genesight algorithm presents recommendations for antidepressants and antipsychotics in "bin status" associated with colors. Green indicates "Use as Directed." Yellow indicates "Use with Caution." Red indicates "Use with Increased Caution and with More Frequent Monitoring." Definitions of the depression questionnaires are found in previous outcome measures. A negative change indicates improvement in the subject's depression/anxiety symptoms, and a positive change indicates a worsening of the subject's depression/anxiety symptoms.

  • Pharmacogenomic Report Utilization [ Time Frame: baseline, 8-week visit ]
    Physicians were directed to complete a survey for each participant detailing their experiences during the study period.

  • Physicians' Perception of Participant's Satisfaction With Their Care [ Time Frame: 8-week visit ]
    Physicians reported on their perception of each participant's satisfaction with their care only for patients who completed the 8-week study. Physicians were directed to complete a survey for each participant detaining their experience during the study period.

  • Responders at Week 8 [ Time Frame: baseline, 8 weeks ]
    Definitions of the depression questionnaires are found in previous outcome measures. Definition of responder: a participant who had 50% or higher reduction in psychiatric score from baseline.

  • Remitters at Week 8 [ Time Frame: baseline, 8 weeks ]
    Definitions of the depression questionnaires are found in previous outcome measures. Definition of remitter: a participant with score less than or equal to certain value (HAMD-17 <=7, QIDS-C16<=5, PHQ-9<5).


Enrollment: 227
Actual Study Start Date: January 2009
Study Completion Date: May 2013
Primary Completion Date: November 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Guided
A pharmacogenomic algorithm (GeneSight) guided treatment decisions for antidepressant medication selection and appropriate dosing.
Other: Pharmacogenomic algorithm
Genetic test results for 4 genes were put through algorithm and provided to physician for guidance prescribing medication.
Other Name: GeneSight
No Intervention: Unguided
Treatment as usual

Detailed Description:
Antidepressant medications are among the most widely prescribed medications. However, only 35% to 45% of depressed patients have a complete remission of their illness when initially treated with these medications. Consequently, the Mayo Clinic psychiatric pharmacogenomic team developed a pharmacogenomic algorithm designed to improve the effectiveness and safety of antidepressant medications by providing guidance in medication selection and appropriate dosing. This algorithm has been incorporated into a new genotyping interpretative report. The pharmacogenomic algorithm is based on genotyping both copies of four informative genes. These four genes are: 1) the Cytochrome (P450 2D6) gene; 2) the Cytochrome (P450 2C19) gene; 3) the Serotonin Transporter gene (SLC6A4); and 4) the Serotonin 2A receptor gene (5HTR2A). The trial took place at the Franciscan Skemp Healthcare System in La Crosse, Wisconsin over the course of 12 months.
  Eligibility

Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patient is between the ages of 18 and 80.
  2. Major depressive disorder or depressive disorder not otherwise specified as ascertained by a physician or mental health professional licensed to diagnose.
  3. Patient is an outpatient and not in imminent need of inpatient hospitalization, or a discharging inpatient with scheduled follow-up with a Behavioral Health psychiatrist.
  4. Patient has been referred to see a psychiatrist for optimum medication management.
  5. Patient's Hamilton Depression Rating score is >14
  6. Ability to read, understand and sign an informed consent document

Exclusion Criteria:

  1. Serious medical illness (as ascertained via the initial triage screening process)
  2. Patients with a diagnosis of Bipolar I disorder
  3. Patients with a diagnosis of Schizophrenia or Schizoaffective disorder
  4. Patients who are legally unable to consent to enrollment in the study (i.e. patients with legal guardians)
  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: NCT01610063

Locations
United States, Wisconsin
Franciscan Skemp HealthCare
La Crosse, Wisconsin, United States, 54601
Sponsors and Collaborators
Mayo Clinic
Assurex Health Home
Investigators
Principal Investigator: Daniel K. Hall-Flavin Mayo Clinic
  More Information

Responsible Party: Daniel K. Hall-Flavin, PI, Mayo Clinic
ClinicalTrials.gov Identifier: NCT01610063     History of Changes
Other Study ID Numbers: 08-005610
Study First Received: May 25, 2012
Results First Received: August 18, 2016
Last Updated: February 10, 2017
Individual Participant Data  
Plan to Share IPD: No

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

Keywords provided by Mayo Clinic:
Algorithm
Depression
Assurex
GeneSight

Additional relevant MeSH terms:
Depression
Behavioral Symptoms
Antidepressive Agents
Psychotropic Drugs

ClinicalTrials.gov processed this record on May 24, 2017