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Clinical Study Evaluating Pharmacogenomics-informed Pharmacotherapy Versus Dosing as Usual in Psychiatric Disorders (PSY-PGx)

Primary Purpose

Mood Disorders, Anxiety Disorders, Psychotic Disorders

Status
Recruiting
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Personalised medication advice based on pharmacogenetic testing
Sponsored by
Maastricht University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mood Disorders focused on measuring Pharmacogenetics

Eligibility Criteria

16 Years - 65 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Suffer from a depressive episode (major depressive disorder and bipolar disorder (currently depressive episode)) (as assessed by the MINI International Neuropsychiatric Interview (M.I.N.I.) in agreement with Diagnostic and Statistical Manual (DSM-5 criteria) of at least moderate severity (assessed using the Structured Interview Guide for the Hamilton Depression Scale (SIGH-D) with a score of 14 or higher) and/or suffer from an anxiety disorder (panic disorder, generalised anxiety disorder) (as assessed by the M.I.N.I. in agreement with DSM-5 criteria) of at least moderate severity (assessed using the Structured Interview Guide for the Hamilton Anxiety Scale (SIGH- A) with a score of 18 or higher) and/or suffer from a psychotic disorder (schizophrenia and schizoaffective disorder) (as assessed by the M.I.N.I. in agreement with DSM-5 criteria) of at least moderate severity (assessed using the Positive and Negative Symptom Scale (PANSS) with a score of 75 or higher). Have had an inadequate response to at least 1 psychotropic treatment during their life-time. Inadequate response is defined as insufficient efficacy of a psychotropic treatment when dosed high enough and maintained long enough, or discontinuation of a psychotropic treatment due to AEs or intolerability. Are about to switch (or have switched within the last 2 weeks prior to first contact with an investigator) to sertraline or escitalopram (for patients with mood or anxiety disorders), or to aripiprazole or risperidone (for patients with psychotic disorders) due to an inadequate response to or intolerance of the current/ previous medication. Currently receiving inpatient or outpatient psychiatric treatment. Be able to understand the requirements of the study and provide written informed consent to participate in this study; a signed and dated informed consent form (ICF) will be obtained from each patient before participation in the study. To give written consent to the use and disclosure of clinical data from their medical records for the purpose of this study. Age between ≥16 and <65 years. Ownership of a mobile phone (Android or iOS operation system) for passive monitoring. Exclusion Criteria: Patients with a history of prior pharmacogenomic testing Patients with no prior use of psychotropic medication (medication-naïve patients) Severe somatic comorbidities as reported in the subject's medical history or based on clinical chemistry/electrocardiography (ECG) results up to six months ago. If any of these comorbidities is detected on the basis of physical examination and/or clinical chemistry and/or ECG at the screening visit, participation is not possible. Liver disease defined as follows: Alanine-Aminotransferase (ALAT) >70u/L Renal disease: Estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2 Diabetes: Blood glucose > 11.1 mmol/L or twice a fasting glucose > 7.0 mmol/L Cardiac disease: prolonged QT-interval. Alcohol and/or substance abuse and/or dependence (except nicotine) Polypharmacy defined as the routine use of five or more medications including over- the-counter, prescription and/or traditional and complementary medicines used by a patient (WHO 2019). Inability to use the mobile phone application Pregnant or breastfeeding women

Sites / Locations

  • SUNY Upstate Medical University, Department of Psychiatry and Behavioural Sciences
  • University Hospital Bonn, Department of Psychiatry and Psychotherapy
  • Ludwig-Maximilian University, University Hospital, Institute of Psychiatric Phenomics and Genomics (IPPG)
  • Parnassia Psychiatric Institute, Department of PsychiatryRecruiting
  • Maastricht University, Department of Psychiatry and NeuropsychologyRecruiting
  • Babeş-Bolyai University, Department of Clinical Psychology and Psychotherapy
  • University of Belgrade, Faculty of PharmacyRecruiting
  • Fundació Clínic per a la Recerca Biomèdica, Department of Psychiatry and Psychology, Hospital Clínic
  • King's College, Institute of Psychiatry, Psychology & Neuroscience

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

PSY-PGx Group

Dosing as usual (DAU) group

Arm Description

This is the intervention group. All patients will be treated according to a personalised medication recommendation based on the results of pharmacogenetic testing, following the prespecified dosing guideline. Prescribing physicians will prescribe one of the predefined drugs and will be unblinded for genotype and the resulting metabolisation phenotype.

This is the control group. In this group, prescribing physicians will also prescribe one of the predefined drugs, but will remain blinded to their patients' genotype and resulting metabolism phenotype for the duration of their participation in the study. After the study, patients in the control group will also be given their pharmacogenetic profile, which will make it possible to personalise their medication if necessary.

Outcomes

Primary Outcome Measures

Patient recovery, as assessed using the Patient Recovery Assessment scale - Domains and Stages (RAS-DS).
A standardised self-report tool that measures mental health recovery as defined by the client. Repeated use of the instrument makes it possible to detect change over time. Score range 38-152. Higher scores mean a better outcome.

Secondary Outcome Measures

Response Mood Disorder, defined as a 50% point reduction in the following scale:
Structured interview Guide for the Hamilton Depression Scale (SIGH-D) for depressive disorder. Score range 0-52. Higher scores mean a worse outcome.
Response Anxiety Disorder, defined as a 50% point reduction in the following scale:
Structured interview Guide for the Hamilton Anxiety Scale (SIGH-A) for anxiety disorder. Score range 0-56. Higher scores mean a worse outcome.
Response Psychotic Disorder, defined as a 50% point reduction in the following scale:
Positive and Negative Symptom Scale (PANSS) for psychotic disorder. Score range 30-210. Higher scores mean a worse outcome.
Symptomatic Remission Mood Disorder, defined as:
SIGH-D score of 7 or less. Score range 0-52. Higher scores mean a worse outcome.
Symptomatic Remission Anxiety Disorder, defined as:
SIGH-A score of 7 or less. Score range 0-56. Higher scores mean a worse outcome.
Symptomatic Remission Psychotic Disorder, defined as:
PANSS score of 57 or less. Score range 30-210. Higher scores mean a worse outcome.
Burden of side effects, as measured by:
Frequency, Intensity and Burden of side effects ratings (FIBSER). Score range 0-18. Higher scores mean a worse outcome.
Side effects, as measured by:
Udvalg for Kliniske Undersogelse - Side Effects Rating Scale (UKU-SERS). Score range 0-135. Higher scores mean a worse outcome.
General wellbeing, as measured by:
The 5-level EQ-5D version (EQ-5D-5L). Score range 5-25. Higher scores mean a worse outcome. Visual Analog Scale (VAS)-score 0-100. A higher score means a better outcome.
Psychosocial functioning, as measured by:
Functioning Assessment short test (FAST). Score range 0-72. Higher scores mean a worse outcome.

Full Information

First Posted
November 30, 2022
Last Updated
September 11, 2023
Sponsor
Maastricht University
Collaborators
Parnassia Psychiatric Institute, University of Belgrade, University of Bonn, Babes-Bolyai University, State University of New York - Upstate Medical University, Ludwig-Maximilians - University of Munich, King's College London, University of Barcelona
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1. Study Identification

Unique Protocol Identification Number
NCT05656469
Brief Title
Clinical Study Evaluating Pharmacogenomics-informed Pharmacotherapy Versus Dosing as Usual in Psychiatric Disorders
Acronym
PSY-PGx
Official Title
A New Intervention for Implementation of Pharmacogenetics in Psychiatry
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 23, 2023 (Actual)
Primary Completion Date
March 2025 (Anticipated)
Study Completion Date
March 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Maastricht University
Collaborators
Parnassia Psychiatric Institute, University of Belgrade, University of Bonn, Babes-Bolyai University, State University of New York - Upstate Medical University, Ludwig-Maximilians - University of Munich, King's College London, University of Barcelona

4. Oversight

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
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A 24-week, patient- and rater-blinded, two-arm, parallel-group controlled, and multi-centre randomized clinical trial (RCT) to establish the benefits of pharmacogenetics-informed pharmacotherapy versus dosing as usual (DAU) in psychiatric patients suffering from mood, anxiety, or psychotic disorders.
Detailed Description
Effective pharmacotherapeutic treatments for mental disorders are available, but their effectiveness is limited by low compliance due to frequent side effects. This is partly due to patient heterogeneity in the genes encoding for drug-metabolising enzymes. Pharmacogenetic testing allows the assessment of person-specific genetic factors that are thought to predict clinical response and side effects. Recent studies have suggested that genotyping genes encoding drug-metabolizing enzymes may improve treatment efficacy and tolerability, potentially benefitting millions of patients. PSY-PGx is the first initiative to propose a large-scale non-industry sponsored clinical study that aims to demonstrate the clinical benefits and potential of the implementation of pharmacogenetics for psychiatric patients in existing medical settings. This is an international 24-week, patient- and rater-blinded, two-arm, parallel-group controlled, and multi-centre randomized clinical trial (RCT) to establish the benefits of pharmacogenetics-informed pharmacotherapy versus dosing as usual (DAU) in psychiatric patients suffering from mood, anxiety, or psychotic disorders.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mood Disorders, Anxiety Disorders, Psychotic Disorders
Keywords
Pharmacogenetics

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
A two-arm, parallel-group controlled, and multi-centre randomized clinical trial (RCT)
Masking
ParticipantOutcomes Assessor
Masking Description
Patient- and rater-blinded
Allocation
Randomized
Enrollment
2500 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
PSY-PGx Group
Arm Type
Experimental
Arm Description
This is the intervention group. All patients will be treated according to a personalised medication recommendation based on the results of pharmacogenetic testing, following the prespecified dosing guideline. Prescribing physicians will prescribe one of the predefined drugs and will be unblinded for genotype and the resulting metabolisation phenotype.
Arm Title
Dosing as usual (DAU) group
Arm Type
No Intervention
Arm Description
This is the control group. In this group, prescribing physicians will also prescribe one of the predefined drugs, but will remain blinded to their patients' genotype and resulting metabolism phenotype for the duration of their participation in the study. After the study, patients in the control group will also be given their pharmacogenetic profile, which will make it possible to personalise their medication if necessary.
Intervention Type
Other
Intervention Name(s)
Personalised medication advice based on pharmacogenetic testing
Intervention Description
Pharmacogenetic genotyping provides personalised medication advice on dosage and choice of currently available and legally approved medication based on the patient's pharmacogenetic profile
Primary Outcome Measure Information:
Title
Patient recovery, as assessed using the Patient Recovery Assessment scale - Domains and Stages (RAS-DS).
Description
A standardised self-report tool that measures mental health recovery as defined by the client. Repeated use of the instrument makes it possible to detect change over time. Score range 38-152. Higher scores mean a better outcome.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Response Mood Disorder, defined as a 50% point reduction in the following scale:
Description
Structured interview Guide for the Hamilton Depression Scale (SIGH-D) for depressive disorder. Score range 0-52. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Response Anxiety Disorder, defined as a 50% point reduction in the following scale:
Description
Structured interview Guide for the Hamilton Anxiety Scale (SIGH-A) for anxiety disorder. Score range 0-56. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Response Psychotic Disorder, defined as a 50% point reduction in the following scale:
Description
Positive and Negative Symptom Scale (PANSS) for psychotic disorder. Score range 30-210. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Symptomatic Remission Mood Disorder, defined as:
Description
SIGH-D score of 7 or less. Score range 0-52. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Symptomatic Remission Anxiety Disorder, defined as:
Description
SIGH-A score of 7 or less. Score range 0-56. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Symptomatic Remission Psychotic Disorder, defined as:
Description
PANSS score of 57 or less. Score range 30-210. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Burden of side effects, as measured by:
Description
Frequency, Intensity and Burden of side effects ratings (FIBSER). Score range 0-18. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
Side effects, as measured by:
Description
Udvalg for Kliniske Undersogelse - Side Effects Rating Scale (UKU-SERS). Score range 0-135. Higher scores mean a worse outcome.
Time Frame
24 weeks
Title
General wellbeing, as measured by:
Description
The 5-level EQ-5D version (EQ-5D-5L). Score range 5-25. Higher scores mean a worse outcome. Visual Analog Scale (VAS)-score 0-100. A higher score means a better outcome.
Time Frame
24 weeks
Title
Psychosocial functioning, as measured by:
Description
Functioning Assessment short test (FAST). Score range 0-72. Higher scores mean a worse outcome.
Time Frame
24 weeks
Other Pre-specified Outcome Measures:
Title
Passive behavioral monitoring using the BeHAPP mobile application.
Description
The BEHAPP mobile application will be used to collect passive, social behavioural data as additional outcome measure that has been shown to be of value in predicting relapse/recurrence. Once the application is installed and initialised, it passively collects (meta)data on phone call activity, Bluetooth devices and WiFi access points in the participant's immediate environment, location updates and mobile application usage.
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Suffer from a depressive episode (major depressive disorder and bipolar disorder (currently depressive episode)) (as assessed by the MINI International Neuropsychiatric Interview (M.I.N.I.) in agreement with Diagnostic and Statistical Manual (DSM-5 criteria) of at least moderate severity (assessed using the Structured Interview Guide for the Hamilton Depression Scale (SIGH-D) with a score of 14 or higher) and/or suffer from an anxiety disorder (panic disorder, generalised anxiety disorder) (as assessed by the M.I.N.I. in agreement with DSM-5 criteria) of at least moderate severity (assessed using the Structured Interview Guide for the Hamilton Anxiety Scale (SIGH- A) with a score of 18 or higher) and/or suffer from a psychotic disorder (schizophrenia and schizoaffective disorder) (as assessed by the M.I.N.I. in agreement with DSM-5 criteria) of at least moderate severity (assessed using the Positive and Negative Symptom Scale (PANSS) with a score of 75 or higher). Have had an inadequate response to at least 1 psychotropic treatment during their life-time. Inadequate response is defined as insufficient efficacy of a psychotropic treatment when dosed high enough and maintained long enough, or discontinuation of a psychotropic treatment due to AEs or intolerability. Are about to switch (or have switched within the last 2 weeks prior to first contact with an investigator) to sertraline or escitalopram (for patients with mood or anxiety disorders), or to aripiprazole or risperidone (for patients with psychotic disorders) due to an inadequate response to or intolerance of the current/ previous medication. Currently receiving inpatient or outpatient psychiatric treatment. Be able to understand the requirements of the study and provide written informed consent to participate in this study; a signed and dated informed consent form (ICF) will be obtained from each patient before participation in the study. To give written consent to the use and disclosure of clinical data from their medical records for the purpose of this study. Age between ≥16 and <65 years. Ownership of a mobile phone (Android or iOS operation system) for passive monitoring. Exclusion Criteria: Patients with a history of prior pharmacogenomic testing Patients with no prior use of psychotropic medication (medication-naïve patients) Severe somatic comorbidities as reported in the subject's medical history or based on clinical chemistry/electrocardiography (ECG) results up to six months ago. If any of these comorbidities is detected on the basis of physical examination and/or clinical chemistry and/or ECG at the screening visit, participation is not possible. Liver disease defined as follows: Alanine-Aminotransferase (ALAT) >70u/L Renal disease: Estimated glomerular filtration rate (eGFR) < 60ml/min/1.73m2 Diabetes: Blood glucose > 11.1 mmol/L or twice a fasting glucose > 7.0 mmol/L Cardiac disease: prolonged QT-interval. Alcohol and/or substance abuse and/or dependence (except nicotine) Polypharmacy defined as the routine use of five or more medications including over- the-counter, prescription and/or traditional and complementary medicines used by a patient (WHO 2019). Inability to use the mobile phone application Pregnant or breastfeeding women
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Roos van Westrhenen, Ass. Prof.
Phone
+31 6 51753521
Email
r.vanwestrhenen@psyq.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Therese van Amelsvoort, Prof. Dr.
Phone
+31 (0)433884077
Email
t.vanamelsvoort@maastrichtuniversity.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roos van Westrhenen, Ass. Prof.
Organizational Affiliation
Parnassia Psychiatric Institute (Amsterdam)
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Therese van Amelsvoort, Prof. Dr.
Organizational Affiliation
Maastricht University, Department of Psychiatry and Neuropsychology
Official's Role
Principal Investigator
Facility Information:
Facility Name
SUNY Upstate Medical University, Department of Psychiatry and Behavioural Sciences
City
Syracuse
State/Province
New York
ZIP/Postal Code
13210
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Thomas Schulze, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Thomas Schulze, Prof. Dr.
Facility Name
University Hospital Bonn, Department of Psychiatry and Psychotherapy
City
Bonn
Country
Germany
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sarah Maywald, MD
First Name & Middle Initial & Last Name & Degree
Alexandra Philipsen, Prof. Dr.
Facility Name
Ludwig-Maximilian University, University Hospital, Institute of Psychiatric Phenomics and Genomics (IPPG)
City
München
Country
Germany
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Urs Heilbronner, PhD
First Name & Middle Initial & Last Name & Degree
Urs Heilbronner, Dr.
Facility Name
Parnassia Psychiatric Institute, Department of Psychiatry
City
Amsterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Roos van Westrhenen, Ass. Prof.
First Name & Middle Initial & Last Name & Degree
Roos van Westrhenen, Ass. Prof.
Facility Name
Maastricht University, Department of Psychiatry and Neuropsychology
City
Maastricht
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maud Daemen, PhD
First Name & Middle Initial & Last Name & Degree
Therese van Amelsvoort, Prof. Dr.
Facility Name
Babeş-Bolyai University, Department of Clinical Psychology and Psychotherapy
City
Cluj-Napoca
Country
Romania
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ramona Moldovan, Prof.
First Name & Middle Initial & Last Name & Degree
Ramona Moldovan, Prof.
Facility Name
University of Belgrade, Faculty of Pharmacy
City
Belgrade
Country
Serbia
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Marin Jukic, Dr.
First Name & Middle Initial & Last Name & Degree
Marin Jukic, Dr.
Facility Name
Fundació Clínic per a la Recerca Biomèdica, Department of Psychiatry and Psychology, Hospital Clínic
City
Barcelona
Country
Spain
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Natalia Elena Fares, PhD
First Name & Middle Initial & Last Name & Degree
Eduard Vieta, Prof. Dr.
Facility Name
King's College, Institute of Psychiatry, Psychology & Neuroscience
City
London
Country
United Kingdom
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Allan Young, Prof. Dr.
First Name & Middle Initial & Last Name & Degree
Allan Young, Prof. Dr.

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
https://www.psy-pgx.org/PSY-PGx
Description
Website of the PSY-PGx consortium

Learn more about this trial

Clinical Study Evaluating Pharmacogenomics-informed Pharmacotherapy Versus Dosing as Usual in Psychiatric Disorders

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