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This is a 6-month randomized, wait-listed, controlled pilot trial conducted in 6 department of family medicine (DFM) clinics at the University of Michigan (UM). Physicians practicing at a UM DFM clinical site who are willing to utilize pharmacogenomic (PGx) test results to manage antidepressant use will be enrolled. Patients of these DFM physicians who are adults with a new prescription for a target antidepressant will also be enrolled.
This is a 6-month randomized, wait-listed, controlled pilot trial conducted in 6 department of family medicine (DFM) clinics at the University of Michigan (UM). We will enroll physicians practicing at a UM DFM clinical site who are willing to utilize PGx test results in conjunction with treating patients prescribed certain antidepressants. We will also enroll patients of these DFM physicians who are adults with a new prescription for an antidepressant (within the past 4 weeks) including patients who have switched to a new antidepressant from another antidepressant or have added on a new antidepressant to current antidepressant therapy. Patients are excluded if taking an antidepressant for more than 4 weeks or if they have had PGx testing in the past. Patients will be randomized to either an intervention or control group. Patients in the intervention group will have PGx test results available soon after enrollment while the control patients will have test results available 3 months after the first visit. All patients will complete a baseline, 3-, and 6-month assessment; control patients will have an additional 9-month assessment. Data to be collected include symptoms and severity (PHQ-8, GAD7), functional health status (SF-12), PGx knowledge, work status changes, demographic information, physician and emergency department visits, adverse effects, and medication alterations and adherence.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Delayed intervention (control arm) | Active Comparator | Patients in this arm will have PGx test results made available to physicians 3 months after study enrollment |
|
| PGx Test | Experimental | Patients in this arm will have PGx test results made available to physicians as soon available after enrollment. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PGx test | Diagnostic Test | A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
| Measure | Description | Time Frame |
|---|---|---|
| Count of Participants Prescribed Antidepressant Medication | Count of participants who have been prescribed antidepressant medications which are not contraindicated | Baseline, 3 months, 6 months, and 9 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Symptom Severity - Patient Health Questionnaire (PHQ-8) | Change in PHQ-8 scores. The PHQ-8 is an 8-item participant-report measure for screening for depression and for establishing depression severity. The total score ranges from 0-24, with a higher score indicating greater depression symptom severity. | Baseline and 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Acceptability of PGx Testing | Acceptability of PGx testing in primary care among persons taking a target antidepressant and primary care physicians who care for them | Baseline and 6 months |
Physician participants
Inclusion criteria:
Exclusion criteria:
-Do not meet inclusion criteria
Patient Participants
Inclusion:
Exclusion:
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| Name | Affiliation | Role |
|---|---|---|
| Lorriane Buis, PhD | University of Michigan Department of Family Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Michigan | Ann Arbor | Michigan | 48109 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31429417 | Background | Manzor Mitrzyk B, Kadri R, Farris KB, Ellingrod VL, Klinkman MS, Ruffin Iv MT, Plegue MA, Buis LR. Using Pharmacogenomic Testing in Primary Care: Protocol for a Pilot Randomized Controlled Study. JMIR Res Protoc. 2019 Aug 19;8(8):e13848. doi: 10.2196/13848. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Delayed Intervention (Control Arm) | Patients in this arm will have PGx test results made available to physicians 3 months after study enrollment PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
| FG001 | PGx Test | Patients in this arm will have PGx test results made available to physicians as soon available after enrollment. PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
| FG002 | Physicians | Physicians who practiced at 1 of the 6 UM Family Medicine clinics. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
1 participant was withdrawn by the study staff and PI after baseline data was collected but before receiving the intervention.
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| ID | Title | Description |
|---|---|---|
| BG000 | Delayed Intervention (Control Arm) | Participants in this arm will have PGx test results made available to physicians 3 months after study enrollment PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Physician age is reported as a study specific outcome measure so that the total means are not mixed between participants and physicians. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Count of Participants Prescribed Antidepressant Medication | Count of participants who have been prescribed antidepressant medications which are not contraindicated | Per protocol, only control arm patients were to have a 9 month assessment. | Posted | Count of Participants | Participants | Baseline, 3 months, 6 months, and 9 months |
|
six months
Per protocol and because they received no intervention, no adverse event data was intended to be collected from physicians, so they are not presented here.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Delayed Intervention (Control Arm) | Patients in this arm will have PGx test results made available to physicians 3 months after study enrollment PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Laurie Buis | University of Michigan | 734-998-5694 | buisl@med.umich.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Sep 7, 2018 | Sep 7, 2022 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D000071185 | Pharmacogenomic Testing |
| ID | Term |
|---|---|
| D005820 | Genetic Testing |
| D019411 | Clinical Laboratory Techniques |
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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|
|
| Change in Symptom Severity - General Anxiety Disorder - 7 (GAD 7) |
The GAD-7 is a self-administered assessment for general anxiety disorder. The total score for the seven items ranges from 0 to 21. Higher values represent a worse outcome. |
| Baseline and 6 months |
| Change in Adherence to Refills and Medication Scale (ARMS) Scores | Change in medication adherence: The Adherence to Refills and Medication was scored by summing together the 14 items after first reversing the final item to be consistent in direction with the others. Individuals were allowed to have up to 2 missing values present which were imputed with the mean of the remaining answered items, only a handful of individuals answered 13 of the 14 questions resulting in a single item within their scale being imputed across the time periods. The questionnaire has 14 items with each item being recorded on a four-point Likert scale. The total score ranges from 14-56 with the lower score indicating better adherence. | Baseline and 6 months |
| For Physician arm only; those physicians who did not have patients who participated |
|
| BG001 | PGx Test | Participants in this arm will have PGx test results made available to physicians as soon available after enrollment. PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
| BG002 | Physicians | Physicians who practiced at 1 of the 6 UM Family Medicine clinics. |
| BG003 | Total | Total of all reporting groups |
| Mean |
| Standard Deviation |
| years |
|
| Sex/Gender, Customized | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
|
| Marital Status | Protocol had no plans to collect marital status from physicians. | Count of Participants | Participants |
|
| Education | Count of Participants | Participants |
|
| Employment | Count of Participants | Participants |
|
| Income | Protocol had no plans to collect income status from physicians. | Count of Participants | Participants |
|
| Number of Children | Protocol had no plans to collect number of children data from physicians. | Count of Participants | Participants |
|
| Smoking Status | Protocol had no plans to collect smoking status from physicians. | Count of Participants | Participants |
|
| Age of Physicians, Continuous | This measure is for physician age only so it does not include patient participant data, in order to have the patient participant data mean totals remain accurate. Therefore patient participants are not analyzed here. | Mean | Standard Deviation | years |
|
| OG001 | PGx Test | Patients in this arm will have PGx test results made available to physicians as soon available after enrollment. PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. |
|
|
| Secondary | Change in Symptom Severity - Patient Health Questionnaire (PHQ-8) | Change in PHQ-8 scores. The PHQ-8 is an 8-item participant-report measure for screening for depression and for establishing depression severity. The total score ranges from 0-24, with a higher score indicating greater depression symptom severity. | PHQ-8 data is unavailable for 8 participants in the control arm and 7 participants in the PGx Test arm because of missing data at 6 months or loss to follow-up. | Posted | Mean | Standard Deviation | score on a scale | Baseline and 6 months |
|
|
|
|
| Secondary | Change in Symptom Severity - General Anxiety Disorder - 7 (GAD 7) | The GAD-7 is a self-administered assessment for general anxiety disorder. The total score for the seven items ranges from 0 to 21. Higher values represent a worse outcome. | Because GAD-7 data is unavailable for 8 participants in the control arm and 7 participants in the PGx Test arm because of missing data at 6 months or loss to follow-up, the data is presented for those participants who had both data points so comparisons between the two time points are appropriate. | Posted | Mean | Standard Deviation | score on a scale | Baseline and 6 months |
|
|
|
|
| Secondary | Change in Adherence to Refills and Medication Scale (ARMS) Scores | Change in medication adherence: The Adherence to Refills and Medication was scored by summing together the 14 items after first reversing the final item to be consistent in direction with the others. Individuals were allowed to have up to 2 missing values present which were imputed with the mean of the remaining answered items, only a handful of individuals answered 13 of the 14 questions resulting in a single item within their scale being imputed across the time periods. The questionnaire has 14 items with each item being recorded on a four-point Likert scale. The total score ranges from 14-56 with the lower score indicating better adherence. | ARMs data is unavailable for 10 participants in the control arm and 8 participants in the PGx Test arm because of missing data at 6 months or loss to follow-up. | Posted | Mean | Standard Deviation | score on a scale | Baseline and 6 months |
|
|
|
|
| Other Pre-specified | Acceptability of PGx Testing | Acceptability of PGx testing in primary care among persons taking a target antidepressant and primary care physicians who care for them | Not Posted | Baseline and 6 months | Participants |
| 0 |
| 26 |
| 0 |
| 26 |
| 0 |
| 26 |
| EG001 | PGx Test | Patients in this arm will have PGx test results made available to physicians as soon available after enrollment. PGx test: A laboratory developed genetic test that differentiates common and uncommon alleles in genes that have been previously identified as being involved in either the metabolism or response of drugs used in the treatment of depression and/or anxiety. The results are provided as a report that contains information related to the allele status of the patient's genes, translates this into a phenotype, and relates this phenotype to recommendation classes for drugs. | 0 | 25 | 0 | 25 | 0 | 25 |
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| D008919 | Investigative Techniques |
| D005821 | Genetic Techniques |
| D033142 | Genetic Services |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| D003954 | Diagnostic Services |
| D011314 | Preventive Health Services |
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| 6 month |
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| 0.027 |
| Superiority |
Null hypothesis of equality. |
| 0.2088 |
| Superiority |
Null hypothesis of equality. |