Generalized Anxiety Disorder, Treatment Resistant Depression
Conditions
Keywords
Major, Depressive, Disorder, Depression, MDD, Treatment Resistant, Anxiety, GAD
Brief summary
Genomind has developed and introduced a battery of genetic tests, the Genecept Assay, which clinicians can administer to patients using a simple saliva sample technique. The present study proposes to enroll 1. Subjects (patients who have consented to using the Genecept Assay) and 2. Clinician study participants (clinicians who have ordered the Assay on behalf of their patients). This study will involve the collection of responses from both Subjects and clinician study participants with the intention of correlating this information to Subject genetic data.
Detailed description
This will be a 3-month prospective study of clinicians who have ordered the Genecept assay and the psychiatric patients for whom the test was ordered. Clinicians who order the Assay for a patient who has been indicated as having a diagnosis of depression will receive an invitation to participate in this study as well as an informational patient study brochure with the test kit. The patient's treating clinician will be prompted to discuss the study with the patient. Clinicians and patients can view a website containing additional information about the study as well as the informed consent document. Potential subjects and clinician study participants will be consented online using a secure electronic method. Study staff will be available by phone and by email to answer any questions related to the study and the informed consent documents and process. Clinicians and patients can choose to participate independently of each other so that if one party declines to enroll, the other may still participate. Whether or not they choose to participate, patients must consent to allow their clinicians to provide responses about their treatment. All subjects and participants will receive a username and password with which to access the secure study portal for completion of study surveys. Subjects and participants will receive sms and email reminders when surveys are due. At baseline, clinician study participants will supervise DNA sample collection and will be prompted to complete a brief survey containing questions about the patient's psychiatric history and severity of illness, current treatment regimen and the treatment intentions of the clinician prior to receiving genetic results. After receiving the results of the Assay, clinician study participants will again be prompted to complete an online study survey containing questions related to the impact of the Genecept Assay on treatment and diagnosis decisions. The subject will continue with treatment as determined by the clinician study participant. At 3 months from baseline, clinician study participants will again be asked to complete an online survey with additional questions related to subsequent changes to the patient's treatment regimen and illness severity since receiving/implementing the results of the Assay. The subject will also be prompted to complete surveys at baseline, 1 month from the receipt of the genetic results and 3 months from the receipt of the genetic results. These surveys include questions about the patient's psychiatric symptoms, quality of life and medication side effects. The 3 month patient assessment will also include a satisfaction questionnaire.
Interventions
DEVICEGenecept Assay
Genetic test which analyzes seven pharmacodynamic and three pharmacokinetic genes important in psychiatric disorders
Sponsors
Genomind, LLC
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Clinician Study Participants: * Valid National Provider Identifier (NPI) number and prescribing privileges * Signed electronic informed consent * Signed requisitions form for order of Genecept Assay * Requisition form includes indication of diagnosis of depression or anxiety for patient Subject Study Participants: * Ability to complete electronic informed consent; includes: * access to appropriate technology (i.e. internet-connected device, internet connection), * cognitively competent * \> or = 18 years old at time of DNA sample collection * Indication of diagnosis of depression or anxiety on requisition form
Exclusion criteria
Clinician Study Participants: * Inability to complete online questionnaires Subject Study Participants: * Inability to complete online questionnaires;includes: * lack of access to appropriate technology (i.e. internet-connected device, internet connection), * cognitive impairment * \< 18 years old at time of DNA sample collection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Clinical Global Impressions Improvement (CGI-I) Scale at 3 Months | 3 months | To determine the efficacy of assay-guided treatment (AGT) in terms of illness severity, as measured by change from baseline using the clinician-administered CGI-I scale, which ranges from scores 1-7 (1=very much improved, 7=very much worse since initiation of treatment). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy Measured by QIDS-SR16, Q-LES-Q-SF, UKU Side Effects; and SAS at 3 Months | 3 months | To determine the efficacy of assay-guided treatment (AGT) in terms of illness severity as measured by change from baseline in self-reported patients scales: 1. Quick Inventory of Depressive Symptoms (QIDS-SR16) scale; scores range from 0-27, 0 means no depression and 27 means very severe depression 2. Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) scale; scores range from 0-100 and greater scores correspond with greater satisfaction with quality of life 3. Undersøgelser (UKU) scale that measures degree of side effects from total scores ranging from 0-100; 0-40 refers to low side effects and 81-100 referring to high side effects rating 4. the Zung Self-Rated Anxiety (SAS) scale measures anxiety severity using the total scores ranging from 20-80; 20-44 being normal and 75-80 meaning most severe |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Clinician-Reported Outcomes Prescribing clinicians responsible for the treatment of patients age 18 and older with a primary diagnosis of Major Depressive Disorder or Generalized Anxiety disorder, and for whom the Genecept Assay has been utilized to perform genetic testing.
Genecept Assay: Genetic test which analyzes seven pharmacodynamic and three pharmacokinetic genes important in psychiatric disorders | 625 |
| Total | 625 |
Baseline characteristics
| Characteristic | Clinician-Reported Outcomes |
|---|---|
| Age, Continuous | 40.5 years |
| Annual Income < $25,000 | 135 participants |
| Annual Income $25,000-75,000 | 152 participants |
| Annual Income > $75,000 | 62 participants |
| Annual Income Unknown | 276 participants |
| Current Smoker Current Smoker | 36 participants |
| Current Smoker Not a smoker | 227 participants |
| Current Smoker Unknown | 362 participants |
| Education >College degree | 145 participants |
| Education High school diploma | 50 participants |
| Education No high school diploma | 6 participants |
| Education Some college | 140 participants |
| Education Unknown | 284 participants |
| Employment Status Full-time | 182 participants |
| Employment Status Part-time | 39 participants |
| Employment Status Retired | 12 participants |
| Employment Status Student | 33 participants |
| Employment Status Unemployed/disabled/leave of absence | 83 participants |
| Employment Status Unknown | 276 participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 25 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 600 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Marital Status Divorced/Separated | 53 participants |
| Marital Status Married | 177 participants |
| Marital Status Single | 118 participants |
| Marital Status Unknown | 276 participants |
| Marital Status Widowed | 1 participants |
| Sex: Female, Male Female | 412 Participants |
| Sex: Female, Male Male | 213 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 625 | 0 / 60 |
| serious Total, serious adverse events | 0 / 625 | 0 / 60 |
Outcome results
Primary
Change From Baseline in Clinical Global Impressions Improvement (CGI-I) Scale at 3 Months
To determine the efficacy of assay-guided treatment (AGT) in terms of illness severity, as measured by change from baseline using the clinician-administered CGI-I scale, which ranges from scores 1-7 (1=very much improved, 7=very much worse since initiation of treatment).
Time frame: 3 months
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Clinician's Utilizing Assay Guided Treatment in Psychiatry | Change From Baseline in Clinical Global Impressions Improvement (CGI-I) Scale at 3 Months | CGI-I Score 1, 2, or 3 | 545 Participants |
| Clinician's Utilizing Assay Guided Treatment in Psychiatry | Change From Baseline in Clinical Global Impressions Improvement (CGI-I) Scale at 3 Months | CGI-I Score 1 or 2 | 386 Participants |
Secondary
Efficacy Measured by QIDS-SR16, Q-LES-Q-SF, UKU Side Effects; and SAS at 3 Months
To determine the efficacy of assay-guided treatment (AGT) in terms of illness severity as measured by change from baseline in self-reported patients scales: 1. Quick Inventory of Depressive Symptoms (QIDS-SR16) scale; scores range from 0-27, 0 means no depression and 27 means very severe depression 2. Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) scale; scores range from 0-100 and greater scores correspond with greater satisfaction with quality of life 3. Undersøgelser (UKU) scale that measures degree of side effects from total scores ranging from 0-100; 0-40 refers to low side effects and 81-100 referring to high side effects rating 4. the Zung Self-Rated Anxiety (SAS) scale measures anxiety severity using the total scores ranging from 20-80; 20-44 being normal and 75-80 meaning most severe
Time frame: 3 months
Population: Only 197 patients completed self-assessments at 3 months.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Clinician's Utilizing Assay Guided Treatment in Psychiatry | Efficacy Measured by QIDS-SR16, Q-LES-Q-SF, UKU Side Effects; and SAS at 3 Months | QIDS-SR16 | 7.8 Scores on a scale | Standard Deviation 0.75 |
| Clinician's Utilizing Assay Guided Treatment in Psychiatry | Efficacy Measured by QIDS-SR16, Q-LES-Q-SF, UKU Side Effects; and SAS at 3 Months | Q-LES-Q-SF | 50.0 Scores on a scale | Standard Deviation 1 |
| Clinician's Utilizing Assay Guided Treatment in Psychiatry | Efficacy Measured by QIDS-SR16, Q-LES-Q-SF, UKU Side Effects; and SAS at 3 Months | UKU: Side Effects | 19.2 Scores on a scale | Standard Deviation 2 |
| Clinician's Utilizing Assay Guided Treatment in Psychiatry | Efficacy Measured by QIDS-SR16, Q-LES-Q-SF, UKU Side Effects; and SAS at 3 Months | SAS | 35.9 Scores on a scale | Standard Deviation 0.5 |