22Q11 Deletion, 22Q11 Deletion Syndrome, ADHD, ADHD - Combined Type, ADHD, Predominantly Hyperactive - Impulsive, ADHD Predominantly Inattentive Type, Anxiety, Anxiety Disorders, Autism, Autism Spectrum Disorder, Fragile X Syndrome, Neurodevelopmental Disorders, Tic Disorders, Tourette Syndrome, Tourette Syndrome in Adolescence, Tourette Syndrome in Children, Tuberous Sclerosis
Conditions
Brief summary
There are currently no approved medications for the treatment of anxiety in children and youth with neurodevelopmental disorders (NDDs), both common and rare. Sertraline, a selective serotonin reuptake inhibitor, has extensive evidence to support its use in children's and youth with anxiety but not within NDDs. More research is needed to confirm whether or not sertraline could help improve anxiety in children and youth with common and rare neurodevelopmental conditions. This is a pilot study, in which we plan to estimate the effect size of reduction in anxiety of sertraline vs. placebo. across rare and common neurodevelopmental disorders, and determine the best measure(s) to be used as a primary transdiagnostic outcome measure of anxiety, as well as diagnosis specific measures in future, larger-scale clinical trials of anxiety in NDDs.
Interventions
DRUGSertraline
Oral capsule (25mg, 50mg, 100mg, 200mg)
OTHERPlacebo
Oral placebo capsule
Sponsors
Holland Bloorview Kids Rehabilitation Hospital
Azrieli Foundation (Funder)
Canadian Institutes of Health Research (Funder)
Ontario Brain Institute (Funder)
McMaster University
Western University
Queen's University
University of Alberta
Alberta Health services
St. Justine's Hospital
Dalhousie University
Unity Health Toronto
University of Toronto
The Hospital for Sick Children
Maternal, Infant, Child and Youth Research Network (MICYRN)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
8 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
1. Outpatients 8-17 years of age, inclusive 2. Females of child bearing potential who are sexually active and agree to use medically acceptable birth control throughout the study and at least one week post last dose of study drug. 3. Meet Diagnostic and Statistical Manual of Mental Disorders - DSM-5 criteria for ASD, ADHD, Tic Disorders, or genetic diagnosis of Fragile X, tuberous sclerosis or 22q11 deletions. 4. Meet DSM-5 criteria for one of the following anxiety disorders: Separation Anxiety Disorder, Social Anxiety Disorder, Agoraphobia, Generalized Anxiety Disorder, or Unspecified Anxiety Disorder, based on expert clinical interview, supported by the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS; Kaufman et al., 2016). Other specified anxiety disorder is included to account for youth with impairing anxiety symptoms who may not meet criteria for one of the other anxiety disorders. 5. Have a Clinician's Global Impression-Severity for anxiety (CGI-S; Guy, 1976)) score ≥ 4 (moderately ill) (inter-rater reliability will be done prior to initiation of enrollment, using videotapes of interviews and vignettes) 6. If already receiving interventions, must meet the following criteria: 1. If receiving concomitant medications affecting behaviour, must be on a stable dose during the month prior to screening and will not electively modify ongoing medications for study duration 2. If already receiving stable non-pharmacological behavioural interventions, have stable participation during 3 months prior to screening, and will not electively modify ongoing interventions 7. Ability to complete assessments in English
Exclusion criteria
1. Receiving other SSRIs within four weeks of randomization (6 weeks for fluoxetine) 2. Previous treatment with sertraline, at an adequate dose (at least 100mg for 6 weeks, or lower dose and duration if not well-tolerated), associated with no response or significant-to-the-participant side effects. 3. Received more than 2 previous appropriate trials of SSRIs with no adequate response 4. Pregnant females or sexually active females on inadequate contraception 5. Serious medical condition that, based on Investigator judgment, might interfere with the conduct of the study, confound interpretation of the study results, or endanger participant. In addition diabetic patients on medications for glycemic control will be excluded as sertraline may interfere with glycemic control. 6. Hypersensitivity to sertraline or any components of its formulation 7. On Monoamine Oxidase Inhibitors or pimozide (as per product monograph) 8. On concomitant medications known to significantly increase QT interval where this would result in unacceptable risk per Investigator judgment. 9. Known congenital QT prolongation 10. HIV, hepatitis B or C, hemophilia, abnormal blood pressure, substance abuse, immunity disorder, major depressive episode or psychosis (as required by Health Canada) 11. Unable to tolerate venipuncture 12. Unable to swallow capsules 13. Enrolled in another intervention study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Screen for Child Anxiety Related Emotional Disorders (SCARED) - parent version | 16 weeks | The SCARED is a 41-item measure of anxiety symptoms, with both child and parent versions. The parent version will be used as a primary outcome measure. The minimum overall score is 0 while the maximum overall score is 82. A score greater than or equal to 25 may indicate the presence of an Anxiety Disorder. Higher scores indicate a higher instance of anxiety symptoms while a lower score indicates a lower instance of anxiety symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Global Impressions - Improvement Scale - Global (CGI-I) | 16 weeks | The CGI-I is a clinician reported scale which will be used to examine the effect of sertraline vs. placebo on measures of global function. The CGI-Improvement Scale employs a seven point (1 = very much improved to 7 = very much worse) to determine the participant's improvement in response to treatment. |
| Adverse events | 16 weeks | Adverse events as elicited by the SMURF. |
| Pediatric Quality of Life Inventory (PedsQL) | 16 weeks | The PedsQL will be used to examine the effect of sertraline vs. placebo on measures of quality of life. The PedsQL is measuring health-related quality of life (HRQOL) in 2- to 18-year-olds. The PedsQL 4.0 Generic Core Scales are multidimensional child self-report and parent-proxy report scales that have been used extensively as an outcome measure, including in ASD. We will use the parent-proxy report scale, and optionally, age-appropriate child self-report scale. Each item is is rated between a 0 (Never a problem) to 4 (Almost always a problem). |
| Whole blood serotonin (5-HT) assessment | 16 weeks | A whole blood serotonin assessment will be completed to examine the effect of sertraline vs. placebo on biomarkers of serotonin. 3mL of blood will be drawn at screening and week 16 visits for the purpose of this assessment. High performance liquid chromatography will be performed using fluorometric detection of 5-HT, tryptophan (TRP), and 5-hydroxyindole acetic acid (5-HIAA), using N-methylserotonin as an internal standard. Using this method, 5-HT intra- and inter- assay coefficients of variation are reliably less than 5% and 10%, respectively. |
| Clinical Global Impressions- Improvement Scale (CGI-I) focused on anxiety | 16 weeks | The CGI-I is a clinician reported scale which will be used to examine the effect of sertraline vs. placebo on measures of global anxiety. The CGI-Improvement Scale employs a seven point (1 = very much improved to 7 = very much worse) to determine the participant's improvement in response to treatment. |
Countries
Canada
Contacts
CONTACTFaiza Khawaja
PRINCIPAL_INVESTIGATORDr. Evdokia Anagnostou
Holland Bloorview Kids Rehab Hospital
Outcome results
None listed