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Trial registered on ANZCTR
Registration number
ACTRN12617000527369
Ethics application status
Approved
Date submitted
5/04/2017
Date registered
11/04/2017
Date last updated
31/05/2021
Date data sharing statement initially provided
21/06/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Effect of addition of anti-inflammatory medication to anti-depressant medication in the treatment of depression
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Scientific title
Effect of addition of anti-inflammatory medication to anti-depressant medication on C-reactive protein levels in the treatment of depression
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Secondary ID [1]
291560
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Nil known
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Universal Trial Number (UTN)
To be announced
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Trial acronym
PREDDICT
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Linked study record
Not applicable
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Health condition
Health condition(s) or problem(s) studied:
Depression
302654
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Condition category
Condition code
Mental Health
302172
302172
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0
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Depression
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This study is a randomised controlled treatment (RCT) trial over 8 weeks, with a 6 month post-RCT trial period, where study participants have the option to continue Vortioxetine in the post-RCT trial period. The study aims to investigate whether the use of a blood test of inflammation levels, prior to antidepressant treatment, can improve treatment of depression by guiding the decision to add anti-inflammatory medication to antidepressant treatment.
Specifically, the study aims to find out whether adding the anti-inflammatory medication Celecoxib to the antidepressant medication Vortioxetine can improve symptoms of depression.
At the start of the study, participants would undergo a blood test to measure levels of the inflammatory marker C-reactive protein (CRP). For CRP, a cut-off level of 3mg/L will be used to determine whether participants are assigned to the "Depression with inflammation" arm, or to the "Depression without inflammation" arm. Within each study arm, participants would then be randomly assigned to 6 weeks of treatment with Vortioxetine plus Celecoxib, or Vortioxetine plus placebo.
All study medications are oral tablets. The dose of Vortioxetine is initially 5 mg daily in those receiving Celecoxib, with an option to increase to Vortioxetine 10mg daily 2 weeks into the study (after review by the Psychiatrist, and if it is thought this dose may benefit the study participant). The planned dose of Celecoxib is 400mg daily.
Study participants will be asked at each visit if any doses of study medication have been missed.
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Intervention code [1]
297621
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Treatment: Drugs
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Comparator / control treatment
Vortioxetine plus placebo, for a duration of 6 weeks. The comparator / control treatments are also oral tablets. The dose of Vortioxetine is initially 10 mg daily, with an option to increase to Vortioxetine 20 mg daily 2 weeks into the study (after review by the Psychiatrist, and if it is thought this dose may benefit the study participant).
The placebo is a microcellulose tablet.
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Control group
Active
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Outcomes
Primary outcome [1]
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Change in MADRS, with a primary endpoint of proportion of study participants with a score reduction by 50% from baseline to 6 weeks (end of treatment).
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Assessment method [1]
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Timepoint [1]
301593
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [1]
333238
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Change in C-reactive protein (CRP) levels, with a secondary endpoint of proportion of study participants with a reduction of CRP levels by 50% between baseline and 6 weeks (end of treatment).
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Assessment method [1]
333238
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Timepoint [1]
333238
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [2]
333417
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Change in levels of the inflammatory markers TNF-a, IL-6, and IL-1b, measured by enzyme linked immunosorbent assay (ELISA), with a secondary endpoint of proportion of study participants with a reduction of 50% of levels of these inflammatory markers between baseline and 6 weeks (end of treatment).
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Assessment method [2]
333417
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Timepoint [2]
333417
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [3]
333418
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Safety of the anti-inflammatory Celecoxib 400 mg when combined with Vortioxetine, with a secondary endpoint of measuring adverse events (AE’s). At each visit, study participants will be asked to report adverse events (e.g. nausea, abdominal pain), and these will all be recorded.
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Assessment method [3]
333418
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Timepoint [3]
333418
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [4]
333421
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Assessment of cognitive dysfunction, using the THINC-It tool: -secondary endpoint of proportion of study participants with a 50% improvement in subjective (PDQ-5) and each objective (Spotter, Symbol Check, Codebreaker, Trails) cognitive measure from baseline to 6 weeks.
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Assessment method [4]
333421
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Timepoint [4]
333421
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [5]
333634
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Change in Clinical Global Impression-Severity (CGI-S)
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Assessment method [5]
333634
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Timepoint [5]
333634
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [6]
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Change in Clinical Global Impression-Improvement (CGI-I)
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Assessment method [6]
333635
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Timepoint [6]
333635
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [7]
333636
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Change in functional measures, as assessed by proportion of study participants with a 50% improvement in Functioning Assessment Short Test (FAST) from baseline to 6 weeks (end of treatment)
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Assessment method [7]
333636
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Timepoint [7]
333636
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [8]
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Change in WHO-5 Well-being Index, as assessed by proportion of study participants with a 50% improvement from baseline to 6 weeks (end of treatment)
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Assessment method [8]
333637
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Timepoint [8]
333637
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [9]
333638
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Change in Sheehan Disability Scale, as assessed by proportion of study participants with a 50% improvement from baseline to 6 weeks (end of treatment)
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Assessment method [9]
333638
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Timepoint [9]
333638
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [10]
333639
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Change in workplace functioning, as assessed by proportion of study participants with a 50% improvement in Work Limitations Questionnaire from baseline to 6 weeks (end of treatment)
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Assessment method [10]
333639
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Timepoint [10]
333639
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Baseline (before treatment) and 6 weeks (end of treatment)
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Secondary outcome [11]
333640
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Change in workplace functioning, as assessed by proportion of study participants with a 50% improvement in Endicott Workplace Productivity Scale from baseline to 6 weeks (end of treatment).
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Assessment method [11]
333640
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Timepoint [11]
333640
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Baseline (before treatment) and 6 weeks (end of treatment)
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Eligibility
Key inclusion criteria
1. The study participant is willing and able to provide informed consent.
2. Age 18 – 75 years of age.
3. Diagnosis of a Major Depressive Episode (MDE) as part of Major Depressive Disorder (MDD), using DSM-5 criteria.
4. Montgomery Asberg Depression Rating Scale (MADRS) score greater than or equal to 26 at screening visit and baseline.
5. Duration of the current MDE is at least 3 months.
6. Use of a previous treatment in at least one prior episode of depression
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Minimum age
18
Years
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Maximum age
75
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Presence of a co-morbid psychiatric disorder other than MDD that is a focus of clinical concern as confirmed by the Mini International Neuropsychiatric Interview (MINI).
2. A known relevant inflammatory or immune-related disorder such as rheumatoid arthritis, colitis, clinically significant asthma, multiple sclerosis, SLE, acute infections or fever.
3. A known neurodegenerative disease
4. Any medication for a general medical disorder that may affect cognitive function
5. Electroconvulsive therapy (ECT) within the last 6 months.
6. The study participant has reported having received investigational agents as part of a separate study within 30 days of the screening visit.
7. Contraindications to the study drugs
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is concealed, by the use of central randomisation by phone/ fax/ computer.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Stratified allocation based on CRP levels at screening (prior to commencement of treatment), with a cut-off level of 3 mg/L to determine whether participants are assigned into the "Depression with inflammation" arm, or the "Depression without inflammation" arm.
Within each arm, the method of sequence generation used will be simple randomisation using a randomisation table created by computer software (i.e. computerised sequence generation).
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
Given a power of 0.95, and an alpha error of 0.05, the study sample size required to detect a change in MADRS of an effect size of 0.25 between baseline and week 6 would be 50 study participants in each of the four groups. This would be a total of 200 study participants (100 participants in the “Depression with inflammation” arm, and 100 study participants in the “Depression without inflammation” arm; 50 participants in each treatment group respectively).
The primary outcome will be analysed using a mixed model for repeated measurements, using all available data. The baseline CRP level and stratified group (“Depression with inflammation” vs “Depression without inflammation”) will be used as a covariate.
The potential treatment effect on CRP will be separated into the stratified arms (“Depression with inflammation” vs “Depression without inflammation”), as well as for total group (all 4 groups).
For dichotomous endpoints, such as response and remission, logistic regression with treatment as a factor and the baseline score as a covariate will be used.
For continuous endpoints, the same methodology as that described for the primary endpoint will also be used. Continuous endpoints will also be analysed using an ANCOVA (OC and last observation carried forward (LOCF)).
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Recruitment
Recruitment status
Stopped early
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Data analysis
Data collected is being analysed
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Reason for early stopping/withdrawal
Participant recruitment difficulties
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Date of first participant enrolment
Anticipated
28/08/2017
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Actual
4/12/2017
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Date of last participant enrolment
Anticipated
31/07/2019
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Actual
13/08/2019
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Date of last data collection
Anticipated
27/09/2019
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Actual
24/04/2020
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Sample size
Target
200
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Accrual to date
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Final
122
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Recruitment in Australia
Recruitment state(s)
SA
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Recruitment hospital [1]
7766
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The Royal Adelaide Hospital - Adelaide
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Recruitment postcode(s) [1]
15699
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5000 - Adelaide
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
296049
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University of Adelaide
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Address [1]
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University of Adelaide
North Terrace
Adelaide
South Australia, 5005
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Country [1]
296049
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Australia
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Primary sponsor type
Individual
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Name
Professor Bernhard Baune
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Address
Professor Bernhard Baune
Discipline of Psychiatry
Level 6, Adelaide Health and Medical Sciences Building
North Terrace
Adelaide
South Australia, 5000
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Country
Australia
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Secondary sponsor category [1]
294984
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None
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Name [1]
294984
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Address [1]
294984
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Country [1]
294984
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
297305
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Royal Adelaide Hospital Research Ethics Committee
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Ethics committee address [1]
297305
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Royal Adelaide Hospital Adelaide SA 5000
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Ethics committee country [1]
297305
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Australia
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Date submitted for ethics approval [1]
297305
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27/03/2017
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Approval date [1]
297305
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25/05/2017
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Ethics approval number [1]
297305
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HREC/17/RAH/111
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Ethics committee name [2]
298365
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University of Adelaide HREC
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Ethics committee address [2]
298365
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University of Adelaide Adelaide, SA
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Ethics committee country [2]
298365
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Australia
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Date submitted for ethics approval [2]
298365
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09/06/2017
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Approval date [2]
298365
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13/06/2017
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Ethics approval number [2]
298365
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Summary
Brief summary
The study is a randomised controlled treatment (RCT) trial over 8 weeks in individuals with Major Depressive Disorder, with a 6 month post-RCT trial period, where study participants have the option to continue Vortioxetine. The purpose of the study is to investigate the effectiveness of using a simple blood test, prior to treatment of depression, to guide the use of anti-inflammatory medication as an addition to antidepressant medication. The study aims to find out whether adding the anti-inflammatory medication Celecoxib (also known as Celebrex) to the antidepressant medication Vortioxetine (also known as Brintellix) can improve symptoms of depression. There is evidence that raised levels of inflammatory markers in the blood are associated with depression. The study measures the inflammatory marker C-reactive protein (CRP) prior to commencing treatment, with study participants assigned to a study "arm" based on CRP levels. Within each study "arm", participants receive treatment for 6 weeks, with either Vortioxetine plus Celecoxib, or Vortioxetine plus placebo. Levels of circulating inflammatory markers, tests of cognitive function, and depression symptoms are measured at baseline (before treatment) and again at the end of this 6 week treatment period.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
73650
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Prof Bernhard Baune
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Address
73650
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Discipline of Psychiatry School of Medicine University of Adelaide Adelaide, SA, 5000
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Country
73650
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Australia
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Phone
73650
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+61 448 757 873
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Fax
73650
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Email
73650
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[email protected]
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Contact person for public queries
Name
73651
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Natalie Mills
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Address
73651
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Discipline of Psychiatry School of Medicine University of Adelaide Adelaide, SA, 5000
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Country
73651
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Australia
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Phone
73651
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+ 61 8 8313 7676
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Fax
73651
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Email
73651
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[email protected]
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Contact person for scientific queries
Name
73652
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Bernhard Baune
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Address
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Discipline of Psychiatry School of Medicine University of Adelaide Adelaide, SA, 5000
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Country
73652
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Australia
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Phone
73652
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+61 448 757 873
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Fax
73652
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Email
73652
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Study findings will be made available in a way so that no individual is identifiable without their consent
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Anti-inflammatory treatment of depression: Study protocol for a randomised controlled trial of vortioxetine augmented with celecoxib or placebo.
2018
https://dx.doi.org/10.1186/s13063-018-2829-7
Embase
Exploratory study of association between blood immune markers and cognitive symptom severity in major depressive disorder: Stratification by body mass index status.
2020
https://dx.doi.org/10.1016/j.bbi.2020.06.007
Embase
Clinical Switching Strategies of Various Antidepressants to Vortioxetine in the PREDDICT Trial.
2021
https://dx.doi.org/10.1093/ijnp/pyaa092
Embase
Exploratory Analysis of the Effects of Celecoxib on Cognitive Function in Vortioxetine-Treated Patients With Major Depressive Disorder in the PREDDICT Study: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.
2023
https://dx.doi.org/10.4088/JCP.23m14829
Embase
Inflammation-stratified augmentation of vortioxetine with celecoxib: Results from a double-blind, randomized, placebo-controlled trial in major depressive disorder.
2023
https://dx.doi.org/10.1111/jnc.15946
Dimensions AI
Emotional Blunting in Depression in the PREDDICT Clinical Trial: Inflammation-Stratified Augmentation of Vortioxetine With Celecoxib
2024
https://doi.org/10.1093/ijnp/pyad066
N.B. These documents automatically identified may not have been verified by the study sponsor.
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