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Trial registered on ANZCTR

Registration number

ACTRN12621000181808

Ethics application status

Approved

Date submitted

4/11/2020

Date registered

22/02/2021

Date last updated

13/10/2024

Date data sharing statement initially provided

22/02/2021

Type of registration

Prospectively registered

Titles & IDs

Public title

The PRESIDE TRIAL

Scientific title

The PRESIDE (PhaRmacogEnomicS In Depression) Trial: a double-blind RCT of
pharmacogenomically-informed prescribing of antidepressants on depression outcomes in
patients with major depressive disorder in primary care.

Secondary ID [1]

nil

Universal Trial Number (UTN)

Trial acronym

The PRESIDE TRIAL

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Depression

Condition category

Condition code

Mental Health

Depression

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

The PRESIDE (PhaRmacogEnomicS In Depression) Trial is a double-blind RCT of pharmacogenomically-informed prescribing of antidepressants on depression outcomes in patients with major depressive disorder in primary care. In other words, participants who have depressive symptoms will be randomly allocated to one of two groups and neither they, nor their GP, nor the researchers will be aware of which group they are in. One group (intervention) will receive recommendations for which antidepressant drugs may be most effective for them based on how their DNA impacts how they break these drugs down. The other group (control) will receive recommendations for antidepressant drugs based on
current Australian guidelines. All participants, regardless of which group they are in, will decide with their GP which antidepressant, if any, is best for them. This trial addresses significant knowledge gaps related to how clinically useful this type of pharmacogenomic (DNA) test may be in managing patients with major depressive disorder in primary care. It will create evidence about the efficacy, safety, and costeffectiveness of this approach, working with health service delivery partners and research end-users to ensure the findings can be implemented into practice as quickly as possible.
Participants will be recruited (informed consent) from participating Australian General Practices.

For those in the intervention arm, the DNA will be used to generate a recommendation for antidepressant prescribing guided by the participants' pharmacogenomic profile. For those in the control arm, the recommendation for prescribing will be based on the TGA guidelines. Each participant's General Practitioner will be provided with the relevant test report and will be blinded to which group the participant has been allocated into. Neither report will refer to specific genomic variants, only a prescription recommendation. Before recruitment, participants will be informed of the randomised nature of the study and that neither they, nor their GP, nor the study team can allocate them to a particular group. The researcher will ensure they understand as part of the consent process. After 6 months, all participants' GPs, regardless of the participant's arm, will receive their full clinical pharmacogenomic report.

The intervention consists of a pharmacogenomic test with resulting recommendations for which antidepressants may work best for that participant.
The DNA sample will be obtained using the Oragene-DNA buccal kit, which we have used successfully in our previous genotyping studies in primary care. The Sonic Pathology PGx panel will be used for genotyping, with specific focus on two genes: CYP2D6 (alleles *2, *3, *4, *4M, *6, *7, *8, *9, *10, *11, *12, *14A, *14B, *13, *15, *17, *18, *19, *20, *29, *36, *38, *41, *5 (gene deletion), XN (gene duplication) (VeriDose® Core and CYP2D6 CNV Panels) and CYP2C19 (alleles *2, *3, *4, *4B, *5, *6, *7, *8, *17). The allele that each participant carries can predict how they metabolise certain drugs. This is used to create actionable recommendations about antidepressant class and dose, based on Clinical Pharmacogenetics Implementation Consortium (CPIC) and Royal Dutch Pharmacogenetics Working Group (DPWG) international guidelines.(10, 11)
Sonic Genetics has an established pharmacogenomic genotyping and interpretive service in conjunction with Translational Software (https://www.translationalsoftware.com/), which will generate the patient-specific prescribing advice. The recommendations will take into account
concurrent medication use, in particular accounting for CYP2D6 and CYP2C19 inducers and inhibitors, by applying an evidence-based algorithm created by CI Bousman (Sequence2Script).

The GPs of those in both the intervention arm and the control arm will receive a specific prescribing recommendation within 2 weeks of entry into the trial. For those in the intervention arm, this report will be based on the participant’s genotype, predicted metaboliser phenotype, concomitant medication use and the Australian Therapeutic Guidelines. For those in the control arm, this will be based on the Australian Therapeutic Guidelines. To ensure blinding, the report will not refer to the participant’s genotype or phenotype but only provide prescribing recommendations.

All participants will be advised to see their GP to discuss this prescribing report and determine clinical management. They will also be advised to see their GP for review at 2, 4, 8 and 12 weeks after the initial consultation to discuss the prescribing report. This is consistent with current practice for the follow-up of patients with depression in primary care. Patient adherence to antidepressant prescribing using the Medication Adherence Report Scale
(MARS-5) at baseline, 4, 8,12 and 26 weeks. We will use PBS data to calculate the Medication Possession Ratio, an objective measure of adherence which is associated with antidepressant response at the completion of the intervention period.

(10) Hicks JK, et al.. Clin Pharmacol Ther. 2015;98(2):127-34.
(11) Hicks JK, et al. Clin Pharmacol Ther. 2017;102(1):37-44.

Intervention code [1]

Diagnosis / Prognosis

Intervention code [2]

Early detection / Screening

Comparator / control treatment

All participants' GPs will receive their full pharmacogenomic report after the follow-up period of the trial (6 months). This will be sent to their GPs directly. For those in the intervention arm, this will add to the information about antidepressant recommendations; for those in the control arm, this will include all drugs, including antidepressants based on TGA guided recommendations.
All aspects of the study will be the same for each group, other than the prescribing report, however the reports will look the same. The participants and their GP will not know which group the participant is in.

Control group

Active

Outcomes

Primary outcome [1]

The primary outcome will be symptom reduction, defined as change in depressive symptom score measured by the PHQ-9 at 12 weeks from the first GP consultation to discuss the prescribing report.

Timepoint [1]

baseline, 4, 8, 12 (primary endpoint), 26 weeks from recruitment.

Secondary outcome [1]

Remission (defined as PHQ-9 score <5) and response (defined as >50% decrease from
baseline score on PHQ-9).

Timepoint [1]

4, 8, 12 & 26 weeks

Secondary outcome [2]

The Antidepressant Side-Effect Checklist (ASEC), a 21-item validated self-reported symptom
checklist previously used in the GENDEP (Genome-Based Therapeutic Drugs for Depression)
study. For each side-effect symptom participants rate severity on a four-point scale (0 –
absent, 3 = severe) and are summed to give a total side-effect score. Outcome is of an exploratory nature.

Timepoint [2]

4, 8, 12 & 26 weeks

Secondary outcome [3]

The Assessment of Quality of Life (AQoL-4D), a validated measure of quality of life used to
calculate quality-adjusted life years (QALYs) via a utility algorithm.

Timepoint [3]

baseline, 12 and 26 weeks

Secondary outcome [4]

Health service use will be determined from a non-validated resource use questionnaire (RUQ) supplemented with administrative data from the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data, with specific participant consent. Hospitalisations/emergency department data will be accessed via the Centre for Victorian Data Linkage.

Timepoint [4]

Baseline, 12 & 26 weeks

Secondary outcome [5]

Number of medication changes, obtained from GP medical record audit and PBS data.

Timepoint [5]

26 weeks / completion of intervention period

Secondary outcome [6]

Concordance of GP prescribing with recommendations in the prescribing report will be captured through GP medical
record audit and PBS data.

Timepoint [6]

26 weeks / at completion of intervention period

Secondary outcome [7]

Patient adherence to antidepressant prescribing using the Medication Adherence Report Scale (MARS-5). This 5-item validated self-reported scale has been used widely to study
medication adherence for a range of chronic and mental health conditions. We will use
PBS data to calculate the Medication Possession Ratio, an objective measure of adherence
which is associated with antidepressant response.

Timepoint [7]

baseline, 4, 8, 12 & 26 weeks

Secondary outcome [8]

FIBSER (frequency, intensity, burden of side effect rating) - medication side effect , using validated questionnaire. Outcome is of an exploratory nature.

Timepoint [8]

baseline, 4, 8, 12 and 26 weeks

Eligibility

Key inclusion criteria

• Eligible participants for the trial are aged between 18 and 65 years old
• Participants able to read and write English and competent to give informed consent
• Participants who are contactable over the next 6 months for the study follow-up
• Symptoms of depression - identified in the PHQ-9 initial screening questionnaire (iPad/phone delivery).

Minimum age

18 Years

Maximum age

65 Years

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

Ineligible
• pregnant
• currently taking antipsychotic medication, except if taking quetiapine (Seroquel) at a dose of 100mg at most PRN for sleep, with no history of psychosis
• significant suicidal risk
• dementia

Study design

Purpose of the study

Treatment

Allocation to intervention

Randomised controlled trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Allocation is done after a participant has been recruited and is sent to the holder of the allocation schedule who is "off-site" at the central study administration site. The allocation sequence is computer-generated, to ensure allocation concealment.

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

sequentially stratified by current antidepressant use and general practice,using a biased-coin algorithm that will be embedded within the online database.

Masking / blinding

Blinded (masking used)

Who is / are masked / blinded?

The people receiving the treatment/s
The people administering the treatment/s

The people analysing the results/data

Intervention assignment

Parallel

Other design features

Phase

Phase 3

Type of endpoint/s

Efficacy

Statistical methods / analysis

588 primary care patient participants across 8-10 GP practices.

Recruitment

Recruitment status

Completed

Date of first participant enrolment

Anticipated

1/04/2021

Actual

25/05/2021

Date of last participant enrolment

Anticipated

31/07/2023

Actual

29/09/2023

Date of last data collection

Anticipated

30/04/2024

Actual

30/04/2024

Sample size

Target

588

Accrual to date

Final

575

Recruitment in Australia

Recruitment state(s)

VIC

Funding & Sponsors

Funding source category [1]

Government body

Name [1]

The Medical Research Future Fund (MRFF), Department of Health

Address [1]

The Medical Research Future Fund (MRFF)
Department of Health
GPO Box 9848
Canberra ACT 2601

Country [1]

Australia

Primary sponsor type

University

Name

The University of Melbourne

Address

Department of General Practice
Faculty of Medicine, Dentistry and Health Sciences
Level 10, Victorian Comprehensive Cancer Centre,
305 Grattan Street, Melbourne VIC 3000

Country

Australia

Secondary sponsor category [1]

None

Name [1]

Address [1]

Country [1]

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

The University of Melbourne Human Research Ethics Committees (HREC)

Ethics committee address [1]

Human Research Ethics Committees (HREC)
The University of Melbourne
Carlton, 3010 VIC

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

10/12/2020

Approval date [1]

22/03/2021

Ethics approval number [1]

20626

Summary

Brief summary

The PRESIDE Trial is a double-blind RCT of pharmacogenomically-informed prescribing of antidepressants on depression outcomes in patients with major depressive disorder in primary care.  Participants who have depressive symptoms will be randomly allocated to one of two groups and neither they, nor their GP, nor the researchers will be aware of which group they are in. One group will receive recommendations for which antidepressant drugs may be most effective for them based on how their DNA impacts how they break these drugs down. The other group will receive recommendations for antidepressant drugs based on current Australian guidelines. All participants, regardless of which group they are in, will decide with their GP which antidepressant, if any, is best for them. This trial addresses significant knowledge gaps related to how clinically useful this type of pharmacogenomic (DNA) test may be in managing patients with major depressive disorder in primary care. It will create evidence about the efficacy, safety, and cost-effectiveness of this approach, working with health service delivery partners and research end-users to ensure the findings can be implemented into practice as quickly as possible.

Trial website

nill

Trial related presentations / publications

nil

Public notes

nil

Contacts

Principal investigator

Name

Prof Jon Emery

Address

Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne Level 10, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne VIC 3000

Country

Australia

Phone

+61385597044

Fax

[email protected]

Contact person for public queries

Name

Sibel Saya

Address

Country

Australia

Phone

+61 3 85597189

Fax

[email protected]

Contact person for scientific queries

Name

Jon Emery

Address

Country

Australia

Phone

+61385597044

Fax

[email protected]

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

No/undecided IPD sharing reason/comment

What supporting documents are/will be available?

Doc. No.	Type	Citation	Link	Email	Attachment
10109	Study protocol	Saya S, Chondros P, Abela A, et al. The PRESIDE (PhaRmacogEnomicS In DEpression) Trial: a double-blind randomised controlled trial of pharmacogenomic-informed prescribing of antidepressants on depression outcomes in patients with major depressive disorder in primary care. Trials 2023;24(1):342. doi: 10.1186/s13063-023-07361-6 [published Online First: 20230519]	https://doi.org/10.1186/s13063-023-07361-6	[email protected]
10110	Ethical approval			[email protected]
10112	Informed consent form			[email protected]
24251	Statistical analysis plan				380870-(Uploaded-08-10-2024-11-18-48)-PRESIDE SAP V1.0 20240927 FINAL SIGNED.pdf

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	The PRESIDE (PhaRmacogEnomicS In DEpression) Trial: a double-blind randomised controlled trial of pharmacogenomic-informed prescribing of antidepressants on depression outcomes in patients with major depressive disorder in primary care.	2023	https://dx.doi.org/10.1186/s13063-023-07361-6

N.B. These documents automatically identified may not have been verified by the study sponsor.

Trial Review

Documents added manually

Documents added automatically