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Published in: Trials 1/2012

Open Access 01-12-2012 | Research

The first 100 patients in the SUN(^_^)D trial (strategic use of new generation antidepressants for depression): examination of feasibility and adherence during the pilot phase

Authors: Shinji Shimodera, Tadashi Kato, Hirotoshi Sato, Kazuhira Miki, Yoshihiro Shinagawa, Masaki Kondo, Hirokazu Fujita, Ippei Morokuma, Yoshio Ikeda, Tatsuo Akechi, Norio Watanabe, Mitsuhiko Yamada, Masatoshi Inagaki, Naohiro Yonemoto, Toshi A Furukawa, For the SUN(^_^)D Investigators

Published in: Trials | Issue 1/2012

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Abstract

Background

Initial glitches and unexpected inconsistencies are unavoidable in the early stage of a large, multi-centre trial. Adaptive modifications of the trial’s protocol and operational procedures to ensure its smooth running are therefore imperative. We started a large pragmatic, multi-centre, assessor-blinded, 25-week trial to investigate the optimal first- and second-line treatments for untreated episodes of nonpsychotic major depression in 2010 [Strategic Use of New generation antidepressants for Depression, abbreviated SUN(^_^)D] and would like to herein report an examination of the trial’s feasibility and adherence among the first 100 participants.

Methods

We examined the participants’ characteristics, the treatments that were allocated and received during each step of the trial, and the quality of the outcome assessments among the first 100 patients enrolled in the SUN(^_^)D trial.

Results

Of the 2,743 first-visit patients who visited the two collaborating centres between December 2010 and July 2011, 382 were judged as potentially eligible, and 100 of these patients provided written informed consent. These patients represented the whole spectrum of mild to very severe depression. Of the 93 patients who had reached Week 3 of the study by the end of July 2011, one withdrew consent for both the treatment and the assessment, and eight withdrew consent for the treatment only. Altogether, the primary outcomes were successfully assessed in 90 (96.8%) of the patients at Week 3. Of the 72 patients who had reached Week 9, three withdrew consent for the treatment, but 70 were successfully interviewed (97.2%). Of the 32 patients who had reached Week 25, 29 (90.5%) were successfully followed up. The inter-rater reliability of the assessments of the primary outcomes was nearly perfect and their successful blinding was confirmed. Minor modifications and clarifications to the protocol were deemed necessary.

Discussion

Given the satisfactory feasibility and adherence to the study protocol and the minor modifications that were necessary, we conclude that the data obtained from the first 100 patients can be safely included in the main study. We now intend to accelerate the study by recruiting more collaborating centres and clinics/hospitals.

Trial registration

ClinicalTrials.gov identifier: NCT01109693
Appendix
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Literature
1.
go back to reference Wisniewski SR, Stegman D, Trivedi M, Husain MM, Eng H, Shores-Wilson K, Luther J, Biggs MM, Burroughs D, Ritz AL: Methods of testing feasibility for sequenced treatment alternatives to relieve depression (STAR*D). J Psychiatr Res. 2004, 38 (3): 241-248. 10.1016/j.jpsychires.2003.06.001.CrossRefPubMed Wisniewski SR, Stegman D, Trivedi M, Husain MM, Eng H, Shores-Wilson K, Luther J, Biggs MM, Burroughs D, Ritz AL: Methods of testing feasibility for sequenced treatment alternatives to relieve depression (STAR*D). J Psychiatr Res. 2004, 38 (3): 241-248. 10.1016/j.jpsychires.2003.06.001.CrossRefPubMed
2.
go back to reference Rendell JM, Juszczak E, Hainsworth J, Gucht EV, Healey C, Morriss R, Ferrier N, Young AH, Young H, Goodwin GM: Developing the BALANCE trail–the role of the pilot study and start-up phase. Bipolar Disord. 2004, 6 (1): 26-31. 10.1046/j.1399-5618.2003.00088.x.CrossRefPubMed Rendell JM, Juszczak E, Hainsworth J, Gucht EV, Healey C, Morriss R, Ferrier N, Young AH, Young H, Goodwin GM: Developing the BALANCE trail–the role of the pilot study and start-up phase. Bipolar Disord. 2004, 6 (1): 26-31. 10.1046/j.1399-5618.2003.00088.x.CrossRefPubMed
3.
go back to reference Furukawa TA, Akechi T, Shimodera S, Yamada M, Miki K, Watanabe N, Inagaki M, Yonemoto N: Strategic use of new generation antidepressants for depression: SUN(^_^)D study protocol. Trials. 2011, 12 (1): 116-10.1186/1745-6215-12-116.CrossRefPubMedPubMedCentral Furukawa TA, Akechi T, Shimodera S, Yamada M, Miki K, Watanabe N, Inagaki M, Yonemoto N: Strategic use of new generation antidepressants for depression: SUN(^_^)D study protocol. Trials. 2011, 12 (1): 116-10.1186/1745-6215-12-116.CrossRefPubMedPubMedCentral
4.
go back to reference Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H: Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009, 373: 746-758. 10.1016/S0140-6736(09)60046-5.CrossRefPubMed Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H: Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet. 2009, 373: 746-758. 10.1016/S0140-6736(09)60046-5.CrossRefPubMed
5.
go back to reference Carpenter LL, Jocic Z, Hall JM, Rasmussen SA, Price LH: Mirtazapine augmentation in the treatment of refractory depression. J Clin Psychiatry. 1999, 60 (1): 45-49. 10.4088/JCP.v60n0110.CrossRefPubMed Carpenter LL, Jocic Z, Hall JM, Rasmussen SA, Price LH: Mirtazapine augmentation in the treatment of refractory depression. J Clin Psychiatry. 1999, 60 (1): 45-49. 10.4088/JCP.v60n0110.CrossRefPubMed
6.
go back to reference Blier P, Gobbi G, Turcotte JE, de Montigny C, Boucher N, Hebert C, Debonnel G: Mirtazapine and paroxetine in major depression: a comparison of monotherapy versus their combination from treatment initiation. Eur Neuropsychopharmacol. 2009, 19 (7): 457-465. 10.1016/j.euroneuro.2009.01.015.CrossRefPubMed Blier P, Gobbi G, Turcotte JE, de Montigny C, Boucher N, Hebert C, Debonnel G: Mirtazapine and paroxetine in major depression: a comparison of monotherapy versus their combination from treatment initiation. Eur Neuropsychopharmacol. 2009, 19 (7): 457-465. 10.1016/j.euroneuro.2009.01.015.CrossRefPubMed
7.
go back to reference Blier P, Ward HE, Tremblay P, Laberge L, Hebert C, Bergeron R: Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry. 2010, 167 (3): 281-288.CrossRefPubMed Blier P, Ward HE, Tremblay P, Laberge L, Hebert C, Bergeron R: Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study. Am J Psychiatry. 2010, 167 (3): 281-288.CrossRefPubMed
8.
go back to reference Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM: Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003, 361 (9358): 653-661. 10.1016/S0140-6736(03)12599-8.CrossRefPubMed Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, Frank E, Goodwin GM: Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet. 2003, 361 (9358): 653-661. 10.1016/S0140-6736(03)12599-8.CrossRefPubMed
9.
go back to reference Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999, 282 (18): 1737-1744.PubMed Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999, 282 (18): 1737-1744.PubMed
10.
go back to reference Beck AT, Steer RA, Brown GK: BDI-II: Beck Depression Inventory, Second Edition, Manual. 1996, The Psychological Corporation, San Antonia Beck AT, Steer RA, Brown GK: BDI-II: Beck Depression Inventory, Second Edition, Manual. 1996, The Psychological Corporation, San Antonia
11.
go back to reference Furukawa TA: Assessment of mood: guides for clinicians. J Psychosom Res. 2010, 68 (6): 581-589. 10.1016/j.jpsychores.2009.05.003.CrossRefPubMed Furukawa TA: Assessment of mood: guides for clinicians. J Psychosom Res. 2010, 68 (6): 581-589. 10.1016/j.jpsychores.2009.05.003.CrossRefPubMed
12.
go back to reference Posner K, Oquendo MA, Gould M, Stanley B, Davies M: Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007, 164 (7): 1035-1043. 10.1176/appi.ajp.164.7.1035.CrossRefPubMedPubMedCentral Posner K, Oquendo MA, Gould M, Stanley B, Davies M: Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007, 164 (7): 1035-1043. 10.1176/appi.ajp.164.7.1035.CrossRefPubMedPubMedCentral
13.
go back to reference Furukawa TA, Kitamura T, Takahashi K: Time to recovery of an inception cohort with hitherto untreated unipolar major depressive episodes. Br J Psychiatry. 2000, 177: 331-335. 10.1192/bjp.177.4.331.CrossRefPubMed Furukawa TA, Kitamura T, Takahashi K: Time to recovery of an inception cohort with hitherto untreated unipolar major depressive episodes. Br J Psychiatry. 2000, 177: 331-335. 10.1192/bjp.177.4.331.CrossRefPubMed
14.
go back to reference Wood AM, White IR, Thompson SG: Are missing outcome data adequately handled? A review of published randomized controlled trials in major medical journals. Clin Trials. 2004, 1 (4): 368-376. 10.1191/1740774504cn032oa.CrossRefPubMed Wood AM, White IR, Thompson SG: Are missing outcome data adequately handled? A review of published randomized controlled trials in major medical journals. Clin Trials. 2004, 1 (4): 368-376. 10.1191/1740774504cn032oa.CrossRefPubMed
15.
go back to reference Akl EA, Briel M, You JJ, Sun X, Johnston BC, Busse JW, Mulla S, Lamontagne F, Bassler D, Vera C: Potential impact on estimated treatment effects of information lost to follow-up in randomised controlled trials (LOST-IT): systematic review. BMJ. 2012, 344: e2809-10.1136/bmj.e2809.CrossRefPubMed Akl EA, Briel M, You JJ, Sun X, Johnston BC, Busse JW, Mulla S, Lamontagne F, Bassler D, Vera C: Potential impact on estimated treatment effects of information lost to follow-up in randomised controlled trials (LOST-IT): systematic review. BMJ. 2012, 344: e2809-10.1136/bmj.e2809.CrossRefPubMed
16.
go back to reference Hrobjartsson A, Forfang E, Haahr MT, Als-Nielsen B, Brorson S: Blinded trials taken to the test: an analysis of randomized clinical trials that report tests for the success of blinding. Int J Epidemiol. 2007, 36 (3): 654-663. 10.1093/ije/dym020.CrossRefPubMed Hrobjartsson A, Forfang E, Haahr MT, Als-Nielsen B, Brorson S: Blinded trials taken to the test: an analysis of randomized clinical trials that report tests for the success of blinding. Int J Epidemiol. 2007, 36 (3): 654-663. 10.1093/ije/dym020.CrossRefPubMed
Metadata
Title
The first 100 patients in the SUN(^_^)D trial (strategic use of new generation antidepressants for depression): examination of feasibility and adherence during the pilot phase
Authors
Shinji Shimodera
Tadashi Kato
Hirotoshi Sato
Kazuhira Miki
Yoshihiro Shinagawa
Masaki Kondo
Hirokazu Fujita
Ippei Morokuma
Yoshio Ikeda
Tatsuo Akechi
Norio Watanabe
Mitsuhiko Yamada
Masatoshi Inagaki
Naohiro Yonemoto
Toshi A Furukawa
For the SUN(^_^)D Investigators
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Trials / Issue 1/2012
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-13-80

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