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Sponsors and Collaborators: |
McGill University Health Center Ontario HIV Treatment Network Schering Canada, Inc. Canadian HIV Trials Network |
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Information provided by: | McGill University Health Center |
ClinicalTrials.gov Identifier: | NCT00317746 |
With the improved prognosis of human immunodeficiency virus (HIV) infection, end stage liver disease due to hepatitis C (HCV) now represents a major cause of morbidity and mortality in people with HIV. Treatment for HCV has become increasingly important as a means of preventing the consequences of chronic HCV infection. Paradoxically, co-infected patients have low rates of treatment initiation and completion in large part because they have a high risk of developing neuropsychiatric symptoms while receiving PEG-interferon (PEG-IFN). There are a large number of co-infected individuals in Canada who could benefit from HCV therapy if tolerability could be improved. This trial will address whether prophylactic use of antidepressants in HIV-HCV infected patients initiating HCV therapy can prevent the development of neuropsychiatric side effects and thus permit more patients to receive full treatment for HCV.
Condition | Intervention | Phase |
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Depression HIV Infections Hepatitis C |
Drug: Citalopram Drug: Placebo |
Phase III |
Study Type: | Interventional |
Study Design: | Prevention, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Efficacy Study |
Official Title: | A PICCO: Preventing Depression Interferon Related Initiating Citalopram in co-Infection Hepatitis C |
Estimated Enrollment: | 76 |
Study Start Date: | November 2006 |
Estimated Study Completion Date: | December 2008 |
Trial design:
This study is a Canadian multicentre randomized, double-blind placebo controlled trial. We will evaluate whether prophylactic citalopram compared to symptomatic treatment of depression can significantly increase the amount of HCV therapy received in co-infected patients during the first 24 weeks. Post study follow-up will extend until 6 months after cessation of HCV therapy (up to 72 weeks) to capture information on SVR (sustained virologic response) for HCV. 76 patients will be randomized in a 1:1 ratio to citalopram or placebo. Patients will be stratified by study centre and HCV genotype. Citalopram (or placebo) will begin 3 weeks before HCV treatment at an initial dose of 10 mg per day then be increased to 20 mg per day after one week and continued throughout treatment with PEG-IFN/ribavirin (up to 48 weeks) and then tapered to discontinuation at completion of HCV therapy. The management of depression emerging in study participants is mandated in the protocol to ensure that the original treatment assignments remain blinded while allowing for all subjects to remain in the study and mimics what would take place in clinical practice.
Analysis:
The analyses will follow the intention-to-treat approach. Random regression modelling will be employed to analyse longitudinal data on adherence to prescribed PEG-IFN and ribavirin dosage at weeks 12 and 24. Survival analyses will be used to compare the two treatment groups with respect to the time to the development of depressions.
Implications:
Prophylactic antidepressants may not only prevent overt depression but may also diminish the development of sub-clinical depressed mood. Effective prevention of a broad range of neuropsychiatric symptoms by use of citalopram has the potential to diminish morbidity associated with PEG-IFN treatment and consequently allow a greater number of patients to complete full therapy. In addition, such an approach may help patients remain adherent to their HIV therapy during the course of HCV treatment which could have long-term personal and public health implications by preventing the emergence of HIV resistance. Furthermore, if shown to be an effective strategy for preventing neuropsychiatric symptoms, treatment for HCV may become more accessible to the large number of patients who may not have ready access to the frequent and intensive psychiatric monitoring, necessary for the early detection and treatment of depression that manifests on PEG-IFN.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Contact: Marina B Klein, MD | 514-934-1934 ext 32523 | marina.klein@muhc.mcgill.ca |
Canada, Quebec | |
Immunodeficiency Service Montreal Chest Institute McGill University Health Centre | Recruiting |
Montreal, Quebec, Canada, H2X 2P4 | |
Contact: Marina B Klein, MD 514-934-1934 ext 32523 marina.klein@muhc.mcgill.ca | |
Principal Investigator: Marina B Klein, MD |
Principal Investigator: | Marina B Klein, MD | Immunodeficiency Service Montreal Chest Institute |
Study ID Numbers: | CTN194, Schering #2229 |
Study First Received: | April 21, 2006 |
Last Updated: | July 17, 2007 |
ClinicalTrials.gov Identifier: | NCT00317746 |
Health Authority: | Canada: Health Canada |
HIV/HCV Co-infection Depression Citalopram |
Liver Diseases Sexually Transmitted Diseases, Viral Depression Interferons Acquired Immunodeficiency Syndrome Hepatitis, Viral, Human Depressive Disorder Citalopram Serotonin Immunologic Deficiency Syndromes Behavioral Symptoms |
Hepatitis Virus Diseases Digestive System Diseases Mental Disorders HIV Infections Sexually Transmitted Diseases Mood Disorders Hepatitis C Dexetimide Retroviridae Infections |
Communicable Diseases Parasympatholytics Neurotransmitter Uptake Inhibitors Neurotransmitter Agents Slow Virus Diseases Cholinergic Antagonists Flaviviridae Infections Molecular Mechanisms of Pharmacological Action Anti-Dyskinesia Agents Physiological Effects of Drugs Psychotropic Drugs Antiparkinson Agents Cholinergic Agents Infection |
Therapeutic Uses Antidepressive Agents, Second-Generation Antidepressive Agents RNA Virus Infections Immune System Diseases Serotonin Uptake Inhibitors Pharmacologic Actions Muscarinic Antagonists Serotonin Agents Autonomic Agents Lentivirus Infections Peripheral Nervous System Agents Central Nervous System Agents |