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Azim L, Hindmarch P, Browne G, Chadwick T, Clare E, Courtney P, Dixon L, Duffelen N, Fouweather T, Geddes JR, Goudie N, Harvey S, Helter T, Holstein EM, Martin G, Mawson P, McCaffery J, Morriss R, Simon J, Smith D, Stokes PRA, Walker J, Weetman C, Wolstenhulme F, Young AH, Watson S, McAllister-Williams RH. Study protocol for a randomised placebo-controlled trial of pramipexole in addition to mood stabilisers for patients with treatment resistant bipolar depression (the PAX-BD study). BMC Psychiatry 2021; 21:334. [PMID: 34225686 PMCID: PMC8256234 DOI: 10.1186/s12888-021-03322-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/10/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Treatment Resistant Bipolar Depression (TRBD) is a major contributor to the burden of disease associated with Bipolar Disorder (BD). Treatment options for people experiencing bipolar depression are limited to three interventions listed by National Institute for Health and Care: lamotrigine, quetiapine and olanzapine, of which the latter two are often not well tolerated. The majority of depressed people with BD are therefore prescribed antidepressants despite limited efficacy. This demonstrates an unmet need for additional interventions. Pramipexole has been shown to improve mood symptoms in animal models of depression, in people with Parkinson's Disease and two proof of principle trials of pramipexole for people with BD who are currently depressed. METHODS The PAX-BD study, funded by the United Kingdom (UK) National Institute for Health Research, aims to extend previous findings by assessing the efficacy, safety and health economic impact of pramipexole in addition to mood stabilisers for patients with TRBD. A randomised, double-blind, placebo controlled design is conducted in a naturalistic UK National Health Service setting. An internal pilot study to examine feasibility and acceptability of the study design is included. Participants with TRBD are screened from National Health Service secondary care services in up to 40 mental health trusts in the UK, with the aim of recruiting approximately 414 participants into a pre-randomisation phase to achieve a target of 290 randomised participants. Primary safety and efficacy measures are at 12 weeks following randomisation, with follow up of participants to 52 weeks. The primary outcome is depressive symptoms as measured by Quick Inventory for Depressive Symptomatology - Self Report. Secondary outcomes include changes in anxiety, manic symptoms, tolerability, acceptability, quality of life and cost-effectiveness. Outcome measures are collected remotely using self-report tools implemented online, and observer-rated assessments conducted via telephone. ANCOVA will be used to examine the difference in rating scale scores between treatment arms, and dependent on compliance in completion of weekly self-report measures. A mixed effects linear regression model may also be used to account for repeated measures. TRIAL REGISTRATION ISRCTN72151939. Registered on 28 August 2019, http://www.isrctn.com/ISRCTN72151939 Protocol Version: 04-FEB-2021, Version 9.0.
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Affiliation(s)
- Lumbini Azim
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
- Northern Centre for Mood Disorders, Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - Paul Hindmarch
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
- Northern Centre for Mood Disorders, Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - Georgiana Browne
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle, UK
| | - Thomas Chadwick
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Emily Clare
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Paul Courtney
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Lyndsey Dixon
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Nichola Duffelen
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Tony Fouweather
- Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Nicola Goudie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle, UK
| | - Sandy Harvey
- Patient, Carer and Public Involvement, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Clinical Research Network in North East and North Cumbria, Newcastle upon Tyne, UK
| | - Timea Helter
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Garry Martin
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Phil Mawson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle, UK
| | - Jenny McCaffery
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle, UK
| | - Richard Morriss
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Judit Simon
- Department of Psychiatry, University of Oxford, Oxford, UK
- Patient, Carer and Public Involvement, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul R A Stokes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Jenn Walker
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle, UK
| | - Chris Weetman
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle, UK
| | | | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Stuart Watson
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
- Northern Centre for Mood Disorders, Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - R Hamish McAllister-Williams
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK.
- Northern Centre for Mood Disorders, Newcastle University Translational and Clinical Research Institute, Newcastle, UK.
- Northern Centre for Mood Disorders, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5LP, UK.
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