PROlonGed ExpoSure Sertraline

NCT ID: NCT01524133

Last Updated: 2018-02-28

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

223 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-11-30

Study Completion Date

2017-05-31

Brief Summary

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The current research study aims to compare the effectiveness of two proven treatments for posttraumatic stress disorder (PTSD): Prolonged Exposure (PE), sertraline, and their combination. In addition, the investigators are examining predictors of response to these two treatments and how PTSD symptoms, thoughts, and biological factors may be changed by such treatments. Biological mechanisms of change are also examined including emotion processing and regulation in fMRI, HPA axis function, and genetics and genomics. In addition, the investigators will examine acceptability of each treatment and reasons for ending treatment.

Detailed Description

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Conditions

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Posttraumatic Stress Disorder

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Sertraline + enhanced medication management (SERT/EMM)

24 weeks of sertraline + enhanced medication management

Group Type ACTIVE_COMPARATOR

Sertraline

Intervention Type DRUG

Initial baseline dose of 25 mg/day. Clinician will attempt to titrate patients to at least 100 mg/day and up to 200 mg/day if tolerated by week 8.

Prolonged Exposure + sertraline (PE/SERT)

Up to 13 sessions of prolonged exposure therapy + 24 weeks of sertraline

Group Type ACTIVE_COMPARATOR

Sertraline

Intervention Type DRUG

Initial baseline dose of 25 mg/day. Clinician will attempt to titrate patients to at least 100 mg/day and up to 200 mg/day if tolerated by week 8.

Prolonged Exposure Therapy

Intervention Type BEHAVIORAL

up to 13 sessions of prolonged exposure

Prolonged Exposure + placebo (PE/PLB)

Up to 13 sessions of prolonged exposure therapy + 24 weeks of placebo

Group Type ACTIVE_COMPARATOR

Prolonged Exposure Therapy

Intervention Type BEHAVIORAL

up to 13 sessions of prolonged exposure

Interventions

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Sertraline

Initial baseline dose of 25 mg/day. Clinician will attempt to titrate patients to at least 100 mg/day and up to 200 mg/day if tolerated by week 8.

Intervention Type DRUG

Prolonged Exposure Therapy

up to 13 sessions of prolonged exposure

Intervention Type BEHAVIORAL

Other Intervention Names

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Zoloft

Eligibility Criteria

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Inclusion Criteria

* Patient is an Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) combat veteran with chronic posttraumatic stress disorder (PTSD) or significant PTSD symptoms (Clinician Administered Posttraumatic Stress Disorder Scale \[CAPS\] \>= 50) of at least 3 months duration

Exclusion Criteria

* Current, imminent risk of suicide (as indicated on C-SSRS)
* Active psychosis
* Alcohol or substance dependence in the past 8 weeks
* Unable to attend regular appointments
* Prior intolerance or failure of adequate trial of prolonged exposure (PE) or sertraline (SERT) (defined as at least 2 months of SERT at least 100mg/day)
* Medical illness likely to result in hospitalization or for which treatments are contraindicated (based on lab results, medical history and physical exam)
* Serious cognitive impairment (as evidenced by cognitive impairment felt likely to interfere with the ability to participate meaningfully in the study)
* Concurrent antidepressants or antipsychotics
* Pregnant females
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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U.S. Army Medical Research and Development Command

FED

Sponsor Role collaborator

VA Ann Arbor Healthcare System

FED

Sponsor Role lead

Responsible Party

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Sheila Rauch

Clinical Director of Wounded Warrior Project and Associate Professor at Emory University, Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sheila Rauch, PhD

Role: PRINCIPAL_INVESTIGATOR

VA Ann Arbor Healthcare System

Locations

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VA San Diego Healthcare System

San Diego, California, United States

Site Status

Ralph H. Johnson VA Medical Center/Savannah Primary Care Clinic

Savannah, Georgia, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

Veterans Affairs Ann Arbor Healthcare System

Ann Arbor, Michigan, United States

Site Status

Countries

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United States

References

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Allard CB, Norman SB, Straus E, Kim HM, Stein MB, Simon NM, Rauch SAM; PROGrESS Study Team. Reductions in guilt cognitions following prolonged exposure and/or sertraline predict subsequent improvements in PTSD and depression. J Behav Ther Exp Psychiatry. 2021 Dec;73:101666. doi: 10.1016/j.jbtep.2021.101666. Epub 2021 Jun 1.

Reference Type DERIVED
PMID: 34147766 (View on PubMed)

Rauch SAM, Kim HM, Lederman S, Sullivan G, Acierno R, Tuerk PW, Simon NM, Venners MR, Norman SB, Allard CB, Porter KE, Martis B, Bui E, Baker AW; PROGrESS Team. Predictors of Response to Prolonged Exposure, Sertraline, and Their Combination for the Treatment of Military PTSD. J Clin Psychiatry. 2021 Jun 15;82(4):20m13752. doi: 10.4088/JCP.20m13752.

Reference Type DERIVED
PMID: 34133087 (View on PubMed)

Sheynin J, Duval ER, King AP, Angstadt M, Phan KL, Simon NM, Rauch SAM, Liberzon I. Associations between resting-state functional connectivity and treatment response in a randomized clinical trial for posttraumatic stress disorder. Depress Anxiety. 2020 Oct;37(10):1037-1046. doi: 10.1002/da.23075. Epub 2020 Jul 15.

Reference Type DERIVED
PMID: 32668087 (View on PubMed)

Rauch SAM, King A, Kim HM, Powell C, Rajaram N, Venners M, Simon NM, Hamner M, Liberzon I. Cortisol awakening response in PTSD treatment: Predictor or mechanism of change. Psychoneuroendocrinology. 2020 Aug;118:104714. doi: 10.1016/j.psyneuen.2020.104714. Epub 2020 May 15.

Reference Type DERIVED
PMID: 32446108 (View on PubMed)

Duval ER, Sheynin J, King AP, Phan KL, Simon NM, Martis B, Porter KE, Norman SB, Liberzon I, Rauch SAM. Neural function during emotion processing and modulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder. Depress Anxiety. 2020 Jul;37(7):670-681. doi: 10.1002/da.23022. Epub 2020 Apr 19.

Reference Type DERIVED
PMID: 32306485 (View on PubMed)

Joshi SA, Duval ER, Sheynin J, King AP, Phan KL, Martis B, Porter KE, Liberzon I, Rauch SAM. Neural correlates of emotional reactivity and regulation associated with treatment response in a randomized clinical trial for posttraumatic stress disorder. Psychiatry Res Neuroimaging. 2020 May 30;299:111062. doi: 10.1016/j.pscychresns.2020.111062. Epub 2020 Mar 5.

Reference Type DERIVED
PMID: 32278278 (View on PubMed)

Goetter EM, Hoeppner SS, Khan AJ, Charney ME, Wieman S, Venners MR, Avallone KM, Rauch SAM, Simon NM. Combat-Related Posttraumatic Stress Disorder and Comorbid Major Depression in U.S. Veterans: The Role of Deployment Cycle Adversity and Social Support. J Trauma Stress. 2020 Jun;33(3):276-284. doi: 10.1002/jts.22496. Epub 2020 Mar 26.

Reference Type DERIVED
PMID: 32216142 (View on PubMed)

Rauch SAM, Kim HM, Powell C, Tuerk PW, Simon NM, Acierno R, Allard CB, Norman SB, Venners MR, Rothbaum BO, Stein MB, Porter K, Martis B, King AP, Liberzon I, Phan KL, Hoge CW. Efficacy of Prolonged Exposure Therapy, Sertraline Hydrochloride, and Their Combination Among Combat Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2019 Feb 1;76(2):117-126. doi: 10.1001/jamapsychiatry.2018.3412.

Reference Type DERIVED
PMID: 30516797 (View on PubMed)

Rauch SAM, Simon NM, Kim HM, Acierno R, King AP, Norman SB, Venners MR, Porter K, Phan KL, Tuerk PW, Allard C, Liberzon I, Rothbaum BO, Martis B, Stein MB, Hoge CW. Integrating biological treatment mechanisms into randomized clinical trials: Design of PROGrESS (PROlonGed ExpoSure and Sertraline Trial). Contemp Clin Trials. 2018 Jan;64:128-138. doi: 10.1016/j.cct.2017.10.013. Epub 2017 Oct 29.

Reference Type DERIVED
PMID: 29081351 (View on PubMed)

Other Identifiers

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PROGrESS

Identifier Type: -

Identifier Source: org_study_id

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