Macarius Donneyong’s research involves digging into existing datasets to find golden nuggets of insight that can improve healthcare outcomes in real-world situations. An assistant professor of pharmacy practice and science in the College of Pharmacy, he recently received an NIH grant to study the treatment of depression among older adults with co-investigator Olivia Ifeoma Okereke, an associate professor at Harvard Medical School and associate psychiatrist at Brigham and Women’s Hospital.
“Drugs are approved based on evidence from randomized, controlled trials, but when they are released to market, they are used by a wider population, including people who are underrepresented in the trials,” explains Donneyong. “Most drug trials have an age cut-off of 60 or 65 years,” he says. “We don’t have enough information on the efficacy of these drugs in the general population, and in this age group.”
The dataset itself will be one of the innovations of the research, Donneyong says. He and Okereke will use the database from the Depression Endpoint Prevention in the VITamin D and OmegA-3 TriaL, or VITAL-DEP, a large ongoing study directed by Okereke. That study looks at the use of vitamin D and omega-3 fatty acids for the treatment of depression in older adults. Donneyong and Okereke will combine the VITAL-DEP information with Medicare Part D data, including prescription information. The dataset includes demographic information contributed by study participants.
“We are developing this database for the first time, but it will be useful for other studies as well,” says Donneyong. “It’s a challenge, but we have some experience with that. It’s definitely a good way to invest resources, because once created it will be very useful. The two databases complement each other.”
The study is not only diverse in terms of age, but also has greater minority representation; about 25 percent of the individuals represented in the VITAL-DEP database have minority racial or ethnic backgrounds that are often underrepresented in drug trials for a variety of reasons, including institutional stigma, a preference for non-pharmaceutical treatments, and distrust of the medical system.
The study will look at both the effectiveness of depression treatment and participants’ adherence to the treatment plan. “There’s some strong debate within the clinical community, some saying SSRIs don’t work, and others are saying of course they don’t work when people aren’t taking it properly,” said Donneyong.
Donneyong’s previous research has also involved poring over data from clinical practice to understand how people manage their health when they are not among a carefully selected population taking a drug in ideal conditions, but people attempting to manage their health and live their everyday lives as well.