- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04270474
Reducing Risk of Dementia Through Deprescribing (R2D2)
March 22, 2023 updated by: Noll Campbell, Indiana University
Reducing Risk of Dementia Through Deprescribing (R2D2)
A cluster-randomized controlled trial (RCT) called "Reducing Risk of Dementia through Deprescribing" (R2D2) to evaluate the impact of a deprescribing intervention on important cognitive and safety outcomes.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The R2D2 study will test whether the adverse cognitive effects of anticholinergic medications are reversible by implementing a pharmacist-based deprescribing intervention for older adults within primary care practices.
Two groups will be recruited: providers (physicians and advanced practice providers including nurse practitioners), and patients.
Primary care providers of those prescribed eligible anticholinergic medications will be recruited for participation in the study, and their patients who also meet eligible criteria will be subsequently approached and recruited.
Participants will be randomized to one of two groups: the deprescribing intervention group or usual care; the intervention group will receive a pharmacist-based deprescribing intervention, while the usual care group will receive care as usually provided by their primary and/or specialty care providers.
The intervention and follow-up data collection will occur over 24 months in order to test the long-term impact of the intervention on the planned clinical outcomes.
Study outcomes include cognition (primary) and safety (secondary) through validated self-reported scales.
Study Type
Interventional
Enrollment (Anticipated)
344
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Indiana
-
Indianapolis, Indiana, United States, 46202
- Recruiting
- Indiana University Health
-
Indianapolis, Indiana, United States, 46202
- Not yet recruiting
- Eskenazi Health
-
Indianapolis, Indiana, United States, 46256
- Recruiting
- Community Health Network Foundation, Inc.
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
65 years and older (Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria for Participants:
- Age 65 and older;
- At least one office visit to their primary care physician within the previous 12 months;
- Use of a target anticholinergic medication within the last two weeks OR medical record evidence of exposure to target anticholinergic medications at or above a cognitive risk threshold in the prior 12 months
- Able to communicate in English;
- Access to a telephone
Exclusion Criteria for Participants:
- Permanent resident of an extended care facility (nursing home)
- Diagnosis of schizophrenia, bipolar disorder, or schizoaffective disorder defined by International Classification of Diseases (ICD) version 9/10 codes
Diagnosis of Alzheimer's Disease or Related Dementia as determined by (a), (b), or (c) below:
- ICD-9/10 codes, or
- Current use of a medication for Alzheimer's Disease or a Related Dementia, or
- A pattern of responses to the Functional Activities Questionnaire (FAQ) that indicate dementia (i.e., ≥ 3 FAQ items are scored at "requires assistance," or if ≥ 1 FAQ item is scored at "dependent").
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Active Intervention (ACT)
Pharmacist-based Deprescribing
|
The active intervention group (ACT) will receive a pharmacist-based deprescribing intervention focused only on targeted anticholinergic medications.
The intervention pharmacist will serve as the central source of communication between participants, providers, and (as needed) dispensing pharmacy to coordinate the deprescribing process.
The study pharmacists will navigate a shared-decision model between the physicians and participant in order to personalize the selection of appropriate alternatives and switch/titration schedules.
Importantly, the pharmacist will supervise the titration and deprescribing plan and communicate with both participants and physicians throughout the study.
|
Sham Comparator: Usual Care (UC)
Usual Care
|
Those in the usual care group will not have access to the study intervention, but will receive a one-time information packet through the mail reviewing risks of polypharmacy, but no information specific to anticholinergic medications.
They will receive clinical care as usually provided by their primary care or specialty care physicians.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Cognitive Composite Score
Time Frame: Baseline, 6, 12, 18, and 24 months
|
Cognitive composite scores will be collected from participants at baseline, 6, 12, 18 and 24 months and changes in the composite scores over time will be compared between the intervention and usual care groups.
An overall cognitive composite score including measures of information processing speed, memory, and executive function will be conducted at each time point from the average of each measure's z-score, constructed by subtracting the mean baseline scores and dividing by the baseline standard deviation.
The z-score transformation of the cognitive composite score will have a mean of 0 and standard deviation of 1 at baseline, with higher scores representing improvement in cognition.
|
Baseline, 6, 12, 18, and 24 months
|
Change in Patient Reported Outcome Measurement Information System (PROMIS)
Time Frame: Baseline, 6, 12, 18, and 24 months
|
Participant self-reported, 4-item scales evaluating depression, anxiety, pain, and insomnia will be collected for each participant at each time point.
Each PROMIS measure raw score can be converted to a T-score where 50 represents the general population norm for that symptom and each 10-point deviation represents one standard deviation (SD) from the population norm.
Changes in the T-scores over time will be compared between the intervention and usual care groups.
|
Baseline, 6, 12, 18, and 24 months
|
Change in Health Utilities Index (HUI)
Time Frame: Baseline, 6, 12, 18, and 24 months
|
Participant self-reported measure of health-related quality of life, evaluating domains including vision, hearing, speech, ambulation, dexterity, emotion, cognitive function and pain.
These attributes produce a single score on a standardized utility measure with individual health domain scores ranging from 0.00 (maximum impairment) to 1.00 (no impairment) and the multi-attribute (HUI) scores ranging from 0.36 to 1.00 with anchors 0.00 = dead and 1.00 = perfect health.
HUI scores will be collected at each outcome assessment and change in HUI scores over time will be compared between the intervention and usual care groups.
|
Baseline, 6, 12, 18, and 24 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
July 20, 2020
Primary Completion (Anticipated)
July 31, 2025
Study Completion (Anticipated)
July 31, 2025
Study Registration Dates
First Submitted
February 10, 2020
First Submitted That Met QC Criteria
February 12, 2020
First Posted (Actual)
February 17, 2020
Study Record Updates
Last Update Posted (Actual)
March 23, 2023
Last Update Submitted That Met QC Criteria
March 22, 2023
Last Verified
March 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Neurocognitive Disorders
- Disease Attributes
- Neurodegenerative Diseases
- Tauopathies
- Dementia
- Alzheimer Disease
- Late Onset Disorders
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Cholinergic Agents
- Cholinergic Antagonists
Other Study ID Numbers
- 1706800075
- R01AG061452 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
Data collected through this trial will be made available to either advance scientific research in a way that is allowed by the federal regulations that protect research subjects, or for the purpose of auditing or program evaluation by the government or funding agency.
Data sharing for scientific purposes is essential for further translation of research results into knowledge, products, and procedures to improve human health.
To protect participants' rights and confidentiality, protected health information will be limited to the minimum necessary for authorized oversight before the data are shared.The final dataset will include demographic, clinical, and limited genetic data.
The final subject-level, de-identified dataset will be made available to qualified individuals within the scientific community.
IPD Sharing Time Frame
The final data set will be made available no later than 9 months of the database lock or at the time of on-line publication of the primary results, whichever comes first.
IPD Sharing Access Criteria
We anticipated access to the study data will be facilitated in collaboration with the Global Alzheimer's Association Interactive Network (GAAIN).
As a GAAIN Data Partner, data from this study will be shared in aggregate through the GAAIN portal (gaain.org).
GAAIN provides a global infrastructure for cooperative research by linking data repositories that have collected information from participants who are at risk for or have been diagnosed with Alzheimer's disease.
The GAAIN network allows the investigator to retain ownership of the data collected in each study, and can detach the data at any time.
Only de-identified data is shared with GAAIN or any other research entity.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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