MYnd Analytics Directed Therapy in Depression
1. listopadu 2017 aktualizováno: Cota Inc.
Randomized Trial Evaluating the Effectiveness of MYnd Analytics Directed Therapy in Depression
The MYnd Analytics PEER Online strategy utilizes EEG diagnostics to direct patients with psychiatric illnesses to the best medication treatments.
This trial will evaluate patients with a diagnosis of depression who will either receive (1) PEER Online directed therapy or (2) conventional treatment without EEG guidance and will compare 6 month clinical and economic outcomes between these groups.
Přehled studie
Postavení
Neznámý
Podmínky
Detailní popis
Mynd Analytics has developed the Psychiatric Electroencephalography Evaluation Registry (PEER) Online® clinical decision support database that uses a combination of software, analytics, and clinical outcomes to provide objective, adjunctive medication response information to physicians treating patients with non-psychotic behavioral disorders. PEER Online uses a statistical analysis of EEG outputs and other patient information to generate a report that indicates the statistical likelihood of the patient's responsiveness to classes of central nervous system (CNS) medications (i.e. antidepressants), groups (i.e. SSRI) and individual agents (i.e. fluoxetine). A discriminant analysis compares neurophysiologic abnormalities of the patient to patterns of abnormalities of known responders to CNS drugs in the company's outcomes database of symptomatic patients. This provides a probability estimate of the similarity of the patient's profile with the profile of groups of individuals constituting the normative and clinical (symptomatic) database, which provides the treating physician guidance to which treatments the patient will most likely respond to, and those treatments to which the patient is least likely to respond.
Procedurally, PEER Online utilizes standard 21-lead digital electroencephalographic equipment measuring the patient in a resting (but awake) state. The recording generally takes 30-60 minutes. Patients are classified based upon the 1,142 variables calculated in the recording (FDA-approved neurometric system) and categorized based on the outcome history in treating patients with similar neurophysiologic outputs. From these outputs and the correlation to the outcome database, reports may indicate single or multiple medications based on the nature of the physiologic abnormality discovered. The entire procedure is rapid, non-invasive, devoid of radiation or high strength magnetic fields, and results in a report, the PEER Outcome Report that is provided to clinicians in a format similar to antibiotic sensitivity testing.
Study Design (summary)
- The patient population will consist of individuals with depression who in the opinion of their physician require medication management. A score of 10 or more on the PHQ-9 instrument will be required for enrollment. Non-psychotic co-morbid illnesses will be permitted. Patients must not currently be receiving psychotropic medications (including stimulants, benzodiazepines, or THC). Patients previously on these medications but off treatment for >30 days are permitted.
- The physician will declare whether they wish to treat the depression or refer to a participating psychiatrist. Individual physicians (prior to enrolling any patients) will be assigned to either agree to utilize MYnd Analytic directed care or to be part of the control cohort. This will minimize any physician learning effect.
- The patient will sign informed consent to participate.
- All patients will undergo a study related EEG and MYnd Analytics will develop a PEER Online report. The report will be released to the treating physicians in the directed care group but will not be released to the control physicians.
- All patients will complete a disease specific assessment tool (QIDS-SR16) at every office visit (at a minimum assessments at baseline, 3 months into treatment, and 6 months into treatment). Patients choosing to withdraw from the study or from treatment will also be offered the assessment at participation endpoint. COTA will score each patient based on the standardized tools as either improved, stable, or worsened. The primary endpoint for this study is QIDS-SR16 percent mean change from baseline, with response being defined as a reduction of >50% from baseline. Physicians may know the results of these tests and may alter therapy per their usual practice.
- Medication management will be at the final discretion of the treating physician. Physicians assigned to the MYnd Analytics directed care cohort will be encouraged, but not required, to follow the PEER Online report. Any change in therapy will be documented by the physician with reason (lack of efficacy, toxicity, patient preference).
Typ studie
Intervenční
Zápis (Očekávaný)
600
Fáze
- Fáze 4
Kontakty a umístění
Tato část poskytuje kontaktní údaje pro ty, kteří studii provádějí, a informace o tom, kde se tato studie provádí.
Studijní místa
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New Jersey
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Brick Township, New Jersey, Spojené státy, 08723
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Richard Reisher, DO
- Telefonní číslo: 732-477-5600
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Brick Township, New Jersey, Spojené státy, 08724
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Jay Vida, DO
- Telefonní číslo: 732-892-4548
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Hackensack, New Jersey, Spojené státy, 07601
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Arthur Chaney, MD
- Telefonní číslo: 201-881-0721
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Holmdel, New Jersey, Spojené státy, 07733
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Anthony DeTulio, MD
- Telefonní číslo: 732-264-8484
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Jackson, New Jersey, Spojené státy, 08527
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Scott Druckman, DO
- Telefonní číslo: 732-987-5780
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Lodi, New Jersey, Spojené státy, 07644
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Aurora Andreescu, MD
- Telefonní číslo: 973-473-3896
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Neptune City, New Jersey, Spojené státy, 07753
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Richard Abramowitz, MD
- Telefonní číslo: 732-897-3990
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Oakhurst, New Jersey, Spojené státy, 07755
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- John Ciciarelli, MD
- Telefonní číslo: 732-663-0900
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Old Bridge, New Jersey, Spojené státy, 08857
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- James Demos, MD
- Telefonní číslo: 732-753-9890
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Paramus, New Jersey, Spojené státy, 07652
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Morey Menacker, DO
- Telefonní číslo: 201-986-1881
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Point Pleasant, New Jersey, Spojené státy, 08742
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Richard Murachanian, MD
- Telefonní číslo: 732-899-2353
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Saddle Brook, New Jersey, Spojené státy, 07653
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Mathew Silverman, DO
- Telefonní číslo: 201-845-4048
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Tinton Falls, New Jersey, Spojené státy, 07724
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Robert Carracino, MD
- Telefonní číslo: 732-450-0961
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Toms River, New Jersey, Spojené státy, 08753
- Nábor
- Hackensack Meridian Health Network
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Kontakt:
- Brenard Wayman, MD
- Telefonní číslo: 732-349-8866
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Kritéria účasti
Výzkumníci hledají lidi, kteří odpovídají určitému popisu, kterému se říká kritéria způsobilosti. Některé příklady těchto kritérií jsou celkový zdravotní stav osoby nebo předchozí léčba.
Kritéria způsobilosti
Věk způsobilý ke studiu
18 let a starší (Dospělý, Starší dospělý)
Přijímá zdravé dobrovolníky
Ne
Pohlaví způsobilá ke studiu
Všechno
Popis
Inclusion Criteria:
- Patients with a clinical diagnosis of depression who in the judgement of their physician require medication management may be eligible for enrollment. A score of 10 or more on the PHQ-9 instrument will be required for enrollment.
- Some practices utilize the PHQ-2 and PHQ-9 are part of routine screening for depression. If the tests are performed routinely, they do not need to be repeated for study eligibility, and may be performed prior to informed consent for this study. If, however, the PHQ-9 is not routinely performed, informed consent must be performed prior to administration. Patients with a score below 10 will be considered screen failures and will not be enrolled or offered the MYnd testing.
- Patients with non-psychotic comorbid conditions may be included.
- Patients must be either medication treatment naïve for behavioral illnesses or have no active medication treatments for at least 1 month prior to enrollment. Prohibited medications at the time of enrollment will include stimulants, benzodiazepines and THC. Prior therapy with these agents is permitted with a washout of >30 days.
- Patients must have private medical insurance coverage through Horizon Blue Cross Blue Shield. This is limited to insured commercial members, including HMO, and excluding, for the avoidance of doubt, members of self-insured customers or Medicare or Medicaid programs.
Exclusion Criteria:
- Diagnosis of a psychotic disorder.
- History of, or current, open head brain trauma. Candidates with any metal, shrapnel or other similar objects in the head that could affect the QEEG
- History of: craniotomy, cerebral metastases, cerebrovascular accident; current diagnosis of seizure disorder, schizophrenia, schizo-affective disorder, dementia, mental retardation, or major depression with psychotic features; or use of depot neuroleptics in last 12 months.
- Uncontrolled thyroid disorders.
- Known pregnancy and/or lactation, or intent to become pregnant during this study.
- Chronic or acute pain requiring prescription pain medication(s) (narcotic or synthetic narcotic)
- Participation in any other therapeutic drug study within 60 days preceding inclusion.
Studijní plán
Tato část poskytuje podrobnosti o studijním plánu, včetně toho, jak je studie navržena a co studie měří.
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Singl
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
|---|---|
|
Experimentální: MYnd Analytics PEER Online directed therapy
Patients in this arm will receive anti-depressants as recommended by the PEER Online algorithm as described below.
|
PEER Online is similar to a standard QEEG in that it uses QEEG output variables, but differs from a standard QEEG in that it references the QEEG to a normative and then symptomatic database.
By comparing a given patient's QEEG to a database of QEEGs of subjects who have tried and responded to a specific medication, PEER Online can provide useful information regarding the response of neuro-physiologically similar patients to a wide number of medications.
PEER Online may thus have the advantage of providing physicians with useful information as to medication outcomes before a medication regime is started.
It has also been used to help select the medication that best matches the QEEG brainwave pattern, regardless of "symptom clusters," currently used for diagnostic nomenclature.
Patients will receive anti-depressant therapy guide by the results of the PEER Online algorithm.
|
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Falešný srovnávač: Conventional therapy
Patients in this arm will receive anti-depressants as chosen by the physician without guidance by the PEER Online algorithm.
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Anti-depressant therapy chosen based on physician best judgement.
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Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
50% Reduction From Baseline in Self-rated Severity of Depressive Symptoms as Measured by Quick Inventory of Depressive Symptomatology Self-Rated 16-item Scale (QIDS-SR-16)
Časové okno: 6 months
|
QIDS-SR-16 is a 16-question self-report inventory that includes the 9 Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria symptom domains: sad mood, concentration, self-outlook, suicidal ideation, involvement, energy/fatigability, sleep disturbance (4 items: initial, middle, late insomnia, and hypersomnia), appetite/weight increased or decrease (4 items), and psychomotor agitation/retardation (2 items).
The QIDS-SR-16 total scores range from 0 (least severe) to 27 (most severe).
This study will examine the percentage of patients with improvement in depression as assessed by the QIDS-SR-16 at the 6 month treatment visit [repeated measures from all visits - for patients who received the intervention ie.
MD followed PEER recommended therapy].
Response will be defined as a >50% reduction in QIDS-SR-16 score from baseline.
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6 months
|
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Clinical improvement based on physician access to MyND Analytic PEER Online report.
Časové okno: 6 months
|
Percentage of patients improving on the standardized assessments stratified by whether the physician had access to the MyND Analytic PEER Online report.
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6 months
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Persistence of PEER recommended therapy.
Časové okno: 3 months
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Percentage of patients remaining on PEER Online concordant therapy vs discordant therapy at the 3 month visit.
Sub-analysis will include whether the patient was on the original therapy or whether changes were made due to lack of efficacy or toxicity.
Switches in medications from a PEER recommended therapy to another recommended therapy based on a physician assessment of lack of efficacy will be counted as a failure, however a switch for toxicity will not be counted as failure.
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3 months
|
Další výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Total cost of care.
Časové okno: 6 months
|
Total cost of care (all cause) for patients on PEER Online concordant therapy vs discordant therapy.
Sub-analysis will focus on total cost of care based on whether the physician had access to the PEER report.
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6 months
|
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Exploring use of Cota Nodal Address (CNA)
Časové okno: 6 months
|
CNA is a unique prognostic classification schema.
All patients will undergo classification at time of diagnosis and exploratory analysis for patterns of responsiveness will be undertaken.
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6 months
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Spolupracovníci a vyšetřovatelé
Zde najdete lidi a organizace zapojené do této studie.
Sponzor
Spolupracovníci
Vyšetřovatelé
- Vrchní vyšetřovatel: Ramon Solhkhah, MD, Hackensack Meridian Health
Publikace a užitečné odkazy
Osoba odpovědná za zadávání informací o studiu tyto publikace poskytuje dobrovolně. Mohou se týkat čehokoli, co souvisí se studiem.
Užitečné odkazy
Termíny studijních záznamů
Tato data sledují průběh záznamů studie a předkládání souhrnných výsledků na ClinicalTrials.gov. Záznamy ze studií a hlášené výsledky jsou před zveřejněním na veřejné webové stránce přezkoumány Národní lékařskou knihovnou (NLM), aby se ujistily, že splňují specifické standardy kontroly kvality.
Hlavní termíny studia
Začátek studia (Aktuální)
1. října 2017
Primární dokončení (Očekávaný)
1. října 2020
Dokončení studie (Očekávaný)
1. října 2020
Termíny zápisu do studia
První předloženo
27. října 2017
První předloženo, které splnilo kritéria kontroly kvality
27. října 2017
První zveřejněno (Aktuální)
1. listopadu 2017
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
6. listopadu 2017
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
1. listopadu 2017
Naposledy ověřeno
1. listopadu 2017
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
Další identifikační čísla studie
- MYnd 001
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Ne
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Ne
Studuje produkt zařízení regulovaný americkým úřadem FDA
Ano
produkt vyrobený a vyvážený z USA
Ne
Tyto informace byly beze změn načteny přímo z webu clinicaltrials.gov. Máte-li jakékoli požadavky na změnu, odstranění nebo aktualizaci podrobností studie, kontaktujte prosím register@clinicaltrials.gov. Jakmile bude změna implementována na clinicaltrials.gov, bude automaticky aktualizována i na našem webu .