Conditioning, the Placebo Effect, and Psoriasis
Role of Conditioning in the Pharmacotherapy of Psoriasis
Studienübersicht
Status
Bedingungen
Detaillierte Beschreibung
The lack of scientific attention devoted to the placebo effect as a phenomenon in its own right probably reflects the paucity of theoretical positions within which to organize the existing data and design new research. This research addresses the clinical significance of behavior-immune system interactions.
This study will capitalize on conditioned immunosuppressive responses to reduce the cumulative amount of corticosteroid medication used in the treatment of psoriasis. We will continue to treat patients with steroid, but will shift experimental patients from their current schedule of continuous reinforcement (active drug whenever medication is applied) to a partial schedule of reinforcement (active drug a percentage of the time and placebo alone at other times). To equate amount of medication, we will treat another group of patients with a reduced dose of steroid in a standard treatment regimen (continuous schedule of reinforcement).
We hypothesize that, holding cumulative dose constant, a partial schedule of reinforcement will enable patients to be maintained on lower cumulative amounts of corticosteroid than patients treated under a continuous schedule of active drug. This is the first attempt to adopt conditioning principles and use schedules of reinforcement to design regimens of drug therapy. If proven effective, this new approach to pharmacotherapy and placebo effects is likely to stimulate new interdisciplinary research in neuropharmacology and behavioral pharmacology for the treatment of autoimmune disorders and a variety of other chronic diseases.
Studientyp
Einschreibung (Tatsächlich)
Phase
- Unzutreffend
Kontakte und Standorte
Studienorte
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California
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Palo Alto, California, Vereinigte Staaten, 94305
- Stanford University
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New York
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Rochester, New York, Vereinigte Staaten, 14642
- Adult Dermatology Clinic, Strong Memorial Hospital
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Teilnahmekriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
- Psoriasis patients with mild to moderate lesions who are able to attend weekly clinic visits at either the University of Rochester School of Medicine and Dentistry in Rochester, NY, or Stanford University in Palo Alto, CA.
- Patients must be in good health (as determined by prescreening examination).
- Patients must not be using systemic treatment (for example, oral medications) or intralesional, UV, or topical therapies except bland emollients for at least 2 weeks before the start date of the study.
- Patients must have chronic, stable plaque psoriasis with a score of greater than or equal to 7 on a routine 9-point Severity Index.
Exclusion Criteria:
- Use of immunosuppressive medication within the past 2 months.
- Pregnant or sexually active women who do not use contraceptives.
- Patients who cannot be monitored regularly.
- History of allergy to corticosteroid or other study ointment components.
- Patients who have more than 10 percent of body surface area covered by psoriatic lesions.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Doppelt
Waffen und Interventionen
Teilnehmergruppe / Arm |
Intervention / Behandlung |
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Experimental: A
Participants will receive 100% of the dose of the medication on the same reinforcement schedule (100%) as received during the baseline (maintenance) period.
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Full dose of Aristicort A (0.1%) 2 times per day for a period of up to 14 weeks.
Andere Namen:
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Experimental: B
Participants will receive 100% of the dose of the medication on a partial reinforcement schedule (25% or 50%) as received during the baseline (maintenance) period
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Dose of 0.1% of Aristocort A on 1-2 of every 4 days for a period of up to 14 weeks.
Andere Namen:
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Experimental: C
Participants will receive 25% or 50% of the dose of the medication on the same reinforcement schedule (100%) as received during the baseline (maintenance) period.
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Dose of 0.025-0.05% of Aristocort A 2 times per day for a period of up to 14 weeks.
Andere Namen:
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Was misst die Studie?
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Zeitfenster |
|---|---|
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Routine and standard quantitative and qualitative assessment of plaque changes and growth
Zeitfenster: Weekly
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Weekly
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Severity Index, clinically described as to redness, flaking and thickness on a total scale of 9
Zeitfenster: Weekly
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Weekly
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Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Zeitfenster |
|---|---|
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Impacts of Events Scale (IES)
Zeitfenster: Once - at the initial start of the study
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Once - at the initial start of the study
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Psoriasis Life Stress Inventory) (PLSI)
Zeitfenster: Weekly
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Weekly
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Hassles Scale
Zeitfenster: Weekly
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Weekly
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Interpersonal Support Evaluation List (ISEL)
Zeitfenster: Once - at the intial start of the study
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Once - at the intial start of the study
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Mitarbeiter und Ermittler
Sponsor
Ermittler
- Hauptermittler: Robert Ader, PhD, University of Rochester
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Ader R, Cohen N. Behaviorally conditioned immunosuppression. Psychosom Med. 1975 Jul-Aug;37(4):333-40. doi: 10.1097/00006842-197507000-00007.
- Ader R, Cohen N, Felten D. Psychoneuroimmunology: interactions between the nervous system and the immune system. Lancet. 1995 Jan 14;345(8942):99-103. doi: 10.1016/s0140-6736(95)90066-7. No abstract available.
- Giang DW, Goodman AD, Schiffer RB, Mattson DH, Petrie M, Cohen N, Ader R. Conditioning of cyclophosphamide-induced leukopenia in humans. J Neuropsychiatry Clin Neurosci. 1996 Spring;8(2):194-201. doi: 10.1176/jnp.8.2.194.
- Ader R. "The role of conditioning in pharmacotherapy." In The placebo effect: An interdisciplinary exploration, edited by A. Harrington, 138-165. Cambridge: Harvard University Press, 1997.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn
Primärer Abschluss (Tatsächlich)
Studienabschluss (Tatsächlich)
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Schätzen)
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Schätzen)
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Hautkrankheiten
- Hautkrankheiten, papulosquamös
- Schuppenflechte
- Physiologische Wirkungen von Arzneimitteln
- Molekulare Mechanismen der pharmakologischen Wirkung
- Enzym-Inhibitoren
- Entzündungshemmende Mittel
- Immunsuppressive Mittel
- Immunologische Faktoren
- Glukokortikoide
- Hormone
- Hormone, Hormonersatzstoffe und Hormonantagonisten
- Triamcinolon
- Triamcinolonacetonid
- Triamcinolonhexacetonid
- Triamcinolondiacetat
Andere Studien-ID-Nummern
- R01AR046825 (US NIH Stipendium/Vertrag)
- NIAMS-051
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