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Patient-oriented Randomized Pragmatic Feasibility Trial With rTMS in Depression and Anxiety (PORT)

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ClinicalTrials.gov Identifier: NCT05028738
Recruitment Status : Recruiting
First Posted : August 31, 2021
Last Update Posted : November 9, 2021
Sponsor:
Information provided by (Responsible Party):
Fidel Vila-Rodriguez, University of British Columbia

Study Description
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Brief Summary:
This trial compares intermittent theta-burst stimulation (iTBS) to low frequency repetitive transcranial magnetic stimulation (LFR) in regards to depression and anxiety outcomes in 100 patients with treatment resistant depression (TRD).

Condition or disease Intervention/treatment Phase
Major Depressive Episode Major Depressive Disorder Device: Repetitive Transcranial Magnetic Stimulation Not Applicable

Detailed Description:

The overarching goal of this trial is to evaluate whether a definite adaptive pragmatic trial would be feasible and establish clear go/no-go criteria as to whether proceeding to such definite trial is feasible. Specific aims include 1) testing the feasibility of recruiting a sample of TRD patients with less strict inclusion and exclusion criteria; 2) comparing different depression and anxiety scales (both clinician-rated and self-rated) and seek input from patients regarding their preferences; 3) seek input from patients with regards to the use of digital phenotyping as a tool to investigate biomarkers as well as engaging in the design of a potential implementation of such biomarker in a future definite trial.

Aim 1. To evaluate the feasibility of a future definite adaptive pragmatic RCT comparing left vs right DLPFC repetitive transcranial magnetic stimulation (rTMS) in TRD.

Hypothesis 1a: Enrollment will be 70% of the planned target over the 1-year recruitment period.

Hypothesis 1b: Retention rate of randomized participants will be ≥70% at the end of the intervention in both groups.

Aim 2. To evaluate patients' preferences regarding information about treatment options when there is no response to allocated treatment.

Hypothesis 2: Patients will prefer to modify treatment when there is no response.

Aim 3. To assess the feasibility of digital phenotyping as an tool to investigate biomarkers in TRD.

Hypothesis 3a: Survey uptake and participation in the study regarding the use of digital phenotyping will be 80% of randomized participants. Hypothesis 3b: Of those survey responders, 75% will indicate they would consent to digital phenotyping in a future definite RCT.

Aim 4. To develop a Bayesian statistical model that continuously updates personalized treatment effect estimates as the trial progresses, and identify the circumstances under which use of the model in a full-scale trial could inform treatment choice as the trial progresses.

Hypothesis 4: The modeling results will identify at least one subgroup for whom early stopping of the definitive trial in that subgroup may be warranted.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Two-arm, randomized feasibility trial
Masking: Double (Investigator, Outcomes Assessor)
Masking Description: Single-masked (i.e. raters)
Primary Purpose: Treatment
Official Title: Patient-oriented Randomized Pragmatic Feasibility Trial With rTMS in Depression and Anxiety
Actual Study Start Date : October 11, 2021
Estimated Primary Completion Date : July 2022
Estimated Study Completion Date : August 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Anxiety

Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Intermittent Theta Burst Stimulation (iTBS)
iTBS to the L-DLPFC
 Device: Repetitive Transcranial Magnetic Stimulation
rTMS will employ the MagPro X100 stimulator equipped with the cool-B70 coil (MagVenture, Farum, Denmark). The dose will be a 120% resting motor threshold (rMT) in accordance to our latest trial using iTBS. Localization of the right and left DLPFC will follow the well-established Beam F3 procedure. Subjects will then undergo 30 sessions of rTMS, once daily on weekdays for 6 weeks. FDA-approved iTBS protocol will consist of bursts of 3 pulses at 50 Hz, bursts repeated at 5 Hz for 600 pulses total, 2 s on, 8 s off, for 3 min 9 sec, at 120% rMT. LFR will consist of 1 Hz stimulation consisting of a single train of 10min duration for 600 pulses total at 120% rMT.
Active Comparator: Low Frequency Right (LFR)
1Hz stimulation to the R-DLPFC
 Device: Repetitive Transcranial Magnetic Stimulation
rTMS will employ the MagPro X100 stimulator equipped with the cool-B70 coil (MagVenture, Farum, Denmark). The dose will be a 120% resting motor threshold (rMT) in accordance to our latest trial using iTBS. Localization of the right and left DLPFC will follow the well-established Beam F3 procedure. Subjects will then undergo 30 sessions of rTMS, once daily on weekdays for 6 weeks. FDA-approved iTBS protocol will consist of bursts of 3 pulses at 50 Hz, bursts repeated at 5 Hz for 600 pulses total, 2 s on, 8 s off, for 3 min 9 sec, at 120% rMT. LFR will consist of 1 Hz stimulation consisting of a single train of 10min duration for 600 pulses total at 120% rMT.


Outcome Measures
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Primary Outcome Measures :
  1. Depression severity [ Time Frame: one week post treatment ]
    Inventory of Depressive Symptoms (IDS-30-SR); Minimum value per question: 0; Maximum value per question: 3; Total minimum value: 0; Total maximum value: 84; Higher score means worse outcome.


Secondary Outcome Measures :
  1. Suicidal ideation [ Time Frame: one week post treatment ]
    Columbia-Suicide Severity Rating Scale (C-SSRS); This questionnaire has binary responses (Yes/No). More responses with "Yes" mean worse outcome.

  2. Anxiety severity [ Time Frame: one week post treatment ]
    Brief Symptom Inventory anxiety subscale (BSI-Anxiety); Minimum value per question: 0 (Not at all); Maximum value per question: 4 (Extremely); Total minimum value: 0; Total maximum value: 24; Higher score means worse outcome.


Eligibility Criteria
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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. are outpatients;
  2. are voluntary and competent to consent to treatment;
  3. are ≥ 18 years;
  4. have a score ≥ 26 on the IDS-30-SR;
  5. have had no increase or initiation of any psychotropic medication in the 4 weeks prior to screening;
  6. able to adhere to the treatment schedule;
  7. pass the TMS adult safety screening (TASS) questionnaire

Exclusion Criteria:

  1. have active suicidal intent;
  2. are pregnant;
  3. have a lifetime diagnosis of schizophrenia, bipolar disorder type I, schizophreniform, schizoaffective disorder or presence of psychotic symptoms within last 3 months;
  4. have a concomitant major unstable medical illness;
  5. have any significant form of dementia or any history of epilepsy;
  6. have any intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or any other metal object within or near the head, excluding the mouth, that cannot be safely removed;
  7. If participating in psychotherapy, must have been in stable treatment for at least 3 months prior to entry into the study, with no anticipation of change in the frequency of therapeutic sessions, or the therapeutic focus over the duration of the study;
  8. If they are taking psychotropic medication, be on a stable dose for 4 weeks before starting treatment, and no initiation of new regular psychotropic medication;
  9. have a clinically significant laboratory abnormality, in the opinion of the one of the principal investigators;
  10. have a non-correctable clinically significant sensory impairment (i.e., cannot hear well enough to cooperate with interview).
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05028738


Contacts
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Contact: Afifa Humaira, BSc 604-827-1361 afifa.humaira@ubc.ca
Contact: Michelle Avina, BSc 604-827-1361 michelle.avina@ubc.ca

Locations
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Canada, British Columbia
Non-Invasive Neurostimulation Therapies (NINET) Laboratory, UBC Department of Psychiatry Recruiting
Vancouver, British Columbia, Canada, V6T 2A1
Contact: Afifa Humaira, B.Sc.    604-822-7308    afifa.humaira@ubc.ca   
Principal Investigator: Fidel Vila-Rodriguez, M.D., Ph.D.         
Sponsors and Collaborators
University of British Columbia
Investigators
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Principal Investigator: Fidel Vila-Rodriguez, MD, PhD University of British Columbia
More Information
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Responsible Party: Fidel Vila-Rodriguez, Principal Investigator, University of British Columbia
ClinicalTrials.gov Identifier: NCT05028738    
Other Study ID Numbers: H17-00161
First Posted: August 31, 2021    Key Record Dates
Last Update Posted: November 9, 2021
Last Verified: November 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Fidel Vila-Rodriguez, University of British Columbia:
Pragmatic
Patient-oriented research
TMS
 Treatment-resistant depression
Transcranial Magnetic Stimulation
rTMS
Additional relevant MeSH terms:
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Depression
Depressive Disorder
Depressive Disorder, Major
 Behavioral Symptoms
Mood Disorders
Mental Disorders