Back to resultsNear-infrared Transcranial Laser Therapy in Subjects With Major Depressive Disorder: A Study of Dosing With Laser
Primary Purpose
Major Depressive Disorder
Status
Recruiting
Phase
Not Applicable
Locations
Peru
Study Type
Interventional
Intervention
Near-infrared Transcranial Laser Therapy
Sponsored by
About this trial
This is an interventional treatment trial for Major Depressive Disorder focused on measuring Near-infrared transcranial laser therapy, Hamilton Depression rating scale, Major depressive Disorder, Clinical trial
Eligibility Criteria
Inclusion Criteria:
- Subjects age at screening will be between 18 and 75 years old (inclusive).
- Diagnosis of major depressive disorder (Mini International Neuropsychiatric Interview, MINI)
- QIDS-CR≥12 at screening
- CGI-S ≥4 or higher, i.e., "moderately depressed"
- Women of child-bearing potential must use a double-barrier method for birth control (e.g. condoms plus spermicide) if sexually active.
- Subject Informed Consent obtained in writing in compliance with local regulations prior to enrollment into this study.
- The subject is willing to participate in this study for at least 12 weeks.
- Subjects will need to be on stable dose(s) of antidepressants (if taking any) for at least six weeks prior to enrollment.
Exclusion Criteria:
- Decrease in Symptoms of Depression Questionnaire (SDQ) self-report from screening to baseline >=30%, calculated as [(SDQ screening-88) - (SDQ initial-88) / (SDQ screening-88)] >=30/100. A score of 88 is "normal" in SDQ.
- The subject is pregnant or lactating.
- The subject failed more than 2 adequate treatments with FDA approved antidepressants during current episode per Antidepressant Treatment Response Questionnaire (ATRQ) criteria (less than 50% decrease in depressive symptomatology).
- Structured psychotherapy focused on treating the subject's depression is permitted if started at least 8 weeks prior to the screening visit.
- Substance dependence or abuse in the past 3 months.
- History of a psychotic disorder or psychotic episode (current psychotic episode per MINI assessment).
- Bipolar affective disorder (per MINI assessment).
- Unstable medical illness, defined as any medical illness which is not well-controlled with standard-of-care medications (e.g., insulin for diabetes mellitus).
- Active suicidal or homicidal ideation (both intention and plan are present), as determined by Columbia-Suicide Severity Rating Scale (C-SSRS) screening.
- The subject has a significant skin condition (i.e., hemangioma, scleroderma, psoriasis, rash, open wound or tattoo) on the subject's scalp that is found to be in proximity to any of the procedure sites.
- The subject has an implant of any kind in the head (e.g. stent, clipped aneurysm, implantable shunt - Hakim valve).
- Any use of light-activated drugs (photodynamic therapy) within 14 days prior to study enrollment (in US: Visudine (verteporfin) for age related macular degeneration; Aminolevulinic Acid- for actinic keratoses; Photofrin (porfimer sodium) - for esophageal cancer, non-small cell lung cancer; Levulan Kerastick (aminolevulinic acid HCl) - for actinic keratosis; 5-aminolevulinic acid (ALA)- for non-melanoma skin cancer)
- Recent history of stroke (90 days).
- The subject failed a device-based intervention FDA-approved for the treatment of depression, during the current episode (e.g. less than 50% decrease in depressive symptomatology with Transcranial Magnetic Stimulation).
- History of dementia, traumatic brain injury (TBI) or any other organic neurological disorder.
Sites / Locations
- Hospital Nacional Hipolito UnanueRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm Type
Experimental
Experimental
Experimental
Sham Comparator
Arm Label
BCW group
BPW-1 group
BPW-2 group
SHAM group
Arm Description
NIR-TLT dose: i. Treatment site(s): EEG F3 and F4 ii. Temporal format: continuous wave iii. Average radiance: 350 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 3.6 kJ (1.8 kJ per treatment location)
NIR-TLT dose: i. Treatment site(s): EEG F3 and F4 ii. Temporal format: pulsed wave, 10 Hz; 50% duty cycle iii. Average radiance: 350 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 3.6 kJ (1.8 kJ per treatment location)
NIR-TLT dose: i. Treatment site(s): EEG F3 and F4 ii. Temporal format: pulsed wave, 40-50 Hz; 50% duty cycle iii. Average radiance: 350 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 3.6 kJ (1.8 kJ per treatment location)
NIR-TLT dose: i. Treatment site(s): none ii. Temporal format: none iii. Average radiance: 0 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 0 kJ
Outcomes
Primary Outcome Measures
Changes in the scores of the Hamilton Depression Rating Scale (HAMD-17) from baseline to week 3 and week 6.
The antidepressant effects of NIR-TLT doses will be measured using the Hamilton Depression rating scale (HAM-D 17). The HAM-D 17 is a 17-item clinician rated instrument developed to quantify the severity of depression in subjects already diagnosed with this disorder. The rating of this tool will be determined in an interview with the psychiatrist, yielding a maximum score of 52. Higher scores represent greater severity of depression.
Secondary Outcome Measures
Changes in the scores of the Quick Inventory of Depressive Symptomatology-Clinician Rated Scale (QIDS-CR) from baseline to week 3 and week 6.
The antidepressant effects of NIR-TLT doses will be measured using the QIDS-CR. This is a brief (16-item) clinician-rated inventory of core depressive symptoms such as sleep, depressed mood, appetite, concentration, suicidal ideation, interest, energy, psychomotor retardation, or agitation. The range score is 0 to 27. Higher scores represent greater severity of depression.
Changes in the scores of the Clinical Global Impressions - Severity (CGI-S) from baseline to week 3 and week 6.
The antidepressant effects of NIR-TLT doses will be measured using the CGI-S. The CGI-S is one of the two components of the CGI test. This tool asks the clinician one question: "Considering your total clinical experience with this particular population, how mentally ill is the patient at this time?" which is rated on the following seven-point scale: 1=normal, not at all ill; 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients.
Changes of electroencephalogram (EEG) espectral power from baseline to week 3 and week 6.
To compare the effects of NIR-TLT doses on brain electrophysiology, changes in EEG spectral power in all spectral bands for each dose will be analyzed. The waves that will be considered are alpha, theta, and delta. For all of them, frequency and amplitude will be registered.
Changes in the scores of the Systemic Assessment for Treatment Emergent Events (SAFTEE-SI) from baseline to week 3 and week 6.
To compare the safety and tolerability of NIR-TLT doses, mean changes in SAFTEE-SI scores will be analyzed. This is a questionnaire developed for psychiatric trials. The SAFTEE-SI allows ratings of five levels of severity and collects information about the onset, duration, pattern, judgment of attribution of cause, and action taken by the clinician when an Adverse Event happens. The range score is 0 to 128.
Brain metabolism effect of NIR-TLT dose (exploratory assessment) from baseline to week 6.
The analysis of the results obtained in the PET will be for exploratory purposes to study the brain metabolism of the participants, before and at the end of the study intervention in the 4 groups. The cortical regions that will be analyzed are the prefrontal lateral and prefrontal medial regions (right and left for both).
Full Information
NCT ID
NCT05435820
First Posted
June 8, 2022
Last Updated
September 26, 2022
Sponsor
Peruvian Clinical Research
Collaborators
NeuroThera
1. Study Identification
Unique Protocol Identification Number
NCT05435820
Brief Title
Near-infrared Transcranial Laser Therapy in Subjects With Major Depressive Disorder: A Study of Dosing With Laser
Official Title
Near-infrared Transcranial Laser Therapy in Subjects With Major Depressive Disorder: A Study of Dosing With Laser
Study Type
Interventional
2. Study Status
Record Verification Date
September 2022
Overall Recruitment Status
Recruiting
Study Start Date
July 1, 2022 (Actual)
Primary Completion Date
July 2024 (Anticipated)
Study Completion Date
July 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Peruvian Clinical Research
Collaborators
NeuroThera
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No
5. Study Description
Brief Summary
The Near-infrared transcranial laser therapy (NIR-TLT) is a non-ionizing electromagnetic wave. The NIR-TLT is invisible, penetrates the skin and skull into brain tissue and is non-invasive. The benefits of NIR-TLT are wavelength specific. A mitochondrial enzyme, the Cytochrome c oxidase, is the primary chromophore for the NIR-TLT with a wavelength of around 830 nm. When this enzyme is activated, it leads to increased adenosine triphosphate (ATP) production and this event is related to the promotion of cellular plasticity and cytoprotection. These are critical cellular processes for recovery of the depressive patients. Therefore, this study will contribute to answer the question of whether NIR-TLT has an antidepressant effect and whether it is acceptable in minority population.
Detailed Description
Study purpose: The main aim is to assess and compare the effect(s) of each of the four doses of the Near-infrared Transcranial Laser Therapy (NIR-TLT) on the symptomatology of depression: antidepressant effect, in subjects with major depressive disorder (MDD). Study design: This protocol is a multicentered, randomized, simulated, and double-blind clinical study. This work will randomize 112 subjects into 4 equal groups: bilateral continuous wave (BCW), bilateral pulsed wave (BPW 1-2) y SHAM. All subjects, investigators (except the study statistician), and outcomes assessors will be blind to group assignment. The device operator will be aware of group assignments. All subjects will receive 3 NIR-TLT treatments per week for 6 weeks. A follow-up evaluation will be performed 2 weeks after the end of the study. The treatment will follow these specifications: wavelength 830 nm; average irradiance 54,8 mW / cm2; average fluence of 65,8 J / cm2 (consistently with parameters used in the ELATED-2 study at MGH with the device Omnilux New U), being the total Fluency delivered: 3.6 kJ (bilateral) o 1.8 kJ (unilateral), either on the subject's forehead, at or near electroencephalography sites (EEG) F3 and F4. All NIR-TLT sessions will last 20 minutes, regardless of group assignment. Study population: Patients eligible for study participation will be diagnosed with major depressive disorder (MDD) by DSM criteria. Subjects will be between 18-75 years of age (have not had 76st birthday) on the date of screening. Duration of participation: Subjects will be followed in the study for 8 weeks (a 6-week treatment period, plus 2 weeks of follow-up). The total duration of the study will be 24 months. Assessment criteria: The primary efficacy criteria is the improvement in depressive symptoms from each of the four doses of NIR-TLT. Assessed using HAMD-17, at 3 time points (visit 1, visit 9 and visit 18).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Major Depressive Disorder
Keywords
Near-infrared transcranial laser therapy, Hamilton Depression rating scale, Major depressive Disorder, Clinical trial
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
112 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
BCW group
Arm Type
Experimental
Arm Description
NIR-TLT dose:
i. Treatment site(s): EEG F3 and F4 ii. Temporal format: continuous wave iii. Average radiance: 350 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 3.6 kJ (1.8 kJ per treatment location)
Arm Title
BPW-1 group
Arm Type
Experimental
Arm Description
NIR-TLT dose:
i. Treatment site(s): EEG F3 and F4 ii. Temporal format: pulsed wave, 10 Hz; 50% duty cycle iii. Average radiance: 350 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 3.6 kJ (1.8 kJ per treatment location)
Arm Title
BPW-2 group
Arm Type
Experimental
Arm Description
NIR-TLT dose:
i. Treatment site(s): EEG F3 and F4 ii. Temporal format: pulsed wave, 40-50 Hz; 50% duty cycle iii. Average radiance: 350 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 3.6 kJ (1.8 kJ per treatment location)
Arm Title
SHAM group
Arm Type
Sham Comparator
Arm Description
NIR-TLT dose:
i. Treatment site(s): none ii. Temporal format: none iii. Average radiance: 0 mW / cm2 iv. Exposure time: 429 sec. v. Total fluence delivered: 0 kJ
Intervention Type
Device
Intervention Name(s)
Near-infrared Transcranial Laser Therapy
Intervention Description
The treatment consists in exposing bilaterally the frontal brain to Transcranial Laser Therapy, which may enhance ATP production in depressed subjects.
Primary Outcome Measure Information:
Title
Changes in the scores of the Hamilton Depression Rating Scale (HAMD-17) from baseline to week 3 and week 6.
Description
The antidepressant effects of NIR-TLT doses will be measured using the Hamilton Depression rating scale (HAM-D 17). The HAM-D 17 is a 17-item clinician rated instrument developed to quantify the severity of depression in subjects already diagnosed with this disorder. The rating of this tool will be determined in an interview with the psychiatrist, yielding a maximum score of 52. Higher scores represent greater severity of depression.
Time Frame
From baseline to week 3 and week 6.
Secondary Outcome Measure Information:
Title
Changes in the scores of the Quick Inventory of Depressive Symptomatology-Clinician Rated Scale (QIDS-CR) from baseline to week 3 and week 6.
Description
The antidepressant effects of NIR-TLT doses will be measured using the QIDS-CR. This is a brief (16-item) clinician-rated inventory of core depressive symptoms such as sleep, depressed mood, appetite, concentration, suicidal ideation, interest, energy, psychomotor retardation, or agitation. The range score is 0 to 27. Higher scores represent greater severity of depression.
Time Frame
From baseline to week 3 and week 6.
Title
Changes in the scores of the Clinical Global Impressions - Severity (CGI-S) from baseline to week 3 and week 6.
Description
The antidepressant effects of NIR-TLT doses will be measured using the CGI-S. The CGI-S is one of the two components of the CGI test. This tool asks the clinician one question: "Considering your total clinical experience with this particular population, how mentally ill is the patient at this time?" which is rated on the following seven-point scale: 1=normal, not at all ill; 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients.
Time Frame
From baseline to week 3 and week 6.
Title
Changes of electroencephalogram (EEG) espectral power from baseline to week 3 and week 6.
Description
To compare the effects of NIR-TLT doses on brain electrophysiology, changes in EEG spectral power in all spectral bands for each dose will be analyzed. The waves that will be considered are alpha, theta, and delta. For all of them, frequency and amplitude will be registered.
Time Frame
From baseline to week 3 and week 6.
Title
Changes in the scores of the Systemic Assessment for Treatment Emergent Events (SAFTEE-SI) from baseline to week 3 and week 6.
Description
To compare the safety and tolerability of NIR-TLT doses, mean changes in SAFTEE-SI scores will be analyzed. This is a questionnaire developed for psychiatric trials. The SAFTEE-SI allows ratings of five levels of severity and collects information about the onset, duration, pattern, judgment of attribution of cause, and action taken by the clinician when an Adverse Event happens. The range score is 0 to 128.
Time Frame
From baseline to week 3 and week 6.
Title
Brain metabolism effect of NIR-TLT dose (exploratory assessment) from baseline to week 6.
Description
The analysis of the results obtained in the PET will be for exploratory purposes to study the brain metabolism of the participants, before and at the end of the study intervention in the 4 groups. The cortical regions that will be analyzed are the prefrontal lateral and prefrontal medial regions (right and left for both).
Time Frame
From baseline to week 6.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subjects age at screening will be between 18 and 75 years old (inclusive).
Diagnosis of major depressive disorder (Mini International Neuropsychiatric Interview, MINI)
QIDS-CR≥12 at screening
CGI-S ≥4 or higher, i.e., "moderately depressed"
Women of child-bearing potential must use a double-barrier method for birth control (e.g. condoms plus spermicide) if sexually active.
Subject Informed Consent obtained in writing in compliance with local regulations prior to enrollment into this study.
The subject is willing to participate in this study for at least 12 weeks.
Subjects will need to be on stable dose(s) of antidepressants (if taking any) for at least six weeks prior to enrollment.
Exclusion Criteria:
Decrease in Symptoms of Depression Questionnaire (SDQ) self-report from screening to baseline >=30%, calculated as [(SDQ screening-88) - (SDQ initial-88) / (SDQ screening-88)] >=30/100. A score of 88 is "normal" in SDQ.
The subject is pregnant or lactating.
The subject failed more than 2 adequate treatments with FDA approved antidepressants during current episode per Antidepressant Treatment Response Questionnaire (ATRQ) criteria (less than 50% decrease in depressive symptomatology).
Structured psychotherapy focused on treating the subject's depression is permitted if started at least 8 weeks prior to the screening visit.
Substance dependence or abuse in the past 3 months.
History of a psychotic disorder or psychotic episode (current psychotic episode per MINI assessment).
Bipolar affective disorder (per MINI assessment).
Unstable medical illness, defined as any medical illness which is not well-controlled with standard-of-care medications (e.g., insulin for diabetes mellitus).
Active suicidal or homicidal ideation (both intention and plan are present), as determined by Columbia-Suicide Severity Rating Scale (C-SSRS) screening.
The subject has a significant skin condition (i.e., hemangioma, scleroderma, psoriasis, rash, open wound or tattoo) on the subject's scalp that is found to be in proximity to any of the procedure sites.
The subject has an implant of any kind in the head (e.g. stent, clipped aneurysm, implantable shunt - Hakim valve).
Any use of light-activated drugs (photodynamic therapy) within 14 days prior to study enrollment (in US: Visudine (verteporfin) for age related macular degeneration; Aminolevulinic Acid- for actinic keratoses; Photofrin (porfimer sodium) - for esophageal cancer, non-small cell lung cancer; Levulan Kerastick (aminolevulinic acid HCl) - for actinic keratosis; 5-aminolevulinic acid (ALA)- for non-melanoma skin cancer)
Recent history of stroke (90 days).
The subject failed a device-based intervention FDA-approved for the treatment of depression, during the current episode (e.g. less than 50% decrease in depressive symptomatology with Transcranial Magnetic Stimulation).
History of dementia, traumatic brain injury (TBI) or any other organic neurological disorder.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Raúl Yepez Adrianzén, Dr.
Phone
+51 999962145
Email
r.yepez@pcr.pe
First Name & Middle Initial & Last Name or Official Title & Degree
Paula Cahuina Lope, Dr.
Phone
+51 923403150
Email
medicalaffairs@pcr.pe
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William Aguilar Rivera, Dr.
Organizational Affiliation
Hospital Nacional Hipolito Unanue
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Beatrice Macciotta Felices, Dr.
Organizational Affiliation
Clinica Vesalio
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Nacional Hipolito Unanue
City
Lima
ZIP/Postal Code
15007
Country
Peru
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Martha Celis Llerena, Bach.
Phone
(+51) 997077107
Email
marjecelle@yahoo.com
First Name & Middle Initial & Last Name & Degree
Elizabeth Valdivia Márquez, Dr.
Phone
(+51) 979181614
Email
evaldiviamarquez@gmail.com
First Name & Middle Initial & Last Name & Degree
William Aguilar Rivera, Dr.
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
After the completion of the study, the researchers will decide if IPDs can be shared. The data will first be sent to the regulatory institutions involved.
Citations:
PubMed Identifier
30346890
Citation
Cassano P, Petrie SR, Mischoulon D, Cusin C, Katnani H, Yeung A, De Taboada L, Archibald A, Bui E, Baer L, Chang T, Chen J, Pedrelli P, Fisher L, Farabaugh A, Hamblin MR, Alpert JE, Fava M, Iosifescu DV. Transcranial Photobiomodulation for the Treatment of Major Depressive Disorder. The ELATED-2 Pilot Trial. Photomed Laser Surg. 2018 Dec;36(12):634-646. doi: 10.1089/pho.2018.4490. Epub 2018 Oct 20.
Results Reference
background
PubMed Identifier
26356811
Citation
Cassano P, Cusin C, Mischoulon D, Hamblin MR, De Taboada L, Pisoni A, Chang T, Yeung A, Ionescu DF, Petrie SR, Nierenberg AA, Fava M, Iosifescu DV. Near-Infrared Transcranial Radiation for Major Depressive Disorder: Proof of Concept Study. Psychiatry J. 2015;2015:352979. doi: 10.1155/2015/352979. Epub 2015 Aug 19.
Results Reference
background
PubMed Identifier
30248638
Citation
Caldieraro MA, Cassano P. Transcranial and systemic photobiomodulation for major depressive disorder: A systematic review of efficacy, tolerability and biological mechanisms. J Affect Disord. 2019 Jan 15;243:262-273. doi: 10.1016/j.jad.2018.09.048. Epub 2018 Sep 17.
Results Reference
background
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Near-infrared Transcranial Laser Therapy in Subjects With Major Depressive Disorder: A Study of Dosing With Laser
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