Conditioning, the Placebo Effect, and Psoriasis

NCT ID: NCT00005922

Last Updated: 2013-09-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

138 participants

Study Classification

INTERVENTIONAL

Study Start Date

2000-08-31

Study Completion Date

2006-07-31

Brief Summary

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This study uses the psychological principle known as classical conditioning to try to improve the standard treatment of psoriasis. Classical conditioning is a process of behavioral modification in which a person learns to connect a certain response-in this case, improvement of psoriasis-with a new action, or stimulus-in this case, application of an inactive cream. The goal of this study is to show that people with psoriasis who are maintained on corticosteroid cream part of the time and an inactive (placebo) cream at other times show a lower incidence of relapse and a reduced severity of psoriasis that patients treated with that same (reduced) amount of medication administered all the time.

Detailed Description

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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.

Conditions

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Psoriasis

Keywords

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Conditioning Corticosteroid Lesions Pharmacotherapy Placebo effect Psoriasis Psychoneuroimmunology

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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A

Participants will receive 100% of the dose of the medication on the same reinforcement schedule (100%) as received during the baseline (maintenance) period.

Group Type EXPERIMENTAL

Standard pharmacotherapeutic protocol

Intervention Type OTHER

Full dose of Aristicort A (0.1%) 2 times per day for a period of up to 14 weeks.

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

Group Type EXPERIMENTAL

Partial schedule of pharmacotherapeutic reinforcement

Intervention Type BEHAVIORAL

Dose of 0.1% of Aristocort A on 1-2 of every 4 days for a period of up to 14 weeks.

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.

Group Type EXPERIMENTAL

Dose control for Arm B

Intervention Type DRUG

Dose of 0.025-0.05% of Aristocort A 2 times per day for a period of up to 14 weeks.

Interventions

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Partial schedule of pharmacotherapeutic reinforcement

Dose of 0.1% of Aristocort A on 1-2 of every 4 days for a period of up to 14 weeks.

Intervention Type BEHAVIORAL

Dose control for Arm B

Dose of 0.025-0.05% of Aristocort A 2 times per day for a period of up to 14 weeks.

Intervention Type DRUG

Standard pharmacotherapeutic protocol

Full dose of Aristicort A (0.1%) 2 times per day for a period of up to 14 weeks.

Intervention Type OTHER

Other Intervention Names

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Aristocort A Aristocort A Aristicort A

Eligibility Criteria

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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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

NIH

Sponsor Role collaborator

University of Rochester

OTHER

Sponsor Role lead

Responsible Party

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University of Rochester School of Medicine and Dentistry

Principal Investigators

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Robert Ader, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Locations

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Stanford University

Palo Alto, California, United States

Site Status

Adult Dermatology Clinic, Strong Memorial Hospital

Rochester, New York, United States

Site Status

Countries

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United States

References

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Ader R, Cohen N. Behaviorally conditioned immunosuppression. Psychosom Med. 1975 Jul-Aug;37(4):333-40. doi: 10.1097/00006842-197507000-00007.

Reference Type BACKGROUND
PMID: 1162023 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 7815892 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 9081556 (View on PubMed)

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.

Reference Type BACKGROUND

Other Identifiers

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R01AR046825

Identifier Type: NIH

Identifier Source: secondary_id

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NIAMS-051

Identifier Type: -

Identifier Source: secondary_id

R01AR046825

Identifier Type: NIH

Identifier Source: org_study_id

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