METHOD AND APPARATUS FOR IDENTIFYING A SAFE AND EFFICACIOUS DOSING REGIMEN

• US 20110208437A1
• Filed: 07/31/2009
• Published: 08/25/2011
• Est. Priority Date: 08/01/2008
• Status: Abandoned Application

• Current Assignee: Mclean Hospital (Mass General Brigham, Inc.)
• Original Assignee: Mclean Hospital (Mass General Brigham, Inc.)
• Inventors: Teicher, Martin
• Application Number:
  US13/056,782
• Publication Number:
  US 20110208437A1
• Time in Patent Office: Days
• US Class Current: 702/19
• CPC Class Codes: A61B 2503/06 Children, e.g. for attention deficit diagnosis
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15

Abstract

The invention features methods and systems to provide, in one test session, information on the patient'"'"'s sensitivity to a probe drug for treating attentional disorders. The methods and systems of the invention can enable clinicians and consumers to ascertain how much benefit an individual would derive from treatment, what dose would be required, and the acute effect of that dose on regularity and rhythmicity of their heartbeat.

Claims

1. A method for measuring the responsiveness of a subject to a probe drug for the treatment of an attentional disorder in said subject, said method comprising:

(a) testing said subject while unmedicated to produce baseline data for test MT₀;

(b) following step (a), administering a first dose of probe drug to said subject;

(c) within two hours of performing step (b), testing said subject to produce medicated data for test MT₁;

(d) following step (c), administering a second dose of probe drug to said subject;

(e) within two hours of performing step (d), testing said subject to produce medicated data for test MT₂; and

(f) analyzing said data, wherein the analysis comprises scoring said baseline data and said medicated data to produce scored data; and

on the basis of said scored data determining whether the symptoms of said attentional disorder are ameliorated by said probe drug,

wherein steps (a) through (e) are performed over a period of less than eight hours.

4. The method of claim 1, wherein

i. step (c) is performed within 1 hour of performing step (b);

ii. step (e) is performed within 1 hour of performing step (d); and

iii. steps (a) through (e) are performed over a period of less than six hours.

5. The method of claim 1, wherein step (e) is performed twice within two hours of performing step (d) to produce medicated data for tests MT_2A and MT_2B.

6. The method of claim 1, further comprising the steps of

(d2) following step (e), administering a third dose of probe drug to said subject;

and

(e2) within two hours of completing step (d2), testing said subject to produce medicated data for test MT₃.

7. The method of claim 6, wherein

iv. step (c) is performed within 1 hour of performing step (b);

v. step (e) is performed within 1 hour of performing step (d);

vi. testing the subject within 1 hour of administering said third dose; and

vii. steps (a) through (e2) are performed over a period of less than six hours.

8. The method of claim 6, wherein step (e2) is performed twice within two hours of performing step (d2) to produce medicated data for tests MT_3A and MT_3B.

9. The method of claim 6, further comprising the steps of:

(e3) following step (e2), administering a fourth dose of probe drug to said subject; and

(d3) within one hour of completing step (e3), testing said subject to produce a medicated data for test MT₄;

wherein steps (a) through (d3) are performed over a period of less than eight hours.

10. The method of claim 9, wherein step (d3) is performed twice within two hours of performing step (e3) to produce medicated data for tests MT_4A and MT_4B.

11. The method of claim 1, wherein said probe drug is a stimulant.

12. The method of claim 11, wherein said probe drug is methylphenidate.

13. The method of claim 12, wherein said subject is an adult, said first dose comprises from 5 to 15 mg of methylphenidate, said second dose comprises from 7.5 to 12.5 mg of methylphenidate, and said third dose comprises from 2.5 to 12.5 mg of methylphenidate.

14. The method of claim 13, wherein said first dose comprises 7.5 mg of methylphenidate, said second dose comprises 10 mg of methylphenidate, and said third dose comprises 5 mg of methylphenidate.

15. The method of claim 12, said subject is a child, said first dose comprises from 2.5 to 12.5 mg of methylphenidate, said second dose comprises from 5 to 7.5 mg of methylphenidate, and said third dose comprises from 1.5 to 7.5 mg of methylphenidate.

16. The method of claim 11, wherein said probe drug is an amphetamine.

17. The method of claim 16, wherein said subject is an adult, said first dose comprises from 2.5 to 7.5 mg of dextroamphetamine, said second dose comprises from 3.75 to 6.25 mg of dextroamphetamine, and said third dose comprises from 3.75 to 6.25 mg of dextroamphetamine.

18. The method of claim 16, wherein said subject is a child, said first dose comprises from 1.25 to 6.25 mg of dextroamphetamine, said second dose comprises from 2.5 to 3.75 mg of dextroamphetamine, and said third dose comprises from 0.75 to 3.75 mg of dextroamphetamine.

19. The method of claim 1, wherein said probe

20. The method of claim 18, wherein said probe drug is a tricyclic antidepressant, atomoxetine, bupropion, modafinil, guanfacine, or clonidine.

21. The method of claim 1, wherein said analysis further comprises identifying said subject as a non-responder or a responder.

22. The method of claim 1, wherein said analysis further comprises calculating a predicted response profile for a dosing regimen of said probe drug in said subject.

23. The method of claim 22, wherein said analysis further comprises the step of calculating the predicted degree of improvement in a symptom of said attentional disorder for said subject when receiving said dosing regimen in comparison to said subject when unmedicated.

24. The method of claim 22, wherein said analysis further comprises the step of determining the relative degree of efficacy for two or more dosing regimens of said probe drug in said subject.

25. The method of claim 1, wherein said analysis further comprises:

(i) analyzing the heart rate of said subject to determine whether said probe drug places the subject at an increased risk of an adverse cardiovascular event, or

(ii) analyzing solicited responses from the subject to determine whether said probe drug places the subject at an increased risk of nervousness, agitation, or loss of appetite.

26. The method of claim 25, wherein said analysis further comprises estimating the severity of the side effects for said subject on a particular dosing regimen of said probe drug. estimating the severity of the side effects for said subject on a particular dosing regimen of said probe drug.

27. The method of claim 1, wherein said attentional disorder is ADD, ADHD, or Hyperkinetic Disorder.

28. The method of claim 1, wherein said testing comprises measuring the activity of said subject using an infrared motion analysis system by tracking the movements of said subject'"'"'s head, leg, or foot using a camera.

29. The method of claim 1, wherein said testing comprises collecting data from an attentional test.

30. The method of claim 29, wherein said analysis comprises assessing the fluctuation in attentional states of said subject.

45. The method of claim 1

wherein the analysis comprises scoring said baseline data and said medicated data to produce scored data;

and on the basis of said scored data, the amount of probe drug administered, the timing of said administering, the timing of said testing, and a population-based PK model for said probe drug, calculating a predicted response profile for said probe drug in said subject.

56. The method of claim 1, wherein said scored data comprises a metric extracted from an attentional test and selected from accuracy, errors of omission, errors of commission, latency, standard deviation of latency, coefficient of variation of latency, number of attention shifts, percent time spent impulsive state, percent time spent in distracted state, percent time spent in random state, percent time spent in minimal response state, percent time spent in contrary response state, percent time spent in attentive state, accuracy-adjusted latency, and composites thereof.

57. The method of claim 1, wherein said scored data comprises a metric extracted from a motor activity test and selected from immobility time of head, area of head movements, temporal scaling exponent, displacement, spatial scaling exponent, number of microevents, area of right and left shin movements, rl_mic, rl_disp, and composites thereof.

2. A method for measuring the responsiveness of a subject to a probe drug for the treatment of an attentional disorder in said subject, said method comprising:

(a) testing said subject while unmedicated to produce baseline data for test MT₀;

(b) following step (a), administering a first dose of probe drug to said subject;

(c) within two hours of performing step (b), testing said subject to produce medicated data for test MT₁;

(d) following step (c), administering a second dose of probe drug to said subject;

(e) within two hours of performing step (d), testing said subject to produce medicated data for test MT₂; and

(f) transmitting said data to a computer for analysis, wherein said analysis comprises scoring said baseline data and said medicated data to produce scored data; and

on the basis of said scored data determining whether the symptoms of said attentional disorder are ameliorated by said probe drug,

wherein steps (a) through (e) are performed over a period of less than eight hours.

3. A method for measuring the responsiveness of a subject to a probe drug for the treatment of an attentional disorder in said subject, said method comprising:

(i) providing data having been collected by the steps of;

(a) testing said subject while unmedicated to produce baseline data for test MT₀;

(b) following step (a), administering a first dose of probe drug to said subject;

(c) within two hours of performing step (b), testing said subject to produce medicated data for test MT₁;

(d) following step (c), administering a second dose of probe drug to said subject; and

(e) within two hours of performing step (d), testing said subject to produce medicated data for test MT₂,

wherein steps (a) through (e) are performed over a period of less than eight hours; and

(ii) performing an analysis, said analysis comprising scoring said baseline data and said medicated data to produce scored data, and on the basis of said scored data determining whether the symptoms of said attentional disorder are ameliorated by said probe drug.

31. A system for measuring the responsiveness of a subject to a probe drug for the treatment of an attentional disorder, said system comprising:

(i) a user interface for communicating the amounts of probe drug administered to said subject;

the timing of the doses; and

the timing of motor activity tests;

(ii) a camera for tracking the movements of said subject'"'"'s head, leg, or foot to produce motor activity data; and

(iii) an output component and program configured to transmit information to a computer for analysis, said information comprising the amounts of probe drug administered to said subject;

the timing of the doses;

the timing of the motor activity tests; and

the motor activity data.

32. A system for measuring the responsiveness of a subject to a probe drug for the treatment of an attentional disorder, said system comprising:

a monitor for generating visual images or a speaker for generating sounds;

(ii) a device that is controllable by a subject; and

(iii) a program for storing or transmitting information about the instances of device activation by said subject in response to said images or said sounds to a computer for analysis, said information comprising attention data and the timing of the collection of the attention data.

33. A system for measuring the responsiveness of a subject to a probe drug for the treatment of an attentional disorder, said system comprising:

an input component configured to receive information comprising the amounts of probe drug administered to said subject;

the timing of the doses;

the timing of subject testing; and

test data; and

(ii) a processor provided with a computer program for (a) scoring said motor activity data to produce scored data, and (b) on the basis of said scored data, determining whether said subject is responsive to said probe drug.

34-44. -44. (canceled)

46-55. -55. (canceled)

58-59. -59. (canceled)