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Minds and Mentors Program (MiMP)- R61

A Mindfulness and Peer Mentoring Program to Improve Adherence to Medication Assisted Treatment for Opioid Use Disorders- R61

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04233671
Acronym
MiMP
Enrollment
21
Registered
2020-01-18
Start date
2020-01-28
Completion date
2021-08-31
Last updated
2023-07-21

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Medication Assisted Treatment, Opioid-use Disorder, Substance Use Disorders

Keywords

Opioid Use Disorder, Mindfulness based therapy, cravings, relapse prevention, treatment retention, depression, stress, anxiety, cortisol, peer mentors

Brief summary

The proposed research effort will: The purpose of this study is as follows: 1. Test the feasibility and acceptability of a twelve- week mindfulness based relapse prevention protocol in combination with peer mentoring in individuals with opioid use disorder who are on medication assisted treatment. 2. Determine whether participation in a combination of mindfulness based relapse prevention and peer mentoring in comparison with an attentional control group: a) improves adherence to MAT b) decreases relapse and cravings c) improves psychosocial outcomes such as depression, anxiety, stress and social support

Detailed description

Although medication assisted therapy (MAT) for opioid use disorders (OUD) is safe and effective and is currently considered the gold standard for treating OUD, adherence to MAT regimens remains a challenge. The goal of the proposed study is to determine the effectiveness of a mindfulness-based intervention that also utilizes peer mentors in addition to professional substance abuse therapists (the Minds and Mentors program \[MiMP\]) in improving adherence to MAT for OUD and reducing relapse rates in a sample of individuals with OUD who are also on MAT versus a twelve-step facilitation (TSF) program. The MiMP is a twelve-week intervention that uses group therapy and meets once a week for about two hours for eight weeks with a professional substance abuse therapist; after the completion of eight therapist led sessions, participants will attend four weeks of group therapy sessions conducted by a peer mentor. The peer mentor will also attend the initial eight sessions with the therapist to establish rapport with participants. The control group will attend twelve weeks of a standard twelve-step facilitation program. This study will utilize an individually randomized group treatment design with ten participants in both the intervention and control groups. Data collection will occur at baseline, end of treatment, and at 3, 6, and 12- month follow-up.

Interventions

BEHAVIORALMindfulness based relapse prevention and peer mentoring

Importantly, the treatment will utilize a group format. Group process can serve as a vital agent in breaking down client denial about drug abuse problems. Groups have also been shown to be suitable for treating problems commonly associated with substance abuse, including depression, isolation, and shame. Additionally, groups intrinsically have many rewarding benefits, including reducing isolation and enabling members to witness the recovery of others. The eight-week group therapy intervention is co-led by a licensed counselor and a peer mentor for eight weeks, then followed by group sessions led by peer mentors for an additional four weeks.

Sponsors

University of Alabama at Birmingham
CollaboratorOTHER
Tuscaloosa Veterans Affairs Medical Center
CollaboratorFED
University of Alabama, Tuscaloosa
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)

Intervention model description

Interventional Study Model: Parallel Assignment

Eligibility

Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
Yes

Inclusion criteria

* At least 19 years old. * Opioid Use disorder diagnosis based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) criteria in the past 30 days * Currently receiving MAT for OUD (e.g. methadone, naloxone, naltrexone, and buprenorphine) from an established provider * Are within maintenance phase of MAT (not actively detoxing) * May meet criteria for a mood, anxiety, or other psychiatric disorder based on the DSM-V criteria. Participants on maintenance medications for a mood or anxiety disorder must be stabilized on medications for at least 2 weeks before therapy initiation * Capable of reading and understanding English * Able to provide written informed consent (i.e. no surrogate) * Willing to commit to 8 group therapy sessions, baseline, and follow-up assessments for 12-months after the end of treatment (14- month total)

Exclusion criteria

* Significant cognitive impairment * Women who are pregnant * Actively suicidal or homicidal * Active psychosis and/ or * Unstable medical conditions that contraindicate proposed treatment Subject exit criteria: * Increases in alcohol or drug use leading to the need for a more intensive level of care (i.e., medical detoxification, inpatient) * Newly developed active suicidal or homicidal ideation * Inability to manage psychiatric symptoms within the inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Number of Days Adherence to Medication Assisted TreatmentLast 4 weeks of the intervention periodThe primary outcome variable is adherence to medication-assisted therapy (MAT), quantified as the number of days MAT was received as indicated during the last 4 weeks of the intervention period. We expect that this can be treated as a continuous variable in regression models.

Secondary

MeasureTime frameDescription
Feasibility of Mindfulness Based Relapse Prevention as Measured by Retention Rate12 monthsRetention rate (the number of participants completing T4 divided by the number who were randomized for each treatment arm)
Acceptability and Adherence to Mindfulness Based Relapse Prevention as Measured by the Treatment Acceptability/Adherence (TAAS) Scale3 months - at the end of the 12 week interventionScores on the TAAS are scored on a scale of 1-7. For ease of interpretation by our participants and for data entry purposes, we asked participants to rate the experience on a scale of 1-10. The composite sum score was used for each person. Therefore, scores ranged from 10 to 100. Higher numbers mean more treatment acceptability and adherence
Satisfaction With the Intervention Program3 months - at the end of the 12 week interventionSatisfaction with the intervention program will be assessed with the 8-item Client Satisfaction Questionnaire (CSQ-8). The total score will be computed by adding the 8 items for a composite score. The range for composite scores is from 8-32. Higher numbers mean more satisfied the participant is with the program.
Acceptability of the Intervention Programs3 monthsExit interviews were conducted with all participants to determine whether participants rated the intervention as acceptable. The number who rated each intervention as acceptable is reported.
Relapse Rate (Number of Participants With Relapse) as Determined by Urine Drug ScreenLast four weeks of the 12-week interventionRelapse will be measured during the last 4 weeks of the intervention period as determined by Urine Drug Screen (UDS). Participants were only considered relapsed if they had opiates (outside prescribed MOUD) or any other illicit substance detected in the urine drug screen during the last four weeks of the 12-week intervention.
Relapse Rate (Number of Participants With Relapse) as Measured Via Self-report3 monthsRelapse will be measured via self-report utilizing the Timeline Follow-back (TLFB). The total number of participants who self-reported relapse during the last four weeks of the intervention period per treatment arm.
Social Support as Measured by the Community Assessment Inventory6 monthsSocial Support as measured by the Community Assessment Inventory (CAI) to assess perceived support. The original CAI contains 37 items covering support within four areas i.e., family living with and outside, friends, and communities, with items in each area summed to create the corresponding subscales. Lower scores indicate less support and higher scores indicate greater support. We will only evaluate community support for the current study (containing 13 items). Therefore, scores ranged from 13 to 52.
Depression as Measured by the Patient Health Questionnaire6 monthsDepression as measured by the Patient Health Questionnaire (PHQ-9), a 9-item self-report that measures depressive symptoms. The participant's score may range from 1- 27. The interpretation of the total score is as follows: 1-4, Minimal depression; 5-9, mild depression; 10-14, Moderate depression; 15-19, Moderately severe depression; 20-27, Severe depression. Higher numbers mean more depressive symptoms at 12 weeks post-end of intervention.
Stress as Measured by the Perceived Stress Scale6 monthsStress as measured by the Perceived Stress Scale (PSS), a 10-item self-report of perceived stress. Scores may range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low stress. Scores ranging from 14 to 26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress.
Anxiety as Measured by the Generalized Anxiety Disorder Scale6 monthsAnxiety as measured by the Generalized Anxiety Disorder Scale (GAD-7), a 7-item self-report of anxiety. The score for the seven items ranges from 0 to 21. Scores of 5-9 represent mild anxiety, 10- 14 represent Moderate anxiety, and scores greater than 15 represent severe anxiety. Higher numbers indicate higher anxiety at 12 weeks post-end of intervention.
Feasibility of Mindfulness-based Relapse Prevention as Measured by Randomization Rate12 monthsRandomization rate (the number of participants randomized divided by the number of participants who consented). Participants consented to hear about the study before screening for eligibility was conducted. This was based on how our protocol was written. Therefore, some of the people who consented did not end up meeting the eligibility criteria for the study, and therefore were not considered enrolled in the study. The difference between consented participants and the enrolled participants is due to the screen failures. Participants are also only considered randomized after they complete all baseline data collection, including providing biosamples. We have revised this protocol for the R33 phase to avoid the issue of screen failures after the consent process is completed.
Feasibility of Mindfulness-based Relapse Prevention as Measured by Enrollment Rate12 monthsEnrollment rate (the number of participants who sign the informed consent form divided by the number who are approached). Participants consented to hear about the study before screening for eligibility was conducted. This was based on how our protocol was written. Therefore, some of the people who consented did not end up meeting the eligibility criteria for the study, and therefore were not considered enrolled in the study. The difference between consented participants and the enrolled participants is due to the screen failures. Participants are also only considered randomized after they complete all baseline data collection, including providing biosamples. We have revised this protocol for the R33 phase to avoid the issue of screen failures after the consent process is completed.
Opioid Cravings as Measured by the Opioid Craving Scale6 monthsCravings as measured by the Opioid Craving Scale (OCS), a modification of the Cocaine Craving Scale will be utilized to assess opioid craving. The OCS consists of three items rated on a visual analog scale from 0-10. The total score is calculated by averaging the three items. Higher means scores represent more craving.

Other

MeasureTime frameDescription
Baseline Cortisol Reactivity to Drug Cuesat baseline data collectionNon-invasive salivary cortisol levels were assessed as a measure of stress reactivity to drug cues at baseline. A saliva sample was collected at baseline and again 20 minutes after watching a video depicting drug use. Saliva samples were assayed for cortisol levels. Cortisol reactivity for each participant was calculated using a difference score in which the baseline sample cortisol level was subtracted from the post-video sample cortisol level.

Countries

United States

Participant flow

Pre-assignment details

We consented 43 participants total over the course of the study. However, participants were only considered enrolled in the study once they completed their baseline data collection and were ready to be randomized. Therefore, there were some participants who signed informed consent but did not follow through to complete baseline data collection. We had 21 participants who followed through and completed the baseline data collection. These were considered enrolled in the study.

Participants by arm

ArmCount
Mindfulness Based Relapse Prevention and Peer Mentoring
MiMP is a twelve week program, meeting once per week for 12 weeks for approximately two hours. Eight weeks are facilitated by a licensed counselor, and four weeks are facilitated by a peer mentor. Mindfulness based relapse prevention and peer mentoring: Importantly, the treatment will utilize a group format. Group process can serve as a vital agent in breaking down client denial about drug abuse problems. Groups have also been shown to be suitable for treating problems commonly associated with substance abuse, including depression, isolation, and shame. Additionally, groups intrinsically have many rewarding benefits, including reducing isolation and enabling members to witness the recovery of others. The eight-week group therapy intervention is co-led by a licensed counselor and a peer mentor for eight weeks, then followed by group sessions led by peer mentors for an additional four weeks.
13
12 Step Treatment Program Control
The control group will meet for 12 weeks for standard 12 Step Facilitation meetings.
8
Total21

Baseline characteristics

CharacteristicMindfulness Based Relapse Prevention and Peer MentoringTotal12 Step Treatment Program Control
Age, Continuous45.54 years
STANDARD_DEVIATION 11.93
43.57 years
STANDARD_DEVIATION 12.34
40.38 years
STANDARD_DEVIATION 13.15
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
1 Participants3 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
12 Participants18 Participants6 Participants
Sex: Female, Male
Female
4 Participants8 Participants4 Participants
Sex: Female, Male
Male
9 Participants13 Participants4 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 130 / 8
other
Total, other adverse events
0 / 130 / 8
serious
Total, serious adverse events
0 / 130 / 8

Outcome results

Primary

Number of Days Adherence to Medication Assisted Treatment

The primary outcome variable is adherence to medication-assisted therapy (MAT), quantified as the number of days MAT was received as indicated during the last 4 weeks of the intervention period. We expect that this can be treated as a continuous variable in regression models.

Time frame: Last 4 weeks of the intervention period

Population: comparing means for the number of days participants were adherent to MOUD at week 12 (end of intervention). These data are accurate. All participants in the mindfulness-based relapse prevention and peer mentoring arm reported taking medications for 28 days.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringNumber of Days Adherence to Medication Assisted Treatment28 daysStandard Deviation 0
12 Step Treatment Program ControlNumber of Days Adherence to Medication Assisted Treatment23.25 daysStandard Deviation 9.5
Secondary

Acceptability and Adherence to Mindfulness Based Relapse Prevention as Measured by the Treatment Acceptability/Adherence (TAAS) Scale

Scores on the TAAS are scored on a scale of 1-7. For ease of interpretation by our participants and for data entry purposes, we asked participants to rate the experience on a scale of 1-10. The composite sum score was used for each person. Therefore, scores ranged from 10 to 100. Higher numbers mean more treatment acceptability and adherence

Time frame: 3 months - at the end of the 12 week intervention

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringAcceptability and Adherence to Mindfulness Based Relapse Prevention as Measured by the Treatment Acceptability/Adherence (TAAS) Scale71 score on a scaleStandard Error 5.6
12 Step Treatment Program ControlAcceptability and Adherence to Mindfulness Based Relapse Prevention as Measured by the Treatment Acceptability/Adherence (TAAS) Scale78 score on a scaleStandard Error 9.8
Secondary

Acceptability of the Intervention Programs

Exit interviews were conducted with all participants to determine whether participants rated the intervention as acceptable. The number who rated each intervention as acceptable is reported.

Time frame: 3 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Mindfulness Based Relapse Prevention and Peer MentoringAcceptability of the Intervention Programs8 Participants
12 Step Treatment Program ControlAcceptability of the Intervention Programs4 Participants
Secondary

Anxiety as Measured by the Generalized Anxiety Disorder Scale

Anxiety as measured by the Generalized Anxiety Disorder Scale (GAD-7), a 7-item self-report of anxiety. The score for the seven items ranges from 0 to 21. Scores of 5-9 represent mild anxiety, 10- 14 represent Moderate anxiety, and scores greater than 15 represent severe anxiety. Higher numbers indicate higher anxiety at 12 weeks post-end of intervention.

Time frame: 6 months

Population: data were present for this variable for 10 participants total. 2 participants did not provide data on this outcome variable.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringAnxiety as Measured by the Generalized Anxiety Disorder Scale6.4 score on a scaleStandard Error 1.8
12 Step Treatment Program ControlAnxiety as Measured by the Generalized Anxiety Disorder Scale12.7 score on a scaleStandard Error 5.9
Secondary

Depression as Measured by the Patient Health Questionnaire

Depression as measured by the Patient Health Questionnaire (PHQ-9), a 9-item self-report that measures depressive symptoms. The participant's score may range from 1- 27. The interpretation of the total score is as follows: 1-4, Minimal depression; 5-9, mild depression; 10-14, Moderate depression; 15-19, Moderately severe depression; 20-27, Severe depression. Higher numbers mean more depressive symptoms at 12 weeks post-end of intervention.

Time frame: 6 months

Population: data were present for this variable for 10 participants total. 2 participants did not provide data on this outcome variable.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringDepression as Measured by the Patient Health Questionnaire8.6 score on a scaleStandard Error 2.5
12 Step Treatment Program ControlDepression as Measured by the Patient Health Questionnaire12.7 score on a scaleStandard Error 6.4
Secondary

Feasibility of Mindfulness-based Relapse Prevention as Measured by Enrollment Rate

Enrollment rate (the number of participants who sign the informed consent form divided by the number who are approached). Participants consented to hear about the study before screening for eligibility was conducted. This was based on how our protocol was written. Therefore, some of the people who consented did not end up meeting the eligibility criteria for the study, and therefore were not considered enrolled in the study. The difference between consented participants and the enrolled participants is due to the screen failures. Participants are also only considered randomized after they complete all baseline data collection, including providing biosamples. We have revised this protocol for the R33 phase to avoid the issue of screen failures after the consent process is completed.

Time frame: 12 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Mindfulness Based Relapse Prevention and Peer MentoringFeasibility of Mindfulness-based Relapse Prevention as Measured by Enrollment Rate43 Participants
Secondary

Feasibility of Mindfulness-based Relapse Prevention as Measured by Randomization Rate

Randomization rate (the number of participants randomized divided by the number of participants who consented). Participants consented to hear about the study before screening for eligibility was conducted. This was based on how our protocol was written. Therefore, some of the people who consented did not end up meeting the eligibility criteria for the study, and therefore were not considered enrolled in the study. The difference between consented participants and the enrolled participants is due to the screen failures. Participants are also only considered randomized after they complete all baseline data collection, including providing biosamples. We have revised this protocol for the R33 phase to avoid the issue of screen failures after the consent process is completed.

Time frame: 12 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Mindfulness Based Relapse Prevention and Peer MentoringFeasibility of Mindfulness-based Relapse Prevention as Measured by Randomization Rate21 Participants
Secondary

Feasibility of Mindfulness Based Relapse Prevention as Measured by Retention Rate

Retention rate (the number of participants completing T4 divided by the number who were randomized for each treatment arm)

Time frame: 12 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Mindfulness Based Relapse Prevention and Peer MentoringFeasibility of Mindfulness Based Relapse Prevention as Measured by Retention Rate8 Participants
12 Step Treatment Program ControlFeasibility of Mindfulness Based Relapse Prevention as Measured by Retention Rate4 Participants
Secondary

Opioid Cravings as Measured by the Opioid Craving Scale

Cravings as measured by the Opioid Craving Scale (OCS), a modification of the Cocaine Craving Scale will be utilized to assess opioid craving. The OCS consists of three items rated on a visual analog scale from 0-10. The total score is calculated by averaging the three items. Higher means scores represent more craving.

Time frame: 6 months

Population: data were present for this variable for 10 participants total. 2 participants did not provide data on this outcome variable.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringOpioid Cravings as Measured by the Opioid Craving Scale2.2 score on a scaleStandard Error 0.9
12 Step Treatment Program ControlOpioid Cravings as Measured by the Opioid Craving Scale3.9 score on a scaleStandard Error 2.4
Secondary

Relapse Rate (Number of Participants With Relapse) as Determined by Urine Drug Screen

Relapse will be measured during the last 4 weeks of the intervention period as determined by Urine Drug Screen (UDS). Participants were only considered relapsed if they had opiates (outside prescribed MOUD) or any other illicit substance detected in the urine drug screen during the last four weeks of the 12-week intervention.

Time frame: Last four weeks of the 12-week intervention

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Mindfulness Based Relapse Prevention and Peer MentoringRelapse Rate (Number of Participants With Relapse) as Determined by Urine Drug Screen3 Participants
12 Step Treatment Program ControlRelapse Rate (Number of Participants With Relapse) as Determined by Urine Drug Screen2 Participants
Secondary

Relapse Rate (Number of Participants With Relapse) as Measured Via Self-report

Relapse will be measured via self-report utilizing the Timeline Follow-back (TLFB). The total number of participants who self-reported relapse during the last four weeks of the intervention period per treatment arm.

Time frame: 3 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Mindfulness Based Relapse Prevention and Peer MentoringRelapse Rate (Number of Participants With Relapse) as Measured Via Self-report3 Participants
12 Step Treatment Program ControlRelapse Rate (Number of Participants With Relapse) as Measured Via Self-report2 Participants
Secondary

Satisfaction With the Intervention Program

Satisfaction with the intervention program will be assessed with the 8-item Client Satisfaction Questionnaire (CSQ-8). The total score will be computed by adding the 8 items for a composite score. The range for composite scores is from 8-32. Higher numbers mean more satisfied the participant is with the program.

Time frame: 3 months - at the end of the 12 week intervention

Population: data were present for this variable for 11 participants total. 1 participants did not provide data on this outcome variable.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringSatisfaction With the Intervention Program28.9 score on a scaleStandard Error 1.1
12 Step Treatment Program ControlSatisfaction With the Intervention Program30.8 score on a scaleStandard Error 7.4
Secondary

Social Support as Measured by the Community Assessment Inventory

Social Support as measured by the Community Assessment Inventory (CAI) to assess perceived support. The original CAI contains 37 items covering support within four areas i.e., family living with and outside, friends, and communities, with items in each area summed to create the corresponding subscales. Lower scores indicate less support and higher scores indicate greater support. We will only evaluate community support for the current study (containing 13 items). Therefore, scores ranged from 13 to 52.

Time frame: 6 months

Population: data were present for this variable for 10 participants total. 2 participants did not provide data on this outcome variable.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringSocial Support as Measured by the Community Assessment Inventory35.7 score on a scaleStandard Error 1.5
12 Step Treatment Program ControlSocial Support as Measured by the Community Assessment Inventory27.0 score on a scaleStandard Error 4.9
Secondary

Stress as Measured by the Perceived Stress Scale

Stress as measured by the Perceived Stress Scale (PSS), a 10-item self-report of perceived stress. Scores may range from 0 to 40 with higher scores indicating higher perceived stress. Scores ranging from 0-13 would be considered low stress. Scores ranging from 14 to 26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress.

Time frame: 6 months

Population: data were present for this variable for 10 participants total. 2 participants did not provide data on this outcome variable.

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringStress as Measured by the Perceived Stress Scale20.6 score on a scaleStandard Error 1.5
12 Step Treatment Program ControlStress as Measured by the Perceived Stress Scale25.7 score on a scaleStandard Error 3.8
Other Pre-specified

Baseline Cortisol Reactivity to Drug Cues

Non-invasive salivary cortisol levels were assessed as a measure of stress reactivity to drug cues at baseline. A saliva sample was collected at baseline and again 20 minutes after watching a video depicting drug use. Saliva samples were assayed for cortisol levels. Cortisol reactivity for each participant was calculated using a difference score in which the baseline sample cortisol level was subtracted from the post-video sample cortisol level.

Time frame: at baseline data collection

ArmMeasureValue (MEAN)Dispersion
Mindfulness Based Relapse Prevention and Peer MentoringBaseline Cortisol Reactivity to Drug Cues-.0837 microgram/dLStandard Deviation 0.132
12 Step Treatment Program ControlBaseline Cortisol Reactivity to Drug Cues-.0045 microgram/dLStandard Deviation 0.063

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026