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Anxiety SymptomsPhase 4NCT04825171

Perceived Changes in Anxiety Symptom Burden During Treatment With Bryophyllum Pinnatum and Tolerability

A Phase 4 study testing Bryophyllum 50 % Chewing Tablets in people with Anxiety Symptoms, run by Markus Schlemmer at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Bryophyllum pinnatum (BP) is a succulent perennial plant from the family Crassulacea (for reviews see Fürer 2016 and Hamburger 2017). Leaf extracts from BP have been used in traditional medicine to treat wounds and ulcers, skin diseases, infections, inflammations, pain, diabetes, hypertension, and cancer. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Anxiety Symptoms
What is being tested?
Bryophyllum 50 % Chewing Tablets
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
51 participants
Where
1 siteSwitzerland
Study dates
31 Aug 2021to 31 Dec 2023
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients referred by their treating physician to the Department of Psychiatry and Psychosomatic of the Clinic Arlesheim waiting for the in-stay
  • Expected waiting time until in-stay is at least two weeks
  • Patients having anxiety symptoms as measured by the GAD-2 questionnaire (cut-off of 3 points)
  • Patients'state of health allows them to complete the questionnaire on their own
  • Signed informed consent
  • No treatment with BP during the last two months
Show all 9Show fewer
  • No planned doses increase of (conventional) anxiolytics or antidepressants for the duration of the period until in-stay
  • Age over 18 years
  • Good German knowledge (at least level B2 from Common European Framework of Reference for Languages)

Who cannot join

  • Wheat allergies
  • Acute life-threatening conditions
  • Withdrawal of informed consent

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • Klinik Arlesheim

    Arlesheim, Basel-Landschaft, 4144

Other trials in Switzerland

About this study

Official title: Perceived Changes in Anxiety Symptom Burden During Treatment With Bryophyllum Pinnatum and Tolerability: a Prospective, Single-Group Pre-post Observational Study as Investigator-Initiated Trial (IIT)

Bryophyllum pinnatum (BP) is a succulent perennial plant from the family Crassulacea (for reviews see Fürer 2016 and Hamburger 2017). Leaf extracts from BP have been used in traditional medicine to treat wounds and ulcers, skin diseases, infections, inflammations, pain, diabetes, hypertension, and cancer. In Europe, BP started to be used at the beginning of the 20th century in Anthroposophic medicine, a form of holistic medicine with an integrative approach. Almost a hundred years later, BP preparations are still often prescribed in Anthroposophic medicine, where it is used in the treatment of a broad spectrum of diagnoses, most often of mental and behavioural disorders (ICD-10 F00-F99), including anxiety, depressive, and sleep disorders (Simões-Wüst 2012).

In Switzerland, during the last decade, BP (50 % tablets) started to be used in conventional settings mainly in the treatment of preterm labour (Simões-Wüst 2018, Plangger 2006), overactive bladder (Betschart 2013), sleep disorders (Simões-Wüst 2015), and restless legs syndrome (Von Manitius 2019).

Read more

Whereas the good effectiveness of BP preparations in the treatment of preterm contractions and overactive bladder is well supported by data obtained using a variety of in vitro models (see e.g. Santos 2018, Bachmann 2017, Simões-Wüst 2010), less is known about possible mechanisms of action that would support their use in the treatment of mental and behavioural disorders.

Nevertheless, the observed improvements of sleep disorders are corroborated by animal experiments showing that different fractions of the leaf extract of BP can prolong the pentobarbitone-induced sleeping time (Yemitan 2005 and Pal 1999), indicating a CNS depressant action. Some of the bufadienolides present in Bryophyllum species are thought to be responsible for the sedative effects (Wagner 1986).

The aim of the present study is to find out if patients suffering from anxiety symptoms perceive improvements of these symptoms during treatment with Bryophyllum 50% tablets. Since anxiety symptoms are often related to depression, reduced sleep quality, stress, reduced health-related quality of life and the feeling of not being able to control owns life (internal coherence), these aspects will be assessed as well.

Read the detailed description

The present IIT (Investigator-Initiated Trial) study is a prospective, single-group, pre-post study (phase IV).

A past study showed that among Anthroposophical physicians the most frequent diagnosis group where BP preparations are prescribed are mental and behavioural disorders such as anxiety and sleep disorders. In the present study, we, therefore, want to investigate the effectiveness of Bryophyllum tablets in patients with anxiety symptoms.

Study participants will be recruited among the patients on the waiting list of the Department of Psychiatry and Psychosomatics at the Clinic Arlesheim.

  • Participant recruitment will continue until 60 patients have concluded the study.
  • Recruitment period will probably last 15 months.
  • Duration of the drug administration is 3 weeks.

Participants will fill in a questionnaire three times. At baseline, after two and after three weeks of Bryophyllum intake.

Being tested
Bryophyllum 50 % Chewing Tablets
Keywords
Anxiety, Depression, Stress, Sleep Quality, Internal Coherence
Medical subject headings
Anxiety Disorders, Depression, Sleep Initiation and Maintenance Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bryophyllum 50 % Chewing TabletsDrug

    Also called Bryophyllum pinnatum/Kalanchoe, Bryophyllum pinnatum (Lam.) Oken.

    Each 350 mg tablet corresponds to 170 mg of leave press juice from Bryophyllum pinnatum, dried down to 17 mg by mixing with lactose; 100 mg dried BP matter in 1 g.

Study groups in NCT04825171
Study groupRoleWhat they receive
Bryophyllum pinnatum 50% chewing tabletsExperimentalBryophyllum is administered for 3 weeks. Bryophyllum is given in form of chewing tablets, 350mg per tablet, 0-2-2-2/d: 2 tablets at midday, 2 tablets in the evening, 2 tablets before bedtime.
Receives: Drug: Bryophyllum 50 % Chewing Tablets

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change of anxiety symptoms

    Assessed with the Beck Anxiety Inventory (BAI, Beckler 2010) score between before treatment and after 2 weeks of treatment. BAI is a 21-question multiple-choice self-report inventory that is used for measuring the severity of anxiety in children and adults. The questions ask about common symptoms of anxiety that the subject has had during the past week (including the day you take it) (such as numbness and tingling, sweating not due to heat, and fear of the worst happening). Each answer to a BAI-question is scored on a scale value of 0 (not at all) to 3 (severely). Higher total scores indicate more severe anxiety symptoms. The standardized cut-offs are: 0-7, minimal anxiety; 8-15, mild anxiety; 16-25, moderate anxiety; 26-63, severe anxiety.

    Measured: 2 weeks

Secondary outcomes (8)
  1. Change of anxiety symptoms

    Assessed with the Beck Anxiety Inventory (BAI) score between before treatment and after 3 weeks of treatment.

    Measured: 3 weeks

  2. Change of anxiety symptoms

    Assessed with the Generalized Anxiety Disorder (GAD-7, Williams 2014) questionnaire. GAD-7 is used to measure symptoms and severity of anxiety; scores range from 0 to 21, with higher scores indicating more severe symptoms. Total scores classify symptoms as normal (0-4), mild (5-9), moderate (10-14), and severe (15-21). A total score≥8 is indicative of clinically significant anxiety symptoms.

    Measured: 2 and 3 weeks

  3. Change of depression symptoms

    Assessed with the nine-question depression scale (PHQ-9, Spitzer 1999). PHQ-9 is used to assess the presence and severity of depressive symptoms; scores range from 0 to 27, with higher scores indicating more severe symptoms. Total scores classify depression symptoms as normal (0-4), mild (5-9), moderate (10-14), moderate-severe (15-19) and severe (20-27). A total score ≥10 is indicative of clinically significant symptoms of depression and of a DSM-IV diagnosis of depression.

    Measured: 2 and 3 weeks

  4. Change of stress symptoms

    Assessed with the Perceived Stress Scale (PSS, Klein 2016). Individual scores on the PSS can 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 14-26 would be considered moderate stress. Scores ranging from 27-40 would be considered high perceived stress.

    Measured: 2 and 3 weeks

  5. Change in sleep quality

    Assessed with the Pittsburgh Sleep Quality Index (PSQI, Buysse 1989). The PSQI contains 19 self-rated questions and are combined to form seven "component" scores, each of which has a range of 0-3 points. In all cases, a score o "0" indicates no difficulty, while a score of "3" indicates severe difficulty. The seven component scores are then added to yield one "global" score, with a range of 0-21 points, "0" indicating no difficulty and "21" indicating severe difficulties in all areas.

    Measured: 2 and 3 weeks

  6. Change in health-related quality of life questionnaire

    Assessed with the Health-related Quality of Life questionnaire (SF-12, Morfeld 2011). The 12 items allow the calculation of two health summary measures, namely physical health summary and mental health summary scales. The scores range from 0 to 60 with higher scores indicating higher degree of difficulty in life.

    Measured: 2 and 3 weeks

  7. Change in the Sense of Coherence

    Assessed with the Internal Coherence Scale (ICS, Kröz 2009). The scores range from 1-50 with higher scores indicating higher degree of internal coherence.

    Measured: 2 and 3 weeks

  8. Brophyllum Prescription report

    It is examined whether and which participants asked for a Bryophyllum 50 % prescription after the study.

    Measured: 3 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Apr 2021
  2. Study start31 Aug 2021
  3. Primary completion31 Dec 2023
  4. Study completion31 Dec 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
51 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04825171
Sponsor's protocol ID
Bryo-KLA-02
Status last verified
Jun 2024
First submitted
15 Mar 2021
Last updated
21 Jun 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All IPD that underlie results in a publication can be shared with other researchers.

Publications

  • Furer K, Simoes-Wust AP, von Mandach U, Hamburger M, Potterat O. Bryophyllum pinnatum and Related Species Used in Anthroposophic Medicine: Constituents, Pharmacological Activities, and Clinical Efficacy. Planta Med. 2016 Jul;82(11-12):930-41. doi: 10.1055/s-0042-106727. Epub 2016 May 24.

    PubMed 27220081
  • M. Hamburger, O. Potterat, K. Fürer, A. P. Simões-Wüst, and U. Von Mandach, "Bryophyllum pinnatum - Reverse engineering of an anthroposophic herbal medicine," in Natural Product Communications, 2017, vol. 12, no. 8, pp. 1359-1364.

  • Simoes-Wust AP, Lapaire O, Hosli I, Wachter R, Furer K, Schnelle M, Mennet-von Eiff M, Seifert B, von Mandach U. Two Randomised Clinical Trials on the Use of Bryophyllum pinnatum in Preterm Labour: Results after Early Discontinuation. Complement Med Res. 2018;25(4):269-273. doi: 10.1159/000487431. Epub 2018 Jun 22. No abstract available.

    PubMed 29945146
  • Betschart C, von Mandach U, Seifert B, Scheiner D, Perucchini D, Fink D, Geissbuhler V. Randomized, double-blind placebo-controlled trial with Bryophyllum pinnatum versus placebo for the treatment of overactive bladder in postmenopausal women. Phytomedicine. 2013 Feb 15;20(3-4):351-8. doi: 10.1016/j.phymed.2012.10.007. Epub 2012 Dec 4.

    PubMed 23218404
  • Schenkel L, Simoes-Wust AP, Hosli I, von Mandach U. Drugs in Pregnancy and Lactation - Medications Used in Swiss Obstetrics. Z Geburtshilfe Neonatol. 2018 Feb 8. doi: 10.1055/s-0043-124975. Online ahead of print.

    PubMed 29421836
  • Furer K, Simoes-Wust AP, Winkler A, Amsler N, Schnelle M, von Mandach U. [The Application of Bryophyllum pinnatum Preparations in Obstetrics and Gynaecology - a Multicenter, Prospective Observational Study]. Forsch Komplementmed. 2015;22(4):231-6. doi: 10.1159/000437154. Epub 2015 Aug 3. German.

    PubMed 26228703
  • Santos S, Haslinger C, Klaic K, Faleschini MT, Mennet M, Potterat O, von Mandach U, Hamburger M, Simoes-Wust AP. A Bufadienolide-Enriched Fraction of Bryophyllum pinnatum Inhibits Human Myometrial Contractility In Vitro. Planta Med. 2019 Mar;85(5):385-393. doi: 10.1055/a-0810-7704. Epub 2018 Dec 18.

    PubMed 30562827
  • Pal S, Sen T, Chaudhuri AK. Neuropsychopharmacological profile of the methanolic fraction of Bryophyllum pinnatum leaf extract. J Pharm Pharmacol. 1999 Mar;51(3):313-8. doi: 10.1211/0022357991772312.

    PubMed 10344633
  • Yemitan OK, Salahdeen HM. Neurosedative and muscle relaxant activities of aqueous extract of Bryophyllum pinnatum. Fitoterapia. 2005 Mar;76(2):187-93. doi: 10.1016/j.fitote.2004.11.009.

    PubMed 15752629
  • H. Wagner, H. Lotter, and M. Fischer, "Die toxischen und sedierend wirkenden Bufadienolide von Kalanchoedaigremontiana HAMETet PERR," Helv. Chim. Acta, vol. 69, no. 2, pp. 359-367, 1986.

  • Furer K, Raith M, Brenneisen R, Mennet M, Simoes-Wust AP, von Mandach U, Hamburger M, Potterat O. Two new flavonol glycosides and a metabolite profile of Bryophyllum pinnatum, a phytotherapeutic used in obstetrics and gynaecology. Planta Med. 2013 Nov;79(16):1565-71. doi: 10.1055/s-0033-1350808. Epub 2013 Sep 26.

    PubMed 24072500
  • Plangger N, Rist L, Zimmermann R, von Mandach U. Intravenous tocolysis with Bryophyllum pinnatum is better tolerated than beta-agonist application. Eur J Obstet Gynecol Reprod Biol. 2006 Feb 1;124(2):168-72. doi: 10.1016/j.ejogrb.2005.05.013. Epub 2005 Jul 26.

    PubMed 16051414
  • Simoes-Wust AP, Jeschke E, Mennet M, Schnelle M, Matthes H, von Mandach U. Prescribing pattern of Bryophyllum preparations among a network of anthroposophic physicians. Forsch Komplementmed. 2012;19(6):293-301. doi: 10.1159/000345841. Epub 2012 Dec 17.

    PubMed 23343584
  • Lambrigger-Steiner C, Simoes-Wust AP, Kuck A, Furer K, Hamburger M, von Mandach U. Sleep quality in pregnancy during treatment with Bryophyllum pinnatum: an observational study. Phytomedicine. 2014 Apr 15;21(5):753-7. doi: 10.1016/j.phymed.2013.11.003. Epub 2013 Dec 25.

    PubMed 24373544
  • Simoes-Wust AP, Hassani TA, Muller-Hubenthal B, Pittl S, Kuck A, Meden H, Eberhard J, Decker M, Furer K, von Mandach U; Bryophyllum Collaborative Group. Sleep Quality Improves During Treatment With Bryophyllum pinnatum: An Observational Study on Cancer Patients. Integr Cancer Ther. 2015 Sep;14(5):452-9. doi: 10.1177/1534735415580680. Epub 2015 Apr 14.

    PubMed 25873294

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Bryophyllum 50 % Chewing Tablets in people with Anxiety Symptoms, run by Markus Schlemmer at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 21 Jun 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change of anxiety symptoms (time frame: 2 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04825171, which also lists 22 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Jun 2024.

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