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A Study Using Functional Magnetic Resonance Imaging (fMRI) to Assess the Effects of Naltrexone SR/ Bupropion SR Therapy in Overweight or Obese Subjects

Primary Purpose

Obesity

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Naltrexone SR 32 mg/bupropion SR 360 mg/day
Placebo
fMRI scan
Sponsored by
Orexigen Therapeutics, Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Obesity focused on measuring obesity, overweight, magnetic resonance imaging, naltrexone, bupropion

Eligibility Criteria

18 Years - 45 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Right-handed, female subjects, 18 to 45 years of age
  • Body mass index (BMI) ≥ 27 and ≤ 40 kg/m²
  • Free from clinically significant illness or disease as determined by medical history and physical examination
  • Able to provide proof of identity during the enrollment process
  • In good general health, without clinically significant medical history, physical examination findings or laboratory results
  • Laboratory values obtained within 30 days of study entry within normal range for healthy volunteers.
  • Normal urinalysis on initial screening day defined as: negative glucose, negative or trace protein, and negative or trace hemoglobin
  • Normotensive (systolic ≤140 mm Hg, diastolic ≤90 mm hg)
  • On no concomitant medications with the exception of oral contraceptives, vitamins, and over the counter pain, indigestion or allergy medication
  • All women of child bearing potential must be non-lactating, must have a negative STAT pregnancy test, and agree to use effective contraception methods throughout study period and for 30 days after discontinuation of study drug. The following are considered effective methods of contraception: Combination or progestin-only birth control pills (oral contraceptives), vaginal contraceptive rings, contraceptive patches, Depo Provera, intrauterine devices, barrier methods with spermicide (condom/foam, diaphragm/ spermicide), abstinence. (Subjects who have had a tubal ligation, hysterectomy or are post-menopausal for 2 years are considered NOT to be of child bearing potential)
  • For women not using hormonal methods of contraception, should be in the follicular phase of the menstrual cycle at the baseline visit.
  • Non-smoker and no use of tobacco or nicotine products for at least 6 months prior to baseline. On screening and study days, we will test the subjects' urine for presence of nicotinine/cotinine (STAT) test as confirmatory evidence of being a non-smoker in addition to their self-report. A Tobacco Questionnaire and Breath CO will also be administered for eligibility on the day of screening for confirmation purposes.
  • No clinically significant abnormality on ECG, baseline QTc <470
  • Able to comply with all required study procedures
  • Available for follow up for the duration of the study
  • Willing and able to give written informed consent

Exclusion Criteria:

  • Obesity of known endocrine or genetic origin (e.g., untreated hypothyroidism, Cushing's syndrome, Prader Willi Syndrome, established Polycystic Ovary Syndrome)
  • Inability to participate in fMRI scanning sessions
  • History of occupational exposure to metal flakes in their bodies or eyes.
  • History of known indwelling ferromagnetic metals or fragments.
  • History of acute or chronic illness that requires medical therapy including active gastrointestinal conditions that might interfere with drug absorption
  • History or presence of hepatic, renal, cardiovascular or gastrointestinal diseases
  • Type I or Type II diabetes mellitus requiring pharmacotherapy
  • Active malignancy or history of malignancy (other than non-melanoma skin cancer or surgically cured cervical cancer) within 5 years of enrollment
  • Serious psychiatric illness, including lifetime history of psychiatric hospitalization, suicide attempt, bipolar disorder, schizophrenia or other psychosis, bulimia, or anorexia nervosa; current serious personality disorder, (e.g. borderline or antisocial), major depressive disorder within the previous two years, suicidal ideation or need for psychiatric treatment in the previous 6 months.
  • In need of medications for the treatment of a psychiatric disorder within the previous 6 months prior to randomization.
  • IDS-SR total score >25 or scores >1 in items 5 (sadness), 6 (irritability), 7 (anxiety/tension) or 18 (suicidality)
  • History of alcohol or drug abuse, current or within 2 years
  • Unable to abstain from caffeinated product consumption for at least 48 hours
  • History of surgical intervention for obesity
  • Use of drugs, herbs, or dietary supplements believed to significantly affect body weight or participation in a weight loss management program within one month prior to randomization.
  • History of hypersensitivity to bupropion or naltrexone
  • History of seizure disorder or predisposition to seizures (e.g., history of cerebrovascular accident, brain surgery, head trauma with ≥5 minutes loss of consciousness, concussion symptoms lasting ≥ 15 minutes, skull fracture, subdural hematoma, or febrile seizures) or need for therapy with anticonvulsant medication.
  • History of treatment with bupropion or naltrexone within 12 months
  • Positive urine drug screen - STAT test performed on each day of study.
  • Pregnant or breast-feeding
  • Planned surgical procedure or trip that can impact the conduct of the study
  • Use of investigational drug, device or procedure within 30 days
  • Any condition which in the opinion of the investigator makes the subject unsuitable for inclusion in this study
  • Participation in any previous clinical trial sponsored by Orexigen Therapeutics.
  • Study personnel, sponsor representatives and their immediate families.

Sites / Locations

  • Brookhaven National Laboratory Medical Department

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

NB32

Placebo

Arm Description

Naltrexone SR 32 mg/bupropion SR 360 mg/day

Placebo tablets

Outcomes

Primary Outcome Measures

Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Frontal
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Anterior Cingulate
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 1
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 2
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Parietal
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Posterior Insula
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.

Secondary Outcome Measures

Percent Change in Body Weight
Dutch Eating Behavior Questionnaire - Change in Restrained Eating Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Restrained Eating subscale consisted of 10 items and the scores ranged from 10 (worse outcome) to 50 (better outcome).
Dutch Eating Behavior Questionnaire - Change in Emotional Eating A Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating A subscale (clearly labeled emotions) consisted of 9 items and the scores ranged from 9 (better outcome) to 45 (worse outcome).
Dutch Eating Behavior Questionnaire - Change in Emotional Eating B Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating B subscale (diffuse emotions) consisted of 4 items and the scores ranged from 4 (better outcome) to 20 (worse outcome).
Dutch Eating Behavior Questionnaire - Change in External Eating Subscale Score
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The External Eating subscale consisted of 10 items and the scores ranged from 10 (better outcome) to 50 (worse outcome).
Change in Question 19 From 21-Item COE (Control of Eating) Questionnaire
Question 19: Generally, how difficult has it been to control your eating? Scoring: 0=not at all difficult; 100=extremely difficult

Full Information

First Posted
July 3, 2008
Last Updated
January 5, 2015
Sponsor
Orexigen Therapeutics, Inc
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1. Study Identification

Unique Protocol Identification Number
NCT00711477
Brief Title
A Study Using Functional Magnetic Resonance Imaging (fMRI) to Assess the Effects of Naltrexone SR/ Bupropion SR Therapy in Overweight or Obese Subjects
Official Title
Naltrexone Sustained Release (SR) 32 mg and Bupropion Sustained Release (SR) 360 mg Combination Therapy in Functional Magnetic Resonance Imaging (fMRI) Changes in Overweight or Obese Subjects
Study Type
Interventional

2. Study Status

Record Verification Date
December 2014
Overall Recruitment Status
Completed
Study Start Date
September 2008 (undefined)
Primary Completion Date
June 2010 (Actual)
Study Completion Date
June 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Orexigen Therapeutics, Inc

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study was to assess the effect of naltrexone SR/bupropion SR (NB) on brain function in response to food cues using functional magnetic resonance imaging in overweight or obese subjects.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity
Keywords
obesity, overweight, magnetic resonance imaging, naltrexone, bupropion

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
46 (Actual)

8. Arms, Groups, and Interventions

Arm Title
NB32
Arm Type
Experimental
Arm Description
Naltrexone SR 32 mg/bupropion SR 360 mg/day
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo tablets
Intervention Type
Drug
Intervention Name(s)
Naltrexone SR 32 mg/bupropion SR 360 mg/day
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Type
Other
Intervention Name(s)
fMRI scan
Other Intervention Name(s)
functional magnetic resonance imaging to assess the effects of the drug/placebo on areas of the brain
Intervention Description
fMRI to assess the effects of the drug/placebo on areas of the brain
Primary Outcome Measure Information:
Title
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Frontal
Description
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time Frame
Baseline, 4 weeks
Title
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Anterior Cingulate
Description
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time Frame
Baseline, 4 weeks
Title
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 1
Description
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time Frame
Baseline, 4 weeks
Title
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Hippocampal Region 2
Description
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time Frame
Baseline, 4 weeks
Title
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Superior Parietal
Description
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time Frame
Baseline, 4 weeks
Title
Response to Food Related Cues Using Functional Magnetic Resonance Imaging - Posterior Insula
Description
Assessment of differences in brain activation in response to food cues before and after 4 weeks of treatment in subjects receiving NB or placebo.
Time Frame
Baseline, 4 weeks
Secondary Outcome Measure Information:
Title
Percent Change in Body Weight
Time Frame
Baseline, 4 weeks
Title
Dutch Eating Behavior Questionnaire - Change in Restrained Eating Subscale Score
Description
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Restrained Eating subscale consisted of 10 items and the scores ranged from 10 (worse outcome) to 50 (better outcome).
Time Frame
Baseline, 4 weeks
Title
Dutch Eating Behavior Questionnaire - Change in Emotional Eating A Subscale Score
Description
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating A subscale (clearly labeled emotions) consisted of 9 items and the scores ranged from 9 (better outcome) to 45 (worse outcome).
Time Frame
Baseline, 4 weeks
Title
Dutch Eating Behavior Questionnaire - Change in Emotional Eating B Subscale Score
Description
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale, where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The Emotional Eating B subscale (diffuse emotions) consisted of 4 items and the scores ranged from 4 (better outcome) to 20 (worse outcome).
Time Frame
Baseline, 4 weeks
Title
Dutch Eating Behavior Questionnaire - Change in External Eating Subscale Score
Description
The Dutch Eating Behavior Questionnaire is a 33-item self-report measure designed to assess the type of eating behavior and is organized into 3 subscales (emotional eating, externally-induced eating, and restrained eating). Subjects rated the frequency of their eating behaviors using a 5-point scale where 1=never, 2=seldom, 3=sometimes, 4=often, and 5=very often. The External Eating subscale consisted of 10 items and the scores ranged from 10 (better outcome) to 50 (worse outcome).
Time Frame
Baseline, 4 weeks
Title
Change in Question 19 From 21-Item COE (Control of Eating) Questionnaire
Description
Question 19: Generally, how difficult has it been to control your eating? Scoring: 0=not at all difficult; 100=extremely difficult
Time Frame
Baseline, 4 weeks

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Right-handed, female subjects, 18 to 45 years of age Body mass index (BMI) ≥ 27 and ≤ 40 kg/m² Free from clinically significant illness or disease as determined by medical history and physical examination Able to provide proof of identity during the enrollment process In good general health, without clinically significant medical history, physical examination findings or laboratory results Laboratory values obtained within 30 days of study entry within normal range for healthy volunteers. Normal urinalysis on initial screening day defined as: negative glucose, negative or trace protein, and negative or trace hemoglobin Normotensive (systolic ≤140 mm Hg, diastolic ≤90 mm hg) On no concomitant medications with the exception of oral contraceptives, vitamins, and over the counter pain, indigestion or allergy medication All women of child bearing potential must be non-lactating, must have a negative STAT pregnancy test, and agree to use effective contraception methods throughout study period and for 30 days after discontinuation of study drug. The following are considered effective methods of contraception: Combination or progestin-only birth control pills (oral contraceptives), vaginal contraceptive rings, contraceptive patches, Depo Provera, intrauterine devices, barrier methods with spermicide (condom/foam, diaphragm/ spermicide), abstinence. (Subjects who have had a tubal ligation, hysterectomy or are post-menopausal for 2 years are considered NOT to be of child bearing potential) For women not using hormonal methods of contraception, should be in the follicular phase of the menstrual cycle at the baseline visit. Non-smoker and no use of tobacco or nicotine products for at least 6 months prior to baseline. On screening and study days, we will test the subjects' urine for presence of nicotinine/cotinine (STAT) test as confirmatory evidence of being a non-smoker in addition to their self-report. A Tobacco Questionnaire and Breath CO will also be administered for eligibility on the day of screening for confirmation purposes. No clinically significant abnormality on ECG, baseline QTc <470 Able to comply with all required study procedures Available for follow up for the duration of the study Willing and able to give written informed consent Exclusion Criteria: Obesity of known endocrine or genetic origin (e.g., untreated hypothyroidism, Cushing's syndrome, Prader Willi Syndrome, established Polycystic Ovary Syndrome) Inability to participate in fMRI scanning sessions History of occupational exposure to metal flakes in their bodies or eyes. History of known indwelling ferromagnetic metals or fragments. History of acute or chronic illness that requires medical therapy including active gastrointestinal conditions that might interfere with drug absorption History or presence of hepatic, renal, cardiovascular or gastrointestinal diseases Type I or Type II diabetes mellitus requiring pharmacotherapy Active malignancy or history of malignancy (other than non-melanoma skin cancer or surgically cured cervical cancer) within 5 years of enrollment Serious psychiatric illness, including lifetime history of psychiatric hospitalization, suicide attempt, bipolar disorder, schizophrenia or other psychosis, bulimia, or anorexia nervosa; current serious personality disorder, (e.g. borderline or antisocial), major depressive disorder within the previous two years, suicidal ideation or need for psychiatric treatment in the previous 6 months. In need of medications for the treatment of a psychiatric disorder within the previous 6 months prior to randomization. IDS-SR total score >25 or scores >1 in items 5 (sadness), 6 (irritability), 7 (anxiety/tension) or 18 (suicidality) History of alcohol or drug abuse, current or within 2 years Unable to abstain from caffeinated product consumption for at least 48 hours History of surgical intervention for obesity Use of drugs, herbs, or dietary supplements believed to significantly affect body weight or participation in a weight loss management program within one month prior to randomization. History of hypersensitivity to bupropion or naltrexone History of seizure disorder or predisposition to seizures (e.g., history of cerebrovascular accident, brain surgery, head trauma with ≥5 minutes loss of consciousness, concussion symptoms lasting ≥ 15 minutes, skull fracture, subdural hematoma, or febrile seizures) or need for therapy with anticonvulsant medication. History of treatment with bupropion or naltrexone within 12 months Positive urine drug screen - STAT test performed on each day of study. Pregnant or breast-feeding Planned surgical procedure or trip that can impact the conduct of the study Use of investigational drug, device or procedure within 30 days Any condition which in the opinion of the investigator makes the subject unsuitable for inclusion in this study Participation in any previous clinical trial sponsored by Orexigen Therapeutics. Study personnel, sponsor representatives and their immediate families.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gene-Jack Wang, MD
Organizational Affiliation
Brookhaven National Laboratory
Official's Role
Principal Investigator
Facility Information:
Facility Name
Brookhaven National Laboratory Medical Department
City
Upton
State/Province
New York
ZIP/Postal Code
11973
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
23924756
Citation
Wang GJ, Tomasi D, Volkow ND, Wang R, Telang F, Caparelli EC, Dunayevich E. Effect of combined naltrexone and bupropion therapy on the brain's reactivity to food cues. Int J Obes (Lond). 2014 May;38(5):682-8. doi: 10.1038/ijo.2013.145. Epub 2013 Aug 8.
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A Study Using Functional Magnetic Resonance Imaging (fMRI) to Assess the Effects of Naltrexone SR/ Bupropion SR Therapy in Overweight or Obese Subjects

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