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Aripiprazole and Topiramate on Free-Choice Alcohol Use (AT)

Primary Purpose

Alcohol Dependence

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Double Placebo
Aripiprazole 15, placebo
Aripiprazole 7.5, Placebo
Topiramate 100, Placebo
Topiramate 200, Placebo
Topiramate 100, Aripiprazole 15
Topiramate 100, Aripiprazole 7.5
Topiramate 100, Aripiprazole 15mg
Topiramate 200, Aripiprazole 7.5mg
Topiramate 200, Aripiprazole 15
Sponsored by
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alcohol Dependence focused on measuring Alcohol dependence, alcohol abuse, topiramate, aripiprazole

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • must be non-treatment seeking for alcohol dependence
  • a current DSM-IV-TR diagnosis of alcohol dependence supported by the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition (SCID-I/P a minimum of ≥ 35drinks a week for men or ≥ 28 or more drinks a week for women
  • must be suitable for outpatient treatment
  • able to read English at an eighth grade level, understand their rights as provided by the informed consent, and be willing to sign an informed consent to participate in the study
  • be between 21 and 65 years on age (inclusive)
  • provide evidence of stable residence in the two months prior to enrollment and no plans to move for the next four months
  • provide a verifiable contact person prior to randomization
  • be in generally good health as determined by the physical exam, medical history, ECG and laboratory tests
  • have a Body Mass Index >18kg/m2 and < 33 kg/m2
  • if female, must be postmenopausal practicing an effective method of birth control, have negative pregnancy tests at randomization and before the ASAE;
  • be willing to be adherent to medication dosing.

Exclusion Criteria:

  • clinically significant medical abnormalities (i.e. ECG, hematological assessment, bilirubin > 150% of the upper limit of normal or ALT or AST elevations >300% the upper limit of normal, biochemistry including urinalysis, electrolytes,). (Persons with medical conditions that are adequately controlled by their primary care physician will not be excluded.)
  • have significant alcohol withdrawal symptoms (clinical institute withdrawal assessment for alcohol revised (CIWA-Ar) >10
  • a history of suicide; history of renal impairment or nephrolithiasis; creatinine clearance of <60 dl/minute
  • pregnant or lactating or not using an adequate form of birth control
  • taking other medications that may have an effect on alcohol consumption or are carbonic anhydrase inhibitors
  • clinically significant diseases of the gastrointestinal system or active liver disease; subjects compelled to receive treatment to avoid imprisonment or loss of employment
  • previously with a history of adverse reaction or hypersensitivity to either Topiramate or aripiprazole
  • have a diagnosis of with schizophrenia or bipolar disorder and/or taking antipsychotics and other drugs that inhibit CYP3A4 or CYP2D6 isoenzymes
  • history of seizures (e.g. epilepsy)
  • patients currently diagnosed with a substance dependence diagnosis other than alcohol or tobacco
  • patients who have participated in any clinical trial with an investigational agent within the past 30 days
  • individuals with a reasonable expectation of being institutionalized during the course of the trial or pending legal charges
  • pregnant or nursing women.

Sites / Locations

  • Brown University Center for Addiction Studies

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm 8

Arm 9

Arm Type

Placebo Comparator

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Double Placebo

Aripiprazole 15, Placebo

Aripiprazole 7.5, Placebo

Topiramate 100mg, Placebo

Topiramate 200, Placebo

Topiramate 100, Aripiprazole 5

Topiramate 200, Aripiprazole 15

Topiramate 100, Aripiprazole 7.5

Topiramate 200, Aripiprazole 7.5mg

Arm Description

Placebo, Placebo

15 mg Aripiprazole, Placebo

Aripiprazole 7.5 mg daily plus Placebo daily

Topiramate 100 mg daily plus Placebo daily

Topiramate 200 mg daily plus Placebo daily

Topiramate 100 daily plus, Aripiprazole 5mg daily

Topiramate 200 mg daily plus Aripiprazole 15mg daily

Topiramate 100 mg daily, Aripiprazole 7.5 mg daily

Topiramate 200 mg daily plus Aripiprazole 7.5mg daily

Outcomes

Primary Outcome Measures

Number of alcoholic drinks consumed in a laboratory setting
Safety and tolerability of the medications singly and in combination, compared to placebo

Secondary Outcome Measures

Drinks consumed during the medication titration period

Full Information

First Posted
April 20, 2009
Last Updated
October 5, 2015
Sponsor
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Collaborators
Brown University
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1. Study Identification

Unique Protocol Identification Number
NCT00884884
Brief Title
Aripiprazole and Topiramate on Free-Choice Alcohol Use
Acronym
AT
Official Title
Aripiprazole and Topiramate on Free-Choice Alcohol Use
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Completed
Study Start Date
September 2007 (undefined)
Primary Completion Date
October 2015 (Actual)
Study Completion Date
October 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Collaborators
Brown University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The current study investigates the effects of two potential alcohol treatment medications on drinking in a laboratory setting. Aripiprazole (APZ), effects dopamine and serotonin receptors with fewer limiting side effects seen with other atypical antipsychotics. Topiramate (TPMT), an antiepileptic, affects glutamate and GABA-A receptors and shows promise in reducing heavy drinking. Few studies have used two medications with such a diverse combination of actions to examine a potential synergistic effect on reducing alcohol consumption. The primary aims are to: determine if APZ and TPMT are each more effective than placebo, and the combination of APZ and TPMT is more effective than either drug alone or placebo, in reducing alcohol use in non-treatment seeking alcohol dependent subjects in a laboratory based alcohol self-administration experiment (ASAE) examine a hypothesized dose-response for three doses of APZ (0, 7.5 mg/d and 15 mg/d) along with three doses of TPMT (0, 100mg/d and 200mg/d) examine the putative mechanisms of action of APZ, TPMT alone and together on craving, subjective stimulation, candidate gene influences and other behavioral effects associated with alcohol consumption establish the safety of giving APZ and TPMT together. Non-treatment seeking, alcohol dependent Participants (N=216) will be recruited from the community and randomly assigned to one of the 9 cells. Subjects drinking and safety is monitored over a 5-week titration to their target dose, leading to an in-laboratory alcohol self administration session, during which clinical and behavioral effects are assessed during access to alcohol. A 1 month follow-up assesses adverse events and drinking.
Detailed Description
Due to the modest effect of current pharmacotherapies, more effective treatments must be developed to optimally treat alcohol dependent patients. Treatments combining pharmacotherapies with different mechanisms of action may better address the diverse neurobiology of alcohol and the heterogeneity of alcoholics. However, little is known about how medication may affect behavior to reduce drinking. Aripiprazole (APZ), a partial dopamine agonist, affects dopamine and serotonin receptors without the limiting side effects seen with other atypical antipsychotics. Dopamine mediates reward based drinking and craving. Topiramate (TPMT), an antiepileptic, affects glutamate and GABA-A receptors and shows promise in reducing heavy drinking. Glutamate and GABA may mediate relief-based drinking and protracted withdrawal. Despite strong evidence that multiple neurotransmitters contribute to alcoholism, few studies have used two medications with such a diverse combination of actions to examine a potential synergistic effect on reducing alcohol consumption. The present study will recruit 216 healthy, alcohol-dependent volunteers who are not currently seeking treatment for their alcohol dependence to learn more about how these medications may work. The primary aims are to: (1) determine if APZ and TPMT are each more effective than placebo, and the combination of APZ and TPMT is more effective than either drug alone or placebo, in reducing alcohol use in non-treatment seeking alcohol dependent subjects in an alcohol self administration experiment (ASAE); (2) examine a hypothesized dose-response for three doses of APZ (0, 7.5mg/d and 15 mg/d) and three doses of TPMT (0, 100mg/d, 200mg/d); (3) examine the putative mechanisms of action of APZ, TPMT alone and together on craving, subjective stimulation, candidate gene influences and other behavioral effects associated with alcohol consumption; and (4) establish the safety of giving APZ and TPMT together. We will use of a 3 X 3 drug (7.5mg, 15mg APZ vs. placebo) by drug (100mg, 200mg TPMT vs. placebo) between-subjects factorial design. Participants are randomly assigned to one of 9 cells. Subjects drinking and safety is monitored over a 5-week titration to their target dose, leading to an in-laboratory alcohol self administration session, during which clinical and behavioral effects are assessed during access to alcohol. A 1 month follow-up assesses adverse events and drinking. The long term objectives of this research are to improve medications available for alcoholism treatment and inform research and theory on the mechanisms of action of such medications.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alcohol Dependence
Keywords
Alcohol dependence, alcohol abuse, topiramate, aripiprazole

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
90 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Double Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo, Placebo
Arm Title
Aripiprazole 15, Placebo
Arm Type
Experimental
Arm Description
15 mg Aripiprazole, Placebo
Arm Title
Aripiprazole 7.5, Placebo
Arm Type
Experimental
Arm Description
Aripiprazole 7.5 mg daily plus Placebo daily
Arm Title
Topiramate 100mg, Placebo
Arm Type
Experimental
Arm Description
Topiramate 100 mg daily plus Placebo daily
Arm Title
Topiramate 200, Placebo
Arm Type
Experimental
Arm Description
Topiramate 200 mg daily plus Placebo daily
Arm Title
Topiramate 100, Aripiprazole 5
Arm Type
Experimental
Arm Description
Topiramate 100 daily plus, Aripiprazole 5mg daily
Arm Title
Topiramate 200, Aripiprazole 15
Arm Type
Experimental
Arm Description
Topiramate 200 mg daily plus Aripiprazole 15mg daily
Arm Title
Topiramate 100, Aripiprazole 7.5
Arm Type
Experimental
Arm Description
Topiramate 100 mg daily, Aripiprazole 7.5 mg daily
Arm Title
Topiramate 200, Aripiprazole 7.5mg
Arm Type
Experimental
Arm Description
Topiramate 200 mg daily plus Aripiprazole 7.5mg daily
Intervention Type
Drug
Intervention Name(s)
Double Placebo
Intervention Description
1 capsule daily
Intervention Type
Drug
Intervention Name(s)
Aripiprazole 15, placebo
Other Intervention Name(s)
Abilify, Topamax
Intervention Description
15 mg Aripiprazole daily plus placebo daily
Intervention Type
Drug
Intervention Name(s)
Aripiprazole 7.5, Placebo
Intervention Description
Aripiprazole 7.5 mg daily plus Placebo daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 100, Placebo
Intervention Description
Topiramate 100 mg daily plus Placebo daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 200, Placebo
Intervention Description
Topiramate 200 mg daily plus Placebo daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 100, Aripiprazole 15
Other Intervention Name(s)
Abilify, Topamax
Intervention Description
Topiramate 100 mg daily plus Aripiprazole 15mg daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 100, Aripiprazole 7.5
Intervention Description
Topiramate 100 mg daily plus Aripiprazole 7.5mg daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 100, Aripiprazole 15mg
Other Intervention Name(s)
Abilify, Topamax
Intervention Description
Topiramate 100 mg daily plus Aripiprazole 15mg daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 200, Aripiprazole 7.5mg
Other Intervention Name(s)
Abilify, Topamax
Intervention Description
Topiramate 200 mg daily plus Aripiprazole 7.5mg daily
Intervention Type
Drug
Intervention Name(s)
Topiramate 200, Aripiprazole 15
Other Intervention Name(s)
Abilify, Topamax
Intervention Description
Topiramate 200mg daily plus Aripiprazole 15mg daily
Primary Outcome Measure Information:
Title
Number of alcoholic drinks consumed in a laboratory setting
Time Frame
90 minutes
Title
Safety and tolerability of the medications singly and in combination, compared to placebo
Time Frame
4 years
Secondary Outcome Measure Information:
Title
Drinks consumed during the medication titration period
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: must be non-treatment seeking for alcohol dependence a current DSM-IV-TR diagnosis of alcohol dependence supported by the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition (SCID-I/P a minimum of ≥ 35drinks a week for men or ≥ 28 or more drinks a week for women must be suitable for outpatient treatment able to read English at an eighth grade level, understand their rights as provided by the informed consent, and be willing to sign an informed consent to participate in the study be between 21 and 65 years on age (inclusive) provide evidence of stable residence in the two months prior to enrollment and no plans to move for the next four months provide a verifiable contact person prior to randomization be in generally good health as determined by the physical exam, medical history, ECG and laboratory tests have a Body Mass Index >18kg/m2 and < 33 kg/m2 if female, must be postmenopausal practicing an effective method of birth control, have negative pregnancy tests at randomization and before the ASAE; be willing to be adherent to medication dosing. Exclusion Criteria: clinically significant medical abnormalities (i.e. ECG, hematological assessment, bilirubin > 150% of the upper limit of normal or ALT or AST elevations >300% the upper limit of normal, biochemistry including urinalysis, electrolytes,). (Persons with medical conditions that are adequately controlled by their primary care physician will not be excluded.) have significant alcohol withdrawal symptoms (clinical institute withdrawal assessment for alcohol revised (CIWA-Ar) >10 a history of suicide; history of renal impairment or nephrolithiasis; creatinine clearance of <60 dl/minute pregnant or lactating or not using an adequate form of birth control taking other medications that may have an effect on alcohol consumption or are carbonic anhydrase inhibitors clinically significant diseases of the gastrointestinal system or active liver disease; subjects compelled to receive treatment to avoid imprisonment or loss of employment previously with a history of adverse reaction or hypersensitivity to either Topiramate or aripiprazole have a diagnosis of with schizophrenia or bipolar disorder and/or taking antipsychotics and other drugs that inhibit CYP3A4 or CYP2D6 isoenzymes history of seizures (e.g. epilepsy) patients currently diagnosed with a substance dependence diagnosis other than alcohol or tobacco patients who have participated in any clinical trial with an investigational agent within the past 30 days individuals with a reasonable expectation of being institutionalized during the course of the trial or pending legal charges pregnant or nursing women.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert M Swift, MD, PhD
Organizational Affiliation
Brown University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Brown University Center for Addiction Studies
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02903
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
29281033
Citation
Haass-Koffler CL, Goodyear K, Zywiak WH, Leggio L, Kenna GA, Swift RM. Comparing and Combining Topiramate and Aripiprazole on Alcohol-Related Outcomes in a Human Laboratory Study. Alcohol Alcohol. 2018 May 1;53(3):268-276. doi: 10.1093/alcalc/agx108. Erratum In: Alcohol Alcohol. 2018 Jul 1;53(4):500.
Results Reference
derived

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Aripiprazole and Topiramate on Free-Choice Alcohol Use

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