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Inflammation, Stress & Social Behavior: Using Ecological Assessments & Model Systems to Enhance Relevance to Health Outcomes

Primary Purpose

Hepatitis C

Status
Withdrawn
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Interferon-alpha
Sponsored by
University of Arizona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Hepatitis C focused on measuring Hepatitis C, interferon, stress, social behavior

Eligibility Criteria

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

Inclusion Criteria:

  • Age 21-65 years including males, females and minorities
  • Ability to speak and read remedial English
  • Serum positive for either anti-HCV antibodies or HCV-RNA positive by PCR
  • Compensated liver disease with the following minimum hematologic and biochemical criteria: hemoglobin ≥13 g/dl for males; ≥12 g/dl for females, white blood cell count > 3,000/mm3, neutrophil count >1,5000/mm3, platelets > 100,000/mm3, prothrombin time ≤ 2 seconds prolonged compared to control, or equivalent INR ratio, albumin stable and within normal limits, serum creatinine within normal limits, thyroid-stimulating hormone within normal limits, direct bilirubin ≤ 0.3 mg/dl or within 20% of upper limit of normal (ULN) for local laboratory, indirect bilirubin ≤ 0.8 mg/dl or within 20% of ULN for local laboratory, fasting blood sugar ≤ 115 mg/dl or within 20% of ULN for non-diabetic patients
  • Negative pregnancy test for women of childbearing potential, and confirmation and documentation that adequate contraception or monogamous relationship with a male partner who has had a vasectomy during the treatment period and for 6 months after discontinuation of therapy
  • Not breastfeeding
  • Documentation and confirmation of adequate contraception in sexually active males
  • Free from all psychotropic medications for 14 days prior to baseline visit (8 weeks for fluoxetine)

Exclusion Criteria:

  • Evidence of untreated or poorly controlled endocrine, cardiovascular, hematological, renal, or neurological disease
  • Evidence of decompensated liver disease (such as a history or presence of ascites, bleeding varices, spontaneous encephalopathy)
  • History of narcolepsy, PLMS or sleep apnea (or documented during the adaptation night)
  • History of CNS trauma or active seizure disorder requiring medication
  • Any cause for liver disease other than chronic hepatitis C, such as co-infection with hepatitis B virus and/or human immunodeficiency virus, hemochromatosis, or Wilson's diseases
  • Prior treatment with ribavirin or other antiviral or immunomodulatory drugs, including corticosteroids within 6 months of entry into protocol
  • Chronic use of agents known to affect monoamine metabolism/function (and hence potentially affect the TSST), including, but not limited to, alpha- and beta-receptor agonists and antagonists, methylphenidate hydrochloride, dextroamphetamine, midodrine hydrochloride, theophylline, ephedrine, systemic antifungal azoles, sumatriptan succinate
  • Psychotropic medications within 14 days prior to baseline visit (8 weeks for fluoxetine)
  • Clinical gout
  • Hypersensitivity to alpha interferon or ribavirin
  • Hemoglobinopathies (e.g. thalassemia)
  • A positive pregnancy test
  • Organ transplants
  • A score of <24 on the Mini Mental Status Exam (MMSE)
  • Active, effective treatment of depression with an antidepressant within the past six months
  • Actively meet criteria for major depression within the past six months
  • Meet criteria for schizophrenia or bipolar disorder (mania) past or present
  • Active abuse of alcohol or illicit/prescription drugs within the past year any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with participating in or completing the protocol

Sites / Locations

  • University of Arizona
  • Emory University

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

HCV Interferon-alpha group

HCV Control Group

Arm Description

Subjects receiving treatment with interferon (IFN)-alpha for chronic hepatitis C virus infection.

Subjects delaying the start of treatment with interferon (IFN)-alpha for chronic hepatitis C virus infection by 7 weeks.

Outcomes

Primary Outcome Measures

Percent time laughing
Percent time expressing empathy for others
Percent of time spent in substantive conversations
Percent of time spent alone

Secondary Outcome Measures

Cortisol concentrations in blood in response to stress test
Interleukin (IL)-6 concentrations in the blood in response to stress test
Diurnal plasma concentrations of interleukin-6 and tumor necrosis factor-alpha type II receptors in response to a stress test
Diurnal plasma concentrations of inflamcortisol in response to a stress test
Wake time after sleep onset measured by actigraphy
Sleep latency by measured by actigraphy
Total sleep time by actigraphy
Sleep efficiency by actigraphy
Structured Interview Guide for the Hamilton Depression Scale and Inventory of Depressive Symptomatology (SIGH-IDS)

Full Information

First Posted
June 11, 2012
Last Updated
July 18, 2013
Sponsor
University of Arizona
Collaborators
Emory University, National Center for Complementary and Integrative Health (NCCIH)
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1. Study Identification

Unique Protocol Identification Number
NCT01625793
Brief Title
Inflammation, Stress & Social Behavior: Using Ecological Assessments & Model Systems to Enhance Relevance to Health Outcomes
Official Title
Inflammation, Stress and Social Behavior: Using Ecological Assessments and Model Systems to Enhance Relevance to Health Outcomes
Study Type
Interventional

2. Study Status

Record Verification Date
July 2013
Overall Recruitment Status
Withdrawn
Why Stopped
New medication coming on the market, made study obsolete.
Study Start Date
June 2012 (undefined)
Primary Completion Date
July 2013 (Actual)
Study Completion Date
July 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Arizona
Collaborators
Emory University, National Center for Complementary and Integrative Health (NCCIH)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The current study has been designed to identify behavioral and physiological mechanisms through which positive social connectivity (PCS) and negative social processes (NSP) interact with psychosocial stress to promote resilience in the context of illness. The investigators model inflammation (a central element of all disease states) through the use of treatment with interferon (IFN)-alpha, which provides a standardized regimen of chronic cytokine exposure known to produce profound behavioral disturbances, including depression, fatigue and sickness, in a high percentage of individuals. To objectively assess social processes, the current project will employ the Electronically Activated Recorder (EAR), which periodically and unobtrusively records snippets of ambient sounds in people's momentary environments. To objectively assess behavioral and physiological responses to psychosocial stress the current project will employ the Trier Social Stress Test (TSST), a standardized laboratory stressor known to reliably activate behavioral, neuroendocrine and inflammatory responses. These novel methodologies and model systems will be employed to test the hypotheses that (a) pre-existing affiliative and prosocial behavior will promote resilience in the context of chronic inflammation and that (b) -conversely-chronic inflammation will reduce affiliative and prosocial behavior via effects on stress reactivity, neuroendocrine function and sleep. Finally, it will explore (c) the potential mediating role of stress physiology. To test these hypotheses, 110 subjects with chronic hepatitis C virus infection will be randomized to receive treatment with pegylated IFN-alpha plus ribavirin or to postpone treatment for 6 weeks: 55 subjects at University of Arizona and 55 subjects at Emory University. Prior to randomization and 6 weeks later all subjects will be evaluated with the EAR and sleep actigraphy in their home environments and will undergo TSST and 14 hour diurnal neuroendocrine and immune measurement.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatitis C
Keywords
Hepatitis C, interferon, stress, social behavior

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
HCV Interferon-alpha group
Arm Type
Active Comparator
Arm Description
Subjects receiving treatment with interferon (IFN)-alpha for chronic hepatitis C virus infection.
Arm Title
HCV Control Group
Arm Type
Placebo Comparator
Arm Description
Subjects delaying the start of treatment with interferon (IFN)-alpha for chronic hepatitis C virus infection by 7 weeks.
Intervention Type
Drug
Intervention Name(s)
Interferon-alpha
Other Intervention Name(s)
Pegintron®, Schering Plough, PEGASYS®, Roche
Intervention Description
Hepatitis C patients who are eligible to receive IFN-alpha treatment and enrolled in this study will be treated with pegylated IFN-alfa-2b or pegylated IFN-alfa-2a plus ribavirin at a dose of 800-1,400 mg/d as determined by the treating gastroenterologist. All medication administration is for purely clinical indications as dictated by treating physicians. Any and all diagnostic or treatment issues related to potential treatment with IFN-alpha will be conducted by treating clinicians. Subjects will be randomized to start their clinical (non-research) treatment following completion of baseline assessments or to delay the start of their clinical (non-research) treatment by 7 weeks.
Primary Outcome Measure Information:
Title
Percent time laughing
Time Frame
7 weeks
Title
Percent time expressing empathy for others
Time Frame
7 weeks
Title
Percent of time spent in substantive conversations
Time Frame
7 weeks
Title
Percent of time spent alone
Time Frame
7 weeks
Secondary Outcome Measure Information:
Title
Cortisol concentrations in blood in response to stress test
Time Frame
7 weeks
Title
Interleukin (IL)-6 concentrations in the blood in response to stress test
Time Frame
7 weeks
Title
Diurnal plasma concentrations of interleukin-6 and tumor necrosis factor-alpha type II receptors in response to a stress test
Time Frame
7 weeks
Title
Diurnal plasma concentrations of inflamcortisol in response to a stress test
Time Frame
7 weeks
Title
Wake time after sleep onset measured by actigraphy
Time Frame
7 weeks
Title
Sleep latency by measured by actigraphy
Time Frame
7 weeks
Title
Total sleep time by actigraphy
Time Frame
7 weeks
Title
Sleep efficiency by actigraphy
Time Frame
7 weeks
Title
Structured Interview Guide for the Hamilton Depression Scale and Inventory of Depressive Symptomatology (SIGH-IDS)
Time Frame
7 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 21-65 years including males, females and minorities Ability to speak and read remedial English Serum positive for either anti-HCV antibodies or HCV-RNA positive by PCR Compensated liver disease with the following minimum hematologic and biochemical criteria: hemoglobin ≥13 g/dl for males; ≥12 g/dl for females, white blood cell count > 3,000/mm3, neutrophil count >1,5000/mm3, platelets > 100,000/mm3, prothrombin time ≤ 2 seconds prolonged compared to control, or equivalent INR ratio, albumin stable and within normal limits, serum creatinine within normal limits, thyroid-stimulating hormone within normal limits, direct bilirubin ≤ 0.3 mg/dl or within 20% of upper limit of normal (ULN) for local laboratory, indirect bilirubin ≤ 0.8 mg/dl or within 20% of ULN for local laboratory, fasting blood sugar ≤ 115 mg/dl or within 20% of ULN for non-diabetic patients Negative pregnancy test for women of childbearing potential, and confirmation and documentation that adequate contraception or monogamous relationship with a male partner who has had a vasectomy during the treatment period and for 6 months after discontinuation of therapy Not breastfeeding Documentation and confirmation of adequate contraception in sexually active males Free from all psychotropic medications for 14 days prior to baseline visit (8 weeks for fluoxetine) Exclusion Criteria: Evidence of untreated or poorly controlled endocrine, cardiovascular, hematological, renal, or neurological disease Evidence of decompensated liver disease (such as a history or presence of ascites, bleeding varices, spontaneous encephalopathy) History of narcolepsy, PLMS or sleep apnea (or documented during the adaptation night) History of CNS trauma or active seizure disorder requiring medication Any cause for liver disease other than chronic hepatitis C, such as co-infection with hepatitis B virus and/or human immunodeficiency virus, hemochromatosis, or Wilson's diseases Prior treatment with ribavirin or other antiviral or immunomodulatory drugs, including corticosteroids within 6 months of entry into protocol Chronic use of agents known to affect monoamine metabolism/function (and hence potentially affect the TSST), including, but not limited to, alpha- and beta-receptor agonists and antagonists, methylphenidate hydrochloride, dextroamphetamine, midodrine hydrochloride, theophylline, ephedrine, systemic antifungal azoles, sumatriptan succinate Psychotropic medications within 14 days prior to baseline visit (8 weeks for fluoxetine) Clinical gout Hypersensitivity to alpha interferon or ribavirin Hemoglobinopathies (e.g. thalassemia) A positive pregnancy test Organ transplants A score of <24 on the Mini Mental Status Exam (MMSE) Active, effective treatment of depression with an antidepressant within the past six months Actively meet criteria for major depression within the past six months Meet criteria for schizophrenia or bipolar disorder (mania) past or present Active abuse of alcohol or illicit/prescription drugs within the past year any other condition which in the opinion of the investigator would make the patient unsuitable for enrollment, or could interfere with participating in or completing the protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Charles L. Raison, MD
Organizational Affiliation
University of Arizona
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Arizona
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724
Country
United States
Facility Name
Emory University
City
Atlanta
State/Province
Georgia
Country
United States

12. IPD Sharing Statement

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Inflammation, Stress & Social Behavior: Using Ecological Assessments & Model Systems to Enhance Relevance to Health Outcomes

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