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Effect of GET73 on MRS Measures of Central Glutamate and GABA in Individuals With Alcohol Use Disorder

Primary Purpose

Alcohol Use Disorder

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
GET73
Placebo
Sponsored by
Laboratorio Farmaceutico Ct S.r.l.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Alcohol Use Disorder focused on measuring Glutamate, Alcohol use, GABA, GET73, Non-treatment seeking

Eligibility Criteria

21 Years - 40 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male participants, or females who are post-menopausal or surgically sterile.
  2. Age between 21 and 40 years old (inclusive).
  3. Meets Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for current Alcohol Use Disorder, moderate severity (4 or more criteria met) as indicated by the Structured Clinical Interview for DSM-5 (SCID-5-RV).
  4. Reports drinking, on average, > 20 standard drinks per week in the 90 days prior to screening evaluation, and in the last week prior to screening.
  5. Must report drinking within the 48 hours prior to the first dose of medication in each study medication period.
  6. Positive for Ethyl Glucuronide (EtG) in urine (> 100 ng/ml) at screening and prior to the first dose of medication in each study medication period.
  7. Currently not engaged in, and does not want treatment for, alcohol related problems.
  8. Able to read and understand questionnaires and informed consent.

Exclusion Criteria:

  1. Current DSM-5 diagnosis of any other substance use disorder except Nicotine Use Disorder.
  2. Any psychoactive substance use (except marijuana and nicotine) within the last 30 days before the screening visit, as indicated by self-report and/or urine drug screen.
  3. No marijuana use within the last seven days before the screening visit, by verbal report and negative urine drug test (< 50 ng/mL); if positive at screening, must be negative or decreasing urine Delta9-Tetrahydrocannabinol (THC) levels (corrected for urine creatinine level) at the second test (Day1 A-1).
  4. Current DSM-5 Axis I diagnosis, including major depression, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar affective disorder, schizophrenia, dissociative disorders, eating disorders, or any other psychotic or organic mental disorder.
  5. Current suicidal or homicidal ideation.
  6. Need for maintenance or acute treatment with any psychoactive medication, including antiepileptic medications.
  7. Current use, or use in the past 30 days, of any medication known to affect alcohol intake (e.g., disulfiram, naltrexone, acamprosate, topiramate).
  8. History of severe alcohol withdrawal (e.g., seizure, delirium tremens), as evidenced by self-report or a Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) score > 10.
  9. Clinically significant medical problems (e.g., unstable hypertension, neurological, cardiovascular, renal, gastrointestinal, or endocrine problems) that would impair participation or limit medication ingestion.
  10. Current or past hepatocellular disease, as indicated by verbal report or elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 300% the upper limit of the normal range, or bilirubin > 150% the upper limit of the normal range.
  11. Lack of a stable living situation.
  12. Presence of ferrous metal in the body, as evidenced by metal screening and self-report.
  13. Severe claustrophobia or weight > 300 pounds that preclude placement in the MRI scanner.
  14. History of head injury with > 2 minutes of unconsciousness.
  15. Participation in any behavioral and/or pharmacological study within the past 30 days;
  16. Concomitant use of CYP2C19 substrates; use of CYP2C19 and CYP3A4 inhibitors or inducers in the 14 days before dosing.

Sites / Locations

  • Department of Psychiatry and Behavioral Sciences - Medical University of South Carolina

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

GET73

Placebo

Arm Description

GET73 is administered at the dose of 300 mg t.i.d. per day, with a minimum gap of 4 hours between administrations and a maximum gap of 9 hours. Each subject ingests a total of 5 capsules of GET73: 3 capsules of GET73 on the first day of the related phase, according to randomization, and 2 capsules on the second day of each phase.

Placebo is administered t.i.d. per day, with a minimum gap of 4 hours between administrations and a maximum gap of 9 hours. Each subject ingests a total of 5 capsules of Placebo: 3 capsules of Placebo on the first day of the related phase, according to randomization, and 2 capsules on the second day.

Outcomes

Primary Outcome Measures

Concentrations of glutamate in dorsal anterior cingulate measured via Proton Magnetic Resonance Spectroscopy
The presence of water and glutamate will be quantified through ¹H-MRS and the change in glutamate/water concentration between baseline and end of treatment will be assessed

Secondary Outcome Measures

Concentrations of GABA in dorsal anterior cingulate measured via Proton Magnetic Resonance Spectroscopy
The presence of water and GABA will be quantified through ¹H-MRS and the change in GABA/water concentration between baseline and end of treatment will be assessed
Change in the blood oxygenation level dependent (BOLD) signal to alcohol cues
Magnitude of change in the blood oxygenation level dependent (BOLD) signal to alcohol cues, relative to neutral beverage cues, in the ventral striatum and dorsal anterior cingulate cortex (alcohol cue reactivity task described in Schacht et al., 2013)

Full Information

First Posted
January 8, 2018
Last Updated
October 5, 2020
Sponsor
Laboratorio Farmaceutico Ct S.r.l.
Collaborators
Latis S.r.l.
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1. Study Identification

Unique Protocol Identification Number
NCT03418623
Brief Title
Effect of GET73 on MRS Measures of Central Glutamate and GABA in Individuals With Alcohol Use Disorder
Official Title
Effect of GET73 on Magnetic Resonance Spectroscopy Measures of Central Glutamate and GABA and Alcohol Cue-elicited Brain Activation in Recently Abstinent Non-treatment Seeking Individuals With Alcohol Use Disorder.
Study Type
Interventional

2. Study Status

Record Verification Date
October 2020
Overall Recruitment Status
Completed
Study Start Date
March 8, 2018 (Actual)
Primary Completion Date
March 13, 2020 (Actual)
Study Completion Date
March 13, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Laboratorio Farmaceutico Ct S.r.l.
Collaborators
Latis S.r.l.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study is aimed at examining whether GET73 modulates the indices of central glutamate and γ-aminobutyric acid (GABA) levels in recently abstinent subjects that meet Alcohol Use Disorder (AUD) criteria, as measured by proton nuclear magnetic resonance spectroscopy (¹H-MRS), in order to provide a human translation of the findings demonstrated in different preclinical models, both in vitro and in vivo. In addition, the study will examine the effects of GET73 on alcohol cue induced brain activation by using a well-established blood-oxygen-level-dependent (BOLD) functional magnetic resonance (fMRI) paradigm in the same individuals. In summary, the study should provide important information on (i) the potential mechanism of action of GET73, (ii) on the brain mechanisms that would support its potential use for reduction in craving and drinking in AUD patients, and (iii) expand data on its safe use as a medication in heavy drinking individuals.
Detailed Description
This study is aimed at examining whether GET73 modulates the indices of central glutamate and γ-aminobutyric acid (GABA) levels in recently abstinent subjects that meet Alcohol Use Disorder (AUD) criteria, as measured by proton nuclear magnetic resonance spectroscopy (¹H-MRS), in order to provide a human translation of the findings demonstrated in different preclinical models, both in vitro and in vivo. In addition, the study will examine the effects of GET73 on alcohol cue induced brain activation by using a well-established blood-oxygen-level-dependent (BOLD) functional magnetic resonance (fMRI) paradigm in the same individuals. In summary, the study should provide important information on (i) the potential mechanism of action of GET73, (ii) on the brain mechanisms that would support its potential use for reduction in craving and drinking in AUD patients, and (iii) expand data on its safe use as a medication in heavy drinking individuals. The enrolment period will last approximately 18 to 21 months. For each subject the study will last 25 to 45 days. The primary objective of the study is to evaluate whether GET73 modulates central glutamate levels in recently abstinent individuals with AUD, using proton nuclear magnetic resonance spectroscopy (¹H-MRS). The secondary objectives of the study are: To evaluate whether GET73 modulates central GABA levels in recently abstinent individuals with AUD, using proton nuclear magnetic resonance spectroscopy (¹H-MRS) To evaluate whether GET73 affects alcohol cue induced brain activity in reward areas of brain. To explore whether the effects of GET73 on glutamate and GABA levels are related to its effects on alcohol cue induced brain activity. Safety Objective To evaluate the safety profile of GET73 in individuals with AUD, comparing Adverse Events (AEs) occurrence during GET73 treatment period vs placebo treatment period. This is a within-subject cross-over, randomized, double-blind, placebo-controlled study. Being a double blinded study, GET73 and placebo will be packaged identically. Both the Investigator and the study participant will be unaware of the treatment administered. The investigational product will be supplied to the Center packaged in "patient kits". Each "patient kit" will be made of 2 bottles (bottle A and bottle B) each containing 20 capsules of either GET73 or placebo. Being a cross-over design, all participants will receive both placebo and active treatment. The sequential order in which they will be administered to each participant will be defined by the randomization list. The participant will always receive bottle A in the phase A of the study and bottle B in phase B, but the content of the two bottles varies according to the randomization list. Research personnel will be blind to the content of the bottles, i.e. what study medication the subject is taking.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alcohol Use Disorder
Keywords
Glutamate, Alcohol use, GABA, GET73, Non-treatment seeking

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
After the eligibility of a subject has been determined in an initial screening period, the study will be conducted in 2 consecutive phases: in the first phase (phase A) the participant will be administered GET73 or placebo in a randomized order, in the other phase (phase B), the participant will be administered the treatment not received during phase A.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
The study will be double-blinded. At initiation visit the Investigator will be instructed on the method for blind breaking. The Contract Research Organization (CRO) will provide the Investigator with a set of sealed envelopes, each containing the unblinding information for a patient kit; the envelopes will be kept in the Pharmacy until the end of the study. A second set of sealed envelopes will be kept by the Sponsor pharmacovigilance officer. Unblinding codes should only be used in emergency situations for reasons of patient safety. The Investigator should contact the Sponsor before breaking the blind or the Sponsor should be informed immediately afterwards. The reason for breaking the blind must be fully documented and entered on the case report form. The unblinding envelopes will be checked for integrity by the Clinical Research Associate (CRA) and returned to the Sponsor at the end of the study. The subjects for whom the blind will be broken will be withdrawn from the study.
Allocation
Randomized
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
GET73
Arm Type
Experimental
Arm Description
GET73 is administered at the dose of 300 mg t.i.d. per day, with a minimum gap of 4 hours between administrations and a maximum gap of 9 hours. Each subject ingests a total of 5 capsules of GET73: 3 capsules of GET73 on the first day of the related phase, according to randomization, and 2 capsules on the second day of each phase.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo is administered t.i.d. per day, with a minimum gap of 4 hours between administrations and a maximum gap of 9 hours. Each subject ingests a total of 5 capsules of Placebo: 3 capsules of Placebo on the first day of the related phase, according to randomization, and 2 capsules on the second day.
Intervention Type
Drug
Intervention Name(s)
GET73
Intervention Description
GET73 300 mg oral capsules, administered three times a day on Visit 2 and 4, and twice a day on Visit 3 and 5.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo oral capsules, administered three times a day on Visit 2 and 4, and twice a day on Visit 3 and 5.
Primary Outcome Measure Information:
Title
Concentrations of glutamate in dorsal anterior cingulate measured via Proton Magnetic Resonance Spectroscopy
Description
The presence of water and glutamate will be quantified through ¹H-MRS and the change in glutamate/water concentration between baseline and end of treatment will be assessed
Time Frame
After 5 doses of medication administered over 2 days, repeated after a wash-out period of 7 to 21 days (crossover design)
Secondary Outcome Measure Information:
Title
Concentrations of GABA in dorsal anterior cingulate measured via Proton Magnetic Resonance Spectroscopy
Description
The presence of water and GABA will be quantified through ¹H-MRS and the change in GABA/water concentration between baseline and end of treatment will be assessed
Time Frame
After 5 doses of medication administered over 2 days, repeated after a wash-out period of 7 to 21 days (crossover design)
Title
Change in the blood oxygenation level dependent (BOLD) signal to alcohol cues
Description
Magnitude of change in the blood oxygenation level dependent (BOLD) signal to alcohol cues, relative to neutral beverage cues, in the ventral striatum and dorsal anterior cingulate cortex (alcohol cue reactivity task described in Schacht et al., 2013)
Time Frame
After 5 doses of medication administered over 2 days, repeated after a wash-out period of 7 to 21 days (crossover design)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male participants, or females who are post-menopausal or surgically sterile. Age between 21 and 40 years old (inclusive). Meets Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for current Alcohol Use Disorder, moderate severity (4 or more criteria met) as indicated by the Structured Clinical Interview for DSM-5 (SCID-5-RV). Reports drinking, on average, > 20 standard drinks per week in the 90 days prior to screening evaluation, and in the last week prior to screening. Must report drinking within the 48 hours prior to the first dose of medication in each study medication period. Positive for Ethyl Glucuronide (EtG) in urine (> 100 ng/ml) at screening and prior to the first dose of medication in each study medication period. Currently not engaged in, and does not want treatment for, alcohol related problems. Able to read and understand questionnaires and informed consent. Exclusion Criteria: Current DSM-5 diagnosis of any other substance use disorder except Nicotine Use Disorder. Any psychoactive substance use (except marijuana and nicotine) within the last 30 days before the screening visit, as indicated by self-report and/or urine drug screen. No marijuana use within the last seven days before the screening visit, by verbal report and negative urine drug test (< 50 ng/mL); if positive at screening, must be negative or decreasing urine Delta9-Tetrahydrocannabinol (THC) levels (corrected for urine creatinine level) at the second test (Day1 A-1). Current DSM-5 Axis I diagnosis, including major depression, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar affective disorder, schizophrenia, dissociative disorders, eating disorders, or any other psychotic or organic mental disorder. Current suicidal or homicidal ideation. Need for maintenance or acute treatment with any psychoactive medication, including antiepileptic medications. Current use, or use in the past 30 days, of any medication known to affect alcohol intake (e.g., disulfiram, naltrexone, acamprosate, topiramate). History of severe alcohol withdrawal (e.g., seizure, delirium tremens), as evidenced by self-report or a Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) score > 10. Clinically significant medical problems (e.g., unstable hypertension, neurological, cardiovascular, renal, gastrointestinal, or endocrine problems) that would impair participation or limit medication ingestion. Current or past hepatocellular disease, as indicated by verbal report or elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 300% the upper limit of the normal range, or bilirubin > 150% the upper limit of the normal range. Lack of a stable living situation. Presence of ferrous metal in the body, as evidenced by metal screening and self-report. Severe claustrophobia or weight > 300 pounds that preclude placement in the MRI scanner. History of head injury with > 2 minutes of unconsciousness. Participation in any behavioral and/or pharmacological study within the past 30 days; Concomitant use of CYP2C19 substrates; use of CYP2C19 and CYP3A4 inhibitors or inducers in the 14 days before dosing.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Raymond F Anton, MD
Organizational Affiliation
Department of Psychiatry and Behavioral Sciences - Medical University of South Carolina
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Psychiatry and Behavioral Sciences - Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
23032071
Citation
Schacht JP, Anton RF, Voronin KE, Randall PK, Li X, Henderson S, Myrick H. Interacting effects of naltrexone and OPRM1 and DAT1 variation on the neural response to alcohol cues. Neuropsychopharmacology. 2013 Feb;38(3):414-22. doi: 10.1038/npp.2012.195. Epub 2012 Oct 3.
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Effect of GET73 on MRS Measures of Central Glutamate and GABA in Individuals With Alcohol Use Disorder

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