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Pharmacological and Behavioral Treatment After Bariatric Surgery: Acute (Stage 1)

Primary Purpose

Loss-of-control Eating, Obesity/Overweight

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Naltrexone and Bupropion medication
Behavioral Weight Loss
Placebo
Sponsored by
Yale University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Loss-of-control Eating

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Be in the age range ≥18 years of age and ≤70 years of age.
  • Have a BMI ≥30 (or BMI ≥27 with a medical comorbidity) and ≤50
  • Have had laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy
  • Approximately six months post-surgery
  • Experience regular loss-of-control eating (defined as at least once weekly over the past 28 days)
  • Be an otherwise healthy subject without uncontrolled medical problems, as determined by the study physician and medical co-investigators (physical examination, laboratory studies).
  • Read, comprehend, and write English at a sufficient level to complete study-related materials.
  • Provide a signed and dated written informed consent prior to study participation.

Be available for participation in the study for up to 19 months (7-month treatment plus 12-month follow up).

Exclusion Criteria:

  • Has a predisposition to seizures (e.g., subject with a history or evidence of seizure disorder, febrile seizures during childhood, brain tumor, cerebrovascular disease, or significant head trauma; has a family history of idiopathic seizure disorder or is currently being treated with medications or treatment regimens that lower seizure threshold).
  • Has a history of anorexia nervosa or history of bulimia nervosa.
  • Is currently taking a medication that is a contraindication to NB medication (e.g., MAOI, opiates).
  • Is currently using other medications for weight loss.
  • Has a history of allergy or sensitivity to bupropion or naltrexone.
  • Has a co-existing psychiatric condition that requires hospitalization or more intensive treatment (such as bipolar mood disorders, psychotic illnesses, or severe depression)
  • Has untreated hypertension with a seated systolic blood pressure > 160 mmHg, diastolic blood pressure > 100 mmHg, or heart rate > 100 beats/minute.
  • Has a history of congenital heart disease, cardiovascular disease, cardiac arrhythmias requiring medication, or a history of cerebrovascular pathology including stroke.
  • Has current uncontrolled hypertension.
  • Has current uncontrolled Type I or Type II diabetes mellitus.
  • Has untreated hypothyroidism with a TSH > 1.5 times the upper limit of normal for the test laboratory with repeat value that also exceeds this limit.
  • Has gallbladder disease.
  • Has a history of severe renal, hepatic, neurological, chronic pulmonary disease, or any other unstable medical disorder.
  • Has a recent history of drug or alcohol dependence (since having bariatric surgery).
  • Is currently in active treatment for eating or weight loss.
  • Is currently participating in another clinical study in which the subject is or will be exposed to an investigational or a non-investigational drug or device.
  • Is breast-feeding or is pregnant or is not using a reliable form of birth control.
  • Reports active suicidal or homicidal ideation.

Sites / Locations

  • Yale Department of PsychiatryRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

Behavioral Weight Loss (BWL) + Naltrexone and Bupropion (NB) medication

BWL + Placebo

NB medication

Placebo

Arm Description

Participants randomly assigned to this arm will receive 16 weeks of BWL counseling and NB medication. The naltrexone and bupropion will be taken daily in pill form.

Participants randomly assigned to this arm will receive 16 weeks of BWL counseling and placebo. Placebo will be inactive and taken daily in pill form.

Participants randomly assigned to this arm will receive 16 weeks of NB medication taken daily in pill form.

Participants randomly assigned to this arm will receive 16 weeks of placebo. Placebo will be inactive and taken daily in pill form.

Outcomes

Primary Outcome Measures

Loss-of-control Eating Frequency
Loss-of-control eating frequency is a continuous variable of loss-of-control eating episodes assessed using the Eating Disorder Examination interview; Loss-of-control eating frequency will be based on the past 28 days and defined as loss-of-control eating episodes per month.
Body Mass Index
BMI is calculated using measured height and weight

Secondary Outcome Measures

Loss-of-control Eating Remission
Categorical: zero episodes/28 days
Weight loss
Categorical: 5% weight loss
Eating Disorder Psychopathology
Eating-disorder psychopathology is a continuous variable as assessed by the global score of the Eating Disorder Examination/Eating Disorder Examination-Questionnaire. Scores range from 0-6 (0=no eating-disorder psychopathology; 6=severe eating-disorder psychopathology).
Depressive Symptoms
Depressive symptoms is a continuous variable of depressive symptomatology as assessed by the self-report measure, the Patient Health Questionnaire - 9. Scores range from 0-27 (0=no depressive symptoms, 27=greater depressive symptoms).

Full Information

First Posted
October 21, 2020
Last Updated
August 30, 2023
Sponsor
Yale University
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT04599478
Brief Title
Pharmacological and Behavioral Treatment After Bariatric Surgery: Acute (Stage 1)
Official Title
Pharmacological and Behavioral Treatments to Treat Loss-of-Control Eating and Improve Weight Outcomes After Bariatric Surgery: Acute (Stage 1)
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 29, 2021 (Actual)
Primary Completion Date
January 2026 (Anticipated)
Study Completion Date
January 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Yale University
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will compare the effectiveness of behavioral and pharmacologic treatments, alone and in combination, for the treatment of loss-of-control eating and weight following bariatric surgery. This is an acute treatment comparing behavioral weight loss alone or in combination with combination naltrexone/bupropion medication.
Detailed Description
Participants who provide informed consent and are determined to be eligible will then participate in the study. A total of 160 patients with obesity and regular LOC-eating following MBS will be randomly assigned (double-blind) in a balanced factorial (2 X 2) design, to one of four 16-week interventions: BWL+NB, BWL+Placebo, NB, or Placebo. The randomization will be in equal proportions but stratified by surgery type.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Loss-of-control Eating, Obesity/Overweight

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Behavioral Weight Loss (BWL) + Naltrexone and Bupropion (NB) medication
Arm Type
Experimental
Arm Description
Participants randomly assigned to this arm will receive 16 weeks of BWL counseling and NB medication. The naltrexone and bupropion will be taken daily in pill form.
Arm Title
BWL + Placebo
Arm Type
Experimental
Arm Description
Participants randomly assigned to this arm will receive 16 weeks of BWL counseling and placebo. Placebo will be inactive and taken daily in pill form.
Arm Title
NB medication
Arm Type
Experimental
Arm Description
Participants randomly assigned to this arm will receive 16 weeks of NB medication taken daily in pill form.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Participants randomly assigned to this arm will receive 16 weeks of placebo. Placebo will be inactive and taken daily in pill form.
Intervention Type
Drug
Intervention Name(s)
Naltrexone and Bupropion medication
Other Intervention Name(s)
Contrave
Intervention Description
NB medication will be taken daily in pill form.
Intervention Type
Behavioral
Intervention Name(s)
Behavioral Weight Loss
Intervention Description
Behavioral Weight Loss (BWL) counseling includes weekly sessions.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo will be inactive and taken daily in pill form.
Primary Outcome Measure Information:
Title
Loss-of-control Eating Frequency
Description
Loss-of-control eating frequency is a continuous variable of loss-of-control eating episodes assessed using the Eating Disorder Examination interview; Loss-of-control eating frequency will be based on the past 28 days and defined as loss-of-control eating episodes per month.
Time Frame
Post-treatment (4 months)
Title
Body Mass Index
Description
BMI is calculated using measured height and weight
Time Frame
Post-treatment (4 months)
Secondary Outcome Measure Information:
Title
Loss-of-control Eating Remission
Description
Categorical: zero episodes/28 days
Time Frame
Post-treatment (4 months)
Title
Weight loss
Description
Categorical: 5% weight loss
Time Frame
Post-treatment (4 months)
Title
Eating Disorder Psychopathology
Description
Eating-disorder psychopathology is a continuous variable as assessed by the global score of the Eating Disorder Examination/Eating Disorder Examination-Questionnaire. Scores range from 0-6 (0=no eating-disorder psychopathology; 6=severe eating-disorder psychopathology).
Time Frame
Post-treatment (4 months)
Title
Depressive Symptoms
Description
Depressive symptoms is a continuous variable of depressive symptomatology as assessed by the self-report measure, the Patient Health Questionnaire - 9. Scores range from 0-27 (0=no depressive symptoms, 27=greater depressive symptoms).
Time Frame
Post-treatment (4 months)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be in the age range ≥18 years of age and ≤70 years of age. Have a BMI ≥30 (or BMI ≥27 with a medical comorbidity) and ≤50 Have had laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy Approximately six months post-surgery Experience regular loss-of-control eating (defined as at least once weekly over the past 28 days) Be an otherwise healthy subject without uncontrolled medical problems, as determined by the study physician and medical co-investigators (physical examination, laboratory studies). Read, comprehend, and write English at a sufficient level to complete study-related materials. Provide a signed and dated written informed consent prior to study participation. Be available for participation in the study for up to 19 months (7-month treatment plus 12-month follow up). Exclusion Criteria: Has a predisposition to seizures (e.g., subject with a history or evidence of seizure disorder, febrile seizures during childhood, brain tumor, cerebrovascular disease, or significant head trauma; has a family history of idiopathic seizure disorder or is currently being treated with medications or treatment regimens that lower seizure threshold). Has a history of anorexia nervosa or history of bulimia nervosa. Is currently taking a medication that is a contraindication to NB medication (e.g., MAOI, opiates). Is currently using other medications for weight loss. Has a history of allergy or sensitivity to bupropion or naltrexone. Has a co-existing psychiatric condition that requires hospitalization or more intensive treatment (such as bipolar mood disorders, psychotic illnesses, or severe depression) Has untreated hypertension with a seated systolic blood pressure > 160 mmHg, diastolic blood pressure > 100 mmHg, or heart rate > 100 beats/minute. Has a history of congenital heart disease, cardiovascular disease, cardiac arrhythmias requiring medication, or a history of cerebrovascular pathology including stroke. Has current uncontrolled hypertension. Has current uncontrolled Type I or Type II diabetes mellitus. Has untreated hypothyroidism with a TSH > 1.5 times the upper limit of normal for the test laboratory with repeat value that also exceeds this limit. Has gallbladder disease. Has a history of severe renal, hepatic, neurological, chronic pulmonary disease, or any other unstable medical disorder. Has a recent history of drug or alcohol dependence (since having bariatric surgery). Is currently in active treatment for eating or weight loss. Is currently participating in another clinical study in which the subject is or will be exposed to an investigational or a non-investigational drug or device. Is breast-feeding or is pregnant or is not using a reliable form of birth control. Reports active suicidal or homicidal ideation.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Valentina Ivezaj, Ph.D.
Phone
203-785-7210
Email
valentina.ivezaj@yale.edu
Facility Information:
Facility Name
Yale Department of Psychiatry
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06510
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Valentina Ivezaj, Ph.D.
Phone
203-785-7210
Email
valentina.ivezaj@yale.edu
First Name & Middle Initial & Last Name & Degree
Carlos M Grilo, Ph.D.

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Pharmacological and Behavioral Treatment After Bariatric Surgery: Acute (Stage 1)

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