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Orexin s Role in the Neurobiology of Substance Use Disorder

Primary Purpose

Nicotine Dependence

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Belsomra
Placebo
Methylphenidate
Sponsored by
National Institute on Drug Abuse (NIDA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Nicotine Dependence focused on measuring Orexin Antagonish, fMRI, Substance Use Disorder, Nicotine Dependence

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesAccepts Healthy Volunteers

INCLUSION CRITERIA: In order to be eligible to participate in this study, an individual must meet all of the following criteria: All Participants Participants will be volunteers between the ages of 18-60 (all genders). Justification: Many neural processes change with age, and these changes could introduce unwanted variability in both behavioral and MRI signals. Participants who are able to become pregnant must have a negative pregnancy test on all study days. Able and willing to provide written informed consent, which includes agreement to all Lifestyle Considerations at the time of study consent. Nicotine Dependence Arm -Participants must be a regular smoker/vaper with a urine cotinine level corresponding to nicotine user status for the specific test being used (typically corresponding to a urine cotinine above about 200 ng/ml) and have been smoking or vaping consistently for at least the past year (excluding quit attempts). EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from participation in this study: Participants cannot meet DSM-5 criteria for lifetime and/or current psychotic disorders such as bipolar disorder, schizophrenia, schizoaffective disorder or medical conditions-that impact reward function. Participants cannot meet DSM-5 criteria for current substance use disorders other than nicotine and marijuana and cannot meet criteria for current moderate or severe alcohol use disorder Participants cannot have positive illicit drug and alcohol screen on each study visit other than for nicotine or marijuana. Medications with the potential to depress CNS function will be assessed by the MAI, PI, or a physician s assistant and participants excluded as necessary. Participants cannot have a history of major head trauma resulting in cognitive impairment, seizure, or other neurological disorders. Participant cannot have any history of neurological disorders, including seizures, epilepsy, or cognitive impairment which may impact MRI metrics. Participants cannot be pregnant or breastfeeding. Justification: The impact of suvorexant on the developing fetus and infant. Individuals with severe hepatic impairment will be excluded Participants cannot be obese as determined by a Body Mass Index (BMI) of greater than 35. Participants cannot be using a CYP3A inhibitor/inducer (metabolism by CYP3A is the major elimination pathway for suvorexant) Participants cannot have any past or present significant cardiac disorders or cerebrovascular conditions such as palpitations, tachycardia, use of the cardiac medication Digoxin, arrhythmias, acute coronary syndrome, ischemic heart disease, or uncontrolled hypertension. Participants cannot have narcolepsy Participants cannot self-report complex sleep behaviors such as sleep driving, preparing and eating food or making phone calls Participants with Major Depressive Disorder who are using medication must be stable on medication for 3 months Subjects with suicidal ideation where outpatient treatment is determined unsafe Subjects that cannot speak English. Justification: To include non-English speakers, we would have to translate the consent and other study documents and hire and train bilingual staff, which would require resources that we do not have and could not justify, given the small sample size for each experiment. Additionally, the data integrity of some of the cognitive tasks and standardized questionnaires used in this study would be compromised as they have only been validated in English. Most importantly, ongoing communication regarding safety procedures is necessary when participants are undergoing MRI procedures. The inability to effectively communicate MRI safety procedures in a language other than English could compromise the safety of non- English-speaking participants Contraindication to MRI as determined by MRI Safety Screening form. Nicotine Dependent Arm - Participants cannot self-report compromised respiratory function such as severe obstructive sleep apnea or severe chronic obstructive pulmonary disease. Control Arm May not have regularly used any nicotine product in the past year. Must have an expired carbon monoxide level of less than or equal to 5 ppm and no detected cotinine. Must not have a history of excessive substance use that may impact reward function, as evaluated by the PI, MAI, and/or designee. Current pharmacological treatment for opioid use disorder (i.e., use of methadone) May not have (or currently be treated/medicated for) any diagnoses/conditions contraindicated for use of methylphenidate.

Sites / Locations

  • National Institute on Drug AbuseRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Control Arm

Nicotine Dependence Arm

Arm Description

80 Volunteers who are between the ages of 18-60 and are non-smokers/vapers. 1. Baseline visit with 2 fMRI scans pre- and post-20mg methylphenidate, 4 acute drug administration (6-14 days in randomized order: 1. Placebo + placebo; 2. 20mg suvorexant + Placebo; 3. Placebo + 40mg methylphenidate; 4. 20 mg suvorexant + 40mg methylphenidate max)

140 Volunteers who are between the ages of 18-60 and are daily smokers/vapers. Suvorexant at 10 mg single dose, and Suvorexant at 10 mg daily for approximately 7 days.

Outcomes

Primary Outcome Measures

fMRI - cue reactivity
Test whether acute and/or chronic suvorexant reduces smoking/vaping cue reactivity
cue reactivity and suvorexant effectiveness
Determine whether baseline variance in cue reactivity contributes to suvorexant s effectiveness
task based fMRI
Determine whether suvorexant blunts reward sensitivity
fMRI
to assess not only whether there is an interaction between acute methylphenidate and suvorexant on brain function and reward/cognition, but also whether any sex differences within this interaction exist

Secondary Outcome Measures

wearable watch sensor
Determine the impact of suvorexant on sleep
Resting state fMRI
Determine the impact of acute and chronic suvorexant on the brain s inherent resting function

Full Information

First Posted
November 24, 2022
Last Updated
October 19, 2023
Sponsor
National Institute on Drug Abuse (NIDA)
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1. Study Identification

Unique Protocol Identification Number
NCT05630781
Brief Title
Orexin s Role in the Neurobiology of Substance Use Disorder
Official Title
Orexin's Role in The Neurobiology of Substance Use Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
October 17, 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 15, 2023 (Actual)
Primary Completion Date
December 31, 2027 (Anticipated)
Study Completion Date
December 31, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute on Drug Abuse (NIDA)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Study Description: Despite the availability of pharmacotherapy for some substance use disorders, relapse vulnerability is still a significant issue. This suggests medications with alternative mechanisms of action should be explored to address this unmet need. Substantial preclinical research indicates that orexin antagonism blunts the internally and externally triggered motivation to attain abused substances. This research project will translate these preclinical findings into the clinical domain by administering the FDA approved orexin antagonist, suvorexant, to those with a substance use disorder. Suvorexant s ability to blunt neurobiological correlates of substance misuse will be assessed. This will be assessed following acute and repeated drug administration. Baseline individual differences will be considered to determine whether neurobiological variance influences suvorexant s impact in those with nicotine dependence. In an independent arm, the interaction between suvorexant and a dopamine agonist (methylphenidate) on cognitive function will be assessed in non-smoking individuals. Objectives: To determine the acute and chronic impact of the orexin antagonist, suvorexant, on neurobiological and behavioral factors linked with substance use disorders. Whether such effects are mediated by baseline characteristics will be tested. Given suvorexant is an FDA approved treatment for insomnia, sleep will be evaluated as well in the nicotine dependent arm. Endpoints: In nicotine-dependent individuals, suvorexant s impact on brain function will be assessed several ways by evaluating: 1) resting function, 2) reactivity to drug cues, 3) reactivity to non-drug related cognitive tasks. Sleep and nicotine use will be measured throughout the study period. In those without nicotine-dependence, the impact of suvorexant and the interaction of acute methylphenidate and suvorexant on brain function will be assessed. This arm will provide insight into how suvorexant impacts reward/cognition as well as impacts the pharmacological influence of methylphenidate on those same measures. Study Population:<TAB> Nicotine dependence arm:140 subjects; Volunteers who are between the ages of 18-60 and are daily smokers/vapers. Control arm: 80 subjects; Volunteers who are between the ages of 18-65 and are non-smokers/vapers This study will be conducted at the NIDA-IRP, Biomedical Research Center, in Baltimore, MD. Description of Study Intervention: Nicotine dependence arm: Suvorexant at 10 mg single dose, and Suvorexant at 10 mg daily for approximately 7 days. Control arm: 1. Baseline visit with 2 fMRI scans pre- and post-20mg methylphenidate, 4 acute drug administration (6-14 days in randomized order: 1. Placebo + placebo; 2. 20mg suvorexant + Placebo; 3. Placebo + 40mg methylphenidate; 4. 20 mg suvorexant + 40mg methylphenidate max) Study Duration: 5 years Participant Duration: 1-2 months
Detailed Description
Study Description: Despite the availability of pharmacotherapy for some substance use disorders, relapse vulnerability is still a significant issue. This suggests medications with alternative mechanisms of action should be explored to address this unmet need. Substantial preclinical research indicates that orexin antagonism blunts the internally and externally triggered motivation to attain abused substances. This research project will translate these preclinical findings into the clinical domain by administering the FDA approved orexin antagonist, suvorexant, to those with a substance use disorder. Suvorexant s ability to blunt neurobiological correlates of substance misuse will be assessed. This will be assessed following acute and repeated drug administration. Baseline individual differences will be considered to determine whether neurobiological variance influences suvorexant s impact . in those with nicotine dependence. In an independent arm, the interaction between suvorexant and a dopamine agonist (methylphenidate) on cognitive function will be assessed in non-smoking individuals. Objectives: The objective is to determine the acute and chronic impact of the orexin antagonist, suvorexant, on neurobiological and behavioral factors linked with substance use disorders. Whether such effects are mediated by baseline characteristics will be tested. Given suvorexant is an FDA approved treatment for insomnia, sleep will be evaluated as well in the nicotine dependent arm. Endpoints: In nicotine-dependent individuals, Suvorexant s impact on brain function will be assessed several ways by evaluating: 1) resting function, 2) reactivity to drug cues, 3) reactivity to non-drug related cognitive tasks. Sleep and nicotine use will be measured throughout the study period. In those without nicotine-dependence, the impact of suvorexant and the interaction of acute methylphenidate and suvorexant on brain function will be assessed. This arm will provide insight into how suvorexant impacts reward/cognition as well as impacts the pharmacological influence of methylphenidate on those same measures.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nicotine Dependence
Keywords
Orexin Antagonish, fMRI, Substance Use Disorder, Nicotine Dependence

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
140 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Control Arm
Arm Type
Active Comparator
Arm Description
80 Volunteers who are between the ages of 18-60 and are non-smokers/vapers. 1. Baseline visit with 2 fMRI scans pre- and post-20mg methylphenidate, 4 acute drug administration (6-14 days in randomized order: 1. Placebo + placebo; 2. 20mg suvorexant + Placebo; 3. Placebo + 40mg methylphenidate; 4. 20 mg suvorexant + 40mg methylphenidate max)
Arm Title
Nicotine Dependence Arm
Arm Type
Experimental
Arm Description
140 Volunteers who are between the ages of 18-60 and are daily smokers/vapers. Suvorexant at 10 mg single dose, and Suvorexant at 10 mg daily for approximately 7 days.
Intervention Type
Drug
Intervention Name(s)
Belsomra
Intervention Description
randomized, double-blind, placebo-controlled crossover design study: Participants will undergo a baseline scan followed by 2 acute drug administration scans where suvorexant or placebo is administered in a randomized manner where both the participant and study staff administering drug are blind. Following the second acute scan, participants will continue with the drug they received at Scan 2 for approximately 7 days. After the first chronic scan, participants will switch to the other drug for an additional ~7 days and then scanned a final time.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
comparator taken for ~10 days
Intervention Type
Drug
Intervention Name(s)
Methylphenidate
Intervention Description
Control Arm: Baseline visit with 2 fMRI scans pre- and post-20mg methylphenidate, 4 acute drug administration (6-14 days in randomized order: 1. Placebo + placebo; 2. 20mg suvorexant + Placebo; 3. Placebo + 40mg methylphenidate; 4. 20 mg suvorexant + 40mg methylphenidate max)
Primary Outcome Measure Information:
Title
fMRI - cue reactivity
Description
Test whether acute and/or chronic suvorexant reduces smoking/vaping cue reactivity
Time Frame
each scan visit
Title
cue reactivity and suvorexant effectiveness
Description
Determine whether baseline variance in cue reactivity contributes to suvorexant s effectiveness
Time Frame
each scan visit
Title
task based fMRI
Description
Determine whether suvorexant blunts reward sensitivity
Time Frame
each scan visit
Title
fMRI
Description
to assess not only whether there is an interaction between acute methylphenidate and suvorexant on brain function and reward/cognition, but also whether any sex differences within this interaction exist
Time Frame
each scan visit
Secondary Outcome Measure Information:
Title
wearable watch sensor
Description
Determine the impact of suvorexant on sleep
Time Frame
2 weeks of daily watch wearing
Title
Resting state fMRI
Description
Determine the impact of acute and chronic suvorexant on the brain s inherent resting function
Time Frame
each scan visit

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
INCLUSION CRITERIA: In order to be eligible to participate in this study, an individual must meet all of the following criteria: All Participants Participants will be volunteers between the ages of 18-60 (all genders). Justification: Many neural processes change with age, and these changes could introduce unwanted variability in both behavioral and MRI signals. Participants who are able to become pregnant must have a negative pregnancy test on all study days. Able and willing to provide written informed consent, which includes agreement to all Lifestyle Considerations at the time of study consent. Nicotine Dependence Arm -Participants must be a regular smoker/vaper with a urine cotinine level corresponding to nicotine user status for the specific test being used (typically corresponding to a urine cotinine above about 200 ng/ml) and have been smoking or vaping consistently for at least the past year (excluding quit attempts). EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from participation in this study: Participants cannot meet DSM-5 criteria for lifetime and/or current psychotic disorders such as bipolar disorder, schizophrenia, schizoaffective disorder or medical conditions-that impact reward function. Participants cannot meet DSM-5 criteria for current substance use disorders other than nicotine and marijuana and cannot meet criteria for current moderate or severe alcohol use disorder Participants cannot have positive illicit drug and alcohol screen on each study visit other than for nicotine or marijuana. Medications with the potential to depress CNS function will be assessed by the MAI, PI, or a physician s assistant and participants excluded as necessary. Participants cannot have a history of major head trauma resulting in cognitive impairment, seizure, or other neurological disorders. Participant cannot have any history of neurological disorders, including seizures, epilepsy, or cognitive impairment which may impact MRI metrics. Participants cannot be pregnant or breastfeeding. Justification: The impact of suvorexant on the developing fetus and infant. Individuals with severe hepatic impairment will be excluded Participants cannot be obese as determined by a Body Mass Index (BMI) of greater than 35. Participants cannot be using a CYP3A inhibitor/inducer (metabolism by CYP3A is the major elimination pathway for suvorexant) Participants cannot have any past or present significant cardiac disorders or cerebrovascular conditions such as palpitations, tachycardia, use of the cardiac medication Digoxin, arrhythmias, acute coronary syndrome, ischemic heart disease, or uncontrolled hypertension. Participants cannot have narcolepsy Participants cannot self-report complex sleep behaviors such as sleep driving, preparing and eating food or making phone calls Participants with Major Depressive Disorder who are using medication must be stable on medication for 3 months Subjects with suicidal ideation where outpatient treatment is determined unsafe Subjects that cannot speak English. Justification: To include non-English speakers, we would have to translate the consent and other study documents and hire and train bilingual staff, which would require resources that we do not have and could not justify, given the small sample size for each experiment. Additionally, the data integrity of some of the cognitive tasks and standardized questionnaires used in this study would be compromised as they have only been validated in English. Most importantly, ongoing communication regarding safety procedures is necessary when participants are undergoing MRI procedures. The inability to effectively communicate MRI safety procedures in a language other than English could compromise the safety of non- English-speaking participants Contraindication to MRI as determined by MRI Safety Screening form. Nicotine Dependent Arm - Participants cannot self-report compromised respiratory function such as severe obstructive sleep apnea or severe chronic obstructive pulmonary disease. Control Arm May not have regularly used any nicotine product in the past year. Must have an expired carbon monoxide level of less than or equal to 5 ppm and no detected cotinine. Must not have a history of excessive substance use that may impact reward function, as evaluated by the PI, MAI, and/or designee. Current pharmacological treatment for opioid use disorder (i.e., use of methadone) May not have (or currently be treated/medicated for) any diagnoses/conditions contraindicated for use of methylphenidate.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
NIDA IRP Screening Team
Phone
(800) 535-8254
Email
researchstudies@nida.nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Amy Janes, Ph.D.
Phone
(667) 312-5164
Email
amy.janes@nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amy Janes, Ph.D.
Organizational Affiliation
National Institute on Drug Abuse (NIDA)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institute on Drug Abuse
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21224
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Betty Jo Salmeron, M.D.
Phone
443-740-2651
Email
bsalmeron@intra.nida.nih.gov

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
.We plan to share data as specified in the protocol and potentially through future data transfer agreement(s). Any shared data will be stripped of identifiers prior to release for sharing. Deidentified data may be shared with properly administered databases and/or with collaborators with whom proper data sharing agreements are in place. Outside of the data sharing plan already specified in the protocol (in what would be outline in a future data sharing agreement), we have not yet finalized decisions on types of supporting information that will be shared, IPD Sharing Time Frame, IPD Sharing Access Criteria for other future data sharing agreements.

Learn more about this trial

Orexin s Role in the Neurobiology of Substance Use Disorder

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