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Semaglutide Therapy for Alcohol Reduction (STAR)

Primary Purpose

Addiction, Alcohol Use Disorder

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Take Control
Semaglutide
Sponsored by
National Institute on Drug Abuse (NIDA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Addiction focused on measuring Alcohol, Pharmacotherapy, GLP-1, Semaglutide

Eligibility Criteria

18 Years - 110 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

INCLUSION CRITERIA: This study will enroll adult individuals with a current diagnosis of AUD. Participants will be recruited without any preference to gender, race, religion, or other social variables, but sociodemographic data will be collected for sample characterization and potential use in the analyses. Since self-reported psychological measures that have been validated in English constitute major part of the study assessments, participants need to be able to speak, read, write, and understand English to be in the study. The information needed to assess eligibility will be collected under an IRB-approved NIDA IRP screening protocol, led by the Office of the Clinical Director (OCD) at the NIDA IRP to assess potential research participants eligibility for entering clinical protocols. Additional details can be found in the NIDA screening protocol documents. Furthermore, NIH medical records (from other NIH clinical protocols) and outside medical records may also be used, if available, to determine whether participants fulfill the eligibility criteria. To be eligible for this study, an individual must meet all of the following criteria: At least 18 years old Alcohol Use Disorder (minimum 2 symptoms on a validated diagnostic tool, e.g., the Mini-International Neuropsychiatric Interview (MINI) or the Structured Clinical Interview for DSM Disorders (SCID)) Self-reported drinking, according to alcohol TimeLine FollowBack (TLFB), of > 7 drinks per week for females or > 14 drinks per week for males during the 28-day period prior to screening + at least four days with > 3 drinks for females or > 4 drinks for males during the 28-day period prior to screening Most recent Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) score < 10 Able to speak, read, write, and understand English as demonstrated by ability to understand and sign the NIDA screening protocol consent Normal or corrected-to-normal (e.g., wearing glasses or contacts) vision and normal or corrected-to-normal (e.g., with the use of a hearing aid) hearing EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from enrolling in this study: BMI < 25 kg/m^2 or BMI >= 50 kg/m^2 Evidence of malnutrition as determined by the Nutrition Risk Screening 2002 (NRS-2002) Most recent blood tests: creatinine >= 2 mg/dL, eGFR <= 60 mL/min/1.73 m^2, triglycerides > 500 mg/dl, ALP > 4(SqrRoot) the upper limit of normal, clinically abnormal lipase levels per study clinician Present diagnosis of diabetes mellitus or blood hemoglobin A1c (HbA1c) >= 6.5 % Current (within the past 30 days) use of the following medications with glucose lowering properties: GLP-1 analogues, sulfonylurea, insulin, metformin, thiazolidinediones, dipeptidyl peptidase-4 (DPP-IV) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors Current (within the past 30 days) use of weight-lowering medications Current (within the past 30 days) use of FDA-approved pharmacotherapy for AUD (oral or intramuscular naltrexone, acamprosate, disulfiram) Current (within the past 30 days) use of medications with known interaction with semaglutide Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) Known history of alcohol ketoacidosis, gastroparesis, pancreatitis (either acute or chronic), pancreatic carcinoma, gallbladder disease, jaundice, Mallory-Weiss syndrome (esophageal tears secondary to vomiting), esophageal varices, cirrhosis Known history of gastric bypass surgery Known history of prior hypersensitivity reaction to semaglutide, any of the product components, or any other GLP-1 analogue Known history of suicidal attempts (within the past 24 months) or active suicidal ideation Known history of vestibular disorders or clinically significant motion sickness Known history of noise-induced hearing loss or tinnitus Contraindication(s) for brain fMRI Unstable cardiovascular conditions (e.g., arrhythmias, clinically significant ECG abnormalities) Physical and/or mental health conditions that are clinically unstable, as determined by the study clinicians, including (but not limited to) major depressive disorder or generalized anxiety disorder unstable during the past three months or other psychiatric conditions (e.g., schizophrenia, bipolar disorder) unstable during the past twelve months prior to screening. Female who is pregnant, breast-feeding, or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method Any other reason or clinical condition that the investigators judge may interfere with study participation and/or be unsafe for a participant

Sites / Locations

  • National Institute on Drug AbuseRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo

Semaglutide

Arm Description

Weekly subcutaneous (s.c.) injections of placebo.

Weekly subcutaneous (s.c.) injections of semaglutide up to 2.4 mg/week or maximum tolerated dose (MTD). Consistent with current recommendations, the dose will be titrated at minimum every four weeks to maximize tolerability and minimize adverse events.

Outcomes

Primary Outcome Measures

Determine whether semaglutide, compared to placebo, reduces alcohol drinking.
Recording the difference of alcohol consumption between baseline and end of the study is crucial to understand whether drinking amount/patterns change throughout the study, potentially due to the use of semaglutide.
Determine the safety and tolerability of semaglutide in individuals with AUD.
High numbers of severe adverse events negatively reflect a drug s safety and tolerability in a specific patient population.

Secondary Outcome Measures

Determine whether semaglutide, compared to placebo, reduces other self-reported alcohol-related outcomes.
Recording the difference of alcohol consumption between baseline and end of the study is crucial to understand whether drinking amount/patterns change throughout the study, potentially due to the use of semaglutide.
Determine whether semaglutide reduces blood Phosphatidylethanol (PEth) levels as a biomarker of alcohol use.
Recording the difference of blood PEth levels between baseline and end of the study will provide an objective biomarker of change in alcohol use throughout the study, potentially due to the use of semaglutide.
Determine whether semaglutide reduces alcohol/food cue-elicited craving assessed in a bar-like laboratory.
Differences in craving scores will demonstrate whether the drug changes cue-reactivity in a population with AUD.
Determine whether semaglutide reduces and/or changes food choices in a virtual reality buffet-like laboratory.
Differences in food choices selected will demonstrate whether the drug changes food-seeking behaviors in a population with AUD.
Determine whether semaglutide reduces brain activity in resting-state and/or task-based fMRI scans.
Differences in fMRI outcomes will demonstrate whether the drug changes brain activity at rest and/or in response to tasks.

Full Information

First Posted
August 28, 2023
Last Updated
September 22, 2023
Sponsor
National Institute on Drug Abuse (NIDA)
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1. Study Identification

Unique Protocol Identification Number
NCT06015893
Brief Title
Semaglutide Therapy for Alcohol Reduction (STAR)
Official Title
Semaglutide Therapy for Alcohol Reduction (STAR): A Proof-of-Concept Phase II Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 19, 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 1, 2023 (Anticipated)
Primary Completion Date
December 31, 2030 (Anticipated)
Study Completion Date
December 31, 2030 (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
Background: Alcohol use disorder (AUD) is a problematic pattern of alcohol use accompanied by clinically significant medical consequences. Medications can help most people reduce their drinking, but the number is limited, and additional treatment options are needed. Objective: To test if a medication named Semaglutide is safe and may reduce alcohol drinking in people with AUD. Who can participate? All Adults aged 18 or older with AUD might be eligible to participate in the study. What will happen during the study? Participants will visit the National Institute on Drug Abuse (NIDA) in Baltimore once a week for about 20 weeks (5 months). Each visit will last between 2 and 6 hours depending on the tasks scheduled for that visit. Participants will be assigned by chance (like flipping a coin) to receive either Semaglutide or placebo. A placebo looks just like a real drug but contains no medicine. The study medication is given as a shot under the skin each week. Participants will undergo different tests throughout the study: They will give blood, urine, and saliva samples. They will engage in self-paced behavioral therapy on a computer. They will answer questions about their mood, diet, alcohol drinking and craving, tobacco use, etc. They will taste several sweet liquids and tell their preferences. They will sit in a bar-like room and be exposed to cues that might make them feel the urge to eat food or drink alcohol. They will wear a virtual reality headset that creates a cafeteria setting. They will walk the virtual cafeteria and choose food and drinks from a buffet. They will have a functional magnetic resonance imaging (fMRI) scan to take pictures of their brain. During the scans, participants will be shown pictures of alcohol-containing drinks, food, and other items.They will perform tasks on a computer screen. Participants will have a follow-up visit about 7 weeks after their last shot.
Detailed Description
Study Description: This study will test the safety/tolerability and early efficacy of subcutaneous (s.c.) semaglutide at the dose of 2.4 mg/week or maximum tolerated dose (MTD) as a potential new treatment for alcohol use disorder (AUD). Objectives: We propose to test safety/tolerability and early efficacy of semaglutide, a glucagon-like peptide-1 (GLP-1) analogue, as a novel pharmacotherapy to reduce alcohol use and related measures. This will be a Phase 2a, pilot, proof-of-concept, outpatient study combined with experimental medicine human laboratory procedures. Endpoints: The co-primary aims will be to determine whether A) semaglutide is safe and tolerable in individuals with AUD, as measured by the frequency/severity of adverse events and the proportion of participants who reach maximum dose, and B) semaglutide reduces alcohol drinking from baseline to endpoint, as measured by total number of standard alcohol-containing drinks consumed per week (drinks per week, DPW). The following secondary aims will also be examined: Whether semaglutide reduces other self-reported alcohol-related outcomes (e.g., heavy drinking days, drinks per drinking days, World Health Organization (WHO) drinking levels) Whether semaglutide reduces blood Phosphatidylethanol (PEth) levels as a biomarker of alcohol use Whether semaglutide reduces alcohol and/or food cue-elicited craving assessed in a bar-like laboratory Whether semaglutide reduces and/or changes food choices in a virtual reality buffet-like laboratory Whether semaglutide reduces brain activation during a functional magnetic resonance imaging (fMRI) scan

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Addiction, Alcohol Use Disorder
Keywords
Alcohol, Pharmacotherapy, GLP-1, Semaglutide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
52 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Weekly subcutaneous (s.c.) injections of placebo.
Arm Title
Semaglutide
Arm Type
Experimental
Arm Description
Weekly subcutaneous (s.c.) injections of semaglutide up to 2.4 mg/week or maximum tolerated dose (MTD). Consistent with current recommendations, the dose will be titrated at minimum every four weeks to maximize tolerability and minimize adverse events.
Intervention Type
Behavioral
Intervention Name(s)
Take Control
Intervention Description
A computer-delivered behavioral therapy derived from the NIAAA s self-help approach, Rethinking Drinking, developed for use in pharmacotherapy trials.
Intervention Type
Drug
Intervention Name(s)
Semaglutide
Intervention Description
Weekly subcutaneous (s.c.) injections of semaglutide (or placebo) up to 2.4 mg/week or maximum tolerated dose (MTD).
Primary Outcome Measure Information:
Title
Determine whether semaglutide, compared to placebo, reduces alcohol drinking.
Description
Recording the difference of alcohol consumption between baseline and end of the study is crucial to understand whether drinking amount/patterns change throughout the study, potentially due to the use of semaglutide.
Time Frame
Difference in number of standard alcohol-containing drinks consumed / week (Drinks Per Week, DPW) from baseline to end of the study.
Title
Determine the safety and tolerability of semaglutide in individuals with AUD.
Description
High numbers of severe adverse events negatively reflect a drug s safety and tolerability in a specific patient population.
Time Frame
Number and severity of adverse events during the study; number of people who reach the target dose.
Secondary Outcome Measure Information:
Title
Determine whether semaglutide, compared to placebo, reduces other self-reported alcohol-related outcomes.
Description
Recording the difference of alcohol consumption between baseline and end of the study is crucial to understand whether drinking amount/patterns change throughout the study, potentially due to the use of semaglutide.
Time Frame
Difference in other alcohol-related outcomes (e.g., heavy drinking days, drinks per drinking days, WHO drinking levels) from baseline to end of the study.
Title
Determine whether semaglutide reduces blood Phosphatidylethanol (PEth) levels as a biomarker of alcohol use.
Description
Recording the difference of blood PEth levels between baseline and end of the study will provide an objective biomarker of change in alcohol use throughout the study, potentially due to the use of semaglutide.
Time Frame
Difference in blood PEth levels from baseline to end of the study.
Title
Determine whether semaglutide reduces alcohol/food cue-elicited craving assessed in a bar-like laboratory.
Description
Differences in craving scores will demonstrate whether the drug changes cue-reactivity in a population with AUD.
Time Frame
Difference in alcohol/food craving scores post exposure between the two groups.
Title
Determine whether semaglutide reduces and/or changes food choices in a virtual reality buffet-like laboratory.
Description
Differences in food choices selected will demonstrate whether the drug changes food-seeking behaviors in a population with AUD.
Time Frame
Difference in food selection in the virtual buffet between the two groups.
Title
Determine whether semaglutide reduces brain activity in resting-state and/or task-based fMRI scans.
Description
Differences in fMRI outcomes will demonstrate whether the drug changes brain activity at rest and/or in response to tasks.
Time Frame
Difference in relevant fMRI measures between the two groups.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
110 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: This study will enroll adult individuals with a current diagnosis of AUD. Participants will be recruited without any preference to gender, race, religion, or other social variables, but sociodemographic data will be collected for sample characterization and potential use in the analyses. Since self-reported psychological measures that have been validated in English constitute major part of the study assessments, participants need to be able to speak, read, write, and understand English to be in the study. The information needed to assess eligibility will be collected under an IRB-approved NIDA IRP screening protocol, led by the Office of the Clinical Director (OCD) at the NIDA IRP to assess potential research participants eligibility for entering clinical protocols. Additional details can be found in the NIDA screening protocol documents. Furthermore, NIH medical records (from other NIH clinical protocols) and outside medical records may also be used, if available, to determine whether participants fulfill the eligibility criteria. To be eligible for this study, an individual must meet all of the following criteria: At least 18 years old Alcohol Use Disorder (minimum 2 symptoms on a validated diagnostic tool, e.g., the Mini-International Neuropsychiatric Interview (MINI) or the Structured Clinical Interview for DSM Disorders (SCID)) Self-reported drinking, according to alcohol TimeLine FollowBack (TLFB), of > 7 drinks per week for females or > 14 drinks per week for males during the 28-day period prior to screening + at least four days with > 3 drinks for females or > 4 drinks for males during the 28-day period prior to screening Most recent Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar) score < 10 Able to speak, read, write, and understand English as demonstrated by ability to understand and sign the NIDA screening protocol consent Normal or corrected-to-normal (e.g., wearing glasses or contacts) vision and normal or corrected-to-normal (e.g., with the use of a hearing aid) hearing EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from enrolling in this study: BMI < 25 kg/m^2 or BMI >= 50 kg/m^2 Evidence of malnutrition as determined by the Nutrition Risk Screening 2002 (NRS-2002) Most recent blood tests: creatinine >= 2 mg/dL, eGFR <= 60 mL/min/1.73 m^2, triglycerides > 500 mg/dl, ALP > 4(SqrRoot) the upper limit of normal, clinically abnormal lipase levels per study clinician Present diagnosis of diabetes mellitus or blood hemoglobin A1c (HbA1c) >= 6.5 % Current (within the past 30 days) use of the following medications with glucose lowering properties: GLP-1 analogues, sulfonylurea, insulin, metformin, thiazolidinediones, dipeptidyl peptidase-4 (DPP-IV) inhibitors, sodium-glucose cotransporter-2 (SGLT-2) inhibitors Current (within the past 30 days) use of weight-lowering medications Current (within the past 30 days) use of FDA-approved pharmacotherapy for AUD (oral or intramuscular naltrexone, acamprosate, disulfiram) Current (within the past 30 days) use of medications with known interaction with semaglutide Personal or family history of medullary thyroid carcinoma (MTC) or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) Known history of alcohol ketoacidosis, gastroparesis, pancreatitis (either acute or chronic), pancreatic carcinoma, gallbladder disease, jaundice, Mallory-Weiss syndrome (esophageal tears secondary to vomiting), esophageal varices, cirrhosis Known history of gastric bypass surgery Known history of prior hypersensitivity reaction to semaglutide, any of the product components, or any other GLP-1 analogue Known history of suicidal attempts (within the past 24 months) or active suicidal ideation Known history of vestibular disorders or clinically significant motion sickness Known history of noise-induced hearing loss or tinnitus Contraindication(s) for brain fMRI Unstable cardiovascular conditions (e.g., arrhythmias, clinically significant ECG abnormalities) Physical and/or mental health conditions that are clinically unstable, as determined by the study clinicians, including (but not limited to) major depressive disorder or generalized anxiety disorder unstable during the past three months or other psychiatric conditions (e.g., schizophrenia, bipolar disorder) unstable during the past twelve months prior to screening. Female who is pregnant, breast-feeding, or intends to become pregnant or is of child-bearing potential and not using a highly effective contraceptive method Any other reason or clinical condition that the investigators judge may interfere with study participation and/or be unsafe for a participant
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Mehdi Farokhnia, M.D.
Phone
(240) 852-9763
Email
mehdi.farokhnia@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Lorenzo Leggio, M.D.
Phone
(240) 478-1503
Email
lorenzo.leggio@nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lorenzo Leggio, M.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
Mehdi Farokhnia, M.D., M.P.H.
Phone
240-852-9763
Email
mehdi.farokhnia@nih.gov

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
26308095
Citation
Lau J, Bloch P, Schaffer L, Pettersson I, Spetzler J, Kofoed J, Madsen K, Knudsen LB, McGuire J, Steensgaard DB, Strauss HM, Gram DX, Knudsen SM, Nielsen FS, Thygesen P, Reedtz-Runge S, Kruse T. Discovery of the Once-Weekly Glucagon-Like Peptide-1 (GLP-1) Analogue Semaglutide. J Med Chem. 2015 Sep 24;58(18):7370-80. doi: 10.1021/acs.jmedchem.5b00726. Epub 2015 Sep 11.
Results Reference
background
PubMed Identifier
28323117
Citation
Jensen L, Helleberg H, Roffel A, van Lier JJ, Bjornsdottir I, Pedersen PJ, Rowe E, Derving Karsbol J, Pedersen ML. Absorption, metabolism and excretion of the GLP-1 analogue semaglutide in humans and nonclinical species. Eur J Pharm Sci. 2017 Jun 15;104:31-41. doi: 10.1016/j.ejps.2017.03.020. Epub 2017 Mar 16.
Results Reference
background
PubMed Identifier
21950636
Citation
Donnelly D. The structure and function of the glucagon-like peptide-1 receptor and its ligands. Br J Pharmacol. 2012 May;166(1):27-41. doi: 10.1111/j.1476-5381.2011.01687.x.
Results Reference
background
PubMed Identifier
26080318
Citation
Suchankova P, Yan J, Schwandt ML, Stangl BL, Caparelli EC, Momenan R, Jerlhag E, Engel JA, Hodgkinson CA, Egli M, Lopez MF, Becker HC, Goldman D, Heilig M, Ramchandani VA, Leggio L. The glucagon-like peptide-1 receptor as a potential treatment target in alcohol use disorder: evidence from human genetic association studies and a mouse model of alcohol dependence. Transl Psychiatry. 2015 Jun 16;5(6):e583. doi: 10.1038/tp.2015.68.
Results Reference
background
PubMed Identifier
33424537
Citation
Marty VN, Farokhnia M, Munier JJ, Mulpuri Y, Leggio L, Spigelman I. Long-Acting Glucagon-Like Peptide-1 Receptor Agonists Suppress Voluntary Alcohol Intake in Male Wistar Rats. Front Neurosci. 2020 Dec 23;14:599646. doi: 10.3389/fnins.2020.599646. eCollection 2020.
Results Reference
background
PubMed Identifier
37192005
Citation
Chuong V, Farokhnia M, Khom S, Pince CL, Elvig SK, Vlkolinsky R, Marchette RC, Koob GF, Roberto M, Vendruscolo LF, Leggio L. The glucagon-like peptide-1 (GLP-1) analogue semaglutide reduces alcohol drinking and modulates central GABA neurotransmission. JCI Insight. 2023 Jun 22;8(12):e170671. doi: 10.1172/jci.insight.170671.
Results Reference
background
PubMed Identifier
36001436
Citation
Farokhnia M, Browning BD, Crozier ME, Sun H, Akhlaghi F, Leggio L. The glucagon-like peptide-1 system is modulated by acute and chronic alcohol exposure: Findings from human laboratory experiments and a post-mortem brain study. Addict Biol. 2022 Sep;27(5):e13211. doi: 10.1111/adb.13211.
Results Reference
background
PubMed Identifier
35906358
Citation
Farokhnia M, Fede SJ, Grodin EN, Browning BD, Crozier ME, Schwandt ML, Hodgkinson CA, Momenan R, Leggio L. Differential association between the GLP1R gene variants and brain functional connectivity according to the severity of alcohol use. Sci Rep. 2022 Jul 29;12(1):13027. doi: 10.1038/s41598-022-17190-3.
Results Reference
background
PubMed Identifier
34532853
Citation
Klausen MK, Thomsen M, Wortwein G, Fink-Jensen A. The role of glucagon-like peptide 1 (GLP-1) in addictive disorders. Br J Pharmacol. 2022 Feb;179(4):625-641. doi: 10.1111/bph.15677.
Results Reference
background

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Semaglutide Therapy for Alcohol Reduction (STAR)

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