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A Novel Compound for Alcoholism Treatment: A Translational Strategy - Part II

Primary Purpose

Alcoholism

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
PF-05190457
Placebo
Sponsored by
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Alcoholism focused on measuring Alcohol Consumption, Alcohol Treatment, Alcoholism, Ghrelin, Ghrelin Antagonism

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:
  • Male or female individuals 18-70 years old (inclusive)
  • Current Alcohol Use Disorder (AUD) by DSM-5 criteria based on the SCID
  • Most recent urine drug test for illegal drugs of abuse is negative
  • Most recent Clinical Institute Withdrawal Assessment for Alcohol - revised (CIWA-Ar) score is less than or equal to 8
  • Heart rate less than or equal to 100 on two separate measurements, both assessed after CIWA-Ar score is less than or equal to 8
  • Female subjects must be of non childbearing potential as defined by at least one of the following criteria:

    a) Females 45-70 years old, who are menopausal, defined as follow:

    i) Females who are between 45-55 years old: they will be considered menopausal if they satisfy all the following three requirements during screening: 1) they are in amenorrhea, defined as absence of menstruation for the previous 12 months; 2) they have a negative urine pregnancy test; and 3) they have a serum FSH level within the laboratory s reference range for postmenopausal females.

ii) Females who are between 56-70 years old: they will be considered menopausal if they are in amenorrhea, defined as absence of menstruation for the previous 12 months before screening.

OR

b) Females 21-70 years old, who have a documented hysterectomy and/or bilateral oophorectomy.

All other female subjects (including females with tubal ligations and females that do NOT have a documented hysterectomy) will be considered to be of childbearing potential.

  • Male subjects must use one of the following methods of contraception from the first dose of study medication and until 28 days after dosing (given that it is unknown whether the effects of this drug can cause birth defects):

    1. Abstinence.
    2. A condom AND one of the following:

      • Vasectomy for more than 6 months.
      • Female partner who meets one of the following conditions:

        1. Has had a tubal ligation, hysterectomy, or bilateral oophorectomy;
        2. Is post menopausal;
        3. Uses one of the following forms of contraception:

          Copper or hormonal containing IUD;

          Spermicidal foam/gel/film/cream/suppository;

          Diaphragm with spermicide;

          Oral contraceptive;

          Injectable progesterone;

          Subdermal implant.

          EXCLUSION CRITERIA:

  • Lifetime clinical diagnosis of schizophrenia or bipolar disorder
  • EKG with QTc > 450 msec as determined by the Fridericia formulas.
  • BMI less than or equal to 18.5 kg/M(2) or anorexia
  • BMI greater than or equal to 40 kg/m(2)
  • History of epilepsy and/or seizures

NOTE: individuals who have a history of alcohol withdrawal seizures may be in the study as long as they have been abstinent from alcohol for at least 2 weeks prior to consent and during that period of abstinence, there were no seizure episodes (otherwise, participant remains not eligible).

  • Most recent blood tests show creatinine greater than or equal to 2 mg/dL, AST or ALT > 3 times the upper normal limit, hemoglobin <10.5 g/dl
  • Subjects who have diabetes and/or are treated with any drug with glucose lowering properties such as sulfonylurea, insulin, metformin, thiazolidinediones (TZD), Dipeptidyl peptidase-4 (DPP4) inhibitors, or Glucagon-like peptide-1(GLP-1)agonists (due to the glucose-lowering properties of PF-05190457 observed in healthy volunteers)
  • Exclusionary Medications:

    • A. Naltrexone, acamprosate, alcohol dehydrogenase inhibitors, topiramate, gabapentin, ondansetron, benzodiazepines, baclofen, drugs that are known to prolong the QTc interval and barbiturates as well as hormone replacement therapy; medications and dietary/herbal supplements (like St. John's wort) that interact with Cytochrome P450 3A4. Patients who take these medications may be enrolled in the study only if the potentially interacting medication has been stopped for a period of at least 5 half-lives of the interacting medication before PF-05190457 administration. Patients who take these medications on an as needed (PRN) schedule or take

the medication as a one-time dose as part of a medical procedure or a diagnostic test, for example, may not have to wait the 5 half-lives period of time before enrollment; this will be evaluated on a case by case basis by the MAI and/or PI, based on the specific pharmacological properties of the medication.

  • Unable to pass a finger rub hearing test
  • Vision is unable to be corrected to (Snellen) 20/100
  • Clinically-significant history of motion or car sickness, or history of vestibular disorders
  • Any other reason or clinical condition for which the PI or the MAI will consider unsafe for a possible participant to participate in this study

EXCLUSION CRITERIA FOR fMRI ONLY:

  • Have contraindications for brain fMRI, as determined by the NIAAA MRI Safety screening form (conducted under the 14-AA-0181 Screening Protocol)
  • Colorblindness (this would prevent subject from completing the Stroop task) using the Ishihara Test for Color Deficiency, Concise Edition, 2014.

Sites / Locations

  • National Institutes of Health Clinical Center, 9000 Rockville Pike

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

PF-05190457, then placebo

Placebo, then PF-05190457

Arm Description

Participants with alcohol use disorder received PF-05190457 100 mg twice a day for a maximum of 14 days followed by a minimum of 2-day washout period, then placebo twice a day for a maximum of 14 days.

Participants with alcohol use disorder received placebo twice a day for a maximum of 14 days followed by a minimum of 2-day washout period then PF-05190457 100 mg twice a day for a maximum of 14 days.

Outcomes

Primary Outcome Measures

Alcohol Cue-elicited Craving Assessed in a "Bar-like" Laboratory
Alcohol cue elicited craving was measured using the Alcohol Urges Questionnaire (AUQ). The AUQ is an 8-item self-administered instrument that assesses craving for alcohol among alcohol users in the current context (i.e., right now). The score ranges from 8 (lowest craving value) to 56 (highest craving value).

Secondary Outcome Measures

Food Choices in a "Virtual Buffet" Conducted in a Virtual Reality Context.
Food choice was assessed by calculating the total of number of calories for a meal selected in a virtual buffet environment. Calories were adjusted for the size of items in the virtual reality environment.

Full Information

First Posted
March 11, 2016
Last Updated
February 23, 2022
Sponsor
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Collaborators
National Institute on Drug Abuse (NIDA), University of Rhode Island
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1. Study Identification

Unique Protocol Identification Number
NCT02707055
Brief Title
A Novel Compound for Alcoholism Treatment: A Translational Strategy - Part II
Official Title
A Novel Compound for Alcoholism Treatment: A Translational Strategy - Part II
Study Type
Interventional

2. Study Status

Record Verification Date
October 2021
Overall Recruitment Status
Terminated
Why Stopped
Early termination of the study due to the COVID-19 pandemic
Study Start Date
June 15, 2016 (Actual)
Primary Completion Date
February 20, 2020 (Actual)
Study Completion Date
September 9, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Collaborators
National Institute on Drug Abuse (NIDA), University of Rhode Island

4. Oversight

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

5. Study Description

Brief Summary
Background: Hormones are naturally occurring chemicals in the body. Ghrelin is a hormone that stimulates appetite. It may also stimulate alcohol cravings and use. Researchers want to learn more about alcohol cravings and test if a drug that blocks ghrelin lowers alcohol cravings. Objective: To test if the drug PF-05190457 decreases alcohol craving. Eligibility: People ages 18-70 who have: Alcohol use disorder No other serious medical problems Woman must be postmenopausal or have had surgery to prevent pregnancy. Design: Participants will stay on the inpatient unit here at the Clinical Center for two 2-week stages, which will be separated by at least 2 days. The inpatient phase include: Taking the study drug or placebo by mouth twice daily Blood tests Tasting several sweet solutions Physical exams Exposure to alcohol, water, and food cues in a bar-like room. Participants answer questions on a computer. Blood pressure and heart rate are monitored through an arm cuff and sensors on the chest. MRIs: Participants lie on a table that slides in and out of the cylinder, and a coil is placed over the head. They complete tasks on a computer screen while in the cylinder. This lasts up to 2 hours. Wearing a virtual reality headset, walking around a virtual room, and selecting virtual food and drink. Physical exams
Detailed Description
Objective: Ghrelin is a 28-amino acid peptide that stimulates appetite and food intake. It is an endogenous ligand for the growth hormone secretagogue receptor (GHSR1a). Preclinical studies suggest that ghrelin modulates alcohol reward processing. Previous work from our research team, indicated that intravenous (IV) ghrelin administration, compared to placebo, results in an acute increase in alcohol craving during a cue-reactivity experiment in alcoholic individuals. Therefore, an oral bioavailable, ghrelin receptor antagonist that is able to pass through the blood brain barrier holds particular promise as a treatment for alcohol use disorder (AUD). This protocol is part of a grant project funded by National Center for Advancing Translational Sciences (NCATS) aimed to generate preliminary evidence in AUD on the safety and efficacy of a ghrelin receptor (GHSR1a) antagonist, PF-05190457, an existing molecule available under the NIH-Industry Pilot Program at NCATS. Completed preclinical and clinical (Protocol #14-AA-0042) work has demonstrated the safety of PF-05190457/alcohol interaction. The goal of this protocol is to conduct a proof-of-concept human laboratory study to assess an early-signal of efficacy of PF-05190457 in AUD. Study population: The study population will be AUD individuals (n = 55). Study Design: A within-subject, counterbalanced, double-blind, placebo-controlled study. Outcome measures: The primary aim will be to determine whether PF-05190457, compared to placebo, reduces alcohol cue-elicited craving. As another outcome will be to determine whether PF-05190457, compared to placebo, reduces brain blood oxygen level dependent (BOLD) response during exposure to alcohol cues, during a task-based fMRI scan. We will also investigate the effects of PF-05190457 on food craving as well as on food choices using a virtual buffet experimental procedure. All these outcomes will be assessed in the inpatient Unit at the NIH Clinical Center (CC). After the inpatient portion of the protocol, patients will be followed-up as outpatients. During the outpatient phase, patients will be offered motivational interviewing and video feedback to explore the effects of this intervention, compared to supportive counseling, on maintaining motivation for alcohol abstinence and inform future studies where medications like PF-05190457 and behavioral treatments may be combined. The outpatient phase is optional for treatment seeking and nontreatment seeking participants.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alcoholism
Keywords
Alcohol Consumption, Alcohol Treatment, Alcoholism, Ghrelin, Ghrelin Antagonism

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
42 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PF-05190457, then placebo
Arm Type
Experimental
Arm Description
Participants with alcohol use disorder received PF-05190457 100 mg twice a day for a maximum of 14 days followed by a minimum of 2-day washout period, then placebo twice a day for a maximum of 14 days.
Arm Title
Placebo, then PF-05190457
Arm Type
Placebo Comparator
Arm Description
Participants with alcohol use disorder received placebo twice a day for a maximum of 14 days followed by a minimum of 2-day washout period then PF-05190457 100 mg twice a day for a maximum of 14 days.
Intervention Type
Drug
Intervention Name(s)
PF-05190457
Intervention Description
Ghrelin Receptor Inverse Agonist
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo
Primary Outcome Measure Information:
Title
Alcohol Cue-elicited Craving Assessed in a "Bar-like" Laboratory
Description
Alcohol cue elicited craving was measured using the Alcohol Urges Questionnaire (AUQ). The AUQ is an 8-item self-administered instrument that assesses craving for alcohol among alcohol users in the current context (i.e., right now). The score ranges from 8 (lowest craving value) to 56 (highest craving value).
Time Frame
96 minutes
Secondary Outcome Measure Information:
Title
Food Choices in a "Virtual Buffet" Conducted in a Virtual Reality Context.
Description
Food choice was assessed by calculating the total of number of calories for a meal selected in a virtual buffet environment. Calories were adjusted for the size of items in the virtual reality environment.
Time Frame
40 minutes

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: Male or female individuals 18-70 years old (inclusive) Current Alcohol Use Disorder (AUD) by DSM-5 criteria based on the SCID Most recent urine drug test for illegal drugs of abuse is negative Most recent Clinical Institute Withdrawal Assessment for Alcohol - revised (CIWA-Ar) score is less than or equal to 8 Heart rate less than or equal to 100 on two separate measurements, both assessed after CIWA-Ar score is less than or equal to 8 Female subjects must be of non childbearing potential as defined by at least one of the following criteria: a) Females 45-70 years old, who are menopausal, defined as follow: i) Females who are between 45-55 years old: they will be considered menopausal if they satisfy all the following three requirements during screening: 1) they are in amenorrhea, defined as absence of menstruation for the previous 12 months; 2) they have a negative urine pregnancy test; and 3) they have a serum FSH level within the laboratory s reference range for postmenopausal females. ii) Females who are between 56-70 years old: they will be considered menopausal if they are in amenorrhea, defined as absence of menstruation for the previous 12 months before screening. OR b) Females 21-70 years old, who have a documented hysterectomy and/or bilateral oophorectomy. All other female subjects (including females with tubal ligations and females that do NOT have a documented hysterectomy) will be considered to be of childbearing potential. Male subjects must use one of the following methods of contraception from the first dose of study medication and until 28 days after dosing (given that it is unknown whether the effects of this drug can cause birth defects): Abstinence. A condom AND one of the following: Vasectomy for more than 6 months. Female partner who meets one of the following conditions: Has had a tubal ligation, hysterectomy, or bilateral oophorectomy; Is post menopausal; Uses one of the following forms of contraception: Copper or hormonal containing IUD; Spermicidal foam/gel/film/cream/suppository; Diaphragm with spermicide; Oral contraceptive; Injectable progesterone; Subdermal implant. EXCLUSION CRITERIA: Lifetime clinical diagnosis of schizophrenia or bipolar disorder EKG with QTc > 450 msec as determined by the Fridericia formulas. BMI less than or equal to 18.5 kg/M(2) or anorexia BMI greater than or equal to 40 kg/m(2) History of epilepsy and/or seizures NOTE: individuals who have a history of alcohol withdrawal seizures may be in the study as long as they have been abstinent from alcohol for at least 2 weeks prior to consent and during that period of abstinence, there were no seizure episodes (otherwise, participant remains not eligible). Most recent blood tests show creatinine greater than or equal to 2 mg/dL, AST or ALT > 3 times the upper normal limit, hemoglobin <10.5 g/dl Subjects who have diabetes and/or are treated with any drug with glucose lowering properties such as sulfonylurea, insulin, metformin, thiazolidinediones (TZD), Dipeptidyl peptidase-4 (DPP4) inhibitors, or Glucagon-like peptide-1(GLP-1)agonists (due to the glucose-lowering properties of PF-05190457 observed in healthy volunteers) Exclusionary Medications: A. Naltrexone, acamprosate, alcohol dehydrogenase inhibitors, topiramate, gabapentin, ondansetron, benzodiazepines, baclofen, drugs that are known to prolong the QTc interval and barbiturates as well as hormone replacement therapy; medications and dietary/herbal supplements (like St. John's wort) that interact with Cytochrome P450 3A4. Patients who take these medications may be enrolled in the study only if the potentially interacting medication has been stopped for a period of at least 5 half-lives of the interacting medication before PF-05190457 administration. Patients who take these medications on an as needed (PRN) schedule or take the medication as a one-time dose as part of a medical procedure or a diagnostic test, for example, may not have to wait the 5 half-lives period of time before enrollment; this will be evaluated on a case by case basis by the MAI and/or PI, based on the specific pharmacological properties of the medication. Unable to pass a finger rub hearing test Vision is unable to be corrected to (Snellen) 20/100 Clinically-significant history of motion or car sickness, or history of vestibular disorders Any other reason or clinical condition for which the PI or the MAI will consider unsafe for a possible participant to participate in this study EXCLUSION CRITERIA FOR fMRI ONLY: Have contraindications for brain fMRI, as determined by the NIAAA MRI Safety screening form (conducted under the 14-AA-0181 Screening Protocol) Colorblindness (this would prevent subject from completing the Stroop task) using the Ishihara Test for Color Deficiency, Concise Edition, 2014.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lorenzo Leggio, M.D., PhD
Organizational Affiliation
National Institute on Drug Abuse (NIDA); National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center, 9000 Rockville Pike
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_2016-AA-0080.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

A Novel Compound for Alcoholism Treatment: A Translational Strategy - Part II

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