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Apathy Cure Through Bupropion in Huntington's Disease (Action-HD)

Primary Purpose

Apathy, Huntington's Disease

Status
Completed
Phase
Phase 2
Locations
Germany
Study Type
Interventional
Intervention
Bupropion
Placebo
Sponsored by
Charite University, Berlin, Germany
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Apathy focused on measuring Huntington's disease, Apathy, Bupropion

Eligibility Criteria

25 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Verified HD mutation carriers aged 25 to 75 years (inclusive) at first dosing
  2. Apathetic as diagnosed by SCIA-D criteria
  3. Stable concomitant medication (no change of medication during last six weeks prior to inclusion)
  4. Written informed consent by prospective study participant before conduct of any trial-related procedure. Participant must be able to make an informed decision of whether or not to participate in the study
  5. Patient has a caregiver (family member or friend), who is living in a close relationship with the patient and is willing to give written informed consent (caregiver) before performance of any trial-related procedure

Exclusion criteria:

  1. Pregnant or nursing women
  2. Active suicidality based on the answer "yes" in questions 4 and 5 of the Columbia-Suicide Severity Rating Scale (baseline version)
  3. Woman of childbearing potential, not using highly effective methods of contraception defined as methods with a Pearl Index < 1 such as oral, topical or injected contraception, IUD, contraceptive vaginal ring, or double barrier method such as diaphragm and condom with spermicide) or not surgically sterile (via hysterectomy, ovariectomy or bilateral tubal ligation) or not at least one year post-menopausal
  4. Male not using an acceptable barrier method for contraception and donating sperm from screening up to three months following treatment
  5. Presence or history of any medically not controllable disease (e.g. uncontrolled arterial hypertension or diabetes mellitus)
  6. Presence or history of seizures or diagnosed epilepsy or history of severe head trauma (contusion) or CNS tumor
  7. Clinical significant renal (calculated creatine clearance < 60 ml/min) or hepatic dysfunction
  8. Clinical significant depression defined by the NPI depression score (score ≥4 points) at screening
  9. Schizophreniform psychosis within the last 6 months prior to first dose
  10. History of anorexia or bulimia
  11. Severe cognitive disorders defined as a score < 18 in the Mini- Mental State Examination (MMSE) at screening
  12. Marked chorea (UHDRS 4) of face, BOL, trunk or extremities
  13. Treatment with neuroleptics other than tiapride, MAO-B inhibitors, amantadine, levodopa, D- or D,L-amphetamine or psychostimulants like methylphenidate, modafinil or atomoxetine within 1 month prior to first dose
  14. Known hypersensitivity reaction associated with bupropion, gelatine, lactose or magnesium stearate
  15. Clinically relevant abnormal findings in the ECG, the vitals, in the physical examination or laboratory values at screening that could interfere with the objectives of the study or the safety of the subject as judged by the investigator
  16. Acute disease state (e.g. nausea, vomiting, fever, diarrhoea, infection) within 7 days of first dose
  17. Definite or suspected personal history or family history of adverse reactions or hypersensitivity to the trial compounds (or to compounds with a similar structure)
  18. Presence of illicit drug and/or alcohol abuse
  19. Participation in another investigative drug trial within 2 months or donation of blood within 12 weeks prior to the first dose or during the trial
  20. Subjects who are unlikely to be compliant and attend scheduled clinic visits as required
  21. Placement in an institution due to governmental or judicial authorities

Sites / Locations

  • Neurologische Klinik der Ruhr-Universität Bochum
  • Universitätsklinikum Ulm, Klinik für Neurologie

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Bupropion

Placebo

Arm Description

First treatment group: 150 mg bupropion or placebo once daily for 2 weeks, followed by 300 mg bupropion or placebo once daily for subsequent 8 weeks (until week 10; visit 4) First tapering and washout: 150 mg bupropion or placebo once daily for 7 days followed by a washout phase of 1 week on placebo

Second treatment group (crossover): placebo or 150 mg bupropion once daily for 2 weeks, followed by placebo or 300 mg bupropion once daily for subsequent 8 weeks (until week 22; visit 6) Second tapering placebo or 150 mg bupropion once daily for 7 days

Outcomes

Primary Outcome Measures

Apathy Evaluation Scale (AES-I)
The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-I, where I [informant] is a friend or family member familiar with the daily activities of the subject) in patients with HD after ten weeks of treatment.

Secondary Outcome Measures

AES-C (clinician)
The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-C, where C [clinician] is the trial investigator) in patients with HD after ten weeks of treatment.
AES-S (self)
The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-S, where S [self] is the patient) in patients with HD after ten weeks of treatment.
Motor symptoms (UHDRS)
The influence of Bupropion compared to placebo on the UHDRS motor score in patients with HD after ten weeks of treatment.
Quantitative grip force motor assessment
The influence of Bupropion compared to placebo on motor scores in patients with HD after ten weeks of treatment.
Cognitive Symptoms
The influence of Bupropion compared to placebo on MMSE in patients with HD after ten weeks of treatment.
Psychiatric symptoms
The influence of Bupropion compared to placebo on UHDRS behavioural assessment in patients with HD after ten weeks of treatment.
Activities of daily living
The influence of Bupropion compared to placebo on UHDRS Functional Assessment in patients with HD after ten weeks of treatment.
Caregiver's distress
The influence of Bupropion compared to placebo on the NPI caregiver's distress score.
ventral striatal and ventromedial prefrontal activation
Change of ventral striatal and ventromedial prefrontal activation in response to a reward paradigm as quantified by fMRI.
Adverse events
The safety and tolerability of Bupropion will be compared with placebo in patients with HD after ten weeks of treatment.

Full Information

First Posted
July 31, 2013
Last Updated
September 8, 2014
Sponsor
Charite University, Berlin, Germany
Collaborators
University of Ulm, Ruhr University of Bochum, University Hospital Muenster
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1. Study Identification

Unique Protocol Identification Number
NCT01914965
Brief Title
Apathy Cure Through Bupropion in Huntington's Disease
Acronym
Action-HD
Official Title
A Randomized, Double-blind, Placebo-controlled Prospective Crossover Trial Investigating the Efficacy and Safety of the Treatment With Bupropion in Patients With Apathy in Huntington's Disease
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Completed
Study Start Date
June 2012 (undefined)
Primary Completion Date
May 2014 (Actual)
Study Completion Date
May 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Charite University, Berlin, Germany
Collaborators
University of Ulm, Ruhr University of Bochum, University Hospital Muenster

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The influence of bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-I, where I [informant] is a friend or family member familiar with the daily activities of the subject) in patients with HD after ten (10) weeks of treatment.
Detailed Description
The safety and tolerability of Bupropion in HD. The influence of Bupropion compared to placebo on the: change of apathy as quantified by the AES-C (clinician) or the AES-S (self), change of motor symptoms (UHDRS) and quantitative grip force motor assessment, change of cognitive symptoms (UHDRS and MMSE), change of psychiatric symptoms (UHDRS, HADS), change of activities of daily living (UHDRS), change of the NPI caregivers' distress score (NPI-D), change of ventral striatal and ventromedial prefrontal activation in response to a reward paradigm as quantified by fMRI.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Apathy, Huntington's Disease
Keywords
Huntington's disease, Apathy, Bupropion

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Bupropion
Arm Type
Active Comparator
Arm Description
First treatment group: 150 mg bupropion or placebo once daily for 2 weeks, followed by 300 mg bupropion or placebo once daily for subsequent 8 weeks (until week 10; visit 4) First tapering and washout: 150 mg bupropion or placebo once daily for 7 days followed by a washout phase of 1 week on placebo
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Second treatment group (crossover): placebo or 150 mg bupropion once daily for 2 weeks, followed by placebo or 300 mg bupropion once daily for subsequent 8 weeks (until week 22; visit 6) Second tapering placebo or 150 mg bupropion once daily for 7 days
Intervention Type
Drug
Intervention Name(s)
Bupropion
Other Intervention Name(s)
Wellbutrin, Budeprion, Prexaton, Elontril, Aplenzin
Intervention Description
Crossover design: Oral administration of 150 mg bupropion once daily for 2 weeks, followed by 300 mg bupropion once daily for subsequent 8 weeks, tapering: 150 mg bupropion once daily for 7 days
Intervention Type
Drug
Intervention Name(s)
Placebo
Other Intervention Name(s)
control
Intervention Description
Crossover design: Oral administration of placebo once daily for 2 weeks, followed by placebo once daily for subsequent 8 weeks, tapering: placebo once daily for 7 days
Primary Outcome Measure Information:
Title
Apathy Evaluation Scale (AES-I)
Description
The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-I, where I [informant] is a friend or family member familiar with the daily activities of the subject) in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Secondary Outcome Measure Information:
Title
AES-C (clinician)
Description
The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-C, where C [clinician] is the trial investigator) in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
AES-S (self)
Description
The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-S, where S [self] is the patient) in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
Motor symptoms (UHDRS)
Description
The influence of Bupropion compared to placebo on the UHDRS motor score in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
Quantitative grip force motor assessment
Description
The influence of Bupropion compared to placebo on motor scores in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
Cognitive Symptoms
Description
The influence of Bupropion compared to placebo on MMSE in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
Psychiatric symptoms
Description
The influence of Bupropion compared to placebo on UHDRS behavioural assessment in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
Activities of daily living
Description
The influence of Bupropion compared to placebo on UHDRS Functional Assessment in patients with HD after ten weeks of treatment.
Time Frame
10 weeks
Title
Caregiver's distress
Description
The influence of Bupropion compared to placebo on the NPI caregiver's distress score.
Time Frame
10 weeks
Title
ventral striatal and ventromedial prefrontal activation
Description
Change of ventral striatal and ventromedial prefrontal activation in response to a reward paradigm as quantified by fMRI.
Time Frame
10 weeks
Title
Adverse events
Description
The safety and tolerability of Bupropion will be compared with placebo in patients with HD after ten weeks of treatment.
Time Frame
10 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Verified HD mutation carriers aged 25 to 75 years (inclusive) at first dosing Apathetic as diagnosed by SCIA-D criteria Stable concomitant medication (no change of medication during last six weeks prior to inclusion) Written informed consent by prospective study participant before conduct of any trial-related procedure. Participant must be able to make an informed decision of whether or not to participate in the study Patient has a caregiver (family member or friend), who is living in a close relationship with the patient and is willing to give written informed consent (caregiver) before performance of any trial-related procedure Exclusion criteria: Pregnant or nursing women Active suicidality based on the answer "yes" in questions 4 and 5 of the Columbia-Suicide Severity Rating Scale (baseline version) Woman of childbearing potential, not using highly effective methods of contraception defined as methods with a Pearl Index < 1 such as oral, topical or injected contraception, IUD, contraceptive vaginal ring, or double barrier method such as diaphragm and condom with spermicide) or not surgically sterile (via hysterectomy, ovariectomy or bilateral tubal ligation) or not at least one year post-menopausal Male not using an acceptable barrier method for contraception and donating sperm from screening up to three months following treatment Presence or history of any medically not controllable disease (e.g. uncontrolled arterial hypertension or diabetes mellitus) Presence or history of seizures or diagnosed epilepsy or history of severe head trauma (contusion) or CNS tumor Clinical significant renal (calculated creatine clearance < 60 ml/min) or hepatic dysfunction Clinical significant depression defined by the NPI depression score (score ≥4 points) at screening Schizophreniform psychosis within the last 6 months prior to first dose History of anorexia or bulimia Severe cognitive disorders defined as a score < 18 in the Mini- Mental State Examination (MMSE) at screening Marked chorea (UHDRS 4) of face, BOL, trunk or extremities Treatment with neuroleptics other than tiapride, MAO-B inhibitors, amantadine, levodopa, D- or D,L-amphetamine or psychostimulants like methylphenidate, modafinil or atomoxetine within 1 month prior to first dose Known hypersensitivity reaction associated with bupropion, gelatine, lactose or magnesium stearate Clinically relevant abnormal findings in the ECG, the vitals, in the physical examination or laboratory values at screening that could interfere with the objectives of the study or the safety of the subject as judged by the investigator Acute disease state (e.g. nausea, vomiting, fever, diarrhoea, infection) within 7 days of first dose Definite or suspected personal history or family history of adverse reactions or hypersensitivity to the trial compounds (or to compounds with a similar structure) Presence of illicit drug and/or alcohol abuse Participation in another investigative drug trial within 2 months or donation of blood within 12 weeks prior to the first dose or during the trial Subjects who are unlikely to be compliant and attend scheduled clinic visits as required Placement in an institution due to governmental or judicial authorities
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Josef Priller, MD
Organizational Affiliation
Charite University, Berlin, Germany
Official's Role
Principal Investigator
Facility Information:
Facility Name
Neurologische Klinik der Ruhr-Universität Bochum
City
Bochum
ZIP/Postal Code
44791
Country
Germany
Facility Name
Universitätsklinikum Ulm, Klinik für Neurologie
City
Ulm
ZIP/Postal Code
89081
Country
Germany

12. IPD Sharing Statement

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Apathy Cure Through Bupropion in Huntington's Disease

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