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Effectiveness of High-frequency rTMS in Reducing Alcohol Consumption in Non-abstinent Patients With an Alcohol Use Disorder (ALCOSTIM)

Primary Purpose

Alcoholism, rTMS Stimulation

Status
Recruiting
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Active rTMS
Placebo rTMS
Questionnaires
Breathalyzer
Sponsored by
Centre Hospitalier Universitaire Dijon
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Alcoholism

Eligibility Criteria

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

Inclusion Criteria:

  • a person who has given his or her free, written and informed consent
  • adult patient
  • patient with mild to severe alcohol use disorder according to DSM-5 criteria
  • voluntary patient to reduce alcohol consumption
  • patient who has already made at least one attempt at alcohol withdrawal (failure or relapse), or at reducing consumption

Exclusion Criteria:

  • person who is not affiliated to or not a beneficiary of national health insurance
  • person subject to a legal protection measure (curatorship, guardianship)
  • person subject to a legal safeguard measure
  • pregnant, parturient or breastfeeding women
  • adult unable to express consent
  • patient of childbearing age with a positive pregnancy test at inclusion
  • patient with an exhaled alcohol level > 0 milligrams/litre inclusive
  • patient with heavy alcohol consumption < 6 days in the 4 weeks prior to inclusion (European Medicine Agency, 2010; one day with alcohol consumption of 60g or more for men and 40g for women)
  • patient with an average alcohol consumption below the WHO average risk level in the 4 weeks prior to inclusion (WHO, 2000, less than or equal to 40g/day for men and 40g for women)
  • patient being abstinent more than 5 days before inclusion
  • patient with a CIWA (Clinical Institute Withdrawal Evaluation: assessment of the severity of alcohol withdrawal) score greater than or equal to 10 at inclusion
  • Patient with concomitant treatment with disulfiram, acamprosate, topiramate, baclofen, naltrexone, and nalmefen (< 1 month)
  • Patient with a history or presence of pre-delirium tremens or delirium tremens
  • Patient with a substance use disorder (DSM-5 criteria) with psychoactive substances other than tobacco and alcohol.
  • Patient with acute psychiatric disorders requiring hospitalization and/or immediate adjustment of psychotropic medication
  • Patient with severe depression, defined by a score of 24 or more on the Hamilton Depression Scale (HAM-D).
  • Patient who has had a recent change (< 1 month) in the prescription of psychotropic treatment
  • Patient with severe and/or chronic psychiatric disorders, including schizophrenia, paranoia and bipolar disorders type I and II
  • Patient with severe heart, kidney, liver or lung failure or other condition that the doctor believes could compromise the patient's participation in the study.
  • Patient with a contraindication to the practice of rTMS; personal history of seizure, pacemaker, neurosurgical clips, carotid or aortic clips, heart valves, hearing aid, ventricular bypass valve, sutures with wires or staples, foreign bodies in the eye, shrapnel, other prosthesis or cephalic ferromagnetic material.
  • Patient simultaneously participating in another therapeutic trial
  • Patient employed by the investigator or trial site
  • Patient who, according to the investigator, is unable to complete a consumption diary and follow up visits for 6 months
  • Patient refusing to sign the "safety contract "* specific to the study

Sites / Locations

  • Chu Dijon BourogneRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

test group

control group

Arm Description

Outcomes

Primary Outcome Measures

total alcohol consumption (g/d)
total alcohol consumption (g/d), measured by average daily consumption
number of days of high consumption
reduction in the number of days of high consumption (≥ 60 g/d for men, ≥ 40 g/d for women)

Secondary Outcome Measures

Full Information

First Posted
February 24, 2021
Last Updated
April 13, 2023
Sponsor
Centre Hospitalier Universitaire Dijon
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1. Study Identification

Unique Protocol Identification Number
NCT04773691
Brief Title
Effectiveness of High-frequency rTMS in Reducing Alcohol Consumption in Non-abstinent Patients With an Alcohol Use Disorder
Acronym
ALCOSTIM
Official Title
Effectiveness of High-frequency rTMS in Reducing Alcohol Consumption in Non-abstinent Patients With an Alcohol Use Disorder: A Multicentre Randomised Controlled Study
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 1, 2021 (Actual)
Primary Completion Date
September 2025 (Anticipated)
Study Completion Date
October 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre Hospitalier Universitaire Dijon

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
The fight against alcoholism is a public health priority. Around 15 million Europeans and 10 million North Americans are alcohol dependent. Worldwide, 1 death out of 25 is thought to be attributed to alcohol. In France, the latest published data on alcohol-related mortality indicates that there were 49,000 alcohol-related deaths in 2009. Alcohol is thought to be the leading cause of hospitalisation for French people, and its social cost is estimated at 37.4 billion euros. However, few patients with an alcohol use disorder are treated: less than 8% in Europe and less than 10.5% in the USA receive appropriate treatment for their alcohol problem. This low rate of treatment is mainly due to the fact that these patients are not ready to stop drinking. They are therefore not attracted by the goal of abstinence that is required by most current therapies and drug treatments. The arrival of new treatments aimed at reducing consumption (rather than abstinence) should make treatment more attractive. To date, nalmefen is the only treatment marketed for this indication. Baclofen should be marketed in 2020, but with restrictive prescription criteria. In this new strategy to reduce consumption, brain stimulation could play a predominant role as an alternative or complementary therapy. Indeed, functional brain imaging techniques have made it possible to visualise the cortical regions involved in craving, in particular the dorsolateral prefrontal cortex (DLPFC). Craving, i.e. the irrepressible desire to consume, is often at the origin of consumption and relapse. Stimulation of the dorsolateral prefrontal cortex with non-invasive cerebral stimulation techniques, such as repeated transcranial magnetic stimulation (rTMS), has provided encouraging results for the reduction of cravings in all addictive behaviours (alcohol, tobacco, cocaine, food). Furthermore, stimulation of the DLPFC seems to modulate decision-making processes: it may thus reduce impulsivity and strengthen inhibitory control, leading to a reduction in substance use. The hypothesis to be tested is that repeated transcranial magnetic stimulation allows a reduction in alcohol consumption in patients with an alcohol use disorder.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alcoholism, rTMS Stimulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
144 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
test group
Arm Type
Experimental
Arm Title
control group
Arm Type
Placebo Comparator
Intervention Type
Device
Intervention Name(s)
Active rTMS
Intervention Description
Two rTMS stimulation sessions spaced 15 minutes apart are delivered daily for 5 consecutive days. A total of 10 sessions. Stimulation parameters: 10 Hz, 1000 pulses per session, 110% of SM, cortical target: right DLPFC
Intervention Type
Device
Intervention Name(s)
Placebo rTMS
Intervention Description
Two rTMS stimulation sessions spaced 15 minutes apart are delivered daily for 5 consecutive days. A total of 10 sessions. Stimulation parameters: delivering a non-significant current at the beginning and end of the stimulation, simulating active stimulation.
Intervention Type
Other
Intervention Name(s)
Questionnaires
Intervention Description
questionnaires for craving assessment: EVA, OCDS, CGI and ADS and signs of physical withdrawal by CIWA
Intervention Type
Device
Intervention Name(s)
Breathalyzer
Intervention Description
estimation of blood alcohol level
Primary Outcome Measure Information:
Title
total alcohol consumption (g/d)
Description
total alcohol consumption (g/d), measured by average daily consumption
Time Frame
through study completion, an average of 1 month
Title
number of days of high consumption
Description
reduction in the number of days of high consumption (≥ 60 g/d for men, ≥ 40 g/d for women)
Time Frame
through study completion, an average of 1 month

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: a person who has given his or her free, written and informed consent adult patient patient with mild to severe alcohol use disorder according to DSM-5 criteria voluntary patient to reduce alcohol consumption patient who has already made at least one attempt at alcohol withdrawal (failure or relapse), or at reducing consumption Exclusion Criteria: person who is not affiliated to or not a beneficiary of national health insurance person subject to a legal protection measure (curatorship, guardianship) person subject to a legal safeguard measure pregnant, parturient or breastfeeding women adult unable to express consent patient of childbearing age with a positive pregnancy test at inclusion patient with an exhaled alcohol level > 0 milligrams/litre inclusive patient with heavy alcohol consumption < 6 days in the 4 weeks prior to inclusion (European Medicine Agency, 2010; one day with alcohol consumption of 60g or more for men and 40g for women) patient with an average alcohol consumption below the WHO average risk level in the 4 weeks prior to inclusion (WHO, 2000, less than or equal to 40g/day for men and 40g for women) patient being abstinent more than 5 days before inclusion patient with a CIWA (Clinical Institute Withdrawal Evaluation: assessment of the severity of alcohol withdrawal) score greater than or equal to 10 at inclusion Patient with concomitant treatment with disulfiram, acamprosate, topiramate, baclofen, naltrexone, and nalmefen (< 1 month) Patient with a history or presence of pre-delirium tremens or delirium tremens Patient with a substance use disorder (DSM-5 criteria) with psychoactive substances other than tobacco and alcohol. Patient with acute psychiatric disorders requiring hospitalization and/or immediate adjustment of psychotropic medication Patient with severe depression, defined by a score of 24 or more on the Hamilton Depression Scale (HAM-D). Patient who has had a recent change (< 1 month) in the prescription of psychotropic treatment Patient with severe and/or chronic psychiatric disorders, including schizophrenia, paranoia and bipolar disorders type I and II Patient with severe heart, kidney, liver or lung failure or other condition that the doctor believes could compromise the patient's participation in the study. Patient with a contraindication to the practice of rTMS; personal history of seizure, pacemaker, neurosurgical clips, carotid or aortic clips, heart valves, hearing aid, ventricular bypass valve, sutures with wires or staples, foreign bodies in the eye, shrapnel, other prosthesis or cephalic ferromagnetic material. Patient simultaneously participating in another therapeutic trial Patient employed by the investigator or trial site Patient who, according to the investigator, is unable to complete a consumption diary and follow up visits for 6 months Patient refusing to sign the "safety contract "* specific to the study
Facility Information:
Facility Name
Chu Dijon Bourogne
City
Dijon
ZIP/Postal Code
21000
Country
France
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
benoit TROJAK
Phone
0380293769
Ext
+33
Email
benoit.trojak@chu-dijon.fr

12. IPD Sharing Statement

Citations:
PubMed Identifier
35022086
Citation
Petit B, Soudry-Faure A, Jeanjean L, Foucher J, Lalanne L, Carpentier M, Jonval L, Allard C, Ravier M, Mohamed AB, Meille V, Trojak B. Efficacy of repetitive transcranial magnetic stimulation (rTMS) for reducing consumption in patients with alcohol use disorders (ALCOSTIM): study protocol for a randomized controlled trial. Trials. 2022 Jan 12;23(1):33. doi: 10.1186/s13063-021-05940-z.
Results Reference
derived

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Effectiveness of High-frequency rTMS in Reducing Alcohol Consumption in Non-abstinent Patients With an Alcohol Use Disorder

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