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Mirtazapine for the Treatment of Methamphetamine Dependence Among MSM (M2.0)

Primary Purpose

Amphetamine-Related Disorders

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Mirtazapine
Placebo
Sponsored by
Phillip Coffin, MD, MIA
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Amphetamine-Related Disorders focused on measuring HIV, sexual behavior

Eligibility Criteria

18 Years - 69 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. born male, or born female and does not identify as female;
  2. reports anal sex with men in the prior three months while under the influence of meth;
  3. diagnosed with meth dependence by SCID;
  4. interested in stopping or reducing meth use;
  5. at least one meth-positive urine during screening and run-in period;
  6. no current acute illness requiring prolonged medical care;
  7. no serious chronic illnesses that are likely to progress clinically during trial participation;
  8. able and willing to provide informed consent and adhere to visit schedule;
  9. age 18-69 years;
  10. baseline CBC, total protein, albumin, glucose, alkaline phosphatase, creatinine, BUN, and electrolytes without clinically significant abnormalities as determined by clinician in conjunction with symptoms, physical exam, and medical history
  11. current CD4 count ≥ 200 cells/mm3; or CD4 count of 100 - 199 cells/mm3 and HIV viral load < 200 copies/mL
  12. text-capable cell phone or access to email

Exclusion Criteria:

  1. Evidence of current major depression by SCID;
  2. history of bipolar disorder or psychotic disorder, as determined by SCID;
  3. known allergy or previous adverse reaction to mirtazapine;
  4. taking an anti-depressant medication within the past 30 days, including mirtazapine or a monoamineoxidase inhibitor;
  5. moderate or severe liver disease (AST, ALT, and total bilirubin >= 5 times upper limit of normal);
  6. impaired renal function (estimated GFR <40 ml/min);
  7. currently participating in another research study;
  8. pending legal proceedings with high risk for incarceration during the time of planned study participation;
  9. any condition that, in the principal investigator's judgment, interferes with safe study participation or adherence to study procedures.

Sites / Locations

  • Substance Use Research Unit

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Mirtazapine

Placebo

Arm Description

mirtazapine 30 mg orally per day

placebo (30 mg) orally per day

Outcomes

Primary Outcome Measures

Number of methamphetamine-positive urine tests
To determine the efficacy of mirtazapine vs placebo at 12 weeks and 24 weeks of treatment plus counseling, and to determine whether efficacy is sustained for an additional 12 weeks after discontinuation of treatment and counseling (weeks 24 to 36).

Secondary Outcome Measures

Sexual risk (see description)
To assess if the intervention reduces HIV risk behaviors, including number of male sex partners, number of male anal sex partners with whom meth is used and episodes of unprotected anal sex with serodiscordant partners.

Full Information

First Posted
June 25, 2013
Last Updated
March 9, 2018
Sponsor
Phillip Coffin, MD, MIA
Collaborators
National Institute on Drug Abuse (NIDA)
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1. Study Identification

Unique Protocol Identification Number
NCT01888835
Brief Title
Mirtazapine for the Treatment of Methamphetamine Dependence Among MSM (M2.0)
Official Title
Mirtazapine for the Treatment of Methamphetamine Dependence Among MSM: a 6-month Randomized Controlled Trial With 3 Months of Follow-up
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Completed
Study Start Date
August 2013 (undefined)
Primary Completion Date
October 2017 (Actual)
Study Completion Date
October 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Phillip Coffin, MD, MIA
Collaborators
National Institute on Drug Abuse (NIDA)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The investigators recently conducted a double-blind, randomized controlled trial (n=60) of limited duration (12 weeks), and found that compared with placebo, oral mirtazapine, an FDA-approved antidepressant, significantly reduced meth use in those receiving mirtazapine, as determined by reduction in meth-positive urines. Sexual risk behaviors also declined significantly in the mirtazapine arm compared to placebo. Mirtazapine decreased meth use despite low adherence: by medical event monitoring system (MEMS) caps, only 48.5% of daily doses were taken. All participants received weekly substance use counseling and monthly, brief clinician-delivered adherence counseling. The investigators propose expanding upon these results by lengthening the treatment period to 24 weeks, with adherence reminders added to the counseling, and determining if efficacy is sustained up to 12 weeks after drug discontinuation. The sample size for this 9-month study is 120.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Amphetamine-Related Disorders
Keywords
HIV, sexual behavior

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
120 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Mirtazapine
Arm Type
Active Comparator
Arm Description
mirtazapine 30 mg orally per day
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
placebo (30 mg) orally per day
Intervention Type
Drug
Intervention Name(s)
Mirtazapine
Other Intervention Name(s)
Remeron
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Number of methamphetamine-positive urine tests
Description
To determine the efficacy of mirtazapine vs placebo at 12 weeks and 24 weeks of treatment plus counseling, and to determine whether efficacy is sustained for an additional 12 weeks after discontinuation of treatment and counseling (weeks 24 to 36).
Time Frame
weekly for 9 months
Secondary Outcome Measure Information:
Title
Sexual risk (see description)
Description
To assess if the intervention reduces HIV risk behaviors, including number of male sex partners, number of male anal sex partners with whom meth is used and episodes of unprotected anal sex with serodiscordant partners.
Time Frame
9 months
Other Pre-specified Outcome Measures:
Title
Adherence to study drug
Description
To measure the acceptability of mirtazapine and placebo by determining (via electronic pill boxes and self-report) medication adherence including percent of doses taken, taking less than 80% of medication, patterns of non-adherence (e.g. use every other day, during the weekend, longer alternating periods on and off medication), and time to stopping medication.
Time Frame
6 months
Title
Number of adverse events
Description
To measure the tolerability of mirtazapine and placebo, as determined by the number of adverse clinical events in the mirtazapine and placebo arms.
Time Frame
6 months

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
69 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: born male, or born female and does not identify as female; reports anal sex with men in the prior three months while under the influence of meth; diagnosed with meth dependence by SCID; interested in stopping or reducing meth use; at least one meth-positive urine during screening and run-in period; no current acute illness requiring prolonged medical care; no serious chronic illnesses that are likely to progress clinically during trial participation; able and willing to provide informed consent and adhere to visit schedule; age 18-69 years; baseline CBC, total protein, albumin, glucose, alkaline phosphatase, creatinine, BUN, and electrolytes without clinically significant abnormalities as determined by clinician in conjunction with symptoms, physical exam, and medical history current CD4 count ≥ 200 cells/mm3; or CD4 count of 100 - 199 cells/mm3 and HIV viral load < 200 copies/mL text-capable cell phone or access to email Exclusion Criteria: Evidence of current major depression by SCID; history of bipolar disorder or psychotic disorder, as determined by SCID; known allergy or previous adverse reaction to mirtazapine; taking an anti-depressant medication within the past 30 days, including mirtazapine or a monoamineoxidase inhibitor; moderate or severe liver disease (AST, ALT, and total bilirubin >= 5 times upper limit of normal); impaired renal function (estimated GFR <40 ml/min); currently participating in another research study; pending legal proceedings with high risk for incarceration during the time of planned study participation; any condition that, in the principal investigator's judgment, interferes with safe study participation or adherence to study procedures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Phillip O Coffin, M.D.
Organizational Affiliation
San Francisco Department of Public Health
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Steven L Batki, M.D.
Organizational Affiliation
University of California, San Francisco
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Emily Behar
Organizational Affiliation
San Francisco Department of Public Health
Official's Role
Study Director
Facility Information:
Facility Name
Substance Use Research Unit
City
San Francisco
State/Province
California
ZIP/Postal Code
94102
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
31825466
Citation
Coffin PO, Santos GM, Hern J, Vittinghoff E, Walker JE, Matheson T, Santos D, Colfax G, Batki SL. Effects of Mirtazapine for Methamphetamine Use Disorder Among Cisgender Men and Transgender Women Who Have Sex With Men: A Placebo-Controlled Randomized Clinical Trial. JAMA Psychiatry. 2020 Mar 1;77(3):246-255. doi: 10.1001/jamapsychiatry.2019.3655.
Results Reference
derived

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Mirtazapine for the Treatment of Methamphetamine Dependence Among MSM (M2.0)

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