Prevention/Reduction of ASRs and PTSD to Sustain Civilian Performance With Sublingual Cyclobenzaprine HCl (TNX-102 SL) (OASIS)
Prevention/Reduction of ASRs and PTSD to Sustain Civilian Performance With Sublingual Cyclobenzaprine HCl (TNX-102 SL) - (Optimizing Acute Stress Reaction Interventions With TNX-102 SL - OASIS)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Contact
Study Contact
- Name: Romina Soudavari
- Phone Number: 9843195030
- Email: romina_soudavari@med.unc.edu
Study Locations
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Alabama
-
Birmingham, Alabama, United States, 35294
- Not yet recruiting
- University of Alabama at Birmingham
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Contact:
- Whitney Taylor
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Principal Investigator:
- Lauren Walter
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Indiana
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Indianapolis, Indiana, United States, 46202
- Recruiting
- Indiana University
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Principal Investigator:
- Paul Musey, MD
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Contact:
- Leah Emmons
- Phone Number: 463-274-2373
- Email: ldemmons@iu.edu
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Kansas
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Kansas City, Kansas, United States, 66160
- Recruiting
- University of Kansas Medical Center
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Contact:
- Lucas Lemar
- Phone Number: 913-588-3580
- Email: llemar@kumc.edu
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Principal Investigator:
- Lindsay Maguire, MD
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Sub-Investigator:
- Chad Cannon, MD
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Missouri
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St Louis, Missouri, United States, 63110
- Recruiting
- Washington University in St. Louis
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Principal Investigator:
- Stacey House, MD
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Contact:
- Jamie Mills
- Phone Number: 314-273-1382
- Email: jamiem@wustl.edu
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New Jersey
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Camden, New Jersey, United States, 08103
- Recruiting
- Cooper University Health System
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Principal Investigator:
- Christopher Jones
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Contact:
- Dylan Kurowsky
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Ohio
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Columbus, Ohio, United States, 43210
- Recruiting
- The Ohio State University
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Contact:
- Hawa Sall
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Principal Investigator:
- Michael Lyons
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Rhode Island
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Providence, Rhode Island, United States, 02903
- Recruiting
- Rhode Island Hospital
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Contact:
- Carolyn Ortega
- Phone Number: 401-444-6619
- Email: cortega@lifespan.org
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Contact:
- Sarah Tokarz
- Phone Number: 401-606-9815
- Email: stokarz1@lifespan.org
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Principal Investigator:
- Adam Aluisio, MD
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Providence, Rhode Island, United States, 02903
- Recruiting
- The Miriam Hospital
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Contact:
- Carolyn Ortega
- Phone Number: 401-444-6619
- Email: cortega@lifespan.org
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Principal Investigator:
- Adam Aluisio, MD
-
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Texas
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San Antonio, Texas, United States, 78229
- Recruiting
- University of Texas Health Science Center at San Antonio
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Contact:
- Stephanie Perez
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Principal Investigator:
- Ralph Riviello
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- ≥ 18 years and ≤ 55 years of age
- Presentation to ED and able to complete enrollment visit activities within 72 hours of MVC
- Anticipated to be discharged home from the ED
- Stated willingness to comply with all study procedures and availability for the duration of the study
- Consent to receive unencrypted communications
- Has a smartphone with continuous service for ≥ 1 year
- Has a personal email address they regularly access
- Able to speak and read English
- Pain severity in the ED ≥ 4 (0-10 numeric rating scale)
- People who are not of childbearing potential (e.g., hysterectomy, bilateral oophorectomy, or confirmed postmenopausal for at least last 12 consecutive months)
- People with the capacity to conceive a pregnancy must agree to employ a highly effective form of birth control throughout the first 28 days of study participation (e.g., oral, injected, transdermal, or implanted hormonal methods of contraception for at least one full menstrual cycle prior to study drug administration; placement of an intrauterine device (IUD) or intrauterine system (IUS); or double barrier methods such as condoms and diaphragms)
Exclusion Criteria:
- Substantial comorbid injury (e.g., long bone fracture)
- People of childbearing potential who are pregnant, breastfeeding, planning to become pregnant, or not using a highly effective form of contraception (e.g., implants, intrauterine devices (IUDs), tubal ligation, hormonal birth control pills, patches, vaginal rings, or injections) during their participation
- Prisoner status
- Any chronic daily opioid use prior to MVC
- Active psychosis, suicidal ideation, or homicidal ideation
- Plans for hospital admission
- History of arrhythmias, heart block or conduction disturbances, congestive heart failure
- Currently in the acute recovery phase of myocardial infarction
- Hypersensitivity to cyclobenzaprine or the excipient in TNX-102 SL or placebo formulations
- History of urinary retention, angle-closure glaucoma, increased intraocular pressure, or hyperthyroidism (TSH < lower limit of normal)
- Concomitant use of monoamine oxidase (MAO) inhibitors or within 14 days after their discontinuation due to risk of potential fatal drug-drug interactions
- Current or planned use of the following prohibited concomitant medications during study participation: anticholinergic medications, guanethidine, selective serotonin reuptake inhibitors (SSRIs) , serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), tramadol, bupropion, meperidine, verapamil, MAO inhibitors, anticholinergic medications, guanethidine, potent cytochrome P450 subtype 3A4 inhibitor, St. John's wort, chronic use muscle relaxants or planned use after MCV or other prohibited concomitant medications listed in section 5.6. PI to assess individual cases where single dose of muscle relaxant is prescribed in ED for inclusion
- Any hepatic impairment or renal disease (defined as AST OR ALT > 3 times the upper limit of normal) or renal disease (defined as GFR ≤ 80 mL/min)
In addition to the lab results in exclusion #13 above, exclude patients who report the following and or if the following are in medical records -
- history of renal disease
- history of urinary retention, angle-closure glaucoma, increased intraocular pressure, or hyperthyroidism
As part of additional screening, exclude patients who answer yes to any of the questions listed below-
- Have you ever been told that you have renal or kidney disease?
- Have you ever been diagnosed with hyperthyroidism or active overactive thyroid?
- Have ever been told that you have a liver disease or cirrhosis, or problems with your liver?
- Any history of seizure disorder
- Lacking capacity to provide informed consent (receipt of sedative, hypnotic agent making the patient non-decisional for consent)
- Any other history or condition that would, in the site investigator's judgement, indicate that the patient would very likely be non-compliant with the study or unsuitable for the study (e.g., might interfere with the study, confound interpretation, or endanger patient)
- Elevated baseline blood pressure defined as systolic blood pressure ≥ 170 mmHg or diastolic blood pressure ≥ 100 mmHg and or elevated heart rate of ≥115
- Abnormal baseline ECG as defined as: QRS duration ≥ 120 ms; QTc > 460 ms; not in sinus rhythm; or 1st, 2nd, or 3rd degree heart block indicated
- Substance or alcohol use disorder, bipolar disorder, or schizophrenia
- History of severe or unexplained oral, or oropharyngeal swelling or edema
- History of presyncope or syncopal episodes
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Placebo Comparator: Placebo
Participants will be instructed to take a half dose (equivalent to 1 tablet, 2.8 mg) of placebo in the ED as part of enrollment procedures.
The placebo is the same formulation as active except the Cyclobenzaprine HCl content is replaced by Mannitol to maintain the same tablet weight and dimensions.
If the time between the first half dose and the planned bedtime of the participant is less than 6 hours, participants will be instructed to take 1 tablet (half dose) the first night at bedtime.
If the time between the first half dose and planned bedtime of the participant is greater than or equal to 6 hours, then participants will be instructed to take a full dose (equivalent to 2 tablets) the first night.
Over the following 13 days, all participants will be instructed to take a full dose of the study drug at bedtime.
Each participant will receive 29 tablets and take either 28 or 29 tablets total for the duration of study participation.
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Placebo sublingual tablets taken sublingually (under the tongue) in the ED and each day at bedtime for a total of 2 weeks.
Other Names:
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Experimental: Cyclobenzaprine HCl
Participants will be instructed to take a half dose (equivalent to 1 tablet, 2.8 mg) of Cyclobenzaprine HCl in the ED as part of enrollment procedures.
If the time between the first half dose and the planned bedtime of the participant is less than 6 hours, participants will be instructed to take 1 tablet (half dose) the first night at bedtime.
If the time between the first half dose and planned bedtime of the participant is greater than or equal to 6 hours, then participants will be instructed to take a full dose (equivalent to 2 tablets) the first night.
Over the following 13 days, all participants will be instructed to take a full dose of the study drug at bedtime.
Each participant will receive 29 tablets and take either 28 or 29 tablets total for the duration of study participation.
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TNX-102 SL (cyclobenzaprine HCl sublingual tablets) taken sublingually (under the tongue) in the ED and each day at bedtime for a total of 2 weeks.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Change in ASD Score
Time Frame: Week 1, 3 after MVC
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Individuals are asked to complete the 14-item Acute Stress Disorder Scale (ASDS) self-report inventory where each item is rated on a 5-point scale (0= Not at all; 1= Mildly; 2= Medium; 3= Quite a bit; 4= Very Much) that indexes acute stress disorder (ASD).
Range of possible total scores is 0-56, with higher total scores indicating greater acute stress symptoms.
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Week 1, 3 after MVC
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Median reaction time of correct responses (general cognitive function)
Time Frame: Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
|
General cognitive function will be assessed using the Test My Brain Digit Symbol Matching Test.
Participants will be asked to match symbols and numbers using a symbol-number key shown on screen.
General cognitive function is assessed via measuring median reaction time of correct responses (medianRTc) to 'test' trials.
Range for medianRTc (ms) is 0-30000.
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Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
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Median reaction time of correct responses (procedural reaction time)
Time Frame: Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
|
Procedural reaction time will be assessed using the Test My Brain Choice Reaction Time Test.
Participants see a set of three arrows, where one arrow is a different color from the rest.
The participant presses left or right to indicate the direction of the odd colored arrow.
Reaction time is assessed via measuring median reaction time of correct responses (medianRTc) to 'test' trials.
Range for medianRTc (ms) is 0-5000.
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Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
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Proportion of targets correctly identified (visuospatial processing and attention)
Time Frame: Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
|
Visuospatial processing and attention will be assessed using the Test My Brain Multiple Object Tracking Test.
In this test of visuospatial processing and attention, participants have to track a set of target circles around the screen (amidst a field of distractors) that move at increasing speed with each trial.
Once the circles stop moving, participants select which were targets must identify targets instead of distractors.
Visuospatial processing and attention are assessed via the proportion of targets correctly identified.
Range for measure is 0-1.
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Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
|
|
d-prime identification (psychomotor vigilance)
Time Frame: Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
|
Psychomotor vigilance will be assessed via the Test My Brain Gradual Onset Continuous Performance Test.
In this task, participants monitor a stream of city and mountain images that rapidly fade from one to the next with no interstimulus interval.
Participants are asked to press/touch for each city image and to withhold for each mountain image.
Vigilance is assessed via measuring d-prime for identification of each city image, a signal detection-based measure that takes into account both hits and false alarms to provide an unbiased estimate of performance where higher values reflect better performance.
Response inhibition is defined as the suppression of actions that are inappropriate in a given context.
Response inhibition is assessed using results from the above, by measuring the number of commission errors (failure to withhold responses) where most positive scores reflect more impulsive responding.
Range for measure is -4.2279 - 4.2279.
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Min 30, Hour 1, 6, 12, Day 1, 2, 3, Week 1, 2, 3, 5, 6, 8, 11, 12 after MVC
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Change in Pain Symptom Score
Time Frame: Baseline, Week 1, 3, 6, 12 after MVC
|
The Regional Pain Scale (RPS) will be used to assess the extent of body pain.
13 items will be scored on a 0-10 pain scale where 0 is no pain and 10 is severe pain.
Range of possible total scores is 0-130, with higher total scores indicative of greater pain symptoms
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Baseline, Week 1, 3, 6, 12 after MVC
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Change in Depressive Symptoms Score
Time Frame: Baseline, Week 1, 3, 6, 12 after MVC
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The Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Short Form 8b; an 8-item scale, and one question from the PROMIS Depression Item Bank will be aggregated/combined to assess depression.
Each item is scored on a 5-point scale where 0 is "none of the time" and 5 means "all or almost all of the time".
Range of possible total scores is 0-45, with higher total scores indicative of greater depressive symptoms.
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Baseline, Week 1, 3, 6, 12 after MVC
|
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Change in Somatic Symptom Score
Time Frame: Baseline, Week 1, 3, 6, 12 after MVC
|
The Pennebaker Inventory of Limbic Languidness (PILL) assesses the frequency of common physical symptoms and sensations.
We will use a version with adapted response options for greater consistency across measures, greater precision in response levels, and to allow administration via self-report.
20 items will be scored on a 0-10 scale where 0 is "no problem" and 10 means "major problem".
Range of possible total scores is 0-200, with higher total scores indicative of greater somatic symptoms.
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Baseline, Week 1, 3, 6, 12 after MVC
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Change in PTSD Symptoms
Time Frame: Baseline, Week 1, 3, 6, 12 after MVC
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The PTSD Checklist for DSM-5 (PCL-5) assesses PTSD symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5).
20 items will be scored on a five-point scale ranging from 0 ("not at all") to 4 ("extremely").
Range of possible total scores is 0-80, with higher total scores indicative of greater PTSD symptoms.
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Baseline, Week 1, 3, 6, 12 after MVC
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Samuel McLean, MD, University of North Carollina at Chapel Hill
- Principal Investigator: Christopher Jones, MD, Cooper University Health Care
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 23-0711
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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