- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00469508
Modafinil vs Placebo for the Treatment of Methamphetamine Dependence (Modafinil)
A Randomized, Double-Blind, Placebo-Controlled Evaluation of Modafinil vs Placebo for the Treatment of Methamphetamine Dependence
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This application proposes a placebo-controlled double-blind trial of modafinil, on a platform of contingency management (CM) and individual cognitive-behavioral counseling (CBT once weekly individual session), for the treatment of methamphetamine dependence. Modafinil is a medication warranting evaluation as a treatment for MA dependence. It has a half-life of approximately 15 hours and reaches steady state in 2-4 days (Package insert) and will likely require once daily dosing, which reduces problems with medication adherence. Modafinil has potent psychiatric and behavioral effects that include brightening mood (Menza et al., 2000; Ninan et al., 2004), improving cognition (Turner et al., 2004a, b; 2003), improving impulse control (Turner et al., 2003; Turner et al., 2004a), and countering fatigue (Beusterien et al., 1999, Stahl et al., 2003). These effects neatly counterbalance effects produced by MA withdrawal (Newton et al., 2004) and may have particular value in ameliorating the negative reinforcing properties of MA, i.e., when MA is used to immediately relieve depressed mood due to recent abstinence (Peck et al., 2005b). CM is a behavioral intervention that effectively helps substance abusers to initiate abstinence, particularly from cocaine (Higgins et al., 1993; Higgins et al., 2000; Higgins et al., 1991) and from methamphetamine (Roll & Shoptaw, in press; Shoptaw et al., 2005). As well, CM has been shown to reduce substance abuse and optimize the effects of medications in reducing substance abuse (Carroll, 2004; Shoptaw et al., 2002). The objective of this study is to determine whether modafinil reduces methamphetamine use and concomitant physical and psychological symptoms more effectively than placebo when administered in conjunction with CM and CBT. The purpose of this project is to evaluate whether methamphetamine abusers seeking outpatient treatment demonstrate significantly significant reductions of methamphetamine when randomly assigned to receive modafinil (400mg qd) in combination with CM and weekly CBT compared their peers randomly assigned to receive placebo in combination with CM and weekly CBT.
Research Hypotheses:
- Participants receiving active experimental drug (modafinil 400mg) will demonstrate statistically significant reductions in methamphetamine use over participants receiving placebo. Methamphetamine use outcomes will be measured using urine samples and analyzed with the following indices: Treatment Effectiveness Score, the Joint Probability Index, self-report of methamphetamine use verified by urine drug screening, and the longest uninterrupted period of methamphetamine abstinence. Primary analyses will be conducted using modeling approaches (Generalized Estimation Equations, Markov Chain Transition Models) depending upon the structure of the dataset. Self-report of methamphetamine use will be analyzed using the Addiction Severity Index drug composite scale and Substance Use Inventory (SUI).
Participants receiving active experimental drug will remain in treatment for significantly longer periods compared to participants receiving placebo. Retention will be measured by the number of days in the protocol and analyzed using survival analysis.
a. Specifically, participants with mild cognitive dysfunction (as measured as <=1 SD below the published mean for the MicroCog assessments) receiving modafinil (400mg) will demonstrate significantly greater overall retention, and attendance to CBT sessions than those participants with cognitive function measured at greater than 1 SD below the mean for the MicroCog assessments who are receiving placebo.
- Participants receiving active experimental drug (modafinil 400mg) will demonstrate statistically significant reductions in reported methamphetamine craving over participants receiving placebo. Craving outcomes will be measured using a visual analogue scale.
- Participants receiving active experimental drug (modafinil 400mg) will demonstrate statistically significant reductions in withdrawal symptoms and somatic complaints compared to participants receiving placebo. These outcomes will be measured using the BSI, the Beck Depression Inventory-II, and the Quality of Well-Being scale.
Exploratory analyses will also be conducted to identify potential genetic variants associated with treatment response to modafinil for MA dependence. Candidate genes implicated by previous research as being involved in the pathogenesis of MA dependence and/or the molecular mechanism of modafinil (for example, genes for neurotransmitter receptors and transporters, including dopamine, norepinephrine, GABA, and glutamate, as well as genes for enzymes involved in the metabolism of these neurotransmitter, such as catechol-O-methyltransferase and monoamine oxidase A) will be sequenced in order to determine the frequency of known single nucleotide polymorphisms (SNPs), as well as potentially identify novel SNPs, in these genes among MA dependent participants. Initial analyses will focus on genes involved in the dopaminergic pathway, given the importance of dopamine in the neurobiology of MA dependence, but additional genes may also be assessed. SNPs associated with response to modafinil will be identified in order to generate hypotheses for future pharmacogenomic studies.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
California
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Hollywood, California, United States, 90038
- UCLA Vine Street Clinic
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- 18 years of age or older;
- meet DSM-IV criteria for methamphetamine dependence;
- willing and able to comply with study procedures;
- willing and able to provide written informed consent;
- if female, not pregnant or lactating and willing to use an acceptable method of barrier birth control (e.g. condoms) during the trial and for one month after discontinuation of study medication (modafinil may reduce the effectiveness of steroidal contraceptives both during administration and for one month after discontinuation).
Exclusion Criteria:
- have a medical condition that, in the study physician's judgment, may interfere with safe study participation (e.g., active TB, unstable cardiac, renal, or liver disease, unstable diabetes, or elevated liver enzymes (SGOT or SGPT) greater than 4 times the upper limit of normal);
- have a current neurological disorder (e.g., organic brain disease, dementia) or major psychiatric disorder not due to substance abuse (e.g., schizophrenia or bipolar illness) as assessed by the SCID and a medical history which would make study agent compliance difficult or which would compromise informed consent, or recent (past 30 days) history of suicide attempts and/or current serious suicidal intention or plan as assessed by the SCID and the BDI-II;
- currently on prescription medication that is known to interact with the study drug;
- have current dependence on cocaine, opiates, alcohol, or benzodiazepines, as defined by DSM-IV-TR criteria;
- have a history of alcohol dependence within the past three years;
- have a history of mitral valve prolapse, left ventricular hypertrophy, cardiac arrhythmias, angina, myocardial infarction, acute coronary syndrome (unstable angina), cardiac syncope or presyncope, or any EKG abnormalities that suggests the presence of one of these conditions;
- have a systolic blood pressure greater than 160, a diastolic blood pressure greater than 100 (i.e. cutoffs for stage 2 hypertension), and a heart rate greater than 70% of the maximum heart rate expected for their age (0.70(220-age)) at any of the study visits.
- any other circumstances that, in the opinion of the investigators, would compromise participant safety;
- have a history of sensitivity to modafinil.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Modafinil
Modafinil 400mg oral dose taken daily for 12 weeks
|
400mg pills taken orally daily for 12 wks.
Other Names:
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Placebo Comparator: Placebo
Modafinil 0mg (sugar pill) oral dose taken daily for 12 weeks
|
400mg pills taken orally daily for 12 wks
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clean Urine Drug Screen
Time Frame: From randomization to end of week 12
|
Urine samples, collected thrice weekly, were tested for metabolites of MA using radioimmunoassay.
Each subject had a possible of 36 urine drug screens to provide during the 12 weeks of medication.
An aggregate measure of urine drug screen results was calculated - the Treatment Effectiveness Score (TES) - which is the average of the sum of MA-free urine specimens provided during the treatment period by participants in each treatment condition.
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From randomization to end of week 12
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Retention
Time Frame: 12 weeks
|
The number of persons who completed the medication phase of the trial (12 weeks of medication).
|
12 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
VAS Score
Time Frame: baseline and last observation during the 12 week treatment period
|
To measure methamphetamine craving, mean change in craving based on visual analog scale (VAS) from 0 (not at all) to 100 (extremely) from baseline to the last week of observation during the 12 week treatment period.
The last observation was carried forward if not available during week 12.
|
baseline and last observation during the 12 week treatment period
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BDI Score
Time Frame: From baseline to end of treatment period (week 12).
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Self-reported depression: mean change on Beck Depression Index (BDI-II) assessed weekly during the 12 week medication phase.
If the week12 measure was not available, the last observation was carried forward.
0 indicates no depression, 63 is the maximum indicating severe depression.
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From baseline to end of treatment period (week 12).
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Steve Shoptaw, Ph.D., University of California, Los Angeles
Publications and helpful links
General Publications
- Heinzerling KG, Swanson AN, Kim S, Cederblom L, Moe A, Ling W, Shoptaw S. Randomized, double-blind, placebo-controlled trial of modafinil for the treatment of methamphetamine dependence. Drug Alcohol Depend. 2010 Jun 1;109(1-3):20-9. doi: 10.1016/j.drugalcdep.2009.11.023. Epub 2010 Jan 25.
- Heinzerling KG, Shoptaw S. Gender, brain-derived neurotrophic factor Val66Met, and frequency of methamphetamine use. Gend Med. 2012 Apr;9(2):112-20. doi: 10.1016/j.genm.2012.02.005. Epub 2012 Mar 23.
- Heinzerling KG, McCracken JT, Swanson AN, Ray LA, Shoptaw SJ. COMT Val158Met, BDNF Val66Met, and OPRM1 Asn40Asp and methamphetamine dependence treatment response: preliminary investigation. J Clin Psychopharmacol. 2012 Feb;32(1):135-7. doi: 10.1097/JCP.0b013e318240a48e. No abstract available.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- P50DA018185-03 (U.S. NIH Grant/Contract)
- P50DA018185 (U.S. NIH Grant/Contract)
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