Aripiprazole Treatment for Methamphetamine Dependence Among High-risk Individuals

February 5, 2014 updated by: Phillip Coffin, MD, MIA, San Francisco Department of Public Health
Studies demonstrate that methamphetamine (meth) use is associated with high-risk sexual behavior among men who have sex with men (MSM), putting meth-using MSM at extraordinarily high risk for transmitting or acquiring HIV. This study is a randomized, double-blind, placebo-controlled trial of the medication aripiprazole for methamphetamine-using individuals, including MSM, and will assess efficacy, acceptability, tolerability, safety, and adherence to study medication.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Population-based surveys estimate that the prevalence of methamphetamine use is 20 times higher among men who have sex with men (MSM) compared to the general population. Methamphetamine-associated sexual risk behavior is also a driving force in the MSM HIV epidemic: methamphetamine use has been associated with increased number of sexual partners, unprotected sex acts, sexually transmitted infections (STIs), and HIV acquisition. Despite these alarming data, relatively few interventions have been tested among methamphetamine-using MSM. Among heterosexual non-injection drug users, methamphetamine use has been associated with well characterized risks for HIV and STDs including increased numbers of sexual partners, less condom use than non-methamphetamine users, engaging in sex work, and self-reported history of STDs. In parallel with the continued testing of behavioral approaches, we believe the time has come to test the feasibility and acceptability of pharmacologic interventions to reduce methamphetamine use among high-risk individuals. Pharmacologic approaches to treating substance use have been successful in treating nicotine, alcohol, and heroin dependencies. Preliminary dosing studies demonstrate that aripiprazole (Abilify), an FDA-approved, well-tolerated antipsychotic and partial dopamine agonist, reduced the effects of methamphetamine in humans and exhibited a good safety profile. We propose to expand upon these promising results by conducting a randomized, double-blind, placebo-controlled pilot study of aripiprazole among sexually-active, methamphetamine-dependent individuals.

The specific aims of this study are:

  1. To test the hypothesis that aripiprazole 20 mg daily will reduce methamphetamine use significantly more than placebo among methamphetamine-dependent individuals, as determined by the proportion of methamphetamine-negative urines and by self-report of methamphetamine use in the aripiprazole versus placebo group.
  2. To measure the acceptability of aripiprazole and placebo among methamphetamine-dependent individuals, by determining (via electronic pill caps and self-report) medication adherence to aripiprazole and placebo.
  3. To measure the safety and tolerability of aripiprazole and placebo among methamphetamine-dependent individuals, as determined by the number of adverse clinical events in the aripiprazole and placebo arms.

If promising, study results will be used to design larger, definitive clinical trials to determine the efficacy of aripiprazole in reducing methamphetamine use and corresponding methamphetamine-associated sexual risk among MSM. This pilot study is therefore designed to reflect the structure of such trials. We will enroll 90 sexually active, methamphetamine-dependent individuals who will be randomized 1:1 to receive aripiprazole (n=45) or placebo (n=45) for 12 weeks. Because we are testing a drug for a new indication in a new population, we will include extensive safety parameters, as done in prior studies of pharmacologic interventions among substance users. We will also include both urine testing and extensive behavioral risk assessments because we anticipate that future definitive efficacy trials will analyze both substance use and sexual risk behavior outcomes. Study participants will be seen at the San Francisco Department of Public Health AIDS Office where they will provide urines for drug testing and participate in substance use counseling. All participants will receive HIV risk-reduction counseling. Behavior will be assessed using standardized measures via audio computer-assisted self-interview (ACASI).

Study Type

Interventional

Enrollment (Actual)

90

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • San Francisco, California, United States, 94102
        • San Francisco Department of Public Health, AIDS Office

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

A total of 90 high-risk individuals with methamphetamine dependence will be enrolled in the study. Subjects will be San Francisco Bay Area residents between 18-60 years of age and in good health. The project is designed specifically for those at high risk for HIV transmission or acquisition.

Inclusion Criteria:

  1. HIV-negative by rapid test, or documentation of HIV infection with a laboratory result of a positive HIV test;
  2. diagnosed with methamphetamine dependence as determined by SCID;
  3. interested in stopping or reducing methamphetamine use;
  4. at least one methamphetamine-positive urine during screening and run-in period;
  5. no current acute illnesses requiring prolonged medical care;
  6. no chronic illnesses that are likely to progress clinically during trial participation;
  7. able and willing to provide informed consent and to be followed over trial period;
  8. age 18-60 years;
  9. baseline CBC, total protein, albumin, glucose, lipid panel, alk phos, creatinine, BUN, and electrolytes without clinically significant abnormalities as determined by investigator in conjunction with symptoms, physical exam, and medical history.
  10. if sex assigned at birth was female and able to become pregnant: agrees to use birth control by any of the following methods - hormonal patch, pills, or injections; IUD; diaphragm; condoms; or abstinence.

Exclusion Criteria:

  1. has a psychiatric disorder as assessed by SCID that in the opinion of evaluating clinician would make the study participation unsafe, or make adherence to study protocol untenable. Conditions include current major depression, current suicidal ideation, bipolar disorder, dementia, or acute psychosis;
  2. taking psychotropic medication within the last 30 days, including aripiprazole;
  3. known allergy to aripiprazole, or known adverse reaction to antipsychotics;
  4. currently using or unwilling not to use phenylephrine or ephedrine-containing products for trial duration (can cause false positive urines for methamphetamine use);
  5. current CD4 count < 200 cells/mm3;
  6. using other medications known to interact with aripiprazole, including ketoconazole and carbamazepine;
  7. measured moderate or severe liver disease (AST, ALT, and total bilirubin > 3 times normal) and/or any symptoms of current liver disease;
  8. impaired renal function (creatinine clearance < 60 ml/min);
  9. diabetes mellitis type I or type II, including cases controlled with diet alone;
  10. Hypertension that is not well-controlled;
  11. BMI ≥ 40; or BMI ≥ 35 with more than one of the following: age > 45, systolic blood pressure > 140 mm Hg, diastolic blood pressure > 90 mm Hg, known hyperlipidemia;
  12. History of, or known active cardiovascular disease including: (a) Previous myocardial infarction (heart attack); (b) angina pectoris; (c) congestive heart failure; (d) valvular heart disease including mitral valve prolapse; (e) cardiomyopathy; (f) pericarditis; (g) stroke or transient ischemic attack; (h) chest pain or shortness of breath with activity (such as walking up stairs); (i) peripheral vascular disease or risk equivalent; (j) other heart conditions under the care of a doctor;
  13. currently participating in another research study;
  14. pregnant, breast-feeding, and/or positive pregnancy test at screening or enrollment visit;
  15. any condition that, in the principal investigator's judgment, interferes with safe study participation or adherence to study procedures.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Aripiprazole
Aripiprazole 5mg daily for week one. Aripiprazole 10mg daily for week two. Aripiprazole 20mg daily for weeks three through twelve.
Drug: Aripiprazole
Other Names:
  • Abilify
Placebo Comparator: Placebo
Placebo (for Aripiprazole) 5mg daily for week one. Placebo (for Aripiprazole) 10mg daily for week two. Placebo (for Aripiprazole) 20mg daily for weeks three through twelve.
Drug: Placebo
Sugar pill manufactured to mimic Aripiprazole gel caps.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
To Test the Hypothesis That Aripiprazole 20 mg Daily Will Reduce Methamphetamine Use Significantly More Than Placebo Among Methamphetamine-dependent Individuals.
Time Frame: Final study visit at week 12
To test the hypothesis that aripiprazole 20 mg daily will reduce methamphetamine use significantly more than placebo among methamphetamine-dependent individuals, as determined by the proportion of methamphetamine-positive urines in the aripiprazole versus placebo group.
Final study visit at week 12
To Measure the Acceptability of Aripiprazole and Placebo Among Methamphetamine-dependent Individuals, by Determining (Via Electronic Pill Caps [MEMS or Medication Event Monitoring System]) Medication Adherence to Aripiprazole and Placebo.
Time Frame: Adherence as determined by MEMS (throughout study, up to 12 weeks)
To measure the acceptability of aripiprazole and placebo among methamphetamine-dependent individuals, by determining (via electronic pill caps [MEMS or Medication Event Monitoring System]) medication adherence to aripiprazole and placebo. (Percent adherence from MEMS is determined by 100* the number of days where MEMS registered an opening out of the number of days a dose was prescribed for each arm.)
Adherence as determined by MEMS (throughout study, up to 12 weeks)
To Measure the Safety and Tolerability of Aripiprazole and Placebo Among Methamphetamine-dependent Individuals, as Determined by the Number of Adverse Clinical Events in the Aripiprazole and Placebo Arms.
Time Frame: Total reported adverse events (throughout study, up to 12 weeks)
Total reported adverse events (throughout study, up to 12 weeks)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

San Francisco Department of Public Health

Collaborators

National Institute on Drug Abuse (NIDA)

Investigators

  • Principal Investigator: Phillip O Coffin, MD, MIA, Director of Substance Use Research, San Francisco Department of Public Health

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2009

Primary Completion (Actual)

March 1, 2012

Study Completion (Actual)

March 1, 2012

Study Registration Dates

First Submitted

July 5, 2007

First Submitted That Met QC Criteria

July 5, 2007

First Posted (Estimate)

July 6, 2007

Study Record Updates

Last Update Posted (Estimate)

March 24, 2014

Last Update Submitted That Met QC Criteria

February 5, 2014

Last Verified

February 1, 2014

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 1R01DA022190-01 (U.S. NIH Grant/Contract)
  • DPMC (Other Identifier: NIDA)
  • 1R01DA023387-01 (U.S. NIH Grant/Contract)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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