- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01846182
Research Examining Gulf War Illness in Our Nations Service Members (REGIONS)
February 18, 2021 updated by: VA Office of Research and Development
RCT of Duloxetine & Pregabalin for the Treatment of Gulf War Illness in Veterans
At least 1 in 4 of the 700,000 U.S. Veterans who served in the 1990-1991 Gulf War suffer from Gulf War Illness (GWI).
Despite considerable research, effective treatments remain elusive.
GWI refers to a complex of symptoms that typically include widespread chronic pain, persistent headache, memory and concentration problems, gastrointestinal difficulties, sleep disturbances and unexplained fatigue.
These symptoms are similar to that of fibromyalgia syndrome (FMS), another multi-symptom condition.
Whereas, effective treatments for GWI have yet to be found, the FDA has approved duloxetine and pregabalin for the treatment of FMS.
The lack of progress in finding effective treatments for GWI, and the similarities between GWI and FMS, provides a rationale for determining if these medications can provide relief to Veterans who suffer from GWI.
This randomized controlled trial will test the efficacy of Duloxetine and Pregabalin for treating Gulf War Veterans who suffer from GWI.
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
At least 1 in 4 of the 700,000 U.S. Veterans who served in the 1990-1991 Gulf War suffer from Gulf War Illness (GWI).
Despite considerable research, effective treatments remain elusive.
GWI refers to a complex of symptoms that typically include widespread chronic pain, persistent headache, memory and concentration problems, gastrointestinal difficulties, sleep disturbances and unexplained fatigue.
This symptom profile is similar to that of fibromyalgia syndrome (FMS), a multi-symptom condition similar to GWI.
Whereas, effective treatments for GWI have yet to be found, progress has been made in identifying medications to treat FMS.
For example, the FDA has approved a number of medications including Duloxetine and Pregabalin for the treatment of FMS.
Compared to placebo (PBO) Duloxetine (a serotonin norepinephrine reuptake inhibitor) and Pregabalin (an alpha-2-alpha-subunit calcium-channel ligand) significantly improved pain responses and fatigue.
The capacity of Duloxetine to increase central levels of serotonin and norepinephrine as well as the more complex alterations of neurotransmitters and central nervous system (CNS) mediators of pain attributed to pregabalin are thought to be responsible for the medication's effects on pain, mood and sleep.
Clinical practice and one open-label trial support the use of these medications in combination to achieve optimal symptom improvement amongst GWI sufferers; however, such combinations have not been formally tested in randomized controlled trials.
The lack of progress in finding effective treatments for GWI, and the similarities between GWI and FMS, provides a rationale for determining if these FDA approved medications can provide significant symptomatic relief to Veterans who suffer from GWI. Central Texas is home to one of the highest number of Gulf War Veterans in the nation, thus the investigators' research team is ideally situated to conduct the proposed study.
In a randomized, double-blind, controlled trial, 180 Veterans who meet defining criteria for GWI and whose symptom profile includes chronic widespread pain and sleep disturbances will be treated with one of the following medications; 1) AM Duloxetine+ PM placebo (PBO); 2) PM Pregabalin + AM PBO or 3) AM PBO + PM PBO.
All active treatments will titrate from a lower dose in 2-week increments to the full therapeutic doses (FDA-approved for FMS).
The outcome of the PBO double-dummy period will be compared statistically with 18 weeks of active therapy (weeks 5-22).
Study Type
Interventional
Enrollment (Actual)
112
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
-
-
Texas
-
Temple, Texas, United States, 76504
- Central Texas Veterans Health Care System, Temple, TX
-
Waco, Texas, United States, 76711
- Central Texas Veterans Health Care System Waco VA Medical Center, Waco, TX
-
-
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
44 years to 70 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Living in Central Texas near Killeen, Austin, Temple or Waco
- Served on active military duty and deployed to the Persian Gulf region for some period between August 1990 & July 1991
- English speaking and able to understand the consent form and study questionnaires
- Willing to be randomized to treatment and participate in 1-month follow up
- men & women between the ages of 43 to 70
- meet Kansas GWI case definition for the diagnosis of GWI
- report a baseline score > 4 on a 10-point Pain Visual Analog Scale (VAS)
- female participants of childbearing potential must test negative for pregnancy at the time of enrollment based on a urine pregnancy test and agree to use a reliable method of birth control (for example, oral contraceptives or Norplant; a reliable barrier method of birth control [diaphragms with contraceptive jelly; cervical caps with contraceptive jelly; condoms with contraceptive foam); intrauterine devices; partner with vasectomy; or abstinence) during the study and for 2 months following the last dose of the study drug. [Note that this inclusion criterion applies only to females of childbearing potential. Females of childbearing potential are defined as women not surgically sterilized and between menarche and 2 years post-menopause.]
Exclusion Criteria:
- Unstable or poorly controlled chronic medical illness such as Diabetes type-II, Hypertension (HTN), heart disease, endocrine disorders, narrow angle glaucoma
- Significant Central Nervous System disease including transient ischemic attacks (TIAs) or stroke, Dementia, syncopal episodes, severe head trauma, multiple sclerosis
- Serious or advanced heart disease or clinically relevant abnormal electrocardiogram (ECG), postural hypotension
- Untreated sleep apnea or body mass index placing patients at risk for undiagnosed sleep apnea (BMI> 35 kg/m2)
- Diabetes type-I and patients with Diabetes type-II associated with peripheral neuropathy, hepatitis, liver failure/cirrhosis
- End stage renal disease
- History of hypersensitivity reaction to pregabalin, duloxetine, venlafaxine; active treatment with duloxetine or pregabalin; History of failure of duloxetine or pregabalin at therapeutic doses; history of angioedema reaction to pregabalin
- Active systemic infectious disease such as tuberculosis and HIV, shingles
- Autoimmune mediated illnesses such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma
- History of mental illness requiring hospitalization (depression, bipolar illness, post traumatic stress disorder, history of suicide attempts, psychosis, schizophrenia spectrum); Current major depression of dysthymia; patients lacking capacity to make medical decisions
- Use of monoamine oxidase inhibitors (MAOIs) within 2 weeks of evaluation; Active ongoing use of the following agents: desvenlafaxine, fenfluramine, linezolid, milnacipran, phentermine, tryptophan, tramadol, opiates
- Current (meets criterion within the last 6 months) for drug or alcohol dependence (except for nicotine and caffeine)
- Cancer other than non-melanoma skin cancers
- Women who are pregnant or desire to become pregnant, breastfeeding, who use unreliable contraception methods
- Those with occupations requiring use and/or operation of hazardous heavy equipment or professional drivers
- Patients for whom the potential risk outweighs the potential benefit in the opinion of the treating psychiatrist
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 |
---|---|
Active Comparator: Group 1
60 mg of duloxetine in the AM for 20 weeks and placebo in PM
|
Placebo
serotonin norepinephrine reuptake inhibitor
Other Names:
|
Active Comparator: Group 2
300 mg of pregabalin in the PM for 20 weeks and placebo in AM
|
Placebo
alpha-2-alpha subunit calcium channel ligand
Other Names:
|
Placebo Comparator: Group 3
placebo in the AM & PM for 20 weeks
|
Placebo
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pain by Likert Scale
Time Frame: 120 days
|
Likert scale of pain rating
|
120 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Side Effects
Time Frame: Assessed every 2 weeks
|
Side effects checklist
|
Assessed every 2 weeks
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Multiple and Unreliable
Time Frame: Assessed every 2 weeks up to 34 weeks
|
Reliability of measurement is highly suspect and data are not suitable for analysis.
|
Assessed every 2 weeks up to 34 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Study Chair: Charles J Foulks, M.D., Central Texas Veterans Health Care System, Temple, TX
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 (Actual)
June 24, 2015
Primary Completion (Actual)
August 1, 2019
Study Completion (Actual)
August 1, 2019
Study Registration Dates
First Submitted
April 16, 2013
First Submitted That Met QC Criteria
April 30, 2013
First Posted (Estimate)
May 3, 2013
Study Record Updates
Last Update Posted (Actual)
March 12, 2021
Last Update Submitted That Met QC Criteria
February 18, 2021
Last Verified
February 1, 2021
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Tranquilizing Agents
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Antidepressive Agents
- Dopamine Agents
- Anti-Anxiety Agents
- Anticonvulsants
- Serotonin and Noradrenaline Reuptake Inhibitors
- Calcium-Regulating Hormones and Agents
- Calcium Channel Blockers
- Duloxetine Hydrochloride
- Pregabalin
Other Study ID Numbers
- SPLD-016-12F
- 6125 (Other Identifier: Stanford IRB)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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