- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02723162
Translational Neuropsychopharmacology Research of Nicotine Addiction
July 22, 2022 updated by: Kevin Gray, MD, Medical University of South Carolina
This study will examine the effects of combining Varenicline (VRN) and N-acetylcysteine (NAC) on neural circuitry function and treating nicotine addiction.
Healthy adult nicotine dependent cigarette smokers interested in quitting (n=110) will be randomized to one of four PBO-controlled conditions for 4 weeks: 1) VRN+NAC, 2) VRN+PBO, 3) NAC+PBO or 4) PBO+PBO.
Following 1 week of medication, participants will be contingently reinforced for 3 days of smoking abstinence and be scanned using functional magnetic resonance imaging (fMRI) techniques, while nicotine deprived during a resting state and a cue-reactivity (CR) task.
Participants will be followed over the next 3 weeks of treatment and clinical variables will be assessed.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
Cigarette (henceforth nicotine) addiction is a chronic, relapsing brain disorder and remains the leading preventable cause of death and disability in the US, costing nearly $200 billion each year.
Although ~20% of adults in the USA currently smoke, the majority want to quit.
In spite of the breadth of research focused on improving health outcomes and reducing the societal burden caused by nicotine addiction, the majority of smokers who attempt to quit will relapse.
Nicotine withdrawal-related disturbances in executive function, negative affect and reward processes compel a smoker to self-administer nicotine-each in turn representing the loss of control to remain abstinent and risk factors for relapse.
Thus, identifying the effects of nicotine addiction on mechanisms of self-regulation, and the value of novel medications for remediating dysregulated behavior are both needed in order to enhance interventions for treating nicotine addiction.
The preliminary data, along with the extant literature, suggest that the maintenance of nicotine addiction is subserved by dysregulated neural function in limbic-striatal and corticostriatal neural circuitry.
While VRN may be effective in treating limbic-striatal circuitry that is associated with promoting abstinence and reducing acute withdrawal; NAC may be effective in treating corticostriatal circuitry function that is associated with relapse vulnerability.
Thus, the current proposal seeks to investigate two medications (VRN & NAC), with potentially complementary effects on the two different brain circuits- limbic-striatal (VRN) and corticostriatal (NAC) circuitry-and that may therapeutically target two different phases in the recovery of nicotine addiction-the promotion of abstinence (VRN) and relapse prevention (NAC).
The placebo (PBO)-controlled design in this proposal will allow the team to identify and translate between the neurobiological substrates and the neurocognitive underpinnings of the effects of VRN+NAC on smoking behavior in humans-thus, advancing the understanding of the pathophysiology of nicotine addiction.
Study Type
Interventional
Enrollment (Actual)
67
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
-
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South Carolina
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Charleston, South Carolina, United States, 29403
- Medical University of South Carolina
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-
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
16 years to 53 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Age 18 - 55
- Right Handed
- English fluency
- 20/20 vision with corrective lenses.
- Smoke ≥ 10 cigarettes/day for a minimum of two years and have an expired carbon monoxide (CO) concentration of ≥ 10 ppm (to confirm inhalation).
- Interest in quitting smoking or contemplating a quit attempt in the next 6 months
- If female, agreement to use birth control
Exclusion Criteria:
- Past head injury or primary neurological disorder associated with MRI abnormalities, including dementia, MCI, brain tumors, epilepsy, Parkinson's disease, or demyelinating diseases
- Any physical or intellectual disability affecting completion of assessments
- Any contraindication to MRI
- Positive urine drug screen for illicit substances (such as marijuana or cocaine).
- Current or past psychosis
- Electroconvulsive therapy in last 6 months
- Use of antidepressant medications or other psychotropic medications in the last month.
- Positive urine pregnancy test or current breast feeding status
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: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: VRN+ NAC
Titrated VRN up to 1mg BID with NAC at 1200mg BID for 28 days
|
VRN will be provided at the standard recommended dose (0.5 mg daily for 3 days, then 0.5 mg twice daily for 4 days, then 1 mg twice daily thereafter for the remaining 21 days of active treatment.
NAC will be dosed at 1200 mg twice daily throughout the 28-day active treatment
|
Active Comparator: NAC+ PBO
1200mg BID for 28 days plus VRN placebo for 28 days
|
Matched placebo
NAC will be dosed at 1200 mg twice daily throughout the 28-day active treatment
|
Active Comparator: VRN+ PBO
Titrated VRN up to 1mg BID with NAC placebo for 28 days
|
Matched placebo
VRN will be provided at the standard recommended dose (0.5 mg daily for 3 days, then 0.5 mg twice daily for 4 days, then 1 mg twice daily thereafter for the remaining 21 days of active treatment.
|
Placebo Comparator: PBO+PBO
Double placebo taken for 28 days
|
Matched placebo
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percent Change in Blood Oxygen Level Dependent (BOLD) Signal Response
Time Frame: 10 Days
|
Measure the Effects of Varenicline and N-Acetylcysteine (NAC) on brain activation to smoking images while participants undergo Functional Magnetic Resonance (fMRI) Imaging.
Mean percent signal change of fMRI BOLD in the insula and nucleus accumbens will be recorded during smoking images.
The lower the BOLD signal response, the better the outcome, meaning reduced reactivity to smoking images.
|
10 Days
|
rZ Change Score in Resting State Functional Connectivity From Baseline
Time Frame: Baseline to day 10
|
Measure the effects of Varenicline and N-Acetylcysteine on resting-state functional connectivity while participants undergo fMRI.
Fisher transformed correlation (rZ) scores will be recorded between medial prefrontal cortex and ventral striatum during a resting state scan.
The higher the rZ score, the better the outcome, meaning stronger functional connectivity.
rZ scores range from -1 to 1.
The rZ-score central value is analogous to a central value to of a Z-score of 0, representing the population mean.
|
Baseline to day 10
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Cigarettes Smoked Per Day
Time Frame: 28 Days
|
Measure the effects of Varenicline and N-Acetylcysteine on smoking behavior over the course of the study
|
28 Days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
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)
May 4, 2016
Primary Completion (Actual)
March 9, 2020
Study Completion (Actual)
March 9, 2020
Study Registration Dates
First Submitted
March 7, 2016
First Submitted That Met QC Criteria
March 23, 2016
First Posted (Estimate)
March 30, 2016
Study Record Updates
Last Update Posted (Actual)
August 18, 2022
Last Update Submitted That Met QC Criteria
July 22, 2022
Last Verified
July 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Chemically-Induced Disorders
- Substance-Related Disorders
- Tobacco Use Disorder
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Cholinergic Agents
- Antiviral Agents
- Protective Agents
- Nicotinic Agonists
- Cholinergic Agonists
- Respiratory System Agents
- Antioxidants
- Antidotes
- Free Radical Scavengers
- Expectorants
- Acetylcysteine
- N-monoacetylcystine
- Varenicline
Other Study ID Numbers
- PRO#48152
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
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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