- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03176953
Topiramate and Prolonged Exposure (TOP)
Combining Topiramate and Prolonged Exposure for PTSD and Alcohol Use Disorder
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Objectives. Alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD) frequently co-occur, and having one condition worsens the course of the other. Individuals with both disorders exhibit worse functioning across a number of domains than individuals with either disorder alone. Prolonged exposure therapy (PE) is among the most effective treatments for PTSD. PE has been rated as a frontline treatment by multiple guidelines and reviews including the VA/DoD Clinical Practice Guidelines for the treatment of PTSD. However, in studies of individuals with PTSD and AUD, changes in alcohol use are only slightly better than in control or standard care conditions, reductions in PTSD symptoms are sometimes modest relative to studies of PE in PTSD patients without AUD, and rates of drop out from treatment are high. Combining PE with medication to curb drinking shows promise to improve upon the effectiveness of PE for individuals with comorbid AUD and PTSD, although thus far few studies have examined combining psychotherapy and medication. Topiramate is the single medication that has shown effectiveness for both AUD and PTSD and shows promise for reducing drinking among individuals with AUD and PTSD. However, the effect of adding topiramate to PE to treat comorbid AUD/PTSD has yet to be examined. The critical next step is to test a best practice PTSD treatment, PE, together with a promising pharmacological agent, topiramate, which has been found to be effective for both AUD and PTSD. Innovation: This application seeks to shift current clinical practice paradigms. A refinement to existing interventions is proposed through integration of two evidence based treatments.
Methodology. The investigators propose to use a randomized, controlled, double blind study design to examine the effect of adding topiramate (TOP) to a best practice treatment for PTSD, PE. Participants will be 120 male and female Veterans from all services with AUD and PTSD. The investigators' primary aims are to determine the relative efficacy of PE+topiramate, as compared to PE+placebo, in reducing problematic drinking, reducing PTSD symptoms, and improving functioning and quality of life among Veterans with comorbid AUD/PTSD at post-treatment and 3- and 6-month post-treatment follow-up. The investigators will explore the extent to which decreases in drinking and PTSD symptoms lead to improvement in functioning.
The proposed study has the potential to improve functional and psychological recovery for a highly prevalent and highly impaired population of Veterans. This study will test a novel and innovative combination of psychotherapy and medication with the goal of improving the care of Veterans. The successful completion of this project will help change the practices that drive treatment for Veterans who have both AUD and PTSD. The fundamental rationale for this study is to improve the evidence base that informs how patients with AUD and PTSD can attain sustained recovery from both of these disorders. The investigators will also explore whether changes in PTSD symptoms in the PE+TOP condition are partially explained by reductions in alcohol cravings.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
-
-
California
-
San Diego, California, United States, 92161-0002
- VA San Diego Healthcare System, San Diego, CA
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Veterans of the U.S. military and/or Reserve/National Guard members,
- at least 18 years of age,
- survivors of a psychological trauma meeting DSM-5 criterion A, and are at least one month post-trauma,
- have current DSM-5 diagnoses of AUD and PTSD based on semi-structured diagnostic interviews,
- have at least 20 days of heavy drinking (>= 5 drinks/day for men and >= 4/drinks per day for women) in the last 90 days spent in a non-restricted environment and meet criteria for heavy drinking at least 4 days in the last 30 days prior to screening,
- are not currently receiving trauma-focused psychotherapy,
- are literate in English and intend to stay in the San Diego area during the study,
- are willing to attend psychotherapy, medication, and assessment sessions,
- trying or planning to try to cut down on or abstain from alcohol,
- for females of childbearing potential, agree to use an approved form of contraception for the duration of the study, including hormonal contraceptives (e.g., oral contraceptives or implantable devices), intrauterine device (IUD), or double barrier methods (e.g., diaphragm with spermicidal condom); barrier method is preferred as topiramate may make birth control less effective,
- Individuals with clinically significant renal disease and/or impaired renal function, as defined by clinically significant elevation of blood urea nitrogen (BUN) or creatinine or an estimated creatinine clearance of < 60 mL/min, can be included with physician approval, however the dosing schedule and maximum dose will be adjusted in accordance with FDA prescribing guidelines,
- if individual is on another addiction medication, they should be on a stable approved addiction medication dose (at least two weeks before starting study drug) throughout the study,
- are capable of giving informed consent.
Exclusion Criteria:
Subjects known to have clinically significant unstable medical or psychiatric conditions, where participation is deemed by investigators and study physicians to be risky, including but not limited to:
- AST and/or ALT >5 times the upper limit of the normal range and/or an increased serum bilirubin >2 times the upper limit of normal.
- Seizure disorders
- have been treated with Topiramate for any reason in the past and discontinued the drug due to hypersensitivity reaction
- in the opinion of the investigator, should not be enrolled because of the precautions, warnings, or contraindications listed on the Topiramate package insert, (e.g., certain types of glaucoma),
- are pregnant, lactating, or plan to become pregnant during the period of participation in the study
- in the judgment of the investigator, represent a significant risk of suicidal or homicidal behavior
Study Plan
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: prolonged exposure + topiramate
psychotherapy plus active medication
|
active medication
psychotherapy
|
Active Comparator: prolonged exposure + placebo
psychotherapy plus placebo medication
|
non-active medication
psychotherapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
CAPS-5 Change
Time Frame: Change from baseline to 16 weeks
|
PTSD symptom diagnostic interview CAPS-5 score range = 0 - 80 Higher scores = more severe PTSD symptoms
|
Change from baseline to 16 weeks
|
Timeline Followback Interview (TLFB)
Time Frame: Change from baseline to 16 weeks
|
substance use severity score range = 0 - 100% of heavy drinking days higher scores = greater percentage of total days that included heavy drinking
|
Change from baseline to 16 weeks
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Sonya B. Norman, PhD, VA San Diego Healthcare System, San Diego, CA
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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
- D2412-R
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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.
Clinical Trials on PTSD and Alcohol Use Disorder
-
Medical University of South CarolinaNational Institute on Alcohol Abuse and Alcoholism (NIAAA)RecruitingPTSD | Alcohol Use DisorderUnited States
-
Medical University of South CarolinaCompleted
-
Medical University of South CarolinaNational Institute on Drug Abuse (NIDA)CompletedPTSD | Alcohol Use Disorders | Substance Use DisordersUnited States
-
VA Office of Research and DevelopmentActive, not recruitingAlcohol Use Disorders | Depressive Disorders | Post-traumatic Stress Disorder (PTSD)United States
-
Pharmacotherapies for Alcohol and Substance Use...Yale University; United States Department of Defense; VA Connecticut Healthcare... and other collaboratorsNot yet recruitingEffect of Sublingual Formulation of Dexmedetomidine Hydrochloride (HCl) (BXCL501) - Outpatient StudyPost Traumatic Stress Disorder (PTSD) | Alcohol Use Disorder (AUD)United States
-
Medical University of South CarolinaNational Institute on Alcohol Abuse and Alcoholism (NIAAA)RecruitingAlcohol Use Disorder | Ptsd | Sexual Assault and RapeUnited States
-
University of Massachusetts, WorcesterNational Institute on Alcohol Abuse and Alcoholism (NIAAA)Not yet recruitingPTSD | Alcohol; Use, Problem
-
Pharmacotherapies for Alcohol and Substance Use...Yale University; United States Department of Defense; VA Connecticut Healthcare... and other collaboratorsCompletedPost Traumatic Stress Disorder (PTSD) | Alcohol Use Disorder (AUD)United States
-
University of Maryland, BaltimoreNational Institute on Alcohol Abuse and Alcoholism (NIAAA)CompletedPTSD | Alcohol Use DisorderUnited States
-
Medical University of South CarolinaUnited States Department of Defense; Institute for Translational NeuroscienceCompletedAlcohol Use Disorder (AUD) | Posttraumatic Stress Disorder (PTSD) | Substance Use Disorder (SUD)United States
Clinical Trials on placebo
-
SamA Pharmaceutical Co., LtdUnknownAcute Bronchitis | Acute Upper Respiratory Tract InfectionKorea, Republic of
-
National Institute on Drug Abuse (NIDA)CompletedCannabis UseUnited States
-
AstraZenecaParexel; Spandauer Damm 130; 14050; Berlin, GermanyCompletedMale Subjects With Type II Diabetes (T2DM)Germany
-
Heptares Therapeutics LimitedCompletedPharmacokinetics | Safety IssuesUnited Kingdom
-
GlaxoSmithKlineCompletedPulmonary Disease, Chronic ObstructiveUnited Kingdom, Netherlands
-
ItalfarmacoCompletedBecker Muscular DystrophyNetherlands, Italy
-
Shijiazhuang Yiling Pharmaceutical Co. LtdXuanwu Hospital, BeijingCompleted
-
GlaxoSmithKlineCompletedInfections, BacterialUnited States
-
West Penn Allegheny Health SystemCompletedAsthma | Allergic RhinitisUnited States