- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04354077
Deep Brain Stimulation Effects In Patients With Opioid Use Disorder
November 7, 2023 updated by: Nestor Tomycz, Allegheny Singer Research Institute (also known as Allegheny Health Network Research Institute)
Pilot Study to Evaluate Deep Brain Stimulation (DBS) of the Nucleus Accumbens (NAc) for Patients With Treatment-refractory Opioid Use Disorder
This is a pilot study to evaluate the safety and efficacy of deep brain stimulation (DBS) of the nucleus accumbens (NAc) as adjunctive treatment for treatment-refractory opioid use disorder.
This study will include 3 individuals with opioid use disorder and relapsing opioid use despite active participation in a drug addiction treatment program.
Study Overview
Detailed Description
Three (N = 3) subjects with treatment refractory opioid use disorder will receive bilateral DBS implants in the NAc using the Abbott Medical Infinity DBS system.
The primary outcome of this study is to demonstrate the safety of bilateral NAc DBS in patients with treatment-refractory opioid use disorder.
Secondary outcomes include time to relapse, remission of opioid use, and change in opioid craving scores.
Other secondary outcomes will include the following: Hamilton Depression Scale (HDS), neurophysiological tests, body weight and biochemical markers of health and nutrition.
If effective, DBS may reduce opioid use and opioid relapse in people with opioid use disorder who may continue to display relapse despite ongoing multidisciplinary standard of care.
DBS brain electrode implantation and implantation of the IPGs and extension wires will be done in the operating room and will require the subject to be admitted post-operatively for an overnight stay.
Two weeks after the DBS operation, subjects will undergo systematic testing each of the quadripolar contacts and formal programming.
Subsequent parameter settings will be changed at routine outpatient visits based on clinical effects.
Standard of care can consist of methadone or buprenorphine maintenance treatment provided by an addiction specialist.
Study Type
Interventional
Enrollment (Estimated)
3
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Donald Whiting, MD
- Phone Number: 412-359-6200
- Email: donald.whiting@ahn.org
Study Contact Backup
- Name: Nestor Tomycz, MD
- Phone Number: 412-359-6200
- Email: nestor.tomycz@ahn.org
Study Locations
-
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Pennsylvania
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Pittsburgh, Pennsylvania, United States, 15212
- Recruiting
- AHN Allegheny General Hospital
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Sub-Investigator:
- Carol Schramke, PhD
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Sub-Investigator:
- Amanda Webb, PA
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Sub-Investigator:
- Stuart Fisk, CRNP
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Contact:
- Clinical Trials Contact
- Phone Number: 412-330-6151
- Email: clinicaltrials@ahn.org
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Principal Investigator:
- Nestor Tomycz, MD
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Sub-Investigator:
- Donald Whiting, MD
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Sub-Investigator:
- Heather Richards, MD
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Sub-Investigator:
- Elizabeth Cuevas, MD
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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
22 years to 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Male and females age ≥ 22 years with diagnosis of opioid use disorder (OUD) based on Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) with at least a 5-year history
- OUD must be the primary disorder
- Failed at least two levels of treatment (Comprehensive Opioid Addiction Treatment (COAT), intensive outpatient COAT, residential, inpatient, alternative to intensive outpatient program, Drug Dependence Unit, which included buprenorphine/naloxone or buprenorphine monotherapy.
- Has exhibited more than 2 episodes of opioid use relapse in prior 12 months despite ongoing participation in MAT program, including either methadone or buprenorphine or suboxone
- No active ilicit substance abuse as based on urine testing
- Has completed a neuro-psychological evaluation to the satisfaction of a neuropsychologist
- Has completed a psychiatric evaluation to the satisfaction of a psychiatrist
- Has had a brain MRI performed and reviewed by neurosurgeon with no contraindication for DBS procedure identified
- Platelet count > 125,000 per cubic mm and prothrombin time (PT) and partial thromboplastin time (PTT) within normal limits
- Negative blood cultures to rule out bacteremia
Exclusion Criteria:
- Prior brain surgery
- Baseline assessment on the Hamilton Depression Rating Scale (HAMD) of greater than 17 or increased risk of suicide based upon any positive response on the Columbia Suicide Severity Scale
- History of suicide attempt in the past 5 years
- History of uncontrolled or persistent seizures
- Suspected dementia based on neuropsychological screening or Mini Mental State Exam (MMSE) Score < 25
Contraindications for MRI:
- Presence of implanted electrical stimulation device or other implanted metal devices (excluding dental braces).
- Claustrophobia
- Body weight exceeding limit of the machine (180 kg/400 lb)
- Females who are pregnant or nursing. Female subjects of child-bearing potential must have a negative pregnancy test during the pre-op phase and must agree to utilize adequate birth control throughout the trial and for at least 30 days following trial completion.
- Coagulopathy secondary to chronic need for anticoagulation medicine (e.g. warfarin) or anti-platelet medication (e.g. aspirin or clopidogrel)
- Diagnosis of neurological disorders (e.g. multiple sclerosis, Parkinson's disease, and stroke)
- Severe brain atrophy or presence of subdural hygromas or subdural hematomas on brain MRI
- Any evidence of underlying endocarditis.
- Primary language other than English
- Have any other medical condition that, in the opinion of the Investigator, makes the subject unsuitable for enrollment.
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: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: NAc DBS
Subjects will receive bilateral DBS of the NAc
|
Deep Brain Stimulation of the Nucleus Accumbens
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Opioid use/abstinence
Time Frame: 6 months
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Percentage of subjects achieving opioid abstinence
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6 months
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Opioid use/abstinence
Time Frame: 1 year post-surgery
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Percentage of subjects achieving opioid abstinence
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1 year post-surgery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Changes in biochemical markers of health
Time Frame: Baseline, 6, 12 and 24 months
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Biochemical battery of tests.
Blood draw for plasma CBC, lytes, BUN, creatinine, Glutamate dehydrogenase (GLDH), gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), erythrocyte mean corpuscular volume (MCV), carbohydrate-deficient transferrin (CDT)
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Baseline, 6, 12 and 24 months
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Changes in biochemical markers of nutrition
Time Frame: Baseline, 6, 12 and 24 months
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Biochemical battery of tests.
Blood draw for plasma, pre-albumin, folate, B12, calcium, magnesium, iron
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Baseline, 6, 12 and 24 months
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Depression score
Time Frame: Baseline, 3, 6, 9, 12 and 24 months post-surgery
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Hamilton Depression Scale: There are 17 items by which an assessor will select one cue which best characterizes the patient (0-4).
All items are added up for a total score, where lower numbers are indicative of a normal score and higher numbers are indicative of worse depression.
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Baseline, 3, 6, 9, 12 and 24 months post-surgery
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Quality of life measure
Time Frame: Baseline, 3, 6, 9, 12 and 24 months post-surgery
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Flanagan QOL scale: Subjects will assign a rank score to 16 items.
Rankings go from 7 to 1, where 7 is a better outcome and 1 is the worst outcome.
The scale is as follows: 7=Delighted, 6=Pleased, 5=Mostly Satisfied, 4=Mixed, 3=Mostly Dissatisfied, 2=Unhappy, 1=Terrible.
All rankings are totaled for a final score.
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Baseline, 3, 6, 9, 12 and 24 months post-surgery
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Primary Safety Objective - Complication rates
Time Frame: 12 months
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Adverse events
|
12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Nestor Tomycz, MD, Allegheny Health Network
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)
February 7, 2022
Primary Completion (Estimated)
February 1, 2025
Study Completion (Estimated)
February 1, 2025
Study Registration Dates
First Submitted
April 2, 2020
First Submitted That Met QC Criteria
April 16, 2020
First Posted (Actual)
April 21, 2020
Study Record Updates
Last Update Posted (Estimated)
November 8, 2023
Last Update Submitted That Met QC Criteria
November 7, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- Addiction DBS
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
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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