A Study of Oral Ibogaine in Opioid Withdrawal

Ibogaine to Determine Maximum Tolerated Dose (MTD) or Treat-to-Target Dose (TTD) for the Evaluation of Efficacy and Safety

Study DMX-IB 201 is a Phase 1/2a study of ibogaine consisting of an initial single ascending dose escalation stage to determine the maximum tolerated dose (MTD) or treat-to-target dose (TTD) in healthy volunteers, followed by a randomized, double-blind, placebo-controlled proof of concept stage to demonstrate the efficacy, safety and tolerability of the selected dose in opioid-dependent patients who seek medically supervised opioid withdrawal

Study Overview

• Status: Completed
• Conditions: Opiate Withdrawal Syndrome
• Intervention / Treatment: Drug: DMX-1002; Drug: Placebo

Detailed Description

Detailed description restricted as elements of this trial are part of a Phase 1 clinical trial.

• Study Type: Interventional
• Enrollment (Actual): 116
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, NW10 7EW
    • Hammersmith Medicines Research (HMR) Limited
  • Greater Mancherster
    • Manchester, Greater Mancherster, United Kingdom, M13 9NQ
      • MAC Clinical Research Manchester (Early Phase Unit), Neuroscience Centre of Excellence

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 55 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Important Inclusion Criteria for both Stages 1 and 2:

• Males and females between 18 years and 55 years of age.
• For Stage 1, healthy volunteers; recreational opioid use is allowed but not required for inclusion in the study.
• For Stage 2, opioid-dependent subjects (DSM-IV) seeking medically supervised opioid withdrawal and presenting with an OOWS score ≥ 5 on Day 1, prior to dosing.
• Self-report of at least 1 prior positive hallucinogen drug experience that included a meaningful altered state of consciousness. Hallucinogenic substances can include psilocybin, LSD, MDMA or other classic hallucinogens.
• Females that are not of child-bearing potential as defined within the protocol.
• Males who agree to use 1 of the acceptable contraceptive regiments and not to donate sperm from the first study drug administration to at least 90 days after the last drug administration or who are unable to procreate (as defined within the protocol).
• For Stage 1, negative urine tests for drugs of abuse (opiates, benzodiazepines, amphetamines, cannabinoids, cocaine, barbiturates, and phencyclidine), and CNS (central nervous system) prescription drugs (SSRIs [selective serotonin reuptake inhibitors], SNRIs [serotonin-norepinephrine reuptake inhibitors], mood stabilizers) both at screening and within approximately 7 days prior to dosing, and negative alcohol test.
• For Stage 2, negative blood and urine tests for methadone, buprenorphine, mitragynine, non-opioid drugs of abuse (benzodiazepines, amphetamines, cannabinoids, cocaine, barbiturates, and phencyclidine), and CNS prescription drugs (SSRIs, SNRIs, mood stabilizers) both at screening and within approximately 7 days prior to dosing, and negative breath alcohol test at Day -1.
• Negative serology test result for human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen, hepatitis C virus antibody at Screening and COVID-19 at Screening and Day -2.
• Willing to not consume citrus fruits (such as grapefruit, Seville oranges) and/or citrus fruit products throughout the study until Day 6.
• Willing to refrain from taking any prescription and non-prescription drugs, including herbal and nutritional supplements within 2 weeks prior to Day 1 and throughout the study until Day 6.
• CYP2D6 genotype that demonstrates gene variants of fast or intermediate metabolism (i.e. not ultra-rapid or poor).

Important Exclusion Criteria for both Stages 1 and 2:

• Current diagnosis of opioid or other substance dependence (except caffeine) according to DSM-IV or DSM-5 definitions (Stage 1 only).
• Any history of seizure or convulsion, including febrile convulsion in childhood or as an adult.
• History of chronic or frequent migraines.
• Current or recent (≤1 year) history of significant alcohol abuse (>3 units per day on a regular basis)
• For Stage 1, drug dependency disorder.
• For Stage 2, polydrug abuse or dependency within the past 3 years other than opioids, caffeine, and/or nicotine.
• Personal history or presence of primary psychotic disorder (including substance-induced or due to a medical condition), bipolar affective disorder Type I or Type II, or schizophrenia (not including non-psychotic, clinically stable disorders such as depression or anxiety).
• First or second-degree family history of primary psychotic disorder, bipolar affective disorder Type I or Type II, or schizophrenia.
• Showing suicidal tendency as per the Columbia Suicide Severity Rating Scale (C-SSRS).
• Any prior use of ibogaine, noribogaine or other chemically related substances or any allergy or intolerance to excipients in the ibogaine capsules.
• History or presence of clinically significant cardiovascular disease including angina, myocardial infarction, coronary artery disease, heart failure, arrhythmias, endocarditis, syncope of unknown origin, or any other condition that, in the opinion of the investigator, may be associated with a higher risk of arrhythmias.
• History or presence at screening (12-lead ECG and 24-hour Holter monitoring) or Day -2 (12-lead ECG) of ECGs that (1) shows QTcF interval duration >420 ms (if QTcF >420 ms prior to dosing on Day 1, subjects need not be excluded provided QTcF was ≤ 420 at Screening and Day -2 and QTcF ≤ 440 on Day 1.), PR interval duration >210 ms, or QRS interval duration >120 ms, obtained as an average from 3 ECG recordings, taken at least 1 minute apart after at least 10 minutes of quiet rest in the supine position; or (2) ECG showing ventricular bigeminy, trigeminy or couplets; or (3) shows, in the opinion of the investigator, any other clinically significant abnormality.
• History or family history of prolonged QT interval cardiac channelopathy or sudden cardiac death.
• Orthostatic hypotension or uncontrolled hypertension as characterized by sustained systolic elevation to ≥160 mmHg and/or diastolic elevation to ≥100 mmHg at screening or Day -2.
• Subjects with an average resting heart rate of <50 bpm on the ECG at screening.
• Use of any prescription drugs in the 28 days prior to the first study drug administration, that are known to inhibit or induce CYP2D6 or to cause QT prolongation or, in the opinion of the investigator, would put into question the status of the participant as healthy.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Single dose IMP (DMX-1002); Stage 1 (single blind, placebo controlled): initial dose of placebo, followed by treatment at one of 4 ascending dose levels of IMP (3, 6, 9 or 12 mg/kg) Stage 2 (blinded): MTD/TTD established in Stage 1 vs placebo (proof of concept)	Drug: DMX-1002; Investigation of the safety, tolerability and pharmacokinetics (PK) in healthy volunteers (Stage 1 - single blind), and the efficacy, safety, tolerability and PK in opioid-dependent patients (Stage 2 - double blind); Other Names: Ibogaine Hydrochloride; Drug: Placebo; Matching placebo to the IMP (DMX-1002); Other Names: Microcrystalline cellulose
Placebo Comparator: Matching Placebo; Placebo using capsules identical to the IMP (DMX-1002)	Drug: Placebo; Matching placebo to the IMP (DMX-1002); Other Names: Microcrystalline cellulose

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stage 2 - Short Opiate Withdrawal Scale of Gossop (SOWS-Gossop) average score from Day 2 to Day 6	The SOWS-Gossop is a 10-item questionnaire to evaluate opioid withdrawal symptom severity. Each item is scored on a 4-point scale. Higher scores indicate greater severity (total score range 0-40).	Day 2 to Day 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stage 2 - Subject completion status at Day 6 (key secondary endpoint)	Proportion of subjects who received study medication and completed the SOWS-Gossop assessment on Day 6	Day 6
Stage 2 - Objective Opiate Withdrawal Scale of Handelsman (OOWS Handelsman) average score from Day 2 to Day 6	The OOWS-Handelsman is an interview and observation tool for assessing opioid withdrawal signs and symptoms. It contains 13 physically observable signs, rated present or absent, based on a timed period of observation of the subject by a rater. Higher scores indicate greater severity (total score range 0-13).	Day 2 to Day 6
Stage 2 - Subject completion status at Day 30	Proportion of subjects who received study medication and completed the SOWS-Gossop assessment on Day 30	Day 30
Stage 2 - Time to drop-out through Day 30	Time to drop-out	Day 1 to Day 30
Stage 2 - Daily subject-rated Visual Analog Scale for Efficacy (VAS-E) score from Day 2 to Day 6 and at Day 30	The VAS-E is a scale to quantify the state of craving a subject experienced in the previous 24 hours. The scale size is 100 mm, anchored on the left by "no craving at all" and anchored on the right by "strongest craving ever."	Day 2 to Day 6 and at Day 30
Stage 2 - Clinician-rated daily Clinical Global Impression - Improvement (CGI-I) score from Day 2 to Day 6	The CGI-I is a 7-point scale that requires the clinician to assess how much the subject's condition has improved or worsened from baseline. The ratings are: 1 - very much improved; 2 - much improved; 3 - minimally improved; 4 - no change; 5 - minimally worse; 6 - much worse; 7 - very much worse.	Day 2 to Day 6
Stage 2 - Hamilton Depression Rating Scale (HAM-D) score at Day 6 and Day 30	The HAM-D is used to determine a subject's level of depression. The study uses the original 17-item scale. Higer scores indicate greater severity (total score range 0-52).	Day 6 and Day 30
Stage 2 - Proportion of subjects requiring clonidine for relief of withdrawal symptoms up to Day 6	Proportion of subjects requiring clonidine for relief of withdrawal symptoms	Day 1 to Day 6

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety (Stage 1 and Stage 2) - Frequency of treatment-emergent adverse events	Number of subjects with treatment-emergent adverse events	Day 1 to Day 30
Safety (Stage 1 and Stage 2) - number of subjects with abnormal electrocardiograms (ECG)	12-Lead ECG including heart rate (HR), QT interval corrected for HR according to Fridericia (QTcF), Individually corrected QTc interval (QTcI), HR-corrected J to T-peak interval (JTpc), PR interval, and QRS interval	Day 1 to Day 30
Safety (Stage 1 and Stage 2) - number of subjects with new magnetic resonance imaging (MRI) findings (in the presence of ataxia greater than 24 hours post-dose)	MRI of the brain	Day 2
Safety (Stage 1 and Stage 2) - number of subjects with abnormal neurological function	Neurological function	Day 2 to Day 6
Safety (Stage 1 and Stage 2) - number of subjects with abnormal Scale for the Assessment and Rating of Ataxia (SARA) scores	The SARA is a tool for assessing ataxia. It includes 8 items related to gait, stance, sitting, speech, finger-chase test, nose-finger test, fast alternating movements and heel-shin test. Total scores range from 0 (no ataxia) to 40 (most severe ataxia).	Day 2
Safety (Stage 2) - number of subjects with newly emerging suicidal ideation or behavior	Suicidality is assessed by means of the Columbia Suicide Severity Rating Scale (C-SSRS). It contains 6 "yes" or "no" questions (Q1: wish to be dead; Q2: non-specific suicidal thoughts; Q3-5: more specific suicidal thoughts and intent to act; Q6: suicidal behavior). An answer of "yes" to any of the six questions may indicate a need for referral to a trained mental health professional and an answer of "yes" to questions 4, 5 or 6 indicate high-risk.	Day 6 and Day 30
Pharmacokinetics (Stage 1 and Stage 2) - maximum whole blood and plasma concentrations [Cmax] of ibogaine and noribogaine	Whole blood and plasma concentrations	0.5 hours pre-dose up to 120 hours post-dose (Day 6)
Pharmacokinetics (Stage 1 and Stage 2) - time to reach Cmax [Tmax] for ibogaine and noribogaine	Tmax	0.5 hours pre-dose up to 120 hours post-dose (Day 6)
Pharmacokinetics (Stage 1 and Stage 2) - area under the concentration-time curve up to the last measurable time point (AUC0-T) for ibogaine and noribogaine	AUC0-T	0.5 hours pre-dose up to 120 hours post-dose (Day 6)
Pharmacokinetics (Stage 1 and Stage 2) - apparent elimination half-life (T-half) of ibogaine and noribogaine	T-half	0.5 hours pre-dose up to 120 hours post-dose (Day 6)
Pharmacokinetics (Stage 1) - renal clearance (CLr) of ibogaine	CLr	0.5 hours pre-dose up to 120 hours post-dose (Day 6)

Collaborators and Investigators

• Sponsor: atai Therapeutics, Inc.
• Collaborators: Hammersmith Medicines Research; ERT: Clinical Trial Technology Solutions; MAC Clinical Research

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2021
• Primary Completion (Actual): January 16, 2024
• Study Completion (Actual): January 16, 2024

Study Registration Dates

• First Submitted: May 13, 2021
• First Submitted That Met QC Criteria: August 30, 2021
• First Posted (Actual): August 31, 2021

Study Record Updates

• Last Update Posted (Actual): August 6, 2024
• Last Update Submitted That Met QC Criteria: August 5, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: opioid use disorder; substance use disorder; opioid detoxification; Opioid withdrawal symptoms; abrupt opioid discontinuation
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders; Substance Withdrawal Syndrome; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Excitatory Amino Acid Antagonists; Excitatory Amino Acid Agents; Psychotropic Drugs; Hallucinogens; Ibogaine
• Other Study ID Numbers: DMX-IB-201

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: No
• Studies a U.S. FDA-regulated device product: No