Department of Defense PTSD Adaptive Platform Trial - Master Protocol

A Phase 2, Multi-center, Multi-arm, Randomized, Placebo-controlled, Double-blind, Adaptive Platform Study to Evaluate the Safety, Tolerability, and Efficacy of Potential Pharmacotherapeutic Interventions in Active-Duty Service Members, Veterans, and Non-Veteran Civilians With PTSD

This is a Phase 2 randomized, double-blinded, placebo-controlled study that will evaluate multiple potential pharmacotherapeutic interventions for PTSD utilizing an adaptive platform trial design. Participants are randomized among the available cohorts in the study and the resulting randomization enables sharing/pooling of control participants, where all interventions may be compared to a common control (placebo). The master protocol describes the default procedures and analyses for all cohorts; treatment-specific eligibility requirements, safety and efficacy procedures, or endpoints are described in the cohort-specific appendices and reflected in the intervention-specific clinicaltrials.gov records.

Study Overview

Detailed Description

The general structure of the M-PACT consists of a 30-day Screening Period, a 12-week Treatment Period, and a 4-week Safety Follow-up. The trial will include up to 5 open cohorts (it is possible for 1 of the cohorts to begin sooner than the others, as necessary). Importantly, the integration of multi-modal biomarker assessments within the M-PACT allows for defining future cohorts based on to be determined biomarker signatures in a multi stage approach. Initial testing in non biomarker defined cohorts will be referred to as "main stage" testing, while testing in biomarker-defined cohorts will occur within "biomarker extensions."

Initially designed as up to 5-arms versus control, the adaptive platform trial will continue enrollment until decisions are made to stop all cohorts. Interim analyses will be conducted at approximately quarterly intervals, beginning after at least 40 participants have been randomized and at least 10 participants have completed the End of Study (EOS) visit. At each interim analyses, unblinded data will be reviewed by an independent, firewalled ISAC and a DSMB. The possible cohort-level decisions that could be made by the prespecified adaptive plan include stopping enrollment to a cohort for futility, stopping enrollment to a cohort for anticipated success, or stopping enrollment to a cohort for reaching the maximum sample size. For cohort-specific interventions intending to pursue a labeling claim (which will be clearly stated in the cohort-specific appendix before cohort initiation), early stopping for success will not be considered. New cohorts for investigation can be added at any time. The DSMB may recommend stopping any cohort for safety reasons.

Candidate biomarker data will be retrospectively analyzed after each cohort has completed main stage testing, and cohort testing may be re-initiated for prospective evaluation of the treatment in a participant population enriched (e.g., either only biomarker "positive" or only biomarker "negative" participants would be enrolled) or stratified based on biomarker status. In addition, candidate biomarkers (which may also be characterized or validated externally to the M-PACT) may be used to stratify randomization across cohorts or as a prospective enrichment strategy at the initiation of a cohort. Exploratory biomarker data will be evaluated throughout the trial to identify additional candidate biomarkers for testing within the M-PACT.

For information specific to each intervention included in this platform trial, please refer to the below corresponding, separate, clinicaltrials.gov records:

Vilazodone NCT05948579; Fluoxetine NCT05948553; Daridorexant NCT05948540; SLS-002 NCT06816433.

Parties interested in having their intervention considered for testing within the M-PACT should email partners@gcaresearch.org

Study Type

Interventional

Enrollment (Estimated)

800

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 Contact

Study Locations

    • Florida
      • Miami, Florida, United States, 33032
        • Recruiting
        • Homestead Associates in Research, Inc.
        • Contact:
    • Georgia
      • Atlanta, Georgia, United States, 30318
        • Recruiting
        • Advanced Discovery Research
        • Contact:
    • Hawaii
    • Kentucky
      • Fort Thomas, Kentucky, United States, 41075
        • Recruiting
        • Cincinnati Veteran's Affairs Medical Center
        • Contact:
    • Maryland
      • Bethesda, Maryland, United States, 20889-5632
        • Recruiting
        • Walter Reed National Military Medical Center (WRNMC)
        • Contact:
        • Contact:
        • Principal Investigator:
          • Aaron Wolfgang, MD
    • New York
      • Williamsville, New York, United States, 14221
        • Recruiting
        • Upstate Clinical Research Associates, LLC
        • Contact:
    • Texas
      • San Antonio, Texas, United States, 78236
        • Recruiting
        • Wilford Hall Ambulatory Surgical Center (WHASC)
        • Contact:
        • Principal Investigator:
          • Paul Sherman, MD
        • Sub-Investigator:
          • Derrek Hamaoka, MD
    • Virginia
      • Fort Belvoir, Virginia, United States, 22060-5285
        • Recruiting
        • Alexander T. Augusta Military Medical Center (ATAMMC):
        • Contact:
        • Contact:
    • Washington
      • Joint Base Lewis McChord, Washington, United States, 98433
        • Recruiting
        • Madigan Army Medical Center
        • Contact:

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

18 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria: An individual must meet all the following criteria to be eligible to participate in this study:

  1. Is willing and able to provide written informed consent.
  2. ≥18 and <65 years of age at Screening.
  3. Meets DSM-5 criteria for PTSD according to CAPS-5-R, Past Month assessment at Screening and Baseline.
  4. The index trauma must have occurred more than 3 months prior to Screening.
  5. Has a CAPS-5-R, Past Month total score of ≥26 at Screening and Baseline. Note: The CAPS-5 scoring grid will be used to score answers and to calculate the total score to determine eligibility.
  6. Participants must be able to read, speak, and understand English sufficiently to complete the CAPS-5, which is the primary efficacy endpoint and is administered by trained Centralized Assessors.
  7. Agrees to consistently use an acceptable method of birth control (required for both males and females who are of reproductive potential and sexually active with partners of the opposite sex) throughout the duration of participants' involvement in the study and for a minimum of 30 days after the last dose of study intervention or longer, as specified in the assigned cohort-specific appendices.

    1. For females of reproductive potential, acceptable birth control methods are defined as: hormonal contraceptives, intrauterine device, or double barrier contraception (ie, male condom and diaphragm, male condom or diaphragm with spermicidal gel or foam). Hormonal contraceptives must have been started at least 2 months prior to the Baseline Visit. In addition, agrees to no egg donation or harvesting for the duration of the study and for at least 30 days after the last dose of study intervention or as specified in the assigned cohort-specific appendices.
    2. Non-reproductive potential for females is defined by a post-menopausal (12 consecutive months without menses or surgically sterile). If in question, an FSH of >40 U/mL, per central laboratory testing must be documented. Surgical sterility (hysterectomy, bilateral oophorectomy, or bilateral tubal ligation) must be documented.
    3. Females of reproductive potential must have a negative pregnancy test at the Screening (serum) Visit and Baseline (urine) Visit.
    4. For males, adequate birth control methods will be defined as the use of double barrier contraception (e.g., male condom and diaphragm, male condom or diaphragm with spermicidal gel or foam). In addition, male participants must agree not to donate sperm for the duration of the study and for at least 30 days after the last dose of study intervention or as specified in the assigned cohort-specific appendices.
    5. Non-reproductive potential for males is defined as surgical sterility (i.e., vasectomy) at least 3 months prior to Baseline.
  8. Is able and willing to participate in study assessments and undergo blood draws.
  9. For participants who consent to the optional MRI: willingness to undergo MRI, e.g., is not claustrophobic, and has no contraindications to MRI.

Exclusion Criteria: An individual who meets any of the following criteria will not be eligible to participate in this trial:

  1. Is pregnant or breastfeeding at the Screening or Baseline Visits or planning pregnancy during the study.
  2. Is at risk for suicide based on any of the following:

    1. Had any suicidal ideation or behavior (including preparatory behavior) that required psychiatric hospitalization in the 3 months prior to screening.
    2. Had more than 2 actual suicide attempts within the last 3 years, not including interrupted or aborted attempts, preparatory acts or behaviors, or non-suicidal self injurious behavior (as per C SSRS response).
    3. Has any history of suicidal ideation and/or intent following initiation of a medication used for psychiatric symptoms or disorders.
    4. Has any history of suicide-related hospitalization following initiation of a medication used for psychiatric symptoms or disorders.
  3. Is taking any prohibited medication or cohort-specific restrictions (see cohort-specific appendices), is unable/unwilling to discontinue medications, or in the PI's judgment, cannot discontinue medications. Participants must agree to a washout period of at least 14 days or 5 half-lives, whichever is longer, prior to the first dose of study intervention. Note, the half-life of the parent drug (not metabolites) should be used in this calculation.
  4. In the 3 months prior to the Baseline Visit, has initiated or terminated individual or group PTSD specific psychotherapy (e.g., Eye Movement Desensitization & Reprocessing, Prolonged Exposure, Cognitive Processing Therapy, Stress Inoculation Training, Present Centered Therapy), or therapy is anticipated to conclude during the study. Completion of ≤2 sessions in the prior 3 months with no plans to continue is not exclusionary. Participants in stable trauma-focused or non-trauma-focused therapy must agree to continue treatment for the duration of participation in the study.
  5. Has undergone or plans to undergo sex reassignment surgery. Note: participants who are currently undergoing stable hormone replacement therapy are eligible for inclusion in the study.
  6. Meets DSM-5 (American Psychiatric Association 2013) criteria for moderate or severe AUD or other SUDs, including cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, or stimulants within 3 months of screening. Nicotine use disorder is allowed.
  7. Has a positive screen for illicit drugs (excluding cannabis) or positive alcohol screen (either positive on qualitative test or above .04% on a quantitative test) at the Baseline Visit.

    1. If the urine drug screen is positive at Screening (excluding cannabis), the participant will not immediately be excluded from participation in the study. The urine drug screen must be repeated at Baseline after at least 7 days since the initial test. If the urine drug screen is positive at Baseline (excluding cannabis), then the participant will be discontinued from the study.
    2. If the urine alcohol screen is positive at Screening, the participant will not immediately be excluded from participation in the study. If the urine alcohol screen is also positive at Baseline, then the participant will be discontinued from the study.
  8. Has a lifetime history or current symptoms of psychotic features, as determined by the MINI Psychotic Disorders and Mood Disorders with Psychotic Features screening questions.
  9. Has a history of neoplastic disease or completion of treatment in the last 5 years, except for treated basal cell or squamous cell carcinoma of the skin.
  10. Has any clinically significant abnormal findings on the 12-lead ECG at the Screening Visit or Baseline Visit, such as:

    1. Abnormal heart rhythm (such as atrial fibrillation, ventricular fibrillation, or torsade de pointes)
    2. ECG with a QTc interval >450 msec for males or >470 msec for females (QT interval corrected with Fridericia correction [QTcF]) At Screening, eligibility will be based on the central ECG reading. At Baseline, eligibility will be based on the local ECG reading by a site investigator.
  11. Has abnormal laboratory results at the Screening Visit:

    1. serum creatinine >1.5 mg/dL OR
    2. estimated creatinine clearance of <50 mL/min calculated by the Cockcroft and Gault formula.
  12. Has clinically significant abnormal laboratory results at the Screening Visit that indicate impaired liver function:

    1. ALT or AST >2 × ULN
    2. total bilirubin level >1.5 × ULN (unless previously known Gilbert syndrome)
    3. prolonged prothrombin time >1.5 × ULN
  13. Has a prior history of drug induced liver injury characterized by ALT or AST >3 × ULN AND total bilirubin level >2 × ULN without cholestasis (ie, ALP <2 × ULN).
  14. Has any other clinically significant laboratory result at Screening that could impact the participant's safety or participation in the study, as determined by the Site PI.
  15. Has any other concurrent psychiatric or medical condition that would impact the participant's safety, ability to appropriately complete evaluations, or participation in the study, as determined by the Site PI.
  16. Does not have a stable method of contact over the duration of the study.
  17. Has participated in any interventional clinical trial or treatment with any investigational drug or other investigational intervention within 3 months or 5 half-lives, whichever is longer, of screening.

    Note: Previous participation in an observational study within 3 months of screening is permitted.

    Note: Participants who are enrolled in the M-PACT, and who are eligible for re randomization, are permitted to remain in the study and receive alternative cohort intervention following a 14-day or 5 half-lives washout period, whichever is longer. The half-life of the parent drug (not metabolites) should be used in this calculation.

  18. Is unavailable for the duration of the trial, unlikely to be compliant with the protocol, or deemed by the Site PI to be unsuitable for participation in the trial for any reason.
  19. Systolic blood pressure >140 mm Hg and/or diastolic blood pressure >90 mm Hg or Systolic blood pressure <90 mm Hg and/or diastolic blood pressure <50 mm Hg.

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
Experimental: Intervention A: Fluoxetine HCl
Fluoxetine will be administered at 10 to 60 mg daily. The initial dose for all participants will be 10 mg daily for 1 week, then increased to 20 mg daily for 2 weeks, then increased to 40 mg daily for 2 weeks, then increased to 60 mg daily for the remainder of the trial. One reduction in dose due to tolerability will be allowed. When a participant's dose is decreased due to tolerability, the dose will not be increased.
Placebo Comparator: Intervention A Placebo
A matching placebo will be administered at 10 to 60 mg daily in the same regimen as the intervention.
Placebo Comparator: Intervention B Placebo
A matching placebo will be administered at 10 to 40 mg daily in the same regimen as the intervention.
Experimental: Intervention C Daridorexant
Daridorexant will be administered 50 mg once daily.
Placebo Comparator: Intervention C Placebo
A matching placebo will be administered at 50 mg daily in the same regimen as the intervention.
Experimental: Intervention D SLS-002
• SLS-002 will be administered via intranasal administration (one spray per nostril, per device) at 78 mg two times per week for the first eight weeks and then once a week for the last four weeks.
Placebo Comparator: Intervention D Placebo
A matching placebo will be administered via intranasal administration (one spray per nostril, per device) two times per week for the first eight weeks and then once a week for the last four weeks.
Experimental: Intervention B Vilazodone HCl
Vilazodone HCl will be administered at 10 mg once daily for 7 days, followed by 20 mg for 7 days, followed by 40 mg for the remainder of the trial. There must be a minimum of 7 days between dosage increases. One reduction in dose due to tolerability will be allowed. After Week 8, dose reduction for tolerability is allowed, but dose increase is not allowed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of new or worsening suicidal thoughts or behaviors as measured by change in Columbia Suicide Severity Rating Scale (C-SSRS) score from baseline.
Time Frame: 12 Weeks
The C-SSRS is an assessment of suicidal ideation and behavior in clinical and research settings. The C-SSRS consists of 16 questions that ask about suicidal ideation and behaviors (the first 10 questions comprise the ideation subscale and the last 6 comprise the behavior subscale). This 5-item subscale ranges from a minimum of 0 (corresponding to no suicidal ideation) to a maximum of 5 (representing active suicidal ideation with plan and intent).
12 Weeks
Absolute change in the Clinician-Administered PTSD Scale-5-Revised (CAPS-5-R) Past Month total score at Week 12 (Final/Early termination Visit).
Time Frame: 12 Weeks
A change in PTSD symptom severity from baseline as measured by CAPS-5-R Past Month. The range of the scale is 0-200. The higher the score at baseline, the worse the PTSD severity. The larger the decrease in score from baseline, the better the outcome.
12 Weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Frequency of treatment-emergent adverse events (TEAEs).
Time Frame: 12 Weeks
The TEAEs recorded during the study will be summarized by system organ class, preferred term, and treatment group. Adverse events and medical history will be coded using the most current version of MedDRA.
12 Weeks
Severity of treatment-emergent adverse events (TEAEs).
Time Frame: 12 Weeks
The TEAEs recorded during the study will be summarized by system organ class, preferred term, and treatment group. Adverse events and medical history will be coded using the most current version of MedDRA.
12 Weeks
Frequency of serious adverse events (SAEs)
Time Frame: 12 Weeks
The SAEs recorded during the study will be summarized by system organ class, preferred term, and treatment group. Adverse events and medical history will be coded using the most current version of MedDRA.
12 Weeks
Severity of serious adverse events (SAEs).
Time Frame: 12 Weeks
The SAEs recorded during the study will be summarized by system organ class, preferred term, and treatment group. Adverse events and medical history will be coded using the most current version of MedDRA.
12 Weeks
Relative change from Baseline to Week 12 in the Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R), Past Month total score.
Time Frame: 12 Weeks
A relative change in PTSD symptom severity from baseline as measured by CAPS-5-R Past Month. The range of the scale is 0-200. The higher the score at baseline, the worse the PTSD severity. The larger the decrease in score from baseline, the better the outcome.
12 Weeks
Number of participants with a Response Rate ≥30%
Time Frame: 12 Weeks
≥30% reduction from Baseline to 12 Weeks in the Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R), Past Month total score. The range of the scale is 0-200. The higher the score, the worse the PTSD severity. The larger the decrease in score from baseline, the better the outcome.
12 Weeks
Number of participants with a Response Rate ≥50%
Time Frame: 12 Weeks
≥50% reduction from Baseline to 12 Weeks in the Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R), Past Month total score. The range of the scale is 0-200. The higher the score, the worse the PTSD severity. The larger the decrease in score from baseline, the better the outcome.
12 Weeks
Number of participants Achieving Remission
Time Frame: 12 Weeks
Achieving remission: defined as the Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R), Past Month total score <18. The range of the scale is 0-200. The higher the score, the worse the PTSD severity.
12 Weeks
Relative and absolute change from Baseline in Clinician-Administered PTSD Scale for DSM-5 Revised (CAPS-5-R), Past Month total score at Weeks 4 and 8
Time Frame: 8 weeks
A relative change in PTSD symptom severity from baseline as measured by CAPS-5-R Past Month. The range of the scale is 0-200. The higher the score at baseline, the worse the PTSD severity. The larger the decrease in score from baseline, the better the outcome.
8 weeks
Absolute change from Baseline at each post-Baseline Visit in GAD-7 questionnaire
Time Frame: Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Generalized anxiety disorder screener (GAD-7) Scale range: 0 to 21 Interpretation: Higher scores indicate worse anxiety symptoms
Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Absolute change from Baseline at each post-Baseline Visit in TLFB for substance use
Time Frame: Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Timeline Follow Back (TLFB) for Substance Use Scale range: Quantitative daily use (no fixed total range) Interpretation: Higher values indicate greater substance use (worse outcome)
Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Absolute change from Baseline at each post-Baseline Visit in FTND questionnaire
Time Frame: Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Fagerström Test for Nicotine Dependence (FTND) Scale range: 0 to 10 Interpretation: Higher scores indicate greater nicotine dependence (worse outcome)
Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Absolute change from Baseline at each post-Baseline Visit in B-IPF questionnaire
Time Frame: Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Brief Inventory of Psychosocial Functioning (B-IPF) Scale range: 0 to 40 Interpretation: Higher scores indicate worse psychosocial functioning (worse outcome)
Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Absolute change from Baseline at each post-Baseline Visit in WHOQOL-BREF
Time Frame: Week 1 (Baseline), Week 12
World Health Organization Quality of Life - BREF (WHOQOL-BREF) Scale range: 0 to 100 Interpretation: Higher scores indicate better quality of life (better outcome)
Week 1 (Baseline), Week 12
Absolute change from Baseline at each post-Baseline Visit in PSS questionnaire
Time Frame: Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Perceived Stress Scale (PSS) Scale range: 0 to 40 Interpretation: Higher scores indicate greater perceived stress (worse outcome)
Week 1 (Baseline), Week 4, Week 6, Week 8, Week 12
Absolute change from Baseline at each post-Baseline Visit in BPI
Time Frame: Week 1 (Baseline), Week 12
Brief Pain Inventory (BPI) Scale range: 0 to 10 (pain severity and interference) Interpretation: Higher scores indicate worse pain severity and interference (worse outcome)
Week 1 (Baseline), Week 12
Absolute change from Baseline in IDSIQ (7-day mean scores prior to visits)
Time Frame: Week 0 (Screening), Week 1 (Baseline), Week 4, Week 8, Week 12, Week 16 (Safety Follow-Up)
Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ) Scale range: 0 to 100 Interpretation: Higher scores indicate worse daytime impairment due to insomnia (worse outcome)
Week 0 (Screening), Week 1 (Baseline), Week 4, Week 8, Week 12, Week 16 (Safety Follow-Up)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the 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)

November 2, 2023

Primary Completion (Estimated)

July 1, 2028

Study Completion (Estimated)

July 1, 2029

Study Registration Dates

First Submitted

June 13, 2022

First Submitted That Met QC Criteria

June 13, 2022

First Posted (Actual)

June 16, 2022

Study Record Updates

Last Update Posted (Actual)

June 5, 2026

Last Update Submitted That Met QC Criteria

June 2, 2026

Last Verified

June 1, 2026

More Information

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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