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- Klinische Studie NCT04026958
Clarithromycin-Mechanismen bei Hypersomnie-Syndromen
Antibiotika-vermittelte Verbesserungen der Wachsamkeit: Wirkmechanismen von Clarithromycin bei Hypersomnie-Syndromen
Studienübersicht
Status
Intervention / Behandlung
Detaillierte Beschreibung
Übermäßige Schläfrigkeit am Tag und lange Schlafzeiten sind gemeinsame Merkmale vieler neurologischer Störungen, einschließlich Myotoner Dystrophie, Parkinson-Krankheit und Hypersomnie-Syndromen des Zentralnervensystems. Diese letzteren Syndrome sind eine Gruppe von Erkrankungen mit überlappenden klinischen Phänotypen und, außer im Fall von Narkolepsie aufgrund von Hypocretinmangel (Narkolepsie Typ 1), möglicherweise gemeinsamer Pathophysiologie.
Pathologische Tagesmüdigkeit bei diesen Erkrankungen beeinträchtigt die Arbeitsleistung, schränkt die Lebensqualität ein und erhöht das Unfallrisiko für Kraftfahrzeuge und andere Personen um mehr als das Doppelte. Da die zugrunde liegende Ursache der meisten dieser Hypersomnie-Syndrome nicht bekannt ist, zielen Behandlungen darauf ab, die monoaminerge Signalübertragung zu verstärken, die an der Weckförderung beteiligt ist. Mindestens ein Viertel der Patienten mit Hypersomnie-Syndromen erreichen jedoch mit diesen Behandlungen keine zufriedenstellende Kontrolle der Symptome, und häufig sind Behinderungen oder medizinische Beurlaubungen erforderlich. Es besteht ein eindeutiger Bedarf an neuartigen Behandlungen für übermäßige Tagesmüdigkeit, um dieses Versagen des derzeitigen Behandlungsstandards zu beheben.
In früheren Studien führte Clarithromycin zu signifikanten, klinisch bedeutsamen Verbesserungen des Schweregrads der Schläfrigkeit, der mit Schläfrigkeit verbundenen Einschränkungen bei erweiterten Aktivitäten des täglichen Lebens und der mit Schläfrigkeit verbundenen Lebensqualität. Lange Schlafdauer und Schlafträgheit, beides Nebensymptome von Hypersomnie-Störungen, die zu funktionellen Beeinträchtigungen beitragen, wurden mit Clarithromycin ebenfalls verbessert.
Hypothese: Clarithromycin reduziert übermäßige Schläfrigkeit und andere Symptome von Hypersomnie-Störungen, gemessen anhand von Selbstberichten und objektiven Tests.
Ziel 1: Identifizierung von Mediatoren des zentralen Nervensystems für die Fähigkeit von Clarithromycin, Wachheit zu fördern und Schläfrigkeit zu reduzieren, bei Patienten mit zentralen Hypersomnie-Syndromen.
Hypothese 1a: Veränderungen in der Liquorverstärkung der Gamma-Aminobuttersäure-A (GABA-A)-Rezeptorfunktion in vitro werden mit Verbesserungen der selbstberichteten und objektiv gemessenen Schläfrigkeit verbunden sein.
Hypothese 1b: Veränderungen der funktionellen Konnektivität werden mit Verbesserungen der selbstberichteten und objektiv gemessenen Schläfrigkeit einhergehen.
Ziel 2: Untersuchung extra-neuronaler Mechanismen, durch die Clarithromycin die Schläfrigkeit reduzieren kann, einschließlich Veränderungen der systemischen Entzündung und Veränderungen der Zusammensetzung der gastrointestinalen Mikrobiota bei Patienten mit zentralen Hypersomnie-Syndromen.
Hypothese 2a: Eine Verbesserung der Schläfrigkeit durch die Verwendung von Clarithromycin wird positiv mit einer Verringerung der systemischen Entzündung, insbesondere einer Verringerung der Spiegel des Tumornekrosefaktors-alpha (TNFα), assoziiert sein.
Hypothese 2b: Die Verbesserung der Schläfrigkeit bei Verwendung von Clarithromycin wird positiv mit der Modulation der gastrointestinalen Dysbiose korrelieren.
Studientyp
Einschreibung (Tatsächlich)
Phase
- Phase 2
Kontakte und Standorte
Studienorte
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Georgia
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Atlanta, Georgia, Vereinigte Staaten, 30329
- Emory Sleep Center
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Teilnahmekriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Beschreibung
Einschlusskriterien:
- Diagnose einer idiopathischen Hypersomnie oder Narkolepsie Typ 2
- Alter 18-60
- frei von wachfördernden Medikamenten, schläfrig trotz aktueller wachfördernder Medikamente oder bereit, aktuelle wachfördernde Medikamente für mindestens 5 Halbwertszeiten vor den Baseline-Maßnahmen abzusetzen
- frei von prä- oder probiotischen Nahrungsergänzungsmitteln für mindestens sechs Monate vor Basismaßnahmen
Ausschlusskriterien:
- andere mögliche Ursachen für Hypersomnolenz, einschließlich mittelschwerer oder schwerer Schlafapnoe, schwerer periodischer Gliedmaßenbewegungsstörung mit Arousal, unkontrollierten Stoffwechselstörungen, Hypocretinmangel oder Kataplexie
- Kontraindikation für Clarithromycin
- Kontraindikation für eines der Studienverfahren
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Grundlegende Wissenschaft
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Doppelt
Waffen und Interventionen
Teilnehmergruppe / Arm |
Intervention / Behandlung |
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Experimental: Clarithromycin
Teilnehmer in diesem Studienarm erhalten Clarithromycin für 14 Tage.
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Clarithromycin wird 14 Tage lang zweimal täglich mit 500 mg dosiert, einmal nach dem Aufwachen und einmal mit dem Mittagessen.
Andere Namen:
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Placebo-Komparator: Placebo
Die Teilnehmer in diesem Studienarm erhalten 14 Tage lang ein Placebo, das Clarithromycin entspricht.
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Ein Placebo, das zu Clarithromycin passt, wird 14 Tage lang zweimal täglich mit 500 mg dosiert, einmal nach dem Aufwachen und einmal mit dem Mittagessen.
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Was misst die Studie?
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
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Change in Epworth Sleepiness Scale (ESS) Score
Zeitfenster: Day -1, Day 14
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The Epworth Sleepiness Scale asks participants to respond to 8 scenarios with how likely they are to fall asleep on a 4-point scale where 0 = "would never doze" and 3 = "high chance of dozing".
Total scores range from 0 to 24 where higher scores indicate a higher chance of falling asleep during daytime activities.
The change in ESS score is obtained by subtracting the total score at Day 14 from the baseline score.
Scores above 0 mean that the mean score at Day 14 was lower than the mean score at Baseline, indicating less sleepiness.
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Day -1, Day 14
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Change in Maintenance of Wakefulness Test (MWT) for Sleep Latency
Zeitfenster: Day -1, Day 14
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The MWT polysomnographic procedure for sleep latency examines how well participants stay awake during several trials where participants relax in a quiet room for 40 minutes.
One study found the mean sleep latency among persons without a sleep disorder to be 35.2
minutes.
The change from baseline is calculated as baseline sleep latency minus sleep latency at Day 14, in minutes.
Positive values result when the duration of sleep latency at Day 14 is lower than at Baseline.
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Day -1, Day 14
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Change in Gamma-aminobutyric Acid Receptor A (GABA-A) Potentiation
Zeitfenster: Day -1, Day 14
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Cerebrospinal fluid (CSF) is drawn to determine the change in levels of GABA-A potentiation between the study arms.
The difference between measured current with GABA alone and the current measured with GABA + CSF yields a measure of potentiation for each CSF sample in each condition.
The change from baseline is calculated as the baseline value minus the value at Day 14.
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Day -1, Day 14
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Change in Default Mode Network (DMN) Connectivity
Zeitfenster: Day -2, Day 13
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The default mode network (DMN) consists of a group of highly correlated brain regions most active during quiet rest, while the task positive network (TPN) is the brain network activated for goal-directed tasks.
DMN connectivity changes with sleep states and it is increasingly implicated in the symptomatology of sleepiness.
During resting state, sleep deprived participants demonstrate reduced static connectivity with the DMN.
Changes in DMN between the Baseline 1 (Day - 2) and Day 13 visits are compared between treatment groups, particularly using quasi-periodic patterns (QPPs), which interrogate network-level connectivity on a dynamic scale.
Preservation of the temporal dimension provides more insight into how this spatiotemporal network propagates across condition and pathology.
The DMN/TPN QPP correlation is reported.
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Day -2, Day 13
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Change in Tumor Necrosis Factor - Alpha (TNF-α)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of TNF-α between the study arms.
TNF-α is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
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Day -1, Day 14
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Change in Gastrointestinal Microbiome Composition
Zeitfenster: Day -1, Day 14
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Changes in microbiome composition, as measured by alpha diversity using the Shannon Index, via 16S ribosomal ribonucleic acid (rRNA) sequencing results are compared between study arms.
The Shannon Index measures both abundance and evenness of microbial species, values of 0 indicate that a community has only one species.
The higher the value the higher the diversity of species in a particular community.
Change from baseline is calculated by subtracting the Day 14 value from the value at Baseline.
Numbers greater than 0 indicate that the Day 14 Shannon index value is lower than at Baseline.
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Day -1, Day 14
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Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
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On-Treatment Sleep Duration
Zeitfenster: Day 1 through Day 14
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Participants log when they go to bed and when they wake up in order to calculate the number of minutes spent sleeping.
The average duration of sleep across 14 days is compared between study arms.
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Day 1 through Day 14
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Change in Fatigue Severity Scale (FSS) Score
Zeitfenster: Day -1, Day 14
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Fatigue severity is measured with the Fatigue Severity Scale (FSS).
The FSS is a 9-item instrument where responses are on a scale of 1 to 7 where 1 = "disagree" and 7 = "agree".
Total scores range from 9 to 63 where higher scores indicate greater fatigue.
The change in FSS score is obtained by subtracting the total score at Day 14 from the Baseline score.
Scores above 0 signify that the mean score at Day 14 was lower than the mean score at Baseline, indicating decreased fatigue.
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Day -1, Day 14
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Change in Multidimensional Fatigue Inventory (MFI-20) Score
Zeitfenster: Day -1, Day 14
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The MFI-20 is a 20-item instrument assessing fatigue severity.
Responses are on a 5-point scale where 1 = "yes, that is true" and 5 = "no, that is not true".
Positively phrased items are reverse scored so that the total score ranges from 20 to 100 where higher scores indicate greater severity of fatigue.
The change in MFI-20 score is obtained by subtracting the total score at Day 14 from the Baseline score.
Scores above 0 signify that the mean score at Day 14 was lower than the mean score at Baseline, indicating decreased fatigue.
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Day -1, Day 14
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Change in Sleep Inertia Questionnaire (SIQ) Score
Zeitfenster: Day -1, Day 14
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The SIQ is an instrument with 21 items with responses on a 5-point scale where 1 = "not at all" and 5 = "all the time".
Two additional questions relate to how much time it takes for the respondent to wake up in the morning.
Total scores range from 21 to 105 and higher scores indicate increased difficulty from tiredness.
The change in SIQ score is obtained by subtracting the total score at Day 14 from the baseline score.
Scores above 0 signify that the mean score at Day 14 was lower than the mean score at Baseline, indicating reduced difficulty awakening.
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Day -1, Day 14
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On-Treatment Sleep Inertia Likert Scale
Zeitfenster: Day 1 through Day 14
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Sleep inertia is measured with a single item on a 10-point Likert scale asking participants how difficult it was for them to wake up in the morning, where 1 = "not difficult at all" and 10 = "very difficult".
The average scores across 14 days are compared between study arms.
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Day 1 through Day 14
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Change in Interleukin 1 Alpha (IL-1α)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-1α between the study arms.
IL-1α is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-1α is obtained by subtracting the IL-1α level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interleukin 1 Beta (IL-1β)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-1β between the study arms.
IL-1β is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-1β is obtained by subtracting the IL-1β level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interleukin 2 (IL-2)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-2 between the study arms.
IL-2 is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-2 is obtained by subtracting the IL-2 level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interleukin 6 (IL-6)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-6 between the study arms.
IL-6 is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-6 is obtained by subtracting the IL-6 level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interleukin (IL-8)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-8 between the study arms.
IL-8 is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-8 is obtained by subtracting the IL-8 level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interleukin (IL-15)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-15 between the study arms.
IL-15 is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-15 is obtained by subtracting the IL-15 level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interleukin (IL-18)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of IL-18 between the study arms.
IL-18 is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in IL-18 is obtained by subtracting the IL-18 level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Tumor Necrosis Factor Beta (TNF-β)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of TNF-β between the study arms.
TNF-β is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in TNF-β is obtained by subtracting the TNF-β level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Interferon Alpha (INF-α2a)
Zeitfenster: Day -1, Day 14
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Blood samples are used to determine the change in levels of INF-α2a between the study arms.
INF-α2a is a soporific cytokine and a reduction in soporific cytokines is hypothesized to reduce daytime sleepiness.
The change in INF-α2a is obtained by subtracting the INF-α2a level at Day 14 from the Baseline level.
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Day -1, Day 14
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Change in Functional Outcomes of Sleep Questionnaire (FOSQ) Score
Zeitfenster: Day -1, Day 14
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The FOSQ is a 30-item instrument assessing how sleepiness impacts daily activities.
There are five subscales assessing General Productivity, Activity Level, Vigilance, Social Outcomes, and Intimate and Sexual Relationships.
Items are scored on a 4-point scale where 1 = extreme difficulty and 4 = no difficulty.
Subscale scores are obtained by calculating the mean score for the items in that subscale and each can range from 1 to 4, where higher scores indicate less difficulty due to sleepiness.
A total score is obtained by calculating the means of the subscale scores and multiplying that by the number of subscales with a score.
The total score ranges from 5 to 20 and higher scores indicate less difficulty from sleepiness.
The change in FOSQ score is obtained by subtracting the total score at Day 14 from the Baseline score.
Scores below 0 signify that the mean score at Day 14 was higher than the mean score at Baseline, indicating reduced difficulty from sleepiness.
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Day -1, Day 14
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Change in Hypersomnia Severity Index (HSI)
Zeitfenster: Day -1, Day 14
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The HSI is a 9-item instrument assessing the severity of excessive sleepiness (hypersomnolence).
Items are scored on a Likert scale where 0 = not at all and 4 = very much.
Total scores range from 0 to 36 and higher scores indicate greater severity of symptoms of hypersomnia.
The change from baseline is calculated as the baseline score minus the score at Day 14.
The change in HSI score is obtained by subtracting the total score at Day 14 from the baseline score.
Scores above 0 signify that the mean score at Day 14 was lower than the mean score at Baseline, indicating reduced severity of hypersomnia symptoms.
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Day -1, Day 14
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Change in MRI Functional Connectivity
Zeitfenster: Day -2, Day 13
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For functional connectivity analyses, each functional scan is parceled into the 246 regions of interest (ROIs), spanning Yeo's 7 networks contained in the Brainnetome Atlas and mean timecourse is calculated for each group.
Pearson correlations between each pair of ROIs are calculated, to determine the strength of functional connectivity between each pair of regions and inter/intra-network.
This yields a functional connectivity matrix for each functional scan (at both a subject- and group-level).
These correlation matrices are Fischer z-transformed and averaged across each condition to create a mean functional connectivity matrix for each condition.
Here, the average default mode network (DMN) connectivity is reported.
Z-scores have a mean of 0 and scores higher than 0 indicate increased functional connectivity.
The change from Baseline is calculated by subtracting the Day 13 score from the score at Day -2.
Values lower than 0 mean that the Day 13 score was higher than at baseline.
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Day -2, Day 13
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Change in MRI Task Performance - N-Back Accuracy
Zeitfenster: Day -2, Day 13
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Participants complete a working memory task during functional magnetic resonance imaging (fMRI).
The change in task performance is measured as accuracy during 3 different levels of back tasks (0-back, 1-back, and 2-back), from baseline to on-treatment (Day 13).
The 0-back test has participants respond to a prespecified stimulus and is a control condition.
The 1-back involves remembering and responding to a prior stimulus, while a stimulus two trials earlier is responded to with the 2-back.
The change in the percentage of correct responses is obtained by subtracting the percentage at Day 14 from the Baseline percentage.
Values below 0 signify that the mean percent accuracy at Day 14 was higher than the mean percent accuracy at Baseline, indicating increased accuracy.
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Day -2, Day 13
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Change in MRI Task Performance - N-Back Reaction Time
Zeitfenster: Day -2, Day 13
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Participants complete a working memory task during functional magnetic resonance imaging (fMRI).
he change in task performance is measured as reaction time during 3 different levels of back tasks (0-back, 1-back, and 2-back), from baseline to on-treatment (Day 13).
The 0-back test has participants respond to a prespecified stimulus and is a control condition.
The 1-back involves remembering and responding to a prior stimulus, while a stimulus two trials earlier is responded to with the 2-back.
The change in the reaction time of responses is obtained by subtracting the time at Day 14 from the Baseline time.
Scores above 0 signify that the mean time at Day 14 was lower than the mean time at Baseline, indicating faster reaction time.
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Day -2, Day 13
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Mitarbeiter und Ermittler
Sponsor
Ermittler
- Hauptermittler: Lynn Marie Trotti, MD, MSc, Emory University
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Primärer Abschluss (Tatsächlich)
Studienabschluss (Tatsächlich)
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
- IRB00108681
- 1R01NS111280 (US NIH Stipendium/Vertrag)
- 2025P011204 (Andere Kennung: Emory IRB)
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