Double-Blind, Placebo Controlled Pilot Study of Octanoic Acid in Essential Tremor

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Mark Hallett, National Institute of Neurological Disorders and Stroke (NINDS)
ClinicalTrials.gov Identifier:
NCT00848172
First received: February 19, 2009
Last updated: November 22, 2012
Last verified: November 2012
  Purpose

Background:

  • Essential tremor (ET) is a neurological disorder characterized by uncontrollable shaking. Several medications are used to treat ET; however, they are often only partly effective and can have side effects.
  • Research studies have shown that octanol, a food additive similar to alcohol, can improve tremor in animals. Octanol is less likely to make people drunk than alcohol. Two earlier NIH studies found that one form of octanol, called 1-octanol, did improve tremor in some people and had few side effects.
  • In the body, 1-octanol is converted to octanoic acid. Researchers are interested in finding out whether octanoic acid can help people with ET.

Objectives:

  • To find out if octanoic acid can improve hand tremor in people with essential tremor.
  • To measure levels of octanoic acid in the blood after it is taken.

Eligibility:

  • Patients 21 years of age and older with ET, who are willing to abstain from alcohol, caffeine, and all medications as required by the study and who are willing and able to fast for up to 12 hours at a time.
  • Participants may not be of Asian or Native American ancestry because of genetic susceptibilities to the intoxicating effects of the study drug.

Design:

  • This study requires a 3-day hospital admission as well as two outpatient visits.
  • Visit 1 (outpatient): Screening visit and blood alcohol level test
  • Medical history, physical and neurological examination, a blood test, and an electrocardiogram to measure heart function. Women who are able to get pregnant will have a urine pregnancy test.
  • Patients will consume 1.5 ounces of alcohol per drink (up to three drinks at least 30 minutes apart), and be tested to evaluate how the tremor responds. Researchers will draw blood to measure blood alcohol level about 1 hour after the first drink and closely monitor patients for signs of intoxication.
  • Inpatient examination
  • Preparation: Researchers will prepare a schedule to stop any tremor medications that patients might be on. Patients may not drink alcohol or eat or drink anything with caffeine, including chocolate, for at least 2 days before admission.
  • Day 1: Vital signs, blood (and urine pregnancy) tests, and electrocardiogram. Patients will be asked to wear a tremor monitor, similar to a wristwatch. Patients will also have IV lines inserted for blood draws.
  • Days 2 and 3: Randomized study medication (octanoic acid on one day, placebo on the other day). Patients will fast before taking the drug, but will be allowed to eat and drink after the tests are completed (around noon).
  • Blood will be drawn before taking the study drug and again (a total of nine times) after taking the drug.
  • Tremor will be measured during the study, before and after taking the drug.
  • Visit 2 (outpatient): 4 to 7 days after discharge
  • Blood test and an electrocardiogram, and a series of questionnaires regarding the study.

Condition Intervention Phase
Essential Tremor
Drug: Octanoic Acid
Drug: Placebo
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Double-Blind, Placebo Controlled Pilot-Study of Octanoic Acid in Essential Tremor

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Normalized Accelerometric Tremor Power, Dominant Hand, 80min After Administration, Weighted Condition [ Time Frame: 80 min after administration of the study drug on day 1 and 2 of Visit 2 ] [ Designated as safety issue: No ]
    Postural tremor was measured using accelerometry with a motion sensor (accelerometer) placed at the dorsum of each hand, and tremor recorded simultaneously with surface-electromyography of wrist flexors and extensors for 2 minutes at each time-point. The recording was repeated with 1 lbs weight added to each wrist, which was described to record the central tremor component. The primary outcome measure was defined as tremor power of the central tremor component (after the addition of weight) 80 minutes after administration, measured at the dominant hand, normalized to baseline (baseline = 1), and comparing octanoic acid vs. placebo. Ratio of tremor power at 80 min divided by tremor power at baseline used for outcome measure calculation.


Secondary Outcome Measures:
  • Normalized Tremor Power, 300 Min After Administration, Weighted Condition, Dominant Hand, OA vs Placebo [ Time Frame: 300 min post dose ] [ Designated as safety issue: No ]
    As described at the section for the primary outcome, normalized accelerometric tremor accelerometry was measured at other time-points to describe a time-course of effect. This stated secondary outcome compared normalized (baseline = 1) accelerometric at the last time-point 300 min post dose after OA vs Placebo. Ratios of tremor power at 300 min divided by tremor power at baseline used for outcome measure calculation.

  • TMax Octanoic Acid [ Time Frame: between 5 and 300 min post dose ] [ Designated as safety issue: No ]
    Time to plasma peak OA

  • PK: AUC After OA [ Time Frame: 5 to 300 min post dose ] [ Designated as safety issue: No ]
    Area under the curve of PA plasma levels after administration


Enrollment: 29
Study Start Date: February 2009
Study Completion Date: November 2010
Primary Completion Date: November 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Octanoic Acid Drug: Octanoic Acid
4mg/kg
Placebo Comparator: Placebo Drug: Placebo
identical capsules

Detailed Description:

OBJECTIVE:

We propose a study to examine the safety and efficacy of octanoic acid in essential tremor (ET).

STUDY POPULATION:

We will study 19 adult subjects with ethanol-responsive ET.

DESIGN:

Octanoic acid will be tested in a double-blind, randomized, placebo-controlled, cross-over design in 19 patients with essential tremor. The active study medication and placebo will be administered as oral single morning doses on consecutive days in a randomized sequence. All subjects will receive a dose that was defined as being safe according to available toxicity data (4mg/kg) and will be monitored closely during the total inpatient study phase of three days (day 0: baseline; days 1-2: active study days).

OUTCOME MEASURES:

The primary outcome measure for this study will be the effect on tremor power of the dominant hand, 80 minutes after administration of the study substance, compared to placebo. Tremor power will be measured using accelerometry with loading to test central tremor component. Secondary outcome measures include recordings of tremor power as measured by accelerometry at multiple other time points up to 300 min after administration, also recorded from the non-dominant hand and without loading. The change in tremor severity documented by spirography and actigraphy as well as data collected regarding drug safety (laboratory testing, documentation of vital signs, adverse events questionnaire and intoxication scale) as well as the pharmacokinetic and pharmacodynamic properties will act as further secondary outcome parameters.

  Eligibility

Ages Eligible for Study:   21 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Male or female patients with alcohol-responsive ET according to published clinical criteria
  • Tremor in both upper limbs should be predominant feature of ET
  • Subjects must be willing and safely able to comply with the study protocol and therefore abstain from any medication for the treatment of tremor for a period of at least 5 plasma half-lives of the individual drug prior to study participation. (For Propranolol/Inderal(Registered Trademark), Gabapentin/Neurontin(Registered Trademark), Topiramate/Topamax(Registered Trademark) this will be 4 days; for Primidone/Mysoline(Registered Trademark): 28 days).
  • Subjects must be willing to refrain from alcohol and caffeine intake starting 48 hr prior to hospitalization until study termination
  • Subject must be willing and able to fast for periods of up to 12 hours during the study

EXCLUSION CRITERIA:

  • Patients with any other significant pathological finding in the neurological examination other than typical symptoms of ET
  • Acute or chronic severe medical conditions which would preclude the subject from participating (e.g., severe heart disease NYHA grade 3 or 4, renal failure, hepatic failure, lung disease, uncontrolled hyperthyroidism)
  • Subjects with diabetes mellitus, hypoglycemia or severe hyperlipidemia (must be documented by referring physician with copy of last fasting routine blood test within one year before the screening visit including glucose and lipid levels; according to NIH guidelines, fasting LDL levels of greater than or equal to 160 mg/dl are considered severe hyperlipidemia; if under treatment, LDL-levels less than 160 have to be documented to be eligible for the study)
  • Subjects with active or past alcohol abuse or dependence
  • Subjects with concomitant therapy with warfarin or NSAIDs, when taken on a regular basis and cannot be discontinued at least 14 days prior to study participation, because of potential interactions with octanoic acid (displacement of albumin binding in human serum)
  • Subjects with clinically significant abnormalities on their baseline laboratory tests
  • Subjects aged less than 21 years
  • Female subjects who are pregnant or lactating
  • Subjects with cognitive impairment interfering with the ability to give informed consent or to cooperate during the study
  • Subjects of Far East Asian or Native American descent, who may possess variant alleles of the genes for alcohol metabolism, i.e., alcohol dehydrogenase and aldehyde dehydrogenase, resulting in altered (slower) metabolism and potentially increased sensitivity to alcohols and their metabolites
  • Subjects where no written informed consent is received or subjects who are unwilling to cooperate during the study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00848172

Locations
United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
  More Information

Publications:
Responsible Party: Mark Hallett, Chief, Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS)
ClinicalTrials.gov Identifier: NCT00848172     History of Changes
Other Study ID Numbers: 090084, 09-N-0084
Study First Received: February 19, 2009
Results First Received: August 6, 2012
Last Updated: November 22, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by National Institutes of Health Clinical Center (CC):
Essential Tremor
Octanol
Octanoic Acid
Ethanol
Accelerometry

Additional relevant MeSH terms:
Tremor
Essential Tremor
Dyskinesias
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Movement Disorders
Central Nervous System Diseases

ClinicalTrials.gov processed this record on August 19, 2014