Delta-THC in Behavioral Disturbances in Dementia

This study has been completed.
Sponsor:
Collaborator:
European Union
Information provided by (Responsible Party):
Marcel Olde Rikkert, Radboud University
ClinicalTrials.gov Identifier:
NCT01302340
First received: February 10, 2011
Last updated: January 21, 2014
Last verified: January 2014
  Purpose

Dementia is a common chronic condition, with predicted increasing prevalence. Nearly all patients with dementia will experience neuropsychiatric symptoms (NPS). This causes significant burden for the individual patients and their caregivers. Current treatment has only modest efficacy and important side-effects. Formulations with Δ9-tetrahydrocannabinol (THC), the psycho-active compound of cannabis, are currently being registered for spasms in multiple sclerosis and other diseases, and may have beneficial effects on NPS.


Condition Intervention Phase
Dementia
Drug: Delta-THC
Drug: placebo
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: Two Phase, Repeated Crossover Study With Dose Escalation on Delta(9)-Tetrahydrocannabinol (Delta-THC) in Behavioral Disturbances in Dementia

Resource links provided by NLM:


Further study details as provided by Radboud University:

Primary Outcome Measures:
  • Neuropsychiatric Inventory (NPI) [ Time Frame: At day 3 and 10 during treatment blocks and after 1 month, 3 months and 6 months in the open label extension phase ] [ Designated as safety issue: No ]
    Improvement in behavior compared to placebo is measured with the NPI, which is the standard measure of Neuro Psychiatric Symptoms in most clinical trials.


Secondary Outcome Measures:
  • Cohen-Mansfield Agitation Inventory (CMAI) [ Time Frame: At days 1, 3, 8, and 10 during treatment blocks 1 and 4 and weekly during treatment blocks 2, 3, 5 and 6 and months 1, 3, 6 and 6 during extension phase ] [ Designated as safety issue: No ]
    Improvement in agitation compared to placebo and during long term treatment is measured with CMAI. It is useful in determining fluctuations in behaviors and emotional states in Alzheimer's Disease

  • Zarit Burden Scale (ZBS) [ Time Frame: At days 3 and 10 during treatment blocks and months 1, 3 and 6 during extension phase ] [ Designated as safety issue: No ]
    Reducing caregiver stress compared to placebo and during long term treatment by focusing on the patients' behavior compared to Zarit burden interviews with the caregiver.

  • Visual Analogue Scale (VAS) Bowdle for feeling high [ Time Frame: At days 1, 3, 8, and 10 during treatment blocks 1 and 4 and weekly during treatment blocks 2, 3, 5 and 6 and months 1, 3, 6 and 6 during extension phase ] [ Designated as safety issue: Yes ]
    severity and duration of feeling high episodes

  • Gait rite® [ Time Frame: At days 1 and 8 during blocks 1 and 4 and at 1, 3 and 6 months during extension phase ] [ Designated as safety issue: Yes ]
    Improvement and/or safety compared to placebo and during long term treatment on balance and mobility. It is a non invasive and highly feasible mobility assessment.

  • Sway Star® [ Time Frame: At days 1 and 8 during blocks 1 and 4 and at 1, 3 and 6 months during extension phase ] [ Designated as safety issue: Yes ]
    Improvement and/or safety compared to placebo and during long term treatment on balance and mobility. It is a non invasive and highly feasible mobility assessments.

  • Time up and go [ Time Frame: At days 1, 3, 8, and 10 during treatment blocks 1 and 4 and weekly during treatment blocks 2, 3, 5 and 6 and months 1, 3, 6 and 6 during extension phase ] [ Designated as safety issue: Yes ]
    Improvement and/or safety compared to placebo and during long term treatment on balance and mobility in elderly patients.

  • Tinetti Balance Assessment Tool [ Time Frame: At days 1, 3, 8, and 10 during treatment blocks 1 and 4 and weekly during treatment blocks 2, 3, 5 and 6 and months 1, 3, 6 and 6 during extension phase ] [ Designated as safety issue: Yes ]
    Improvement and/or safety compared to placebo and during long term treatment on balance and mobility in elderly patients. It is a performance-oriented assessment of mobility problems in elderly patients.

  • pharmacogenetics [ Time Frame: day 1 ] [ Designated as safety issue: No ]

    The following polymorphisms will be genotyped:

    • CYP2C9*2
    • CYP2C9*3
    • CYP2C19*2
    • CYP2C19*3
    • CYP2C19*17

    To investigate the role of CYP2C9 and CYP2C19 genetic polymorphisms in the interindividual variation in pharmacokinetics, efficacy and adverse events of THC.



Enrollment: 22
Study Start Date: September 2011
Study Completion Date: December 2013
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Delta-THC
THC will be administered twice daily during three consecutive days per treatment block(0.75 or 1.5 mg twice daily)
Drug: Delta-THC
Active treatment consists of THC in tablet form. Patients receive 0.75 mg THC twice daily during the first three treatment blocks (period A) and 1.5 mg THC twice daily during the latter three treatment blocks (period B). Placebo treatment consists of two tablets daily and is matched to the active treatment for taste, color and size. Study medication will be administered at 10 a.m. and 4 p.m., by the primary caregiver. These time points are chosen because NPS often occur later on the day, when fatigue and external signals build up to the stress and result in NPS. The order of administration of THC and placebo (1:1) will be determined by randomization per block: THC followed by placebo or placebo followed by THC.
Other Names:
  • Namisol
  • Cannabis
  • ECP002A
Drug: Delta-THC
In case either 2 times daily 1 tablet 0,75mg or 2 times daily 1 tablet 1.5mg Delta-THC appeared to be efficacious for a particular patient, this patient can continue the effective dose of delta-THC in an open label extension phase during 6 months.
Other Names:
  • Namisol
  • Cannabis
  • ECP002A
Placebo Comparator: placebo
Placebo will be administered twice daily during three consecutive days per treatment block.
Drug: placebo
Active treatment consists of THC in tablet form. Patients receive 0.75 mg THC twice daily during the first three treatment blocks (period A) and 1.5 mg THC twice daily during the latter three treatment blocks (period B). Placebo treatment consists of two tablets daily and is matched to the active treatment for taste, color and size. Study medication will be administered at 10 a.m. and 4 p.m., by the primary caregiver. These time points are chosen because NPS often occur later on the day, when fatigue and external signals build up to the stress and result in NPS. The order of administration of THC and placebo (1:1) will be determined by randomization per block: THC followed by placebo or placebo followed by THC.
Other Name: Placebo Namisol

Detailed Description:

Design Phase II pilot study, multi-center, repeated cross-over, double blinded randomized trial. The study consists of two weeks baseline measurements to assure that the neuropsychiatric symptoms are stable and six successive treatment blocks of 2 weeks. Each treatment block lasts for two weeks and contains two double-blinded drug periods, each lasting three days of oral THC or placebo, separated by four day washout periods. After three treatment blocks (period A), the dosage of active treatment was increased for the latter three treatment blocks (period B). After the two treatment periods, subjects will proceed to the extension phase if applicable.

Study centers The department of Geriatrics from Radboud University Nijmegen Medical Centre and the department of Elderly from Vincent van Gogh voor Geestelijke Gezondheidszorg Venray (VVG) will participate in this multi center study.

Participants 20 subjects with dementia and NPS. Intervention Namisol® in doses of twice daily 0,75 mg tablet (period A) and twice daily 1.5 mg (period B) THC oral tablets. Placebo of twice daily 0,75 mg and twice daily 1.5 mg oral tablets Outcome measures Primary outcome is NPI score, secondary CMAI, Zarit Burden scale. Other outcomes include vital signs, side-effects, physical exam, mobility and pharmacogenetics.

Visits This study will be assessed fully ambulatory, starting with a 5 hour clinical visit on day 1 and 8 of block 1 and a phone call on day 2 and 9 for assessment of Adverse Events. Furthermore, the research physician will conduct a weekly home visit weekly during the crossover phase for assessment of , among others, the primary outcome measure. These visits will all be repeated in period B of the crossover phase.

During the 6 month open label extension phase, subjects will visit the clinic three times.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of Alzheimer's Disease (AD), Vascular Dementia (VD) or mixed, according to the criteria of NINCDS-ADRDA or NINCDS-AIREN
  • Clinical Dementia Rating score between 0.5 and 3
  • NPS symptoms, with at least agitation or aggression

Exclusion Criteria:

  • Diagnosis of Lewy Body Dementia (LBD) or Fronto-Temporal Dementia (FTD)
  • Major psychiatric disorder
  • Severe concomitant illness, seizure, arrhythmias (except sinus arrhythmia and atrial fibrillation), heart failure New York Heart Association (NYHA) class III or IV
  • Tri Cyclic Antidepressives (TCA) or opioids used within 30 days before randomization till the end of the study
  • Changes in dosage of antidepressives within 6 weeks before randomization and during study, and changes in dosage antipsychotics or benzodiazepines within 2 weeks prior to randomization and during 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: NCT01302340

Locations
Netherlands
Radboud university medical center
Nijmegen, Gelderland, Netherlands, 6525EX
Vincent van Gogh Institute for Psychiatry, department of Elderly
Venray, Limburg, Netherlands, 5803
Sponsors and Collaborators
Radboud University
European Union
Investigators
Principal Investigator: Marcel Olde Rikkert, prof MD Radboud University
  More Information

No publications provided

Responsible Party: Marcel Olde Rikkert, Prof. dr., Radboud University
ClinicalTrials.gov Identifier: NCT01302340     History of Changes
Other Study ID Numbers: GER001-02-01, 2009-019329, 2010-024577-39, Supplies Investigational Drug
Study First Received: February 10, 2011
Last Updated: January 21, 2014
Health Authority: Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)

Keywords provided by Radboud University:
Dementia
Alzheimer
Cannabis
THC
Behavioral Disturbances
Neuropsychiatric Inventory

Additional relevant MeSH terms:
Dementia
Brain Diseases
Central Nervous System Diseases
Delirium, Dementia, Amnestic, Cognitive Disorders
Mental Disorders
Nervous System Diseases
Dronabinol
Analgesics
Analgesics, Non-Narcotic
Cannabinoid Receptor Agonists
Cannabinoid Receptor Modulators
Central Nervous System Agents
Hallucinogens
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Peripheral Nervous System Agents
Pharmacologic Actions
Physiological Effects of Drugs
Psychotropic Drugs
Sensory System Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on October 28, 2014