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| Sponsor: | Massachusetts General Hospital |
|---|---|
| Information provided by: | Massachusetts General Hospital |
| ClinicalTrials.gov Identifier: | NCT00916721 |
Purpose
Smoking is the leading cause of preventable morbidity and mortality in the US. While approximately 70% of smokers attempt to quit each year, only 5-15% maintain abstinence for 12 months, even with effective pharmacological and psychological interventions. Novel therapies are needed for smoking cessation and relapse prevention. Previous studies show that early post-cessation craving or urge to smoke is a powerful predictor of relapse. A current model of the pathogenesis of addiction maintains that a substance of abuse causes a marked increase release in phasic dopamine release, which in turn strengthens or increases the salience of the memory of the drug experience, leading to a powerful and persistent memory that is easily activated, leading to drug craving and often to drug use. This highly salient memory is also implicated in the physiological arousal associated with craving responses to smoking cues. This process is thought to be implicated in relapse to drug use after even long periods of abstinence. Recent animal research indicates that retrieval returns a consolidated memory such as those associated with drug craving, to a labile state from which it must be restabilized to persist in a process termed reconsolidation. If memories of drug-related experiences are labile when reactivated, this could represent a window of opportunity in which the memory of drug use that underlies drug craving can be influenced pharmacologically. Our hypothesis is that post-reactivation administration of the B-adrenergic blocker, propranolol, following retrieval of drug-associated memories will reduce the strength or salience of the memory by influencing reconsolidation, a process called memory reconsolidation blockade. In this study we will test the hypothesis that a single dose of propranolol given one hour prior to smoking-related cue exposure (post-reactivation treatment) will decrease psychophysiological responses to smoking cues one week later and will predict clinical response to an ensuing series of 6 post-reactivation treatments with script-driven imagery and propranolol. In order to do so, we propose to conduct a randomized, double-blind, placebo-controlled trial of post-reactivation treatment with propranolol in 50 adult smokers. Outcome measures will include in physiological responses to smoking-related cues after one and six post-reactivation treatments and smoking behavior during the treatment and during a 3-month follow-up period.
| Condition | Intervention | Phase |
|---|---|---|
|
Smoking Cessation |
Drug: Propranolol Drug: Placebo |
Phase III |
| Study Type: | Interventional |
| Study Design: | Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator), Parallel Assignment, Efficacy Study |
| Official Title: | Memory Reconsolidation Blockade as a Novel Intervention for Nicotine Dependence |
| Estimated Enrollment: | 100 |
| Study Start Date: | April 2008 |
| Estimated Study Completion Date: | January 2010 |
| Estimated Primary Completion Date: | July 2009 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Propranolol: Active Comparator |
Drug: Propranolol
Visit 2 (first smoking-related memory reactivation session) the subject will be given 0.67 mg/kg (minimum 40 mg; maximum 80 mg) of short-acting propranolol (or placebo) rounded to the nearest 10 mg. Ninety minutes after this dose, if subject has tolerated the short-acting dose well, and if systolic blood pressure has not fallen by 10 mmHg or more to below 100 mmHg, the subject will be given oral long-acting propranolol 1 mg/kg (minimum 60 mg; maximum 120 mg) or placebo rounded to the nearest 20 mg. . If the subject tolerates the combination dose well, during treatment phase (from visit 7 to 12), both the short- and long-acting doses will be given together immediately prior to memory reactivation.
|
| Placebo: Placebo Comparator |
Drug: Placebo
Visit 2 (first smoking-related memory reactivation session) the subject will be given 0.67 mg/kg (minimum 40 mg; maximum 80 mg) of short-acting propranolol (or placebo) rounded to the nearest 10 mg. Ninety minutes after this dose, if subject has tolerated the short-acting dose well, and if systolic blood pressure has not fallen by 10 mmHg or more to below 100 mmHg, the subject will be given oral long-acting propranolol 1 mg/kg (minimum 60 mg; maximum 120 mg) or placebo rounded to the nearest 20 mg. . If the subject tolerates the combination dose well, during treatment phase (from visit 7 to 12), both the short- and long-acting doses will be given together immediately prior to memory reactivation.
|
SPECIFIC AIMS
To achieve these aims, we will conduct a double-blind, randomized, placebo-controlled trial in a convenience sample of 50 smokers.
Eligibility| Ages Eligible for Study: | 18 Years to 65 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
Exclusion Criteria:
Contacts and Locations| Contact: Gladys N Pachas, MD | 617-643-1991 | gpachas1@partners.org |
| Contact: Johanna Nino, MD | 617-643-1984 | jnino@partner.org |
| United States, Massachusetts | |
| Massachusetts General Hospital - Center For Addiction Medicine | Recruiting |
| Boston, Massachusetts, United States, 02114 | |
| Contact: Gladys N Pachas, MD 617-643-1991 gpachas1@partners.org | |
| Principal Investigator: A Eden Evins, MD, MPH | |
| Sub-Investigator: Gladys N Pachas, MD | |
| Sub-Investigator: Loebl Tsafrir, MD | |
| Sub-Investigator: Johanna Nino, MD | |
| Sub-Investigator: Roger Pitman, MD | |
| Principal Investigator: | A. Eden Evins, MD, MPH | Massachusetts General Hospital |
More Information
| Responsible Party: | Massachusetts General Hospital ( A. Eden Evins, MD, MPH ) |
| Study ID Numbers: | 2007P-001903, NIH grant 207610 |
| Study First Received: | June 5, 2009 |
| Last Updated: | November 25, 2009 |
| ClinicalTrials.gov Identifier: | NCT00916721 History of Changes |
| Health Authority: | United States: Institutional Review Board |
|
Smoking cessation propranolol memory reconsolidation blockade craving |
|
Vasodilator Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Adrenergic Agents Tobacco Use Disorder Physiological Effects of Drugs Disorders of Environmental Origin Cardiovascular Agents Antihypertensive Agents Pharmacologic Actions |
Smoking Habits Propranolol Mental Disorders Therapeutic Uses Substance-Related Disorders Adrenergic beta-Antagonists Adrenergic Antagonists Anti-Arrhythmia Agents |