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Nepicastat for Posttraumatic Stress Disorder (PTSD) in OIF/OEF Veterans (Nepicastat)

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ClinicalTrials.gov Identifier: NCT00659230
Recruitment Status : Completed
First Posted : April 16, 2008
Results First Posted : June 1, 2017
Last Update Posted : October 13, 2017
Sponsor:
Collaborators:
Acorda Therapeutics
Ralph H. Johnson VA Medical Center
Baylor College of Medicine
San Diego Veterans Healthcare System
James J. Peters Veterans Affairs Medical Center
Information provided by (Responsible Party):
Lori Davis, MD, Tuscaloosa Research & Education Advancement Corporation

Brief Summary:

This study proposes a multi-site, randomized, double-blind, placebo-controlled clinical trial of the dopamine-ß-hydroxylase (DBH) inhibitor, nepicastat, for the treatment of posttraumatic stress disorder (PTSD) in outpatients who have previously served in a combat zone during Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF)or other Southwest conditions since 19800. A DBH inhibitor's mechanism of action is to decrease neuronal noradrenaline (NA) release by inhibiting DBH conversion of dopamine (DA) to NA. Animal models of PTSD and human studies have found a substantial increase in NA activity for these animal models and for PTSD in humans. Furthermore, recent clinical studies have improved PTSD hyper-arousal symptoms by reducing the NA over-activity using agents like NA post-synaptic antagonists. Key support for the proposed study is based on a similar improvement in PTSD symptoms after treatment with the DBH inhibitor, disulfiram.

In the experience of the clinical investigators, the most common chief complaint of the OIF/OEF veterans with PTSD is hyperarousal (DSM-IV criterion D symptom cluster). These symptoms significantly interfere with social, occupational, and interpersonal function. Standard treatments with antidepressants are not fully effective in treating the symptoms of PTSD in veterans; thus, new treatments are needed. An intervention, such as nepicastat, aimed at reducing hyperarousal, as well as other PTSD symptoms, would have significant impact of restoring overall function and quality of life in OIF/OEF veterans with PTSD. Since hyperarousal symptoms responded relatively quickly to medications of this type, our study in 120 outpatient veterans with PTSD will compare nepicastat 120 mg/day vs. placebo in a 6-week double-blind, randomized clinical trial (RCT). The veterans will be followed for an additional 8 weeks after the RCT, during which, those who have a priori defined positive clinical response to the study medication, nepicastat vs. placebo, will be continued on the study medication, in order to assess further improvement and safety. Those patients who do not have a positive clinical response during the 6 week RCT will be offered the addition of the standard first-line PTSD pharmacotherapy, paroxetine, during the 8 weeks extension phase. Thus, weeks 7-14 offer an opportunity to evaluate longer-term nepicastat efficacy and to compare the treatment response of nonresponders after augmentation with paroxetine.


Condition or disease Intervention/treatment Phase
Posttraumatic Stress Disorder Drug: Nepicastat Drug: Placebo Phase 2

Detailed Description:

HYPOTHESES Primary Hypothesis: Compared to placebo treatment, nepicastat-treated OIF/OEF veterans with PTSD will have significantly reduced PTSD hyperarousal symptoms as defined by the Clinician Administered PTSD Scale [CAPS], subscale D (CAPS-D).

Secondary Hypotheses: Compared to placebo, nepicastat-treated OIF/OEF veterans with PTSD will have:

  • Significantly reduced PTSD symptoms (total CAPS)
  • Significantly reduced PTSD reexperiencing symptoms (CAPS-B)
  • Significantly reduced PTSD avoidance symptoms (CAPS-C)

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Placebo-Controlled Trial of the Dopamine-B-Hydroxylase (DBH) Inhibitor, Nepicastat, for the Treatment of PTSD in OIF/OEF Veterans
Actual Study Start Date : July 1, 2009
Actual Primary Completion Date : July 5, 2012
Actual Study Completion Date : August 30, 2012


Arm Intervention/treatment
Placebo Comparator: Placebo
Arm 1
Drug: Placebo
100-800mg placebo

Active Comparator: Nepicastat
Arm 2
Drug: Nepicastat
100-800mg
Other Names:
  • SYN117
  • Dopamine beta hydroxylase (DBH) inhibitor




Primary Outcome Measures :
  1. Clinician Administered PTSD Scale Subscore D (Hyperarousal) [ Time Frame: Baseline, week 2, 4 and 6 ]
    The Clinician Administered PTSD Scale subscore D (CAPS-D) measures the hyperarousal cluster for PTSD symptoms (5 items). Higher scores indicate greater severity. Range for CAPS-D is zero to 40. The CAPS has acceptable test-retest reliability (0.98), sensitivity (0.84), specificity (0.95), internal consistency (0.76-0.88) and validity (κ=0.78).


Secondary Outcome Measures :
  1. Clinician Administered PTSD Scale Total Score [ Time Frame: Baseline, week 2,4, and 6 ]
    The Clinician Administered PTSD Scale (CAPS) measures the full spectrum of PTSD symptoms. Higher scores indicate greater severity. Range for CAPS is zero to 136. The CAPS has acceptable test-retest reliability (0.98), sensitivity (0.84), specificity (0.95), internal consistency (0.76-0.88) and validity (κ=0.78).

  2. Clinician Administered PTSD Scale Subscale B Score [ Time Frame: 6 weeks ]
    The Clinician Administered PTSD Subscale B (CAPS-B) measures the re-experiencing cluster of PTSD symptoms. Higher scores indicate greater severity. Range for CAPS-B is zero to 40. The CAPS has acceptable test-retest reliability (0.98), sensitivity (0.84), specificity (0.95), internal consistency (0.76-0.88) and validity (κ=0.78). Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., Kean, T.M., 1995, The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8:75-90.

  3. Clinician Administered PTSD Scale Subscale C Score [ Time Frame: Baseline, week 2, 4, and 6 ]
    The Clinician Administered PTSD Subscale C (CAPS-C) measures the Avoidance and emotional numbing cluster of PTSD symptoms. Higher scores indicate greater severity. Range for CAPS-C is zero to 56. The CAPS has acceptable test-retest reliability (0.98), sensitivity (0.84), specificity (0.95), internal consistency (0.76-0.88) and validity (κ=0.78).



Information from the National Library of Medicine

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Ages Eligible for Study:   19 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Signed informed consent
  • Patient understands the risks and benefits and agrees to visit frequency and procedures
  • Male or female
  • Any race or ethnic origin
  • Served in OIF/OEF or Afghanistan conflicts or other Southwest Asia conditions
  • Currently Active Duty, National Guard, Reservist, Veteran, and/or Retired Military
  • Diagnosis of PTSD (by MINI (Mini International Neuropsychiatric Interview) and CAPS-DX (Clinician Administered PTSD scale- Diagnostic Form) using Rule of Fours and total CAPS-DX score of 45)
  • No substance use disorders in the previous 2 weeks and no substance dependence disorders in the past 4 weeks (except for nicotine and caffeine)
  • Free of psychotropic medication for 2 weeks prior to randomization
  • Physical and laboratory panel are within normal limits or not clinically significant
  • Women of childbearing potential must be using medically-approved methods of birth control
  • ≥19 to 65 years of age

Exclusion Criteria:

  • Lifetime history of bipolar I, schizophrenia, schizoaffective or cognitive disorders
  • Actively considering plans of suicide or homicide
  • Psychotic symptoms that in the investigator's opinion impair the patient's ability to give informed consent or make it unsafe for patient to be maintained without a neuroleptic
  • Unstable general medical conditions or a contraindication to the use of nepicastat
  • Women planning to become pregnant or breastfeed during the study
  • Current or pending incarceration
  • Terminal Illness

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00659230


Locations
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United States, Alabama
Tuscaloosa VAMC
Tuscaloosa, Alabama, United States, 35404
United States, California
VA San Diego Healthcare System
San Diego, California, United States, 92161
United States, New York
James J.Peters VA Medical Center
The Bronx, New York, United States, 10468
Sponsors and Collaborators
Tuscaloosa Research & Education Advancement Corporation
Acorda Therapeutics
Ralph H. Johnson VA Medical Center
Baylor College of Medicine
San Diego Veterans Healthcare System
James J. Peters Veterans Affairs Medical Center
Investigators
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Study Chair: Carlos Berry, M.D. IRB Tuscaloosa VAMC

Publications:
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Responsible Party: Lori Davis, MD, Associate Chief of Staff, Tuscaloosa Research & Education Advancement Corporation
ClinicalTrials.gov Identifier: NCT00659230     History of Changes
Other Study ID Numbers: 08-06
PT074384/W81XWH-08-2-0071 ( Other Grant/Funding Number: Department of Defense/USAMRAA )
PT074384/W81XWH-09-1-0287 ( Other Grant/Funding Number: Department of Defense/USAMRAA )
First Posted: April 16, 2008    Key Record Dates
Results First Posted: June 1, 2017
Last Update Posted: October 13, 2017
Last Verified: September 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Lori Davis, MD, Tuscaloosa Research & Education Advancement Corporation:
PTSD
Veterans
Nepicastat
OIF/OEF

Additional relevant MeSH terms:
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Stress Disorders, Traumatic
Stress Disorders, Post-Traumatic
Trauma and Stressor Related Disorders
Mental Disorders
Dopamine
Cardiotonic Agents
Sympathomimetics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Protective Agents