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The Effects of Naltrexone on Active Crohn's Disease (LDN)

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ClinicalTrials.gov Identifier: NCT00663117
Recruitment Status : Completed
First Posted : April 22, 2008
Results First Posted : May 17, 2013
Last Update Posted : May 17, 2013
Sponsor:
Collaborators:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The Broad Foundation
Information provided by (Responsible Party):
Jill P. Smith, Penn State University

Brief Summary:

It is hypothesized that the opioid antagonist naltrexone will improve inflammation of the bowel and quality of life in subjects with active Crohn's disease compared to placebo. In order to test this hypothesis the following specific aims are proposed:

  1. Evaluate the effects of low dose naltrexone compared to placebo on the activity of Crohn's disease by the following end points: Crohn's Disease Activity Index (CDAI), pain assessment, laboratory values (CRP and ESR), endoscopic appearance, histology, and quality of life surveys;
  2. Examine the effects of naltrexone given over 3 months compared to 6 months for durability of response;
  3. Determine the safety and toxicity of low dose naltrexone in subjects with active Crohn's disease, and
  4. Study the mechanism by which naltrexone exerts its effect by measuring plasma enkephalin levels of subjects on therapy.

Purpose statement: The purpose of this study is to evaluate the effects of low dose naltrexone in a blinded placebo controlled study to determine the safety and efficacy of this compound in those with active Crohn's disease.


Condition or disease Intervention/treatment Phase
Inflammation Crohn's Disease Drug: Naltrexone-HCl Drug: Placebo Phase 2

Detailed Description:
Study design : The study is designed as a double-blind placebo controlled study for 3 months followed by a pseudo cross-over such that all subjects receiving placebo the first 3 months will receive active drug the second 3 months and all receiving naltrexone the first 3 months remain on the drug the last 3 months of this 6 month study.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Effects of Naltrexone in Active Crohn's Disease
Study Start Date : September 2006
Actual Primary Completion Date : October 2009
Actual Study Completion Date : October 2009

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Crohn's Disease

Arm Intervention/treatment
Placebo Comparator: Placebo, Sugar pill
placebo for 3 months blinded then followed by an open-labelled study and all are treated with naltrexone 4.5 mg for 3 additional months
Drug: Naltrexone-HCl
naltrexone 4.5 mg
Other Names:
  • LDN
  • Revia

Drug: Placebo
Placebo
Other Name: sugar pill

Active Comparator: Naltrexone-HCl
Subjects are treated in a blinded fashion for 3 months with naltrexone 4.5 mg po for active Crohn's disease followed an open-labelled study where naltrexone is given an additional 3 months at 4.5 mg po; hence the total treatment interval in this arm is 6 months. The response to the intervention administered is measured in the activity index and mucosal healing by colonoscopy.
Drug: Naltrexone-HCl
naltrexone 4.5 mg
Other Names:
  • LDN
  • Revia




Primary Outcome Measures :
  1. Percentage of Subjects Achieving a 70-point Decline in CDAI Scores (Crohn's Disease Activity Index) Scores; [ Time Frame: 3 months ]
    The CDAI score is a number which consists of information collected from a 7-day diary from the patient regarding symptoms. It also includes objective information from the physical exam, weight and hemotocrit. Remission is considered a score of 150 or less. Active disease is considered 220 or greater. A response to therapy is considered a decline in the CDAI score of 70-points from baseline.


Secondary Outcome Measures :
  1. Percentage Change From Baseline of Quality of Life IBDQ (Inflammatory Bowel Disease Quality of Life Survey) [ Time Frame: Between baseline and 3 months ]
    IBDQ (Inflammatory bowel Disease questionnaire) contains questions about health ranging from a score of poor (i.e., 32) to excellent (i.e., 224) an increase from baseline indicates improvement in quality of life.

  2. Percentage of Patients With a 5 Point Drop in CDEIS Score by Endoscopy [ Time Frame: 12 weeks ]
    A secondary outcome was the appearance of the colonic mucosa on endoscopy using the Crohn's Disease Endoscopic Index of Severity (CDEIS) score described by Mary et al. Gut 1989;30:983-989.This score ranges from 0-44 based upon the extent and severity of inflammation and ulcers seen during endoscopy of the colon. A response is a drop of > 5 points from baseline. Endoscopic remission is a score of < 6 and Complete endoscopic remission is a score of > 3.

  3. Histology Inflammatory Score by Colon Biopsies [ Time Frame: 12 weeks ]
    Histology scores to assess microscopic inflammation and structural architecture were determined at baseline and after 12 weeks of either naltrexone therapy or placebo by mucosal biopsy samples obtained during colonoscopies.The pathology specimens were reviewed and scored by a Pathologist blinded to the treatment. The mean scores at baseline were the same between both groups.Differences between naltrexone and placebo treated subjects was assessed.The range in scores could be 0-25, with 0 representing no inflammation and 25 being maximum or severe inflammation..



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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • All subjects must give written informed consent
  • Male or female subjects, > 18 years
  • Patients must have endoscopic, histologic, or radiographic confirmed Crohn's Disease.
  • Patients must have a Crohn's Disease Activity Index (CDAI) of at least 220 at Baseline
  • Stable doses of medications for Crohn's disease over proceeding 4 weeks (for aminosalicylates and steroids: prednisone of 10mg or less daily and Entocort 3 mg/ day are allowed), and 12 weeks for azathioprine or 6-mercaptopurine.)

Exclusion Criteria:

  • Subjects with ostomies or ileorectal anastomosis from prior surgical colectomy.
  • Subjects who received infliximab (Remicade) within 8 weeks of study screening or humira for 4 weeks.
  • Subjects requiring steroids either intravenously or prednisone >10mg /day or Entocort > 3 mg daily.
  • Subjects with short-bowel syndrome.
  • Abnormal liver enzymes at screening visit or known hepatitis or cirrhosis
  • Hemoglobin less than 10.
  • Subjects with cancer (other than skin cancer) in past 5 years.
  • Women of childbearing potential unless surgically sterile or using adequate contraception (either IUD, oral or deport contraceptive, or barrier plus spermicide), and willing and able to continue contraception for 3 months after the completion of the study.
  • Women who are pregnant or breastfeeding

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): NCT00663117


Locations
United States, Pennsylvania
Penn State Hershey Medical Center
Hershey, Pennsylvania, United States, 17033
Sponsors and Collaborators
Penn State University
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
The Broad Foundation
Investigators
Principal Investigator: Jill P. Smith, M.D. Pennsylvania State University College of Medicine

Additional Information:
Publications of Results:
Other Publications:
Responsible Party: Jill P. Smith, Professor Emeritus of Medicine, Penn State University
ClinicalTrials.gov Identifier: NCT00663117     History of Changes
Other Study ID Numbers: DK073614 l
1R03DK073614 ( U.S. NIH Grant/Contract )
IBD-0180R ( Other Grant/Funding Number: Broad Medical Research Program )
First Posted: April 22, 2008    Key Record Dates
Results First Posted: May 17, 2013
Last Update Posted: May 17, 2013
Last Verified: May 2013

Keywords provided by Jill P. Smith, Penn State University:
naltrexone
LDN
IBD
Inflammatory bowel disease

Additional relevant MeSH terms:
Inflammation
Crohn Disease
Pathologic Processes
Inflammatory Bowel Diseases
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Intestinal Diseases
Naltrexone
Narcotic Antagonists
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents