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Dutasteride Treatment for Reducing Heavy Drinking in AUD: Predictors of Efficacy

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ClinicalTrials.gov Identifier: NCT04098302
Recruitment Status : Recruiting
First Posted : September 23, 2019
Last Update Posted : October 21, 2019
Sponsor:
Collaborator:
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Information provided by (Responsible Party):
Jonathan Covault, UConn Health

Brief Summary:
The purpose of this study is to evaluate the safety and efficacy of dutasteride in reducing drinking and heavy drinking in men and women with alcohol use disorder. The investigators hypothesize that dutasteride 1 mg per day will be well tolerated in this patient population and that, compared to placebo treatment, dutasteride will result in a greater reduction in drinks per week and in the frequency of heavy drinking days.

Condition or disease Intervention/treatment Phase
Alcohol Use Disorder Drug: Dutasteride Capsules Drug: Placebo Capsules Phase 2 Phase 3

Detailed Description:

Heavy drinking remains a significant public health problem and is frequently under treated. Although several medications have been shown to help patients stop or reduce drinking, additional medication options are needed as there is considerable variability in effectiveness or tolerability of existing medications for individual patients. Additionally, identification of individual subject level predictors of efficacy are needed to better personalize pharmacotherapy treatment recommendations. This study will seek to replicate and extend our results showing efficacy of a novel medication dutasteride for reducing drinking and will examine potential easily measured predictors of response.

Dutasteride is a widely prescribed medication for benign prostatic hypertrophy and androgenic hair loss that also modulates the elimination of cortisol and the production of some neuroactive steroids. Changes in the regulation of cortisol and neuroactive steroids have each been suggested as factors which may contribute to the maintenance of alcohol dependence. Data from a recently completed first randomized placebo controlled trial of dutasteride for AUD in a sample of male drinkers, indicates that dutasteride is well tolerated in alcoholics and has efficacy in helping subjects reduce drinking. Additionally, results indicate that dutasteride may be particularly helpful for patients who drink to cope with anxiety and negative emotions, a group of patients with poor response to other treatments.

This 24-week treatment study will use an innovative randomized placebo controlled step therapy design to examine the safety and efficacy of dutasteride to reduce drinking by treatment seeking women and men with hazardous levels of alcohol use. At 12-weeks placebo non-responders will transition to dutasteride and dutasteride non-responders will transition to naltrexone, an FDA approved medication with demonstrated efficacy for reducing heavy drinking. 12-week responders (reduction in drinks/week of 60% or greater compared with screening) will continue for an additional 12-weeks on their initial study medication assignment (dutasteride or placebo).

Additionally, the investigators will examine several baseline measures as predictors of dutasteride efficacy, including drinking to cope, anxiety, adverse child events, and perceived life stress as well as stress resilient vs. reactive genotypes of FKBP5 a chaperone protein involved in regulation of glucocorticoid, androgen and progesterone receptor function.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 190 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The study consists of two 12-week phases, the first being a 12-week parallel-groups comparison of dutasteride and placebo to evaluate the safety and efficacy of dutasteride 1 mg/day in reducing the likelihood of drinking and heavy drinking in treatment-seeking men and women with alcohol use disorder. In the second 12-week phase, responders in phase 1 (defined as a ≥60% reduction in SD/wk for weeks 9-12 compared with screening) will continue on their initial medication assignment, while non-responder subjects treated with placebo in phase 1 will be given dutasteride during phase 2, and non-responder subjects treated with dutasteride in phase 1 will receive naltrexone daily in phase 2. This design maintains double blind conditions in both phases 1 and 2.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking Description: UConn Health Investigational Pharmacy will randomize to dutasteride vs. placebo for phase 1 at baseline
Primary Purpose: Treatment
Official Title: Dutasteride Treatment for Reducing Heavy Drinking in AUD: Predictors of Efficacy
Actual Study Start Date : October 15, 2019
Estimated Primary Completion Date : May 30, 2024
Estimated Study Completion Date : May 30, 2025

Resource links provided by the National Library of Medicine

Drug Information available for: Dutasteride

Arm Intervention/treatment
Active Comparator: dutasteride
two 0.5 mg capsules of dutasteride daily
Drug: Dutasteride Capsules
1 mg/day oral dutasteride (2 x 0.5 mg capsules)
Other Name: Avodart

Placebo Comparator: placebo capsule
inactive placebo matched in appearance with dutasteride capsules
Drug: Placebo Capsules
Placebo capsules with matching appearance as Dutasteride Capsules
Other Name: inactive placebo




Primary Outcome Measures :
  1. Change in Heavy Drinking Days Per Week by Medication Group [ Time Frame: 12 weeks (from initiation to end of treatment phase 1) ]
    Change in the number of heavy drinking days (i.e., four or more drinks in a day for women and five or more drinks in a day for men) during treatment phase of study. Daily drinking data will be aggregated to the weekly level.

  2. Change in Drinks Per Week by Medication Group [ Time Frame: 12 weeks (from initiation to end of treatment phase 1) ]
    Change in the number of drinks per week during treatment phase of study. Daily drinking data will be aggregated to the weekly level.



Information from the National Library of Medicine

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Ages Eligible for Study:   35 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • men and women age 35 to 70 yo inclusive
  • have an average weekly ethanol consumption of >24 SD for men and >18 for women and at least 2 HDD/wk over the 8 weeks prior to screening
  • current DSM-5 AUD
  • no evidence of significant cognitive impairment
  • for women of child-bearing potential (i.e., no hysterectomy, bilateral oophorectomy, or tubal ligation; or <2 years postmenopausal) must be non-lactating, practicing a reliable method of birth control and agree to continue such throughout the study and for 6 months following participation, and have a negative serum pregnancy test prior to initiation of treatment.

Exclusion Criteria:

  • history of serious alcohol withdrawal symptoms (e.g., perceptual distortions, seizures, delirium, or hallucinations)
  • subjects who on clinical examination by a physician are deemed to be too severely alcohol dependent to permit them to participate in a pbo-controlled study (e.g., evidence of serious adverse medical or psychiatric effects that are exacerbated by heavy drinking and would, for safety reasons, lead the physician to urge the patient to be totally abstinent and engage in an empirically supported treatment)
  • current, clinically significant physical disease or abnormality on the basis of medical history, physical examination, or routine laboratory evaluation, including direct bilirubin more than 2.5 times the upper limit of normal or transaminase elevations 5 times the upper limit of normal (the investigators will not exclude patients with hypertension, diabetes, asthma or other common medical conditions, if these are adequately controlled and the patient has an ongoing relationship with a primary care provider)
  • have a serious psychiatric illness on the basis of history or psychiatric examination (i.e., schizophrenia, active clinically significant mood episode of bipolar disorder or major depression, organic mental disorder, current clinically significant eating disorder, or substantial suicide or violence risk)
  • have a current DSM-5 diagnosis of moderate drug use disorder (other than caffeine or nicotine dependence)
  • currently taking finasteride, dutasteride, medication for treatment of AUD, or chronic use of opioid pain medication
  • are considered by the investigators to be an unsuitable candidate for an investigational drug

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): NCT04098302


Contacts
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Contact: Marcia Lawlor, BS 860-679-7000 lawlor@uchc.edu

Locations
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United States, Connecticut
University of Connecticut Health Center Recruiting
Farmington, Connecticut, United States, 06030
Contact: Jonathan Covault, MD    860-679-7560    jocovault@uchc.edu   
Sub-Investigator: Cheryl Oncken, MD         
Sub-Investigator: Rao Surita, MBBS         
Sub-Investigator: Tennen Howard, PhD         
Principal Investigator: Covault Jonathan, MD, PhD         
Sponsors and Collaborators
UConn Health
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Investigators
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Principal Investigator: Jonathan Covault, MD, PhD UConn Health

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Responsible Party: Jonathan Covault, Professor, UConn Health
ClinicalTrials.gov Identifier: NCT04098302     History of Changes
Other Study ID Numbers: 19-147-2
P50AA027055 ( U.S. NIH Grant/Contract )
First Posted: September 23, 2019    Key Record Dates
Last Update Posted: October 21, 2019
Last Verified: October 2019
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
Additional relevant MeSH terms:
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Alcoholism
Alcohol-Related Disorders
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Dutasteride
5-alpha Reductase Inhibitors
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs