A Multi-site Expanded Access Program for MDMA-assisted Psychotherapy for Patients With Treatment-resistant PTSD (EAMP1)

• ClinicalTrials.gov Identifier: NCT04438512
• Expanded Access Status: Temporarily not available
• First Posted: June 18, 2020
• Last Update Posted: November 17, 2020
• Sponsor: Multidisciplinary Association for Psychedelic Studies
• Information provided by (Responsible Party): Multidisciplinary Association for Psychedelic Studies

Study Description

Brief Summary:

This is an open-labeled, expanded access protocol for eligible patients with treatment resistant PTSD. This protocol is designed to provide access to MDMA-assisted psychotherapy to patients who are not eligible for participation in another ongoing MDMA-assisted psychotherapy clinical trial.

Condition or disease	Intervention/treatment
Post Traumatic Stress Disorder	Drug: MDMA; Behavioral: Psychotherapy

Detailed Description:

PTSD is a serious debilitating disorder that negatively impacts a person's daily life, and can result in diminished cognitive and psychosocial functioning, fractured relationships, inability to maintain employment, substance abuse, high-cost healthcare utilization, increased depression, and suicide risk. People who suffer from PTSD relive their traumatic experience(s) through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged. Symptoms can be severe and long lasting.

3,4-methylenedioxymethamphetamine (MDMA) is a drug that releases serotonin, norepinephrine and dopamine in the brain and indirectly increases levels of the neurohormones oxytocin, arginine vasopressin and cortisol. The combined neurobiological effects of MDMA increase compassion, reduce defenses and fear of emotional injury, and enhance communication and introspection. MDMA produces anxiolytic and prosocial effects, which counteract avoidance and hyperarousal in the context of therapy. A combined treatment of MDMA and psychotherapy may be especially useful for treating PTSD. The subjective effects of MDMA create a productive psychological state that enhances the therapeutic process.

This is an open-labeled, expanded access protocol with the primary purpose of providing MDMA-assisted psychotherapy to patients with treatment-resistant PTSD, who are not eligible for participation in another ongoing MDMA-assisted psychotherapy clinical trial. In addition, this study will provide supportive data on safety and tolerability of MDMA-assisted psychotherapy in treatment-resistant patients with PTSD. The study will enroll up to 50 patients. A flexible dose of MDMA, followed by a supplemental half-dose unless contraindicated, is administered duringthe Treatment Period with manualized psychotherapy in up to three open-label Experimental Sessions. During the Treatment Period, each Experimental Session is preceded by three 90-minute Preparatory Sessions and followed by three 90-minuteIntegrative Sessions of non-drug psychotherapy. Experimental Sessions will be followed by an overnight stay.

Study Design

• Study Type: Expanded Access
• Expanded Access Type: Intermediate-size Population, Treatment IND/Protocol
• Official Title: An Intermediate-size Multi-site Expanded Access Program for MDMA-assisted Psychotherapy for Patients With Treatment-resistant PTSD

Interventions

Intervention Details:

• Drug: MDMA
  Administration of 80 or 120 mg MDMA in combination with psychotherapy and a supplemental dose offered 1.5/2 hrs later of 40 or 60 mg MDMA respectively
  Other Name: 3,4-methylenedioxymethamphetamine
• Behavioral: Psychotherapy
  Standardized non-directive psychotherapy performed by therapist team

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All

Criteria

Inclusion Criteria:

• At Screening, meet criteria for PTSD diagnosis according to the MINI and have at least moderate PTSD symptoms in the last month based on PCL-5.
• Have had at least two unsuccessful attempts at treatment for PTSD. Treatment attempts can consist of adequate dose and duration of medication treatment (at least 3 months of Paroxetine or Sertraline or other SSRI at dosages recommended in the package insert) or adequate duration of psychotherapy treatment (at least 12 sessions of psychotherapy) or any combination of these two categories
• Are at least 18 years old
• Are fluent in speaking and reading a recognized language of the study site
• Are able to swallow pills
• Agree to have study visits recorded, including Experimental Sessions and non-drug psychotherapy sessions
• Must provide a contact (relative, spouse, close friend or other support person) who is willing and able to be reached by the investigators in the event of a patient becoming suicidal or unreachable
• Must agree to inform the investigators within 48 hours of any medical conditions and procedures
• If of childbearing potential, must have a negative pregnancy test at study entry and prior to each Experimental Session, and must agree to use adequate birth control through 10 days after the last Experimental Session.
• Agree to the following lifestyle modifications: comply with requirements for fasting and refraining from certain medications prior to Experimental Sessions, not participate in any other interventional clinical trials during the duration of the study, be driven home after each Experimental Session (unless medically necessary or therapeutically important in the judgment of the therapists to remain at the study site overnight) , and commit to medication dosing, therapy, and study procedures
• May have well-controlled hypertension that has been successfully treated with anti-hypertensive medicines, if they pass additional screening within the past year to rule out underlying cardiovascular disease
• May have asymptomatic Hepatitis C virus (HCV) that has previously undergone evaluation and treatment as needed
• May have alcohol or substance use disorder if participant is not in withdrawal or requiring detox.
• May have a history of or current Diabetes Mellitus (Type 1 or Type 2), if the patient passes additional screening to rule out underlying cardiovascular disease

Exclusion Criteria:

• Are not able to give adequate informed consent
• Have used Ecstasy (material represented as containing MDMA) within 3 months of the first Experimental Session; or have previously participated in a MAPS-sponsored MDMA clinical trial
• Have any current problem which, in the opinion of the investigator or Medical Monitor, might interfere with participation
• In the investigator's opinion, lack a stable living situation or supportive family/network
• Have received Electroconvulsive Therapy (ECT) within 12 weeks of enrollment
• Have evidence or history of significant medical and psychiatric disorders
• Any patient presenting current serious suicide risk
• Would present a serious risk to others as established through clinical interview and contact with treating psychiatrist
• Require ongoing concomitant therapy with a psychiatric medication
• Have evidence or history of significant hematological, endocrine, cerebrovascular, cardiovascular, coronary, pulmonary, renal, gastrointestinal, immunocompromising, or neurological disease, including seizure disorder, or any other medical disorder judged by the investigator to significantly increase the risk of MDMA
• Have a history of ventricular arrhythmia, other than occasional PVCs in the absence of ischemic heart disease, at any time or with a history of supraventricular arrhythmia within the past year.
• Have uncontrolled hypertension using the standard criteria of the American Heart Association (values of 140/90 milligrams of Mercury [mmHg] or higher assessed on three separate occasions)
• Have a marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a QTc interval >450 milliseconds [ms] corrected by Bazett's formula)
• Have a history of additional risk factors for Torsade de pointes (e.g., heart failure, hypokalemia, family history of Long QT Syndrome)
• Require use of concomitant medications that prolong the QT/QTc interval during Experimental Sessions
• Have symptomatic liver disease or have significant liver enzyme elevation
• Have a history of HCV that has not been evaluated and treated successfully if treatment is indicated
• Have history of hyponatremia or hyperthermia
• Are pregnant or able to bear children and are not practicing an effective means of birth control
• Are breastfeeding (unless willing to dispose of breastmilk from dosing through 84 hours after each Experimental Session)

Contacts and Locations

Sponsors and Collaborators

Multidisciplinary Association for Psychedelic Studies

Investigators

• Study Director: Corine de Boer, MD; MAPS Public Benefit Corp.

More Information

• Responsible Party: Multidisciplinary Association for Psychedelic Studies
• ClinicalTrials.gov Identifier: NCT04438512
• Other Study ID Numbers: EA
• First Posted: June 18, 2020
• Last Update Posted: November 17, 2020
• Last Verified: October 2020

Additional relevant MeSH terms:

Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Trauma and Stressor Related Disorders; Mental Disorders; N-Methyl-3,4-methylenedioxyamphetamine; Hallucinogens; Physiological Effects of Drugs; Psychotropic Drugs; Serotonin Agents; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Adrenergic Uptake Inhibitors; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Adrenergic Agents