Lofexidine for Inpatient Opiate Detox
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|ClinicalTrials.gov Identifier: NCT00235729|
Recruitment Status : Completed
First Posted : October 10, 2005
Last Update Posted : March 20, 2009
|Condition or disease||Intervention/treatment||Phase|
|Opiate Addiction||Drug: Lofexidine Drug: Placebo||Phase 3|
Hide Detailed Description
Primary Objective: The primary objective of this study is to investigate the efficacy of lofexidine hydrochloride, an alpha-2-adrenergic agonist, in reducing withdrawal symptoms in subjects undergoing opioid detoxification as assessed by 1)Day 3 SOWS-Gossop score during treatment phase, and 2)Time to dropout during treatment phase.
Secondary Objectives: Secondary objectives include determining Lofexidine's: 1) Efficacy in the reduction in withdrawal symptoms in subjects undergoing opioid detoxification (assessed by longitudinal changes in SOWS-Gossop, OOWS-Handelsman, VAS-E and MGCI (subject and rater); 2)Efficacy in the reduction in the need of any concomitant medication to alleviate opiate withdrawal symptoms: 3) Efficacy in increasing the number of completers during the treatment phase; and 4) Safety in the study population.
Study Design: This is a randomized, multi-center, double blind, placebo-controlled, parallel-group study. There are 3 major phases of the study. During Phase I (Screening) screening assessments will be performed; during Phase II (Days 1-5), subjects will be admitted to an inpatient unit and randomized to receive either lofexidine (0.8 mg QID) or placebo QID after the baseline assessments are performed prior to randomization on Day 1; and during Phase III (Days 6-8), all subjects will receive placebo QID on Days 6-7, and then be discharged on Day 8 following the post-treatment assessments. An adaptive randomization procedure will be used to randomly allocate subjects in one of the two treatment groups - lofexidine or placebo.
Study Population: 264 subjects with Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV) criteria for current dependence on any opioid with a half-life similar to heroin or morphine determined by structured clinical interview (SCID) will be randomized in one of the treatment groups (132 subjects per group). Subjects at least 18 years-of-age with positive urine toxicology screen for opiates and negative for methadone, LAM/LAAM, or buprenorphine during screening, with the ability to understand and provide written informed consent that meet all the inclusion criteria and do not meet any of the exclusion criteria may be randomized into the study.
Treatments: On Day 1, subjects are randomized to either lofexidine or placebo and receive lofexidine (0.8 mg [4 x 0.2 mg lofexidine tablets] QID) or placebo (4 matching placebo tablets QID). Lofexidine or placebo will be administered orally within 15 minutes before or after 0800, 1300, 1800 and 2300 hours on Days 1-5. On Days 6 and 7, all subjects will receive placebo using the same dosing schedule as above.
Efficacy Assessments: The primary efficacy outcome measures will be the Short Opiate Withdrawal Scale (SOWS-Gossop) scores (range = 0-30) on Day 3 of the treatment phase defined as Days 1-5, and the number of days representing the duration of stay in the treatment program after randomization. SOWS-Gossop will be administered once during Baseline on Day 1 prior to randomization and after 3.5 hours after the first dose on Days 1 - 7. Secondary outcome measures evaluating the treatment effects on opioid withdrawal symptoms include, the proportion of subjects requiring any concomitant medication to alleviate opiate withdrawal symptoms and the proportion of subjects who are completers. In addition, the composite longitudinal scores of the SOWS-Gossop, Objective Opiate Withdrawal Scale (OOWS-Handelsman), Modified Global Clinical Impression Scale (Subject and Rater), and Visual Analog Scale - Efficacy (VAS-E) will also be used to assess the treatment efficacy to reduce the withdrawal symptoms. OOWS-Handelsman, MGCI (Subject and Rater), and VAS-E will be administered once during Baseline on Day 1 prior to randomization and 3.5 hours after the first dose on Days 1-7.
Safety Assessments: After signing the informed consent and completing the consent quiz, the subject will complete Screening assessments to determine eligibility for study enrollment. A complete physical examination will be performed on the first day of screening. A repeat physical exam will be performed at 3-4 hours after randomization on Day 1, and prior to discharge on Day 8 or at early termination. A 12-lead ECG will be conducted on the first day of screening and immediately prior to admission. Four hours after receiving the first dose of study medication on Days 1-7, a 12-lead ECG will also be conducted. A 12-lead ECG will be done prior to discharge on Day 8 or at early termination. If, in the opinion of the investigator, clinically significant changes are noted on the ECG, these measurements should be performed more frequently. Additionally, the next scheduled dose of study medication may be withheld at the discretion of the investigator, or the subject may be discontinued from the study. Subjects will be awakened and weighed each morning prior to breakfast. Vital signs (systolic and diastolic blood pressure, heart rate, respiration rate, and body temperature) are to be measured 3 hours after each dose of study medication at 0800, 1300, and 1800 on Days 1-7, and prior to discharge on Day 8. For the orthostatic blood pressure readings, subjects will remain sitting for 3 minutes prior to a blood pressure reading, and then stand for 1 minute prior to a second blood pressure reading. Clinical lab tests will be done during Screening, on Day 7 or early termination, and as needed at the physician?s discretion. The urine sample collected on the first day of Screening will be divided into two aliquots. One sample will go to the local lab for confirmatory drug testing. The other sample will be used for immediate "dip-stick" analysis of pregnancy (for the female patients only). A second "dip-stick" pregnancy test will be done during Baseline, prior to randomization. Adverse events and concomitant medication use will be assessed every day during the study (Days 1-8).
Subjects who demonstrate symptoms of withdrawal will be treated with a standard of care using the concomitant medications listed in Section 13.11. At subject?s request, and at any time, subject can be discontinued from the study without prejudice, and will be medically stabilized; subject will then be referred, at subject's expense, for further treatment.
Analysis: The primary outcome measures and each of the secondary outcome measures will be analyzed using appropriate statistical methods for the intent-to-treat, the evaluable and for the completer groups. The Intent-to-Treat (ITT) group is defined as the subjects who are randomized to treatment. The evaluable group is defined as subjects in the ITT group who receive at least one dose of study medication and complete the post-medication SOWS on Day 1. The completer group will consist of all patients in the ITT group who meet the following criteria: receive at least one dose of study drug on Day 5, and complete the SOWS-Gossop assessment on Day 5.
It is hypothesized that lofexidine treatment, compared to placebo, will be associated with a significant reduction in opiate withdrawal symptoms. All statistical tests will be two-sided at 5% Type-I error rate. Confidence intervals will be two-sided with a 95% confidence coefficient.
Summaries of the characteristics of the subject population in both treatment groups at baseline will be prepared for the modified intent-to-treat group and the completer group. A summary will be prepared to show dropouts/retention over time in each group and for subpopulations. All adverse events will be reported quarterly indicating the counts of unique adverse events by body system and preferred term (MedDRA coded) as experienced by study subjects in both the groups. Laboratory data, physical examinations, and vital signs will be reported in tabular form.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||264 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Triple (Participant, Care Provider, Investigator)|
|Official Title:||CSP #1024 - A Phase III, Randomized, Multi-Center, Double Blind, Placebo-Controlled Study of Safety and Efficacy of Lofexidine for Relief of Symptoms in Subjects Undergoing Inpatient Opiate Detoxification.|
|Study Start Date :||June 2006|
|Actual Primary Completion Date :||October 2007|
|Actual Study Completion Date :||October 2007|
Lofexidine 0.8 mg QID
Lofexidine is an alpha2-adrenergic-agonist with mild to moderate antihypertensive actions. It is mainly used in the alleviation of opioid withdrawal signs and symptoms.
Placebo Comparator: 2
Placebo is an exact match of lofexidine, less the active ingredient.
- SOWS-Gossop score on Day 3 during the treatment phase & time-to-dropout for the subjects in the two treatment groups. during the treatment phase. [ Time Frame: Day 3 of treatment phase for the SOWs score. Time to dropout will be measured as the number of 6-hour time quadrants until a subject withdraws or completes the treatment phase of the study ]
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): NCT00235729
|United States, California|
|Cerritos, California, United States, 90703|
|United States, District of Columbia|
|CNS Psychiatric Institute of Washington|
|Washington, District of Columbia, United States, 20016|
|United States, Georgia|
|Atlanta Center for Medical Research|
|Atlanta, Georgia, United States, 30308|
|United States, Illinois|
|Alexian Center for Psychiatric Research|
|Hoffman Estates, Illinois, United States, 60194|
|United States, Kentucky|
|University of Kentucky|
|Lexington, Kentucky, United States, 40502|
|United States, Maryland|
|VA Maryland Health Care System, Baltimore|
|Baltimore, Maryland, United States, 21201|
|United States, Michigan|
|Wayne State University School of Medicine|
|Detroit, Michigan, United States, 48207|
|United States, New York|
|Richmond Medical Center|
|Staten Island, New York, United States, 10304|
|United States, Pennsylvania|
|VA Medical Center, Philadelphia|
|Philadelphia, Pennsylvania, United States, 19104|
|United States, Rhode Island|
|VA Medical Center, Providence|
|Providence, Rhode Island, United States, 02908|
|United States, Tennessee|
|Psychiatric Hospital at Vanderbilt|
|Nashville, Tennessee, United States, 37232-8650|
|United States, Texas|
|Research Across America|
|Dallas, Texas, United States, 75234|
|University of Texas Health Science Center at San Antonio|
|San Antonio, Texas, United States, 78229-3900|
|United States, Utah|
|VA Salt Lake City Health Care System, Salt Lake City|
|Salt Lake City, Utah, United States, 84148|
|United States, Washington|
|VA Puget Sound Health Care System, Seattle|
|Seattle, Washington, United States, 98108|
|United States, Wisconsin|
|Aurora Psychiatric Hospital|
|Wauwatosa, Wisconsin, United States, 53213|
|Study Chair:||Charles W. Gorodetzky||VA Maryland Health Care System, Baltimore|