Obsessive Compulsive Disorder
Conditions
Keywords
Obsessive compulsive disorder
Brief summary
This study will examine the feasibility and potential efficacy of augmenting SRIs with minocycline. The study will assess whether the addition of minocycline leads to measurable changes in striatal glutamate (Glu) levels. This study will recruit up to 45 youth ages 8-20 diagnosed with clinically significant OCD who have demonstrated no more than minimal response to SRI treatment and are currently on a stable dose of SRI medication for at least 12 weeks. Participants will be randomized to receive either 12 weeks of minocycline treatment or pill placebo. Randomization will be 2:1 so that 2 of 3 participants receive minocycline. Screening for eligibility will take place for 1-4 weeks. Participants will undergo magnetic resonance spectroscopy (MRS) scans to measure striatal Glu levels prior to randomization, and again immediately following the treatment period. During the treatment period, participants will meet initially weekly and then every other week with the study psychiatrist. All participants will be offered three months of open medication treatment following participation. The clinical trial will only be conducted at the New York State Psychiatric Institute (NYSPI) and the MRS scans may be conducted at Weill Cornell Medical Center or NYSPI.
Detailed description
Please see the brief summary for study description.
Interventions
DRUGMinocycline
Participants randomized to minocycline will receive approximately 2 mg/kg/day, the FDA-approved dose for minocycline. Participants will take either minocycline or pill placebo for 12 weeks.
OTHERPlacebo
A placebo pill will be administered twice a day (BID) for 12 weeks.
Sponsors
National Institute of Mental Health (NIMH)
Weill Medical College of Cornell University
New York State Psychiatric Institute
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
8 Years to 20 Years
Healthy volunteers
No
Inclusion criteria
* Participants must be ages of 8-20 at the time of consent * Participants must weigh at least 25kg * Participants and a parent/guardian must be able to read and understand English * Participants must meet diagnostic criteria for obsessive-compulsive disorder with score ≥ 16 on the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS) * Participants must be on stable dose of serotonin reuptake inhibitor (SRI) medication, and must have had a minimal adequate trial of SRI medication * Report of at least minimal, but not full, response to current SRI medication to warrant ongoing SRI treatment * For participants younger than 18, written informed assent by the participant and consent by the parent. For participants 18 and older, written consent by the participant and permission for legal guardian/parent to provide information
Exclusion criteria
* Lifetime diagnosis of: psychotic disorder, bipolar disorder, eating disorder, pervasive developmental disorder, mental retardation, or substance/alcohol dependence * Current diagnosis of major depressive disorder, Tourette's/Tic Disorder, or substance/alcohol abuse * Positive urine screen for illicit drugs * Medical or psychiatric conditions that would make participation in the study unsafe * Active suicidal ideation * Females who are using hormonal birth control * Presence of metallic device or dental braces incompatible with MRS * Intelligence quotient (IQ) \<80 * OCD patients with primary symptoms of hoarding (determined by CYBOCS checklist) * Current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) * Individuals who are currently receiving Exposure and Response Prevention therapy and are in the acute phase of treatment. * Documented history of hypersensitivity or intolerance to tetracycline antibiotics * Use of medications that are contra-indicated with minocycline (e.g., concomitant use of antacids, iron, calcium, magnesium, aluminum, zinc salts as they impair minocycline absorption; of anti-coagulant drugs as minocycline has been shown to depress plasma prothrombin activity; of other antibiotics or Accutane due to the rare side effect of pseudotumor cerebri) * Inability of participant or parent/guardian to read or understand English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Change from Baseline at 4, 8, and 12 weeks | The Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) is a semi-structured measure of Obsessive-Compulsive Disorder (OCD) severity with excellent inter-rater reliability, internal consistency, and test-retest reliability. It is validated in those starting at age 7 and used in studies up to age 20. The CYBOCS differs from the adult YBOCS only in its use of simpler language. The total CYBOCS score ranges from 0 to 40, with higher scores indicating more severe symptomatology. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS). | Change from Baseline at 12 weeks | The change in striatal glutamate level will be assessed. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants randomized to placebo will receive pills that are identical in appearance to the study drug but contain no active medication.
Placebo: A placebo pill will be administered BID for 12 weeks. | 10 |
| Minocycline Augmentation Those randomized to minocycline will receive approximately 2 mg/kg/day, the FDA-approved dose for minocycline (minimum 50 mg/day and maximum 200 mg/day). After randomization, participants will receive child proofed bottles that contain enough study medication until the next visit with an additional 3 days coverage in case of scheduling issues. All participants will have a minocycline level drawn at week 12 to confirm treatment adherence. Minocycline is FDA-approved in those ages 8 and above for treatment of infections and acne and has a favorable risk-benefit profile.
Minocycline: Participants randomized to minocycline will receive approximately 2 mg/kg/day, the FDA-approved dose for minocycline. Participants will take either minocycline or pill placebo for 12 weeks. | 21 |
| Total | 31 |
Baseline characteristics
| Characteristic | Placebo | Minocycline Augmentation | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 8 Participants | 16 Participants | 24 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 2 Participants | 5 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 1 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 8 Participants | 20 Participants | 28 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 5 Participants | 19 Participants | 24 Participants |
| Region of Enrollment United States | 10 Participants | 21 Participants | 31 Participants |
| Sex: Female, Male Female | 5 Participants | 11 Participants | 16 Participants |
| Sex: Female, Male Male | 5 Participants | 10 Participants | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 21 |
| other Total, other adverse events | 10 / 10 | 21 / 21 |
| serious Total, serious adverse events | 0 / 10 | 5 / 21 |
Outcome results
Primary
Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS)
The Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) is a semi-structured measure of Obsessive-Compulsive Disorder (OCD) severity with excellent inter-rater reliability, internal consistency, and test-retest reliability. It is validated in those starting at age 7 and used in studies up to age 20. The CYBOCS differs from the adult YBOCS only in its use of simpler language. The total CYBOCS score ranges from 0 to 40, with higher scores indicating more severe symptomatology.
Time frame: Change from Baseline at 4, 8, and 12 weeks
Population: Due to the early-termination of some participants, not all completed the CYBOCS at Week 12
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Baseline | 28.20 units on a scale | Standard Deviation 3.79 |
| Placebo | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Week 4 | 26.67 units on a scale | Standard Deviation 4.69 |
| Placebo | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Week 8 | 25.33 units on a scale | Standard Deviation 5.22 |
| Placebo | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Week 12 | 26.44 units on a scale | Standard Deviation 5.1 |
| Minocycline Augmentation | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Week 12 | 25.59 units on a scale | Standard Deviation 6.39 |
| Minocycline Augmentation | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Baseline | 29.0 units on a scale | Standard Deviation 3.49 |
| Minocycline Augmentation | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Week 8 | 25.47 units on a scale | Standard Deviation 5.77 |
| Minocycline Augmentation | Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) | Week 4 | 27.11 units on a scale | Standard Deviation 5.61 |
Secondary
Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS).
The change in striatal glutamate level will be assessed.
Time frame: Change from Baseline at 12 weeks
Population: Due to the early-termination of some participants, not all completed MRS at Week 12
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Placebo | Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS). | Baseline | 44.49 Arbitrary Units | Standard Deviation 6.76 |
| Placebo | Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS). | Week 12 | 42.97 Arbitrary Units | Standard Deviation 8.25 |
| Minocycline Augmentation | Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS). | Baseline | 43.96 Arbitrary Units | Standard Deviation 9.18 |
| Minocycline Augmentation | Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS). | Week 12 | 39.35 Arbitrary Units | Standard Deviation 6.47 |