Alcohol Use Disorder
Conditions
Keywords
alcohol craving, human laboratory, lacosamide, non-treatment seeking
Brief summary
The overall goal of the proposed project is to improve the treatment of individuals with AUD. The investigators will conduct the first pilot human laboratory study to assess the effects of two doses of lacosamide on alcohol drinking and craving. The investigators will assess its effects on reducing alcohol intake using a human laboratory method, the Yale Alcohol Drinking Paradigm (ADP). The investigators will also assess the feasibility of the Alcohol Drinking Paradigm (ADP) in order to position our research team to have the capacity to conduct future, larger, hypothesis-testing human laboratory-based experiments designed to test the efficacy of potential alcohol treatments.
Detailed description
Four heavy-drinking non-treatment seeking male community volunteers with a diagnosis of AUD will undergo 3 ADP sessions. In each of the 3 ADP sessions, they will receive one of the following 3 different interventions: either 100 mg of lacosamide, 200 mg of lacosamide or placebo. The ADP session is a one day human laboratory session at the SFVA Medical Center. This human laboratory session involves the self-administration of alcoholic beverages by research participants under highly structured, observed conditions in order to evaluate the effects of the study drug interventions (either 100 mg lacosamide, 200 mg lacosamide, or placebo) on alcohol craving and alcohol consumption. The study follows a double-blind placebo-controlled crossover design in which each participant receives each of the 3 drug interventions in a randomly assigned sequence. There were 4 possible sequences representing the 4 arms of the study.
Interventions
Sponsors
San Francisco VA Health Care System
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Double-blind, placebo-controlled
Eligibility
Sex/Gender
MALE
Age
21 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
1. Men, ages 21-50; 2. Able to read English and to complete study evaluations; 3. Meet DSM-V criteria for current alcohol use disorder (AUD); 4. Average weekly alcohol use of 25-70 standard drinks for men over the past 30 days; 5. No more than 3 days/week of alcohol abstinence in the past 30 days, to maximize likelihood that participants will choose to drink during the laboratory sessions.
Exclusion criteria
1. Individuals who are seeking AUD treatment or have been in treatment within the past 6 months; 2. Current DSM-V non-alcohol use disorder other than tobacco or cannabis; 3. Positive urine drug test results at more than one baseline appointment for opioids, cocaine, benzodiazepines or barbiturates; 4. Regular use of psychoactive drugs including antipsychotics, anxiolytics and antidepressants during the 30 days prior to entry, as well as anticonvulsants, beta blockers, central nervous system stimulants or depressants, or other drugs that cause excessive sedation; 5. Taking medications that may interact with lacosamide, e.g. medications that prolong the ECG PR interval, or medications with strong CYP3A4 and CYP2C9; 6. Psychosis or any other serious mental illness as judged by SCID and study physician assessment; 7. Medical conditions that in the judgment of the study physician contraindicate the consumption of alcohol; 8. Medical conditions that in the judgment of the study physician contraindicate LAC (non contraindications listed in the FDA-approved Prescribing Information for LAC); 9. Any other medical conditions that in the opinion of the study physician would make study participation hazardous; 10. History of serious alcohol withdrawal (e.g. seizures, DTs, hospitalization) or a Clinical Institute Withdrawal Assessment Scale (CIWA-AD) score greater than or equal to 8; 11. Participants who report disliking spirits will be excluded because 80 proof liquor will be provided during the alcohol self-administration periods; 12. Participants who have taken any investigational drug within 4 weeks preceding study entry; 13. Participants with first-degree atrioventricular block (AV block), PR interval lengthened beyond 0.20 seconds or greater.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recruitment Feasibility (Time, in Months,) Required to Recruit, Screen and Conduct the Study Procedures | 7 months | Recruitment feasibility will be measured as the time (in months) required to recruit, screen and conduct the study procedures for a total of 4 participants. |
| Retention Feasibility (Proportion of Participants Completing the Alcohol Drinking Paradigm (ADP) Sessions) | 6.5 weeks | Retention feasibility will be measured by the proportion of participants completing the Alcohol Drinking Paradigm (ADP) Sessions 1, 2 and 3. |
| Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | 3 days (1 day each for ADP Session 1, 2, and 3) | Tolerability will be measured by the number of participants with mild, moderate, and severe adverse events for each of the 3 drug interventions (100 mg lacosamide, 200 mg lacosamide and placebo). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Alcohol Craving | 3 days (1 day each for ADP Session 1, 2, and 3. Each ADP Session included 1 dose of the drug intervention, either Placebo, Lacosamide 100 mg, or Lacosamide 200 mg). | Alcohol craving will be measured during Alcohol Drinking Paradigm (ADP) sessions 1, 2 and 3 using the total score of the Alcohol Urge Questionnaire (AUQ). The AUQ has 8 items. Each item is scored on a 1 to 7 scale (Strongly Disagree = 1 and Strongly Agree = 7; items 2 and 7 are reverse scored). Higher scores reflect greater craving. Total score range is from a minimum of 8 to a maximum of 56. The AUQ is administered before study medication and at various times after study medication. The AUQ score reported here is the highest AUQ score following administration of study medication. |
| Alcohol Consumption (Number of Standard Drinks Consumed) | 3 days (1 day each for ADP Session 1, 2, and 3. Each ADP Session included 1 dose of the drug intervention, either Placebo, Lacosamide 100 mg, or Lacosamide 200 mg). | Alcohol consumption is measured during each of the Alcohol Drinking Paradigm (ADP) sessions, 1, 2 and 3. In each session participants received one of the 3 drug interventions, Placebo, Lacosamide 100 mg, or Lacosamide 200 mg. Consumption was measured using the number of alcoholic standard drinks consumed during the ADP sessions. A standard drink per NIAAA definition is 14 grams of pure alcohol. |
| Subjective Effects of Alcohol Consumption | 3 days (1 day each for ADP Session 1, 2, and 3. Each ADP Session included 1 dose of the drug intervention, either Placebo, Lacosamide 100 mg, or Lacosamide 200 mg). | Subjective effects of alcohol consumption are measured during the Alcohol Drinking Paradigm (ADP) sessions 1, 2 and 3 using the Biphasic Alcohol Effects Scale (BAES), which has 2 subscales; the Stimulation Subscale range is 0 - 70, where 0 is the least and 70 is the greatest stimulation; the Sedation Subscale range is 0 - 70, where 0 is the least and 70 is the greatest sedation. The BAES was administered both before and at various timepoints after study medication administration in each of the ADP sessions. The BAES scores reported here are the peak Stimulation scores after medication administration and peak Sedation scores after medication administration for each of ADP sessions 1, 2 and 3. |
Countries
United States
Participant flow
Recruitment details
52 participants who were community volunteers were screened for eligibility between September 17, 2018 and April 17, 2019 at the San Francisco VA Medical Center.
Pre-assignment details
4 of the 52 were randomized. Of the 48 not randomized, 5 declined to participate and 43 did not meet inclusion criteria.
Participants by arm
| Arm | Count |
|---|---|
| Crossover Sequence A: Placebo, Then Lacosamide 200 mg, Then Lacosamide 100 mg Participant received single dose of placebo in ADP Session 1. After a 1 week washout period, they then underwent ADP Session 2 in which they received a single dose of lacosamide 200 mg. After another 1 week washout period, they underwent ADP Session 3 in which they received a single dose of lacosamide 100 mg.
(2) 200 mg capsule of lacosamide, an FDA-approved anticonvulsant. A single dose is given at the beginning of 1 of the 3 ADP sessions.
(3) Placebo. A single dose is given at the beginning of 1 of 3 ADP sessions.
Lacosamide: Oral medication Placebo: Oral medication | 1 |
| Crossover Sequence B: Lacosamide 200 mg, Then Lacosamide 100 mg, Then Placebo Participant received a single dose of lacosamide 200 mg in ADP Session 1. After a 1 week washout period, they then underwent ADP Session 2 in which they received a single dose of lacosamide 100 mg. After another 1 week washout period, they underwent ADP Session 3 in which they received a single dose of placebo. | 1 |
| Crossover Sequence C: Lacosamide 200 mg, Then Placebo, Then Lacosamide 100 mg Participant received a single dose of lacosamide 200 mg in ADP Session 1. After a 1 week washout period, they then underwent ADP Session 2 in which they received a single dose of placebo. After another 1 week washout period, they underwent ADP Session 3 in which they received a single dose of lacosamide 100 mg. | 1 |
| Crossover Sequence D: Lacosamide 100 mg, Then Lacosamide 200 mg, Then Placebo Participant received a single dose of lacosamide 100 mg in ADP Session 1. After a 1 week washout period, they then underwent ADP Session 2 in which they received a single dose of lacosamide 200 mg. After another 1 week washout period, they underwent ADP Session 3 in which they received a single dose of placebo. | 1 |
| Total | 4 |
Baseline characteristics
| Characteristic | Crossover Sequence A: Placebo, Then Lacosamide 200 mg, Then Lacosamide 100 mg | Crossover Sequence B: Lacosamide 200 mg, Then Lacosamide 100 mg, Then Placebo | Crossover Sequence C: Lacosamide 200 mg, Then Placebo, Then Lacosamide 100 mg | Crossover Sequence D: Lacosamide 100 mg, Then Lacosamide 200 mg, Then Placebo | Total |
|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 0 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 2 Participants |
| Region of Enrollment United States | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 4 Participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 1 Participants | 1 Participants | 1 Participants | 1 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 4 | 0 / 3 | 0 / 4 |
| other Total, other adverse events | 1 / 4 | 3 / 3 | 3 / 4 |
| serious Total, serious adverse events | 0 / 4 | 0 / 3 | 0 / 4 |
Outcome results
Primary
Recruitment Feasibility (Time, in Months,) Required to Recruit, Screen and Conduct the Study Procedures
Recruitment feasibility will be measured as the time (in months) required to recruit, screen and conduct the study procedures for a total of 4 participants.
Time frame: 7 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Total | Recruitment Feasibility (Time, in Months,) Required to Recruit, Screen and Conduct the Study Procedures | 7.0 months |
Primary
Retention Feasibility (Proportion of Participants Completing the Alcohol Drinking Paradigm (ADP) Sessions)
Retention feasibility will be measured by the proportion of participants completing the Alcohol Drinking Paradigm (ADP) Sessions 1, 2 and 3.
Time frame: 6.5 weeks
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Total | Retention Feasibility (Proportion of Participants Completing the Alcohol Drinking Paradigm (ADP) Sessions) | 3 Participants |
Primary
Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events)
Tolerability will be measured by the number of participants with mild, moderate, and severe adverse events for each of the 3 drug interventions (100 mg lacosamide, 200 mg lacosamide and placebo).
Time frame: 3 days (1 day each for ADP Session 1, 2, and 3)
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Total | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | severe adverse events | 0 Participants |
| Total | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | moderate adverse events | 1 Participants |
| Total | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | mild adverse events | 1 Participants |
| Lacosamide 100 mg | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | severe adverse events | 0 Participants |
| Lacosamide 100 mg | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | mild adverse events | 3 Participants |
| Lacosamide 100 mg | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | moderate adverse events | 1 Participants |
| Lacosamide 200 mg | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | moderate adverse events | 1 Participants |
| Lacosamide 200 mg | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | mild adverse events | 3 Participants |
| Lacosamide 200 mg | Tolerability (Number of Participants With Mild, Moderate, or Severe Adverse Events) | severe adverse events | 1 Participants |
Secondary
Alcohol Consumption (Number of Standard Drinks Consumed)
Alcohol consumption is measured during each of the Alcohol Drinking Paradigm (ADP) sessions, 1, 2 and 3. In each session participants received one of the 3 drug interventions, Placebo, Lacosamide 100 mg, or Lacosamide 200 mg. Consumption was measured using the number of alcoholic standard drinks consumed during the ADP sessions. A standard drink per NIAAA definition is 14 grams of pure alcohol.
Time frame: 3 days (1 day each for ADP Session 1, 2, and 3. Each ADP Session included 1 dose of the drug intervention, either Placebo, Lacosamide 100 mg, or Lacosamide 200 mg).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Total | Alcohol Consumption (Number of Standard Drinks Consumed) | 3.44 standard drinks | Standard Deviation 2.41 |
| Lacosamide 100 mg | Alcohol Consumption (Number of Standard Drinks Consumed) | 2.84 standard drinks | Standard Deviation 2 |
| Lacosamide 200 mg | Alcohol Consumption (Number of Standard Drinks Consumed) | 4.46 standard drinks | Standard Deviation 2.83 |
Secondary
Alcohol Craving
Alcohol craving will be measured during Alcohol Drinking Paradigm (ADP) sessions 1, 2 and 3 using the total score of the Alcohol Urge Questionnaire (AUQ). The AUQ has 8 items. Each item is scored on a 1 to 7 scale (Strongly Disagree = 1 and Strongly Agree = 7; items 2 and 7 are reverse scored). Higher scores reflect greater craving. Total score range is from a minimum of 8 to a maximum of 56. The AUQ is administered before study medication and at various times after study medication. The AUQ score reported here is the highest AUQ score following administration of study medication.
Time frame: 3 days (1 day each for ADP Session 1, 2, and 3. Each ADP Session included 1 dose of the drug intervention, either Placebo, Lacosamide 100 mg, or Lacosamide 200 mg).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Total | Alcohol Craving | 34.7 score on a scale | Standard Deviation 19.1 |
| Lacosamide 100 mg | Alcohol Craving | 36 score on a scale | Standard Deviation 16.4 |
| Lacosamide 200 mg | Alcohol Craving | 37.8 score on a scale | Standard Deviation 8.9 |
Secondary
Subjective Effects of Alcohol Consumption
Subjective effects of alcohol consumption are measured during the Alcohol Drinking Paradigm (ADP) sessions 1, 2 and 3 using the Biphasic Alcohol Effects Scale (BAES), which has 2 subscales; the Stimulation Subscale range is 0 - 70, where 0 is the least and 70 is the greatest stimulation; the Sedation Subscale range is 0 - 70, where 0 is the least and 70 is the greatest sedation. The BAES was administered both before and at various timepoints after study medication administration in each of the ADP sessions. The BAES scores reported here are the peak Stimulation scores after medication administration and peak Sedation scores after medication administration for each of ADP sessions 1, 2 and 3.
Time frame: 3 days (1 day each for ADP Session 1, 2, and 3. Each ADP Session included 1 dose of the drug intervention, either Placebo, Lacosamide 100 mg, or Lacosamide 200 mg).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Total | Subjective Effects of Alcohol Consumption | Stimulation subscale | 31.3 score on a scale | Standard Deviation 27.7 |
| Total | Subjective Effects of Alcohol Consumption | Sedative subscale | 27.3 score on a scale | Standard Deviation 4.7 |
| Lacosamide 100 mg | Subjective Effects of Alcohol Consumption | Stimulation subscale | 44.3 score on a scale | Standard Deviation 22.4 |
| Lacosamide 100 mg | Subjective Effects of Alcohol Consumption | Sedative subscale | 26.7 score on a scale | Standard Deviation 7 |
| Lacosamide 200 mg | Subjective Effects of Alcohol Consumption | Stimulation subscale | 45.2 score on a scale | Standard Deviation 16 |
| Lacosamide 200 mg | Subjective Effects of Alcohol Consumption | Sedative subscale | 30.5 score on a scale | Standard Deviation 10 |