Nicotine Dependence, Smoking Cessation, Smoking, Cigarette
Conditions
Brief summary
The purpose of this study is to examine the effects of rapamycin (sirolimus) versus a placebo, an inactive substance, on responses to smoking cues in individuals with nicotine dependence. Rapamycin (sirolimus) is a FDA-approved antibiotic and immunosuppressive drug that is currently used to (a) prevent organ transplant recipients from rejecting their transplants (b) treat cardiovascular diseases, and (c) treat some forms of cancer. Rapamycin (sirolimus) is not FDA-approved for smoking cessation. The use of rapamycin (sirolimus) in this study is investigational, meaning that the study medication is not a proven treatment for nicotine dependence, however this study will examine the medication's use as a potential future treatment for nicotine dependence.
Detailed description
The proposed study will employ 58 ND treatment-seeking smokers who will be randomly assigned to receive either 15-mg of sirolimus or placebo (group n's=29) immediately after the first of two smoking cue exposure sessions scheduled to occur on consecutive days. The first session will serve as a Retrieval session during which smoking (e.g., handling and lighting of a cigarette) cue exposure will elicit retrieval and reconsolidation of smoking-related memories; the second session will be a Test session to examine the potential modulatory role of sirolimus on the reconsolidation of memories putatively elicited during the retrieval session. Participants will be required to refrain from smoking the night before (bedtime) their first laboratory (i.e., Retrieval) session and will remain abstinent from smoking until the completion of the second laboratory (i.e., Test) session. It is posited that changes in reactivity during the test session will reflect medication effects on memory reconsolidation that occurred following the retrieval session. Measures of subjective responses (i.e., craving) and physiological reactivity (i.e., heart rate & skin conductance) will be obtained before, during and after cue presentations in both sessions. The durability of any observed treatment effects will be assessed in a Follow-up session performed 7-days following completion of the test session. Treatment effects on self-report measures of smoking behavior during the 7-days preceding the Follow-up session will also be assessed.
Interventions
DRUGsirolimus
Rapamycin (sirolimus) is administered in three 5mg oral capsules. This administration happens once during the first visit.
DRUGPlacebo
Placebo is administered in three 5mg oral capsules. This administration happens once during the first visit.
Sponsors
Medical University of South Carolina
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participants must smoke 10+ cigarettes/day for three or more years * Have a Fagerström Test for Nicotine Dependence score greater than or equal to 4 * Be willing to make a cessation attempt * Willing to comply with reinforced abstinence requirements for the three laboratory sessions * Willing to use appropriate birth control methods during study participation including oral contraceptives, barrier methods (diaphragm or condoms with spermicide or both), surgical sterilization, use of an intra-uterine contraceptive device, or complete abstinence from sexual intercourse * Remain abstinent from alcohol and all non-prescription drugs prior to medication administration and testing sessions * Live with within a 50 mile radius of our research program and have reliable transportation * Consent to fast for a two-hour period prior to medication administration * Consent to random assignment to rapamycin (sirolimus) vs. placebo conditions
Exclusion criteria
* Dependence on other substances (may meet criteria for abuse) * Undergoing other smoking cessation treatment (e.g., nicotine replacement, Chantix) * Taking medications that may interact with the study medication or alter responding on any study measure * Are pregnant, nursing, or of childbearing potential and not using birth control * Present evidence of or a history of significant endocrine, cardiovascular, pulmonary, renal or neurological disease, as these conditions may affect heart rate or skin conductance measurement * Have significant liver impairment (as indicated by alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) values that are three times the upper limit of normal) as rapamycin (sirolimus) is hepatically metabolized * Have an existing infection or immune system disorder as rapamycin (sirolimus) has known immunosuppressive properties * Have a history of or current psychotic disorder, severe major depression as evidenced by active and profound psychomotor retardation and/or persistent and intense suicidal ideation * Currently taking anti-arrhythmic agents, psychostimulants or any other agents known to interfere with heart rate and skin conductance monitoring * Have known or suspected hypersensitivity to macrolide compounds (such as rapamycin/sirolimus) * Taking medications that could adversely interact with study medication including but not limited to significant inhibitors of CYP2D6 or CYP3A4 (voriconazole, fluconazole, itraconazole, erythromycin, clarithromycin, diltiazem, verapamil, etc.) or significant inducers of CYP3A4, such as anticonvulsants (carbamazepine, phenobarbital, phenytoin, etc.) and antibiotics (rifabutin, rifapentine, etc.) * Have a history of thrombocytopenia, idiopathic thrombocytopenia purpura (ITP), or with a current platelet count of less than 100,000 cells per mm3, * Have any unhealed wounds, including but not limited to oral ulcers, foot ulcers, or recent surgical or trauma wounds * Have any planned surgeries within the next month, including surgical dental procedures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Craving Levels in Response to Cue | Study visit 1 (Baseline; day 0), visit 2 (day 7) and visit 3 (day 14) | Patients are asked about craving level on a scale of 0-100, 0 is least amount of craving and 100 is highest amount of craving |
| Heart Rate in Response to Cue | Study visit 1 (Baseline; day 0), visit 2 (day 7) and visit 3 (day 14) | Heart rate is measured using a Biopac machine and Acqknowledge software at different timepoints throughout each visit while the participants are exposed to smoking cues. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Average Cigarettes Smoked Per Day | Visit 1 through Visit 3 (day 0-day 14) | Patients will be asked how many cigarettes per day they smoked 90 days prior to starting the study. Patients are then given a smoking and alcohol diary to complete during the course of the trial. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Rapamycin 15mg (Sirolimus) Participants will receive three 5mg pills from a nurse in the Research Nexus, some participants will receive the study medication and others will be randomized to the placebo control group.
sirolimus: Rapamycin (sirolimus) is administered in three 5mg oral capsules. This administration happens once during the first visit. | 12 |
| Placebo Participants will receive three 5mg pills from a nurse in the Research Nexus, some participants will receive the study medication and others will be randomized to the placebo control group.
Placebo: Placebo is administered in three 5mg oral capsules. This administration happens once during the first visit. | 10 |
| Total | 22 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Protocol Violation | 1 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 1 |
Baseline characteristics
| Characteristic | Rapamycin 15mg (Sirolimus) | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 51.3 years STANDARD_DEVIATION 11.3 | 47.1 years STANDARD_DEVIATION 15.2 | 49.4 years STANDARD_DEVIATION 13 |
| Cigarettes Per Day | 21.5 Cigarettes Per Day STANDARD_DEVIATION 9.5 | 19.7 Cigarettes Per Day STANDARD_DEVIATION 10.3 | 20.7 Cigarettes Per Day STANDARD_DEVIATION 9.7 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants | 1 Participants | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 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 | 8 Participants | 8 Participants | 16 Participants |
| Region of Enrollment United States | 12 participants | 10 participants | 22 participants |
| Sex: Female, Male Female | 3 Participants | 2 Participants | 5 Participants |
| Sex: Female, Male Male | 9 Participants | 8 Participants | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 12 | 0 / 10 |
| other Total, other adverse events | 6 / 12 | 5 / 10 |
| serious Total, serious adverse events | 0 / 12 | 0 / 10 |
Outcome results
Primary
Craving Levels in Response to Cue
Patients are asked about craving level on a scale of 0-100, 0 is least amount of craving and 100 is highest amount of craving
Time frame: Study visit 1 (Baseline; day 0), visit 2 (day 7) and visit 3 (day 14)
Population: Data entered are the number of participants under the cue condition at study visit 1 (Baseline; day 0), visit 2 (day 7) and visit 3 (day 14)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue+10 min | 53.1 score on a scale | Standard Deviation 33.4 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue+10 min | 43.1 score on a scale | Standard Deviation 37.2 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Pre-Cue | 69.6 score on a scale | Standard Deviation 26.3 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue+20 min | 43.4 score on a scale | Standard Deviation 37.9 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue+20 min | 50.4 score on a scale | Standard Deviation 37.7 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue+30 min | 40.4 score on a scale | Standard Deviation 40 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Pre-Cue | 37.3 score on a scale | Standard Deviation 36.8 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue+40 min | 39.8 score on a scale | Standard Deviation 40.5 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue | 56.1 score on a scale | Standard Deviation 35.2 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue+50 min | 39.7 score on a scale | Standard Deviation 40.6 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Cue | 45 score on a scale | Standard Deviation 34.5 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue+40 min | 39.1 score on a scale | Standard Deviation 39.7 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Cue+0 min | 44.3 score on a scale | Standard Deviation 34.5 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue+0 min | 46.8 score on a scale | Standard Deviation 36.1 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Cue+10 min | 43.6 score on a scale | Standard Deviation 32.4 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue+50 min | 38.1 score on a scale | Standard Deviation 37.7 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Visit 3: Cue+20 min | 40.3 score on a scale | Standard Deviation 32.1 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue+0 min | 62.6 score on a scale | Standard Deviation 34.4 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Cue+30 min | 39.5 score on a scale | Standard Deviation 32.7 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Pre-Cue | 40.9 score on a scale | Standard Deviation 37.6 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Cue+40 min | 40.5 score on a scale | Standard Deviation 32.3 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 0: Cue+30 min | 44.3 score on a scale | Standard Deviation 37.7 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 14: Cue+50 min | 41.2 score on a scale | Standard Deviation 33.1 |
| Rapamycin 15mg (Sirolimus) | Craving Levels in Response to Cue | Day 7: Cue | 41.9 score on a scale | Standard Deviation 38.1 |
| Placebo | Craving Levels in Response to Cue | Day 14: Cue+50 min | 37.2 score on a scale | Standard Deviation 30.1 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue | 67.2 score on a scale | Standard Deviation 29.3 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue+50 min | 49.4 score on a scale | Standard Deviation 33.2 |
| Placebo | Craving Levels in Response to Cue | Day 14: Pre-Cue | 41.7 score on a scale | Standard Deviation 31.1 |
| Placebo | Craving Levels in Response to Cue | Day 0: Pre-Cue | 66.3 score on a scale | Standard Deviation 27.8 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue | 74.4 score on a scale | Standard Deviation 16.1 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue+0 min | 83.2 score on a scale | Standard Deviation 18.1 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue+10 min | 72.8 score on a scale | Standard Deviation 16.8 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue+20 min | 71.7 score on a scale | Standard Deviation 23.5 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue+30 min | 67.8 score on a scale | Standard Deviation 25.9 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue+40 min | 67.2 score on a scale | Standard Deviation 27.6 |
| Placebo | Craving Levels in Response to Cue | Day 0: Cue+50 min | 63.7 score on a scale | Standard Deviation 32.1 |
| Placebo | Craving Levels in Response to Cue | Day 7: Pre-Cue | 62.2 score on a scale | Standard Deviation 27.7 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue+0 min | 68.3 score on a scale | Standard Deviation 28.7 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue+10 min | 59.4 score on a scale | Standard Deviation 27.4 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue+20 min | 55.5 score on a scale | Standard Deviation 29.6 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue+30 min | 52.8 score on a scale | Standard Deviation 30.7 |
| Placebo | Craving Levels in Response to Cue | Day 7: Cue+40 min | 52.2 score on a scale | Standard Deviation 31 |
| Placebo | Craving Levels in Response to Cue | Day 14: Cue | 46.7 score on a scale | Standard Deviation 32.3 |
| Placebo | Craving Levels in Response to Cue | Day 14: Cue+0 min | 48.9 score on a scale | Standard Deviation 32.1 |
| Placebo | Craving Levels in Response to Cue | Day 14: Cue+10 min | 45.6 score on a scale | Standard Deviation 29.5 |
| Placebo | Craving Levels in Response to Cue | Visit 3: Cue+20 min | 40 score on a scale | Standard Deviation 28.6 |
| Placebo | Craving Levels in Response to Cue | Day 14: Cue+30 min | 43.3 score on a scale | Standard Deviation 31.2 |
| Placebo | Craving Levels in Response to Cue | Day 14: Cue+40 min | 38.9 score on a scale | Standard Deviation 30.7 |
Primary
Heart Rate in Response to Cue
Heart rate is measured using a Biopac machine and Acqknowledge software at different timepoints throughout each visit while the participants are exposed to smoking cues.
Time frame: Study visit 1 (Baseline; day 0), visit 2 (day 7) and visit 3 (day 14)
Population: Data entered are the number of participants under the cue condition at study visit 1 (Baseline; day 0), visit 2 (day 7) and visit 3 (day 14)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Cue+0 min | 71 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Cue+50 min | 70 Beats per minute | Standard Deviation 12 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Cue+10 min | 69 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Cue+30 min | 70 Beats per minute | Standard Deviation 13 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Cue+20 min | 71 Beats per minute | Standard Deviation 10 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Cue+20 min | 69 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Cue+30 min | 71 Beats per minute | Standard Deviation 12 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Cue+40 min | 71 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Cue+40 min | 71 Beats per minute | Standard Deviation 13 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Pre-Cue | 75 Beats per minute | Standard Deviation 7 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Pre-Cue | 72 Beats per minute | Standard Deviation 9 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Cue+0 min | 70 Beats per minute | Standard Deviation 15 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Cue+50 min | 72 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Cue+10 min | 70 Beats per minute | Standard Deviation 15 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Cue+50 min | 72 Beats per minute | Standard Deviation 10 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Cue+20 min | 71 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 7: Pre-Cue | 73 Beats per minute | Standard Deviation 9 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Cue+30 min | 73 Beats per minute | Standard Deviation 9 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Cue+0 min | 71 Beats per minute | Standard Deviation 11 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 14: Cue+40 min | 72 Beats per minute | Standard Deviation 13 |
| Rapamycin 15mg (Sirolimus) | Heart Rate in Response to Cue | Day 0: Cue+10 min | 69 Beats per minute | Standard Deviation 12 |
| Placebo | Heart Rate in Response to Cue | Day 14: Cue+40 min | 68 Beats per minute | Standard Deviation 16 |
| Placebo | Heart Rate in Response to Cue | Day 0: Cue+10 min | 70 Beats per minute | Standard Deviation 14 |
| Placebo | Heart Rate in Response to Cue | Day 0: Cue+20 min | 69 Beats per minute | Standard Deviation 15 |
| Placebo | Heart Rate in Response to Cue | Day 14: Cue+50 min | 70 Beats per minute | Standard Deviation 16 |
| Placebo | Heart Rate in Response to Cue | Day 7: Cue+40 min | 71 Beats per minute | Standard Deviation 12 |
| Placebo | Heart Rate in Response to Cue | Day 7: Cue+50 min | 72 Beats per minute | Standard Deviation 14 |
| Placebo | Heart Rate in Response to Cue | Day 0: Pre-Cue | 75 Beats per minute | Standard Deviation 16 |
| Placebo | Heart Rate in Response to Cue | Day 0: Cue+0 min | 73 Beats per minute | Standard Deviation 13 |
| Placebo | Heart Rate in Response to Cue | Day 0: Cue+30 min | 72 Beats per minute | Standard Deviation 12 |
| Placebo | Heart Rate in Response to Cue | Day 0: Cue+40 min | 68 Beats per minute | Standard Deviation 12 |
| Placebo | Heart Rate in Response to Cue | Day 0: Cue+50 min | 70 Beats per minute | Standard Deviation 11 |
| Placebo | Heart Rate in Response to Cue | Day 7: Pre-Cue | 75 Beats per minute | Standard Deviation 11 |
| Placebo | Heart Rate in Response to Cue | Day 7: Cue+0 min | 74 Beats per minute | Standard Deviation 11 |
| Placebo | Heart Rate in Response to Cue | Day 7: Cue+10 min | 75 Beats per minute | Standard Deviation 9 |
| Placebo | Heart Rate in Response to Cue | Day 7: Cue+20 min | 74 Beats per minute | Standard Deviation 12 |
| Placebo | Heart Rate in Response to Cue | Day 7: Cue+30 min | 74 Beats per minute | Standard Deviation 14 |
| Placebo | Heart Rate in Response to Cue | Day 14: Pre-Cue | 73 Beats per minute | Standard Deviation 14 |
| Placebo | Heart Rate in Response to Cue | Day 14: Cue+0 min | 73 Beats per minute | Standard Deviation 17 |
| Placebo | Heart Rate in Response to Cue | Day 14: Cue+10 min | 66 Beats per minute | Standard Deviation 14 |
| Placebo | Heart Rate in Response to Cue | Day 14: Cue+20 min | 66 Beats per minute | Standard Deviation 14 |
| Placebo | Heart Rate in Response to Cue | Day 14: Cue+30 min | 68 Beats per minute | Standard Deviation 15 |
Secondary
Average Cigarettes Smoked Per Day
Patients will be asked how many cigarettes per day they smoked 90 days prior to starting the study. Patients are then given a smoking and alcohol diary to complete during the course of the trial.
Time frame: Visit 1 through Visit 3 (day 0-day 14)
Population: Self-reported average cigarettes smoked per day reported between study visit 1 and visit 3
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Rapamycin 15mg (Sirolimus) | Average Cigarettes Smoked Per Day | 7.6 Cigarettes Per Day | Standard Deviation 6.2 |
| Placebo | Average Cigarettes Smoked Per Day | 13.5 Cigarettes Per Day | Standard Deviation 9.5 |