Topiramate Treatment of Problem Drinkers

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Information provided by (Responsible Party):
Henry Kranzler, University of Connecticut Health Center
ClinicalTrials.gov Identifier:
NCT00626925
First received: February 21, 2008
Last updated: June 18, 2013
Last verified: June 2013
  Purpose

The purpose of this study is to evaluate the safety and efficacy of topiramate in reducing drinking and heavy drinking frequency in problem drinkers. We hypothesize that at a dosage of up to 200mg/day, topiramate will be well tolerated in this patient population and that, compared to placebo treatment, topiramate will result in a greater reduction in the frequency of both drinking days and heavy drinking days.


Condition Intervention Phase
Alcohol Drinking
Drug: topiramate
Drug: placebo
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: Topiramate Treatment of Problem Drinkers

Resource links provided by NLM:


Further study details as provided by University of Connecticut Health Center:

Primary Outcome Measures:
  • drinking days and heavy drinking days [ Time Frame: 12 weeks (from initiation to end of treatment); 3- and 6-months post-treatment ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • mean daily alcohol consumption [ Time Frame: 12 weeks (from initiation to end of treatment); 3- and 6-months post-treatment ] [ Designated as safety issue: No ]
  • change in gamma-glutamyl transferase (GGT) or carbohydrate-deficient transferrin (CDT) levels [ Time Frame: 12 weeks (from initiation to end of treatment); 3- and 6-months post-treatment ] [ Designated as safety issue: No ]
  • severity of alcohol-related problems (as measured on the Short Inventory of Problems; SIP) [ Time Frame: 12 weeks (from intiation to end of treatment); 3- and 6-months post-treatment ] [ Designated as safety issue: No ]

Estimated Enrollment: 160
Study Start Date: February 2008
Estimated Study Completion Date: November 2013
Estimated Primary Completion Date: November 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
topiramate (up to 200 mg orally)
Drug: topiramate
up to 200mg/day orally (over 12 weeks during which the dosage is gradually increased up to 200 mg orally and then maintained, and 1 week of medication taper)
Other Name: Topamax
Placebo Comparator: 2
placebo
Drug: placebo
placebo (12 weeks during which the dosage of study medication is gradually increased up to 200 mg orally and then maintained, and 1 week of medication taper)

Detailed Description:

It is estimated that 30% of the general population are problem drinkers (NIAAA 2007). Despite its high prevalence, problem drinkers are understudied, particularly with respect to medications that may help them to reduce their drinking to safe levels. The study will extend to this patient population findings from a trial of topiramate, which showed the drug to be well tolerated and efficacious in moderately-severe alcohol-dependent patients (Johnson et al. 2003).

This is a 13-week, double-blind, placebo-controlled study of topiramate (12 weeks during which the dosage of study medication is gradually increased up to 200 mg orally and then maintained, and 1 week of medication taper) and medical management counseling to reduce drinking among problem drinkers (i.e., heavy drinkers without evidence of physical dependence on alcohol) who want to reduce their drinking.

Participants attend weekly study visits for the first 5 weeks and then bi-weekly visits for the last 8 weeks of the study, and are randomly assigned to receive topiramate or placebo on a daily basis. In addition to study visits, participants report daily moods, drinking, and medication usage through an Interactive Voice Response (IVR) system they call each night. In-person follow-up evaluations are conducted at 3 and 6 months post-treatment to provide a measure of the durability of treatment effects. This study also aims to examine the relation between genotype and the response to topiramate treatment.

An additional aim is to conduct a substudy to examine neural cells generated from skin fibroblast cells obtained from study participants via a skin biopsy (participation in the substudy is completely optional). Initially, we will examine variables key to reliably generating neurons from the cells and characterize these neurons using a variety of laboratory measures. A longer term goal is to compare gene expression in individuals who show a robust reduction in drinking following treatment with topiramate with those who show no beneficial treatment effects.

A second additional aim is to explore whether the therapeutic and adverse effects of topiramate are similar in patients on a stable regimen of an antidepressant to those not receiving such therapy. Although exploratory, given the absence of data that directly address this issue, we will stratify subjects by the presence or absence of current antidepressant therapy.

Careful evaluation of the study's hypotheses will provide important information on the efficacy and mechanism of effects of topiramate as a treatment for problem drinkers.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • age 18 to 65 years, inclusive;
  • have an average weekly ethanol consumption of >=24 standard drinks for men, or >=18 standard drinks for women;
  • be able to read English at the 8th grade or higher level and show no evidence of significant cognitive impairment;
  • be willing to nominate an individual who will know the patient's whereabouts in order to facilitate follow up during the study;
  • if a woman of child-bearing potential (i.e., who has not had a hysterectomy, bilateral oophorectomy, tubal ligation or who are less than two years postmenopausal), must be non-lactating, practicing a reliable method of birth control, and have a negative serum pregnancy test prior to initiation of treatment;
  • if applicable, individuals being treated with a single antidepressant that has been stable in dosage for a minimum of four weeks; and
  • be willing to provide signed, informed consent to participate in the study (including a willingness to reduce drinking to non-hazardous levels).

Exclusion Criteria:

  • a current, clinically significant physical disease or abnormality on the basis of medical history, physical examination, or routine laboratory evaluation, including direct bilirubin elevations of >110% or transaminase elevations >300% normal (We will not exclude patients with hypertension, diabetes mellitus, asthma or other common medical conditions, as long as these are adequately controlled and the patient has an ongoing relationship with a primary-care practitioner);
  • a history of nephrolithiasis;
  • a history of glaucoma;
  • a serious psychiatric illness (i.e., schizophrenia, bipolar disorder, severe or psychotic major depression, panic disorder, borderline or antisocial personality disorder, organic mood or mental disorders, eating disorder, or substantial suicide or violence risk) on the basis of history or psychiatric examination;
  • a current Diagnostic & Statistical Manual of Mental Disorders 4th ed (DSM-IV) diagnosis of drug dependence (other than nicotine dependence);
  • a current Diagnostic and Statistical Manual of Mental Disorders 4th ed (DSM-IV) diagnosis of alcohol dependence that is clinically moderate or severe;
  • a history of hypersensitivity to topiramate;
  • currently taking any tricyclic antidepressant (e.g., Adapin (doxepin), Anafranil (clomipramine), Elavil (amitryptyline), Pamelor (nortryptyline), Tofranil (imipramine), Sinequan (doxepin); or
  • are considered by the investigators to be an unsuitable candidate for receipt of an investigational drug.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00626925

Locations
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
Sponsors and Collaborators
University of Connecticut Health Center
Investigators
Principal Investigator: Henry R Kranzler, M.D. University of Pennsylvania
  More Information

No publications provided

Responsible Party: Henry Kranzler, Professor of Psychiatry, University of Connecticut Health Center
ClinicalTrials.gov Identifier: NCT00626925     History of Changes
Other Study ID Numbers: 08-052-2, P60AA03510-5
Study First Received: February 21, 2008
Last Updated: June 18, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by University of Connecticut Health Center:
Randomized Trial
Medication for Heavy Drinking
Topiramate Treatment

Additional relevant MeSH terms:
Alcohol Drinking
Drinking Behavior
Topiramate
Anticonvulsants
Central Nervous System Agents
Therapeutic Uses
Pharmacologic Actions
Neuroprotective Agents
Protective Agents
Physiological Effects of Drugs
Anti-Obesity Agents

ClinicalTrials.gov processed this record on August 26, 2014