Apathy Cure Through Bupropion in Huntington's Disease

Study Overview
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Brief Summary
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The influence of bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-I, where I [informant] is a friend or family member familiar with the daily activities of the subject) in patients with HD after ten (10) weeks of treatment.

Detailed Description
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The safety and tolerability of Bupropion in HD. The influence of Bupropion compared to placebo on the: change of apathy as quantified by the AES-C (clinician) or the AES-S (self), change of motor symptoms (UHDRS) and quantitative grip force motor assessment, change of cognitive symptoms (UHDRS and MMSE), change of psychiatric symptoms (UHDRS, HADS), change of activities of daily living (UHDRS), change of the NPI caregivers' distress score (NPI-D), change of ventral striatal and ventromedial prefrontal activation in response to a reward paradigm as quantified by fMRI.

Official Title
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A Randomized, Double-blind, Placebo-controlled Prospective Crossover Trial Investigating the Efficacy and Safety of the Treatment With Bupropion in Patients With Apathy in Huntington's Disease

Conditions
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Apathy, Huntington's Disease

Intervention / Treatment
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* Drug: Bupropion
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Verified HD mutation carriers aged 25 to 75 years (inclusive) at first dosing Apathetic as diagnosed by SCIA-D criteria Stable concomitant medication (no change of medication during last six weeks prior to inclusion) Written informed consent by prospective study participant before conduct of any trial-related procedure. Participant must be able to make an informed decision of whether or not to participate in the study Patient has a caregiver (family member or friend), who is living in a close relationship with the patient and is willing to give written informed consent (caregiver) before performance of any trial-related procedure Exclusion criteria: Pregnant or nursing women Active suicidality based on the answer yes in questions 4 and 5 of the Columbia-Suicide Severity Rating Scale (baseline version) Woman of childbearing potential, not using highly effective methods of contraception defined as methods with a Pearl Index < 1 such as oral, topical or injected contraception, IUD, contraceptive vaginal ring, or double barrier method such as diaphragm and condom with spermicide) or not surgically sterile (via hysterectomy, ovariectomy or bilateral tubal ligation) or not at least one year post-menopausal Male not using an acceptable barrier method for contraception and donating sperm from screening up to three months following treatment Presence or history of any medically not controllable disease (e.g. uncontrolled arterial hypertension or diabetes mellitus) Presence or history of seizures or diagnosed epilepsy or history of severe head trauma (contusion) or CNS tumor Clinical significant renal (calculated creatine clearance < 60 ml/min) or hepatic dysfunction Clinical significant depression defined by the NPI depression score (score ≥4 points) at screening Schizophreniform psychosis within the last 6 months prior to first dose History of anorexia or bulimia Severe cognitive disorders defined as a score < 18 in the Mini- Mental State Examination (MMSE) at screening Marked chorea (UHDRS 4) of face, BOL, trunk or extremities Treatment with neuroleptics other than tiapride, MAO-B inhibitors, amantadine, levodopa, D- or D,L-amphetamine or psychostimulants like methylphenidate, modafinil or atomoxetine within 1 month prior to first dose Known hypersensitivity reaction associated with bupropion, gelatine, lactose or magnesium stearate Clinically relevant abnormal findings in the ECG, the vitals, in the physical examination or laboratory values at screening that could interfere with the objectives of the study or the safety of the subject as judged by the investigator Acute disease state (e.g. nausea, vomiting, fever, diarrhoea, infection) within 7 days of first dose Definite or suspected personal history or family history of adverse reactions or hypersensitivity to the trial compounds (or to compounds with a similar structure) Presence of illicit drug and/or alcohol abuse Participation in another investigative drug trial within 2 months or donation of blood within 12 weeks prior to the first dose or during the trial Subjects who are unlikely to be compliant and attend scheduled clinic visits as required Placement in an institution due to governmental or judicial authorities

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Bupropion<br>First treatment group: 150 mg bupropion or placebo once daily for 2 weeks, followed by 300 mg bupropion or placebo once daily for subsequent 8 weeks (until week 10; visit 4) First tapering and washout: 150 mg bupropion or placebo once daily for 7 days followed by a washout phase of 1 week on placebo | Drug: Bupropion<br>* Crossover design: Oral administration of 150 mg bupropion once daily for 2 weeks, followed by 300 mg bupropion once daily for subsequent 8 weeks, tapering: 150 mg bupropion once daily for 7 days<br>* Other names: Wellbutrin, Budeprion, Prexaton, Elontril, Aplenzin;Drug: Placebo<br>* Crossover design: Oral administration of placebo once daily for 2 weeks, followed by placebo once daily for subsequent 8 weeks, tapering: placebo once daily for 7 days<br>* Other names: control;|
| Placebo Comparator: Placebo<br>Second treatment group (crossover): placebo or 150 mg bupropion once daily for 2 weeks, followed by placebo or 300 mg bupropion once daily for subsequent 8 weeks (until week 22; visit 6) Second tapering placebo or 150 mg bupropion once daily for 7 days | Drug: Bupropion<br>* Crossover design: Oral administration of 150 mg bupropion once daily for 2 weeks, followed by 300 mg bupropion once daily for subsequent 8 weeks, tapering: 150 mg bupropion once daily for 7 days<br>* Other names: Wellbutrin, Budeprion, Prexaton, Elontril, Aplenzin;Drug: Placebo<br>* Crossover design: Oral administration of placebo once daily for 2 weeks, followed by placebo once daily for subsequent 8 weeks, tapering: placebo once daily for 7 days<br>* Other names: control;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Apathy Evaluation Scale (AES-I) | The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-I, where I [informant] is a friend or family member familiar with the daily activities of the subject) in patients with HD after ten weeks of treatment. | 10 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| AES-C (clinician) | The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-C, where C [clinician] is the trial investigator) in patients with HD after ten weeks of treatment. | 10 weeks | 
| AES-S (self) | The influence of Bupropion compared to placebo on the change of apathy as quantified by the apathy evaluation scale (AES-S, where S [self] is the patient) in patients with HD after ten weeks of treatment. | 10 weeks | 
| Motor symptoms (UHDRS) | The influence of Bupropion compared to placebo on the UHDRS motor score in patients with HD after ten weeks of treatment. | 10 weeks | 
| Quantitative grip force motor assessment | The influence of Bupropion compared to placebo on motor scores in patients with HD after ten weeks of treatment. | 10 weeks | 
| Cognitive Symptoms | The influence of Bupropion compared to placebo on MMSE in patients with HD after ten weeks of treatment. | 10 weeks | 
| Psychiatric symptoms | The influence of Bupropion compared to placebo on UHDRS behavioural assessment in patients with HD after ten weeks of treatment. | 10 weeks | 
| Activities of daily living | The influence of Bupropion compared to placebo on UHDRS Functional Assessment in patients with HD after ten weeks of treatment. | 10 weeks | 
| Caregiver's distress | The influence of Bupropion compared to placebo on the NPI caregiver's distress score. | 10 weeks | 
| ventral striatal and ventromedial prefrontal activation | Change of ventral striatal and ventromedial prefrontal activation in response to a reward paradigm as quantified by fMRI. | 10 weeks | 
| Adverse events | The safety and tolerability of Bupropion will be compared with placebo in patients with HD after ten weeks of treatment. | 10 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Huntington's disease, Apathy, Bupropion