Pharmacogenomics and Pharmacometabolomics of Acamprosate Treatment Outcome

Study Overview
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Brief Summary
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AUDs are difficult to treat, and relapse rates are high, with an estimated 80% of individuals with AUDs returning to alcohol use after completing addictions treatment. Novel treatment approaches are needed to enhance long term sobriety. The investigator's research team has been investigating the use of acamprosate to prevent relapse to alcohol use. Unfortunately despite being FDA approved and endorsed by the American Psychiatric Association only 10% of patients treated for AUD are prescribed acamprosate or other antidipsotropic medications. The number is higher for patients treated in programs affiliated with Mayo Clinic Addiction Services (approximately 20%) but is way less than expected. The most common reasons behind these low numbers are the understanding that not every patient benefits from the use of specific medication and the lack of biomarkers predictive of response. The purpose of this project is to identify such biomarkers by discovery of genomic and metabolomic markers associated with response to acamprosate treatment.

Official Title
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Pharmacogenomics and Pharmacometabolomics of Acamprosate Treatment Outcome

Conditions
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Alcohol Use Disorder

Intervention / Treatment
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* Drug: Acamprosate
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 to85; DSM-5 diagnosis of AUD determined by PRISM; Completion of alcohol detoxification (CIWA score < 5) and no alcohol for at least 7 days (but no more than 35 days); Ability to provide informed consent Ability to speak English Willingness to use the study medications for 3 months and attend follow-up visits. No chronic/daily use of benzodiazepines, opioids, or stimulants for a period of time which is determined by 3 x the medication half-life value (see addendum A) to be completed before the initiation of study medication (acamprosate or placebo). Willingness to discontinue previously prescribed acamprosate for a period of at least 3 days before randomization to study medication (acamprosate or placebo). Exclusion Criteria: Hypersensitivity or allergy to acamprosate Current use of wellbutrin and not willing to switch to an acceptable antidepressant medication Renal impairment (creatinine level >1.5 mg/dL); Diagnosis of advanced liver disease indicated in the medical record or by a MELD score of above 10; Women who are pregnant, breastfeeding, or planning to become pregnant during the next year; Primary diagnosis of substance use disorder other than alcohol as determined by PRISM or in medical record review or secondary diagnosis of active (within the past year) benzo/sedative dependence, opioid dependence, stimulant dependence, heroin dependence, and/or cocaine dependence Refusal to abstain from any chronic/daily use of prescribed benzodiazepines, opioids, stimulants, cannabis related medication such as CBD or medical marijuana, during the course of participation. Current use of Naltrexone and not willing to stop and switch to Acamprosate/Placebo Current use of Antabuse. Active suicidal ideation or any unstable medical or psychiatric condition as determined by responses to PRISM or by the investigator. Status of involuntary or court-ordered admission at time of consent.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Acamprosate<br>All participants will be randomized to receive acamprosate or placebo in a double-blinded placebo-controlled trial. The most common side effect associated with acamprosate use is diarrhea, which occurs in approximately 16% of patients. Other frequently occurring side effects include asthenia, nausea, pruritus, and flatulence, headache, abdominal pain, flu syndrome, edema, weight gain, and myalgia. | Drug: Acamprosate<br>* The research pharmacy contracted for this study will randomize the study participants for all sites with placebo or acamprosate.<br>|
| Placebo Comparator: Placebo<br>All participants will be randomized to receive acamprosate or placebo in a double-blinded placebo-controlled trial. | Other: Placebo<br>* The research pharmacy contracted for this study will randomize the study participants for all sites with placebo or acamprosate.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alcohol Timeline Follow Back | The Alcohol Timeline Follow Back (TLFB) is a drinking assessment method that obtains estimates of daily drinking and has been evaluated with clinical and nonclinical populations. Using a calendar, people provide retrospective estimates of their daily drinking over a specified time period that can vary up to 12 months from the interview date. | will be defined as continuous sobriety (yes/no) during 3 months of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alcohol Timeline Follow Back | The Alcohol Timeline Follow Back (TLFB) is a drinking assessment method that obtains estimates of daily drinking and has been evaluated with clinical and nonclinical populations. Using a calendar, people provide retrospective estimates of their daily drinking over a specified time period that can vary up to 12 months from the interview date. | The number of days until first alcohol use assessed by TLFB during 3 months of treatment |