Clinical trial NCT01001520: Neural Substrates in Nicotine Withdrawal
Official title: Neural Substrates of Cognitive Deficits in Nicotine Withdrawal
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Tobacco Use Disorder
Keywords: Genetics
Nicotine
Cognition
fMRI
Lead sponsor: University of Pennsylvania
Sponsor class: OTHER
Collaborators: name: National Institute on Drug Abuse (NIDA)
First posted: 2009-10-26
Enrollment: 218
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: TREATMENT

Brief summary: This study will test the hypothesis that a medication called tolcapone (Brand Name: Tasmar) will help reduce cognitive problems that smokers experience when they quit. This study will also determine whether the benefits of this medication differ depending on a smokers' genetic background.

Detailed description: Tolcapone, an FDA-approved treatment for Parkinson's disease, improves cognitive performance in healthy controls with COMT val/val genotypes, putatively by increasing prefrontal dopamine levels. We propose a within-subject double-blind cross-over neuroimaging study of short-term (11 days) treatment with tolcapone (vs. placebo).

Thirty chronic smokers (15 with val/val genotypes and 15 with val/met or met/met genotypes) will undergo blood oxygenation level dependent (BOLD) fMRI during the two medication periods:

1. after 24 hours of monitored abstinence while on tolcapone, and
2. after 24 hours of monitored abstinence while on placebo (medication order counterbalanced with at least a 10-day washout).

The BOLD fMRI data will be acquired while subjects perform a working memory task (Fractal N-back), a sustained attention task (Continuous Performance Task; CPT), and a response inhibition task (Go/No-Go). The primary outcome is medication effects (within subject) on task-related BOLD activation after 24 hours of abstinence. Changes in behavioral performance and subjective symptoms will be examined in relation to brain activity changes.

The proposed study will provide a critical mechanistic understanding of the role of COMT in abstinence-induced cognitive symptoms that promote smoking relapse. Information obtained in this study may further establish cognitive performance measures as endophenotypes for nicotine dependence.

Eligibility criteria: Inclusion Criteria:

* Smokers who are between 18 and 65 years of age who self-report smoking at least 10 cigarettes (menthol and non-menthol) per day for at least the last 6 months.
* Healthy as determined by the Study Physician, based on a medical evaluation including medical history and physical examination, psychiatric evaluation, and liver function tests (LFTs and GGT enzyme levels).
* Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the combined consent and HIPAA form.
* Women of childbearing potential must consent to use a medically accepted method of birth control while participating in the study (e.g., condoms and spermicide, oral contraceptive, Depo-provera injection, contraceptive patch, tubal ligation) and have 3 months of regular menstrual cycles.
* Capable of providing a Carbon Monoxide (CO) breath test reading greater than 10 parts per million (ppm) at the medical screening visit.

Exclusion Criteria:

Smoking behavior

* Current enrollment or plans to enroll in another research or smoking cessation program in the next 3 months.
* Provide a CO reading less than or equal to 10ppm at the medical screening visit.
* Plans to use nicotine substitutes (gum, patch, lozenge, e-cigarette) while enrolled in the study.

Alcohol/Drug Exclusion:

* History (past 2 years) or current diagnosis of substance abuse and/or currently receiving treatment for substance abuse (alcohol, THC, cocaine, PCP, amphetamines, methamphetamines, MDMA/ecstasy, opiates, methadone, benzodiazepines, tricyclic antidepressants, and barbiturates).
* Current alcohol consumption that exceeds 21 standard drinks/week over the last 6 months.
* Positive urine drug screen (for substances listed previously) at the medical screening visit or either testing day.
* Breath Alcohol Concentration (BrAC) assessment greater than or equal to 0.01 at medical screening visit or either testing day.

Medication Exclusion Criteria:

Current use or recent discontinuation (within last 28 days) of any medication including the following:

* Any form of psychotropic medications including: Antipsychotics; Mood-stabilizers (e.g., lithium, valproic acid, carbamazepine/tegretol); Anti-depressants (tricyclics, SSRI's, MAOI's, non-selective MAOIs, Wellbutrin, St. John's Wort); Anti-anxiety/Anti-panic agents; Anti-obsessive agents; Prescription stimulants (e.g., Provigil, Ritalin); Diet Pills/Anorectics; Systemic Steroids; Daily medication for chronic pain (e.g., opiates) or muscle spasms; Daily use of over the counter stimulants in pill form (e.g., ephedrine)
* Anti-coagulants (e.g., Warfarin)
* Any heart medications (e.g., dobutamine, isoproterenol)
* Daily medication for asthma
* Parkinson's disease medications (e.g., levodopa, methyldopa, apomorphine)
* Sympathomimetic (e.g., albuterol, pseudoephedrine)
* Other smoking cessation medications (Wellbutrin/Zyban, Chantix/varenicline)

Medical Exclusion Criteria:

* Women who are pregnant, planning a pregnancy within the next 3 months, or lactating.
* History or current diagnosis of any Axis 1 disorder as identified by the MINI (Mini International Neuropsychiatric Interview) or self-report. For major depression, only a current diagnosis will be exclusionary.
* History or current diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD).
* Serious or unstable disease (e.g., cancer within the past 6 months \[except squamous cell carcinoma\], HIV, Parkinson's disease).
* History of epilepsy or a seizure disorder.
* History or current diagnosis (last 6-months) of abnormal rhythms and/or tachycardia (\>100 beats/minute); history or current diagnosis of COPD, cardiovascular disease (stroke, angina, coronary heart disease); heart attack in the last 6 months; uncontrolled hypertension (SBP\>150 or DBP\>90).
* History or current kidney and/or liver failure (including transplant), disease, or impairment (e.g., cirrhosis); history or current diagnosis of hepatitis (excluding hepatitis A); liver function tests more than 20% outside of the normal range; Gamma-glutamyl Transpepsidase (GGT) values greater than 20% outside the normal range.
* Allergy to the study medication, tolcapone (Tasmar).
* History of severe, uncontrolled muscle movements (e.g., uncontrolled jerking, twitching) or a certain severe muscle problem (rhabdomyolysis).
* Low or borderline intellectual functioning - determined by receiving a score of less than 90 on the Shipley Institute of Living Scale (SILS) which correlates with the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Estimated IQ Test (administered at the medical screening visit).
* Experience of dizziness or lightheadedness upon standing on a daily basis.
* Lifetime history of stroke.

fMRI Exclusion Criteria:

* Self-reported history of claustrophobia.
* Left-handedness.
* Color blindness.
* Any impairment preventing subjects from using response pad necessary for cognitive testing.
* Circumstances or conditions that may interfere with magnetic resonance imaging (MRI).
* Having a cochlear implant or wearing bilateral hearing aids.
* Self-reported history of head trauma (including being knocked unconscious for 3 minutes or greater and diagnosis of a concussion) or CNS tumor.
* Self-reported use of pacemakers, certain metallic implants, or presence of metal in the eye as contraindicated for MRI.
* History of gunshot wound.
* Weight greater than 300lbs. at medical screening or either testing day.
* Completion of cognitive testing in study #810493 or #811325 within the last 6 months.

Genetic Profile Exclusion Criteria:

* In order to balance the distribution of males and females, some participants who meet genotype and other eligibility criteria may not be enrolled in the study.

General Exclusion Criteria:

* Any medical condition or concomitant medication that could compromise subject safety or treatment, as determined by the Principal Investigator and/or Study Physician.
* Inability to provide informed consent or complete any of the study tasks as determined by the Principal Investigator and/or Study Physician.

Primary outcomes:
measure: Measure of Brain Activity: Blood Oxygen Level Dependent (BOLD) fMRI Signal Change During the "N-back" Working Memory Task (Brain Region: Right Dorsolateral Prefrontal Cortex; Right DLPFC)
timeFrame: At fMRI scan sessions - Days 8 and 29
measure: Measure of Brain Activity: Blood Oxygen Level Dependent (BOLD) fMRI Signal Change During the "N-back" Working Memory Task (Brain Region: Left Dorsolateral Prefrontal Cortex; Left DLPFC)
timeFrame: At fMRI scan sessions - Days 8 and 29
measure: Measure of Brain Activity: Blood Oxygen Level Dependent (BOLD) fMRI Signal Change During the "N-back" Working Memory Task (Brain Region: Dorsal Cingulate/Medial Prefrontal Cortex; MF/CG)
timeFrame: At fMRI scan sessions - Days 8 and 29
measure: Measure of Brain Activity: Blood Oxygen Level Dependent (BOLD) fMRI Signal Change During the "N-back" Working Memory Task (Brain Region: Posterior Cingulate Cortex; PCC)
timeFrame: At fMRI scan sessions - Days 8 and 29
measure: Measure of Brain Activity: Blood Oxygen Level Dependent (BOLD) fMRI Signal Change During the "N-back" Working Memory Task (Brain Region: Ventromedial Prefrontal Cortex; vmPFC)
timeFrame: At fMRI scan sessions - Days 8 and 29
Secondary outcomes:
measure: Cognitive Performance: Accuracy
timeFrame: At fMRI scan sessions - Days 8 and 29
measure: Cognitive Performance: Reaction Time
timeFrame: At fMRI scan sessions - Days 8 and 29
measure: Subjective Symptoms: Smoking Behavior
timeFrame: Days 1 through 7 of each study period
measure: Subjective Symptoms: Cigarette Craving
timeFrame: Day 8 (fMRI scanning session) of each study period
measure: Subjective Symptoms: Withdrawal Symptoms
timeFrame: Day 8 of each study period
Other outcomes:
Locations:
city: Philadelphia
country: United States
facility: University of Pennsylvania
state: Pennsylvania
Study officials:
affiliation: University of Pennsylvania
name: Caryn Lerman, Ph.D.
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Pennsylvania
name: James Loughead, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References: