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    Clinical Trial Results:
    Double-blind, 36 month, placebo-controlled trial of mifepristone on cognition in alcoholics

    Summary
    EudraCT number
    2009-015837-55
    Trial protocol
    GB  
    Global end of trial date
    24 Jun 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    28 Oct 2018
    First version publication date
    28 Oct 2018
    Other versions
    Summary report(s)
    FINAL STUDY REPORT

    Trial information

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    Trial identification
    Sponsor protocol code
    RAA09-004
    Additional study identifiers
    ISRCTN number
    ISRCTN54001953
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    King's College London
    Sponsor organisation address
    The Strand, London, United Kingdom, WC2R 2LS
    Public contact
    Professor Colin Drummond, Institute of Psychiatry, King's College London, 0044 2078480817, colin.drummond@kcl.ac.uk
    Scientific contact
    Professor Colin Drummond, Institute of Psychiatry, King's College London, 0044 2078480817, colin.drummond@kcl.ac.uk
    Sponsor organisation name
    South London & Maudsley NHS Foundation Trust
    Sponsor organisation address
    Bethlem Royal Hospital, Monks Orchard Road, Beckenham, United Kingdom, BR3 3BX
    Public contact
    Professor Colin Drummond,, South London & Maudsley NHS Foundation Trust, 0044 2078480817, colin.drummond@kcl.ac.uk
    Scientific contact
    Professor Colin Drummond,, South London & Maudsley NHS Foundation Trust, 0044 2078480817, colin.drummond@kcl.ac.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    24 Jun 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    24 Jun 2016
    Global end of trial reached?
    Yes
    Global end of trial date
    24 Jun 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Does the action of the drug, mifepristone, in preventing the effects of the naturally released glucocorticoid hormone cortisol on the Type II glucocorticoid receptor reduce the cognitive deficits and/or the depression experienced by alcoholics?
    Protection of trial subjects
    The procedures involved in this research are unlikely to cause significant discomfort or distress to participants. All questionnaire measures and research procedures have been widely validated and used in previous research without causing any problems to participants. Mifepristone has a good safety record and has been used clinically for over 15 years for other applications. However should any distress or discomfort occur with any of the procedures trained medical and nursing staff will be available on a 24 h basis to provide help and support.
    Background therapy
    None
    Evidence for comparator
    -
    Actual start date of recruitment
    02 Oct 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 27
    Worldwide total number of subjects
    27
    EEA total number of subjects
    27
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    27
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    A total of 57 people were screened to take part in the trial and 27 (47%) were randomised

    Pre-assignment
    Screening details
    Inclusion criteria: (i) diagnosis of alcohol dependence by DSM-IV for 5 years or more (ii) male (iii) aged between 18 and 60 years (inclusive) (iv) willingness to provide informed consent.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    The placebo tablets will be identical in appearance to the mifepristone tablets (light yellow, cylindrical biconvex tablets) but will contain no active ingredient.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Group A -Mifepristone
    Arm description
    Participants were randomised to receive 600mg of mifepristone or placebo (one 200mg tablet three times a day) for 7 days starting on the first day of detoxification and 400mg for the following 7 days (one 200mg tablet twice a day)
    Arm type
    Experimental

    Investigational medicinal product name
    Mifepristone
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Participants were randomised to receive 600mg of mifepristone (one 200mg tablet three times a day) for 7 days starting on the first day of detoxification and 400mg for the following 7 days (one 200mg tablet twice a day)

    Arm title
    Group B - Placebo
    Arm description
    Participants were randomised to receive 600mg of mifepristone or placebo (one 200mg tablet three times a day) for 7 days starting on the first day of detoxification and 400mg for the following 7 days (one 200mg tablet twice a day)
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Participants were randomised to receive 600mg of mifepristone or placebo (one 200mg tablet three times a day) for 7 days starting on the first day of detoxification and 400mg for the following 7 days (one 200mg tablet twice a day)

    Number of subjects in period 1
    Group A -Mifepristone Group B - Placebo
    Started
    14
    13
    Completed
    2
    8
    Not completed
    12
    5
         Consent withdrawn by subject
    2
    3
         Physician decision
    1
    -
         Lost to follow-up
    9
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Trial
    Reporting group description
    -

    Reporting group values
    Overall Trial Total
    Number of subjects
    27 27
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    27 27
        From 65-84 years
    0 0
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    0 0
        Male
    27 27

    End points

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    End points reporting groups
    Reporting group title
    Group A -Mifepristone
    Reporting group description
    Participants were randomised to receive 600mg of mifepristone or placebo (one 200mg tablet three times a day) for 7 days starting on the first day of detoxification and 400mg for the following 7 days (one 200mg tablet twice a day)

    Reporting group title
    Group B - Placebo
    Reporting group description
    Participants were randomised to receive 600mg of mifepristone or placebo (one 200mg tablet three times a day) for 7 days starting on the first day of detoxification and 400mg for the following 7 days (one 200mg tablet twice a day)

    Primary: Primary Outcome

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    End point title
    Primary Outcome [1]
    End point description
    Cognitive function measured using the CANTAB and depressive symptomatology measured by the Beck depression scale (BDI-II).
    End point type
    Primary
    End point timeframe
    Duration of trial
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Please see attached document for details of results.
    End point values
    Group A -Mifepristone Group B - Placebo
    Number of subjects analysed
    2
    8
    Units: whole
    2
    8
    No statistical analyses for this end point

    Secondary: Secondary Outcome Measure

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    End point title
    Secondary Outcome Measure
    End point description
    Severity of the acute phase of alcohol withdrawal, alcohol craving, and symptoms of protracted withdrawal including sleep disturbances
    End point type
    Secondary
    End point timeframe
    Duration of trial
    End point values
    Group A -Mifepristone Group B - Placebo
    Number of subjects analysed
    2
    8
    Units: whole
    2
    8
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events are reported from initial dose until 14 days after the last dose of IMP or placebo.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.1
    Reporting groups
    Reporting group title
    Mifeprestone - Active Group
    Reporting group description
    -

    Reporting group title
    Placebo group
    Reporting group description
    -

    Serious adverse events
    Mifeprestone - Active Group Placebo group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 13 (7.69%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Cardiac disorders
    Chest pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 13 (7.69%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Mifeprestone - Active Group Placebo group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    9 / 14 (64.29%)
    6 / 13 (46.15%)
    Injury, poisoning and procedural complications
    Bitten tongue
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Vascular disorders
    High blood pressure
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    4 / 14 (28.57%)
    6 / 13 (46.15%)
         occurrences all number
    4
    6
    Nose Bleed
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Poor balance
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Blood and lymphatic system disorders
    Swollen Glands
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Night chills
         subjects affected / exposed
    2 / 14 (14.29%)
    0 / 13 (0.00%)
         occurrences all number
    2
    0
    Shooting pain in temples
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Immune system disorders
    Allergic reaction to penicillin
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    allergic reaction hands & torso
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Toothache
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 13 (15.38%)
         occurrences all number
    0
    2
    Stomach cramps and pain
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Constipation
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Heartburn
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Nausea & Vomitting
         subjects affected / exposed
    1 / 14 (7.14%)
    3 / 13 (23.08%)
         occurrences all number
    1
    3
    Indigestion
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 13 (15.38%)
         occurrences all number
    0
    2
    Diarrhoea
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Respiratory, thoracic and mediastinal disorders
    headache & flu like symptoms
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Chest Infection
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Skin and subcutaneous tissue disorders
    Dry skin
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Itchy skin
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 13 (7.69%)
         occurrences all number
    2
    1
    Rash on arms
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Self harmed
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 13 (15.38%)
         occurrences all number
    0
    2
    Panic attack
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Low mood
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 13 (7.69%)
         occurrences all number
    1
    1
    Musculoskeletal and connective tissue disorders
    Exacerbation of sciatica
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0
    Back pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 13 (7.69%)
         occurrences all number
    0
    1
    Infections and infestations
    Dry Eyes
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 13 (0.00%)
         occurrences all number
    1
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Jan 2011
    Change in Labaratory providing analysis services and changes to sampling (blood and urine) within the protocol.
    14 Apr 2011
    Administrative changes in the protocol and change from in-patient services to out patient services
    27 Sep 2011
    Removal of ‘independent clinician’ to determine the patients’ capacity to give consent. This will be determined by the delegated physician. Addition of AUQ in the trial summary. Correction to timing of CIWA-Ar administration during Weeks 2-4. Removal of illicit drug urine test during initial screening Removal of Appendix to reduce potential confusion from having two lists of contraindicated drugs Removal of Appendix A to reduce potential confusion Removal of illicit drug urine test during initial screening. Re-numbering of items Specification of follow-up measures (3, 6, 12 months) Removal of ‘independent clinician’ to determine the patients’ capacity to give consent. This will be determined by the delegated physician. Patients with psychoses will be excluded from the trial.
    16 Apr 2012
    Addition of Barnsley Path lab contact details Removal of University of Bern because arrangements changed for proteomic analysis. Addition of Epsom (formerly West Park) Path lab contact details SHAPS questionnaire added to list of abbreviations Return to wording of Protocol 5.1 for an ‘independent clinician’ to determine the patients’ capacity to give consent. Change to the normal admission period, owing to the recent changes in the NHS alcohol services Addition of AUQ in the trial summary. Clarification to wording as patients may be outpatient during week 3 and/or week 4. Change to number of saliva samples Inclusion of the SHAPS instrument to assess anhedonia. Correction to wording Change to number of saliva samples Removal of path lab names. Where possible, Path tests will be performed at the local path lab for each site. Path lab details are listed on pg. 2 Removal of path lab names as these are listed on pg. 2 Change to number and timing of saliva samples Correction to wording Where possible pathology tests will be performed at the local (CPA certified) pathology lab at each site. Removal of reference to the University of Bern Return to wording of Protocol 5.1 for an ‘independent clinician’ to determine the patients’ capacity to give consent. Correction to Exclusion criteria. Renal dysfunction cannot be diagnosed from a urine sample.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/26912003
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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