Feasibility Trial of Pregnenolone for Posttraumatic Stress Disorder and Alcohol Use Disorder

University of Texas Southwestern Medical Center

Overview

Pregnenolone is a neurosteroid and an over-the-counter supplement that has shown promise in clinical studies of stress-related disorders, such as anxiety, depression and posttraumatic stress disorder (PTSD). Epidemiological studies suggest that patients with PTSD are at higher risk of developing addiction, including alcohol use disorder (AUD).The following hypothesis will be tested in this trial: pregnenolone is associated with a reduction in both PTSD symptoms and the number of standard drinks per week in outpatients with PTSD and AUD.

Investigators will conduct an 8-week, non-randomized, open label trial of pregnenolone in 20 persons with PTSD and AUD. The study will serve as a pilot study to determine feasibility and collect pilot data for NIH R01 proposals. All participants will be titrated to 800 mg/day of pregnenolone over the course of 4 weeks and maintain this dose for the remainder of the study. The study will consist of a screening visit to determine eligibility (Baseline I) and a Baseline II visit where participants will receive study medication, and follow-up visits at Weeks 1, 2, 3, 4, 6, and 8. Participants will complete a variety of assessments at each study visit, including clinician-rated and self-report measures of PTSD, alcohol use, depressive symptoms, cognitive performance, and side effects. Blood work will be done to ensure participant health and safety prior to randomization into the study, as well as to assess pregnenolone blood levels. All participants will meet with a study clinician at each visit to monitor safety and assess any adverse events.

Study Type

INTERVENTIONAL

Allocation

Purpose

BASIC_SCIENCE

Masking

NONE

Conditions

Post Traumatic Stress Disorder Alcohol Use Disorder

Interventions

Pregnenolone 250 mgDRUG

Pregnenolone 250 mg capsule BID (500 mg QD total)

Pregnenolone 400 mgDRUG

Pregnenolone 400 mg capsule BID (800 mg QD total)

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Outpatient adults (males and females) 18-70 years of age * Meet criteria for current PTSD based on SCID-CV for DSM 5. * Meet criteria for current AUD based on SCID-CV for DSM 5. * Alcohol use of 14 standard drinks per week for men and 7 for women based on TLFB in the last week. * Able to read and speak in English. * If taking psychotropic medications, taking a stable dose for the past 2 weeks and during the study treatment. Exclusion Criteria: * Vulnerable populations (e.g., pregnancy/nursing, severe cognitive impairment, incarcerated). * Current DSM-5 diagnosis of bipolar disorder, schizophrenia or other psychotic disorders based on SCID-CV. * High risk for suicide (active SI with plan/intent or \> 3 lifetime attempts in lifetime or any in the past 3 months). * Coronary artery disease, atrial fibrillation, stroke, deep vein thrombosis, pulmonary embolism or blood clotting disorder, uncontrolled hypertension, cirrhosis or any severe, life threatening or unstable, medical condition as determined by clinician assessment. * Clinically significant laboratory or physical examination findings. * AST or ALT \> 3 times the upper limit of normal. * Evidence of clinically significant alcohol withdrawal symptoms defined as a CIWA-Ar score of ≥ 10. * Current (last 14 days) treatment with naltrexone, acamprosate, disulfiram, topiramate. * Intensive outpatient treatment (defined as ≥ 3 visits each week) for substance abuse (AA, NA meetings, or less intensive counseling at baseline will be allowed) or intensive psychosocial treatment for PTSD. * Hormone-sensitive conditions (i.e. breast cancer; uterine/ovarian cancer, endometriosis, uterine fibroids). * Use of oral contraceptives or hormone replacement therapy. * History of allergic reaction or side effects with prior pregnenolone use.

Outcomes

Primary Outcomes

Clinician-Administered PTSD Scale for DSM-5 (CAPS-5)

CAPS-5 is a 30-item questionnaire, corresponding to the DSM-5 diagnosis for PTSD. CAPS-5 total symptom severity score is calculated by summing severity scores for the 20 DSM-5 PTSD symptoms. Similarly, CAPS-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C (items 6-7); Criterion D (items 8-14); and, Criterion E (items 15-20). A symptom cluster score may also be calculated for dissociation by summing items 19 and 20. The higher scores are associated with greater PTSD severity.

Time frame: Baseline to 8 weeks

Standard alcoholic drinks per week

The Timeline Followback will be used to assess the change in the number of standard alcoholic drinks per week. The TLFB will be administered by an interviewer and involves asking participants to retrospectively estimate their alcohol use 28 days prior to the first appointment and between each visit. The reported drinks are then converted to standard drinks based on the drink's alcohol by volume (ABV). The higher number is associated with more standard drinks and worse outcome.

Time frame: Baseline to 8 weeks

Timeline Followback (TLFB) heavy drinking days

The Timeline Followback will be used to assess the change in the number of standard alcoholic drinks per week. The TLFB will be administered by an interviewer and involves asking participants to retrospectively estimate their alcohol use 28 days prior to the first appointment and between each visit. The reported drinks are then converted to heavy drinking days based on the drink's alcohol by volume (ABV) and participant's sex (male/female) - 5 drinks per day for males and 4 for females. Each day during which 4-5 drinks are consumed is counted as a heavy drinking day within a given assessment period. The higher number is associated with more heavy drinking days and worse outcome.

Time frame: Baseline to 8 weeks

Systematic Assessment for Treatment Emergent Events (SAFTEE)

SAFTEE is a side effect self-report assessment scale that consists of 56 potential side effects. Participants rate how bothersome each side effect is on a scale of "none" (0), "mild" (1), "moderate" (2), "severe" (3). The higher total score (all items summed together) indicates a higher level of side effect burden.

Data from ClinicalTrials.gov

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