Additional pharmacotherapies in the treatment of alcohol dependence are needed. Sodium oxybate showed efficacy in the maintenance of abstinence in alcohol-dependent patients in several small randomized trials of short duration. The aim of the present phase III/IV study is to confirm in a randomized-controlled study the efficacy and safety of oral sodium oxybate in the maintenance of abstinence.
Alcohol dependence (AD) is the most severe form of alcohol use disorder. It occurs in 2.6% of people aged 15+ years worldwide and can result in a reduction of life-expectancy by several years as compared with the general population. Currently, disulfiram, acamprosate and naltrexone are the main medicinal products registered for the maintenance of abstinence in AD patients. Although effective on the group level, effects sizes are limited, and many AD patients fail to respond to these medications. Therefore, additional pharmacological treatments are needed. Sodium oxybate 50mg/kg/day showed evidence of efficacy compared to placebo and naltrexone in the maintenance of abstinence in AD patients in a series of open label and blinded randomized controlled trials (RCTs). However, studies were generally small and did not investigate the sustainability of the Sodium oxybate effect post-treatment. The present phase III/IV RCT (GATE 2) aimed to confirm the efficacy and safety of oral Sodium oxybate in the maintenance of abstinence. Secondary aims included the assessment of sustained SMO effects during the 6-month medication free period immediately following the 6-month treatment period and monitoring the risk of Sodium oxybate dependence.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
314
solution for oral administration
solution for oral administration
Cumulative Abstinence Duration (CAD)
to demonstrate that sodium oxybate is superior to placebo in the CAD during the treatment period.
Time frame: 6-month treatment period
CAD stratified
CAD during treatment period according to subtype patients stratified by Lesch's categories.
Time frame: 6-month treatment period
Assessment of the exposure-corrected CAD
assessment of the exposure-corrected cumulative abstinence duration (CCAD) during treatment.
Time frame: 6-month treatment period
CAD during the whole study
CAD during the whole observation period
Time frame: 12 months: 6-month treatment period + 6-month follow-up
Proportion of abstinent patients
proportion of abstinent patients at the end of the 6-month treatment period and at the end of the entire observation period.
Time frame: 12 months: 6-month treatment period + 6-month follow-up
Time to the first relapse
assessment of the time to the first relapse during the treatment period.
Time frame: 6-month treatment period
Change from baseline in the craving for alcohol intensity and frequency by the Lubecker Craving Risiko Ruckfall (LCRR) questionnaire.
The LCRR provides the patient's current state about his craving for alcohol. The clinician interviews the patient to rate the intensity of the desire for alcohol (item-1) on a 4-point scale ranging from 1 (no desire) to 4 (very strong desire), and to rate the frequency of the desire for alcohol (item-2) on a 6-point scale ranging from 1 (never) to 6 (nearly continuous). Higher scores mean a worse outcome.
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Time frame: 12 months: 6-month treatment period + 6-month follow-up
Assessment of the time course of γ-GT as biological marker of alcohol abuse, during treatment and at the end of follow-up.
γ-GT values
Time frame: Month 6
Adverse events
evaluation of the frequency, nature and severity of adverse clinical events, including mortality and morbidity
Time frame: 6-month treatment period
Number of participants with Adverse Events (AEs)
Overview of AEs.
Time frame: 6-month treatment period
Risk of Secondary Dependence - treatment period
Evaluation of the risk of onset of dependence from the medication, by means of a 2-item questionnaire. The first to rate the intensity of the desire for medication since the last visit in a scale ranging from 0 to 100. The second to rate the approach to the next dose in a scale ranging from 1 (I just waited for the time to come) to 6 (I took the dose sooner than planned). Higher scores mean a worse outcome.
Time frame: 6-month treatment period
Assessment of the time course of MCV as biological marker of alcohol abuse, during treatment and at the end of follow-up.
MCV values
Time frame: Month 6