Methamphetamine use disorder (MUD) is becoming an increasing public health concern in Canada. While the evidence on the efficacy and safety of prescription psychostimulants for the treatment of MUD is promising, the knowledge on the maintenance therapy using stimulant agonist therapy is scarce and needs further investigation, especially in terms of long-term retention in treatment. The goal of this clinical trial is to evaluate the feasibility of a long-term (25 weeks) administration of high-dose stimulant agonist therapy, using Lisdexamfetamine (LDX-01) on top of treatment-as-usual (TAU), in a population of people with moderate to severe MUD, as measured by study retention, treatment retention, treatment adherence and satisfaction compared against a placebo group. Participants will be placed randomly into one of two groups: 1. TAU and high-dose LDX-01 2. TAU and placebo
This trial is a single-centre, randomized double-blind (LDX-01), dose-ascending, placebo-controlled trial. This study is an extension to a parent trial, Addition of high-dose stimulant and engagement-focused contingency management, alone and in combination, to treatment as usual for the management of methamphetamine use disorder (ASCME): a pan-Canadian multi-centre, randomized, controlled trial (NCT05854667). Participants will be enrolled in one of the 2 treatment arms: Arm 1 : TAU plus high-dose LDX-01 Arm 2 : TAU plus placebo The trial will enroll 62-80 participants who have completed the parent trial in the Quebec site. The participants will be enrolled in the trial for 30 weeks. Participation includes the following: 1. Participants will receive medication or placebo weekly for 25 weeks 2. Participants will attend the clinic for weekly treatment 3. Participants will attend the clinic once every week for study visits. At these visits, participants will be asked to provide a urine sample (Weeks 1-25: every two weeks, week 26 and week 30) and/or complete questionnaires
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
80
Participants receive once daily LDX-01 for 25 weeks, as well as TAU at a clinical site. Medication is provided in 3 phases: Week 1 (Induction Phase): 100 mg (Days 1 and 2), 150 mg (Days 3 and 4), 200 mg (Days 5, 6 and 7); Weeks 2-21 (Maintenance Phase): 250 mg (or the maximum tolerated for each individual) ; Weeks 22-25 (Taper Phase): 200 mg (Week 22), 150 mg (Week 23), 100 mg (Week 24) and 50 mg (Week 25).
Participants receive once daily LDX-01-matched placebo for 25 weeks, as well as TAU at a clinical site. Medication is provided in 3 phases: Week 1 (Induction Phase): 100 mg (Days 1 and 2), 150 mg (Days 3 and 4), 200 mg (Days 5, 6 and 7); Weeks 2-21 (Maintenance Phase): 250 mg (or the maximum tolerated for each individual) ; Weeks 22-25 (Taper Phase): 200 mg (Week 22), 150 mg (Week 23), 100 mg (Week 24) and 50 mg (Week 25).
Centre hospitalier de l'Université de Montréal (CHUM)
Montreal, Quebec, Canada
RECRUITINGRetention in treatment
Retention in treatment will be measured as the proportion of study participants who receive any intervention during the 4 weeks before week 22 and 4 weeks before week 26
Time frame: Weeks 18, 19, 20, 21 and weeks 22, 23, 24, 25
Treatment satisfaction
Participant treatment satisfaction will be measured by evaluating participant satisfaction using the Client Satisfaction Questionnaire-8 (CSQ-8) questionnaire. The total score ranges from 8 (minimum) to 32 (maximum) with the higher values showing greater satisfaction.
Time frame: Weeks 22, 26
Retention in study
Retention in study will be measured as 1) the proportion of study participants who return for the study visit at week 22 with or without receiving the study interventions, 2) the proportion of study participants who return for the study visit at week 26 with or without receiving the study interventions, and 3) the proportion of study participants who return for the last study visit at week 30 with or without receiving the study interventions.
Time frame: Weeks 22, 26 and 30
Treatment adherence
Treatment adherence will be first, measured individually, as the total proportion of the number of the assigned medications (LDX-01/placebo) taken through the intervention (from baseline until the end of week 25) and then averaged across all study completers.
Time frame: from week 1 day 1 to week 25
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