Semaglutide for Treatment of People With Methamphetamine Use Disorder: the SHIFT Study

Phase 2Not Yet RecruitingNCT07509112

Kirby Institute40 enrolled

Overview

Methamphetamine use disorder is a major public health concern in Australia and globally. GLP-1 medications such as semaglutide (e.g. Ozempic) are approved for diabetes and medication, and may potentially affect craving for other substances apart from food. We do not know if this will help people who use methamphetamine ('ice') to reduce their use. This study will treat people who use methamphetamine with weekly injections of semaglutide. It will provide data on if this is a potentially safe and practical treatment for this group of people.

Methamphetamine use disorder is a major public health concern in Australia and globally, associated with high morbidity and limited treatment options. People with methamphetamine use disorder frequently face social marginalisation, psychiatric comorbidity, housing instability, and criminal justice involvement, contributing to poor treatment access and outcomes. At present, no pharmacotherapies have been approved for the treatment of methamphetamine use disorder. While several agents have demonstrated preliminary promise-including mirtazapine, which has shown consistent findings across trials-none have yet established sufficient efficacy to achieve regulatory approval. Ongoing registrational trials, such as those evaluating extended-release naltrexone combined with bupropion, and mirtazapine, may clarify the potential role of these agents in clinical practice. Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide, are approved for diabetes and obesity and have central effects on reward pathways relevant to addiction. Preclinical studies show GLP-1 agonists reduce stimulant-related dopamine signalling and drug-seeking behaviour. Observational studies in humans suggest semaglutide may reduce risk of alcohol use disorder, hospitalisations related to substance use, and overdose, and a recent randomised controlled trial demonstrated reductions in cravings, and use of, alcohol and tobacco. However, no trials have yet evaluated semaglutide in methamphetamine use disorder. This pilot study will be the first to assess its feasibility, safety, and preliminary efficacy for methamphetamine use disorder.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Conditions

Methamphetamine Use Disorder

Interventions

12 weeks of weekly subcutaneous semaglutide injectionDRUG

12 weeks of subcutaneous semaglutide administered once weekly, starting at 0.25 mg once weekly, titrated as tolerated up to 1.0 mg over the 12-week study period.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Has provided voluntary, written informed consent; 2. Aged 18 years or older; 3. Diagnosed with moderate to severe methamphetamine use disorder (DSM-5 criteria); 4. Self-reported methamphetamine use on at least 14 of past 28 days and a positive oral fluid drug screen for amphetamine/methamphetamine; 5. Willing and able to comply with study procedures and follow-up visits; 6. People of child-bearing potential must agree to use effective contraception during treatment and during the 60 days after treatment end. Exclusion Criteria: 1. Uncontrolled medical or psychiatric conditions that may interfere with participation; 2. Body mass index less than 22 kg/m2; 3. Confirmed diagnosis of diabetes mellitus (either known history of diabetes; concomitant treatment with insulin, metformin, sulfonylureas, thiazolidinediones, SGLT2 inhibitor, DPP4 inhibitor; or HbA1c \>6.5 at screening); 4. Currently taking a GLP-1 receptor agonist; 5. Known hypersensitivity or contraindications to GLP-1 receptor agonists as per product information; 6. Current enrolment in another interventional trial; 7. Lactating, pregnant or at risk of pregnancy not willing to avoid pregnancy 8. History of pancreatitis; 9. History of medullary thyroid cancer; 10. Current admission to a residential rehabilitation program or inpatient program or planned admission during the study period, which would interfere with participation in study visits or procedures; 11. Currently experiencing psychosis or current active suicidality 12. Any condition or circumstance that, in the opinion of the investigator, would compromise the participant's ability to comply with the study procedures, complete protocol requirements, or provide reliable data.

Locations (5)

Kirketon Road Centre

Darlinghurst, New South Wales, Australia

Rankin Court Treatment Centre, St Vincent's Hospital Sydney

Darlinghurst, New South Wales, Australia

Alcohol & Drug Service, Metro Health North Brisbane

Brisbane, Queensland, Australia

Drug and Alcohol Services, South Australia

Morphett Vale, South Australia, Australia

Outcomes

Primary Outcomes

Efficacy Outcome (exploratory)

Last 4-week methamphetamine use measured by the TLFB method at week 12 compared to screening

Time frame: 12 weeks

Secondary Outcomes

Secondary exploratory outcome

Total number of days of self-reported methamphetamine use

Time frame: 12 weeks

Secondary exploratory outcome

End-of-treatment abstinence from methamphetamine (self-reported and oral fluid drug screens);

Time frame: 12 weeks

Secondary exploratory outcome

Use of, and end-of-treatment abstinence from, other substances (e.g., opioids, benzodiazepines, tobacco, alcohol).

Time frame: 12 weeks

Secondary exploratory outcome

Change in methamphetamine craving score on visual analogue scale

Time frame: 12 weeks

Secondary exploratory outcome

Weight loss

Time frame: 12 weeks

Secondary exploratory outcome

Retention in opioid agonist treatment (OAT) programs at 12 weeks (for those enrolled in OAT)

Time frame: 12 weeks

Secondary exploratory outcome

Change in health-related quality of life utility score on the EQ-5D-5L

Time frame: 12 weeks

Central Contacts

David Goodman-Meza, MD, PhD

CONTACT

+61 2 9385 0900 shiftstudy@unsw.edu.au

Data from ClinicalTrials.gov

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