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Behavioural DisturbancesPhase 2NCT01608217

Delta-THC in Dementia

A Phase 2 study testing delta-9-tetrahydrocannabinol (delta-THC) and Acetaminophen in people with Behavioural Disturbances and Pain, run by Radboud University Medical Center at 2 sites in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a phase II, randomized, placebo-controlled, double-blind, parallel-group, multicentre study to the efficacy and safety of low dose delta-9-THC in behavioural disturbances and pain in patients with mild to severe dementia, when added to an analgesic treatment with acetaminophen. Read more about this study

Who is it for?
Ages 40 years and older
Conditions the study is for
Behavioural Disturbances, Pain, Dementia
What is being tested?
delta-9-tetrahydrocannabinol (delta-THC) and Acetaminophen
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
50 participants
Where
2 sitesNetherlands
Study dates
Jun 2012to Jun 2014
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subject has possible or probable dementia, type Alzheimer, vascular or mixed type dementia, according to the criteria of NINCDS-ADRDA/NINCDS-AIREN or based on an expert panel decision.
  • Clinical Dementia Rating (CDR) score 1 to 3 (mild to severe dementia).
  • Age ≥ 40 years.
  • Clinically relevant behavioral disturbances existing at least one month prior to screening, defined as a score of ≥ 10 on the NPI, including presence of the domain agitation/aggression or motor disturbance.
  • Women should be in the postmenopausal phase.
  • Availability of an informal or formal caregiver, being in touch with the subject at least twice a week.
  • Informed consent by the subject and subject's informal caregiver.
  • If applicable: subject is willing to stop his/her own pain medication, for the duration of the study.

Who cannot join

  • Dementia other than AD, VaD or AD/VaD
  • Major psychiatric disorder such as: major depression according to DSM IV within 6 months prior to randomization, history of psychosis or mania, current hallucinations and/or delirium, current suicidal ideation or major anxiety disorder.
  • History of, or current drug abuse.
  • Current alcohol abuse or unwillingness to use no more than 2 alcoholic consumptions daily or raised gamma-glutamine transpeptidase and alkaline phosphatase .
  • Clinical or biochemical evidence of liver disease (ALT or AST ≥ twice the upper limit of normal) or known allergy to acetaminophen.
  • Severe (and/or unstable) concomitant or intercurrent illness, such as seizure, arrhythmias requiring other drugs than a beta blocker or digoxin (except sinus arrhythmia and atrial fibrillation), unstable angina pectoris, heart failure NYHA III or IV, and severe concomitant illness that requires treatment changes.
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  • Known or suspected sensitivity to cannabinoids.
  • Lactosis intolerance.
  • Frequent falling due to orthostatic hypotension.
  • Use of tricyclic antidepressants (TCA), fluoxetine and/or carbamazepine.
  • Changes in dosage of antipsychotics, benzodiazepines or cholinesterase inhibitors within 2 weeks prior to intervention.
  • Participation in any other study other than the descriptive 'Parelsnoer' study.

Trial locations and contacts

2 sites in 1 country.

Netherlands2 sites
  • Radboud university medical center, department of Geriatrics

    Nijmegen, Gelderland, 6525

  • Vincent van Gogh Institute for Psychiatry, department of Elderly

    Venlo, Limburg, 5912

Other trials in Netherlands

About this study

Official title: Efficacy and Safety of Delta-9-tetrahydrocannabinol (∆9-THC) in Behavioural Disturbances and Pain in Dementia

This is a phase II, randomized, placebo-controlled, double-blind, parallel-group, multicentre study to the efficacy and safety of low dose delta-9-THC in behavioural disturbances and pain in patients with mild to severe dementia, when added to an analgesic treatment with acetaminophen.

It is hypothesized that Namisol® will lead to more behavioural disturbances than placebo, when added to an analgesic treatment with acetaminophen, and as measured by a change in Neuropsychiatric Inventory (NPI) score, after a three week treatment period.

It is expected that this will be due, primarily, to psychoactive effects of Namisol® and secondary to a reduction in pain sensation (as measured with VRS and PACSLAC-D). It is expected that a reduction in NPS will positively affect quality of life and lead to better functioning in daily living.

Read the detailed description

There is a high prevalence of behavioural disturbances (NPS) in persons with dementia. Persistent pain complaints can be a cause of NPS. Unfortunately, there is a lack of appropriate drugs for treating both these problems. This and positive suggestions from preliminary clinical studies with THC on NPS and directly fuel the study presented here.

This will be a phase II study in which the efficacy and safety of Namisol® (a tablet with THC) on behavioural disturbances, such as agitation, aggression and motor disturbances in dementia patients will be evaluated.

Secondary study objectives are :

  1. To evaluate the efficacy of Namisol® on other secondary outcome measures, such as quality of life and functioning in daily activities.
  2. To evaluate safety of Namisol® as assessed with physical examination, effects on cognitive functioning and adverse event monitoring.
  3. For the subgroup of subjects suffering from pain: to evaluate the efficacy of Namisol® pain intensity

It is hypothesized that Namisol® will lead to more reduction in behavioural disturbances than placebo, when added to an analgesic treatment with acetaminophen, and as measured by a change in Neuropsychiatric Inventory (NPI) score, after a three week treatment period. It is expected that this will be due, primarily, to psychoactive effects of Namisol® and secondary to a reduction in pain sensation (as measured with VRS and PACSLAC-D). It is expected that a reduction in NPS will positively affect quality of life and lead to better functioning in daily living

This is a randomized placebo-controlled double-blind parallel-group multicentre study.

Subjects who appear to fulfill the eligibility criteria are informed about the study. After signing informed consent by the subject and/or caregiver, a screening visit will take place. Subjects who are eligible for participation enter a wash-out period, for discontinuation of their own analgesic medication (if applicable). Subjects will be randomly allocated to receive one of the two interventions (Namisol® 1.5 mg + acetaminophen 1000 mg three times daily, or placebo + acetaminophen 1000 mg three times daily) for a double-blind intervention period of three weeks. After two weeks the primary outcome measure (NPI) is assessed by a telephone interview with the caregiver. Subjects visit the site twice (at baseline and after three weeks treatment) for assessments of the outcome parameters, including the NPI. For the purpose of compliance and safety, there will be a weekly phone call, performed by the researcher. After completion of this period subject's own analgesic treatment will be restarted (if applicable). After a follow up phase of two weeks, the subject is contacted by telephone for assessment of adverse events.

Being tested
delta-9-tetrahydrocannabinol (delta-THC), Placebo, Acetaminophen
Keywords
Behavioural disturbances, Pain, Dementia, Alzheimer's dementia, Vascular dementia, THC, Cannabis
Medical subject headings
Mental Disorders, Pain, Dementia, Alzheimer Disease, Dementia, Vascular, Marijuana Abuse

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • delta-9-tetrahydrocannabinol (delta-THC)Drug

    Also called Namisol, Cannabis, ECP002A

    delta-THC 1.5 mg (tablet)three times daily for a period of 3 weeks.

  • PlaceboDrug

    placebo (tablet) three times daily for a period of three weeks.

  • AcetaminophenDrug

    Also called Paracetamol

    Acetaminophen 1000 mg three times daily for a period of 3 weeks

  • AcetaminophenDrug

    Also called Paracetamol

    Acetaminophen 1000 mg three times daily for a period of three weeks

Study groups in NCT01608217
Study groupRoleWhat they receive
NamisolActive comparatorNamisol is a tablet containing delta-9-tetrahydrocannabinol, the main cannabinoid from Cannabis sativa L. Namisol is added to a standardized treatment with acetaminophen.
Receives: Drug: delta-9-tetrahydrocannabinol (delta-THC); Drug: Acetaminophen
PlaceboPlacebo comparatorThe control product is placebo, consisting of a tablet with similar appearance and taste of the test product. Placebo is added to a standardized treatment with acetaminophen.
Receives: Drug: Placebo; Drug: Acetaminophen

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Neuropsychiatric Inventory (NPI)

    The NPI has been accepted as the standard measure of NPS in most clinical trials, due to high validity, good inter-rater reliability, high internal consistency and its sensitivity to drug treatment effects. In clinical practice as well as clinical research the NPI is the most commonly used instrument to assess behavioral changes. The NPI evaluates 12 behavioral domains. The frequency and severity of these behaviors is scored by the informal caregiver.

    Measured: Screening, baseline, T= 2 weeks (by telephone interview) and T=3 weeks

Secondary outcomes (8)
  1. Pain Assessment Checklist for Seniors with Limited Ability to Communicate Dutch version (PACSLAC-D)

    The PACSLAC-D is a brief version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate in Dutch to observe pain related behavior It consists of 24 items, separated in three subscales (facial and vocal expressions, resistance/defense, social-economical aspects/mood). This scale is one of the few instruments in which the items are specifically geared towards elderly with dementia.

    Measured: baseline (T = 0) and T= 3 weeks

  2. Caregiver Clinical Global Impression of Change (CCGIC)

    The CCGIC is a 7-point Likert scale that assesses global change from baseline. The scale ranges from 1 ('very much improved') to 7 ('very much worse'). It has been frequently used in several psychopharmacological trials and in early clinical trials for antidementia drugs. When the caregiver rates the subject as changed compared to baseline, this change is, by definition, clinically meaningful.

    Measured: baseline (T=0), T= 2 wks (by telephone interview) and T=3 wks

  3. Cohen-Mansfield Agitation Inventory (CMAI)

    The CMAI is selected to assess agitation and aggression. It is an internationally validated instrument, specifically developed to measure behavioral disturbance in people with dementia

    Measured: baseline (T=0) and T= 3 weeks

  4. Quality of Life-Alzheimer's Disease Scale (QoL-AD)

    The QoL-AD is a 13 -item self-report scale, using four-point Likert-scales, but can also be completed in conjunction with the interviewer. It is developed for assessment of quality of life in subjects with mild to moderate severe dementia, but there is also evidence for reliability in severe dementia.

    Measured: baseline (T=0) and T= 3 weeks

  5. Barthel Index

    The Barthel Index was originally developed to assess disability in patients with neuromuscular and musculoskeletal conditions receiving rehabilitation, but is also recommended for functional assessment in elderly. Barthel Index is an easy to conduct, 10-item scale which scores several primary activities of daily living.

    Measured: baseline (T=0) and T = 3 weeks

  6. Paired Associates Learning test Wechsler Memory Scale Revised(PAL WMS-R)

    The PAL is a WMS subtest for assessment of episodic memory function. The PAL is sensitive to midtemporal lobe dysfunction and therefore suitable for assessment of effects of THC on hippocampal functioning. This test entails the presentation of 10 pairs of common words that have to be remembered (6 semantically related and 4 unrelated pairs). After presentation of the word pairs, the researcher reads aloud the first word of each pair, which has to be completed by the subject, thereby assessing the capacity to recall.

    Measured: baseline (T = 0) and T = 3 weeks

  7. Safety assessments

    Safety will be assessed by physical examination, including vital signs and internal examination. On indication extended physical (internal and neurological) examination or diagnostic tests can be performed. An ECG will be performed in all subjects during every visit. The occurrence of (serious) adverse events will be monitored, from first administration of study medication onwards. Weekly telephone calls are scheduled using a THC-specific symptom checklist to assess possible adverse events

    Measured: screening, baseline (T=0), T= 3 weeks. AE and compliance during telephone calls at T= 1week, T= 2 weeks and T= 5 weeks (follow up phone call)

  8. Verbal Rating Scale (VRS)

    The VRS is an ordinal self-reporting scale for assessment of pain intensity. It is a 6-point scale consisting of a list of phrases that describe increasing levels of pain intensity. The subject selects that phrase best characterizing his/her pain intensity at that moment. In agreement with the Interdisciplinary Consensus Statement on Assessment of Pain in Older Persons the VRS is chosen as the self-reporting assessment method for pain intensity in this group with mild to moderate impaired cognitive function.

    Measured: screening, baseline, T= 3 weeks, follow up (T= 5 weeks) and daily in a medication diary

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 May 2012 (estimated)
  2. Study startJun 2012
  3. Primary completionJun 2014
  4. Study completionJun 2014

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01608217
Sponsor's protocol ID
GER001-02-02
Other IDs
2011-005289-39, NL38617.091.12
Status last verified
Jun 2014
First submitted
25 May 2012
Last updated
30 Jun 2014
Results posted
No
Data monitoring committee
No

Publications

  • Bosnjak Kuharic D, Markovic D, Brkovic T, Jeric Kegalj M, Rubic Z, Vuica Vukasovic A, Jeroncic A, Puljak L. Cannabinoids for the treatment of dementia. Cochrane Database Syst Rev. 2021 Sep 17;9(9):CD012820. doi: 10.1002/14651858.CD012820.pub2.

    PubMed 34532852

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing delta-9-tetrahydrocannabinol (delta-THC) and Acetaminophen in people with Behavioural Disturbances and Pain, run by Radboud University Medical Center at 2 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 30 Jun 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Neuropsychiatric Inventory (NPI) (time frame: Screening, baseline, T= 2 weeks (by telephone interview) and T=3 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01608217, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Jun 2014.

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