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Alcohol Withdrawal SyndromePhase 3MAGMANCT03033823

MAGnesium Adjunction in Alcohol Withdrawal Syndrome: a Multicenter Assessment (MAGMA)

A Phase 3 study testing Magnesium in people with Alcohol Withdrawal Syndrome, run by Assistance Publique - Hôpitaux de Paris at 11 sites in France.

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 study examine the efficacy of oral magnesium supplementation as an adjuvant therapy for decreasing intensity of alcohol withdrawal symptoms among inpatients requiring pharmacological treatment of their AWS. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Alcohol Withdrawal Syndrome
What is being tested?
Magnesium
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
105 participants
Where
11 sitesFrance
Study dates
16 Nov 2017to 23 Oct 2020
Phase
Phase 3
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 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult inpatients, men and women (i.e. age>18 years and <75 years) ;
  • Current AWS according to DSM-5 criteria;
  • Score at the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) >8;
  • Written informed consent to participate in the study;
  • Affiliation to the French Social Security Health Care plan.

Who cannot join

  • Age less than 18 or greater than 75;
  • Hemodynamic failure;
  • Arythmia;
  • Lack of fulfilling AWS criteria according to DSM-5;
  • Score at the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) <=8;
  • Benzodiazepine misuse according to the opinion of the investigator;
Show all 17Show fewer
  • Substance use disorder according to the opinion of the investigator, regarding licit and illicit substances, except for tobacco;
  • Pregnancy or breast-feeding;
  • Unable to take oral medications;
  • Creatinine clearance < 45mL/min less than 6 months old. If there is no dosage in the last 6 months, creatinine clearance must be <30mL/min at inclusion (creatinine clearance computed according to the Cockcroft-Gault Equation);
  • Cognitive disorders already known at inclusion that impair the informed consent, including dementia (except for acute withdrawal delirium), according to the opinion of the investigator;
  • Psychiatric disorder requiring hospitalization or specific cares in emergency (e.g. suicidal crisis, acute psychotic episode);
  • Magnesium supplementation (regardless the type of delivery) within 3 months prior to inclusion;
  • Actual quinidine intake;
  • No written informed consent to participate in the study;
  • Patient under tutorship or curatorship;
  • Hypersensitivity to Magnespasmyl® or to any of its excipients (including sucrose) or to lactose (placebo excipient).

Trial locations and contacts

11 sites in 1 country.

11 sites in 1 country

France11 sites
  • Hôpital Louis Mourier, AP-HP

    Colombes, Île-de-France Region, 92700

  • Clinique des Platanes

    Épinay-sur-Seine, Île-de-France Region, 93800

  • Hôpital Corentin Celton, AP-HP

    Issy-les-Moulineaux, Île-de-France Region, 92130

  • Institut MGEN de la Verriere

    Le Mesnil-Saint-Denis, Île-de-France Region, 78322

  • Institut MGEN la Verriere-service SSR addictologie

    Le Mesnil-Saint-Denis, Île-de-France Region, 78322

  • Hôpital Emile ROUX

    Limeil-Brévannes

  • Clinique des maladies mentales et de l'encéphale

    Paris, Île-de-France Region, 75014

  • Hôpital Européen Georges Pompidou-Service de chirugie orthopédique, AP-HP

    Paris, Île-de-France Region, 75015

  • Hôpital Européen Georges Pompidou-Service de médecine interne, AP-HP

    Paris, Île-de-France Region, 75015

  • Hôpital européen Georges-Pompidou-Service hépato-gastroentérologie

    Paris, Île-de-France Region, 75015

  • Centre Hospitalier des quatre villes

    Sèvres, Île-de-France Region, 92310

Other trials in France

About this study

Official title: Multicenter Randomized Placebo Controlled Trial Assessing the Efficacy of Oral Adjuvant Magnesium Supplementation in the Treatment of Alcohol Withdrawal Syndrome

This study examine the efficacy of oral magnesium supplementation as an adjuvant therapy for decreasing intensity of alcohol withdrawal symptoms among inpatients requiring pharmacological treatment of their AWS. This double blind randomized multicenter clinical trial planned to treat half of participants as usal plus placebo and the other half as usual plus magnesium.

Read the detailed description

Alcohol withdrawal syndrome (AWS) is a frequent and potentially fatal outcome. It is crucial to treat AWS in order to reduce symptoms severity, to prevent severe complications and to increase patient motivation to maintain long-term alcohol abstinence. Clarify the relevance of oral magnesium supplementation as a routine adjuvant therapy of AWS can give rise to a major evolution of guidelines regarding management of alcohol use disorder and make AWS more comfortable for hundred thousand patients.

Magnesium acts as a competitor of glutamate on NMDA receptor binding site, limiting glutamate toxicity leading to AWS. Previous findings suggested a correlation between AWS intensity and hypomagnesaemia degree, and an increased risk of severe AWS (i.e. delirium tremens and seizure) when there is deep depletion. In addition to magnesium role as a glutamatergic modulator via an NMDA-receptor antagonism activity, magnesium may also modulate GABAergic neurotransmission and affect numerous transduction pathways, including proteinkinase C, possibly influencing the access of corticosteroids to the brain.

Moreover, magnesium has been found to be a cofactor required for thiamine-dependent enzymes whereas thiamine supplementation is crucial to prevent from Wernicke's encephalopathy in the treatment of AWS. Finally, magnesium supplementation could help to reduce benzodiazepines use.

The primary endpoint is the between-group absolute difference of the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) score change from baseline, 3 days after randomization.

The secondary endpoints are:

a Total benzodiazepine consumption compared between experimental and control groups throughout the duration of the study (i.e. 15 days); b Time required to obtain a total score of 0 at the CIWA-Ar compared between experimental and control groups; c Rate of patients experiencing seizures and delirium tremens during the study compared between intervention and control groups; d Stratify results of the Primary endpoint following score at the Charlson Comorbidity Index; e Stratify results of the Primary endpoint by age; f Number of participants who left the hospital against medical advice during the study compared between experimental and control groups; g Number of participants who made an appointment in an addiction unit during the study (i.e. before the last follow-up point, 15 days after baseline), compared between experimental and control groups after stratification following AUD duration and number of previous addiction healthcare; h Patient Satisfaction Questionnaire-18 (PSQ-18) scores at the last follow-up point (i.e. days after baseline) compared between experimental and control groups; i Total plasmatic or serum magnesium concentration changes between baseline, 3 days after baseline, and 7 days after baseline; j Rate of all adverse events occurred during the study incidence compared between experimental and control groups;

Practical procedure:

Patients recruited are inpatients, hospitalized whatever the main reason for hospitalization (i.e. alcohol withdrawal syndrome or other reason). Inclusion visit starts with signature of informed consent, then confirms the eligibility and finally, ends with randomization and administration of the first dose of treatment. Patients are followed 15 days after baseline. Total plasmatic or serum magnesium concentration is dosed at baseline, 3 days and 7 days. In addition to CIWA-Ar and AUDIT, the following assessments are performed at baseline: Charlson comorbidity index, DIGS, SCL-90, MINI. We will use tablets of 465.4 mg of magnesium lactate dehydrate (Magnespasmyl©), which corresponds to 47.4mg of magnesium (i.e. 1.9mmol of magnesium per tablet). These tablets will be prescribed as follows: 3 tablets three times per day. In case of diarrhea, nearly half-dosage will be used until the end of the follow-up (i.e. 189.6mg per day, 3 times a day as follows: 1 tablet, 2 tablets, 1 tablet). Patients will be informed that treatment is to be taken during meals and to avoid sodas during the study.

Being tested
Magnesium, Placebo Oral Tablet
Keywords
Alcoholism, Delirium, Magnesium Deficiency
Medical subject headings
Alcoholism, Delirium, Magnesium Deficiency

What participants receive

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

  • MagnesiumDrug

    Usual care (i.e. without any restriction of drug therapy) plus oral tablet magnesium supplementation: 426.6mg of magnesium per day three times daily (i.e. 142.2 mg for each shot) throughout the study (i.e. fifteen days). In case of diarrhea, nearly half-dosage will be used (i.e. 189.6mg).

  • Placebo Oral TabletDrug

    Also called Placebo

    Usual care (i.e. without any restriction of drug therapy) plus oral placebo, totally similar to the verum, three times daily throughout the study (i.e. fifteen days). In case of diarrhea, nearly half-dosage will be used.

Study groups in NCT03033823
Study groupRoleWhat they receive
InterventionExperimentalUsual care (i.e. without any restriction of drug therapy) plus oral tablet magnesium supplementation: 426.6mg of magnesium per day three times daily (i.e. 142.2 mg for each shot) throughout the study (i.e. fifteen days). In case of diarrhea, nearly half-dosage will be used (i.e. 189.6mg).
Receives: Drug: Magnesium
ControlPlacebo comparatorUsual care (i.e. without any restriction of drug therapy) plus oral placebo, totally similar to the verum, three times daily throughout the study (i.e. fifteen days). In case of diarrhea, nearly half-dosage will be used.
Receives: Drug: Placebo Oral Tablet

What is being measured

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

  1. Between-group absolute difference of the CIWA-Ar score (revised clinical institute withdrawal assessment for alcohol scale) change from baseline

    Measured: 3 days after randomization

Secondary outcomes (10)
  1. Total benzodiazepine consumption compared between experimental and control groups throughout the duration of the study

    Measured: 15 days after randomization

  2. The delay compared between experimental and control groups until having a total score of 0 at the CIWA-Ar

    Measured: 15 days after randomization

  3. The rate of patients experiencing seizures and delirium tremens during the study compared between intervention and control groups

    Measured: 15 days after randomization

  4. Between-group absolute difference of the CIWA-Ar score change from baseline, considering two subgroups: score at the Charlson Comorbidity Index (CCI) min-score at the CCI median versus score score at the CCI median-score at the CCI min

    Measured: 3 days after randomization

  5. Between-group absolute difference of the CIWA-Ar score (revised clinical institute withdrawal assessment for alcohol scale) change from baseline considering two subgroups: 18-59 years versus 60-75 years

    Measured: 3 days after randomization

  6. The number of participants who left the hospital against medical advice during the study compared between intervention and control groups

    Measured: 15 days after randomization

  7. The number of participants who made an appointment in an addiction unit during the study compared between intervention and control groups after stratification following alcohol use disorder (AUD) duration and number of previous addiction healthcare

    Measured: 15 days after randomization

  8. Patient Satisfaction Questionnaire-18 scores at the last follow-up point compared between experimental and control groups

    Measured: 15 days after randomization

  9. Total plasmatic or serum magnesium concentration changes between baseline,3 days after baseline, and 7 days after baseline, compared between intervention and control groups

    Measured: 3 days and 7 days after randomization

  10. Rate of all adverse events occurred during the study and compare their incidence between intervention and control groups

    Measured: 15 days after randomization

Timeline

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

  1. First posted27 Jan 2017 (estimated)
  2. Study start16 Nov 2017
  3. Primary completion23 Oct 2020
  4. Study completion23 Oct 2020

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 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
105 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03033823
Sponsor's protocol ID
P150939
Other IDs
2016-002072-26, PHRC, 2016
Acronym
MAGMA
Status last verified
Dec 2021
First submitted
3 Jan 2017
Last updated
21 Dec 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Magnesium in people with Alcohol Withdrawal Syndrome, run by Assistance Publique - Hôpitaux de Paris at 11 sites in France.

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 5 inclusion and 17 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 21 Dec 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 11 sites in France. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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?

Between-group absolute difference of the CIWA-Ar score (revised clinical institute withdrawal assessment for alcohol scale) change from baseline (time frame: 3 days after randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 21 Dec 2021.

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