Treatment With Lorcaserin for Cocaine Use: The TLC Study

Phase 2

Terminated

Conditions: Cocaine Use Disorder

Interventions: Drug: Placebo Oral Tablet
Drug: lorcaserin
Behavioral: Substance use counseling
Behavioral: ACASI
Diagnostic Test: Cocaine metabolites
Behavioral: Ecological Momentary Assessment (EMA)
Behavioral: Balloon Analogue Risk Task (BART)
Behavioral: Qualitative Exit Interview

Registration Number: NCT03192995

Lead Sponsor: Glenn-Milo Santos

Brief Summary: This project is a placebo-controlled, double-blind randomized trial evaluating the feasibility, tolerability, acceptability and adherence for lorcaserin among actively using, men who have sex with men (MSM) with cocaine use disorders.The study will enroll 45 individuals who will randomly be assigned to either the treatment (lorcaserin) arm or the placebo arm, to be taken twice a day for 12 weeks.

Detailed Description: This is a randomized, double-blind, placebo-controlled, 12-week parallel group pilot study with 2:1 random assignment to 20 mg of extended-release oral lorcaserin versus placebo. Participants are recruited via street outreach, recruitment flyers, sexually transmitted diseases (STD) and HIV clinics, needle exchanges, community organizations, MSM bars, online Web sites, and social media. Potential participants complete a brief telephone screen to assess initial eligibility and, if eligible, are scheduled for an in-person screening visit. All participants give informed consent using University of California at San Francisco (UCSF) Institutional Review Board (IRB)-approved consent forms. A 10-item true/false questionnaire is used to verify participants' understanding of the trial. The target sample size for the study was 45 participants (The Food and Drug Administration (FDA) closed down the study early due to a long-term safety study showing that long term use of lorcaserin could be hazardous to your health). Only 22 of the 45 participants were randomized to the study.

With the proposed sample size, we estimate that proportions for our feasibility and acceptability outcomes would be estimated within margins of sampling error (Mean squared error (MSEs); i.e., half widths of 95% confidence intervals) of ≤14.4 percentage points, and means with MSEs of 0.30 standard deviations, both typical for a small pilot study.

Participants are screened for eligibility based on inclusion criteria. At Enrollment, participants are instructed to take one pill each day of extended-release lorcaserin 20mg or placebo. Medications are dispensed in bottles with Medication Events Monitoring (MEMS) caps, which are wireless medication monitoring devices that record each opening as a real-time medication event. All participants are asked about potential adverse events at each follow-up visit; symptom-driven physical exams and safety laboratory monitoring are done at weeks 4, 8, and 12. Adverse events are classified using the Division of AIDS (DAIDS) Table for Grading Severity of Adult Adverse Experiences for HIV Prevention Trials Network. Participants are seen every week for substance use counseling and urine tests for cocaine metabolites. Trained staff, supervised by a clinical psychologist, administered brief (20-30 minutes) substance use counseling at follow-up visits. Audio-computer assisted self-interviews (ACASI) are used to standardize data collection and minimize reporting bias. Standardized measures are used to assess drug and alcohol use using timeline followback, substance use treatment, craving and severity of cocaine dependence, and sexual risk behavior. Acceptability measures include questions on attitudes about trial participation, level of satisfaction with trial procedures, and trial medication.

Recruitment & Eligibility

Status: TERMINATED

Sex: Male

Target Recruitment: 22

Inclusion Criteria

Male gender assigned at birth and transgender men;
self-reported anal intercourse with men in the prior six months while under the influence of cocaine;
cocaine use disorder by (Diagnostic and Statistical Manual of Mental Health Disorders (DSM-V) and Structured clinical interviews (SCID) criteria;
current cocaine use confirmed by urinalysis and cocaine use at least 15 days in the past 30 days;
HIV-negative by rapid test or HIV-positive with a medical record of HIV infection;
no current acute illnesses requiring prolonged medical care;
no chronic illnesses that are likely to progress clinically during trial;
able and willing to provide informed consent and adhere to visit schedule;
age 18-65 years;
baseline complete blood count (CBC), total protein, albumin, glucose, alkaline phosphatase, creatinine, Blood Urea Nitrogen (BUN), and electrolytes without clinically significant abnormalities as determined by study clinician in conjunction with symptoms, physical exam, and medical history

Exclusion Criteria

Any psychiatric condition (e.g., depression with suicidal ideation, schizophrenia) or medical condition that would preclude safe study participation;
HIV-positive test result at screening visit but previously unaware of HIV infection (i.e., newly diagnosed with HIV infection at screening; those with a medical record of HIV infection are eligible);
any moderate to severe alcohol or substance use disorders (other than cocaine use disorders), according to DSM-V criteria;
known allergy or previous adverse reaction to lorcaserin;
current T-cell count (CD4) count < 200 cells/mm3 ;
moderate/sever liver disease (Aspartate Transferase (AST), Alanine Transaminase (ALT) > 3 times upper limit or normal);
severely impaired renal function (creatinine clearance £ 30 ml/min);
use of medications that affect the serotonergic neurotransmitter system (e.g., selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs));
predisposition to priapism;
currently participating in another longitudinal intervention research study;
body mass index (BMI) < 15; or ≥ 30 with desire to use weight management medication, or BMI > 35;
anticipated use of agents that are associated with valvulopathy and/or pulmonary hypertension
Are currently treated with an opiate-substitute (buprenorphine or methadone) maintenance treatment or received therapy with any opiate-substitute within 30 days preceding screening
Currently in court-mandated cocaine use treatment;
Had previous history of suicidal behavior in the last 12 months ("yes" answer to the suicidal behavior question 6 of the Columbia-Suicide Severity Rating Scale (C-SSRS)); or currently have suicidal ideation as determined by 'yes' answers to questions 4 or 5 on the C-SSRS administered by a study clinician;
Any physical condition affecting drug absorption (e.g., gastrectomy);
12-lead Electrocardiogram (ECG) demonstrating Corrected QT interval (QTc) > 450 or a Q wave, R wave and S wave (QRS) interval > 120 msec at screening. If Fridericia (QTcF) exceeds 450 msec, or QRS exceeds 120 msec, the ECG should be repeated two more times and the average of the three QTc values should be used to determine the subject's eligibility.

(Note: Participants newly diagnosed with HIV at screening who consent to be contacted for re-screening will be called in the subsequent month, or later, depending on participant preference).

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Experimental	Cocaine metabolites	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	Placebo Oral Tablet	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	Substance use counseling	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	Balloon Analogue Risk Task (BART)	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Experimental	Balloon Analogue Risk Task (BART)	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	Cocaine metabolites	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	Ecological Momentary Assessment (EMA)	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	Qualitative Exit Interview	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Experimental	Substance use counseling	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Experimental	ACASI	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Experimental	Ecological Momentary Assessment (EMA)	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Control	ACASI	Placebo, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Experimental	Qualitative Exit Interview	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment
Experimental	lorcaserin	lorcaserin, extended release, Substance use counseling, ACASI behavioral questionnaire, BART, and ecological momentary assessment

Primary Outcome Measures

Name	Time	Method
Adverse Clinical Events in the Lorcaserin and Placebo Arms (Descriptive)	12 weeks	To explore the tolerability of lorcaserin vs. placebo the investigators will compute the number of adverse events, both overall and by type. A participant could have more than one AE.
Mean Percentage of Weekly Follow-up Visits of Randomized Study Participants	12 weeks	To determine the feasibility of retaining individuals on lorcaserin vs. placebo, the investigators have calculated the mean weekly percentage of follow-up visits of those randomized in the study
Cumulative Percent Adherence of Medication Events Monitoring (MEMs) Cap	12 weeks	To evaluate the adherence of lorcaserin vs. placebo, the investigators measured adherence as the frequency of taking the study drug as measured by the number of MEMS cap openings (wireless medication monitoring devices that record each opening as a real-time medication event). Cumulative percent adherence was calculated by dividing the frequency of openings at a given time point divided by the number of days since baseline.
Proportion of Self-reported Past Week Cocaine Use Among Lorcaserin and Placebo Groups at Baseline and at 12 Weeks	12 weeks	The outcome measure determines the proportion of self-reported past week cocaine use by Time-Line-Follow-back (TLFB) among lorcaserin and placebo groups at Baseline and at 12 weeks.
Proportion of Urine-positive Samples With Cocaine Positivity Among Lorcaserin and Placebo Groups at Baseline and at Week 12	Week 12	The outcome measure determines the proportion of urine-positive samples with cocaine positivity among lorcaserin and placebo groups at Baseline and at Week 12