Novel Medication Strategies Targeting Brain Mechanisms in Pediatric OCD

Phase 2

Completed

Brief Summary: This study will examine the feasibility and potential efficacy of augmenting SRIs with minocycline. The study will assess whether the addition of minocycline leads to measurable changes in striatal glutamate (Glu) levels. This study will recruit up to 45 youth ages 8-20 diagnosed with clinically significant OCD who have demonstrated no more than minimal response to SRI treatment and are currently on a stable dose of SRI medication for at least 12 weeks. Participants will be randomized to receive either 12 weeks of minocycline treatment or pill placebo. Randomization will be 2:1 so that 2 of 3 participants receive minocycline. Screening for eligibility will take place for 1-4 weeks. Participants will undergo magnetic resonance spectroscopy (MRS) scans to measure striatal Glu levels prior to randomization, and again immediately following the treatment period. During the treatment period, participants will meet initially weekly and then every other week with the study psychiatrist. All participants will be offered three months of open medication treatment following participation. The clinical trial will only be conducted at the New York State Psychiatric Institute (NYSPI) and the MRS scans may be conducted at Weill Cornell Medical Center or NYSPI.

Recruitment & Eligibility

Inclusion Criteria

Participants must be ages of 8-20 at the time of consent
Participants must weigh at least 25kg
Participants and a parent/guardian must be able to read and understand English
Participants must meet diagnostic criteria for obsessive-compulsive disorder with score ≥ 16 on the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS)
Participants must be on stable dose of serotonin reuptake inhibitor (SRI) medication, and must have had a minimal adequate trial of SRI medication
Report of at least minimal, but not full, response to current SRI medication to warrant ongoing SRI treatment
For participants younger than 18, written informed assent by the participant and consent by the parent. For participants 18 and older, written consent by the participant and permission for legal guardian/parent to provide information

Exclusion Criteria

Lifetime diagnosis of: psychotic disorder, bipolar disorder, eating disorder, pervasive developmental disorder, mental retardation, or substance/alcohol dependence
Current diagnosis of major depressive disorder, Tourette's/Tic Disorder, or substance/alcohol abuse
Positive urine screen for illicit drugs
Medical or psychiatric conditions that would make participation in the study unsafe
Active suicidal ideation
Females who are using hormonal birth control
Presence of metallic device or dental braces incompatible with MRS
Intelligence quotient (IQ) <80
OCD patients with primary symptoms of hoarding (determined by CYBOCS checklist)
Current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS)
Individuals who are currently receiving Exposure and Response Prevention therapy and are in the acute phase of treatment.
Documented history of hypersensitivity or intolerance to tetracycline antibiotics
Use of medications that are contra-indicated with minocycline (e.g., concomitant use of antacids, iron, calcium, magnesium, aluminum, zinc salts as they impair minocycline absorption; of anti-coagulant drugs as minocycline has been shown to depress plasma prothrombin activity; of other antibiotics or Accutane due to the rare side effect of pseudotumor cerebri)
Inability of participant or parent/guardian to read or understand English

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Participants randomized to placebo will receive pills that are identical in appearance to the study drug but contain no active medication.
Minocycline Augmentation	Minocycline	Those randomized to minocycline will receive approximately 2 mg/kg/day, the FDA-approved dose for minocycline (minimum 50 mg/day and maximum 200 mg/day). After randomization, participants will receive child proofed bottles that contain enough study medication until the next visit with an additional 3 days coverage in case of scheduling issues. All participants will have a minocycline level drawn at week 12 to confirm treatment adherence. Minocycline is FDA-approved in those ages 8 and above for treatment of infections and acne and has a favorable risk-benefit profile.

Primary Outcome Measures

Name	Time	Method
Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS)	Change from Baseline at 4, 8, and 12 weeks	The Yale-Brown Obsessive Compulsive Scale, Child Version (CYBOCS) is a semi-structured measure of Obsessive-Compulsive Disorder (OCD) severity with excellent inter-rater reliability, internal consistency, and test-retest reliability. It is validated in those starting at age 7 and used in studies up to age 20. The CYBOCS differs from the adult YBOCS only in its use of simpler language. The total CYBOCS score ranges from 0 to 40, with higher scores indicating more severe symptomatology.

Secondary Outcome Measures

Name	Time	Method
Striatal Glutamate Level Measured by Magnetic Resonance Spectroscopy (MRS).	Change from Baseline at 12 weeks	The change in striatal glutamate level will be assessed.

Locations (2): Weill Cornell Medical Center
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New York, New York, United States
New York State Psychiatric Institute
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New York, New York, United States