Primary:- To investigate the modulatory effect profile of single doses of oral CBD on THC-induced effects in healthy volunteers.Secondary:- To assess the analgesic effect of a single dose of THC in healthy volunteers measured with the PainCart test…
ID
Source
Brief title
Condition
- Other condition
- Neurological disorders NEC
Synonym
Health condition
Chronic neuropathic pain
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
NeuroCart test battery:
Body sway:
o antero-posterior sway (mm);
* Visual Analog Scales (VAS) according to Bond and Lader to assess:
o mood (mm),
o alertness (mm), and
o calmness (mm).
* Visual Analog Scales (VAS) according to Bowdle to assess:
o Feeling high (mm)
o Internal perception (mm)
o External perception (mm)
* Stroop colour word
o Stroop card 1, 2 and 3
- Time completing cards (sec)
- Number of incorrect answers of cards
o Stroop effect: difference in reaction time between card 3 and 2 (sec)
* Adaptive Tracking
o Average performance (%);
* Simple Reaction Time Task (SRT)
o Reaction time (ms)
Questionnaires:
* State-Trait Anxiety Inventory (STAI)
o State anxiety score
* Brief Symptom Inventory (BSI)
o General somatic symptoms
o Cognitive symptoms
o Interpersonal sensitivity
o Depressed mood
o Anxiety
o Hostility
o Phobic anxiety
o Paranoid thoughts
o Psychoticism
o Global severity index
Neuroendocrine markers:
* Prolactin (*g/L)
* Cortisol (nmol/L)
Physiological markers:
* Heart rate (bpm)
Secondary outcome
PainCart test battery:
* Thermal Pain (capsaicin sensitized skin and untreated control skin):Pain
Detection Threshold (PDT), Area Under the Visual Analogue Scale(VAS) pain Curve
(AUC), VAS, Short Form McGill Pain Questionnaire (SFMPQ)
* McGill MPQ-SF
* Pressure Pain: PDT, PTT, AUC, VAS, SF-MPQ
* Cold Pressor: PDT, PTT, AUC, VAS, SF-MPQ
* Electrical Stair: PDT, PTT, AUC, VAS, SF-MPQ
* Pinprick pain assessment: area of secondary mechanical allodynia
following capsaicin application using von Frey hair filaments
PK parameters of THC (and metabolites: 11-OH-THC, THCCOOH), CBD (and
metabolites: 6*-OH-CBD, 6*-OH-CBD, 7-OH-CBD, 7-CBD-COOH and 2'-CBD-Glucuronide)
by non-compartmental analysis of the plasma concentration-time data:
* AUCinf, AUClast, CL/F, Cmax, t1/2, tlag, tmax, Vz/F
* Dose-normalized PK parameters: AUCinf, AUClast, Cmax
* Treatment-emergent (serious) adverse events ((S)AEs) throughout the study at
every study visit
* Concomitant medication throughout the study at every study visit
* Vital signs (Pulse Rate (bpm), Systolic blood pressure (mmHg), Diastolic
blood pressure (mmHg)) as per assessment schedule
* Clinical laboratory tests (Hematology, blood chemistry,glucose and
urinalysis) as per assessment schedule
* ECG parameters (Heart Rate (HR) (bpm), PR, QRS, QT, QTcB, QTcF) as per
assessment schedule
Background summary
THC shows promise as an analgesic compound for some (although not all) patients
with chronic neuropathic pain. However, lack of efficacy in broad patient
populations and adverse effects limit the therapeutic potential of THC for
chronic neuropathic pain. There is an unmet medical need for a way to improve
the tolerability of THC by reducing its adverse effects without compromising
its analgesic properties.
There is clinical evidence for CBD counteracting negative effects of THC,
although this effect has not been found consistently. There is no consensus yet
regarding a beneficial ratio of CBD to THC for clinical practice with regards
to improved side-effect profiles, or improved overall therapeutic effects.
The goal of this trial is to investigate whether (and at which dose or ratio)
CBD has a modulating effect on the psychotropic effects of THC by comparing the
effects of THC to the combination of THC with CBD in a range of ratios.
Simultaneously, this study will compare the analgesic effects THC with
combinations of THC and CBD. We will measure the psychoactive effects of the
study treatments with the validated NeuroCart test battery and the analgesic
effects using the validated PainCart test battery. This study is funded by the
ZonMW *Goed Gebruik Geneesmiddelen* program. The findings from this study may
influence the selection of a THC:CBD ratio in a future trial in patients with
chronic neuropathic pain.
Study objective
Primary:
- To investigate the modulatory effect profile of single doses of oral CBD on
THC-induced effects in healthy volunteers.
Secondary:
- To assess the analgesic effect of a single dose of THC in healthy volunteers
measured with the PainCart test battery.
- To assess the effect of a single dose of CBD on the analgesic properties of a
single dose of THC in healthy volunteers measured with the PainCart test
battery.
- To assess the plasma pharmacokinetics of THC and CBD and their major
metabolites when co-administered in healthy volunteers.
- To assess the safety and tolerability of single oral doses of THC and CBD
when co-administered in healthy volunteers.
Exploratory:
- To explore the relationships between THC and CBD concentrations and
pharmacodynamic markers with PK/PD modelling if deemed beneficial.
- To determine whether capsaicin-induced dermal blood flow is increased by
administration of THC and combinations of THC and CBD compared to placebo
Study design
This study is a randomized, double blind, placebo-controlled, 5-way cross-over
study designed to assess the modulating effect of CBD on the psychotropic
effects of THC at 3 different THC:CBD ratios
Intervention
*9-tetrahydrocannabinol (THC) (Namisol®) and Cannabidiol (CBD) (Arvisol®).
Each study participant will receive the following study treatments:
- Placebo THC + placebo CBD
- THC 9 mg + placebo CBD
- THC 9 mg + CBD 10 mg
- THC 9 mg + CBD 30 mg
- THC 9 mg + CBD 450 mg
Capsaicin 1% (ethanolic solution) is used as a challenge drug (PainCart).
Capsaicin will be administered at screening and during each study period, on
the dominant volar forearm on a pre-defined 30x30 mm area.
Study burden and risks
The current formulation of THC (Namisol ®) has been administered up to 10 mg in
multiple studies including healthy volunteers and different patient
populations. Single oral doses of 8 mg and 10 mg THC have been administered
previously in CHDR0828 and CHDR1440 respectively, and were well tolerated, see
Section E.9. Cannabis use is a known risk factor for triggering psychosis in
vulnerable individuals, and only a very small proportion of the general
population exposed to cannabis develops a psychotic illness. Cannabis is
thought to be a *component cause* in development of schizophrenia or psychotic
disorders, but neither a necessary nor a sufficient cause on its own. To
mitigate this risk, any subjects with a prior history of psychotic illness will
not be allowed to participate in the study. Since all subjects in this study
will have used cannabis prior to participation, the treatment in this study
will not put its participants at an additional risk.
CBD doses are generally known to have a favorable safety and tolerability
profile. Doses far exceeding those planned for this study have been safe and
well tolerated in previous clinical trials. Co-administration of THC and CBD is
not expected to result in an interaction, which would increase risk for the
study participants. On the contrary, clinical studies on the combination of THC
and CBD generally report either a reduction of adverse effects or no difference
compared to THC alone.
Paternal and maternal cannabis use may have adverse effects on pregnancy and
the unborn child. However, the extent of exposure to THC in this trial is
modest compared to the study populations of abovementioned literature. The
single, relatively infrequent doses administered in this study are not expected
to have a large negative impact on the pregnancy and the foetus. The
contraceptive requirements in this study are required as a precaution.
No benefit is expected for study participants, but this study will shed light
on some important gaps in knowledge of these widely used cannabinoids.
Zernikedreef 8
Leiden 2333CL
NL
Zernikedreef 8
Leiden 2333CL
NL
Listed location countries
Age
Inclusion criteria
1. Signed informed consent prior to any study-mandated procedure.
2. Healthy male or female subjects, 18 to 45 years of age, inclusive at
screening.
3. Body mass index (BMI) between 18 and 30 kg/m2, inclusive at screening, and
with a minimum weight of 50 kg.
4. All women of childbearing potential and all males must practice effective
contraception during the study and be willing and able to continue
contraception for at least 90 days after their last dose of study treatment.
5. Has the ability to communicate well with the Investigator in the Dutch
language and willing to comply with the study restrictions.
6. Subject is familiar with cannabis use for at least one year. In the previous
6 months, cannabis use of no more than once a month on average, and able to
refrain from using cannabinoids from at least 3 weeks prior to the first
treatment period to the end of the last study day.
Exclusion criteria
1. Evidence of any active or chronic disease or condition that could interfere
with, or for which the treatment of might interfere with, the conduct of the
study, or that would pose an unacceptable risk to the subject in the opinion of
the investigator (following a detailed medical history, physical examination,
vital signs (systolic and diastolic blood pressure, pulse rate, body
temperature) and 12-lead electrocardiogram (ECG)). Minor deviations from the
normal range may be accepted, if judged by the Investigator to have no clinical
relevance.
2. Clinically significant abnormalities, as judged by the investigator, in
laboratory test results (including hepatic and renal panels, complete blood
count, chemistry panel and urinalysis). In the case of uncertain or
questionable results, tests performed during screening may be repeated before
randomization to confirm eligibility or judged to be clinically irrelevant for
healthy subjects.
3. Positive Hepatitis B surface antigen (HBsAg), Hepatitis C antibody (HCV Ab),
or human immunodeficiency virus antibody (HIV Ab) at screening.
4. Systolic blood pressure (SBP) greater than 140 or less than 90 mm Hg, and
diastolic blood pressure (DBP) greater than 90 or less than 50 mm Hg at
screening.
5. Abnormal findings in the resting ECG at screening defined as:
a. QTcF> 450 or < 300 msec for men and QTcF> 470 or < 300 msec for women
b. Notable resting bradycardia (HR < 40 bpm) or tachycardia (HR > 100 bpm)
c. Personal or family history of congenital long QT syndrome or sudden death;
d. ECG with QRS and/or T wave judged to be unfavourable for a consistently
accurate QT measurement (e.g., neuromuscular artefact that cannot be readily
eliminated, arrhythmias, indistinct QRS onset, low amplitude T wave, merged T-
and U-waves, prominent U waves);
e. Evidence of atrial fibrillation, atrial flutter, complete branch block,
Wolf-Parkinson-White Syndrome, or cardiac pacemaker
6. Use of any medications (prescription or over-the-counter [OTC]), within 7
days of study drug administration, or less than 5 half-lives (whichever is
longer). Exceptions will only be made if the rationale is clearly documented by
the investigator.
7. Use of any vitamin, mineral, herbal, and dietary supplements within 7 days
of study drug administration, or less than 5 half-lives (whichever is longer).
Exceptions will only be made if the rationale is clearly documented by the
investigator.
8. Participation in an investigational drug or device study (last dosing of
previous study was within 90 days prior to first dosing of this study).
9. History of abuse of addictive substances (alcohol, illegal substances) or
current use of more than 21 units alcohol per week, drug abuse, or regular user
of sedatives, hypnotics, tranquillisers, or any other addictive agent.
10. Positive test for drugs of abuse at screening or pre-dose.
11. Alcohol will not be allowed from at least 24 hours before screening or
pre-dose.
12. Smoker of more than 10 cigarettes per day prior to screening or who use
tobacco products equivalent to more than 10 cigarettes per day and unable to
abstain from smoking whilst in the unit.
13. Is demonstrating excess in caffeine consumption (more than eight cups of
coffee or equivalent per day
14. Any confirmed significant allergic reactions (urticaria or anaphylaxis)
against any drug, or multiple drug allergies (non-active hay fever is
acceptable).
15. Loss or donation of blood over 500 mL within three months (males) or four
months (females) prior to screening or intention to donate blood or blood
products during the study.
16. If a woman, pregnant, or breast-feeding, or planning to become pregnant
during the study.
17. Any known factor, condition, or disease that might interfere with treatment
compliance, study conduct or interpretation of the results such as drug or
alcohol dependence or psychiatric disease.
18. Any current, clinically significant, known medical condition in particular
any existing conditions that would affect sensitivity to cold (such as
atherosclerosis, Raynaud*s disease, urticaria, hypothyroidism) or pain (disease
that causes pain, hypesthesia, hyperalgesia, allodynia, paraesthesia,
neuropathy, etc.);
19. Subjects indicating pain tests intolerable at screening or achieving
tolerance at >80% of maximum input intensity for any pain test for cold,
pressure and electrical tests.
20. Subject indicating intolerable pain after capsaicin administration at
screening.
21. History of cannabis-induced psychosis, schizophrenia or other clinically
relevant psychiatric disorders, as judged by the investigator.
22. No secondary mechanical allodynia induced in subject (area of secondary
mechanical allodynia = 0 mm2) at screening.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2021-001660-17-NL |
CCMO | NL77327.056.21 |
OMON | NL-OMON21413 |