Effect of AEF0117 on Treatment-seeking Patients With Cannabis Use Disorder (CUD): SICA 2: SPECIFIC SIGNALING INHIBITOR IN CANNABIS ADDICTION
Cannabis use is increasing and will only further escalate with legalization of recreational and medical cannabis use in western countries , with a prevalence greater than 30 % in the US and most European countries for individuals between 16 and 24 years of age. Approximately 9 % of those who use cannabis will become addicted. The number goes up to about 1 in 6 among those who start using cannabis as teenagers and to 25 to 50 % among those who smoke cannabis daily. The consequences of cannabis abuse in the most prone population (14-25 years of age) are extremely serious, and may include addiction, altered brain development, poorer educational outcomes, cognitive impairment, lower income, greater welfare dependence, unemployment and lower relationship and life satisfaction. There are no available pharmacological treatments of cannabis use disorder (CUD). Thus, the development of safe and effective medications for the treatment of CUD is an urgent public health priority.The preclinical efficacy and available ADMET (Administration, Distribution, Metabolism, Elimination and Toxicology) in animal and human data suggest that AEF0117, an investigational new study drug, could constitute a very efficacious and safe treatment for cannabis abuse disorders. The purpose of this research is to study how AEF0117 influences the subjective effects of cannabis in subjects with CUD. AEF0117 acts in the same parts of the brain as THC (tetrahydrocannabinol), the active ingredient of marijuana, and may temporarily alter some of cannabis's effects. The safety and tolerability of AE0117 has been demonstrated in the clinical studies conducted to date. This study will provide additional data on the efficacy of AEF0117 on treatment-seeking subjects with moderate to severe CUD. This is a phase 2b, randomized, double-blind, placebo-controlled, 4-arm, parallel-group, prospective, multicenter study. The overall purpose of this study is to assess the efficacy and safety of AEF0117 in subjects with moderate to severe CUD who are treatment-seeking. The primary objective of this study is to demonstrate that AEF0117 induces a greater proportion of RESPONDERS (i.e., subjects with a RESPONSE of ≤1 day of cannabis use per week) compared to placebo in treatment-seeking subjects with moderate to severe CUD, according to DSM-5 criteria.The secondary objectives are to investigate the proportion of subjects that reach various levels of reduction and how this influences their quality of life, and to evaluate the safety and tolerability of AEF0117. And the exploratory objectives of this study are to further evaluate the effect of AEF0117 on pattern of cannabis use and change in various signs and symptoms, and in addition to assess effects during the grace period and the entire treatment period.
- Male or female subjects between 18 and 65 years old, both inclusive.
- Subjects must meet DSM-5 criteria for moderate to severe CUD as assessed by the standard MINI-5.
- Subjects must be treatment-seeking and have a mean cannabis use of ≥5 days per week within the last 4 weeks at the screening and baseline visit of the study. Mean cannabis use is assessed by the TLFB and a positive urine concentration test (creatinine-normalized [THC-COOH] ≥50 ng/mL).
- Subjects must use inhalation (i.e., smoking, vaping) consistently as the primary route of cannabis administration. Additional use of edible cannabis is allowed.
- Written informed consent to participate in the study.
- Body mass index (BMI) between ≥18 and <35 kg/m2, inclusive, by Nomograph for BMI at screening.
- Female subjects of childbearing potential, defined as having a menstrual cycle that is confirmed prior to enrollment, and who are heterosexually active and not surgically sterile or at least 2 years postmenopausal, must agree to use one of the following forms of contraception throughout the study and until 21 days after the last dose of study drug: abstinence, hormonal (oral, transdermal, implant, or injection), barrier (condom, diaphragm with spermicide), intrauterine device, or vasectomized partner (6 months minimum).
- Male subjects are to refrain from donating sperm and heterosexually active male subjects must agree to the use of highly effective contraceptive methods (e.g., double barrier with at least condoms and spermicide) from screening through 90 days after the last dose of study drug, or their female partner must use a highly effective method of contraception as listed in inclusion criteria 7 from screening through 90 days after the last dose.
- No clinically significant abnormal findings in the medical history, on physical examination, ECG, or clinical laboratory results (see Appendix B) during screening that could jeopardize the safety of the subject or impact the validity of the study.
- Subjects must agree to return to the study site as required, be able to read English, and be willing to comply with all required study procedures.
- A history of clinically significant gastrointestinal, renal, hepatic, neurologic, hematologic, endocrine, oncologic, pulmonary, immunologic, psychiatric, or cardiovascular disease, or any other condition which, in the opinion of the principal investigator, would jeopardize the safety of the subject or impact the validity of the study results. For psychiatric disease, see more details below.
- Subject has had significant traumatic injury, major surgery, or open biopsy within 30 days prior to the screening visit.
- Presence or history within 12 months prior to screening of other substance use disorders according to DSM-5 criteria (as assessed by the MINI-5, psychiatric assessment, urine drug screen, breath analyzer, as appropriate) except for mild alcohol use disorder (as defined in DSM-5) or tobacco use disorder. Current use (within 30 days prior to screening) of opioid agonist or antagonist.
- Subjects meeting DSM-5 criteria for schizophrenia, schizoaffective illness, psychotic disorder other than transient psychosis due to drug abuse, bipolar illness, or psychiatric disorders (other than substance abuse).
- Subjects with major depression and a HAM-D >17, and subjects with a baseline CGI >4 for other psychiatric disorders. Subjects with major depression or other current psychiatric disorders, in whom stable control has not been obtained within the 3 months prior to screening (with either behavioral treatment or unchanged medication and dose). Subjects with a current psychiatric disorder treated with prohibited medications (e.g., benzodiazepines, antipsychotics, and anticonvulsants). Present psychiatric state as established by the MINI-5 (severity and change in symptoms will be measured by the Hamilton Anxiety [HAM-A] and Depression [HAM-D] Scales [14-item anxiety and 17-item depression] at start of and during the study).
- Subjects with a history of or current homicidal ideations or attempts.
- Subjects with a past suicide attempt within the past 2 years or any Suicidal Ideation of 3, 4, or 5 or any Suicidal Behavior in Lifetime using the Baseline/Screening version of the C-SSRS.
- Subjects who use daily supplements of steroids (or food containing steroids), including pregnenolone, during the 4 weeks prior to the first screening visit. Topical use of steroids is allowed, and hormonal contraceptives are allowed if using a stable regimen throughout the study.
- Subjects with frequent regular use of diet or supplements (e.g., St. John's Wort), food or grapefruit juice that may interfere with the activities of CYP P450.
- Participation in a clinical trial within 1 month prior to the first dose of study drug, or 2 months if terminal half-life of the investigational drug is more than 120 hours.
- Female subjects who are trying to conceive, are pregnant, are lactating or have a positive serum pregnancy test at screening or a positive urine pregnancy test at study visits, regardless of childbearing potential.
- A positive urine drug screen for other drugs of abuse other than cannabinoids and/or a positive breath test for alcohol. One repeat alcohol breath test is allowed at a second screening visit or at the baseline visit.
- Subjects with known allergy to corn or corn derivatives.
- Subjects under any administrative or legal supervision.
- Subjects taking any of the medications or substances