Double-Blind Placebo-Controlled Trial of Riluzole in Pediatric Bipolar Disorder
| Status: | Terminated |
|---|---|
| Conditions: | Anxiety, Depression, Psychiatric, Bipolar Disorder |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 9 - 17 |
| Updated: | 4/21/2016 |
| Start Date: | November 2008 |
| End Date: | June 2012 |
Pediatric Bipolar Disorder (BD) is uncommon in children. Its symptoms include periods of
manic behavior (being overly happy or giddy, feeling grandiose, feeling a decreased need for
sleep, having too much energy, moving more than usual, talking fast, having speeded-up
thoughts and other symptoms). Sometimes there also is depression (extreme feelings of
sadness or irritability, not taking pleasure in things, even ones that used to be enjoyable,
feeling worthless or guilty, sleeping too much or having trouble getting to or staying
asleep, feeling slowed down or restless, having wishes to be dead or suicidal ideas, and
other symptoms). Pediatric BD is often difficult to treat; children may respond only
partially to the medications now available or have too many side effects to tolerate them.
Riluzole is a medication that is thought to work on a brain chemical called glutamate that
may be involved in symptoms of depression and BD. Previous research studies have shown that
riluzole may help adults with BD who have depression and adults who have depression, anxiety
disorders, or obsessive-compulsive disorders. Riluzole may also be helpful for children with
obsessive-compulsive disorder. However, it has never been given to children with BD.
This study will evaluate the effectiveness of riluzole in 80 patients between 9 and 17 years
of age who have BD and symptoms of anxiety. Participants must have tried at least two other
medications that have not been effective.
The study will consist of four phases carried out over 4 to 5 months. Most children will be
inpatients at the Pediatric Behavioral Health Unit for at least part of the study.
In Phase 1, each patient will undergo blood and urine tests, and will gradually taper off
his or her medication. The duration of this phase depends on the medication that the patient
was receiving before starting the study.
In Phase 2, the patient will remain off all medication for 1 week. Throughout this time,
patients will be monitored carefully and medication will be restarted if needed.
In Phase 3, which lasts 8 weeks, patients will be assigned randomly to receive only riluzole
or only a placebo. Those who receive riluzole will have the dose adjusted as needed.
Patients and families will be informed of which drug they were on at the end of this phase.
Patients who improved on riluzole may continue to receive it from NIH for 1 month and will
then be prepared for discharge from the study. Patients who received placebo and improved,
and those who received riluzole but did not improve, will be treated with standard
medications as appropriate and prepared for discharge from the study.
Phase 4 is for patients who received placebo and did not improve. They will be given the
chance to try riluzole for 8 weeks and, if it is effective, continue it for an additional 4
weeks while they prepare to be discharged from the study.
Patients will not be able to receive riluzole at the National Institutes of Health after the
completion of the study. However, the child's doctor may be able to prescribe riluzole as an
off-label use.
Most patients will be admitted to the Pediatric Behavioral Health Unit at the National
Institutes of Health Clinical Center during the medication withdrawal part of the study
(Phases 1 and 2). From Phase 3 on, a patient may participate as an inpatient, outpatient, or
in day treatment, depending on what is in his or her best interests.
All participants in this study will be invited to also enroll in the National Institute of
Mental Health protocol 00-M-0198, The Phenomenology and Neurophysiology of Affective
Dysregulation In Children And Adolescents With Bipolar Disorder. Some research tests for
that protocol will be done during the medication-free period of this protocol.
manic behavior (being overly happy or giddy, feeling grandiose, feeling a decreased need for
sleep, having too much energy, moving more than usual, talking fast, having speeded-up
thoughts and other symptoms). Sometimes there also is depression (extreme feelings of
sadness or irritability, not taking pleasure in things, even ones that used to be enjoyable,
feeling worthless or guilty, sleeping too much or having trouble getting to or staying
asleep, feeling slowed down or restless, having wishes to be dead or suicidal ideas, and
other symptoms). Pediatric BD is often difficult to treat; children may respond only
partially to the medications now available or have too many side effects to tolerate them.
Riluzole is a medication that is thought to work on a brain chemical called glutamate that
may be involved in symptoms of depression and BD. Previous research studies have shown that
riluzole may help adults with BD who have depression and adults who have depression, anxiety
disorders, or obsessive-compulsive disorders. Riluzole may also be helpful for children with
obsessive-compulsive disorder. However, it has never been given to children with BD.
This study will evaluate the effectiveness of riluzole in 80 patients between 9 and 17 years
of age who have BD and symptoms of anxiety. Participants must have tried at least two other
medications that have not been effective.
The study will consist of four phases carried out over 4 to 5 months. Most children will be
inpatients at the Pediatric Behavioral Health Unit for at least part of the study.
In Phase 1, each patient will undergo blood and urine tests, and will gradually taper off
his or her medication. The duration of this phase depends on the medication that the patient
was receiving before starting the study.
In Phase 2, the patient will remain off all medication for 1 week. Throughout this time,
patients will be monitored carefully and medication will be restarted if needed.
In Phase 3, which lasts 8 weeks, patients will be assigned randomly to receive only riluzole
or only a placebo. Those who receive riluzole will have the dose adjusted as needed.
Patients and families will be informed of which drug they were on at the end of this phase.
Patients who improved on riluzole may continue to receive it from NIH for 1 month and will
then be prepared for discharge from the study. Patients who received placebo and improved,
and those who received riluzole but did not improve, will be treated with standard
medications as appropriate and prepared for discharge from the study.
Phase 4 is for patients who received placebo and did not improve. They will be given the
chance to try riluzole for 8 weeks and, if it is effective, continue it for an additional 4
weeks while they prepare to be discharged from the study.
Patients will not be able to receive riluzole at the National Institutes of Health after the
completion of the study. However, the child's doctor may be able to prescribe riluzole as an
off-label use.
Most patients will be admitted to the Pediatric Behavioral Health Unit at the National
Institutes of Health Clinical Center during the medication withdrawal part of the study
(Phases 1 and 2). From Phase 3 on, a patient may participate as an inpatient, outpatient, or
in day treatment, depending on what is in his or her best interests.
All participants in this study will be invited to also enroll in the National Institute of
Mental Health protocol 00-M-0198, The Phenomenology and Neurophysiology of Affective
Dysregulation In Children And Adolescents With Bipolar Disorder. Some research tests for
that protocol will be done during the medication-free period of this protocol.
OBJECTIVE: To test the efficacy of riluzole in youth with bipolar disorder
STUDY POPULATION: Youth, ages 9-17, with DSM-IV bipolar disorder, who have failed to respond
to two adequate trials of medication, one with an atypical antipsychotic medication, and the
second with either a mood stabilizing medication or a second atypical antipsychotic
medication.
DESIGN: Medication withdrawal, followed by a 15-day dose stabilization phase and a 6-week
double-blind, placebo-controlled treatment trial. The first two phases will be completed as
inpatients or in day treatment, while the third phase can be completed either in those
settings or as an outpatient. Individuals who received placebo will be offered an 8-week
open trial of riluzole followed by an additional 4 weeks if they respond, while those who
received riluzole in the placebo-controlled trial and wish to continue it will receive 4
weeks of open treatment. Thus, all patients will have the opportunity to receive a total of
12 weeks of riluzole treatment.
OUTCOME MEASURES: Clinical rating scales, including the Pediatric Anxiety Rating Scale and
the Clinical Global Improvement Scale
STUDY POPULATION: Youth, ages 9-17, with DSM-IV bipolar disorder, who have failed to respond
to two adequate trials of medication, one with an atypical antipsychotic medication, and the
second with either a mood stabilizing medication or a second atypical antipsychotic
medication.
DESIGN: Medication withdrawal, followed by a 15-day dose stabilization phase and a 6-week
double-blind, placebo-controlled treatment trial. The first two phases will be completed as
inpatients or in day treatment, while the third phase can be completed either in those
settings or as an outpatient. Individuals who received placebo will be offered an 8-week
open trial of riluzole followed by an additional 4 weeks if they respond, while those who
received riluzole in the placebo-controlled trial and wish to continue it will receive 4
weeks of open treatment. Thus, all patients will have the opportunity to receive a total of
12 weeks of riluzole treatment.
OUTCOME MEASURES: Clinical rating scales, including the Pediatric Anxiety Rating Scale and
the Clinical Global Improvement Scale
- INCLUSION CRITERIA:
- Boys and girls
- Ages 9-17 years of age
- Meet DSM-IV criteria for bipolar disorder.
- The child must have a primary caregiver who can accompany him or her on trips to
NIMH, provide reliable history and information, and complete rating scales.
- Patients must have a psychiatrist who provides clinical care for their BPD.
- All youth accepted into the study must be able to complete self-rating forms and to
cooperate with other study procedures.
- Previous treatment failure as defined by:
1. Failure to respond to an adequate trial (adequate dose for at least two weeks)
of a mood stabilizer (either lithium or divalproex) plus an adequate trial
(sufficient dose for an adequate duration) of an atypical antipsychotic (such as
risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole)
2. Failure to respond to an adequate trial (sufficient dose for an adequate
duration) of two atypical antipsychotics (such as risperidone, olanzapine,
quetiapine, ziprasidone, or aripiprazole) or
3. Evidence of intolerance (severe weight gain or other side effects) of a mood
stabilizer or atypical antipsychotic agent.
- The child is failing his/her current treatment as defined by (all 3 met):
1. The child's current CGAS score must be less than 60.
2. The child's current psychiatrist must agree that the child's response to his/her
current treatment is no more than minimal or there are drug side effects that
are proving problematic. According to this criterion, it would be clinically
appropriate to change the child's current treatment.
3. On the basis of record review and interviews with child and parent, the research
team agrees that the child's response to his/her current treatment is no more
than minimal.
- Subject has a PARS score of greater than or equal to 10, derived from the total of
the following individual items: 3 (overall severity of anxious feelings), 5 (overall
avoidance), 6 (interference with family), and 7 (interference outside of the home).
In addition, patients must score 3 or higher (i.e., in the clinical range) on at
least one of the four items noted above.
EXCLUSION CRITERIA:
- I.Q. less than 70
- Autistic disorder or severe pervasive developmental disorder; psychosis that
interferes with the child's capacity to understand and comply with study procedures;
- Unstable medical illness (e.g. severe asthma) or contraindication to riluzole
- Medical illness that could cause the symptoms of bipolar illness (e.g. multiple
sclerosis, thyroid disease);
- Pregnancy
- Renal or hepatic dysfunction that would interfere with excretion or metabolism of
riluzole as evidenced by increase above upper limits of normal for BUN/creatinine, or
two-fold elevation of serum transaminases (ALT/SGPT, AST/SGOT), gamma glutamate
(GGT), or bilirubin.
- Documented history of hypersensitivity or intolerance to riluzole.
- Substance abuse within two months of study entry
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
Click here to add this to my saved trials
