Atomoxetine PBPK-PD Clinical Study

NCT03154359 | Completed Results FDA Drug

• 2 other identifiers: 16100728U54HD090258-01
• Study Type: observational
• Target: 51
• Locations: 1 country
• Sites: 1

Brief Summary

The primary aims of this study focus on characterizing the relationship between atomoxetine exposure and clinical outcomes, as assessed by standardized measures. We will also simultaneously monitor side effect of atomoxetine, another measure of clinical outcomes, and categorize study participants on their ability to tolerate atomoxetine.

Conditions

ADHD

Outcome Measures

Primary Outcomes (13)

• Number of Participants Classified as Responders and Non-responders to Intervention

  Classification of participants as "responders" versus "non-responders" is based on percent reduction in total National Initiative for Children's Healthcare Quality (NICHQ) Vanderbilt Assessment Scale (3rd edition) score from baseline. Participants with ≥40% reduction in total score from baseline are classified as responders. The scale assesses the presence and severity of 18 DSM-V criteria for attention deficit hyperactivity disorder (ADHD) symptoms. Symptoms are rated on a 4-point Likert-type scale: 0 ("Never") to 3 ("Very Often"). Maximum total symptom score is 54.The measure includes 8 questions assessing functional impairment ("Performance"). Impairment is rated on a 5-point Likert-type scale: 1 ("Excellent") to 5 ("Problematic").

  6 weeks

• Number of Participants Classified as Responders and Non-responders to Intervention

  Classification of participants as "responders" versus "non-responders" is based on percent reduction in total National Initiative for Children's Healthcare Quality (NICHQ) Vanderbilt Assessment Scale (3rd edition) score from baseline. Participants with ≥40% reduction in total score from baseline are classified as responders. The scale assesses the presence and severity of 18 DSM-V criteria for attention deficit hyperactivity disorder (ADHD) symptoms. Symptoms are rated on a 4-point Likert-type scale: 0 ("Never") to 3 ("Very Often"). Maximum total symptom score is 54.The measure includes 8 questions assessing functional impairment ("Performance"). Impairment is rated on a 5-point Likert-type scale: 1 ("Excellent") to 5 ("Problematic").

  18 weeks

• Maximum Plasma Concentration (Cmax) of Atomoxetine

  Cmax is the highest concentration of atomoxetine measured over a 12-hour period following administration of the drug on pharmacokinetic study days occurring at baseline (first dose). Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders.

  Baseline (first dose)

• Maximum Plasma Concentration (Cmax) of Atomoxetine

  Cmax is the highest concentration of atomoxetine measured following administration of the drug on pharmacokinetic study days occurring at 6 weeks. Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders.

  6 weeks

• Maximum Plasma Concentration (Cmax) of Atomoxetine

  Cmax is the highest concentration of atomoxetine measured following administration of the drug on pharmacokinetic study days occurring at 18 weeks. Cmax is an estimate of atomoxetine systemic exposure and is compared between responders and non-responders.

  18 weeks

• Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine

  AUC is the area under the plasma concentration-time curve following administration of atomoxetine. For the baseline pharmacokinetic study (first dose of atomoxetine) plasma concentrations were measured at 17 timepoints between 0 and 72 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, 24, 48, and 72 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) after dose administration for all other participants. The AUC was generated using a mixed log-linear approach and extrapolated to infinity. AUC is compared between responders and non-responders.

  Baseline (first dose)

• Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine

  For the steady-state pharmacokinetic studies at 6 weeks, plasma concentrations were measured at 15 timepoints between 0 and 24 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and at 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) and extrapolated to 24 hours for all other participants. AUC is compared between responders and non-responders.

  6 weeks

• Area Under the Plasma Concentration-time Curve (AUC) of Atomoxetine

  For the steady-state pharmacokinetic studies at 18 weeks, plasma concentrations were measured at 15 timepoints between 0 and 24 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 hours) post-dose for CYP2D6 poor and intermediate metabolizers, and at 12 timepoints between 0 and 12 hours (0, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 10, and 12 hours) and extrapolated to 24 hours for all other participants. AUC is compared between responders and non-responders.

  18 weeks

• Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG)

  DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, absolute baseline and pre-dose concentrations of DHPG will be compared between atomoxetine responders and non-responders.

  Baseline

• Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG)

  DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, pre-dose concentration of DHPG at the 6-week pharmacokinetic study visit will be compared between atomoxetine responders and non-responders.

  6 weeks

• Plasma Concentration of 3,4-dihydroxyphenylglycol (DHPG)

  DHPG has been proposed as a biomarker of the activity of the norepinephrine reuptake transporter (NET; SLC6A2), the target of atomoxetine action. DHPG is a degradation product of norepinephrine after it has been taken up by pre-synaptic neurons, and higher concentrations in plasma are considered to reflect higher NET activity (higher reuptake of norepinephrine into pre-synaptic neurons). To assess the potential value of DHPG as a biomarker of atomoxetine response in ADHD, pre-dose concentration of DHPG at the 18-week pharmacokinetic study visit will be compared between atomoxetine responders and non-responders.

  18 weeks

• Change in Plasma Concentration of DHPG From Baseline

  The change in DHPG will be compared between atomoxetine responders and non-responders.

  6 weeks

• Change in Plasma Concentration of DHPG From Baseline

  The change in DHPG will be compared between atomoxetine responders and non-responders.

  18 weeks

Interventions

Atomoxetine Hydrochloride DRUG

Atomoxetine dose adjusted to achieve pre-defined concentration

Eligibility Criteria

• Age: 6 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

Males and females 6-18 years of age, with a diagnosis of ADHD.

You may qualify if:

• Diagnosis of ADHD, as confirmed by a Study Physician at intake visit.
• Intention of the Study Physician to begin therapy with ATX at intake visit
• Willing to provide written permission/assent to participate
• ADHD Medication Status is one of the following:
• ADHD medication naïve or not currently taking ADHD medication including stimulants, α2-agonists, and ATX, or
• Currently taking a stimulant for ADHD and is willing to wash out of stimulants prior to starting ATX. This washout is also approved by a Study Physician, or other qualified study personnel (see Section 11.0 for Procedures Involved).

You may not qualify if:

• An IQ \< 70
• A diagnosis of Autism Spectrum Disorder
• Inability or unwillingness to have blood drawn as described in the protocol schedule of events and consent
• Underlying risk for cardiotoxicity, such as presentation of structural cardiac abnormalities, cardiomyopathy, or arrhythmias
• Clinically significant abnormal safety laboratory values as determined by treating physician
• Diagnosis that may cause abnormal absorption or gastric emptying, such as reflux, inflammatory bowel disease, or Crohn's disease
• For females, a positive urine pregnancy test
• Previous history of adverse drug reaction to ATX
• Use of drugs known to inhibit CYP2D6:
• Concurrent therapy with sertraline, venlafaxine, imipramine, nortriptyline, quinidine, propafenone, cimetidine, tamoxifen, bupropion, over-the-counter medications containing diphenhydramine, codeine, tramadol, hydrocodone, or oxycodone
• Concurrent or previous therapy with fluoxetine or paroxetine in the last 2 months
• Concurrent or previous therapy with terbinafine in the last 6 months
• Unwillingness or inability to washout of stimulant ADHD medications
• Concurrent or recent use of other psychiatric/behavioral health drugs including SSRIs, SNRIs, antipsychotics, anxiolytics, anti-epileptics, and α2-agonists that would impact the participant's pharmacokinetic and/or pharmacodynamic baseline
• Subject is considered by PI to be unsuitable for participation in the study for any reason

Sponsors & Collaborators

• Children's Mercy Hospital Kansas City: lead
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator

Study Sites (1)

Children's Mercy Hospital and Clinics

Kansas City, Missouri, 64108, United States

Location

Related Publications (10)

• Newcorn JH, Sutton VK, Weiss MD, Sumner CR. Clinical responses to atomoxetine in attention-deficit/hyperactivity disorder: the Integrated Data Exploratory Analysis (IDEA) study. J Am Acad Child Adolesc Psychiatry. 2009 May;48(5):511-518. doi: 10.1097/CHI.0b013e31819c55b2.

  PMID: 19318988 BACKGROUND

• Seneca N, Gulyas B, Varrone A, Schou M, Airaksinen A, Tauscher J, Vandenhende F, Kielbasa W, Farde L, Innis RB, Halldin C. Atomoxetine occupies the norepinephrine transporter in a dose-dependent fashion: a PET study in nonhuman primate brain using (S,S)-[18F]FMeNER-D2. Psychopharmacology (Berl). 2006 Sep;188(1):119-27. doi: 10.1007/s00213-006-0483-3. Epub 2006 Aug 4.

  PMID: 16896954 BACKGROUND

• Michelson D, Read HA, Ruff DD, Witcher J, Zhang S, McCracken J. CYP2D6 and clinical response to atomoxetine in children and adolescents with ADHD. J Am Acad Child Adolesc Psychiatry. 2007 Feb;46(2):242-51. doi: 10.1097/01.chi.0000246056.83791.b6.

  PMID: 17242628 BACKGROUND

• Kim CH, Hahn MK, Joung Y, Anderson SL, Steele AH, Mazei-Robinson MS, Gizer I, Teicher MH, Cohen BM, Robertson D, Waldman ID, Blakely RD, Kim KS. A polymorphism in the norepinephrine transporter gene alters promoter activity and is associated with attention-deficit hyperactivity disorder. Proc Natl Acad Sci U S A. 2006 Dec 12;103(50):19164-9. doi: 10.1073/pnas.0510836103. Epub 2006 Dec 4.

  PMID: 17146058 BACKGROUND

• Gaedigk A, Twist GP, Leeder JS. CYP2D6, SULT1A1 and UGT2B17 copy number variation: quantitative detection by multiplex PCR. Pharmacogenomics. 2012 Jan;13(1):91-111. doi: 10.2217/pgs.11.135. Epub 2011 Nov 23.

  PMID: 22111604 BACKGROUND

• Gaedigk A, Simon SD, Pearce RE, Bradford LD, Kennedy MJ, Leeder JS. The CYP2D6 activity score: translating genotype information into a qualitative measure of phenotype. Clin Pharmacol Ther. 2008 Feb;83(2):234-42. doi: 10.1038/sj.clpt.6100406. Epub 2007 Oct 31.

  PMID: 17971818 BACKGROUND

• Gaedigk A, Ndjountche L, Divakaran K, Dianne Bradford L, Zineh I, Oberlander TF, Brousseau DC, McCarver DG, Johnson JA, Alander SW, Wayne Riggs K, Steven Leeder J. Cytochrome P4502D6 (CYP2D6) gene locus heterogeneity: characterization of gene duplication events. Clin Pharmacol Ther. 2007 Feb;81(2):242-51. doi: 10.1038/sj.clpt.6100033.

  PMID: 17259947 BACKGROUND

• Gaedigk A, Jaime LK, Bertino JS Jr, Berard A, Pratt VM, Bradfordand LD, Leeder JS. Identification of Novel CYP2D7-2D6 Hybrids: Non-Functional and Functional Variants. Front Pharmacol. 2010 Oct 4;1:121. doi: 10.3389/fphar.2010.00121. eCollection 2010.

  PMID: 21833166 BACKGROUND

• Gaedigk A, Fuhr U, Johnson C, Berard LA, Bradford D, Leeder JS. CYP2D7-2D6 hybrid tandems: identification of novel CYP2D6 duplication arrangements and implications for phenotype prediction. Pharmacogenomics. 2010 Jan;11(1):43-53. doi: 10.2217/pgs.09.133.

  PMID: 20017671 BACKGROUND

• Gaedigk A. Complexities of CYP2D6 gene analysis and interpretation. Int Rev Psychiatry. 2013 Oct;25(5):534-53. doi: 10.3109/09540261.2013.825581.

  PMID: 24151800 BACKGROUND

MeSH Terms

Conditions

Attention Deficit Disorder with Hyperactivity

Interventions

Atomoxetine Hydrochloride

Condition Hierarchy (Ancestors)

Attention Deficit and Disruptive Behavior Disorders; Neurodevelopmental Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Propylamines; Amines; Organic Chemicals

Limitations and Caveats

Recruitment was severely affected by the COVID-19 pandemic, and did not recover as hospital operations adapted to the pandemic. Therefore, study was terminated before enrollment goal was met.

Results Point of Contact

• Title: James Steven Leeder, PharmD, PhD
• Organization: Children's Mercy Hospital

sleeder@cmh.edu

816-731-7116

Study Officials

• James S Leeder, PharmD, PhD

  Children's Mercy Hospital Kansas City

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Deputy Director, Children's Mercy Research Institute

Study Record Dates

• First Submitted: May 4, 2017
• First Posted: May 16, 2017
• Study Start: December 12, 2017
• Primary Completion: June 1, 2022
• Study Completion: June 16, 2022
• Last Updated: August 8, 2023
• Results First Posted: August 8, 2023

Record last verified: 2023-08

Locations

US (1)