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大麻二酚加纳曲酮对酒精依赖者酒精渴望的联合作用研究:一项II期随机、双盲、安慰剂对照、平行组试验的研究方案——ICONICplus试验

Investigation of the combined effects of cannabidiol plus naltrexone on alcohol craving in alcohol dependence: study protocol of a phase II randomised, double-blind, placebo-controlled, parallel-group trial - ICONICplus Trial.

作者信息

Vetter Sina, Weinberg Julia, Thomas Bettina C, Kirchner Marietta, Thalmann Paul, Klose Christina, Pfisterer Marlen, Kölsch Torsten, Oesterle Selma, Vollstaedt-Klein Sabine, Koopmann Anne, Lenz Bernd, Kiefer Falk, Link Tobias, Bach Patrick

机构信息

Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Heidelberg University Medical Faculty, Mannheim, Germany

German Center for Mental Health, Mannheim, Germany.

出版信息

BMJ Open. 2025 Aug 12;15(8):e106348. doi: 10.1136/bmjopen-2025-106348.


DOI:10.1136/bmjopen-2025-106348
PMID:40803733
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12352239/
Abstract

INTRODUCTION: Alcohol dependence (AD) is highly prevalent and has severe consequences on health and quality of life. However, the efficacy of approved pharmacotherapies such as naltrexone (NTX) remains limited, highlighting the need for novel pharmacotherapeutic approaches. Cannabidiol (CBD) is a promising candidate, which has shown potential to reduce craving and alcohol use by modulating brain circuits involved in craving and addiction. Preclinical studies suggest that CBD may enhance NTX's therapeutic effects. METHODS AND ANALYSIS: This is a three-armed, randomised, double-blind, placebo-controlled parallel group, multicentre phase II clinical trial. A total of 150 patients with AD will be randomised (1:1:1) to receive either 800 mg or 1200 mg CBD plus 50 mg oral NTX or placebo plus 50 mg oral NTX for 14 days. Alcohol craving will be assessed using the Obsessive Compulsive Drinking Scale (OCDS-G) where the primary endpoint is the change from baseline to the end of treatment. Secondary outcomes include craving during the entire study, quality of life, depressive symptoms, anxiety, patient-reported outcomes, neural brain activation, CBD plasma levels, time to relapse, alcohol use and treatment safety. For the comparison of each experimental group to the control group, a strata-adjusted (centre and baseline OCDS-G) van Elteren test is applied with adjustment for multiple testing by Bonferroni-Holm. ETHICS AND DISSEMINATION: The trial has been approved by the Ethics Committee and the competent authority (ID: B_03510). All participants will provide written informed consent. An independent Data and Safety Monitoring Board will monitor safety. This trial complies with national and international regulations. TRIAL REGISTRATION NUMBER: NCT06845124; EU Trial Number: 2024-518164-12-00.

摘要

引言:酒精依赖(AD)非常普遍,对健康和生活质量有严重影响。然而,纳曲酮(NTX)等已获批药物疗法的疗效仍然有限,这凸显了对新型药物治疗方法的需求。大麻二酚(CBD)是一个有前景的候选药物,它已显示出通过调节与渴望和成瘾相关的脑回路来减少渴望和酒精使用的潜力。临床前研究表明,CBD可能增强NTX的治疗效果。 方法与分析:这是一项三臂、随机、双盲、安慰剂对照平行组多中心II期临床试验。总共150名酒精依赖患者将被随机分组(1:1:1),接受800毫克或1200毫克CBD加50毫克口服NTX或安慰剂加50毫克口服NTX,为期14天。使用强迫性饮酒量表(OCDS-G)评估酒精渴望,主要终点是从基线到治疗结束的变化。次要结局包括整个研究期间的渴望、生活质量、抑郁症状、焦虑、患者报告的结局、脑神经元激活、CBD血浆水平、复发时间、酒精使用和治疗安全性。为了将每个实验组与对照组进行比较,应用分层调整(中心和基线OCDS-G)的范埃尔特伦检验,并通过邦费罗尼-霍尔姆法进行多重检验调整。 伦理与传播:该试验已获得伦理委员会和主管部门批准(编号:B_03510)。所有参与者将提供书面知情同意书。一个独立的数据和安全监测委员会将监测安全性。本试验符合国家和国际法规。 试验注册号:NCT06845124;欧盟试验编号:2024-518164-12-00。

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本文引用的文献

[1]
Acute cannabidiol administration reduces alcohol craving and cue-induced nucleus accumbens activation in individuals with alcohol use disorder: the double-blind randomized controlled ICONIC trial.

Mol Psychiatry. 2025-6

[2]
ON-ICE trial: Investigation of the combined effects of oxytocin and naltrexone on stress-induced and alcohol cue-induced craving in alcohol use disorder-Study protocol of a phase II randomised double-blind placebo-controlled parallel-group trial.

BMJ Open. 2022-4-11

[3]
THC and CBD effects on alcohol use among alcohol and cannabis co-users.

Psychol Addict Behav. 2021-9

[4]
Therapeutic Efficacy of Cannabidiol (CBD): A Review of the Evidence from Clinical Trials and Human Laboratory Studies.

Curr Addict Rep. 2020-9

[5]
Cannabidiol for the treatment of cannabis use disorder: a phase 2a, double-blind, placebo-controlled, randomised, adaptive Bayesian trial.

Lancet Psychiatry. 2020-10

[6]
Dosage, Efficacy and Safety of Cannabidiol Administration in Adults: A Systematic Review of Human Trials.

J Clin Med Res. 2020-3

[7]
Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial.

Am J Psychiatry. 2019-5-21

[8]
Incubation of neural alcohol cue reactivity after withdrawal and its blockade by naltrexone.

Addict Biol. 2020-1

[9]
Cannabidiol as a Novel Candidate Alcohol Use Disorder Pharmacotherapy: A Systematic Review.

Alcohol Clin Exp Res. 2019-2-19

[10]
Effects of cannabidiol plus naltrexone on motivation and ethanol consumption.

Br J Pharmacol. 2018-7-1

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