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CompletedNCT03087201CANNA-TICSUpdated Dec 10, 2020

CANNAbinoids in the Treatment of TICS (CANNA-TICS)

A Phase 3 interventional study of nabiximols and placebo in Tourette Syndrome and Tic Disorders, sponsored by Hannover Medical School. Completed at 6 sites in Germany. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-12-10.

Sponsored by Hannover Medical School · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
98
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This is a multicentre, randomized, double-blind, placebo controlled, parallel-group, phase IIIb trial.

Patients (≥18 years) with chronic tic disorders and Tourette syndrome will be recruited.

The objective of the trial is to demonstrate that treatment with the cannabis extract nabiximols is superior to placebo in reducing tics and comorbidities in patients with Tourette syndrome and chronic tic disorders.

02

Conditions studied

  • Tourette Syndrome
  • Tic Disorders

Keywords

  • Chronic tic disorders
  • Tourette syndrome
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Chronic tic disorder or Tourette syndrome according to DSM-5
  2. Age ≥18 years
  3. Total tic score of the Yale Global Tic Severity Scale (YGTSS-TTS) > 14 for patients with Tourette syndrome or YGTSS-TTS > 10 for patients with chronic motor or vocal tics only (= CTD)
  4. Clinical Global Impression-Severity Score (CGI-S) ≥ 4
  5. Medication (and stimulation parameters for deep brain stimulation) for tics and comorbidities must be on a stable dose for at least 30 days before entering the study and patient must consent to maintain the stable dose during the study
  6. Signed written informed consent and willingness to comply with treatment and follow-up procedures
  7. Patients capable of understanding the investigational nature, potential risks and benefits of the clinical trial
  8. Prevention of pregnancy:

Women without childbearing potential defined as follows:

  • at least 6 weeks after surgical sterilization by bilateral tubal ligation or bilateral oophorectomy or
  • hysterectomy or uterine agenesis or
  • ≥ 50 years and in postmenopausal state ≥ 1 year or
  • \< 50 years and in postmenopausal state ≥ 1 year with urine FSH > 40 IU/l and urine oestrogen \< 30 ng/l or a negative oestrogen test or

Women of childbearing potential with a negative urine ß-HCG pregnancy test at screening who agree to meet one of the following criteria from the time of screening, during the study and for a period of three months following the last administration of study medication:

  • correct use of contraception methods. The following are acceptable: hormonal contraceptives (combined oral contraceptives, oestrogen-free pills with desogestrel, implants, transdermal patches, hormonal vaginal devices or injections with prolonged release), intrauterine device (IUS)
  • true abstinence (periodic abstinence and withdrawal are not acceptable methods of contraception)
  • sexual relationship only with female partners and/or sterile male partners or Males who are not surgically sterile and who are sexually active with female partner(s) of childbearing potential must agree to correct use of one of the following contraception methods from the time of screening, during the study and for a period of three months following the last administration of study medication: hormonal contraceptives (combined oral contraceptives, oestrogen-free pills with desogestrel, implants, transdermal patches, hormonal vaginal devices or injections with prolonged release), intrauterine device (IUS)

Exclusion criteria

Exclusion Criteria:

  1. Comorbid obsessive-compulsive disorder (OCD), attention deficit/hyperactivity disorder (ADHD), depression, anxiety disorder when unstable or in need of an initial adjustment for a therapy
  2. Ongoing behavioural treatment for tics
  3. History of schizophrenia, psychotic, severe personality, or pervasive developmental disorder
  4. Patient has a history of suicidal ideation with intent to act or a plan to act in the 12 months preceding the Screening Visit
  5. Current clinical diagnosis of substance abuse or dependence and compulsive disorder
  6. Secondary tic disorders and other significant neurological disorders that, in the opinion of the investigator, might interfere with the patient's participation in the study, poses added risk for the patient, or confounds the assessment of patient safety
  7. Severe cardiovascular diseases, hepatitis C, or other severe hepatic and renal disorders by history that, in the opinion of the investigator, might interfere with the patient's participation in the study, poses added risk for the patient, or confounds the assessment of patient safety
  8. Any medical condition based on medical history, physical examination, and vital sign measurements that, in the opinion of the Investigator, might interfere with the patient's participation in the study, poses added risk for the patient, or confounds the assessment of patient safety
  9. Use of cannabis or cannabinoid-based medicine (CBM) in the 30-day period prior to study entry and/or positive delta-9-tetrahydrocannabinol (THC) urine test
  10. Positive urine pregnancy test
  11. Pregnancy or lactation period
  12. The subject has received any investigational medication or used any investigational device within 30 days prior to the first dose of study medication or is actively participating in any investigational drug or device study, or is scheduled to receive an investigational drug or to use an investigational device during the course of the study.
  13. Known or suspected hypersensitivity to any of the active substances or any excipients of the investigational medicinal product
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Investigator)
Enrollment
98 participants (actual)

Study arms

  • Experimental
    nabiximols, oromucosal spray

    1-12 puffs nabiximols / day, Duration of treatment: 13 weeks

    Drug: nabiximols

  • Placebo comparator
    placebo, oromucosal spray

    1-12 puffs placebo / day, Duration of treatment: 13 weeks

    Drug: placebo

Interventions

  • Drugnabiximols

    starting dose (1 puff): 2.7 mg delta-9-tetrahydrocannabinol (THC) and 2.5 mg cannabidiol (CBD), maximum dose (12 puffs): 32.4 mg THC/30 mg CBD, no target dose is defined Duration of treatment: 13 weeks

  • Drugplacebo

    analogous to experimental intervention

05

What researchers measure

Primary outcomes

  1. Response-rate to treatment according to YGTSS-TTS (Total Tic-Score of the Yale Global Tic Severity Scale [YGTSS])

    Time frame: 13 weeks

Secondary outcomes

  1. Fitness to Drive Test

    Reaction time and choice reaction (RT)

    Time frame: 13 weeks

  2. Fitness to Drive Test

    Stress Behavior capacity (DT-Auslastung)

    Time frame: 13 weeks

  3. Fitness to Drive Test

    Stress Behavior performance quantity (DT Mengenleistung)

    Time frame: 13 weeks

  4. Fitness to Drive Test

    Concentration (COG)

    Time frame: 13 weeks

  5. Fitness to Drive Test

    Perceptual speed (ATAVT)

    Time frame: 13 weeks

  6. YGTSS-TTS

    Time frame: 8 weeks and 1 month after end of treatment (17 weeks)

  7. YGTSS-TTS

    Time frame: Baseline and 13 weeks

  8. YGTSS-Global Score (YGTSS-GS)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  9. Modified Rush Video-Based Tic Rating Scale (MRVS)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  10. Clinical Global Impression-Improvement Score (CGI-I)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  11. Clinical Global Impression-Severity Score (CGI-S)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  12. Adult Tic Questionnaire (ATQ)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  13. Tourette Syndrome-Quality of Life Scale (GTS-QoL)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  14. Pre-monitory Urge for Tics Scale (PUTS)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  15. Beck Depression Inventory-II (BDI-II)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  16. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  17. Conners' Adult ADHD Rating Scale (CAARS)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  18. Beck Anxiety Inventory (BAI)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  19. Pittsburgh Sleep Quality Index (PSQI)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  20. Skala Impulsives-Verhalten-8 (I-8)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  21. 12-item short-form Health Survey (SF-12)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

  22. Rage Attacks Questionnaire for Adults with GTS (RAQ-GTS)

    Time frame: 8 weeks, 13 weeks and 1 month after end of treatment (17 weeks)

Other outcomes

  1. Assessment of adverse events (AEs)

    Time frame: through study completion, an average of 17 weeks

  2. Assessment of serious adverse events (SAEs)

    Time frame: through study completion, an average of 17 weeks

  3. blood pressure

    Time frame: through study completion, an average of 17 weeks

  4. pulse

    Time frame: through study completion, an average of 17 weeks

06

Study locations

6 sites
  • Uniklinik RWTH Aachen, Psychiatry and Psychotherapy
    Aachen, Germany
  • University Hospital Cologne, Psychiatry and Psychotherapy
    Cologne, Germany
  • University of Freiburg, Psychiatry and Psychotherapy
    Freiburg, Germany
  • Hannover Medical School, Clinic of Psychiatry, Socialpsychiatry and Psychotherapy
    Hannover, Germany
  • University Hospital Schleswig-Holstein, Institute of Neurogenetics, Department of Pediatric and Adult Movement Disorders and Neuropsychiatrics
    Luebeck, Germany
  • LMU Munich, Psychiatry and Psychotherapy
    Munich, Germany
07

References and documents

Publications

  • Szejko N, Saramak K, Lombroso A, Muller-Vahl K. Cannabis-based medicine in treatment of patients with Gilles de la Tourette syndrome. Neurol Neurochir Pol. 2022;56(1):28-38. doi: 10.5603/PJNNS.a2021.0081. Epub 2021 Oct 28. PubMed 34708399 ↗
  • Jakubovski E, Pisarenko A, Fremer C, Haas M, May M, Schumacher C, Schindler C, Hackl S, Aguirre Davila L, Koch A, Brunnauer A, Cimpianu CL, Lutz B, Bindila L, Muller-Vahl K. The CANNA-TICS Study Protocol: A Randomized Multi-Center Double-Blind Placebo Controlled Trial to Demonstrate the Efficacy and Safety of Nabiximols in the Treatment of Adults With Chronic Tic Disorders. Front Psychiatry. 2020 Nov 26;11:575826. doi: 10.3389/fpsyt.2020.575826. eCollection 2020. PubMed 33324255 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03087201
Lead sponsor
Hannover Medical School
Collaborators
German Research Foundation
Responsible party
Sponsor
First posted
Mar 22, 2017
Start date
Apr 5, 2018
Primary completion
Nov 20, 2020
Completion
Nov 20, 2020
Last update
Dec 10, 2020

Study contacts

Kirsten Müller-Vahl, MD
principal investigator · Hannover Medical School, Clinic of Psychiatry, Socialpsychiatry and Psychotherapy

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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