SNPMiner Trials by Shray Alag


SNPMiner Trials: Clinical Trial Report


Report for Clinical Trial NCT03718104

Developed by Shray Alag, 2019.
SNP Clinical Trial Gene

Safety, Efficacy, Pharmacokinetics, and Pharmacogenomics of Extended-Release Naltrexone in Pregnant Women

This is a multi-center prospective comparative cohort study examining the safety, efficacy, pharmacokinetics, and pharmacogenomics of naltrexone for pregnant women with opioid use disorder. Pregnancy, delivery, and maternal and infant outcomes to 12 months post-delivery will be examined and compared with a cohort treated with buprenorphine/naloxone.

NCT03718104 Opioid-use Disorder Neonatal Abstinence Syndrome Pregnancy, High Risk
MeSH: Neonatal Abstinence Syndrome

4 Interventions

Name: Pharmacokinetic analysis

Description: Pharmacokinetic analysis of maternal blood, maternal urine, cord blood, infant blood and urine for dyads in the naltrexone group at various time points in the pregnancy, at delivery, and 4 weeks postpartum.

Type: Other

Naltrexone

Name: Safety and Efficacy

Description: Examination of the safety and efficacy of naltrexone and comparison of outcomes with the buprenorphine/naloxone cohort. Outcomes examined will include: 1) maternal outcomes (relapse, retention in care, preterm labor); 2) fetal outcomes (growth, fetal anomalies, fetal distress, cortisol levels); and 3) infant outcomes (NAS, growth, neurodevelopment via NNNS exam at 4 weeks and Bayley exam at 12 months of age).

Type: Other

Naltrexone Buprenorphine/Naloxone

Name: Genetic and epigenetic analysis

Description: Maternal blood and saliva DNA samples will be genotyped for single nucleotide polymorphisms in the mu opioid receptor gene (OPRM1) to look for associations with effectiveness of NTX and BPH. In addition, DNA methylation levels in the OPRM1 promoter within maternal and infant saliva and placenta at delivery and 4 weeks postpartum will be examined. Lastly, we will compare genome-wide DNA methylation levels at delivery and 4 weeks postpartum in mother-infant dyads.

Type: Genetic

Naltrexone Buprenorphine/Naloxone

Name: Breast milk analysis

Description: Mothers in the naltrexone group will have their breast milk analyzed at 4 weeks post-delivery for naltrexone levels, with corresponding maternal and infant plasma levels.

Type: Other

Naltrexone


Primary Outcomes

Description: Maternal relapse of illicit and/or unprescribed drug use from maternal/provider report and or from urine toxicology testing at any point during the pregnancy and up to 12 months after delivery

Measure: Maternal drug use relapse

Time: up to 12 months post-delivery

Secondary Outcomes

Description: Number and type of side effects or adverse events such as injection site reactions, gastrointestinal upset, syncope, headaches, or dizziness reported by participant or provider

Measure: Naltrexone side effects or adverse events

Time: up to 12 months post-delivery

Description: Mean fetal heart rate (FHR), FHR variability, and episodic accelerations of FHR (count) from each routine care non-stress test (NST) in the third trimesters.

Measure: Fetal heart rate monitoring from NST

Time: 27- 41 weeks gestation

Description: The biophysical profile uses electronic fetal heart rate monitoring to examine the fetus. There are five components measured during the biophysical examination (fetal breathing movements, gross body movement, fetal tone, amninotic fluid volume and whether the NST is reactive or nonreactive. A score of 2 points is given for each component The points are then added for a possible maximum score of 10. The test is continued until all criteria are met or 30 minutes have elapsed. HIgher scores are more favorable.

Measure: Biophysical profile score calculated from NST

Time: 27 - 41 weeks gestation

Description: Hair cortisol levels will be obtained from maternal hair samples obtained at birth and 4 weeks after delivery, and compared between the naltrexone and buprenorphine groups. Higher hair cortisol levels in the mother may indicate exposure to higher levels of stress over the preceding 3 months period.

Measure: Maternal hair cortisol levels

Time: Birth and 4 weeks post-delivery

Description: Hair cortisol levels will be obtained from infant hair samples obtained at birth and 4 weeks after delivery, and compared between the naltrexone and buprenorphine groups. Higher hair cortisol levels in the infant may indicate exposure to higher levels of stress over the preceding 3 months period.

Measure: Infant hair cortisol levels

Time: Birth and 4 weeks post-delivery

Description: Fetal growth will be assessed at the time of routine growth scans at 18-20, and then q4 weeks until delivery. Fetal size will be compared to Intergrowth standards to produce z-scores and SGA (<10%ile) for averaged 2nd and 3rd trimester measurements.

Measure: Fetal growth based on ultrasound measurements

Time: 18 - 41 weeks gestation

Description: Fetal, placental, or amniotic fluid anomalies identified during routine ultrasounds in the second and third trimesters will be documented.

Measure: Congenital fetal anomalies by ultrasound

Time: 18 - 41 weeks gestation

Description: Infants will be routinely assessed at birth during the physical examination for any external anomalies.

Measure: Congenital anomalies by physical examination

Time: Birth

Description: NAS diagnosis will be based on opioid withdrawal signs and symptoms in the infant after delivery as assessed by NAS withdrawal scores (either the Finnegan score or the via the ESC (Eat, Sleep, Console) assessment tool. The Finnegan scale assesses 21 of the most common signs of neonatal drug withdrawal syndrome and is scored on the basis of pathological significance and severity of the adverse symptoms, which sometimes requires pharmacological treatment. Measurements are performed every 4 hours, typically with 2-3 consecutive scores that are equal to or greater than 8, or 1-2 scores of 12 or greater, pharmacologic treatment for withdrawal is started. For the ESC assessment, clinicians assess whether or not the infant has poor feeding, is unable to sleep for at least 1 hour after feeding, and is consolable (rating of 1-3) due to symptoms of opioid withdrawal. Poor feeding, sleeping, or consolability triggers a huddle and possible start of pharmacologic treatment.

Measure: Diagnosis of Neonatal Abstinence Syndrome (NAS)

Time: From birth to 30 days

Description: The need for pharmacologic treatment will be recorded as Y/N as will the need for adjunctive agents.

Measure: Infant need for pharmacologic treatment

Time: From birth to 30 days

Description: The need for adjunctive agents will be recorded as Y/N

Measure: Infant need for adjunctive agent

Time: From birth to 30 days

Description: The total mgs of morphine/methadone needed for pharmacologic treatment and the total number of total opioid treatment days will be obtained from the birth hospitalization medical records.

Measure: Infant opioid replacement pharmacologic treatment

Time: From birth to 30 days

Description: Number of continuous days infant hospitalized after birth.

Measure: Infant birth hospitalization length of stay

Time: From birth to 30 days

Description: Growth parameters of infant weight in grams will be obtained by the clinician at birth, 4 weeks, and 12 months at each study visit. Percentiles will be calculated.

Measure: Infant weight

Time: Birth, 4 weeks, and 12 months

Description: Growth parameters of infant length measured by the clinician in cm will be obtained at birth, 4 weeks, and 12 months at each study visit. Percentiles will be calculated.

Measure: Infant length

Time: Birth, 4 weeks, and 12 months

Description: Growth parameters of infant head circumference in cm will be obtained by the clinician at birth, 4 weeks, and 12 months at each study visit. Percentiles will be calculated.

Measure: Infant head circumference

Time: Birth, 4 weeks, and 12 months

Description: The NICU Network Neurobehavioral Scale (NNNS) is a comprehensive assessment of both neurologic integrity and behavioral functioning, including signs of stress. It assesses the full range of infant neurobehavioral performance (orientation to auditory and visual stimuli); infant stress (color changes, tremors, startles), neurologic functioning (reflexes, tone); some features of gestational age; self-soothing capacities; states and their organization. The 13 summary scores (i.e., orientation, habituation, hypertonicity, hypotonicity, excitability, arousal, lethargy, non-optimal reflexes, asymmetric reflexes, stress, self-regulation, quality of movement, handling) are typically used to summarize a clinical examination .

Measure: Infant neurobehavior-function assessed by the NNNS

Time: 4 weeks of age

Description: The Bayley III is a standard series of measurements used to assess the development of infants and toddlers, ages 1-42 months. It has 5 scales, 3 administered with child interaction - cognitive, motor, language, and 2 with parent questionnaires- social-emotional, adaptive behavior. A developmental quotient (DQ) is derived from the results.

Measure: Infant neurodevelopment assessed by Bayley III

Time: 12 months of age

Description: Naltrexone levels from maternal blood and plasma will be obtained at regular intervals for pharmacokinetic analysis.

Measure: Pharmacokinetic analysis of maternal naltrexone levels

Time: 2nd trimester, 3rd trimester, delivery, 2-4 days after delivery, 4 weeks post-delivery

Description: Naltrexone levels from infant blood and plasma will be obtained at regular intervals for pharmacokinetic analysis.

Measure: Pharmacokinetic analysis of infant naltrexone levels

Time: Delivery, 2-4 days after delivery, 4 weeks post-delivery

Other Outcomes

Description: Mothers will have a genome wide methylation profile at 36 weeks gestation from a blood sample.

Measure: Maternal DNA methylation profile

Time: 36 weeks gestation

Description: Mothers will be genotyped for the ORPM1 A118G SNP at 36 weeks gestation from a blood sample to see if genotype is associated with treatment response and risk for relapse.

Measure: Mu opioid receptor (OPRM1) gene single nucleotide (SNP) genotype

Time: 36 weeks gestation

Description: Mothers will have their OPRM1 methylation status examined via saliva samples to see if OPRM1 methylation is altered by maternal treatment.

Measure: Maternal saliva OPRM1 methylation status

Time: Birth, 4 weeks postpartum

Description: Infants will have their OPRM1 methylation status examined via saliva samples at to see if OPRM1 methylation is altered by maternal treatment.

Measure: Infant saliva OPRM1 methylation status

Time: Birth, 4 weeks postpartum

Description: Naltrexone levels will be measured from the breast milk of breastfeeding mothers who are on naltrexone.

Measure: Breast milk naltrexone level

Time: 4 weeks postpartum

Description: Length of time mother continues medication assisted treatment (MAT) from provider or participant report

Measure: Retention in addiction treatment

Time: up to 12 months post-delivery

Description: Data on maternal healthcare utilization, including emergency room visits, primary care visits, and re-hospitalizations will be collected.

Measure: Maternal healthcare utilization

Time: up to 12 months post-delivery

Description: Data on infant healthcare utilization, including emergency room visits, primary care visits, and re-hospitalizations will be collected.

Measure: Infant healthcare utilization

Time: up to 12 months post-delivery

Time Perspective: Prospective

Cohort


There is one SNP

SNPs


1 A118G

Mothers will be genotyped for the ORPM1 A118G SNP at 36 weeks gestation from a blood sample to see if genotype is associated with treatment response and risk for relapse.. Maternal saliva OPRM1 methylation status. --- A118G ---



HPO Nodes