Evidence map›Paper›PMID 36258248›Full record

Trial reportTrials2022

FORWARDS-1: an adaptive, single-blind, placebo-controlled ascending dose study of acute baclofen on safety parameters in opioid dependence during methadone-maintenance treatment-a pharmacokinetic-pharmacodynamic study.

L M Paterson, D Barker, S Cro, P Mozgunov, R Phillips, C Smith, L Nahar, S Paterson, A R Lingford-Hughes

Registry-linked trialOpen access · goldAbstract readClinical Trial
In one paragraph

Trial report in Trials, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05161351 (Evaluating the Safety of Acute Baclofen in Methadone-maintained Individuals With Opiate Dependence. An Adaptive, Single-blind, Placebo-controlled Ascending Dose Study of Acute Baclofen on Safety Parameters in Opioid Dependence During Methadone-maintenance Treatment; a Pharmacokinetic-pharmacodynamic Study), which is not on this map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05161351 phase4completednot on this map

Evaluating the Safety of Acute Baclofen in Methadone-maintained Individuals With Opiate Dependence. An Adaptive, Single-blind, Placebo-controlled Ascending Dose Study of Acute Baclofen on Safety Parameters in Opioid Dependence During Methadone-maintenance Treatment; a Pharmacokinetic-pharmacodynamic Study

TypeinterventionalSponsorImperial College LondonRan2021 to 2022Enrolled16ConditionsAddiction OpiateArmsBaclofen, Vitamin D3
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 2 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 3 institutions in 1 country.

L M PatersonDivision of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK. l.paterson@imperial.ac.uk.ORCID http://orcid.org/0000-0001-9137-4419
D BarkerDivision of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
S CroImperial Clinical Trials Unit, Imperial College London, London, UK.
P MozgunovMRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
R PhillipsImperial Clinical Trials Unit, Imperial College London, London, UK.
C SmithImperial Clinical Trials Unit, Imperial College London, London, UK.
L NaharToxicology Unit, Imperial College London, London, UK.
S PatersonToxicology Unit, Imperial College London, London, UK.
A R Lingford-HughesDivision of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
Imperial College London · GBNIHR Imperial Biomedical Research Centre · GBUniversity of Cambridge · GB

Funding

Central and North West London NHS Foundation Trust Starter GrantMedical Research Council MR/T025557/1NIHR Imperial Biomedical Research Centre PA3040
6 · The paper itself

Abstract

backgroundTreatment of opiate addiction with opiate substitution treatment (e.g. methadone) is beneficial. However, some individuals desire or would benefit from abstinence but there are limited options to attenuate problems with opiate withdrawal. Preclinical and preliminary clinical evidence suggests that the GABA-B agonist, baclofen, has the desired properties to facilitate opiate detoxification and prevent relapse. This study aims to understand whether there are any safety issues in administering baclofen to opioid-dependent individuals receiving methadone.

methodsOpiate-dependent individuals (DSM-5 severe opioid use disorder) maintained on methadone will be recruited from addiction services in northwest London (NHS and third sector providers). Participants will be medically healthy with no severe chronic obstructive pulmonary disease or type 2 respiratory failure, no current dependence on other substances (excluding nicotine), no current severe DSM-5 psychiatric disorders, and no contraindications for baclofen or 4800 IU vitamin D (placebo). Eligible participants will be randomised in a 3:1 ratio to receive baclofen or placebo in an adaptive, single-blind, ascending dose design. A Bayesian dose-escalation model will inform the baclofen dose (10, 30, 60, or 90 mg) based on the incidence of 'dose-limiting toxicity' (DLT) events and participant-specific methadone dose. A range of respiratory, cardiovascular, and sedative measures including the National Early Warning Score (NEWS2) and Glasgow Coma Scale will determine DLT. On the experimental day, participants will consume their usual daily dose of methadone followed by an acute dose of baclofen or placebo (vitamin D3) ~ 1 h later. Measures including oxygen saturation, transcutaneous CO DISCUSSION: Study outcomes will determine what dose of baclofen is safe to prescribe to those receiving methadone, to inform a subsequent proof-of-concept trial of the efficacy baclofen to facilitate opiate detoxification. To proceed, the minimum acceptable dose is 30 mg of baclofen in patients receiving ≤ 60 mg/day methadone based on the clinical experience of baclofen's use in alcoholism and guidelines for the management of opiate dependence.

trial registrationClinicaltrials.gov NCT05161351. Registered on 16 December 2021.

Indexed as

Opioid-Related DisordersAnalgesics, OpioidBaclofenBayes TheoremCarbon DioxideCholecalciferolGABA-B Receptor AgonistsHumansHypnotics and SedativesMethadoneNicotineOpiate Substitution TreatmentSingle-Blind MethodVitamin DAnalgesics, OpioidBaclofenCarbon DioxideCholecalciferolGABA-B Receptor AgonistsHypnotics and SedativesMethadoneNicotineVitamin DAdaptiveAddictionBaclofenBayesianDependenceDose escalationGABA-BMethadoneOpiatePhase I

Identifiers

PMID36258248
PMCPMC9579625
OpenAlexW4306725868

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.