Metadoxine as a novel pharmacotherapy for older adults with alcohol use disorder

项目总结 K99/R00提案研究了一种治疗老年人(老年人)酒精使用障碍(AUD)的新药物疗法 ≥65)。随着人口以前所未有的速度老龄化，酒精是最常用的毒品 老年人，老年人中的AUD正在成为公共卫生和卫生领域日益重要的领域 临床研究。长期饮酒会加速衰老，加剧与年龄相关的疾病 后遗症，包括慢性炎症和认知能力下降。因此，找出一种安全有效的 对于患有AUD的老年人来说，治疗方案至关重要。因为老年人往往有共同的健康状况 这需要开多种药物，添加一种药物与药物相互作用很少的药物是 派拉蒙。美他多辛是一种欧洲批准用于治疗急性酒精中毒的药物，因为它 能够诱导人体排出尿液中的乙醇。美他多辛是吡哆醛的盐化产物 (维生素B6)和吡咯烷酮羧酸，具有极好的安全性。此外，美他多辛已被 研究表明，这与减少饮酒欲望、改善认知测试和减少 发炎。初步数据还表明，美他多辛可能会减少酒精消耗量。然而，没有 已有研究评估了美他多辛在老年人中的安全性或有效性，也没有使用线索反应范式来评估 渴望。在K99阶段，我们提出了一个受试者内、交叉、双盲、安慰剂控制的人类 老年≥患者(65岁)的实验室安全性和耐受性研究。对于R00，我们建议进行一次试点 老年人(65岁≥)的双盲、受试者间、安慰剂对照随机对照试验 用澳元。对于试验性随机对照试验，我们将评估老年人对美多多辛的可接受性和可行性，评估 使用已建立的线索反应范式对酒精渴求的影响，并评估其对认知的影响 相对于安慰剂的作用。此外，我们还将获得有关美多多辛减少酒精的疗效的数据。 消费和炎症。研究计划由一支杰出的导师团队和 布朗大学公共卫生学院酒精与成瘾研究中心的培训计划。这个 申请者在衰老、神经科学和临床酒精方面有广泛的背景。 通过在与人体实验室研究、临床研究相关的特定方法中提出新的、有重点的指导进行研究 临床数据的试验、老年学研究和生物统计学。综合研究和培训计划将 为申请人在临床酒精研究中成功的独立职业生涯做好准备，重点是识别 老年人的新型治疗方法。这项研究与NIAAA发展和改进的战略目标是一致的 治疗AUD和酒精相关后果，并加强NIAAA对公众健康的影响-- 受资助的研究。随着老年人口的持续增长，这项研究是迫切需要的 澳元的发病率呈指数增长，而且患病率继续上升。

PROJECT SUMMARY This K99/R00 proposal examines a novel pharmacotherapy for alcohol use disorder (AUD) in older adults (aged ≥65). As the population is aging at an unprecedented rate and alcohol is the most commonly used drug among older adults, AUD in the older adult population is becoming an increasing area of importance in public health and clinical research. Chronic alcohol consumption leads to accelerated aging and exacerbation of age-related sequelae, including chronic inflammation and cognitive decline. Therefore, identifying a safe and effective treatment option for older adults with AUD is critical. As older adults tend to have co-morbid health conditions which necessitate being prescribed multiple medications, adding a medication with few drug-drug interactions is paramount. Metadoxine is a medication approved in Europe for the treatment of acute alcohol intoxication as it is able to induce urinary excretion of ethanol from the body. Metadoxine is formed by the salification of pyridoxal (vitamin B6) and pyrrolidone carboxylic acid and has an excellent safety profile. Moreover, metadoxine has been shown to be associated with reduced alcohol craving, improvement on cognitive tests, and decreased inflammation. Preliminary data also suggest that metadoxine may reduce alcohol consumption. However, no studies have evaluated metadoxine safety or efficacy in older adults nor used a cue reactivity paradigm to assess craving. During the K99 phase, we propose a within-subjects, crossover, double-blind, placebo-controlled human laboratory safety and tolerability study in older adults (aged ≥65) with AUD. For the R00, we propose a pilot double-blind, between-subjects, placebo-controlled randomized controlled trial (RCT) in older adults (aged ≥ 65) with AUD. For the pilot RCT we will assess acceptability and feasibility of metadoxine for older adults, evaluate the effect on alcohol craving using an established cue reactivity paradigm, and assess the effect on coginitive function relative to placebo. Additionally, we will obtain data on the efficacy of metadoxine for reducing alcohol consumption and inflammation. The research plan is complemented by an exceptional mentorship team and training plan at the Center for Alcohol and Addiction Studies, School of Public Health, Brown University. The application builds on the applicant’s extensive background in aging and neuroscience and clinical alcohol research by proposing new, focused mentorship in specific methods related to human laboratory studies, clinical trials, gerontological research, and biostatistics with clinical data. The combined research and training plans will prepare the applicant for a successful independent career in clinical alcohol research focused on identifying novel treatments for older adults. This research is aligned with NIAAA’s strategic goals to develop and improve treatments for AUD and alcohol-related consequences and to enhance the public health impact of NIAAA- supported research. This research is urgently needed as the older adult population continues to grow exponentially and prevalence of AUD continues to increase.