Tolcapone in Obsessive Compulsive Disorder

The goal of the proposed study is to evaluate the efficacy and safety of tolcapone in adults with obsessive compulsive disorder (OCD). The hypothesis to be tested is that tolcapone will be more effective and well tolerated in adults with OCD compared to placebo. The proposed study will provide needed data on the treatment of a disabling disorder where current treatments are often ineffective.

The primary aim of this application is to conduct a randomized placebo-controlled pharmacotherapy trial using tolcapone in 20 participants with OCD. The study will consist of two phases: a 2 week active treatment phase with tolcapone, a one-week wash-out phase, and a 2 week placebo phase. The subjects will be randomized to either receive tolcapone or placebo treatment in the first 2 weeks, and the other during the remaining 2 week phase.

This will be one of few studies assessing the use of pharmacotherapy for the treatment of OCD in adults. Assessing the efficacy and safety of tolcapone will help inform clinicians about additional treatment options for adults suffering from this disorder.

• Tolcapone 200 MG (Drug), also known as No other names: All eligible study subjects will go through a 2-week treatment phase during which they will begin tolcapone at 100mg twice a day.

Primary outcomes

• Yale Brown Obsessive Compulsive Scale (Y-BOCS) [2 weeks (start of study to washout period OR two weeks following washout period)]: The entire study for the subject will last 5 weeks. Every 2 weeks and after the one week washout period the subject will take the YBOCS. The change in scores from baseline to after 5 weeks will be assessed. The scale itself assesses severity of OCD symptoms. The YBOCS scale ranges from 0 to 40, with 0 being no symptoms and 40 being severe.

Secondary outcomes

• Clinical Global Impression- Severity and Improvement (CGI) [2 weeks (start of study to washout period OR two weeks following washout period)]: The entire study for the subject will last 5 weeks. Every two weeks and after the one week washout period the subject will complete the CGI. The change in scores from baseline to after 5 weeks will be assessed. The scale itself assesses overall disorder severity on a scale from 1 to 7 with 1 being "not at all" and 7 being "among the most severe cases"
• Sheehan Disability Scale (SDS) [2 weeks (start of study to washout period OR two weeks following washout period)]: The entire study for the subject will last 5 weeks. Every two weeks and after the one week washout period the subject will complete the SDS. The change in scores from baseline to after 5 weeks will be assessed. The scale itself assesses the level of disability from obsessive compulsive disorder (or target disorder). The SDS is a brief, 5-item self-report tool that assesses functional impairment in work/school, social life, and family life. Work/school scores range from 0 to 10, Social life scores range from 0 to 10, Family life/home responsibilities scores range from 0 to 10). Total scores are calculated by adding the scores for work/school, social life, and family life. Total scores range from a minimum of 0 to a maximum of 30 (0 unimpaired, 30 highly impaired).
• Hamilton Anxiety Rating Scale (HAM-A) [2 weeks (start of study to washout period OR two weeks following washout period)]: Every study visit, the subject will complete the HAM-A. The change in scores from baseline to after 5 weeks will be assessed. The scale itself assesses level of anxiety. Higher scores indicate higher levels of anxiety, with 0 being no symptoms of anxiety and 30 being severe anxiety.
• Hamilton Depression Rating Scale (HAM-D) [2 weeks (start of study to washout period OR two weeks following washout period)]: The entire study for the subject will last 5 weeks. The HAM-D will be administered at every study visit. The change in scores from baseline to after the end of the 2-week active treatment period will be assessed and the change in scores from baseline to the end of the 2-week placebo period. The scale itself assesses level of depression. The minimum score is 0 and indicates no depressive symptoms, while the highest possible score is 50. Higher total scores indicate high levels of depression. Higher scores indicate a worse outcome. Higher total scored (14-50) indicate higher levels of depression, while a score between 0-7 is considered normal.

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

1. Males and females age 18-65;
2. Diagnosis of current OCD based on DSM-5 criteria and confirmed using the clinician-administered Structured Clinical Interview for DSM-5 (SCID);
3. Able and willing to provide written consent for participation.

Exclusion Criteria:

1. Unstable medical illness, including liver disease, as determined by the investigator;
2. History of seizures;
3. Clinically significant suicidality (defined by the Columbia Suicide Severity Rating Scale);
4. Baseline score of ≥17 on the Hamilton Depression Rating Scale (17-item HDRS);
5. Lifetime history of bipolar disorder type I or II, schizophrenia, autism, any psychotic disorder, or any substance use disorder;
6. Initiation of psychotherapy or behavior therapy within 3 months prior to study baseline;
7. Previous treatment with tolcapone;
8. Any history of psychiatric hospitalization in the past year;
9. Currently pregnant (confirmed by urine pregnancy test)

Participant flow

Outcome results

• Yale Brown Obsessive Compulsive Scale (Y-BOCS) (Primary), Mean, mean change in YBOCS score: Tolcapone -4.24 +/- 6.20; Placebo -1.10 +/- 4.71
• Clinical Global Impression- Severity and Improvement (CGI) (Secondary), Mean, score on a scale: Tolcapone 3.78 +/- 1.43; Placebo 3.5 +/- 0.90
• Sheehan Disability Scale (SDS) (Secondary), Mean, mean change in SDS score: Tolcapone -2.68 +/- 4.41; Placebo -1.97 +/- 6.62
• Hamilton Anxiety Rating Scale (HAM-A) (Secondary), Mean, mean change in HAM-A score: Tolcapone -1.90 +/- 4.39; Placebo -1.60 +/- 4.07
• Hamilton Depression Rating Scale (HAM-D) (Secondary), Mean, mean change in HAM-D score: Tolcapone -1.65 +/- 3.67; Placebo -2.00 +/- 4.42

Adverse events

Time frame: Adverse event data were collected through study completion, as necessary over the period of 5 week (the length of the trial).

Other adverse events by term

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• Study Protocol and Statistical Analysis Plan (PDF, 2020-08-26)

• Jon E Grant, JD,MD,MPH, Principal investigator, University of Chicago