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Trial of Cannabis for Essential Tremor

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ClinicalTrials.gov Identifier: NCT03805750
Recruitment Status : Completed
First Posted : January 16, 2019
Results First Posted : October 13, 2022
Last Update Posted : October 13, 2022
Sponsor:
Collaborators:
International Essential Tremor Foundation
Tilray
Center for Medicinal Cannabis Research
Information provided by (Responsible Party):
Fatta B Nahab, University of California, San Diego

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Crossover Assignment;   Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor);   Primary Purpose: Treatment
Condition Essential Tremor
Interventions Drug: CBD/THC
Drug: Placebo oral capsule
Enrollment 7
Recruitment Details This is a cross-over design where each subject receives both a placebo and treatment arm in blinded random order.
Pre-assignment Details  
Arm/Group Title CBD/THC First Then Placebo Placebo First Then CBD/THC
Hide Arm/Group Description After randomization, each patient will receive study medication in two study periods. Each study period includes 1-week titration, 2-week treatment, and 1-week tapering. There is a 3-week washout period between the two study periods. During the titration period, patients will have a starting dose of 1 capsule (placebo or 5mg THC/100mg CBD) per day; 2 capsules per day on day 3; 3 capsules per day on day 6. If the patient or investigator feel that the higher study drug dose of 3 caps per day is causing troublesome side effects, the dosage may be lowered to 2 caps per day. Patients will continue on this target dose during the 2-week treatment and then gradually taper from medication over one week. Patients will crossover to the alternate treatment after a 3-week washout period. After randomization, each patient will receive study medication in two study periods. Each study period includes 1-week titration, 2-week treatment, and 1-week tapering. There is a 3-week washout period between the two study periods. During the titration period, patients will have a starting dose of 1 capsule (placebo or 5mg THC/100mg CBD) per day; 2 capsules per day on day 3; 3 capsules per day on day 6. If the patient or investigator feel that the higher study drug dose of 3 caps per day is causing troublesome side effects, the dosage may be lowered to 2 caps per day. Patients will continue on this target dose during the 2-week treatment and then gradually taper from medication over one week. Patients will crossover to the alternate treatment after a 3-week washout period.
Period Title: First Intervention - 4 Weeks
Started 3 4
Completed 3 4
Not Completed 0 0
Period Title: Second Intervention - 4 Weeks
Started 3 4
Completed 3 2
Not Completed 0 2
Reason Not Completed
Adverse Event             0             2
Arm/Group Title All Participants
Hide Arm/Group Description After randomization, each patient will receive study medication in two study periods. Each study period includes 1-week titration, 2-week treatment, and 1-week tapering. There is a 3-week washout period between the two study periods. During the titration period, patients will have a starting dose of 1 capsule (placebo or 5mg THC/100mg CBD) per day; 2 capsules per day on day 3; 3 capsules per day on day 6. If the patient or investigator feel that the higher study drug dose of 3 caps per day is causing troublesome side effects, the dosage may be lowered to 2 caps per day. Patients will continue on this target dose during the 2-week treatment and then gradually taper from medication over one week. Patients will crossover to the alternate treatment after a 3-week washout period.
Overall Number of Baseline Participants 7
Hide Baseline Analysis Population Description
[Not Specified]
Age, Categorical  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 7 participants
<=18 years
0
   0.0%
Between 18 and 65 years
4
  57.1%
>=65 years
3
  42.9%
Age, Continuous  
Mean (Standard Deviation)
Unit of measure:  Years
Number Analyzed 7 participants
67.0  (11.3)
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 7 participants
Female
0
   0.0%
Male
7
 100.0%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 7 participants
Hispanic or Latino
0
   0.0%
Not Hispanic or Latino
7
 100.0%
Unknown or Not Reported
0
   0.0%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 7 participants
American Indian or Alaska Native
0
   0.0%
Asian
0
   0.0%
Native Hawaiian or Other Pacific Islander
0
   0.0%
Black or African American
0
   0.0%
White
7
 100.0%
More than one race
0
   0.0%
Unknown or Not Reported
0
   0.0%
Region of Enrollment  
Measure Type: Number
Unit of measure:  Participants
United States Number Analyzed 7 participants
7
1.Primary Outcome
Title Digital Spirography
Hide Description The tremor mean amplitude calculated using computerized spirography to measure kinetic tremors.
Time Frame Day 22 (100 minutes post-dose)
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 5 7
Mean (Standard Deviation)
Unit of Measure: millimeters of tremor amplitude
1.04  (0.57) 1.00  (0.42)
2.Secondary Outcome
Title Change in Score on a Scale From Baseline of the Tremor Research Group Essential Tremor Rating Scale (TETRAS)
Hide Description The performance sub scale of the TETRAS will be used to measure tremor severity. The scale ranges from 0 to 60 points (0 being no tremor).
Time Frame Baseline and Day 22
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 5 7
Mean (Standard Deviation)
Unit of Measure: score on a scale
-8.07  (5.71) -10.3  (3.9)
3.Secondary Outcome
Title Global Impression of Change
Hide Description The Global impression of change will be calculated based on both physician and patient report. The scale ranges from a score of 1 (very much improved) to 7 (very much worse) with a score of 4 indicating 'no change'.
Time Frame Day 22
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 5 7
Mean (Full Range)
Unit of Measure: score on a scale
Clinical Global Impression of Change
3
(3 to 4)
4
(2 to 4)
Patient Global Impression of Change
3
(3 to 4)
4
(2.5 to 4)
4.Secondary Outcome
Title Number of Participants Reporting Adverse Events Based on Common Terminology Criteria
Hide Description Side effects survey
Time Frame Days 1, 3, 6, 22
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 7 7
Measure Type: Count of Participants
Unit of Measure: Participants
Ringing in ears
7
 100.0%
6
  85.7%
Numbness/tingling
4
  57.1%
4
  57.1%
Dyspnea on exertion
4
  57.1%
4
  57.1%
Watery eyes
3
  42.9%
3
  42.9%
Runny nose
3
  42.9%
2
  28.6%
Decreased concentration
7
 100.0%
0
   0.0%
Sleepiness
4
  57.1%
1
  14.3%
Insomnia
0
   0.0%
2
  28.6%
Increased sleepiness
2
  28.6%
1
  14.3%
Dizziness
4
  57.1%
0
   0.0%
Memory problems
3
  42.9%
0
   0.0%
Imbalance
3
  42.9%
0
   0.0%
Mild headache
0
   0.0%
1
  14.3%
Groggy
0
   0.0%
1
  14.3%
Tired
0
   0.0%
1
  14.3%
Thumb pain
0
   0.0%
1
  14.3%
Anxiety
2
  28.6%
0
   0.0%
Headache
2
  28.6%
0
   0.0%
Lightheaded
2
  28.6%
0
   0.0%
Felt high
1
  14.3%
0
   0.0%
Decreased libido
1
  14.3%
0
   0.0%
Diarrhea
1
  14.3%
0
   0.0%
Dry mouth
1
  14.3%
0
   0.0%
Euphoria
1
  14.3%
0
   0.0%
Fatigue
1
  14.3%
0
   0.0%
Feels relaxed
1
  14.3%
0
   0.0%
Increased thirst
1
  14.3%
0
   0.0%
Felt buzzed
1
  14.3%
0
   0.0%
Quivering voice
1
  14.3%
0
   0.0%
Visual slowing
1
  14.3%
0
   0.0%
5.Secondary Outcome
Title Number of Participants at Risk for Suicide Based on Columbia-Suicide Severity Rating Scale (C-SSRS)
Hide Description This is a scale looking at risk assessment of suicidality. The presence of any positive responses will lead to further evaluation.
Time Frame Day 22
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 5 7
Measure Type: Count of Participants
Unit of Measure: Participants
0
   0.0%
0
   0.0%
6.Secondary Outcome
Title Number of Participants With New Study-related Electrocardiogram (EKG) Abnormalities
Hide Description Electrocardiographic changes from baseline measures will trigger further evaluation. EKG's will be rated as normal/abnormal relative to the baseline EKG reading, and abnormal findings will be rated as clinically significant/not clinically significant.
Time Frame Day 22
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 5 7
Measure Type: Count of Participants
Unit of Measure: Participants
0
   0.0%
0
   0.0%
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection CBD/THC, Placebo
Comments [Not Specified]
Type of Statistical Test Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.52
Comments [Not Specified]
Method Regression, Logistic
Comments [Not Specified]
7.Secondary Outcome
Title Accelerometry-based Assessment of Tremor Severity
Hide Description The spectral power density measure of accelerometry data to measure will serve as a measure of tremor severity, comparing tremor amplitude from this digital biomarker at the time of the primary outcome to the same measure at baseline.
Time Frame Baseline and Day 22
Hide Outcome Measure Data
Hide Analysis Population Description
Participants in both treatment arms will undergone tremor measurement using accelerometry as a surrogate of tremor severity.
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description:

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
Overall Number of Participants Analyzed 5 7
Mean (Standard Deviation)
Unit of Measure: Proportion of baseline spectral power
0.012  (0.03) 0.007  (0.011)
Time Frame Over the course of the study period (77 days).
Adverse Event Reporting Description [Not Specified]
 
Arm/Group Title CBD/THC Placebo
Hide Arm/Group Description

Treatment arm

CBD/THC: Oral formulation of CBD and THC.

Placebo oral capsule: Placebo
All-Cause Mortality
CBD/THC Placebo
Affected / at Risk (%) Affected / at Risk (%)
Total   0/7 (0.00%)   0/7 (0.00%) 
Hide Serious Adverse Events
CBD/THC Placebo
Affected / at Risk (%) Affected / at Risk (%)
Total   0/7 (0.00%)   0/7 (0.00%) 
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 0%
CBD/THC Placebo
Affected / at Risk (%) Affected / at Risk (%)
Total   7/7 (100.00%)   6/7 (85.71%) 
Cardiac disorders     
Lightheadedness   2/7 (28.57%)  0/7 (0.00%) 
Ear and labyrinth disorders     
Ringing in ears   7/7 (100.00%)  6/7 (85.71%) 
Eye disorders     
Watery eyes   3/7 (42.86%)  3/7 (42.86%) 
Visual slowing   1/7 (14.29%)  0/7 (0.00%) 
Gastrointestinal disorders     
Diarrhea   1/7 (14.29%)  0/7 (0.00%) 
Dry mouth   1/7 (14.29%)  0/7 (0.00%) 
Increased thirst   1/7 (14.29%)  0/7 (0.00%) 
General disorders     
Decreased libido   1/7 (14.29%)  0/7 (0.00%) 
Fatigue   1/7 (14.29%)  0/7 (0.00%) 
Feeling relaxed   1/7 (14.29%)  0/7 (0.00%) 
Nervous system disorders     
Numbness/tingling   4/7 (57.14%)  4/7 (57.14%) 
Decreased concentration   7/7 (100.00%)  0/7 (0.00%) 
Sleepiness   4/7 (57.14%)  1/7 (14.29%) 
Insomnia   0/7 (0.00%)  2/7 (28.57%) 
Increased sleepiness   2/7 (28.57%)  1/7 (14.29%) 
Dizziness   4/7 (57.14%)  0/7 (0.00%) 
Memory problems   3/7 (42.86%)  0/7 (0.00%) 
Imbalance   3/7 (42.86%)  0/7 (0.00%) 
Mild headache   0/7 (0.00%)  1/7 (14.29%) 
Grogginess/cognitive slowing   0/7 (0.00%)  1/7 (14.29%) 
Tiredness   0/7 (0.00%)  1/7 (14.29%) 
Headache   2/7 (28.57%)  0/7 (0.00%) 
Feeling high/intoxication   1/7 (14.29%)  0/7 (0.00%) 
Felt buzzed   1/7 (14.29%)  0/7 (0.00%) 
Psychiatric disorders     
Anxiety   2/7 (28.57%)  0/7 (0.00%) 
Euphoria   1/7 (14.29%)  0/7 (0.00%) 
Respiratory, thoracic and mediastinal disorders     
Dyspnea on exertion   4/7 (57.14%)  4/7 (57.14%) 
Runny nose   3/7 (42.86%)  2/7 (28.57%) 
Quivering voice   1/7 (14.29%)  0/7 (0.00%) 
Skin and subcutaneous tissue disorders     
Thumb pain   0/7 (0.00%)  1/7 (14.29%) 
Indicates events were collected by systematic assessment
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: F.B. Nahab MD
Organization: University of California San Diego
Phone: 858-822-6683
EMail: fnahab@health.ucsd.edu
Layout table for additonal information
Responsible Party: Fatta B Nahab, University of California, San Diego
ClinicalTrials.gov Identifier: NCT03805750    
Other Study ID Numbers: 180414
First Submitted: January 9, 2019
First Posted: January 16, 2019
Results First Submitted: February 15, 2022
Results First Posted: October 13, 2022
Last Update Posted: October 13, 2022