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PLoS One. 2017 Mar 21;12(3):e0173872. doi: 10.1371/journal.pone.0173872. eCollection 2017.

Bupropion for the treatment of apathy in Huntington's disease: A multicenter, randomised, double-blind, placebo-controlled, prospective crossover trial.

Author information

1
Department of Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
2
Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
3
European Huntington's Disease Network, Ulm, Germany.
4
Department of Neurology, University of Ulm, Ulm, Germany.
5
Department of Neurology, Huntington-Center NRW, St. Josef Hospital, Ruhr-University, Bochum, Germany.
6
Institute of Medical Statistics, Computer Sciences and Documentation, Jena Universityhospital, Jena, Germany.
7
Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands.
8
Cluster of Excellence NeuroCure, DZNE and BIH, Berlin, Germany.

Abstract

OBJECTIVE:

To evaluate the efficacy and safety of bupropion in the treatment of apathy in Huntington's disease (HD).

METHODS:

In this phase 2b multicentre, double-blind, placebo-controlled crossover trial, individuals with HD and clinical signs of apathy according to the Structured Clinical Interview for Apathy-Dementia (SCIA-D), but not depression (n = 40) were randomized to receive either bupropion 150/300mg or placebo daily for 10 weeks. The primary outcome parameter was a significant change of the Apathy Evaluation Scale (AES) score after ten weeks of treatment as judged by an informant (AES-I) living in close proximity with the study participant. The secondary outcome parameters included changes of 1. AES scores determined by the patient (AES-S) or the clinical investigator (AES-C), 2. psychiatric symptoms (NPI, HADS-SIS, UHDRS-Behavior), 3. cognitive performance (SDMT, Stroop, VFT, MMSE), 4. motor symptoms (UHDRS-Motor), 5. activities of daily function (TFC, UHDRS-Function), and 6. caregiver distress (NPI-D). In addition, we investigated the effect of bupropion on brain structure as well as brain responses and functional connectivity during reward processing in a gambling task using magnetic resonance imaging (MRI).

RESULTS:

At baseline, there were no significant treatment group differences in the clinical primary and secondary outcome parameters. At endpoint, there was no statistically significant difference between treatment groups for all clinical primary and secondary outcome variables. Study participation, irrespective of the intervention, lessened symptoms of apathy according to the informant and the clinical investigator.

CONCLUSION:

Bupropion does not alleviate apathy in HD. However, study participation/placebo effects were observed, which document the need for carefully controlled trials when investigating therapeutic interventions for the neuropsychiatric symptoms of HD.

TRIAL REGISTRATION:

ClinicalTrials.gov 01914965.

PMID:
28323838
PMCID:
PMC5360242
DOI:
10.1371/journal.pone.0173872
[Indexed for MEDLINE]
Free PMC Article

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