Safety Study of Riluzole to Treat Post-traumatic Stress Disorder (PTSD)

• Sponsor: Uniformed Services University of the Health Sciences (U.S. Fed)
• Overall Status: Completed
• CT.gov ID: NCT02155829
• Collaborator: U.S. Army Medical Research and Development Command (U.S. Fed)
• Enrollment: 75
• Locations: 2
• Arms: 2
• Duration (Months): 53
• Patients Per Site: 37.5
• Patients Per Site Per Month: 0.7

Study Details

Study Description

Brief Summary

The purpose of this study is to determine whether Riluzole is effective in the augmentation treatment of post-traumatic stress disorder (PTSD) that is experienced by Active Duty military service members and Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans who have not had symptom reduction after one or more kinds of medications or therapies.

Condition or Disease	Intervention/Treatment	Phase
PTSD	Drug: Riluzole; Drug: Placebo (for Riluzole)	Phase 1/Phase 2

Detailed Description

Riluzole is a glutamatergic modulator that inhibits glutamate release and enhances AMPA trafficking and clearance of excessive synaptic glutamate resulting in neuroprotective properties. Riluzole is FDA-approved for the treatment of amyotrophic lateral sclerosis (ALS) and has been found to have antidepressant and anxiolytic properties in animals and in humans (Zarate et al., 2004). Posttraumatic stress disorder (PTSD) is a chronic and seriously debilitating anxiety disorder that develops following exposure to severe trauma, such as combat exposure. Structural magnetic resonance imaging has been used to measure the volume of crucial structures implicated in the pathophysiology of PTSD, with several morphometric studies confirming smaller hippocampal volume in PTSD patients. Current pharmacological treatment for PTSD, and particularly combat-related PTSD, is suboptimal. Drugs that alter neuronal survival pathways through reduction of glutamate activity may play a role in reversing the loss of neuronal integrity and possible focal atrophy in regions of the brain implicated in the pathophysiology of PTSD, potentially improving the symptoms of PTSD, as well as TBI. This study will evaluate the efficacy of acute riluzole treatment in active duty and Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) veterans with PTSD, with or without mild TBI (mTBI), who are sub-optimally responsive to other medication treatments. A total of 158 active duty and OIF, OEF and OND veterans, aged 18 to 65 will be enrolled from WRNMMC and the Syracuse VA Medical Center to participate in this 8-week randomized, double- blind, placebo-controlled, parallel study. Patients who are suboptimal responders to their current psychotropic drugs will continue these at stable dosage for at least 2 weeks prior to randomization during the screening period. We hypothesize that those subjects with PTSD, with or without mTBI, who are only partially responsive to initial therapy and are subsequently randomized to augmentation therapy with Riluzole (100-200mg/day) will have a superior response rate compared to those subjects randomized to placebo.

Study Design

• Study Type: Interventional
• Actual Enrollment: 75 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Riluzole for PTSD: Efficacy of a Glutamatergic Modulator as Augmentation Treatment for Posttraumatic Stress Disorder
• Study Start Date: Jul 1, 2013
• Actual Primary Completion Date: Oct 30, 2017
• Actual Study Completion Date: Nov 30, 2017

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Riluzole Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks	Drug: Riluzole; Other Names: Rilutek
Placebo Comparator: Placebo Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks	Drug: Placebo (for Riluzole); Other Names: Inert tablet manufactured to be indistinguishable from a Riluzole 50 mg tablet

Outcome Measures

Primary Outcome Measures

1. Clinician Administered PTSD Scale (CAPS) Score [Week 1 and 8]

   CAPS is a 30-item structured interview that can be used to make current (past month) diagnoses of PTSD, make lifetime diagnoses of PTSD, and assess PTSD symptoms over the past week. A summed score of 17 items: Minimum Score: 0 (no symptoms) Maximum Score: 136 (very severe symptoms) Subscales: Subscale B (re-experiencing): items 1-5, a score of 0-40. Subscale C (avoidance): items 6-12, a score of 0-56. Subscale D (hyperarousal): items 13-17, a score of 0-40. CAPS scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

Secondary Outcome Measures

1. PTSD Check List Specific (PCL-S) [Week 1 and 8]

   A 17-item self-report measure used to assess PTSD symptoms related to a specific traumatic event. Scoring: A sum of all 17 items. Minimum: 17 (no symptoms) Maximum: 85 (very severe symptoms) PCL-S scores were measured at every study visit. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

2. Montgomery-Åsberg Depression Rating Scale (MADRS) Score [Week 1 and 8]

   A ten-item diagnostic questionnaire to measure the severity of depressive episodes. Scoring: A sum of all 10 items. Minimum: 0 (no symptoms) Maximum: 60 (very severe symptoms) MADRS scores were measured at every study visit. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

3. Hamilton Anxiety Rating Scale (HAM-A) [Week 1 and 8]

   A 14-item clinician-administered assessment measuring anxiety symptoms. Scoring: A sum of all 14 items. Minimum: 0 (no symptoms) Maximum: 56 (very severe symptoms) HAM-A scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

4. Sheehan Disability Scale (SDS) Score [Week 1 and 8]

   A 3-item self-report measure to assess functional impairment in work/school, social, and family life. Scoring: A sum of all 3 items. Minimum: 0 (no symptoms) Maximum: 30 (very severe symptoms) SDS scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

5. Clinician Administered PTSD Subscale D (CAPS-D) [Week 1 and 8]

   Subscale D (items 13-17 on the CAPS-IV) measures Hyperarousal symptoms of PTSD Scoring: A sum of items 13-17. Minimum: 0 (no symptoms) Maximum: 40 (very severe symptoms) CAPS-D scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

6. PTSD Checklist - D (PCL-D) [Week 1 and week 8]

   The subscale D (items 13-17 on the PCL) measures hyperarousal symptoms of PTSD. Scoring: A sum of items 13 to 17. Minimum: 5 (no symptoms) Maximum: 25 (very severe symptoms) PCL-D scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.

Other Outcome Measures

1. NAA/Cr Ratio [Measured at study start (Week 0) for baseline and measured at study completion (Week 8)]

   The N-acetyl aspartate to creatine ratio (NAA/Cr) in the hippocampus and anterior cingulate, measured using magnetic resonance spectroscopy (1H MRS), will be evaluated for change after 8-week treatment with riluzole.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years to 65 Years
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Active-duty service member or an Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), or Operation New Dawn (OND) veteran.

• Clinical diagnosis of PTSD and have not achieved remission with an adequate trial of medication treatment (8 weeks) as indicated by self-report at referral and confirmed by baseline CAPS score of greater than or = to 40 after informed consent is obtained.

Exclusion Criteria:

1. Female subjects of childbearing capacity who test positively for ß-HCG, or are either self-reporting as pregnant, planning to become pregnant, or nursing.

2. Presence of psychotic features.

3. Unable to provide informed consent or comply with study procedures.

4. Previous treatment with riluzole.

5. Serious, unstable illnesses including hepatic, renal, gastroenterological, respiratory, cardiovascular (including ischemic heart disease), endocrinologic, neurologic, immunologic, hematologic disease, or HIV. This includes individuals with a history of COPD by diagnosis as well as persons taking inhalers for Asthma or Reactive Airway Disease.

6. Clinically significant abnormal levels (3x ULN or greater) of serum transaminases (ALT/SGPT; AST/SGOT), current or past blood dyscrasia.

7. Subjects with uncorrected hypothyroidism or hyperthyroidism.

8. DSM-IV alcohol or substance abuse or dependence within 90 days of the screening visit.

9. Treatment with a reversible MAOI, guanethidine, or guanadrel within 1 week, or any change in fluoxetine dosing within 8 weeks prior to visit 2. Use of antidepressant and sedative/hypnotic drugs at stable dose is permitted.

10. Documented history of hypersensitivity or intolerance to riluzole.

11. Subjects with a current or past history of other axis I disorders including schizophrenia, schizoaffective disorder, bipolar disorder or dementia. However, those with a co-morbid history of other Axis I disorder like major depression, dysthymia or other anxiety disorders will be included; the justification for this is that approximately 70% of subjects with PTSD have co-morbid depression and or alcohol abuse, and restricting the sample to PTSD patients without depression will not accurately reflect the scope of this disorder.

12. Patients who are currently at high risk for homicide or suicide, as indicated by an affirmative answer to the question: "In the last three months, have you attempted to kill yourself, made specific plans to kill yourself, or had the intention to kill yourself?"

13. Current or planned litigation regarding the traumatic event.

14. Patients who recently started trauma focused cognitive behavioral psychotherapy (Patient's underlying educational or supportive individual or group therapy will be included).

15. Patient's actively enrolled in an evidence based psychotherapy treatment (e.g., Cognitive Processing Therapy or Prolonged Exposure Therapy) will be excluded until that therapy has concluded, but may be re-approached at that time if patient self-report or clinician referral suggests persistent PTSD symptoms upon conclusion of that treatment.

16. Subjects with an artificial cardiac pacemaker or metallic implants within their body will be enrolled at WRNMMC for the placebo-control clinical trial portion of the study only. These individuals, due to their pre-existing medical condition, are medically ineligible to participate in the 1H MRS imaging portion of the study. Further, the Magnetic Resonance (MRI) Screening Form is use at WRNMMC will be used for participant screening prior to any imaging procedures.

17. Use of benzodiazepines.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Walter Reed National Military Medical Center	Bethesda	Maryland	United States	20814
2	Syracuse VA Medical Center, Center for Integrated Healthcare (116C)	Syracuse	New York	United States	13210

Sponsors and Collaborators

• Uniformed Services University of the Health Sciences
• U.S. Army Medical Research and Development Command

Investigators

• Principal Investigator: David M Benedek, MD, USUHS, WRNMMC

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Apr 30, 2019
• Informed Consent Form - Jul 27, 2018

More Information

Additional Information:

• Study conducted by the Center for the Study of Traumatic Stress

Publications

None provided.

• Responsible Party: David M. Benedek, Principal Investigator, Uniformed Services University of the Health Sciences
• ClinicalTrials.gov Identifier: NCT02155829
• Other Study ID Numbers: 380797
• First Posted: Jun 4, 2014
• Last Update Posted: May 24, 2021
• Last Verified: Apr 1, 2021

• Keywords provided by David M. Benedek, Principal Investigator, Uniformed Services University of the Health Sciences: PTSD; TBI; Riluzole; Rilutek; augmentation; supplement; double blinded; clinical trial; placebo; RCT; Randomized Control Trial
• Additional relevant MeSH terms: Stress Disorders, Traumatic; Riluzole

Study Results

Participant Flow

Recruitment Details	Recruitment from WRNMMC = Walter Reed National Military Medical Center ; SVAMC = Syracuse Veterans Administration Medical Center

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks
Period Title: Overall Study
STARTED	37	38
COMPLETED	31	35
NOT COMPLETED	6	3

Baseline Characteristics

Arm/Group Title	Riluzole	Placebo	Total
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Riluzole	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)	Total of all reporting groups
Overall Participants	36	38	74
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	37.4 (8.9)	38.1 (8.2)	37.8 (8.5)
Sex: Female, Male (Count of Participants)
Female	5 13.9%	6 15.8%	11 14.9%
Male	31 86.1%	32 84.2%	63 85.1%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	9 25%	3 7.9%	12 16.2%
Not Hispanic or Latino	23 63.9%	33 86.8%	56 75.7%
Unknown or Not Reported	4 11.1%	2 5.3%	6 8.1%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	1 2.8%	1 2.6%	2 2.7%
Asian	0 0%	0 0%	0 0%
Native Hawaiian or Other Pacific Islander	2 5.6%	0 0%	2 2.7%
Black or African American	2 5.6%	6 15.8%	8 10.8%
White	26 72.2%	25 65.8%	51 68.9%
More than one race	1 2.8%	3 7.9%	4 5.4%
Unknown or Not Reported	4 11.1%	3 7.9%	7 9.5%
Clinician Administered PTSD Scale - IV (units on a scale) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [units on a scale]	70.6 (19.8)	62.4 (16.9)	66.4 (18.7)

Outcome Measures

1. Primary Outcome

Title	Clinician Administered PTSD Scale (CAPS) Score
Description	CAPS is a 30-item structured interview that can be used to make current (past month) diagnoses of PTSD, make lifetime diagnoses of PTSD, and assess PTSD symptoms over the past week. A summed score of 17 items: Minimum Score: 0 (no symptoms) Maximum Score: 136 (very severe symptoms) Subscales: Subscale B (re-experiencing): items 1-5, a score of 0-40. Subscale C (avoidance): items 6-12, a score of 0-56. Subscale D (hyperarousal): items 13-17, a score of 0-40. CAPS scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Riluzole	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-21.1 (18.9)	-16.7 (17.2)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.442
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

2. Secondary Outcome

Title	PTSD Check List Specific (PCL-S)
Description	A 17-item self-report measure used to assess PTSD symptoms related to a specific traumatic event. Scoring: A sum of all 17 items. Minimum: 17 (no symptoms) Maximum: 85 (very severe symptoms) PCL-S scores were measured at every study visit. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-15.4 (13.5)	-14.5 (11.4)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.994
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

3. Secondary Outcome

Title	Montgomery-Åsberg Depression Rating Scale (MADRS) Score
Description	A ten-item diagnostic questionnaire to measure the severity of depressive episodes. Scoring: A sum of all 10 items. Minimum: 0 (no symptoms) Maximum: 60 (very severe symptoms) MADRS scores were measured at every study visit. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Riluzole	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-7.9 (7.6)	-8.2 (9.6)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.684
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

4. Secondary Outcome

Title	Hamilton Anxiety Rating Scale (HAM-A)
Description	A 14-item clinician-administered assessment measuring anxiety symptoms. Scoring: A sum of all 14 items. Minimum: 0 (no symptoms) Maximum: 56 (very severe symptoms) HAM-A scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Riluzole	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-7.8 (7.4)	-6.7 (6.9)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.913
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

5. Secondary Outcome

Title	Sheehan Disability Scale (SDS) Score
Description	A 3-item self-report measure to assess functional impairment in work/school, social, and family life. Scoring: A sum of all 3 items. Minimum: 0 (no symptoms) Maximum: 30 (very severe symptoms) SDS scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Riluzole	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-6.3 (6.8)	-5.7 (5.9)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.746
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

6. Secondary Outcome

Title	Clinician Administered PTSD Subscale D (CAPS-D)
Description	Subscale D (items 13-17 on the CAPS-IV) measures Hyperarousal symptoms of PTSD Scoring: A sum of items 13-17. Minimum: 0 (no symptoms) Maximum: 40 (very severe symptoms) CAPS-D scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-6.8 (8.2)	-3.7 (7.3)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.057
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

7. Secondary Outcome

Title	PTSD Checklist - D (PCL-D)
Description	The subscale D (items 13-17 on the PCL) measures hyperarousal symptoms of PTSD. Scoring: A sum of items 13 to 17. Minimum: 5 (no symptoms) Maximum: 25 (very severe symptoms) PCL-D scores were measured at baseline, mid-treatment, and post-treatment. For outcome analyses, differences between pre-treatment and post-treatment scores were used.
Time Frame	Week 1 and week 8

Outcome Measure Data

Analysis Population Description

One participant failed to meet minimum Clinician-Administered PTSD Scale IV (CAPS-IV) score for inclusion at phase 2 baseline and was excluded from intent-to treat (ITT) analyses.

Arm/Group Title	Riluzole	Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks	Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks Placebo (for Riluzole)
Measure Participants	36	38
Mean (Standard Deviation) [score on a scale]	-5.9 (5.6)	-3.4 (4.9)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Riluzole, Placebo
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	0.0496
	Comments
	Method	ANCOVA
	Comments	ANCOVA covariate included site.

8. Other Pre-specified Outcome

Title	NAA/Cr Ratio
Description	The N-acetyl aspartate to creatine ratio (NAA/Cr) in the hippocampus and anterior cingulate, measured using magnetic resonance spectroscopy (1H MRS), will be evaluated for change after 8-week treatment with riluzole.
Time Frame	Measured at study start (Week 0) for baseline and measured at study completion (Week 8)

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title

Arm/Group Description

Adverse Events

Time Frame	10 weeks
Arm/Group Title	Riluzole		Placebo
Arm/Group Description	Weeks 1 and 2: Riluzole 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Riluzole 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks		Weeks 1 and 2: Placebo 50 mg tablet by mouth every 12 hours (100 mg/day) for 2-weeks Weeks 3 to 8 (optional dose increase): 2 Placebo 50 mg tablets by mouth every 12 hours (200 mg/day) for 6-weeks
All Cause Mortality
	Riluzole		Placebo
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/37 (0%)		0/38 (0%)
Serious Adverse Events
	Riluzole		Placebo
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/37 (0%)		0/38 (0%)
Other (Not Including Serious) Adverse Events
	Riluzole		Placebo
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	2/37 (5.4%)		0/38 (0%)
Gastrointestinal disorders
Gastrointestinal Symptoms	2/37 (5.4%)	2	0/38 (0%)	0
Hepatobiliary disorders
LFT Elevation	2/37 (5.4%)	2	0/38 (0%)	0
Psychiatric disorders
Clinical deterioration	1/37 (2.7%)	1	0/38 (0%)	0

Limitations/Caveats

Result limited to combat-related PTSD in military and veterans of recent conflict.

More Information

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.