The CREST-E study of creatine for Huntington disease: A randomized controlled trial

Abstract

Objective: To investigate whether creatine administration could slow progressive functional decline in adults with early symptoms of Huntington disease.

Methods: We conducted a multicenter, randomized, double-blind, placebo-controlled study of up to 40 g daily of creatine monohydrate in participants with stage I and II HD treated for up to 48 months. The primary outcome measure was the rate of change in total functional capacity (TFC) between baseline and end of follow-up. Secondary outcome measures included changes in additional clinical scores, tolerability, and quality of life. Safety was assessed by adverse events and laboratory studies.

Results: At 46 sites in North America, Australia, and New Zealand, 553 participants were randomized to creatine (275) or placebo (278). The trial was designed to enroll 650 patients, but was halted for futility after the first interim analysis. The estimated rates of decline in the primary outcome measure (TFC) were 0.82 points per year for participants on creatine, 0.70 points per year for participants on placebo, favoring placebo (nominal 95% confidence limits -0.11 to 0.35). Adverse events, mainly gastrointestinal, were significantly more common in participants on creatine. Serious adverse events, including deaths, were more frequent in the placebo group. Subgroup analysis suggested that men and women may respond differently to creatine treatment.

Conclusions: Our data do not support the use of creatine treatment for delaying functional decline in early manifest HD.

Clinicaltrialsgov identifier: NCT00712426.

Classification of evidence: This study provides Class II evidence that for patients with early symptomatic HD, creatine monohydrate is not beneficial for slowing functional decline.

Figure 1. Patient flow

At the time of study closure, 533 (278 + 275) participants had been randomized, of whom 169 (72 + 97) had withdrawn from the study, 110 (55 + 55) had completed the study, and 274 (151 + 123) were still active in the study. The total numbers of participants with at least 2, 3, and 4 years primary outcome data at the time of study conclusion were 296, 152, and 36, respectively. Sixteen participants at one site were excluded from the analysis due to Good Clinical Practice issues identified prior to the interim analysis. Data from one participant enrolled after study closure were also excluded.

Figure 2. Changes from baseline to each visit in total functional capacity (TFC) and total motor score (TMS), mean ± standard error

(A) TFC for all patients assigned to active creatine and to placebo. (B) TMS for all patients assigned to active creatine and to placebo. In A (primary analysis) and B (supporting analysis), the 2 track curves track closely except at the final point where the data are sparse (see text for details).