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Use of Cannabinoids in Patients With Multiple Sclerosis

Primary Purpose

Multiple Sclerosis

Status
Unknown status
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
Sativex
Sponsored by
S. Andrea Hospital
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Multiple sclerosis, Cannabinoids, Spasticity, fMRI, TMS

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Male or female subjects between 18 and 60 years of age (inclusive) Have definite Multiple Sclerosis as per Poser Criteria Have either relapsing remitting or secondary progressive course Baseline EDSS score from 3.0 to 6.5 (inclusive) Stable disease for at least 30 days prior to study entry Be right-handed with normal right hand function Female patients of child bearing potential and male patients whose partner is of child bearing potential who are willing to ensure that they or their partner use effective contraception during the study and for three months thereafter If female, be neither pregnant nor breast-feeding. Confirmation that the subjects not pregnant must be established by a negative serum hCG pregnancy test at baseline. No cannabinoids use (cannabis, Marinol, Nabilone) for at least three months prior to entry into the study and willing to abstain from any use of cannabis during the study Significant spasticity in at least two muscle groups defined as a score of 2 or more on the Ashworth scale for each muscle group Antispastic/antiepileptic treatments (dosage, frequency and route of administration) stable for at least one month prior the study entry - Exclusion Criteria: Have a primary progressive MS Patients under disease modifying therapies prescribed in the 6 months prior the study entry Patients who have participated in another research study in the past 6 months Changes in antispastic/antiepileptic treatments (dosage, frequency and route of administration) within one month prior the study entry Have a psychiatric disorders or cognitive impairment that preclude safe participation in the study Known history of alcohol or substance abuse Concurrent clinically important immunologic, pulmonary, renal, liver, active thyroid, and/or other major disease other than MS Severe cardiovascular, disorders, such as ischaemic heart disease, arrhythmias, poorly controlled hypertension or severe heart failure Patients suffering from acute or chronic pain History of epilepsy Female patient who is pregnant, lactating or planning pregnancy during the course of the study Scheduled elective surgery or other procedures requiring general anaesthesia during the study Patient who is terminally ill or is inappropriate for placebo medication Systemic corticosteroid therapy within 4 weeks of randomization or exacerbation of MS within 30 days Regular levodopa therapy within 7 days of the study entry Male patient currently receiving sildenafil (Viagra) and unwilling to stop medication for the duration of the study Patients who are currently taking antiarrhythmic medications Known or suspected adverse reaction to cannabinoids Travel outside the Italy planned during the study Donation of blood during the study Contraindications to MRI scans -

Sites / Locations

  • Department of Neurology- University of Rome la SapienzaRecruiting

Outcomes

Primary Outcome Measures

To evaluate the effect of Sativex on: a)patterns of brain activation associated with movement(fMRI); b) changes in level of spasticity (H-reflex); c)changes in intracortical excitability and on synaptic intracortical network of the motor areas(TMS).

Secondary Outcome Measures

Full Information

First Posted
September 12, 2005
Last Updated
November 28, 2005
Sponsor
S. Andrea Hospital
Collaborators
University of Roma La Sapienza
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1. Study Identification

Unique Protocol Identification Number
NCT00202423
Brief Title
Use of Cannabinoids in Patients With Multiple Sclerosis
Official Title
fMRI and Neurophysiological Study Protocol on Cannabinoids in Multiple Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
September 2005
Overall Recruitment Status
Unknown status
Study Start Date
July 2005 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
S. Andrea Hospital
Collaborators
University of Roma La Sapienza

4. Oversight

5. Study Description

Brief Summary
This is a 10-week, randomised, double blind, placebo-controlled, crossover trial to investigate the effect of Cannabis Based Medicine Extract (Sativex) on patterns of brain activation associated with movement in 20 MS patients suffering from lower limb spasticity. Spasticity is a common symptom in Multiple Sclerosis (MS), occurring all over the course of the disease, particularly in the progressive phase.Physiologically, spasticity and hyperreflexia habitually seen in patients with pyramidal syndrome is due to lesions of other descending pathways, such as the cortico reticulospinal pathways, which participate in voluntary movements.It is now known that an endocannabinoid system acts in humans by at least two types of cannabinoids receptors, CB1 and CB2. There is evidence to support the view that the psychoactive ingredient in cannabis, delta 9-tetrahydrocannabinol (delta 9-THC), and cannabinoids in general, can reduce muscle spasticity in people with MS. Aim of the study will be to evaluate the effect of Sativex on: (i) patterns of brain activation associated with movement (fMRI) in MS patients suffering from spasticity; (ii) changes in level of spasticity (H-reflex); (iii) changes in intracortical excitability and on synaptic intracortical network of the motor areas (double shock TMS).
Detailed Description
Baseline assessment will be followed by randomisation and dose introduction. Patients will be randomly assigned to two counterbalanced groups starting either with Sativex or with placebo as the first drug. They will be dispensed sufficient study medication for two weeks together with a diary. During the two-week treatment period all the patients will have to be reached the optimal, individualised dosage to subjectively relief spasticity.Patient will return after three weeks and they will undergo the fMRI and neurophysiological evaluations.Then patients will perform a two-week washout period and they will be requested to intake the alternative medicine. After two weeks patients will perform a second fMRI/neurophysiological study. Two weeks later, after a second washout period, a last visit will be performed to conclude the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis
Keywords
Multiple sclerosis, Cannabinoids, Spasticity, fMRI, TMS

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
Double
Allocation
Randomized
Enrollment
20 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Sativex
Primary Outcome Measure Information:
Title
To evaluate the effect of Sativex on: a)patterns of brain activation associated with movement(fMRI); b) changes in level of spasticity (H-reflex); c)changes in intracortical excitability and on synaptic intracortical network of the motor areas(TMS).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects between 18 and 60 years of age (inclusive) Have definite Multiple Sclerosis as per Poser Criteria Have either relapsing remitting or secondary progressive course Baseline EDSS score from 3.0 to 6.5 (inclusive) Stable disease for at least 30 days prior to study entry Be right-handed with normal right hand function Female patients of child bearing potential and male patients whose partner is of child bearing potential who are willing to ensure that they or their partner use effective contraception during the study and for three months thereafter If female, be neither pregnant nor breast-feeding. Confirmation that the subjects not pregnant must be established by a negative serum hCG pregnancy test at baseline. No cannabinoids use (cannabis, Marinol, Nabilone) for at least three months prior to entry into the study and willing to abstain from any use of cannabis during the study Significant spasticity in at least two muscle groups defined as a score of 2 or more on the Ashworth scale for each muscle group Antispastic/antiepileptic treatments (dosage, frequency and route of administration) stable for at least one month prior the study entry - Exclusion Criteria: Have a primary progressive MS Patients under disease modifying therapies prescribed in the 6 months prior the study entry Patients who have participated in another research study in the past 6 months Changes in antispastic/antiepileptic treatments (dosage, frequency and route of administration) within one month prior the study entry Have a psychiatric disorders or cognitive impairment that preclude safe participation in the study Known history of alcohol or substance abuse Concurrent clinically important immunologic, pulmonary, renal, liver, active thyroid, and/or other major disease other than MS Severe cardiovascular, disorders, such as ischaemic heart disease, arrhythmias, poorly controlled hypertension or severe heart failure Patients suffering from acute or chronic pain History of epilepsy Female patient who is pregnant, lactating or planning pregnancy during the course of the study Scheduled elective surgery or other procedures requiring general anaesthesia during the study Patient who is terminally ill or is inappropriate for placebo medication Systemic corticosteroid therapy within 4 weeks of randomization or exacerbation of MS within 30 days Regular levodopa therapy within 7 days of the study entry Male patient currently receiving sildenafil (Viagra) and unwilling to stop medication for the duration of the study Patients who are currently taking antiarrhythmic medications Known or suspected adverse reaction to cannabinoids Travel outside the Italy planned during the study Donation of blood during the study Contraindications to MRI scans -
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Carlo Pozzilli, MD
Phone
+390649914716
Email
carlo.pozzilli@uniroma1.it
First Name & Middle Initial & Last Name or Official Title & Degree
Emanuela Onesti, MD
Phone
+390649914716
Email
emanuela.onesti@uniroma1.it
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Maurizio Inghilleri, MD
Organizational Affiliation
Policlinico Umberto I, University of Rome "La Sapienza"
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Carlo Pozzilli, MD
Organizational Affiliation
Policlinico Umberto I, University of Rome "La Sapienza"
Official's Role
Study Director
Facility Information:
Facility Name
Department of Neurology- University of Rome la Sapienza
City
Rome
ZIP/Postal Code
00185
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maurizio Inghilleri, MD
First Name & Middle Initial & Last Name & Degree
Carlo Pozzilli, MD
First Name & Middle Initial & Last Name & Degree
Valentina Tomassini, MD
First Name & Middle Initial & Last Name & Degree
Emanuela Onesti, MD
First Name & Middle Initial & Last Name & Degree
Patrizia Pantano, MD

12. IPD Sharing Statement

Citations:
PubMed Identifier
11060760
Citation
Pertwee RG. Cannabinoid receptor ligands: clinical and neuropharmacological considerations, relevant to future drug discovery and development. Expert Opin Investig Drugs. 2000 Jul;9(7):1553-71. doi: 10.1517/13543784.9.7.1553.
Results Reference
background
PubMed Identifier
12137404
Citation
Smith PF. Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. Curr Opin Investig Drugs. 2002 Jun;3(6):859-64.
Results Reference
background
PubMed Identifier
14615106
Citation
Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A; UK MS Research Group. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet. 2003 Nov 8;362(9395):1517-26. doi: 10.1016/S0140-6736(03)14738-1.
Results Reference
background
PubMed Identifier
10716447
Citation
Baker D, Pryce G, Croxford JL, Brown P, Pertwee RG, Huffman JW, Layward L. Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature. 2000 Mar 2;404(6773):84-7. doi: 10.1038/35003583.
Results Reference
background
PubMed Identifier
12617376
Citation
Wade DT, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil. 2003 Feb;17(1):21-9. doi: 10.1191/0269215503cr581oa.
Results Reference
background
PubMed Identifier
15327042
Citation
Wade DT, Makela P, Robson P, House H, Bateman C. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler. 2004 Aug;10(4):434-41. doi: 10.1191/1352458504ms1082oa.
Results Reference
background
PubMed Identifier
15327040
Citation
Vaney C, Heinzel-Gutenbrunner M, Jobin P, Tschopp F, Gattlen B, Hagen U, Schnelle M, Reif M. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler. 2004 Aug;10(4):417-24. doi: 10.1191/1352458504ms1048oa.
Results Reference
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Use of Cannabinoids in Patients With Multiple Sclerosis

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