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Caprylic Triglyceride for Treatment of Cognitive Impairments in Multiple Sclerosis

Primary Purpose

Relapsing Remitting MS, Secondary Progressive MS, Primary Progressive MS

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Caprylic Triglyceride
Placebo
Sponsored by
University of Miami
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Relapsing Remitting MS focused on measuring Cognition, Neuropsychology, Multiple Sclerosis

Eligibility Criteria

18 Years - 59 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Institutional Review Board (IRB)-approved Informed Consent Form signed by patient
  2. A diagnosis of MS as defined by the Revised McDonald criteria.
  3. All subtypes of MS, relapsing and progressive, are eligible.
  4. Males and females age 18 to 59 years old.
  5. Complaints of difficulties with memory or other aspects of cognition.
  6. Mini-Mental Status Exam (MMSE) score >=24 for determination of ability to provide informed consent.
  7. 8th grade English reading proficiency as determined by Wide Range Achievement Test-4th edition-reading .
  8. Females of childbearing potential must have a negative pregnancy test prior to entry into treatment phase and must simultaneously use two forms of effective contraception during the treatment and for one month or one menstrual cycle after discontinuation of the study medication.
  9. All concomitant medication doses must be stable for at least 30 days prior to randomization and remain stable for the study duration.
  10. An Expanded Disability Status Scale (EDSS) score of at least a 2.0 with a Functional System Score of at least a 2 in the Cerebral section due to decreased mentation.
  11. Stable neurologic function with no multiple sclerosis relapses for at least 30 days prior to study entry.
  12. No clinically significant abnormal findings on the physical examination, medical history, or clinical laboratory results during Screen.
  13. Documented memory deficit as defined by a score at least 0.5 standard deviations (SD) below age- and gender-based normative values on the Total Learning Score of the CVLT-II OR a documented processing speed deficit as defined by a score of at least 1.0 SD below normative values on the SDMT.

Exclusion Criteria:

  1. Any condition that would render the patient or the caregiver unsuitable for the study, or place them at substantial risk of adverse outcome.
  2. Unwillingness/inability of the patient to fulfill the study requirements.
  3. Evidence of major depression or a score on the BDI-II > or = 30 OR a score < 30 on BDI-II but with endorsed suicidal ideation.
  4. Hypothyroidism
  5. B12 deficiency
  6. Diabetes (Type 1 or 2).
  7. Positive rapid plasma reagin.
  8. Fasting triglyceride level>2 times upper limit of normal value w/in 3 months of Study Visit 1.
  9. History of malignancy of any organ system (other than localized squamous and basal cell carcinoma of the skin), treated or untreated, within the past 2 years.
  10. Clinically significant renal disease or insufficiency.
  11. Clinically significant hepatic disease or insufficiency.
  12. Ethanol consumption greater than an equivalent of 2 oz/20 g/2 units of spirits per day OR 14 oz/140 g/14 units of spirits per week. One oz/10 g/1 unit of spirits = 6 oz/15 g/1 unit of wine = 12 oz/12 g/1 unit of beer.
  13. History of current alcohol or substance abuse.
  14. Known HIV infection.
  15. History of head injury with loss of consciousness > 30 minutes.
  16. History of inflammatory bowel syndrome.
  17. History of severe irritable bowel disease.
  18. History of severe gastroesophageal reflux disease.
  19. History of diverticular disease.
  20. Use of any investigational compound within 30 days prior to screening.
  21. Prior or current use of medium chain triglycerides for medical purposes.
  22. Known allergies to dairy products or soy.
  23. Use of anticholinergic medication within 30 days prior to Study Visit 1.
  24. Use of acetylcholinesterase inhibitors within 30 days prior to Study Visit 1.
  25. Use of memantine within 30 days prior to Study Visit 1.
  26. Use of stimulants within 30 days prior to Study Visit 1
  27. Use of modafinil, amantadine, and dalfampridine within 30 days prior to Study Visit 1, unless the dose has been stable for 90 days prior to Study Visit 1
  28. Use of orlistat within 30 days prior to Study Visit 1.

Sites / Locations

  • University of Miami Miller School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Caprylic Triglyceride

Placebo

Arm Description

Caprylic Triglyceride (40 gram packet orally once a day for 90 days)

Placebo (40 gram packet orally once a day for 90 days)

Outcomes

Primary Outcome Measures

Change in Total Learning (Trials 1-5) on the California Verbal Learning Test-2nd Edition (CVLT-II) (range from 0 to 80)
measure of verbal learning and memory
Change in Symbol Digit Modalities Test (SDMT) (range from 0-110)
measure of processing speed and attention
Number of participants reporting adverse events
The number of participants experiencing adverse events in the active treatment and placebo group will be examined.

Secondary Outcome Measures

Change in EDSS
measure of disease severity
Change in Beck Depression Inventory -2nd edition (BDI-II)
Self-report depression scale
Change in Multiple Sclerosis Quality of Life Inventory (MSQOL-54)
Quality of life inventory
Change in Modified Fatigue Impact Scale (MFIS)
Self-report Fatigue scale

Full Information

First Posted
April 16, 2013
Last Updated
January 23, 2018
Sponsor
University of Miami
Collaborators
National Multiple Sclerosis Society, Cerecin
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1. Study Identification

Unique Protocol Identification Number
NCT01848327
Brief Title
Caprylic Triglyceride for Treatment of Cognitive Impairments in Multiple Sclerosis
Official Title
A Randomized Double-Blind Placebo-Controlled Study of Caprylic Triglyceride for Cognitive Impairment in Subjects With Multiple Sclerosis.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2018
Overall Recruitment Status
Completed
Study Start Date
February 2013 (Actual)
Primary Completion Date
December 2017 (Actual)
Study Completion Date
December 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Miami
Collaborators
National Multiple Sclerosis Society, Cerecin

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Background/Rationale: Cognitive problems are a common symptom in individuals with Multiple Sclerosis (MS). Treatment options are limited, and there is a pressing need for new interventions to treat MS-related cognitive impairment. Glucose (a type of sugar) is used to fuel the cells of the healthy brain. For people with neurological conditions such as MS, glucose is not converted into energy as efficiently as it would be in a healthy brain, which can lead to a decrease in cognitive function. Caprylic Triglyceride may work to bypass this problem by providing an alternative energy source that is metabolized in the liver and used by the brain. Objective: To evaluate the therapeutic effects of 90 days of caprylic triglyceride on cognitive impairment in multiple sclerosis. Design: Randomized, double blinded, placebo controlled trial of 158 subjects. Outcome: Change in Total Learning (Trials 1-5) on the California Verbal Learning Test-2nd Edition-(CVLT-II) AND Change in Symbol Digit Modalities Test (SDMT) (at day 90
Detailed Description
Patients with all types of MS (Relapsing Remitting, Secondary Progressive, or Primary Progressive) are eligible to participate. Participants will undergo detailed cognitive assessment before initiating treatment and again after 90 days of treatment, to determine whether Caprylic Triglyceride demonstrates a benefit over placebo. Dosage: 40 gram packet orally once a day Duration of Treatment: 90 days Analyses: Interim analyses will be conducted after 72 subjects have completed the trial and objective STOP criteria for efficacy and futility have been defined in the protocol. Final analyses will be an intent-to-treat (ITT) analysis to evaluate each of the primary aims.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Relapsing Remitting MS, Secondary Progressive MS, Primary Progressive MS
Keywords
Cognition, Neuropsychology, Multiple Sclerosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
124 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Caprylic Triglyceride
Arm Type
Experimental
Arm Description
Caprylic Triglyceride (40 gram packet orally once a day for 90 days)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo (40 gram packet orally once a day for 90 days)
Intervention Type
Dietary Supplement
Intervention Name(s)
Caprylic Triglyceride
Other Intervention Name(s)
Axona
Intervention Description
Caprylic Triglyceride is a medical food that is used for the dietary management of the metabolic processes associated with mild to moderate Alzheimer's disease.
Intervention Type
Dietary Supplement
Intervention Name(s)
Placebo
Intervention Description
Placebo (40 gram packet orally once a day for 90 days)
Primary Outcome Measure Information:
Title
Change in Total Learning (Trials 1-5) on the California Verbal Learning Test-2nd Edition (CVLT-II) (range from 0 to 80)
Description
measure of verbal learning and memory
Time Frame
Baseline and 90 days
Title
Change in Symbol Digit Modalities Test (SDMT) (range from 0-110)
Description
measure of processing speed and attention
Time Frame
Baseline and 90 days
Title
Number of participants reporting adverse events
Description
The number of participants experiencing adverse events in the active treatment and placebo group will be examined.
Time Frame
Baseline and 90 days
Secondary Outcome Measure Information:
Title
Change in EDSS
Description
measure of disease severity
Time Frame
Baseline and 90 days
Title
Change in Beck Depression Inventory -2nd edition (BDI-II)
Description
Self-report depression scale
Time Frame
Baseline and 90 days
Title
Change in Multiple Sclerosis Quality of Life Inventory (MSQOL-54)
Description
Quality of life inventory
Time Frame
Baseline and 90 days
Title
Change in Modified Fatigue Impact Scale (MFIS)
Description
Self-report Fatigue scale
Time Frame
Baseline and 90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
59 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Institutional Review Board (IRB)-approved Informed Consent Form signed by patient A diagnosis of MS as defined by the Revised McDonald criteria. All subtypes of MS, relapsing and progressive, are eligible. Males and females age 18 to 59 years old. Complaints of difficulties with memory or other aspects of cognition. Mini-Mental Status Exam (MMSE) score >=24 for determination of ability to provide informed consent. 8th grade English reading proficiency as determined by Wide Range Achievement Test-4th edition-reading . Females of childbearing potential must have a negative pregnancy test prior to entry into treatment phase and must simultaneously use two forms of effective contraception during the treatment and for one month or one menstrual cycle after discontinuation of the study medication. All concomitant medication doses must be stable for at least 30 days prior to randomization and remain stable for the study duration. An Expanded Disability Status Scale (EDSS) score of at least a 2.0 with a Functional System Score of at least a 2 in the Cerebral section due to decreased mentation. Stable neurologic function with no multiple sclerosis relapses for at least 30 days prior to study entry. No clinically significant abnormal findings on the physical examination, medical history, or clinical laboratory results during Screen. Documented memory deficit as defined by a score at least 0.5 standard deviations (SD) below age- and gender-based normative values on the Total Learning Score of the CVLT-II OR a documented processing speed deficit as defined by a score of at least 1.0 SD below normative values on the SDMT. Exclusion Criteria: Any condition that would render the patient or the caregiver unsuitable for the study, or place them at substantial risk of adverse outcome. Unwillingness/inability of the patient to fulfill the study requirements. Evidence of major depression or a score on the BDI-II > or = 30 OR a score < 30 on BDI-II but with endorsed suicidal ideation. Hypothyroidism B12 deficiency Diabetes (Type 1 or 2). Positive rapid plasma reagin. Fasting triglyceride level>2 times upper limit of normal value w/in 3 months of Study Visit 1. History of malignancy of any organ system (other than localized squamous and basal cell carcinoma of the skin), treated or untreated, within the past 2 years. Clinically significant renal disease or insufficiency. Clinically significant hepatic disease or insufficiency. Ethanol consumption greater than an equivalent of 2 oz/20 g/2 units of spirits per day OR 14 oz/140 g/14 units of spirits per week. One oz/10 g/1 unit of spirits = 6 oz/15 g/1 unit of wine = 12 oz/12 g/1 unit of beer. History of current alcohol or substance abuse. Known HIV infection. History of head injury with loss of consciousness > 30 minutes. History of inflammatory bowel syndrome. History of severe irritable bowel disease. History of severe gastroesophageal reflux disease. History of diverticular disease. Use of any investigational compound within 30 days prior to screening. Prior or current use of medium chain triglycerides for medical purposes. Known allergies to dairy products or soy. Use of anticholinergic medication within 30 days prior to Study Visit 1. Use of acetylcholinesterase inhibitors within 30 days prior to Study Visit 1. Use of memantine within 30 days prior to Study Visit 1. Use of stimulants within 30 days prior to Study Visit 1 Use of modafinil, amantadine, and dalfampridine within 30 days prior to Study Visit 1, unless the dose has been stable for 90 days prior to Study Visit 1 Use of orlistat within 30 days prior to Study Visit 1.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Leticia Tornes, M.D.
Organizational Affiliation
University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Miami Miller School of Medicine
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Via Publications

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Caprylic Triglyceride for Treatment of Cognitive Impairments in Multiple Sclerosis

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