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Switching From Oral Dopamine Agonists to Rotigotine (SWITCH)

Primary Purpose

Restless Legs Syndrome, Ekbom Syndrome, Willis-Ekbom Disease

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Rotigotine
Sponsored by
John Winkelman, MD, PhD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Restless Legs Syndrome focused on measuring Restless Legs Syndrome, Ekbom Syndrome, Willis-Ekbom Disease, Rotigotine, Neupro, Dopamine Agonist

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • A diagnosis of RLS, defined by International Restless Legs Study Group (IRLS) essential criteria:

    1. An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.
    2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting.
    3. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.
    4. The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night.

(Although some subjects may not meet these criteria on their current oral regimen, these symptoms must have been present prior to treatment.)

  • Current treatment with either pramipexole (≤1 mg total daily dose) or ropinirole (≤4 mg total daily dose) with unchanged dose for the past 30 days. Patients also on other RLS medications will be allowed to participate if the dosing has been stable for the past 30 days and the subject agrees to maintain a stable dose for the duration of the trial.
  • Inadequate symptom control or patient dissatisfaction with current oral regimen.
  • Able to speak and read English.
  • Able to provide informed consent.
  • Able to learn and demonstrate appropriate patch application.
  • Returns appropriately completed RLS symptom log at Visit 2.
  • Confirms understanding of cross-titration schedule and is able to restate or summarize these instructions at Visit 2.
  • Age ≥18 and ≤75.
  • BMI ≥18 and ≤35
  • History and/or clinical records document no change in medications active in the central nervous system (antidepressants, analgesics, antipsychotics, antiepileptics, hypnotics, etc.) for at least 30 days prior to visit 1.
  • Able to understand study procedures and agrees to remain on stable medications during the period of the study.
  • Women of childbearing potential must agree to use a medically accepted method of birth control. Acceptable forms of birth control include:

    1. Condom + spermicide

      • b. Diaphragm + spermicide
      • c. Oral contraceptive pills, hormone implants (like Norplant),or injections (like Depo-Provera)
      • Intrauterine Device

Exclusion Criteria:

  • Known secondary cause of RLS, including end-stage renal disease, severe iron deficiency (ferritin <18), pregnancy.
  • History of frequent symptomatic orthostatic hypotension.
  • Current treatment with a dopamine antagonist medication.
  • Another chronic pain syndrome that would, in the opinion of the investigator, interfere with evaluation of RLS symptoms or the response to the study medication.
  • Plan to undergo a procedure that may require short or long-term opiates for pain control during the course of the trial.
  • Women who are pregnant, lactating, or planning to become pregnant.
  • Shift work or other commitments that do not allow for regular sleep at night.
  • Known hypersensitivity or intolerance to rotigotine.
  • Known allergy to sulfite-containing drugs.
  • History of problematic skin hypersensitivity to adhesives.
  • Previous or current clinically significant impulse control disorder, as determined by clinical interview.
  • Anticipated change in psychiatric or neurologic status likely to require adjustment of CNS-active medications during the study period.
  • Unwillingness of subject to remain on stable doses of CNS-active medications.
  • Unwillingness of subject to refrain from as-needed use of RLS medications.
  • Significant risk for suicide by clinical interview.
  • History of severe mental illness or psychosis
  • Current unstable medical illness.
  • Any medical or psychiatric condition that, in the opinion of the investigator, would interfere with participation in the study.

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Oral Dopamine Agonist to Rotigotine

Arm Description

During the study, we will switch patients who are not satisfied with their current oral dopamine agonist to rotigotine. Cross-titration will allow determination of the lowest effective dose of rotigotine. We will use as initial guidance the equivalence determined from the Parkinson's Disease trials, in which 1 mg rotigotine was shown to be approximately equivalent to 1-1.5 mg ropinirole or 0.25 -0.375 mg pramipexole. Tolerability, adverse events, and RLS symptom control will be evaluated. These data will provide clinicians with practical guidance to optimize RLS treatment while minimizing adverse events.

Outcomes

Primary Outcome Measures

Proportion of Patients Completing the Switch and Their Adverse Events
The primary endpoint will be the safety and tolerability of switching from an oral dopamine agonist to rotigotine. The CGIC scales were developed to assess treatment outcomes in pharmacological studies. The scales are meant completed by the clinician in person after assessment of the subject. They include 4 global scales describing the severity of illness, change in severity from baseline, therapeutic efficacy, and tolerability of treatment. Clinical Global Impression - Improvement scale (CGI-I) rated as: 1, very much improved since the baseline week; 2, much improved; 3, minimally improved; 4, no change from baseline; 5, minimally worse; 6, much worse; or 7, very much worse since the baseline week. The CGI-I was performed at baseline and at Week 5 to see which participants rated as much or very much improved. Adverse Events are reported in the Adverse Events module.

Secondary Outcome Measures

International Restless Legs Scale (IRLS)
The IRLS will be used to determine the overall efficacy of RLS symptom control on rotigotine. The IRLS is a well-validated instrument for measuring RLS severity during the past week. It includes 10 questions encompassing intensity and frequency of symptoms, associated sleep problems, and the impact of symptoms on the patients' mood and daily functioning. This scale has been shown to have high internal consistency, inter-examiner reliability, test-retest reliability, and convergent validity. Minimum score 0, maximum score 40. A decrease in the IRLS score indicates a better outcome.
RLS-6 Scale
The RLS-6 scale will be used to determine the overall efficacy of RLS symptom control on rotigotine, calculated as a mean score for each scale during the final treatment week vs baseline. The RLS-6 scale are 11-point (0=not present to 10=very severe) metrics for measuring RLS severity. Four questions delineate a severity profile of RLS during different night and daytime periods: at bedtime, during the night, during the day at rest, during daily activities. The final two questions assess satisfaction with sleep and severity of sleepiness during the day. The RLS-6 scales have been validated on a day-to-day basis, with relatively low placebo effect compared to other RLS rating scales. Minimum score 0, maximum score 60. A decrease in the RLS-6 score indicates a better outcome. The RLS-6 scale was completed each day of the study and averaged for the baseline week (approximately days 1-7 of the study) and the final week (approximately days 21-28 of the maintenance period).
Preference of Medication Scale (POM)
The POM will be used to assess patient satisfaction with treatment. The POM scale is designed to summarize subjects' preference for the study medication compared to prior therapy. It asks a single question: "How does this current medicine compare to the previous RLS medicine(s) you were taking?" The response set is as follows: (1) Much Better, I prefer this medication (indicating preference for rotigotine); (2) Slightly Better; (3) About the Same; (4) Slightly Worse; (5) Much Worse, I much prefer my previous medication (indicating preference for oral dopamine agonist).
The Patient Global Impression of Change Scale
The Patient Global Impression of Change scale (PGIC) will be used to assess patient satisfaction with treatment. The PGIC assesses subjective changes in symptoms during clinical trials. This single-item scale asks participants to rate their symptoms as "very much improved," "much improved," "minimally improved," "no change," "minimally worse," "much worse," or "very much worse." The measure provides a responsive and easily interpretable assessment of participants' evaluations of the importance of their improvement or worsening.
The Clinician Global Impression of Change Scale
The Clinician Global Impression of Change scale (CGIC) will be used to assess patient satisfaction with treatment.

Full Information

First Posted
October 25, 2013
Last Updated
October 13, 2016
Sponsor
John Winkelman, MD, PhD
Collaborators
UCB Pharma
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1. Study Identification

Unique Protocol Identification Number
NCT01976871
Brief Title
Switching From Oral Dopamine Agonists to Rotigotine
Acronym
SWITCH
Official Title
A Method to Switch From Oral Dopamine Agonists to Rotigotine in Patients With Restless Legs Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
October 2016
Overall Recruitment Status
Completed
Study Start Date
August 2014 (undefined)
Primary Completion Date
May 2015 (Actual)
Study Completion Date
December 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
John Winkelman, MD, PhD
Collaborators
UCB Pharma

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The primary objective is to demonstrate safety and tolerability of switching patients with Restless Legs Syndrome (RLS) from an oral dopamine agonist to rotigotine. As a secondary objective, the investigators will evaluate control of RLS symptoms on rotigotine compared to the prior oral regimen.
Detailed Description
The study will consist of 3 in-person visits and 4 scheduled telephone appointments over the course of approximately 6 weeks. The first visit will be the screening visit during which eligibility will be confirmed and informed consent obtained. After the first visit, subjects will continue their current oral dopamine agonist for a one-week baseline period during which they will record RLS symptoms daily. The second visit will be the baseline visit. The IRLS scale, a commonly used measure of RLS symptoms, will be obtained. An individualized schedule for down-titration of oral dopamine agonist and concomitant up-titration of rotigotine will be provided. After the second visit, subjects will begin this cross-titration. This will entail a pre-determined incremental taper of the oral medication and flexible up-titration of rotigotine according to symptoms. During this time, subjects will keep diaries of RLS symptoms and will speak with the investigator over the phone a total of 3 times (visits 2a-2c) to discuss dosing of rotigotine. After the titration is complete, subjects will enter the maintenance period, which will last 28 days. There will be another phone contact (2d) one week after the titration is complete to adjust the dose of rotigotine as needed. The subject will then continue the chosen dose for the next 3 weeks of the maintenance period. There will be one final phone contact (2e) 1 week prior to the end of the maintenance period to remind subjects to resume RLS symptom diaries during the final week of the maintenance period. The third and final visit will take place at the end of the maintenance period. RLS symptoms will be discussed and the IRLS scale, Clinician Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), and Preference of Medication Scale (POMS) will be administered.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Restless Legs Syndrome, Ekbom Syndrome, Willis-Ekbom Disease
Keywords
Restless Legs Syndrome, Ekbom Syndrome, Willis-Ekbom Disease, Rotigotine, Neupro, Dopamine Agonist

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Oral Dopamine Agonist to Rotigotine
Arm Type
Experimental
Arm Description
During the study, we will switch patients who are not satisfied with their current oral dopamine agonist to rotigotine. Cross-titration will allow determination of the lowest effective dose of rotigotine. We will use as initial guidance the equivalence determined from the Parkinson's Disease trials, in which 1 mg rotigotine was shown to be approximately equivalent to 1-1.5 mg ropinirole or 0.25 -0.375 mg pramipexole. Tolerability, adverse events, and RLS symptom control will be evaluated. These data will provide clinicians with practical guidance to optimize RLS treatment while minimizing adverse events.
Intervention Type
Drug
Intervention Name(s)
Rotigotine
Other Intervention Name(s)
Neupro
Intervention Description
Rotigotine is FDA approved for the treatment of Restless Legs Syndrome at doses of 1 mg/24h, 2 mg/24h, and 3 mg/24h. The prescribed dose of rotigotine may be achieved using single or multiple patches. Subjects will titrate the dose based on discussions with the investigator.
Primary Outcome Measure Information:
Title
Proportion of Patients Completing the Switch and Their Adverse Events
Description
The primary endpoint will be the safety and tolerability of switching from an oral dopamine agonist to rotigotine. The CGIC scales were developed to assess treatment outcomes in pharmacological studies. The scales are meant completed by the clinician in person after assessment of the subject. They include 4 global scales describing the severity of illness, change in severity from baseline, therapeutic efficacy, and tolerability of treatment. Clinical Global Impression - Improvement scale (CGI-I) rated as: 1, very much improved since the baseline week; 2, much improved; 3, minimally improved; 4, no change from baseline; 5, minimally worse; 6, much worse; or 7, very much worse since the baseline week. The CGI-I was performed at baseline and at Week 5 to see which participants rated as much or very much improved. Adverse Events are reported in the Adverse Events module.
Time Frame
Participants will be monitored for the duration of the study, approximately 6-10 weeks depending upon scheduling of visits
Secondary Outcome Measure Information:
Title
International Restless Legs Scale (IRLS)
Description
The IRLS will be used to determine the overall efficacy of RLS symptom control on rotigotine. The IRLS is a well-validated instrument for measuring RLS severity during the past week. It includes 10 questions encompassing intensity and frequency of symptoms, associated sleep problems, and the impact of symptoms on the patients' mood and daily functioning. This scale has been shown to have high internal consistency, inter-examiner reliability, test-retest reliability, and convergent validity. Minimum score 0, maximum score 40. A decrease in the IRLS score indicates a better outcome.
Time Frame
Study Visit 1 (Day 1) and Study Visit 3 (approximately 35 days after initiating the switch from the oral dopamine agonist to the transdermal rotigotine)
Title
RLS-6 Scale
Description
The RLS-6 scale will be used to determine the overall efficacy of RLS symptom control on rotigotine, calculated as a mean score for each scale during the final treatment week vs baseline. The RLS-6 scale are 11-point (0=not present to 10=very severe) metrics for measuring RLS severity. Four questions delineate a severity profile of RLS during different night and daytime periods: at bedtime, during the night, during the day at rest, during daily activities. The final two questions assess satisfaction with sleep and severity of sleepiness during the day. The RLS-6 scales have been validated on a day-to-day basis, with relatively low placebo effect compared to other RLS rating scales. Minimum score 0, maximum score 60. A decrease in the RLS-6 score indicates a better outcome. The RLS-6 scale was completed each day of the study and averaged for the baseline week (approximately days 1-7 of the study) and the final week (approximately days 21-28 of the maintenance period).
Time Frame
Average of Baseline titration week (approximately days 1-7 of the study) vs. Average of Final Treatment week (integrating data from days 28-35 after initiating the switch from the oral dopamine agonist to the transdermal rotigotine)
Title
Preference of Medication Scale (POM)
Description
The POM will be used to assess patient satisfaction with treatment. The POM scale is designed to summarize subjects' preference for the study medication compared to prior therapy. It asks a single question: "How does this current medicine compare to the previous RLS medicine(s) you were taking?" The response set is as follows: (1) Much Better, I prefer this medication (indicating preference for rotigotine); (2) Slightly Better; (3) About the Same; (4) Slightly Worse; (5) Much Worse, I much prefer my previous medication (indicating preference for oral dopamine agonist).
Time Frame
Study Visit 1 (Day 1) and Study Visit 3 (approximately 35 days after initiating the switch from the oral dopamine agonist to the transdermal rotigotine)
Title
The Patient Global Impression of Change Scale
Description
The Patient Global Impression of Change scale (PGIC) will be used to assess patient satisfaction with treatment. The PGIC assesses subjective changes in symptoms during clinical trials. This single-item scale asks participants to rate their symptoms as "very much improved," "much improved," "minimally improved," "no change," "minimally worse," "much worse," or "very much worse." The measure provides a responsive and easily interpretable assessment of participants' evaluations of the importance of their improvement or worsening.
Time Frame
Study Visit 1 (Day 1) and Study Visit 3 (approximately 35 days after initiating the switch from the oral dopamine agonist to the transdermal rotigotine)
Title
The Clinician Global Impression of Change Scale
Description
The Clinician Global Impression of Change scale (CGIC) will be used to assess patient satisfaction with treatment.
Time Frame
Study Visit 1 (Day 1) and Study Visit 3 (approximately 35 days after initiating the switch from the oral dopamine agonist to the transdermal rotigotine)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A diagnosis of RLS, defined by International Restless Legs Study Group (IRLS) essential criteria: An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues. The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night. (Although some subjects may not meet these criteria on their current oral regimen, these symptoms must have been present prior to treatment.) Current treatment with either pramipexole (≤1 mg total daily dose) or ropinirole (≤4 mg total daily dose) with unchanged dose for the past 30 days. Patients also on other RLS medications will be allowed to participate if the dosing has been stable for the past 30 days and the subject agrees to maintain a stable dose for the duration of the trial. Inadequate symptom control or patient dissatisfaction with current oral regimen. Able to speak and read English. Able to provide informed consent. Able to learn and demonstrate appropriate patch application. Returns appropriately completed RLS symptom log at Visit 2. Confirms understanding of cross-titration schedule and is able to restate or summarize these instructions at Visit 2. Age ≥18 and ≤75. BMI ≥18 and ≤35 History and/or clinical records document no change in medications active in the central nervous system (antidepressants, analgesics, antipsychotics, antiepileptics, hypnotics, etc.) for at least 30 days prior to visit 1. Able to understand study procedures and agrees to remain on stable medications during the period of the study. Women of childbearing potential must agree to use a medically accepted method of birth control. Acceptable forms of birth control include: Condom + spermicide b. Diaphragm + spermicide c. Oral contraceptive pills, hormone implants (like Norplant),or injections (like Depo-Provera) Intrauterine Device Exclusion Criteria: Known secondary cause of RLS, including end-stage renal disease, severe iron deficiency (ferritin <18), pregnancy. History of frequent symptomatic orthostatic hypotension. Current treatment with a dopamine antagonist medication. Another chronic pain syndrome that would, in the opinion of the investigator, interfere with evaluation of RLS symptoms or the response to the study medication. Plan to undergo a procedure that may require short or long-term opiates for pain control during the course of the trial. Women who are pregnant, lactating, or planning to become pregnant. Shift work or other commitments that do not allow for regular sleep at night. Known hypersensitivity or intolerance to rotigotine. Known allergy to sulfite-containing drugs. History of problematic skin hypersensitivity to adhesives. Previous or current clinically significant impulse control disorder, as determined by clinical interview. Anticipated change in psychiatric or neurologic status likely to require adjustment of CNS-active medications during the study period. Unwillingness of subject to remain on stable doses of CNS-active medications. Unwillingness of subject to refrain from as-needed use of RLS medications. Significant risk for suicide by clinical interview. History of severe mental illness or psychosis Current unstable medical illness. Any medical or psychiatric condition that, in the opinion of the investigator, would interfere with participation in the study.
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

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Switching From Oral Dopamine Agonists to Rotigotine

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