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A Study to Evaluate the Botulinum Toxin Type A for Injection(HengLi®) in Subjects With Post-stroke Upper Limb Spasticity

Primary Purpose

Cerebrovascular Accident

Status
Completed
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Botulinum Toxin Type A for Injection
placebo
Sponsored by
Lanzhou Institute of Biological Products Co., Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cerebrovascular Accident focused on measuring Spasticity, Post-Stroke, Botulinum toxin type A for Injection, upper limb spasticity

Eligibility Criteria

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

Inclusion Criteria:

  • ≥40kg in weight.
  • Subjects voluntarily sign the informed consent.
  • Subjects with upper limb spasticity who are at least 3 months post stroke and present with spasticity of both the wrist and fingers in the study limb.
  • Both wrist flexor muscle tone and finger flexor muscle tone evaluation recorded 2 or greater individually as measured by MAS (0 to 4).
  • At least one functional disability item (i.e., hygiene, dressing, pain, or cosmesis) evaluated 2 or greater by DAS (0 to 3).
  • If using oral anti-spasticity medications, must be stable for at least 1 month prior to study enrolment.
  • If taking any physical therapy or occupational therapy, must be stable on frequency, type, and intension for at least 1 month prior to study enrolment.
  • In the opinion of the investigator, subject must clearly understand the intent of the study and be willing and able to comply with study instructions and complete the entire study.

Exclusion Criteria:

  • Females who are pregnant, nursing, or planning a pregnancy during the study period, or females of childbearing potential, not using a reliable means of contraception.
  • Known allergy or sensitivity to study medication or its components.
  • Infection or dermatological condition at the injection sites.
  • Significant inflammation in the study limb limiting joint movement.
  • Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, esophageal or gastric varices or persistent jaundice), cirrhosis, known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones).
  • History of or planned surgical intervention for spasticity of the study limb.
  • Participation in another clinical study currently, or within the one months immediately prior to enrolment.
  • Within six months prior to the study had received any treatment of patients with botulinum toxin of any serotype.
  • Any medical condition that may put the subject at increased risk with exposure , including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other disorder that might have interfered with neuromuscular function.
  • History of or planned treatment for spasticity with phenol or alcohol block in the study limb.
  • Current treatment for spasticity with an intrathecal baclofen.
  • QTc criteria: (either QTcb or QTcf, machine or manual overread, males or females); include the following details as appropriate: QTc≥450 millisecond (msec) or≥480msec for subjects with Bundle Branch Block-values based on either single electrocardiogram (ECG) values or triplicate ECG averaged QTc values obtained over a brief recording period.
  • Liver function tests: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≥2xULN; alkaline phosphatase and bilirubin >1.5xULN (isolated bilirubin >1.5ULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).
  • Concurrent use of aminoglycoside antibiotics or other agents that might interfere with neuromuscular function.
  • Presence of clinically unstable severe cardiovascular, renal or respiratory disease.
  • Profound atrophy of muscles to be injected (in the investigators opinion).
  • Planned or anticipated initiation of new antispasticity medications during the clinical study.
  • History (within 3 months of qualification) of or planned (during study period) casting of the study limb.
  • patients with severe cognitive impairment or neurological diseases affecting the implementation or evaluation of the test, and drug-dependent patients.
  • Researchers believe there are other factors unfit to participate in this study of patients .

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Botulinum Toxin Type A for Injection

    placebo

    Arm Description

    HengLi002(Botulinum Toxin Type A for Injection,also known as "HengLi®")

    excipient

    Outcomes

    Primary Outcome Measures

    Change From Baseline at Week 6 of Wrist Flexor Muscle Tone is calculated by the Modified Ashworth Scale (MAS)
    The investigator, physiotherapist, or occupational therapist extended the participant's wrist as quickly as possible to grade flexor muscle tone. The MAS wrist score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at Week 6 was calculated as the value at Week 6 minus the value at Baseline.

    Secondary Outcome Measures

    Area Under the Curve (AUC) for the Change From Baseline at Weeks 6 and 12 for MAS Wrist Score
    horizontal axis (HA): plotting time points; vertical axis: Mean changes from Baseline for the MAS wrist score are calculated as the value at Week 6 and Week 12 minus the value at Baseline
    Change From Baseline at Weeks 1, 4, 8, 12, 16 and 18 for Wrist Flexor Muscle Tone are calculated by the MAS
    The investigator, physiotherapist, or occupational therapist extended the participant's wrist as quickly as possible to grade flexor muscle tone. The MAS wrist score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at the indicated time points was calculated as the value at the indicated time points minus the value at Baseline.
    Proportion of subjects Classified as Wrist Treatment Responders at All Post-injection Visits
    Definition of Wrist Treatment Responder: The MAS wrist score reduces at least 1 point. The MAS wrist score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension).
    Changes From Baseline at Week 1, 4, 6, 8, 12, 16 and 18 of Finger Flexor Muscle Tone are calculated by the MAS
    The investigator, physiotherapist, or occupational therapist extended the participant's finger as quickly as possible to grade the flexor muscle tone. The MAS finger score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at the indicated time points was calculated as the value at Week 1, 4, 6, 8, and 12 minus the value at Baseline.
    Changes From Baseline at Week 1, 4, 6, 8, 12, 16 and 18 of Thumb Flexor Muscle Tone are calculated by the MAS
    The investigator, physiotherapist, or occupational therapist extended the participant's thumb as quickly as possible to grade the flexor muscle tone. The MAS thumb score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at the indicated time points was calculated as the value at Week 1, 4, 6, 8, and 12 minus the value at Baseline.
    Changes From Baseline at Week 1, 4, 6, 8, 12, 16 and 18 of individual situations are calculated by the Disability Assessment Scale (DAS)
    The investigator evaluates 4 areas of disability, hygiene, pain, dressing, and limb posture, with the 4-point DAS (0=No functional disability to 3=Severe disability). Prior to the initial administration, the investigator, in consultation with the participant, selects 1 functional disability item (The item should be scored 2 or greater as measured by the DAS, indicating moderate to severe disability) from the 4 areas of disability and assessed it as a principal measure. Change from Baseline at the indicated time points was calculated at Week 1, 4, 6, 8, 12, 16 and 18 minus the value at Baseline.
    Global Assessment Scale (GAS) Score as Evaluated by the Physician at the Indicated Time Points
    The investigators use the GAS to assess response after administration at each visit (visit 1 to 7). The 9-point GAS (-4, -3, -2, -1, 0, +1, +2, +3, +4; -4=very marked worsening, 0=unchanged, +4=very marked improvement) is chosen to measure at the indicated time points.
    GAS Score as Evaluated by the Care Giver or the Participants at the Indicated Time Points
    The caregivers or participants take the GAS to assess response after administration at each visit (visit 1 to 7). The 9-point GAS (-4, -3, -2, -1, 0, +1, +2, +3, +4; -4=very marked worsening, 0=unchanged, +4=very marked improvement) is chosen to measure at the indicated time points.

    Full Information

    First Posted
    October 29, 2014
    Last Updated
    September 22, 2016
    Sponsor
    Lanzhou Institute of Biological Products Co., Ltd
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02280083
    Brief Title
    A Study to Evaluate the Botulinum Toxin Type A for Injection(HengLi®) in Subjects With Post-stroke Upper Limb Spasticity
    Official Title
    A Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Botulinum Toxin Type A for Injection in Chinese Subjects With Post-stroke Upper Limb Spasticity
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2016
    Overall Recruitment Status
    Completed
    Study Start Date
    July 2014 (undefined)
    Primary Completion Date
    February 2016 (Actual)
    Study Completion Date
    September 2016 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Lanzhou Institute of Biological Products Co., Ltd

    4. Oversight

    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This is a multicenter, double-blind, randomized, placebo-controlled study designed to compare Botulinum Toxin Type A for Injection (HengLi®) with placebo on the efficacy and safety of treatment in post-stroke subjects with focal wrist, finger and in some cases, thumb spasticity. Approximately 180 subjects will be enrolled. The core period of the subjects will receive a single treatment session of intramuscular HengLi® 200U or 240U (if thumb spasticity is present) or placebo in a randomization ratio of 2:1. Research contains two parts: core phase and extension phase. In the core phase, subjects will finish 6 visits (12 weeks ) after initial injection. During the extension phase, subjects will accept two follow-up visit (6 weeks). Outcome measures include changes from baseline at every post injection visit as measured on the Modified Ashworth Scale (MAS), Disability Assessment Scale (DAS) and Global Assessment Scale(GAS). The primary efficacy endpoint is the change from baseline at week 6 for wrist flexor muscle tone as measured on the Modified Ashworth Scale. Safety parameters will also be measured including adverse events, vital signs (pulse and blood pressure) and clinical laboratory tests (haematology, serum chemistry and urinanalysis).
    Detailed Description
    The primary purpose is to prove the efficacy of treatment administration with Botulinum Toxin Type A for Injection (HengLi®) beyond placebo in subjects with post-stroke upper limb spasticity of both wrist and fingers flexors as measured on the Modified Ashworth Scale (MAS). Subjects will receive a single treatment session of intramuscular HengLi® 200U or 240U (if thumb spasticity is present) or placebo after they first enroll the core phase randomly. Totally 180 subjects will be recruited in this part. Each completed subject should finish 8 (visit 0 to 7) clinic visits. Subjects will receive a single intramuscular treatment with either HengLi® or placebo at day 0 (visit 0). The else 7 visits are at week 1, 4, 6, 8, 12, 16 and 18 (visits 1 to 7) and week 6 (visit 3) is appointed as the primary visit to determine efficacy. The primary endpoint is the change from baseline at week 6 for wrist flexor muscle tone as measured on the Modified Ashworth Scale (MAS). The secondary endpoints involve the area under curve (AUC) for the MAS wrist score change from baseline, change from baseline for wrist/finger/thumb flexor muscle tone as measured on MAS, DAS and GAS. The safety measures involve adverse events, clinical laboratory tests and pulse, blood pressure.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Cerebrovascular Accident
    Keywords
    Spasticity, Post-Stroke, Botulinum toxin type A for Injection, upper limb spasticity

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    180 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Botulinum Toxin Type A for Injection
    Arm Type
    Experimental
    Arm Description
    HengLi002(Botulinum Toxin Type A for Injection,also known as "HengLi®")
    Arm Title
    placebo
    Arm Type
    Placebo Comparator
    Arm Description
    excipient
    Intervention Type
    Drug
    Intervention Name(s)
    Botulinum Toxin Type A for Injection
    Other Intervention Name(s)
    HengLi®
    Intervention Description
    HengLi002(Botulinum Toxin Type A for Injection,also known as "HengLi®")
    Intervention Type
    Drug
    Intervention Name(s)
    placebo
    Intervention Description
    placebo
    Primary Outcome Measure Information:
    Title
    Change From Baseline at Week 6 of Wrist Flexor Muscle Tone is calculated by the Modified Ashworth Scale (MAS)
    Description
    The investigator, physiotherapist, or occupational therapist extended the participant's wrist as quickly as possible to grade flexor muscle tone. The MAS wrist score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at Week 6 was calculated as the value at Week 6 minus the value at Baseline.
    Time Frame
    Baseline (Day 0) and Week 6
    Secondary Outcome Measure Information:
    Title
    Area Under the Curve (AUC) for the Change From Baseline at Weeks 6 and 12 for MAS Wrist Score
    Description
    horizontal axis (HA): plotting time points; vertical axis: Mean changes from Baseline for the MAS wrist score are calculated as the value at Week 6 and Week 12 minus the value at Baseline
    Time Frame
    Baseline (Day 0), Week 6, and Week 12
    Title
    Change From Baseline at Weeks 1, 4, 8, 12, 16 and 18 for Wrist Flexor Muscle Tone are calculated by the MAS
    Description
    The investigator, physiotherapist, or occupational therapist extended the participant's wrist as quickly as possible to grade flexor muscle tone. The MAS wrist score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at the indicated time points was calculated as the value at the indicated time points minus the value at Baseline.
    Time Frame
    Baseline (Day 0) and Weeks 1, 4, 8, 12, 16 and 18
    Title
    Proportion of subjects Classified as Wrist Treatment Responders at All Post-injection Visits
    Description
    Definition of Wrist Treatment Responder: The MAS wrist score reduces at least 1 point. The MAS wrist score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension).
    Time Frame
    Weeks 1, 4, 6, 8, 12, 16 and 18
    Title
    Changes From Baseline at Week 1, 4, 6, 8, 12, 16 and 18 of Finger Flexor Muscle Tone are calculated by the MAS
    Description
    The investigator, physiotherapist, or occupational therapist extended the participant's finger as quickly as possible to grade the flexor muscle tone. The MAS finger score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at the indicated time points was calculated as the value at Week 1, 4, 6, 8, and 12 minus the value at Baseline.
    Time Frame
    Baseline (Day 0) and Weeks 1, 4, 6, 8, 12, 16 and 18
    Title
    Changes From Baseline at Week 1, 4, 6, 8, 12, 16 and 18 of Thumb Flexor Muscle Tone are calculated by the MAS
    Description
    The investigator, physiotherapist, or occupational therapist extended the participant's thumb as quickly as possible to grade the flexor muscle tone. The MAS thumb score was calculated by using the 6-point MAS (0, 1, 1+ [regarded as 1.5], 2, 3, and 4; 0=no increase in muscle tone; 4=affected part[s] rigid in flexion/extension). Change from Baseline at the indicated time points was calculated as the value at Week 1, 4, 6, 8, and 12 minus the value at Baseline.
    Time Frame
    Baseline (Day 0) and Weeks 1, 4, 6, 8, 12, 16 and 18
    Title
    Changes From Baseline at Week 1, 4, 6, 8, 12, 16 and 18 of individual situations are calculated by the Disability Assessment Scale (DAS)
    Description
    The investigator evaluates 4 areas of disability, hygiene, pain, dressing, and limb posture, with the 4-point DAS (0=No functional disability to 3=Severe disability). Prior to the initial administration, the investigator, in consultation with the participant, selects 1 functional disability item (The item should be scored 2 or greater as measured by the DAS, indicating moderate to severe disability) from the 4 areas of disability and assessed it as a principal measure. Change from Baseline at the indicated time points was calculated at Week 1, 4, 6, 8, 12, 16 and 18 minus the value at Baseline.
    Time Frame
    Baseline (Day 0) and Weeks 1, 4, 6, 8, 12, 16 and 18
    Title
    Global Assessment Scale (GAS) Score as Evaluated by the Physician at the Indicated Time Points
    Description
    The investigators use the GAS to assess response after administration at each visit (visit 1 to 7). The 9-point GAS (-4, -3, -2, -1, 0, +1, +2, +3, +4; -4=very marked worsening, 0=unchanged, +4=very marked improvement) is chosen to measure at the indicated time points.
    Time Frame
    Weeks 1, 4, 6, 8, 12, 16 and 18
    Title
    GAS Score as Evaluated by the Care Giver or the Participants at the Indicated Time Points
    Description
    The caregivers or participants take the GAS to assess response after administration at each visit (visit 1 to 7). The 9-point GAS (-4, -3, -2, -1, 0, +1, +2, +3, +4; -4=very marked worsening, 0=unchanged, +4=very marked improvement) is chosen to measure at the indicated time points.
    Time Frame
    Weeks 1, 4, 6, 8, 12, 16 and 18

    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: ≥40kg in weight. Subjects voluntarily sign the informed consent. Subjects with upper limb spasticity who are at least 3 months post stroke and present with spasticity of both the wrist and fingers in the study limb. Both wrist flexor muscle tone and finger flexor muscle tone evaluation recorded 2 or greater individually as measured by MAS (0 to 4). At least one functional disability item (i.e., hygiene, dressing, pain, or cosmesis) evaluated 2 or greater by DAS (0 to 3). If using oral anti-spasticity medications, must be stable for at least 1 month prior to study enrolment. If taking any physical therapy or occupational therapy, must be stable on frequency, type, and intension for at least 1 month prior to study enrolment. In the opinion of the investigator, subject must clearly understand the intent of the study and be willing and able to comply with study instructions and complete the entire study. Exclusion Criteria: Females who are pregnant, nursing, or planning a pregnancy during the study period, or females of childbearing potential, not using a reliable means of contraception. Known allergy or sensitivity to study medication or its components. Infection or dermatological condition at the injection sites. Significant inflammation in the study limb limiting joint movement. Unstable liver disease (as defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminaemia, esophageal or gastric varices or persistent jaundice), cirrhosis, known biliary abnormalities (with the exception of Gilbert's syndrome or asymptomatic gallstones). History of or planned surgical intervention for spasticity of the study limb. Participation in another clinical study currently, or within the one months immediately prior to enrolment. Within six months prior to the study had received any treatment of patients with botulinum toxin of any serotype. Any medical condition that may put the subject at increased risk with exposure , including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other disorder that might have interfered with neuromuscular function. History of or planned treatment for spasticity with phenol or alcohol block in the study limb. Current treatment for spasticity with an intrathecal baclofen. QTc criteria: (either QTcb or QTcf, machine or manual overread, males or females); include the following details as appropriate: QTc≥450 millisecond (msec) or≥480msec for subjects with Bundle Branch Block-values based on either single electrocardiogram (ECG) values or triplicate ECG averaged QTc values obtained over a brief recording period. Liver function tests: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≥2xULN; alkaline phosphatase and bilirubin >1.5xULN (isolated bilirubin >1.5ULN is acceptable if bilirubin is fractionated and direct bilirubin <35%). Concurrent use of aminoglycoside antibiotics or other agents that might interfere with neuromuscular function. Presence of clinically unstable severe cardiovascular, renal or respiratory disease. Profound atrophy of muscles to be injected (in the investigators opinion). Planned or anticipated initiation of new antispasticity medications during the clinical study. History (within 3 months of qualification) of or planned (during study period) casting of the study limb. patients with severe cognitive impairment or neurological diseases affecting the implementation or evaluation of the test, and drug-dependent patients. Researchers believe there are other factors unfit to participate in this study of patients .
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Xinhua Wan, archiater
    Organizational Affiliation
    Peking Union Medical College Hospital
    Official's Role
    Study Director
    First Name & Middle Initial & Last Name & Degree
    Shengyuan Yu, archiater
    Organizational Affiliation
    The General Hospital of People's Liberation Army(301 hospital)
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    A Study to Evaluate the Botulinum Toxin Type A for Injection(HengLi®) in Subjects With Post-stroke Upper Limb Spasticity

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