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Noninvasive Peripheral Nerve Stimulation for Restless Legs Syndrome During Opioid Medication Reduction

Primary Purpose

Restless Legs Syndrome

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Noninvasive Peripheral Nerve Stimulation (NPNS)
Sponsored by
Noctrix Health, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Restless Legs Syndrome

Eligibility Criteria

18 Years - 89 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Subject has received a medical diagnosis of primary restless legs syndrome (RLS)
  • Subject is currently taking a stable dose of at least one prescription opioid for RLS, where the total opioid dose is less than or equal to 60mg morphine milligram equivalents (MME) per day.
  • RLS symptoms are most significant in the subject's legs and/or feet.
  • Subject possesses the necessary equipment, internet/phone accessibility, and communication ability to complete electronic questionnaires and respond to electronic communications and phone calls from the research staff throughout the in-home portion of the study.
  • Subject is 18 to 89 years of age (inclusive) when written informed consent is obtained.
  • Subject has signed a valid, Institutional Review Board (IRB)-approved informed consent form, can understand the requirements of the study and instructions for device usage, and can converse in English.
  • Subject has been taking a stable dose and schedule of prescription opioids for RLS for at least 3 months prior to enrollment.

Exclusion Criteria:

  • Subject has RLS that is known to be caused by another diagnosed condition (i.e. secondary RLS).
  • Subject was misdiagnosed with RLS, as determined by the investigator (e.g. actual diagnosis of Periodic Leg Movement Disorder (PLMD), arthritis, leg spasms or neuropathy without comorbid RLS).
  • Subject has primary sleep disorder other than RLS that significantly interferes with sleep at the present time (e.g. unmanaged sleep apnea or general insomnia).
  • Subject has been diagnosed with one of the following conditions at any time: Epilepsy or other seizure disorder, Severe movement disorder symptoms (Parkinson's disease, Huntington's disease, dyskinesia, dystonia), Deep Vein Thrombosis, Multiple sclerosis
  • Subject has an active diagnosis of one of the following conditions: Acute or chronic infection other than viral upper respiratory tract infections, Stage 4-5 chronic kidney disease or renal failure, Iron-deficient anemia, Severe edema affecting lower legs
  • Subject has any of the following at the location of device application: Acute injury, Cellulitis, Open sores
  • Subject has a malignancy within the past 5 years (not including basal or squamous cell skin cancer)
  • Subject is on dialysis or anticipated to start dialysis while participating in the study
  • Subject has severe peripheral neuropathy affecting the lower legs and/or subject has neuropathy and is unable to clearly distinguish between symptoms of neuropathy and symptoms of RLS.
  • During NPNS calibration, subject has a sensation threshold above the upper-cutoff value (e.g. 30mA), the subject finds stimulation intensities less than 15 mA to be uncomfortable or distracting, or the device does not properly fit the subject.
  • Subject has significantly changed dose or schedule of a medication that may impact RLS symptoms within the 30 days prior to enrollment, as judged by the investigator (e.g. antidepressants, sleep medications, sedative antihistamines).
  • Subject has received an investigational drug or device within the last 30 days or is planning to receive an investigational device during the duration of the study.
  • Subject has another medical condition that may affect validity of the study as determined by the investigator.
  • Subject is unable or unwilling to comply with study requirements.
  • Moderate or severe cognitive disorder or mental illness.
  • Subject has prior experience with Noctrix Health NPNS devices.
  • Subject has active implantable medical devices anywhere in the body (including pacemakers), or metal implant at the site of study device electrode application.
  • Subject has known allergy to electrode gel, polyurethane foam, or lycra.
  • Subject is pregnant or trying to become pregnant.
  • Subject has undergone a major surgery (excluding dental work) in the previous 30 days.
  • Subject has another medical condition that may put the subject at risk as determined by the investigator.

Sites / Locations

  • Mark J Buchfuhrer private practice
  • Ohio Sleep Medicine Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Noninvasive Peripheral Nerve Stimulation (NPNS)

Arm Description

NPNS device programmed to deliver active stimulation.

Outcomes

Primary Outcome Measures

Opioid reduction tolerability rate during step-down #1 as measured by Clinical Global Impression - Improvement (CGI-I) scale
Percentage of subjects without a clinically significant increase in RLS symptoms (i.e. CGI-I score of 5 or less relative to baseline) during the first Phase involving an opioid dose reduction of >= 20% relative to baseline.

Secondary Outcome Measures

Opioid reduction tolerability rate during step-down #2 as measured by Clinical Global Impression - Improvement (CGI-I) scale
Percentage of subjects without a clinically significant increase in RLS symptoms (i.e. CGI-I score of 5 or less relative to baseline) during the first Phase involving an opioid dose reduction of >= 1/3 relative to baseline
Change from baseline in International Restless Legs Syndrome Study Group Rating Scale (IRLS) score during step-down #1
IRLS is a participant-rated questionnaire that rates RLS severity from 0-40, where 40 is the most severe.
Change from baseline in IRLS score during step-down #2
IRLS is a participant-rated questionnaire that rates RLS severity from 0-40, where 40 is the most severe.
Maximal tolerated reduction in opioid dose
Maximal percentage reduction in opioid dose relative to baseline associated with a CGI-I score of 5 or less, averaged across subjects.

Full Information

First Posted
January 4, 2021
Last Updated
June 27, 2023
Sponsor
Noctrix Health, Inc.
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
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1. Study Identification

Unique Protocol Identification Number
NCT04698343
Brief Title
Noninvasive Peripheral Nerve Stimulation for Restless Legs Syndrome During Opioid Medication Reduction
Official Title
Exploratory Study Assessing the Response of Restless Legs Syndrome (RLS) Patients to Non-invasive Peripheral Nerve Stimulation (NPNS) During Opioid Medication Reduction
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
April 6, 2021 (Actual)
Primary Completion Date
February 27, 2023 (Actual)
Study Completion Date
March 28, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Noctrix Health, Inc.
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Prospective open-label single-arm feasibility study assessing the tolerability of opioid medication reduction in conjunction with noninvasive peripheral nerve stimulation (NPNS) for patients taking prescription opioids to treat moderate-severe primary RLS.
Detailed Description
For RLS patients taking a stable dose of prescription opioid medications prior to study entry, iterative opioid dose reduction is performed in conjunction with open-label NPNS treatment. For each of two iterative step-downs in opioid dose (step-down #1 and step-down #2), a 1-2-week run-in phase to allow resolution of opioid withdrawal symptoms unrelated to RLS is followed by a 1-wk assessment phase to evaluate if RLS symptoms have increased. Study participation is terminated if there is a clinically significant increase in RLS severity during the assessment phase or if there are intolerable opioid withdrawal symptoms at any time. Participants who tolerate both step-downs have the option of an extension phase involving a third step-down with the same format.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Restless Legs Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Noninvasive Peripheral Nerve Stimulation (NPNS)
Arm Type
Experimental
Arm Description
NPNS device programmed to deliver active stimulation.
Intervention Type
Device
Intervention Name(s)
Noninvasive Peripheral Nerve Stimulation (NPNS)
Intervention Description
NPNS device programmed to deliver active stimulation.
Primary Outcome Measure Information:
Title
Opioid reduction tolerability rate during step-down #1 as measured by Clinical Global Impression - Improvement (CGI-I) scale
Description
Percentage of subjects without a clinically significant increase in RLS symptoms (i.e. CGI-I score of 5 or less relative to baseline) during the first Phase involving an opioid dose reduction of >= 20% relative to baseline.
Time Frame
1 week assessment period for step-down #1 compared to 1 week baseline period
Secondary Outcome Measure Information:
Title
Opioid reduction tolerability rate during step-down #2 as measured by Clinical Global Impression - Improvement (CGI-I) scale
Description
Percentage of subjects without a clinically significant increase in RLS symptoms (i.e. CGI-I score of 5 or less relative to baseline) during the first Phase involving an opioid dose reduction of >= 1/3 relative to baseline
Time Frame
1 week assessment period for step-down #2 compared to 1 week baseline period
Title
Change from baseline in International Restless Legs Syndrome Study Group Rating Scale (IRLS) score during step-down #1
Description
IRLS is a participant-rated questionnaire that rates RLS severity from 0-40, where 40 is the most severe.
Time Frame
1 week assessment period for step-down #1 compared to 1 week baseline period
Title
Change from baseline in IRLS score during step-down #2
Description
IRLS is a participant-rated questionnaire that rates RLS severity from 0-40, where 40 is the most severe.
Time Frame
1 week assessment period for step-down #2 compared to 1 week baseline period
Title
Maximal tolerated reduction in opioid dose
Description
Maximal percentage reduction in opioid dose relative to baseline associated with a CGI-I score of 5 or less, averaged across subjects.
Time Frame
Time Frame: 1 week assessment period for final step-down compared to 1 week baseline period
Other Pre-specified Outcome Measures:
Title
NPNS tolerability rate
Description
Percentage of subjects who withdraw from study prior to the Extension Phase citing lack of tolerability of NPNS as the primary reason for withdrawal.
Time Frame
Full duration of NPNS usage through study completion, up to 9 weeks
Title
Frequency of Grade 2 or higher NPNS-related adverse events.
Description
Frequency of Grade 2 or higher NPNS-related adverse events.
Time Frame
Full duration of NPNS usage through study completion, up to 9 weeks
Title
Frequency of Grade 3 or higher NPNS-related adverse events.
Description
Frequency of Grade 3 or higher NPNS-related adverse events.
Time Frame
Full duration of NPNS usage through study completion, up to 9 weeks
Title
NPNS compliance during step-down #1
Description
Frequency of device usage during assessment period during step-down #1
Time Frame
1 week assessment period for step-down #1
Title
NPNS compliance during step-down #2
Description
Frequency of device usage during assessment period during step-down #2
Time Frame
1 week assessment period for step-down #2

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
89 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has received a medical diagnosis of primary restless legs syndrome (RLS) Subject is currently taking a stable dose of at least one prescription opioid for RLS, where the total opioid dose is less than or equal to 60mg morphine milligram equivalents (MME) per day. RLS symptoms are most significant in the subject's legs and/or feet. Subject possesses the necessary equipment, internet/phone accessibility, and communication ability to complete electronic questionnaires and respond to electronic communications and phone calls from the research staff throughout the in-home portion of the study. Subject is 18 to 89 years of age (inclusive) when written informed consent is obtained. Subject has signed a valid, Institutional Review Board (IRB)-approved informed consent form, can understand the requirements of the study and instructions for device usage, and can converse in English. Subject has been taking a stable dose and schedule of prescription opioids for RLS for at least 3 months prior to enrollment. Exclusion Criteria: Subject has RLS that is known to be caused by another diagnosed condition (i.e. secondary RLS). Subject was misdiagnosed with RLS, as determined by the investigator (e.g. actual diagnosis of Periodic Leg Movement Disorder (PLMD), arthritis, leg spasms or neuropathy without comorbid RLS). Subject has primary sleep disorder other than RLS that significantly interferes with sleep at the present time (e.g. unmanaged sleep apnea or general insomnia). Subject has been diagnosed with one of the following conditions at any time: Epilepsy or other seizure disorder, Severe movement disorder symptoms (Parkinson's disease, Huntington's disease, dyskinesia, dystonia), Deep Vein Thrombosis, Multiple sclerosis Subject has an active diagnosis of one of the following conditions: Acute or chronic infection other than viral upper respiratory tract infections, Stage 4-5 chronic kidney disease or renal failure, Iron-deficient anemia, Severe edema affecting lower legs Subject has any of the following at the location of device application: Acute injury, Cellulitis, Open sores Subject has a malignancy within the past 5 years (not including basal or squamous cell skin cancer) Subject is on dialysis or anticipated to start dialysis while participating in the study Subject has severe peripheral neuropathy affecting the lower legs and/or subject has neuropathy and is unable to clearly distinguish between symptoms of neuropathy and symptoms of RLS. During NPNS calibration, subject has a sensation threshold above the upper-cutoff value (e.g. 30mA), the subject finds stimulation intensities less than 15 mA to be uncomfortable or distracting, or the device does not properly fit the subject. Subject has significantly changed dose or schedule of a medication that may impact RLS symptoms within the 30 days prior to enrollment, as judged by the investigator (e.g. antidepressants, sleep medications, sedative antihistamines). Subject has received an investigational drug or device within the last 30 days or is planning to receive an investigational device during the duration of the study. Subject has another medical condition that may affect validity of the study as determined by the investigator. Subject is unable or unwilling to comply with study requirements. Moderate or severe cognitive disorder or mental illness. Subject has prior experience with Noctrix Health NPNS devices. Subject has active implantable medical devices anywhere in the body (including pacemakers), or metal implant at the site of study device electrode application. Subject has known allergy to electrode gel, polyurethane foam, or lycra. Subject is pregnant or trying to become pregnant. Subject has undergone a major surgery (excluding dental work) in the previous 30 days. Subject has another medical condition that may put the subject at risk as determined by the investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jonathan D Charlesworth, PhD
Organizational Affiliation
Noctrix Health, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Mark J Buchfuhrer private practice
City
Downey
State/Province
California
ZIP/Postal Code
90241
Country
United States
Facility Name
Ohio Sleep Medicine Institute
City
Dublin
State/Province
Ohio
ZIP/Postal Code
43017
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Noninvasive Peripheral Nerve Stimulation for Restless Legs Syndrome During Opioid Medication Reduction

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