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Histaminergic Basis of Fatigue in Multiple Sclerosis

Primary Purpose

Multiple Sclerosis

Status
Withdrawn
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
L-Histidine
Placebo
Lodosyn
Sponsored by
University of Miami
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Fatigue, Histamine

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion and Exclusion Criteria

For Healthy (Normal) Participants

Inclusion Criteria:

  • Male or female subjects between the ages of 18 and 60
  • In good physical health without a history of chronic illness and considered generally healthy.

Exclusion Criteria:

  • Adults unable to give informed consent due to cognitive impairment or mental disorders.
  • Children below the age of consent
  • Pregnant women (if the pregnancy test is positive during any stage of the study, subject will be removed from it)
  • Prisoners
  • Chronic untreated disorders like hypertension, diabetes, hyperlipidemia, depression, hypothyroidism etc., that could confound or interfere with the proposed therapy in the view of the PI are excluded. Stable treated above conditions are not exclusionary.
  • Known chronic fatigue syndrome
  • Blood disorders or coagulopathy
  • Chronic allergies or history of asthma.
  • Using antihistamines, bronchodilators or H2 blockers for hyperacidity
  • Using medications for sleep, or known sleep disorders
  • Any medication or condition deemed unsuitable by the PI. If necessary, subjects should wash out such medications for a duration of at least 5 half-lives.
  • All medications prescribed and over the counter, should be approved by the PI during the duration of the trial.

For Multiple Sclerosis Participants

Inclusion Criteria:

  • Established Multiple Sclerosis by McDonald Criteria - 2010 Revision or McDonald Criteria 2017. Relapsing-Remitting and progressive forms of MS are eligible
  • Severe fatigue that has lasted greater than 6 months
  • Clinically stable on a current therapy with any Disease Modifying Therapies (DMT)
  • Fatigue Severity Score of >/= 4.0 will qualify as long as all other inclusion/exclusion criteria is met.

Exclusion Criteria:

  • Adults unable to give informed consent due to cognitive impairment or mental disorders.
  • Children below the age of consent
  • Pregnant women (if the pregnancy test is positive during any stage of the study, subject will be removed from it)
  • Prisoners
  • Systemic disorders known to cause fatigue such as severe anemia, infections, chronic systemic infectious or inflammatory disorders, including known autoimmune disorders. (allowed as long is not present. Subject might qualify as per discretion of the Principal Investigator)
  • Chronic fatigue syndrome
  • Hypothyroidism (If treated and/or controlled subject might qualify as per discretion of the Principal Investigator)
  • Systemic malignancy. Remote history of a malignancy is not a contraindication.
  • Undergoing chemotherapy
  • Depression (If treated and/or controlled subject might qualify as per discretion of the Principal Investigator)
  • Sleep disorders including narcolepsy, excessive day-time sleep. (If treated and/or controlled subject might qualify as per discretion of the Principal Investigator)
  • Ongoing substance abuse
  • Excessive consumption of coffee or over-the-counter stimulants. Use of caffeine is not exclusionary but subjects are instructed to not change the use for the duration of the study.
  • Concomitant medications of amantadine, methylphenidate, amphetamines, pemoline, barbiturates, tizanidine, MonoAmine Oxidase (MAO) inhibitors, benzodiazepines, barbiturates, tricyclic antidepressants, antihistamines, H2 blockers for Gastroesophageal reflux disease (GERD), Selective Serotonin Reuptake Inhibitor (SSRIs) and any other medication that in the opinion of the PI should be excluded. If used and approved by the PI at study entry, any change for the duration of the study is not permitted.
  • Patients who were using modafinil for treatment of fatigues prior to the study may participate but will be required to undergo a washout of five half-lives prior to entry into the trial.

Sites / Locations

  • University of Miami

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

Experimental

Arm Label

PK/PD Group

L-Histidine and Lodosyn followed by Placebo Group

Placebo followed by L-Histidine and Lodosyn Group

Arm Description

Participants in the Pharmacokinetic (PK)/pharmacodynamic (PD) Group will receive L-Histidine and Lodosyn daily for 7 consecutive days.

Participants in this group will receive L-Histidine and Lodosyn daily for 2 consecutive weeks followed by Placebo for an additional 2 consecutive weeks with a 1-week wash-out period in between.

Participants in this group will receive Placebo daily for 2 consecutive weeks followed by L-Histidine and Lodosyn for an additional 2 consecutive weeks with a 1 week wash out period in between.

Outcomes

Primary Outcome Measures

Incidence of Adverse Events
Adverse events will be evaluated by treating physician.

Secondary Outcome Measures

Efficacy as measured by FSS scores
Efficacy will be reported as the number of participants that dropped one point or more from their baseline Fatigue Severity Scale (FSS) scores. FSS is a 9-item questionnaire with questions related to how fatigue interferes with certain activities according to a self-reported scale. Each of the items are scored on a 7 point scale with 1 = strongly disagree and 7 = strongly agree.
Efficacy as measured by MFIS Scores
Modified Fatigue Impact Scale (MFIS) is a scale is used to measure fatigue with the total score ranging from 0 to 84 with 0 being the best possible score and 84 being the worst score.
Efficacy as measured by the VAS scores
The Visual Analog Scale (VAS) allows participants to rate their health on a 20 cm vertical with a higher number indicating better outcomes.
Efficacy as measured by the MSQOL Scores
Multiple Sclerosis Quality of Life (MSQOL) has a total score ranging from 0 to 100 with a higher score indicating a better quality of life.

Full Information

First Posted
February 18, 2021
Last Updated
July 22, 2021
Sponsor
University of Miami
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1. Study Identification

Unique Protocol Identification Number
NCT04764383
Brief Title
Histaminergic Basis of Fatigue in Multiple Sclerosis
Official Title
Histaminergic Basis of Fatigue in Multiple Sclerosis
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Withdrawn
Why Stopped
Withdrawn as more data drug analysis is recommended before the study.
Study Start Date
January 1, 2022 (Anticipated)
Primary Completion Date
October 30, 2022 (Anticipated)
Study Completion Date
October 30, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Miami

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this research study is to identify a way to improve the feeling of exhaustion that patients might experience because of Multiple Sclerosis (MS).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis
Keywords
Fatigue, Histamine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
double-blind randomized cross-over
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
PK/PD Group
Arm Type
Experimental
Arm Description
Participants in the Pharmacokinetic (PK)/pharmacodynamic (PD) Group will receive L-Histidine and Lodosyn daily for 7 consecutive days.
Arm Title
L-Histidine and Lodosyn followed by Placebo Group
Arm Type
Placebo Comparator
Arm Description
Participants in this group will receive L-Histidine and Lodosyn daily for 2 consecutive weeks followed by Placebo for an additional 2 consecutive weeks with a 1-week wash-out period in between.
Arm Title
Placebo followed by L-Histidine and Lodosyn Group
Arm Type
Experimental
Arm Description
Participants in this group will receive Placebo daily for 2 consecutive weeks followed by L-Histidine and Lodosyn for an additional 2 consecutive weeks with a 1 week wash out period in between.
Intervention Type
Drug
Intervention Name(s)
L-Histidine
Other Intervention Name(s)
Histamine
Intervention Description
1000 mg capsules taken by mouth (PO) twice daily (BID).
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Microcrystalline cellulose (placebo) 1000 mg capsules taken by mouth (PO) twice daily (BID).
Intervention Type
Drug
Intervention Name(s)
Lodosyn
Intervention Description
50 mg capsules taken PO BID.
Primary Outcome Measure Information:
Title
Incidence of Adverse Events
Description
Adverse events will be evaluated by treating physician.
Time Frame
Up to 5 weeks
Secondary Outcome Measure Information:
Title
Efficacy as measured by FSS scores
Description
Efficacy will be reported as the number of participants that dropped one point or more from their baseline Fatigue Severity Scale (FSS) scores. FSS is a 9-item questionnaire with questions related to how fatigue interferes with certain activities according to a self-reported scale. Each of the items are scored on a 7 point scale with 1 = strongly disagree and 7 = strongly agree.
Time Frame
Up to 5 weeks
Title
Efficacy as measured by MFIS Scores
Description
Modified Fatigue Impact Scale (MFIS) is a scale is used to measure fatigue with the total score ranging from 0 to 84 with 0 being the best possible score and 84 being the worst score.
Time Frame
Up to 5 weeks
Title
Efficacy as measured by the VAS scores
Description
The Visual Analog Scale (VAS) allows participants to rate their health on a 20 cm vertical with a higher number indicating better outcomes.
Time Frame
Up to 5 weeks
Title
Efficacy as measured by the MSQOL Scores
Description
Multiple Sclerosis Quality of Life (MSQOL) has a total score ranging from 0 to 100 with a higher score indicating a better quality of life.
Time Frame
Up to 5 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion and Exclusion Criteria For Healthy (Normal) Participants Inclusion Criteria: Male or female subjects between the ages of 18 and 60 In good physical health without a history of chronic illness and considered generally healthy. Exclusion Criteria: Adults unable to give informed consent due to cognitive impairment or mental disorders. Children below the age of consent Pregnant women (if the pregnancy test is positive during any stage of the study, subject will be removed from it) Prisoners Chronic untreated disorders like hypertension, diabetes, hyperlipidemia, depression, hypothyroidism etc., that could confound or interfere with the proposed therapy in the view of the PI are excluded. Stable treated above conditions are not exclusionary. Known chronic fatigue syndrome Blood disorders or coagulopathy Chronic allergies or history of asthma. Using antihistamines, bronchodilators or H2 blockers for hyperacidity Using medications for sleep, or known sleep disorders Any medication or condition deemed unsuitable by the PI. If necessary, subjects should wash out such medications for a duration of at least 5 half-lives. All medications prescribed and over the counter, should be approved by the PI during the duration of the trial. For Multiple Sclerosis Participants Inclusion Criteria: Established Multiple Sclerosis by McDonald Criteria - 2010 Revision or McDonald Criteria 2017. Relapsing-Remitting and progressive forms of MS are eligible Severe fatigue that has lasted greater than 6 months Clinically stable on a current therapy with any Disease Modifying Therapies (DMT) Fatigue Severity Score of >/= 4.0 will qualify as long as all other inclusion/exclusion criteria is met. Exclusion Criteria: Adults unable to give informed consent due to cognitive impairment or mental disorders. Children below the age of consent Pregnant women (if the pregnancy test is positive during any stage of the study, subject will be removed from it) Prisoners Systemic disorders known to cause fatigue such as severe anemia, infections, chronic systemic infectious or inflammatory disorders, including known autoimmune disorders. (allowed as long is not present. Subject might qualify as per discretion of the Principal Investigator) Chronic fatigue syndrome Hypothyroidism (If treated and/or controlled subject might qualify as per discretion of the Principal Investigator) Systemic malignancy. Remote history of a malignancy is not a contraindication. Undergoing chemotherapy Depression (If treated and/or controlled subject might qualify as per discretion of the Principal Investigator) Sleep disorders including narcolepsy, excessive day-time sleep. (If treated and/or controlled subject might qualify as per discretion of the Principal Investigator) Ongoing substance abuse Excessive consumption of coffee or over-the-counter stimulants. Use of caffeine is not exclusionary but subjects are instructed to not change the use for the duration of the study. Concomitant medications of amantadine, methylphenidate, amphetamines, pemoline, barbiturates, tizanidine, MonoAmine Oxidase (MAO) inhibitors, benzodiazepines, barbiturates, tricyclic antidepressants, antihistamines, H2 blockers for Gastroesophageal reflux disease (GERD), Selective Serotonin Reuptake Inhibitor (SSRIs) and any other medication that in the opinion of the PI should be excluded. If used and approved by the PI at study entry, any change for the duration of the study is not permitted. Patients who were using modafinil for treatment of fatigues prior to the study may participate but will be required to undergo a washout of five half-lives prior to entry into the trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kottil Rammohan, MD
Organizational Affiliation
University of Miami
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Miami
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Histaminergic Basis of Fatigue in Multiple Sclerosis

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