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Cannabis as a Complementary Treatment in Multiple Sclerosis (CANSEP)

Primary Purpose

Multiple Sclerosis

Status
Recruiting
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Cannabis oil vs placebo
Sponsored by
Centre hospitalier de l'Université de Montréal (CHUM)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis

Eligibility Criteria

21 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Participants must meet the following criteria:

  1. Diagnosed with MS (any subtype), for at least six months, by a MS neurologist, according to the recent version of the McDonald criteria;
  2. Spasticity due to MS of at least one-month duration and not relieved with current therapy, at a level of 4 or more on the numerical rating scale (NRS);
  3. Stable dose of standard therapies for at least 30 days prior to the screening visit and willingness for these to be maintained for the duration of the study;
  4. Aged 21 years or older;
  5. Ability (in the investigator's opinion) and willingness to comply with all study requirements;
  6. Ability to speak and read French or English (grade-nine level of language required);

Exclusion Criteria:

Participants will be excluded if any of the following criteria are met:

  1. Concomitant disease with symptoms of spasticity, or that may have influenced their level;
  2. Received a botulinum toxin injection within four months prior to the screening visit or unwillingness to stop receiving botulinum toxin injections for the duration of the study;
  3. Use of cannabis or cannabinoid-based medications within 7 days of study entry and unwillingness to abstain for the duration of the study;
  4. History of schizophrenia, other psychotic illness or other significant psychiatric disorder other than anxiety or depression associated with their underlying condition;
  5. Alcohol or substance use disorder other than nicotine;
  6. History of epilepsy or recurrent seizures;
  7. Hypersensitivity to cannabinoids or any of the excipients of the study medication;
  8. Clinically relevant cardiac dysfunction within the last 12 months or had a cardiac disorder that, in the opinion of the investigator would put the subject at risk of a clinically relevant arrhythmia or myocardial infarction;
  9. Impaired renal function i.e., serum creatinine clearance lower than 50 ml/min;
  10. Significantly impaired hepatic function, at visit 1, in the investigator's opinion and/or had liver function tests of equal to or greater than three times the upper limit of normal;
  11. Pregnancy or breastfeeding;
  12. Men with history of fertility problems and who plan to conceive at any time in the future;
  13. Any participant who plans to conceive either at screening or while enrolled in the study;
  14. Inability (or unwillingness) of women of childbearing potential and men to use a medically acceptable form of contraception throughout the study duration;
  15. Inability to use a medically acceptable form of contraception throughout the study duration; m) any other significant disease or disorder which, in the opinion of the investigator, may either put the subject at risk because of participation in the study, may influence the result of the study, or the subject's ability to participate in the study;
  16. Intention to travel internationally, or to donate blood during the study.

Sites / Locations

  • CRCHUMRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Placebo Comparator

Arm Label

CBD alone

THC alone

THC and CBD combined

Placebo

Arm Description

Dosage form : Softgel Dosage & frequency : 40 mg /day of CBD up to 200 mg in two doses a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.

Dosage form : Softgel Dosage & frequency : 4 mg /day of THC up to 20 mg in two doses a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.

Dosage form : Softgel Dosage & frequency : 40 mg /day of CBD up to 200 mg and 4 mg /day of THC up to 20 mg in two doses a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.

Dosage form : Softgel Dosage & frequency : caps of placebo twice a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.

Outcomes

Primary Outcome Measures

Spasticity patient reported change assessment
Patient-reported spasticity: a Numerical rating scale - 0 (No pain) to 10 (worst pain)

Secondary Outcome Measures

Full Information

First Posted
September 1, 2021
Last Updated
July 10, 2023
Sponsor
Centre hospitalier de l'Université de Montréal (CHUM)
Collaborators
Canadian Institutes of Health Research (CIHR), Multiple Sclerosis Society of Canada
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1. Study Identification

Unique Protocol Identification Number
NCT05092191
Brief Title
Cannabis as a Complementary Treatment in Multiple Sclerosis
Acronym
CANSEP
Official Title
Efficacy of Cannabinoids to the Current Standard Treatments on Symptom Relief in Persons With Multiple Sclerosis: Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 10, 2022 (Actual)
Primary Completion Date
March 15, 2024 (Anticipated)
Study Completion Date
March 15, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Centre hospitalier de l'Université de Montréal (CHUM)
Collaborators
Canadian Institutes of Health Research (CIHR), Multiple Sclerosis Society of Canada

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) afflicting over 77,000 Canadians. Unfortunately, the therapeutic arsenal to relieve MS symptoms is limited. It is therefore essential to develop better approaches to treat the symptoms of MS. The use of cannabis for recreational purposes is now legal in Canada. However, for many years, people with Multiple Sclerosis (PwMS) have used cannabis either to relax, to reduce pain and spasticity, or to improve sleep and daily functioning. Currently, there is little scientifically established evidence that cannabis works on these symptoms in people with MS. It is therefore important to carry out studies to better understand the efficacy Δ-9-tetrahydrocannabinol (THC), and cannabidiol (CBD) on MS symptoms . THC is known for its analgesic, neuroprotective and anti-inflammatory properties and CBD seems to have positive effects on anxiety and cognitive abilities (memory, concentration). For this study, investigators hypothesize that administering different doses of THC alone, CBD alone, and THC and CBD combined will result in a significant beneficial effect on spasticity relief compared to placebo.
Detailed Description
The aim of this study is to document, The efficacy of THC and CBD, alone and in combination, as add-on therapies to the current standard treatments for relief of spasticity and other symptoms in PwMS (muscle spasms and stiffness); Assess the tolerability profile of THC and CBD, alone and in combination, when used in PwMS; Identify the mechanisms underlying such therapeutic and adverse effects of different types of cannabis-based medicines in PwMS, Participants will initially receive THC 4mg/day or CBD 40mg/day or THC/CBD combination (THC 4mg and CBD 40mg/day), or placebo, on the first day. Dose will be increased up to 20mg (THC) and 200mg (CBD) per day, if well tolerated. Participants will receive the allocated treatment for a total of 4 weeks, followed by an additional 12 weeks of treatment for responders who will be identified as patients who had a decrease from baseline in spasticity of at least one point on the Numerical Rating Scale . THC and CBD will be taken as oil softgels in two divided doses per day. Cannabis extract and placebo will taste and look exactly the same. To protect from all contingencies and to minimize the risk of adverse reactions, the presence of adverse events will be evaluated at each research visit, as well as through courtesy calls between visits. If any mental or physical symptoms occur that require medical attention, the PwMS will be referred as required to an attending neurologist, psychiatrist, or other specialists .

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Factorial Assignment
Masking
Participant
Allocation
Randomized
Enrollment
250 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
CBD alone
Arm Type
Experimental
Arm Description
Dosage form : Softgel Dosage & frequency : 40 mg /day of CBD up to 200 mg in two doses a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.
Arm Title
THC alone
Arm Type
Experimental
Arm Description
Dosage form : Softgel Dosage & frequency : 4 mg /day of THC up to 20 mg in two doses a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.
Arm Title
THC and CBD combined
Arm Type
Experimental
Arm Description
Dosage form : Softgel Dosage & frequency : 40 mg /day of CBD up to 200 mg and 4 mg /day of THC up to 20 mg in two doses a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Dosage form : Softgel Dosage & frequency : caps of placebo twice a day Duration : 4 weeks of treatment followed by 12 additional weeks of follow up.
Intervention Type
Drug
Intervention Name(s)
Cannabis oil vs placebo
Other Intervention Name(s)
Randomized Controlled Trial
Intervention Description
Eligibility, Screening and Baseline (T0): Candidates will be seen by both research staff and a neurologist. Full written informed consent will be obtained before completing questionnaires and administering physical and medical evaluations. If eligibility is confirmed, a blood sample will be collected followed by participant randomisation . Follow-up visits: Randomized participants come back after 4 weeks (T1) for the same assessments administered at T0. Only participants who had a decrease in their level of spasticity can continue their participation in the same allocated arm for an additional period of 12 weeks. At the end of the additional period of 12 weeks (T2), another visit is scheduled for a last assessments which are the same as T0 and T1. Throughout study, courtesy calls will be scheduled and standard care for MS will also be offered to ensure participants 'safety and well-being.
Primary Outcome Measure Information:
Title
Spasticity patient reported change assessment
Description
Patient-reported spasticity: a Numerical rating scale - 0 (No pain) to 10 (worst pain)
Time Frame
Change from Baseline Patient reported spasticity at 28 weeks and 16 weeks
Other Pre-specified Outcome Measures:
Title
Spasticity change Clinician assessment
Description
Spasticity: Ashworth scale -1 (normal) to 4 (rigid)
Time Frame
Change from Baseline Clinician evaluation spasticity at 28 weeks and 16 weeks
Title
Pain change assessment
Description
Pain: Pain Effects-1 (Not at all) to 4 (extreme)
Time Frame
Change from Baseline pain at 28 weeks and 16 weeks
Title
Mobility Change assessement
Description
Mobility: Timed 25-Foot Walk test
Time Frame
Change from Baseline mobility at 28 weeks and 16 weeks
Title
Fatigue change assessement
Description
Fatigue: Modified Fatigue Impact Scale-0 (never) to 4 (always)
Time Frame
Change from Baseline fatigue at 28 weeks and 16 weeks
Title
Sleep change assessement
Description
Sleep: Pittsburgh Study Quality sleep Index-0 (no difficult) to 3 (severe)
Time Frame
Change from Baseline sleep at 28 weeks and 16 weeks
Title
Drowsiness change assessement
Description
Drowsiness: Epworth Sleepiness scale-0 (no chance) to 3 (High chance)
Time Frame
Change from Baseline Drowsiness at 28 weeks and 16 weeks
Title
Bowel /Bladder dysfunction change assessement
Description
Bowel /Bladder dysfunction: Bowel/Bladder Control Scale-0 (not at all) to 4 (Daily)
Time Frame
Change from Baseline Bowel/Bladder dysfunction at 28 weeks and 16 weeks
Title
Sexual dysfunction change assessement
Description
Sexual dysfunction: Sexual Satisfaction Scale-0 (Extremely Satisfied) to 6 (Extremely Dissatisfied)
Time Frame
Change from Baseline Sexual dysfunction at 28 weeks and 16 weeks
Title
Restless Legs Syndrome change assessement
Description
Restless Legs Syndrome - 4 (V.severe) to 0 (None)
Time Frame
Change from Baseline Restless Legs Syndrome at 28 weeks and 16 weeks
Title
Mental Health disorder change assessement
Description
Mental Health issues: Mental Health inventory-1 (All of the time) to 6 (None of the time)
Time Frame
Change from Baseline Mental Health at 28 weeks and 16 weeks
Title
Anxiety/Depression change assessement
Description
Anxiety/Depression: Hospital Anxiety and Depression-0 to 3 (highest level)
Time Frame
Change from Baseline Anxiety/Depression at 28 weeks and 16 weeks
Title
Cannabis use disorder assesssment
Description
Cannabis use disorder : diagnosis
Time Frame
Cannabis use disorder : assessment at only baseline
Title
Cognition change assessement
Description
Cognition tests
Time Frame
Change from Baseline cognition at 28 weeks and 16 weeks
Title
Quality of life change assessement
Description
Quality of life: Health Status Questionnaire (Higher scores indicate better health)
Time Frame
Change from Baseline Quality of life at 28 weeks and 16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must meet the following criteria: Diagnosed with MS (any subtype), for at least six months, by a MS neurologist, according to the recent version of the McDonald criteria; Spasticity due to MS of at least one-month duration and not relieved with current therapy, at a level of 4 or more on the numerical rating scale (NRS); Stable dose of standard therapies for at least 30 days prior to the screening visit and willingness for these to be maintained for the duration of the study; Aged 21 years or older; Ability (in the investigator's opinion) and willingness to comply with all study requirements; Ability to speak and read French or English (grade-nine level of language required); Exclusion Criteria: Participants will be excluded if any of the following criteria are met: Concomitant disease with symptoms of spasticity, or that may have influenced their level; Received a botulinum toxin injection within four months prior to the screening visit or unwillingness to stop receiving botulinum toxin injections for the duration of the study; Use of cannabis or cannabinoid-based medications within 7 days of study entry and unwillingness to abstain for the duration of the study; History of schizophrenia, other psychotic illness or other significant psychiatric disorder other than anxiety or depression associated with their underlying condition; Alcohol or substance use disorder other than nicotine; History of epilepsy or recurrent seizures; Hypersensitivity to cannabinoids or any of the excipients of the study medication; Clinically relevant cardiac dysfunction within the last 12 months or had a cardiac disorder that, in the opinion of the investigator would put the subject at risk of a clinically relevant arrhythmia or myocardial infarction; Impaired renal function i.e., serum creatinine clearance lower than 50 ml/min; Significantly impaired hepatic function, at visit 1, in the investigator's opinion and/or had liver function tests of equal to or greater than three times the upper limit of normal; Pregnancy or breastfeeding; Men with history of fertility problems and who plan to conceive at any time in the future; Any participant who plans to conceive either at screening or while enrolled in the study; Inability (or unwillingness) of women of childbearing potential and men to use a medically acceptable form of contraception throughout the study duration; Inability to use a medically acceptable form of contraception throughout the study duration; m) any other significant disease or disorder which, in the opinion of the investigator, may either put the subject at risk because of participation in the study, may influence the result of the study, or the subject's ability to participate in the study; Intention to travel internationally, or to donate blood during the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Pierre Duquette
Phone
514 890 8000
Ext
0831
Email
pierre.duquette.med@ssss.gouv.qc.ca
First Name & Middle Initial & Last Name or Official Title & Degree
Amel Zertal
Phone
514 890 8000
Ext
30883
Email
amel.zertal.chum@ssss.gouv.qc.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pierre Duquette, MD
Organizational Affiliation
Centre hospitalier de l'Université de Montréal (CHUM)
Official's Role
Principal Investigator
Facility Information:
Facility Name
CRCHUM
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H2X 0A9
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amel, Zertal (Project Manager)
Phone
15148908000
Ext
30883
Email
amel.zertal.chum@ssss.gouv.qc.ca
First Name & Middle Initial & Last Name & Degree
Dr Pierre, Duquette (PI)
Phone
15148908000
Ext
0831
Email
pierre.duquette.med@ssss.gouv.qc.ca

12. IPD Sharing Statement

Learn more about this trial

Cannabis as a Complementary Treatment in Multiple Sclerosis

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