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Amantadine and Transcranial Magnetic Stimulation for Treating Fatigue in Multiple Sclerosis (FETEM)

Primary Purpose

Multiple Sclerosis, Fatigue

Status
Recruiting
Phase
Phase 3
Locations
Spain
Study Type
Interventional
Intervention
Transcranial Magnetic Stimulation
Amantadine Hydrochloride 100 mg (milligrams) Oral Capsule
Sponsored by
Hospital San Carlos, Madrid
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Amantadine, Multiple Sclerosis, Fatigue, Transcranial Magnetic Stimulation (TMS), Modified Fatigue Impact Scale (MFIS)

Eligibility Criteria

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

Inclusion Criteria: Expanded Disability Status Scale mark 1.5 - 4.5 Fatigue Severity Scale > 4 Beck Depression Inventory < 30 No relapse for, at least, three month prior to screening Drug washout period = 4 weeks for any fatigue aimed drug Patient capable to sign the informed consent Exclusion Criteria: Fatigue causing disease other than multiple sclerosis: sleep apnea other autoimmune disease that could be explain the fatigue. endocrine autoimmune disease if the blood test is not in range in the last 6 month. patient with diagnosis of chronic fatigue Patient with high blood pressure out of range or decompensated heart failure or New York Heart Association (NYHA) 3-4. Secondary Epilepsy or neuropathic chronic pain which requires continuous treatment. Contraindication for trial treatment: Some kind of magnetic metal. Epilepsy antecedents. Any drugs that could decrease the seizure threshold Amantadine sensitivity Cardiopathy disease, severe kidney failure, Angle-closure glaucoma Breastfeeding, pregnancy, or pregnancy planning phase in the next year. Of childbearing potential and willing to use an acceptable method of contraception during the study period. Patient with a terminal disease with no more than one year life expectancy. Patient has been treated for a maligned disease in the past three years. A scheduled surgery in the course of the trials. Any condition that a member of research team consider could affect to participation/follow up patient. Alcoholic o toxics condition in the last year. Major mental disorders Poor communication skills or poor cognitive condition. Other trial participation in the previous 4 month. Use a chronic drug that could interfere in the clinical outcome.

Sites / Locations

  • Hospital Puerta del MarRecruiting
  • Hospital General Gregorio MarañonRecruiting
  • Hospital Clínico San CarlosRecruiting
  • Hospitalario Universitario Nuestra Señora de la CandelariaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Placebo Comparator

Experimental

Sham Comparator

Arm Label

Amantadine

Placebo

TMS

TMS sham

Arm Description

Outcomes

Primary Outcome Measures

To assess the fatigue severity
To compare the effect of TMS and amantadine alone or in combination therapy compared with placebo on fatigue determined using the Modified Fatigue Impact Scale (Total MFIS score: Range from 0 to 84, from minimal to severe fatigue).

Secondary Outcome Measures

To assess the cognitive condition
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on cognition determined by the Symbol Digit Modalities Test (SDMT).
To assess the depression condition
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on depression measured using the Beck Depression Inventory Scale (BDI-II score: Range from 0 to 63, from minimal to severe depression).
To assess the quality of life
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on the quality of life determined by the Short Form 12 Mental Health scale (SF-12 score: Range from 0 to 100, from worse to better physical and mental health functioning).
Safety assessment
Analyze the incidence of the adverse events detected in each of the branches, whether or not with multiple sclerosis
Cost-effectivity assessment
Determine the cost-effectiveness of the different interventions. The total costs of hospitalization and treatment, as well as other health care, will be measured.

Full Information

First Posted
March 20, 2023
Last Updated
April 9, 2023
Sponsor
Hospital San Carlos, Madrid
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1. Study Identification

Unique Protocol Identification Number
NCT05809414
Brief Title
Amantadine and Transcranial Magnetic Stimulation for Treating Fatigue in Multiple Sclerosis
Acronym
FETEM
Official Title
Amantadine and Transcranial Magnetic Stimulation for Treating Fatigue in Multiple Sclerosis: Phase III Study, Controlled, Randomized, Crossed Over and Double Blind.
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 28, 2022 (Actual)
Primary Completion Date
July 15, 2024 (Anticipated)
Study Completion Date
February 28, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hospital San Carlos, Madrid

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Multiple Sclerosis (MS) is the most frequent cause of non-traumatic disability in people under 55 years of age. Fatigue is the most frequent and disabling symptom in the disease, and for which there is no effective treatment. Among the proposed drugs, amantadine is the one that could be most useful, although up to now it has not been adequately demonstrated due to a lack of sufficiently powerful and methodologically appropriate clinical trials. Transcranial magnetic stimulation (TMS) has recently been proposed as a useful treatment for fatigue in MS in preliminary studies.
Detailed Description
Multiple Sclerosis (MS) is the most frequent cause of non-traumatic disability in people under 55 years of age. Fatigue is the most frequent and disabling symptom in the disease, and for which there is no effective treatment. Among the proposed drugs, amantadine is the one that could be most useful, although up to now it has not been adequately demonstrated due to a lack of sufficiently powerful and methodologically appropriate clinical trials. Transcranial magnetic stimulation (TMS) has recently been proposed as a useful treatment for fatigue in MS in preliminary studies. The main objective of the study is to evaluate the change in the severity of fatigue in MS patients undergoing treatment with amantadine, TMS and both in combination, compared to placebo. A randomized, placebo-controlled, crossover, double-blind clinical trial will be conducted. As secondary objectives, changes in cognition, depression and quality of life will be evaluated. For all this, the reference scales adequately validated for each of the objectives will be used.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis, Fatigue
Keywords
Amantadine, Multiple Sclerosis, Fatigue, Transcranial Magnetic Stimulation (TMS), Modified Fatigue Impact Scale (MFIS)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Model Description
All patients will receive all possible combinations (TMS+placebo, TMS+amantadine, TMS sham+amantadine, TMS sham+placebo), the only difference being the sequence in which they are administered.
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
144 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Amantadine
Arm Type
Experimental
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Title
TMS
Arm Type
Experimental
Arm Title
TMS sham
Arm Type
Sham Comparator
Intervention Type
Device
Intervention Name(s)
Transcranial Magnetic Stimulation
Other Intervention Name(s)
TMS
Intervention Description
TMS is a technique for electrical stimulation of brain tissue by generating a magnetic field, which modulates neural activity at the stimulation site and in interconnected neural networks. The treatment will be applied to the left dorsolateral prefrontal region. Each patient will receive 3 sessions per week of approximately 10 minutes for 6 weeks. In the case of TMS sham, a placebo coil will be used, which is indistinguishable from the therapeutic one. In addition, the sessions will be carried out with the same frequency, so the patient will be unaware of the treatment they are receiving.
Intervention Type
Drug
Intervention Name(s)
Amantadine Hydrochloride 100 mg (milligrams) Oral Capsule
Intervention Description
It will be used at a dose of 100 mg, 1 capsule a day for 1 week, followed by 2 daily doses of 100 mg until completing 6 weeks in total. After completing the treatment phase, the dose will be de-escalated (1 capsule a day for 5 days and discontinued). In the case of placebo amantadine capsules, they will have the same organoleptic characteristics as amantadine. The start, maintenance and de-escalation pattern will be identical.
Primary Outcome Measure Information:
Title
To assess the fatigue severity
Description
To compare the effect of TMS and amantadine alone or in combination therapy compared with placebo on fatigue determined using the Modified Fatigue Impact Scale (Total MFIS score: Range from 0 to 84, from minimal to severe fatigue).
Time Frame
6 weeks after starting treatment
Secondary Outcome Measure Information:
Title
To assess the cognitive condition
Description
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on cognition determined by the Symbol Digit Modalities Test (SDMT).
Time Frame
6 weeks after starting treatment
Title
To assess the depression condition
Description
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on depression measured using the Beck Depression Inventory Scale (BDI-II score: Range from 0 to 63, from minimal to severe depression).
Time Frame
6 weeks after starting treatment
Title
To assess the quality of life
Description
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on the quality of life determined by the Short Form 12 Mental Health scale (SF-12 score: Range from 0 to 100, from worse to better physical and mental health functioning).
Time Frame
6 weeks after starting treatment
Title
Safety assessment
Description
Analyze the incidence of the adverse events detected in each of the branches, whether or not with multiple sclerosis
Time Frame
6 months after randomization
Title
Cost-effectivity assessment
Description
Determine the cost-effectiveness of the different interventions. The total costs of hospitalization and treatment, as well as other health care, will be measured.
Time Frame
6 weeks after starting treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Expanded Disability Status Scale mark 1.5 - 4.5 Fatigue Severity Scale > 4 Beck Depression Inventory < 30 No relapse for, at least, three month prior to screening Drug washout period = 4 weeks for any fatigue aimed drug Patient capable to sign the informed consent Exclusion Criteria: Fatigue causing disease other than multiple sclerosis: sleep apnea other autoimmune disease that could be explain the fatigue. endocrine autoimmune disease if the blood test is not in range in the last 6 month. patient with diagnosis of chronic fatigue Patient with high blood pressure out of range or decompensated heart failure or New York Heart Association (NYHA) 3-4. Secondary Epilepsy or neuropathic chronic pain which requires continuous treatment. Contraindication for trial treatment: Some kind of magnetic metal. Epilepsy antecedents. Any drugs that could decrease the seizure threshold Amantadine sensitivity Cardiopathy disease, severe kidney failure, Angle-closure glaucoma Breastfeeding, pregnancy, or pregnancy planning phase in the next year. Of childbearing potential and willing to use an acceptable method of contraception during the study period. Patient with a terminal disease with no more than one year life expectancy. Patient has been treated for a maligned disease in the past three years. A scheduled surgery in the course of the trials. Any condition that a member of research team consider could affect to participation/follow up patient. Alcoholic o toxics condition in the last year. Major mental disorders Poor communication skills or poor cognitive condition. Other trial participation in the previous 4 month. Use a chronic drug that could interfere in the clinical outcome.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jorge Matias-Guiu Guia, MD PhD
Phone
+34 913303000
Ext
3511
Email
matiasguiu@gmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Jordi Matias-Guiu Antem, MD PhD
Phone
+34 913303000
Ext
3511
Email
jordimatiasguiu@hotmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jorge Matias-Guiu Guia, MD PhD
Organizational Affiliation
Hospital San Carlos, Madrid
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Puerta del Mar
City
Cadiz
ZIP/Postal Code
11009
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lucía Forero Díaz, MD PhD
Email
lucia.forero.diaz@hotmail.es
Facility Name
Hospital General Gregorio Marañon
City
Madrid
ZIP/Postal Code
28007
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
María Luisa Martínez Ginés, MD PhD
Email
marisamgines@hotmail.com
Facility Name
Hospital Clínico San Carlos
City
Madrid
ZIP/Postal Code
28040
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jorge Matias-Guiu Guia, MD PhD
Email
matiasguiu@gmail.com
First Name & Middle Initial & Last Name & Degree
Jorge Matias-Guiu Guia, MD PhD
First Name & Middle Initial & Last Name & Degree
Jordi Matias-Guiu Antem, MD PhD
Facility Name
Hospitalario Universitario Nuestra Señora de la Candelaria
City
Santa Cruz De Tenerife
ZIP/Postal Code
38010
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Miguel Ángel Hernández Pérez, MD PhD
Email
mhernandezp78@hotmail.com

12. IPD Sharing Statement

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Amantadine and Transcranial Magnetic Stimulation for Treating Fatigue in Multiple Sclerosis

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