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BX-1 in Spasticity Due to Multiple Sclerosis

Primary Purpose

Spasticity Due to Multiple Sclerosis

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
BX-1
Placebo
Sponsored by
Bionorica SE
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spasticity Due to Multiple Sclerosis focused on measuring cannabinoid, dronabinol

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female patients aged 18 to 65 years
  2. Presence of MS according to 2010 or 2017 revised McDonald criteria
  3. Patients with stable MS for at least 3 months before enrolment in the opinion of the treating physician Note: Patients with a MS relapse during 3 month prior to enrolment are not considered to have stable MS
  4. Ongoing spasticity for at least 3 months before enrolment
  5. Spasticity in at least 2 lower limb muscles
  6. Expanded Disability Status Scale (EDSS) score ≥ 3.0 and ≤ 6.5
  7. Previous treatment with at least two different optimized oral MS anti-spasticity therapies before inclusion. Both treatment attempts must include at least baclofen or oral tizanidine, which can be combined with other anti-spasticity drugs.

    AND Patients currently receiving an optimized treatment corresponding to the last treatment attempt with stable dosage for at least 30 days prior to Visit 0.

  8. Female patients of non-childbearing potential or if of childbearing potential using highly effective contraceptive methods or double barrier contraception.

    For men: no specific contraception methods need to be used.

  9. Willingness to follow the study procedure for the whole duration of the trial and signed informed consent at screening prior to any trial-related procedure

Exclusion Criteria:

  1. Any present disease other than MS that could affect spasticity (e.g. traumatic brain injury, spinal cord injury, brain damage due to a lack of oxygen, stroke, encephalitis, meningitis)
  2. Intake of not permitted concomitant medication prior to screening and concomitant medication which should be unaltered prior to screening in an unstable dosage regimen
  3. Significant fixed tendon contractures
  4. History of epileptic seizures
  5. History of or existing relevant CNS disorder (other than MS)
  6. History of or existing relevant psychiatric disorders (e.g. schizophrenia, psychosis, manic disorders, severe depressive disorders, suicidal ideations, drug and/or alcohol abuse etc.)
  7. Patients with a positive drug abuse screening test, except for medications used to treat a medical condition and reported as such by the patient; all patients with a positive result for cannabis/THC
  8. History of or existing cardiac diseases or pathological findings (e.g. chronic insufficiency NYHA III/IV, severe arrhythmia, unstable angina pectoris, myocardial infarction within the past 6 months, QT prolongation)
  9. Known HIV, and/or active Hepatitis B or C infection
  10. History of or existing malignancy during the 5 years before screening except history of basal cell carcinoma and melanoma in situ
  11. Significantly impaired renal function (estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73m2)
  12. Significant impaired hepatic function (Alanine Aminotransferase > 3 times upper limit of normal or bilirubin > 2 times upper limit of normal, except Gilbert syndrome)
  13. Known allergic reactions to the active ingredients used or to constituents of the IMP
  14. Chronic or active infection requiring a systemic therapy
  15. Pregnancy, breastfeeding or planned pregnancy
  16. Any condition that interferes with the participation in the clinical trial at the discretion of the investigator
  17. Patients not able to follow study instructions, not able to follow the study assessments defined by the protocol, unable to understand the written and verbal instructions, in particular regarding the risks and inconveniences they will be exposed to during their participation in the clinical trial
  18. Patients in custody by judicial or official order
  19. Patients who are members of the staff of the trial centre, staff of the sponsor or CRO, the investigator him/herself or close relatives of the investigator
  20. Parallel participation in another clinical trial, participation in another trial within less than 30 days or five half-lives of IMP (whatever is longer) to screening, or previous participation in this trial (except one time screening failures). A patient may be re-screened once, if any inclusion criterion is not met or any exclusion criterion is met during the first screening attempt.

Sites / Locations

  • Investigative Site
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  • Investigative Site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

BX-1 (dronabinol)

Placebo

Arm Description

BX-1

Placebo of BX-1

Outcomes

Primary Outcome Measures

Responder analysis: proportion of patients showing improvement in spasticity of 18% or more in average Numerical Rating Scale for Spasticity (NRS-S) assessment at end of treatment
Responder analysis: proportion of patients showing improvement in spasticity (change from baseline corresponding to the mean NRS-S score during 7 days prior to randomisation) of 18% or more in average NRS-S assessment at end of treatment (mean NRS-S score during 7 days prior to Visit 6).

Secondary Outcome Measures

Responder analysis: proportion of patients showing improvement in spasticity (change from baseline) of 30% or more in average NRS-S assessment at end of treatment (Visit 6)
Responder analysis: proportion of patients showing improvement in spasticity (change from baseline) of 50% or more in average NRS-S assessment at end of treatment (Visit 6)
Time to response: time to reach first improvement in spasticity (change from baseline) of 18% or more, based on patient's daily spasticity assessment on the NRS-S
Time to response: time to reach first improvement in spasticity (change from baseline) of 30% or more, based on patient's daily spasticity assessment on the NRS-S
Weekly mean of the patient's daily spasticity assessments on the NRS-S during Visit 0 - Visit 6
Weekly mean of the patient's daily pain assessments on the Numerical Rating Scale for Pain (NRS-P) during Visit 0 - Visit 6
Responder analysis: proportion of patients showing improvement in pain (change from baseline) of 15% or more in average NRS-P assessment at end of treatment (Visit 6)
Responder analysis: proportion of patients showing improvement in pain (change from baseline) of 30% or more in average NRS-P assessment at end of treatment (Visit 6)
Time to response: time to reach first improvement in pain (change from baseline) of 15% or more, based on patient's pain assessment on the NRS-P
Time to response: time to reach first improvement in pain (change from baseline) of 30% or more, based on patient's pain assessment on the NRS-P
Weekly mean of the patient's daily spasm frequency and severity assessments on the Penn Spasm Frequency Scale (PSFS) during Visit 0 - Visit 6
Mean change from baseline of spasm frequency and severity assessments on the PSFS at end of treatment (Visit 6)
Mean change from baseline of Timed 25-Foot Walk (T25-FW) at Visit 4 and Visit 6
Responder analysis: proportion of patients showing improvement in TF25-FW (change from baseline) of 20% or more at Visit 6
Mean change from baseline of the physical and psychological impact of multiple sclerosis assessed with the Multiple Sclerosis Impact Scale- 29 version 2 (MSIS-29 v2) at Visit 4 and Visit 6
Mean change from baseline of quality of life measured with Short-Form Health Survey of the Medical Outcomes Study Version 2 (SF-36 v2) at Visit 6
Mean change from baseline of sleep quality measured with the Numerical Rating Scale for Sleep Quality (NRS-SQ) at Visit 3 - Visit 6
Mean change from baseline of fatigue measured with the Numerical Rating Scale for Fatigue (NRS-F) at Visit 3 - Visit 6
Overall patients' status measured by Patient´s Global Impression of Change scale (PGIC) at Visit 5 and Visit 6
Overall patients' status measured by Clinical Global Impression - Improvement scale (CGI-I) at Visit 5 and Visit 6

Full Information

First Posted
November 20, 2018
Last Updated
May 4, 2021
Sponsor
Bionorica SE
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1. Study Identification

Unique Protocol Identification Number
NCT03756974
Brief Title
BX-1 in Spasticity Due to Multiple Sclerosis
Official Title
A Phase III, Multi-centre, Randomised, Double-blind, Placebo-controlled, Parallel-group Clinical Trial to Investigate the Efficacy and Safety of BX-1 for the Symptomatic Relief of Spasticity in Patients With Multiple Sclerosis (MS)
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
February 18, 2019 (Actual)
Primary Completion Date
March 30, 2021 (Actual)
Study Completion Date
March 30, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Bionorica SE

4. Oversight

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

5. Study Description

Brief Summary
To investigate the efficacy and safety of orally administered BX-1 compared to placebo in patients with spasticity due to multiple sclerosis not sufficiently controlled by current anti-spasticity medication
Detailed Description
The aim of the present phase III clinical trial is to demonstrate superiority of BX-1, an oral solution containing dronabinol, over placebo in patients with spasticity due to MS not sufficiently controlled by their current anti-spasticity medication. The trial is designed to show that BX-1 is able to reduce spasticity in MS patients not showing sufficient response to their current anti-spasticity treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spasticity Due to Multiple Sclerosis
Keywords
cannabinoid, dronabinol

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
BX-1 (dronabinol)
Arm Type
Experimental
Arm Description
BX-1
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo of BX-1
Intervention Type
Drug
Intervention Name(s)
BX-1
Intervention Description
BX-1 (dronabinol), oral solution. All patients enrolled establish their individually tolerable dose by dose Titration.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo of BX-1, oral solution
Primary Outcome Measure Information:
Title
Responder analysis: proportion of patients showing improvement in spasticity of 18% or more in average Numerical Rating Scale for Spasticity (NRS-S) assessment at end of treatment
Description
Responder analysis: proportion of patients showing improvement in spasticity (change from baseline corresponding to the mean NRS-S score during 7 days prior to randomisation) of 18% or more in average NRS-S assessment at end of treatment (mean NRS-S score during 7 days prior to Visit 6).
Time Frame
16 weeks
Secondary Outcome Measure Information:
Title
Responder analysis: proportion of patients showing improvement in spasticity (change from baseline) of 30% or more in average NRS-S assessment at end of treatment (Visit 6)
Time Frame
16 weeks
Title
Responder analysis: proportion of patients showing improvement in spasticity (change from baseline) of 50% or more in average NRS-S assessment at end of treatment (Visit 6)
Time Frame
16 weeks
Title
Time to response: time to reach first improvement in spasticity (change from baseline) of 18% or more, based on patient's daily spasticity assessment on the NRS-S
Time Frame
16 weeks
Title
Time to response: time to reach first improvement in spasticity (change from baseline) of 30% or more, based on patient's daily spasticity assessment on the NRS-S
Time Frame
16 weeks
Title
Weekly mean of the patient's daily spasticity assessments on the NRS-S during Visit 0 - Visit 6
Time Frame
21 weeks
Title
Weekly mean of the patient's daily pain assessments on the Numerical Rating Scale for Pain (NRS-P) during Visit 0 - Visit 6
Time Frame
21 weeks
Title
Responder analysis: proportion of patients showing improvement in pain (change from baseline) of 15% or more in average NRS-P assessment at end of treatment (Visit 6)
Time Frame
16 weeks
Title
Responder analysis: proportion of patients showing improvement in pain (change from baseline) of 30% or more in average NRS-P assessment at end of treatment (Visit 6)
Time Frame
16 weeks
Title
Time to response: time to reach first improvement in pain (change from baseline) of 15% or more, based on patient's pain assessment on the NRS-P
Time Frame
16 weeks
Title
Time to response: time to reach first improvement in pain (change from baseline) of 30% or more, based on patient's pain assessment on the NRS-P
Time Frame
16 weeks
Title
Weekly mean of the patient's daily spasm frequency and severity assessments on the Penn Spasm Frequency Scale (PSFS) during Visit 0 - Visit 6
Time Frame
21 weeks
Title
Mean change from baseline of spasm frequency and severity assessments on the PSFS at end of treatment (Visit 6)
Time Frame
16 weeks
Title
Mean change from baseline of Timed 25-Foot Walk (T25-FW) at Visit 4 and Visit 6
Time Frame
16 weeks
Title
Responder analysis: proportion of patients showing improvement in TF25-FW (change from baseline) of 20% or more at Visit 6
Time Frame
16 weeks
Title
Mean change from baseline of the physical and psychological impact of multiple sclerosis assessed with the Multiple Sclerosis Impact Scale- 29 version 2 (MSIS-29 v2) at Visit 4 and Visit 6
Time Frame
16 weeks
Title
Mean change from baseline of quality of life measured with Short-Form Health Survey of the Medical Outcomes Study Version 2 (SF-36 v2) at Visit 6
Time Frame
16 weeks
Title
Mean change from baseline of sleep quality measured with the Numerical Rating Scale for Sleep Quality (NRS-SQ) at Visit 3 - Visit 6
Time Frame
12 weeks
Title
Mean change from baseline of fatigue measured with the Numerical Rating Scale for Fatigue (NRS-F) at Visit 3 - Visit 6
Time Frame
12 weeks
Title
Overall patients' status measured by Patient´s Global Impression of Change scale (PGIC) at Visit 5 and Visit 6
Time Frame
16 weeks
Title
Overall patients' status measured by Clinical Global Impression - Improvement scale (CGI-I) at Visit 5 and Visit 6
Time Frame
16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients aged 18 to 65 years Presence of MS according to 2010 or 2017 revised McDonald criteria Patients with stable MS for at least 3 months before enrolment in the opinion of the treating physician Note: Patients with a MS relapse during 3 month prior to enrolment are not considered to have stable MS Ongoing spasticity for at least 3 months before enrolment Spasticity in at least 2 lower limb muscles Expanded Disability Status Scale (EDSS) score ≥ 3.0 and ≤ 6.5 Previous treatment with at least two different optimized oral MS anti-spasticity therapies before inclusion. Both treatment attempts must include at least baclofen or oral tizanidine, which can be combined with other anti-spasticity drugs. AND Patients currently receiving an optimized treatment corresponding to the last treatment attempt with stable dosage for at least 30 days prior to Visit 0. Female patients of non-childbearing potential or if of childbearing potential using highly effective contraceptive methods or double barrier contraception. For men: no specific contraception methods need to be used. Willingness to follow the study procedure for the whole duration of the trial and signed informed consent at screening prior to any trial-related procedure Exclusion Criteria: Any present disease other than MS that could affect spasticity (e.g. traumatic brain injury, spinal cord injury, brain damage due to a lack of oxygen, stroke, encephalitis, meningitis) Intake of not permitted concomitant medication prior to screening and concomitant medication which should be unaltered prior to screening in an unstable dosage regimen Significant fixed tendon contractures History of epileptic seizures History of or existing relevant CNS disorder (other than MS) History of or existing relevant psychiatric disorders (e.g. schizophrenia, psychosis, manic disorders, severe depressive disorders, suicidal ideations, drug and/or alcohol abuse etc.) Patients with a positive drug abuse screening test, except for medications used to treat a medical condition and reported as such by the patient; all patients with a positive result for cannabis/THC History of or existing cardiac diseases or pathological findings (e.g. chronic insufficiency NYHA III/IV, severe arrhythmia, unstable angina pectoris, myocardial infarction within the past 6 months, QT prolongation) Known HIV, and/or active Hepatitis B or C infection History of or existing malignancy during the 5 years before screening except history of basal cell carcinoma and melanoma in situ Significantly impaired renal function (estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73m2) Significant impaired hepatic function (Alanine Aminotransferase > 3 times upper limit of normal or bilirubin > 2 times upper limit of normal, except Gilbert syndrome) Known allergic reactions to the active ingredients used or to constituents of the IMP Chronic or active infection requiring a systemic therapy Pregnancy, breastfeeding or planned pregnancy Any condition that interferes with the participation in the clinical trial at the discretion of the investigator Patients not able to follow study instructions, not able to follow the study assessments defined by the protocol, unable to understand the written and verbal instructions, in particular regarding the risks and inconveniences they will be exposed to during their participation in the clinical trial Patients in custody by judicial or official order Patients who are members of the staff of the trial centre, staff of the sponsor or CRO, the investigator him/herself or close relatives of the investigator Parallel participation in another clinical trial, participation in another trial within less than 30 days or five half-lives of IMP (whatever is longer) to screening, or previous participation in this trial (except one time screening failures). A patient may be re-screened once, if any inclusion criterion is not met or any exclusion criterion is met during the first screening attempt.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Luitgard Spitznagel-Schminke
Organizational Affiliation
Bionorica SE
Official's Role
Study Director
Facility Information:
Facility Name
Investigative Site
City
Choceň
ZIP/Postal Code
56501
Country
Czechia
Facility Name
Investigative Site
City
Havířov
ZIP/Postal Code
73601
Country
Czechia
Facility Name
Investigative Site
City
Hradec Králové
ZIP/Postal Code
50003
Country
Czechia
Facility Name
Investigative site
City
Hradec Králové
ZIP/Postal Code
50341
Country
Czechia
Facility Name
Investigative Site
City
Olomouc
ZIP/Postal Code
77520
Country
Czechia
Facility Name
Investigative Site
City
Plzen
ZIP/Postal Code
31200
Country
Czechia
Facility Name
Investigative Site
City
Praha
ZIP/Postal Code
10034
Country
Czechia
Facility Name
Investigative Site
City
Praha
ZIP/Postal Code
12808
Country
Czechia
Facility Name
Investigative Site
City
Praha
ZIP/Postal Code
14059
Country
Czechia
Facility Name
Investigative Site
City
Praha
ZIP/Postal Code
18600
Country
Czechia
Facility Name
Investigative Site
City
Teplice
ZIP/Postal Code
41529
Country
Czechia
Facility Name
Investigative Site
City
Freiburg
ZIP/Postal Code
79106
Country
Germany
Facility Name
Investigative Site
City
Ulm
ZIP/Postal Code
89073
Country
Germany
Facility Name
Investigative Site
City
Budapest
ZIP/Postal Code
1024
Country
Hungary
Facility Name
Investigative Site
City
Budapest
ZIP/Postal Code
1116
Country
Hungary
Facility Name
Investigative Site
City
Budapest
ZIP/Postal Code
1145
Country
Hungary
Facility Name
Investigative Site
City
Debrecen
ZIP/Postal Code
4031
Country
Hungary
Facility Name
Investigative Site
City
Győr
ZIP/Postal Code
9024
Country
Hungary
Facility Name
Investigative Site
City
Miskolc
ZIP/Postal Code
3526
Country
Hungary
Facility Name
Investigative Site
City
Szeged
ZIP/Postal Code
6725
Country
Hungary
Facility Name
Investigative Site
City
Szolnok
ZIP/Postal Code
5000
Country
Hungary
Facility Name
Investigative Site
City
Tatabánya
ZIP/Postal Code
2800
Country
Hungary
Facility Name
Investigative Site
City
Bydgoszcz
ZIP/Postal Code
85-065
Country
Poland
Facility Name
Investigative Site
City
Częstochowa
ZIP/Postal Code
42-280
Country
Poland
Facility Name
Investigative Site
City
Katowice
ZIP/Postal Code
40-555
Country
Poland
Facility Name
Investigative Site
City
Katowice
ZIP/Postal Code
40-588
Country
Poland
Facility Name
Investigative Site
City
Katowice
ZIP/Postal Code
40-611
Country
Poland
Facility Name
Investigative Site
City
Katowice
ZIP/Postal Code
40-650
Country
Poland
Facility Name
Investigative Site
City
Kraków
ZIP/Postal Code
30-539
Country
Poland
Facility Name
Investigative Site
City
Plewiska
ZIP/Postal Code
62-064
Country
Poland
Facility Name
Investigative Site
City
Poznań
ZIP/Postal Code
61-853
Country
Poland
Facility Name
Investigative Site
City
Warszawa
ZIP/Postal Code
00-874
Country
Poland
Facility Name
Investigative Site
City
Warszawa
ZIP/Postal Code
01-684
Country
Poland
Facility Name
Investigative Site
City
Barcelona
ZIP/Postal Code
08003
Country
Spain
Facility Name
Investigative Site
City
Barcelona
ZIP/Postal Code
08025
Country
Spain
Facility Name
Investigative Site
City
Hospitalet de Llobregat
ZIP/Postal Code
08907
Country
Spain
Facility Name
Investigative Site
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Investigative Site
City
Málaga
ZIP/Postal Code
29010
Country
Spain
Facility Name
Investigative Site
City
Salt
ZIP/Postal Code
17190
Country
Spain
Facility Name
Investigative Site
City
Valencia
ZIP/Postal Code
46026
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
No

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BX-1 in Spasticity Due to Multiple Sclerosis

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