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Efficacy of RIVAstigmine on Motor, Cognitive and Behavioural Impairment in Progressive Supranuclear Palsy (RIVA-PSP)

Primary Purpose

Progressive Supranuclear Palsy (PSP)

Status
Completed
Phase
Phase 3
Locations
France
Study Type
Interventional
Intervention
Rivastigmine
Placebo
Sponsored by
Assistance Publique Hopitaux De Marseille
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Progressive Supranuclear Palsy (PSP)

Eligibility Criteria

41 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Probable PSP of the Richardson subtype as defined by the NINDS-SPSP criteria modified so as to allow inclusions of patients who have first fallen within 3 years of disease onset.
  • Aged 41 to 80 years at the time of screening
  • Judged by site investigator to be able to comply with gait/balance and neuropsychological evaluations at baseline and throughout the study
  • Able to ambulate independently or with assistance (cane)
  • Score ≥ 20 on the mini-mental state examination (MMSE) at screening
  • A reliable caregiver - defined as a person having frequent contact with subject (≥ 3 hours per day) and willing to fill the fall diaries and monitor study medication compliance and the subject's health and concomitant medication throughout the study - must accompany the subject to all visits.
  • A fall or near fall rate ≥ 2/week in average (estimated through interview at screening and confirmed during a 2-week period between screening and baseline using fall postcards).
  • Any parkinsonian medication taken by the subject must be stable in dose for 4 weeks prior to screening and must remain stable for the duration of the study
  • Stable on all other chronic medications for 4 weeks prior to screening
  • Written informed consent provided by subject and caregiver.

Exclusion Criteria:

  • Non ambulatory patient.
  • History and clinical examination suggesting another parkinsonian syndrome (Parkinson's disease, Dementia with Lewy Bodies, Corticobasal Degeneration, Multisystem Atrophy, Vascular Parkinsonism, tumoral parkinsonism, anti-psychotic drug-induced parkinsonism)
  • Presence of other significant neurological or psychiatric disorders: Alzheimer's disease, epilepsy, history of stroke, psychotic disorder, severe bipolar or unipolar disorder
  • A fall or near fall rate < 2/week in average (during a 2-week period between screening and baseline using fall postcards).
  • Insufficient fluency in local language to complete neuropsychological, global and gait/balance assessments
  • Score < 20 on the mini-mental state examination at screening
  • Within 4 weeks of screening or during the course of the study concurrent treatment with any cholinesterase inhibitor medication (donepezil, galantamine, rivastigmine) or any cholinergic agent (agonist or antagonist) including memantine.
  • History of deep brain stimulation surgery.
  • Within 4 weeks of screening or during the course of the study concurrent treatment with beta blockers, any antipsychotic drugs or mood stabilisers.
  • Any malignancy within 5 years of screening or current significant - judged as such by the site investigator - hematological, endocrine, cardiovascular, renal, hepatic, gastrointestinal, or neurological disease.
  • Presence of an active gastro-duodenal ulcer, unstable asthma or chronic obstructive pulmonary disease.
  • History of or current urinary retention requiring either anticholinergic medication or urethral catheterisation.
  • The systolic blood pressure measurement is > 190 or < 85 mm Hg and/or the diastolic blood pressure measurement is > 105 or < 50 mm Hg at screening.
  • Clinically significant laboratory abnormalities at screening, including creatinine ≥ 2.5 mg/dL, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 3 times the upper limit of the normal reference range.
  • The ECG is abnormal at screening and judged to be clinically significant by the site investigator. Particular attention will be given to any sign suggesting conduction disorders.
  • Treatment with any investigational drugs or device within 60 days of screening.
  • Ongoing pregnancy or lactation. Women with childbearing potential not using any form of efficacious contraception.
  • Any contraindication for rivastigmine as defined by the ANSM
  • Known hypersensitivity to rivastigmine or any cholinesterase inhibitor medication.

Sites / Locations

  • Service de Neurologie et Pathologie du Mouvement Hôpital de La Timone

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Rivastigmine

Placebo

Arm Description

Subject will receive a treatment of Rivastigmine twice daily during 24 weeks of treatment. Study drug will be administered orally. Sufficient test drug will be dispensed to subjects or their caregivers at each study visit to allow twice daily dosing until the next scheduled study visit

Subject will receive a placebo twice daily during 24 weeks of treatment. Study drug will be administered orally. Sufficient test drug will be dispensed to subjects or their caregivers at each study visit to allow twice daily dosing until the next scheduled study visit

Outcomes

Primary Outcome Measures

Efficacy will be assessed at 4 months as the change from baseline of the number of falls and near falls over the past 2 week
Efficacy will be assessed at 4 months as the change from baseline of the number of falls and near falls over the past 2 weeks using fall postcards sent weekly and filled daily by the subject and caregiver. The number of falls and near-falls will be expressed both as the total number of occurrences over that period and as the number of occurrence adjusted to the distance and number of hours walked (assessed using continuous accelerometer recordings)

Secondary Outcome Measures

Change from baseline at 4 months measured by the global ans sub scores of the PSPRS scale (Progressive Supranuclear Palsy Rating Scale)
Change from baseline at 4 months measured by the Clinical Global Impression scale (patient and caregiver)
Apathy assessed using the Lille Apathy Rating Scale (LARS) both subject and caregiver versions
Assessment of the Quality of life of patient using the PSP-Quality of Life Scale (PSP-QoL)
Assessment of the Quality of life of patient using the EQ-5D
Assessment of the Quality of life of the caregiver using the PSP-Quality of Life Scale (PSP-QoL)
Assessment of the Quality of life of the caregiver using the EQ-5D
Caregiver burden assessed using the Caregiver Reaction Assessement (CRA)
Safety: recording of adverse events at each study visit and at the phone calls
Vital signs, laboratory tests and ECGs will be performed at each study visit to monitor any biological or cardiac adverse event

Full Information

First Posted
June 30, 2016
Last Updated
July 19, 2023
Sponsor
Assistance Publique Hopitaux De Marseille
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1. Study Identification

Unique Protocol Identification Number
NCT02839642
Brief Title
Efficacy of RIVAstigmine on Motor, Cognitive and Behavioural Impairment in Progressive Supranuclear Palsy
Acronym
RIVA-PSP
Official Title
RIVA-PSP: Efficacy of Rivastigmine on Motor, Cognitive and Behavioural Impairment in Progressive Supranuclear Palsy: A Randomised Double Blind Placebo-controlled Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Completed
Study Start Date
July 26, 2016 (Actual)
Primary Completion Date
June 3, 2022 (Actual)
Study Completion Date
November 17, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Assistance Publique Hopitaux De Marseille

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease from the parkinsonian syndrome group. It represents 5 to 10% of all parkinsonian syndromes and affects 3,000 to 10,000 persons in France. PSP is characterised by a doparesistant parkinsonism with axial signs such as early gait instability and falls, oculomotor signs such as a vertical gaze palsy, dysphagia and dysarthria, and both cognitive and behavioural disturbances. The latter predominantly manifest as psycho-motor slowness, apathy and frontal executive deficits. Swallowing impairments and falls may lead to life-threatening situations and death occurs 6-9 years after disease onset. Apart from L-dopa which may transiently and inconsistently improve motor symptoms no effective symptomatic, disease-modifying or neuroprotective therapy is presently available to reduce disability in any way. Therefore these patients often receive mostly non-medical care such as physiotherapy and speech therapy. In addition to dopaminergic degeneration there is evidence of cholinergic deficits in PSP correlated with gait and balance impairments . This stands in contrast with the limited number of studies of cholinergic augmentation strategies in PSP. Trials of cholinesterase inhibitors in PSP have produced rather conflicting results: donepezil improves cognition but deteriorates some motor functions whereas a case series of 5 PSP patients treated with rivastigmine found an improvement in several cognitive aspects and no deterioration of motor functions .On the other hand in Parkinson's disease there is convincing evidence of a positive effect of rivastigmine on cognition , apathy and falls Investigators' hypothesis is that rivastigmine (an acetyl- and butyryl-cholinesterase inhibitor) may reduce gait and postural impairment in PSP and may therefore limit the number of falls and their consequences both in terms of injuries sustained (fractures etc...) and on the patients' autonomy. In addition investigators hypothesise that rivastigmine may also reduce the cognitive and behavioural impairment associated with PSP. Taken together these improvements are likely to produce a significant effect on the patients' quality of life and their caregiver burden.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Progressive Supranuclear Palsy (PSP)

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Rivastigmine
Arm Type
Active Comparator
Arm Description
Subject will receive a treatment of Rivastigmine twice daily during 24 weeks of treatment. Study drug will be administered orally. Sufficient test drug will be dispensed to subjects or their caregivers at each study visit to allow twice daily dosing until the next scheduled study visit
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subject will receive a placebo twice daily during 24 weeks of treatment. Study drug will be administered orally. Sufficient test drug will be dispensed to subjects or their caregivers at each study visit to allow twice daily dosing until the next scheduled study visit
Intervention Type
Drug
Intervention Name(s)
Rivastigmine
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Efficacy will be assessed at 4 months as the change from baseline of the number of falls and near falls over the past 2 week
Description
Efficacy will be assessed at 4 months as the change from baseline of the number of falls and near falls over the past 2 weeks using fall postcards sent weekly and filled daily by the subject and caregiver. The number of falls and near-falls will be expressed both as the total number of occurrences over that period and as the number of occurrence adjusted to the distance and number of hours walked (assessed using continuous accelerometer recordings)
Time Frame
baseline, 2 weeks, 4 months
Secondary Outcome Measure Information:
Title
Change from baseline at 4 months measured by the global ans sub scores of the PSPRS scale (Progressive Supranuclear Palsy Rating Scale)
Time Frame
Baseline and 4 months
Title
Change from baseline at 4 months measured by the Clinical Global Impression scale (patient and caregiver)
Time Frame
Baseline and 4 months
Title
Apathy assessed using the Lille Apathy Rating Scale (LARS) both subject and caregiver versions
Time Frame
Baseline and 4 months
Title
Assessment of the Quality of life of patient using the PSP-Quality of Life Scale (PSP-QoL)
Time Frame
Baseline and 4 months
Title
Assessment of the Quality of life of patient using the EQ-5D
Time Frame
Baseline and 4 months
Title
Assessment of the Quality of life of the caregiver using the PSP-Quality of Life Scale (PSP-QoL)
Time Frame
Baseline and 4 months
Title
Assessment of the Quality of life of the caregiver using the EQ-5D
Time Frame
Baseline and 4 months
Title
Caregiver burden assessed using the Caregiver Reaction Assessement (CRA)
Time Frame
Baseline and 4 months
Title
Safety: recording of adverse events at each study visit and at the phone calls
Description
Vital signs, laboratory tests and ECGs will be performed at each study visit to monitor any biological or cardiac adverse event
Time Frame
4 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
41 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Probable PSP of the Richardson subtype as defined by the NINDS-SPSP criteria modified so as to allow inclusions of patients who have first fallen within 3 years of disease onset. Aged 41 to 80 years at the time of screening Judged by site investigator to be able to comply with gait/balance and neuropsychological evaluations at baseline and throughout the study Able to ambulate independently or with assistance (cane) Score ≥ 20 on the mini-mental state examination (MMSE) at screening A reliable caregiver - defined as a person having frequent contact with subject (≥ 3 hours per day) and willing to fill the fall diaries and monitor study medication compliance and the subject's health and concomitant medication throughout the study - must accompany the subject to all visits. A fall or near fall rate ≥ 2/week in average (estimated through interview at screening and confirmed during a 2-week period between screening and baseline using fall postcards). Any parkinsonian medication taken by the subject must be stable in dose for 4 weeks prior to screening and must remain stable for the duration of the study Stable on all other chronic medications for 4 weeks prior to screening Written informed consent provided by subject and caregiver. Exclusion Criteria: Non ambulatory patient. History and clinical examination suggesting another parkinsonian syndrome (Parkinson's disease, Dementia with Lewy Bodies, Corticobasal Degeneration, Multisystem Atrophy, Vascular Parkinsonism, tumoral parkinsonism, anti-psychotic drug-induced parkinsonism) Presence of other significant neurological or psychiatric disorders: Alzheimer's disease, epilepsy, history of stroke, psychotic disorder, severe bipolar or unipolar disorder A fall or near fall rate < 2/week in average (during a 2-week period between screening and baseline using fall postcards). Insufficient fluency in local language to complete neuropsychological, global and gait/balance assessments Score < 20 on the mini-mental state examination at screening Within 4 weeks of screening or during the course of the study concurrent treatment with any cholinesterase inhibitor medication (donepezil, galantamine, rivastigmine) or any cholinergic agent (agonist or antagonist) including memantine. History of deep brain stimulation surgery. Within 4 weeks of screening or during the course of the study concurrent treatment with beta blockers, any antipsychotic drugs or mood stabilisers. Any malignancy within 5 years of screening or current significant - judged as such by the site investigator - hematological, endocrine, cardiovascular, renal, hepatic, gastrointestinal, or neurological disease. Presence of an active gastro-duodenal ulcer, unstable asthma or chronic obstructive pulmonary disease. History of or current urinary retention requiring either anticholinergic medication or urethral catheterisation. The systolic blood pressure measurement is > 190 or < 85 mm Hg and/or the diastolic blood pressure measurement is > 105 or < 50 mm Hg at screening. Clinically significant laboratory abnormalities at screening, including creatinine ≥ 2.5 mg/dL, alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥ 3 times the upper limit of the normal reference range. The ECG is abnormal at screening and judged to be clinically significant by the site investigator. Particular attention will be given to any sign suggesting conduction disorders. Treatment with any investigational drugs or device within 60 days of screening. Ongoing pregnancy or lactation. Women with childbearing potential not using any form of efficacious contraception. Any contraindication for rivastigmine as defined by the ANSM Known hypersensitivity to rivastigmine or any cholinesterase inhibitor medication.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Catherine GEINDRE
Organizational Affiliation
Assistance Publique Hôpitaux de Marseille
Official's Role
Study Director
Facility Information:
Facility Name
Service de Neurologie et Pathologie du Mouvement Hôpital de La Timone
City
Marseille Cedex 5
ZIP/Postal Code
13385
Country
France

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Efficacy of RIVAstigmine on Motor, Cognitive and Behavioural Impairment in Progressive Supranuclear Palsy

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