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Melatonin 3mg and 5mg Compared to Cognitive Behavioral Therapy for Insomnia (CBT-I) in the Treatment of Insomnia (Morfeu)

Primary Purpose

Insomnia Disorder

Status
Unknown status
Phase
Phase 2
Locations
Brazil
Study Type
Interventional
Intervention
CBT-I plus placebo
CBT-I plus Melatonin 3 mg
CBT-I plus Melatonin 5 mg
Sponsored by
Ache Laboratorios Farmaceuticos S.A.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Insomnia Disorder focused on measuring insomnia, cognitive behavioral therapy for insomnia, melatonin

Eligibility Criteria

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

Inclusion Criteria:

  • Fulfill the criteria for insomnia disorder, according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition);
  • Complaint of difficulty falling asleep;
  • Ability to understand and consent their participation in this clinical study, expressed by signing the Informed Consent Form (ICF).

Exclusion Criteria:

  • Any finding of clinical/physical observation or laboratory examination to be interpreted by the investigator as a risk to the inclusion of the participant in the clinical study;
  • Known hypersensitivity to drug components used during the study;
  • Participant have any family relationship to the second degree or bond with employees or employees of Sponsor and Sites;
  • Participant has used beta-blockers (in the last 30 days prior to screening visit), psychoactive drugs or sedative effect, such as, but not limited to: sedatives (in the last 14 days prior to screening visit), hypnotics (in the last 07 days prior to screening visit), muscle relaxants (in the last 11 days prior to screening visit), antihistamines first generation (in the last 08 days prior to screening visit), and antidepressants, antiepileptics, antipsychotics, among others (in the last 30 days prior to screening visit);
  • Participants diagnosed with clinical diseases that interfere with sleep, such as chronic pain, nocturia, hypothyroidism, hyperthyroidism, severe heart disease, serious neurological and psychiatric disorders according to the assessment of the investigator;
  • Participants diabetics insulin dependent;
  • Sleep apnea moderate to severe - AHI > 20 (Apnoea-Hypopnoea Index) assessed by polysomnography at the baseline;
  • Participants who work at night;
  • Participant who has BMI ≥ 30;
  • Participant score above 50 in Anxiety Inventory to assess the degree of anxiety;
  • Participant with cognitive impairment, based on the result obtained in the Mini-Mental State Examination. The cognitive impairment will be considered with score below 13 points for illiterates, below 18 for participants with one to eight incomplete years of schooling, below 26 for those with education of eight or more years;
  • Participant score above 20 on the Beck Inventory to assess depression;
  • Abuse of alcohol or illicit drugs, according to the assessment of the investigator;
  • Male participants who do not agree to use acceptable methods of contraception; 1) male participants: barrier methods, except surgically sterile (vasectomy) or participants who declare to perform sexual practices on a not to reproductive way. 2) methods of contraception for the male participant's partner: oral contraceptives, injectable contraceptives, intrauterine device (IUD), hormonal implants, hormonal patch, tubal ligation and barrier methods; except surgically sterile (bilateral oophorectomy or hysterectomy) or the menopausal for at least one year;
  • Female participants who are in the reproductive age and do not agree to use acceptable methods of contraception (oral contraceptives, injectable contraceptives, intrauterine device (IUD), hormonal implants, barrier methods, hormonal patch and tubal ligation); except surgically sterile (bilateral oophorectomy or hysterectomy), the menopausal for at least one year and participants who declare to perform sexual practices on a not to reproductive way;
  • Women in gestation period or who are breastfeeding;
  • Participant who has participated in clinical trial protocols in the last twelve (12) months (CNS Resolution 251 of August 7, 1997, Part III, sub-item J), unless the investigator considers that there may be a direct benefit to the same.

Sites / Locations

  • CEDOES - Centro de Diagnóstico e Pesquisa da Osteoporose do Espirito Santo.Recruiting
  • Hospital de Clínicas de Porto Alegre
  • Allergisa Pesquisa Dermato Cosmética Ltda.Recruiting
  • Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto USPRecruiting
  • Centro de Estudos Multidisciplinar CEPES da Faculdade de Medicina do ABC
  • Dr Consulta Clinica Medica LtdaRecruiting
  • Centro Paulista de Investigação Clínica e Serviços Médicos Ltda.
  • Centro de Desenvolvimento em Estudo Clínicos Brasil - CDEC BrasilRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Other

Arm Label

CBT-I plus Melatonin 3 mg

CBT-I plus Melatonin 5 mg

CBT-I plus placebo

Arm Description

It's a tablet manufactured by Aché S.A., composed of melatonin 3mg. Melatonin 3mg tablet will be dispensed to 65 participants (first stage) of this group in a cartridge of 3 blisters with 10 tablets each, totalizing 30 tablets. If this arm is the best set for the second stage, more 56 participants will be randomly allocated in this group.The participant shall administer 01 tablet orally every 24 hours one hour before bedtime. The duration of treatment may be 21(±2) days. CBT-I is a non-pharmacological effective treatment for insomnia disorder. Behavioral techniques of Sleep Hygiene and Stimuli control are the most used. The CBT-I guidelines are standardized in protocol.

It's a tablet manufactured by Aché S.A., composed of melatonin 5mg. Melatonin 5mg tablet will be dispensed to 65 participants (first stage) of this group in a cartridge of 3 blisters with 10 tablets each, totalizing 30 tablets. If this arm is the best set for the second stage, more 56 participants will be randomly allocated in this group.The participant shall administer 01 tablet orally every 24 hours one hour before bedtime. The duration of treatment may be 21(±2) days. CBT-I is a non-pharmacological effective treatment for insomnia disorder. Behavioral techniques of Sleep Hygiene and Stimuli control are the most used. The CBT-I guidelines are standardized in protocol.

It's a tablet manufactured by Aché S.A,. composed of placebo. The participants shall administer the placebo tablets to enable the double-blind study. Placebo will be dispensed to 65 (first stage) and 56 (second stage) participants of this group and shall administer 01 tablet orally every 24 hours one hour before bedtime for 21(±2) days. Sleep hygiene is a psychoeducational intervention that teaches patients to prevent external or environmental factors generate adverse effects and harmful to sleep. The stimulus control technique is based on five instructions that encourages the patient to establish a proper sleep-wake rhythm and strengthens the links between the way for a quick and well consolidated sleep. The CBT-I guidelines are standardized in clinical protocol.

Outcomes

Primary Outcome Measures

Change of Sleep Latency after 21 (±2) days of the treatment.
Absolute change in sleep latency (in minutes) at the end of treatment compared to baseline. Sleep latency will be assessed by polysomnography.

Secondary Outcome Measures

Quality of Sleep - Pittsburgh Sleep Quality Index
Absolute change the overall score PSQI-BR, at the end of treatment from baseline
Wellness Day - Well-Being Index-5 (WHO-5)
Absolute change the overall score of the WHO-5 level, in the range of 0 to 100 points, at the end of treatment from baseline.
Severity of Insomnia - Insomnia Severity Index
Absolute change the overall score of the Insomnia Severity Index at the end of treatment from baseline
Total Sleep Time - Polysomnography
Evaluate the total sleep time by polysomnography at the end of treatment from baseline
Sleep Architecture - the length and proportion of N1(non-rapid eyes movement) stages, N2, N3 and REM
Proportion of participants with sleep architecture classified as normal or abnormal, assessed by polysomnography at the end of treatment from baseline.
Sleep Efficiency - Polysomnography
Sleep efficiency variation assessed by polysomnography at the end of treatment from baseline
The Latency of Persistent Sleep - Polysomnography
Latency of persistent sleep variation assessed by polysomnography at the end of treatment from baseline
Latency of REM (rapid eyes movement) Sleep - Polysomnography
Latency of REM sleep variation assessed by polysomnography at the end of treatment from baseline
Satisfaction of the participants with the treatment.
Proportion of participants in each level of satisfaction category Likert 5 point (1. totally dissatisfied, 2. dissatisfied, 3. neither satisfied nor dissatisfied, 4. satisfied, 5. completely satisfied) evaluated comparing the groups at the end of treatment

Full Information

First Posted
June 9, 2016
Last Updated
September 1, 2020
Sponsor
Ache Laboratorios Farmaceuticos S.A.
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1. Study Identification

Unique Protocol Identification Number
NCT02798367
Brief Title
Melatonin 3mg and 5mg Compared to Cognitive Behavioral Therapy for Insomnia (CBT-I) in the Treatment of Insomnia
Acronym
Morfeu
Official Title
National, Phase II/III, Multicenter, Randomized, Double-blind, Controlled, Parallel,Effect of Melatonin 3mg and 5mg Plus Cognitive Behavioral Therapy for Insomnia (CBT-I) Compared to the CBT-I Alone in the Treatment of Insomnia Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Unknown status
Study Start Date
March 22, 2018 (Actual)
Primary Completion Date
October 31, 2021 (Anticipated)
Study Completion Date
November 30, 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ache Laboratorios Farmaceuticos S.A.

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
National clinical trials, phase II/III, combined in two stages, randomized, double-blind, controlled, parallel, study of superiority, in which three hundred and seven (307) participants of both sexes, aged equal or more than 55 years will be randomly allocated to one of three treatment groups. In the first stage. The group 01 will use Melatonin 3mg plus CBT-I, the group 02 will use Melatonin 5mg plus CBT-I and the group 03 will use CBT-I plus placebo. Based on the results of an interim analysis will be making a decision on whether to proceed with the study and, if so, on which the doses will be selected for the second stage of the study, to be better studied. The final analysis of the treatments, melatonin in the selected dose plus CBT-I versus CBT-I alone and placebo, will include participants from both stages.
Detailed Description
The treatment of insomnia disorder can be accomplished through pharmacological and nonpharmacological approaches. Behavioral techniques of Sleep Hygiene and Stimuli control are the most used. The Sleep hygiene is a psychoeducational intervention that teaches patients to prevent external or environmental factors generate adverse effects and harmful to sleep. The stimulus control technique is based on five instructions that encourages the patient to establish a proper sleep-wake rhythm and strengthens the links between the way for a quick sleep and well established. Melatonin is a hormone that participates in the regulation of the sleep-wake cycle, which is produced and secreted primarily by the pineal gland in the dark period and prepares the individual to sleep. Melatonin is involved in the induction of sleep and has proven therapeutic action in insomnia disorders, and may also play a role in the circadian timing system of mammals and serve as a marker for "biological clock".

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Insomnia Disorder
Keywords
insomnia, cognitive behavioral therapy for insomnia, melatonin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
307 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
CBT-I plus Melatonin 3 mg
Arm Type
Experimental
Arm Description
It's a tablet manufactured by Aché S.A., composed of melatonin 3mg. Melatonin 3mg tablet will be dispensed to 65 participants (first stage) of this group in a cartridge of 3 blisters with 10 tablets each, totalizing 30 tablets. If this arm is the best set for the second stage, more 56 participants will be randomly allocated in this group.The participant shall administer 01 tablet orally every 24 hours one hour before bedtime. The duration of treatment may be 21(±2) days. CBT-I is a non-pharmacological effective treatment for insomnia disorder. Behavioral techniques of Sleep Hygiene and Stimuli control are the most used. The CBT-I guidelines are standardized in protocol.
Arm Title
CBT-I plus Melatonin 5 mg
Arm Type
Experimental
Arm Description
It's a tablet manufactured by Aché S.A., composed of melatonin 5mg. Melatonin 5mg tablet will be dispensed to 65 participants (first stage) of this group in a cartridge of 3 blisters with 10 tablets each, totalizing 30 tablets. If this arm is the best set for the second stage, more 56 participants will be randomly allocated in this group.The participant shall administer 01 tablet orally every 24 hours one hour before bedtime. The duration of treatment may be 21(±2) days. CBT-I is a non-pharmacological effective treatment for insomnia disorder. Behavioral techniques of Sleep Hygiene and Stimuli control are the most used. The CBT-I guidelines are standardized in protocol.
Arm Title
CBT-I plus placebo
Arm Type
Other
Arm Description
It's a tablet manufactured by Aché S.A,. composed of placebo. The participants shall administer the placebo tablets to enable the double-blind study. Placebo will be dispensed to 65 (first stage) and 56 (second stage) participants of this group and shall administer 01 tablet orally every 24 hours one hour before bedtime for 21(±2) days. Sleep hygiene is a psychoeducational intervention that teaches patients to prevent external or environmental factors generate adverse effects and harmful to sleep. The stimulus control technique is based on five instructions that encourages the patient to establish a proper sleep-wake rhythm and strengthens the links between the way for a quick and well consolidated sleep. The CBT-I guidelines are standardized in clinical protocol.
Intervention Type
Behavioral
Intervention Name(s)
CBT-I plus placebo
Intervention Description
Behavioral techniques of Sleep Hygiene and Stimulus Control standardized in clinical protocol plus placebo (01 tablet, orally, always at night one hour before bedtime) for 21(±2) days)
Intervention Type
Drug
Intervention Name(s)
CBT-I plus Melatonin 3 mg
Other Intervention Name(s)
Melatonin
Intervention Description
Behavioral techniques of Sleep Hygiene and Stimulus Control standardized in clinical protocol plus Melatonin 3 mg (01 tablet, orally, always at night one hour before bedtime) for 21(±2) days.
Intervention Type
Drug
Intervention Name(s)
CBT-I plus Melatonin 5 mg
Other Intervention Name(s)
Melatonin
Intervention Description
Behavioral techniques of Sleep Hygiene and Stimulus Control standardized in clinical protocol plus Melatonin 5 mg (01 tablet, orally, always at night one hour before bedtime) for 21(±2) days.
Primary Outcome Measure Information:
Title
Change of Sleep Latency after 21 (±2) days of the treatment.
Description
Absolute change in sleep latency (in minutes) at the end of treatment compared to baseline. Sleep latency will be assessed by polysomnography.
Time Frame
21 (±2) days
Secondary Outcome Measure Information:
Title
Quality of Sleep - Pittsburgh Sleep Quality Index
Description
Absolute change the overall score PSQI-BR, at the end of treatment from baseline
Time Frame
21 (±2) days
Title
Wellness Day - Well-Being Index-5 (WHO-5)
Description
Absolute change the overall score of the WHO-5 level, in the range of 0 to 100 points, at the end of treatment from baseline.
Time Frame
21 (±2) days
Title
Severity of Insomnia - Insomnia Severity Index
Description
Absolute change the overall score of the Insomnia Severity Index at the end of treatment from baseline
Time Frame
21 (±2) days
Title
Total Sleep Time - Polysomnography
Description
Evaluate the total sleep time by polysomnography at the end of treatment from baseline
Time Frame
21 (±2) days
Title
Sleep Architecture - the length and proportion of N1(non-rapid eyes movement) stages, N2, N3 and REM
Description
Proportion of participants with sleep architecture classified as normal or abnormal, assessed by polysomnography at the end of treatment from baseline.
Time Frame
21 (±2) days
Title
Sleep Efficiency - Polysomnography
Description
Sleep efficiency variation assessed by polysomnography at the end of treatment from baseline
Time Frame
21 (±2) days
Title
The Latency of Persistent Sleep - Polysomnography
Description
Latency of persistent sleep variation assessed by polysomnography at the end of treatment from baseline
Time Frame
21 (±2) days
Title
Latency of REM (rapid eyes movement) Sleep - Polysomnography
Description
Latency of REM sleep variation assessed by polysomnography at the end of treatment from baseline
Time Frame
21 (±2) days
Title
Satisfaction of the participants with the treatment.
Description
Proportion of participants in each level of satisfaction category Likert 5 point (1. totally dissatisfied, 2. dissatisfied, 3. neither satisfied nor dissatisfied, 4. satisfied, 5. completely satisfied) evaluated comparing the groups at the end of treatment
Time Frame
21 (±2) days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Fulfill the criteria for insomnia disorder, according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition); Complaint of difficulty falling asleep; Ability to understand and consent their participation in this clinical study, expressed by signing the Informed Consent Form (ICF). Exclusion Criteria: Any finding of clinical/physical observation or laboratory examination to be interpreted by the investigator as a risk to the inclusion of the participant in the clinical study; Known hypersensitivity to drug components used during the study; Participant have any family relationship to the second degree or bond with employees or employees of Sponsor and Sites; Participant has used beta-blockers (in the last 30 days prior to screening visit), psychoactive drugs or sedative effect, such as, but not limited to: sedatives (in the last 14 days prior to screening visit), hypnotics (in the last 07 days prior to screening visit), muscle relaxants (in the last 11 days prior to screening visit), antihistamines first generation (in the last 08 days prior to screening visit), and antidepressants, antiepileptics, antipsychotics, among others (in the last 30 days prior to screening visit); Participants diagnosed with clinical diseases that interfere with sleep, such as chronic pain, nocturia, hypothyroidism, hyperthyroidism, severe heart disease, serious neurological and psychiatric disorders according to the assessment of the investigator; Participants diabetics insulin dependent; Sleep apnea moderate to severe - AHI > 20 (Apnoea-Hypopnoea Index) assessed by polysomnography at the baseline; Participants who work at night; Participant who has BMI ≥ 30; Participant score above 50 in Anxiety Inventory to assess the degree of anxiety; Participant with cognitive impairment, based on the result obtained in the Mini-Mental State Examination. The cognitive impairment will be considered with score below 13 points for illiterates, below 18 for participants with one to eight incomplete years of schooling, below 26 for those with education of eight or more years; Participant score above 20 on the Beck Inventory to assess depression; Abuse of alcohol or illicit drugs, according to the assessment of the investigator; Male participants who do not agree to use acceptable methods of contraception; 1) male participants: barrier methods, except surgically sterile (vasectomy) or participants who declare to perform sexual practices on a not to reproductive way. 2) methods of contraception for the male participant's partner: oral contraceptives, injectable contraceptives, intrauterine device (IUD), hormonal implants, hormonal patch, tubal ligation and barrier methods; except surgically sterile (bilateral oophorectomy or hysterectomy) or the menopausal for at least one year; Female participants who are in the reproductive age and do not agree to use acceptable methods of contraception (oral contraceptives, injectable contraceptives, intrauterine device (IUD), hormonal implants, barrier methods, hormonal patch and tubal ligation); except surgically sterile (bilateral oophorectomy or hysterectomy), the menopausal for at least one year and participants who declare to perform sexual practices on a not to reproductive way; Women in gestation period or who are breastfeeding; Participant who has participated in clinical trial protocols in the last twelve (12) months (CNS Resolution 251 of August 7, 1997, Part III, sub-item J), unless the investigator considers that there may be a direct benefit to the same.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Elisangela Rorato
Phone
+55 11 2608-6130
Email
elisangela.rorato@ache.com.br
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mauro Crippa Jr.
Organizational Affiliation
Allergisa Search Dermato Cosmetic Ltda.
Official's Role
Principal Investigator
Facility Information:
Facility Name
CEDOES - Centro de Diagnóstico e Pesquisa da Osteoporose do Espirito Santo.
City
Vitória
State/Province
Espírito Santo
ZIP/Postal Code
29055-450
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Karina Oliveira
Facility Name
Hospital de Clínicas de Porto Alegre
City
Porto Alegre
State/Province
Rio Grande Do Sul
ZIP/Postal Code
90035-903
Country
Brazil
Individual Site Status
Terminated
Facility Name
Allergisa Pesquisa Dermato Cosmética Ltda.
City
Campinas
State/Province
São Paulo
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mauro Crippa Jr.
Phone
+55 19 3789-8615
Facility Name
Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto USP
City
Ribeirão Preto
State/Province
São Paulo
ZIP/Postal Code
14048-900
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alan Eckeli
Facility Name
Centro de Estudos Multidisciplinar CEPES da Faculdade de Medicina do ABC
City
Santo André
State/Province
São Paulo
Country
Brazil
Individual Site Status
Terminated
Facility Name
Dr Consulta Clinica Medica Ltda
City
São Paulo
ZIP/Postal Code
01141-020
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tatiana Hirakawa
Facility Name
Centro Paulista de Investigação Clínica e Serviços Médicos Ltda.
City
São Paulo
ZIP/Postal Code
04266-010
Country
Brazil
Individual Site Status
Terminated
Facility Name
Centro de Desenvolvimento em Estudo Clínicos Brasil - CDEC Brasil
City
São Paulo
Country
Brazil
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dalva Poyares
Phone
+55 11 5579 0373

12. IPD Sharing Statement

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Melatonin 3mg and 5mg Compared to Cognitive Behavioral Therapy for Insomnia (CBT-I) in the Treatment of Insomnia

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