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Phase 3, 28-week, Randomized, Double-blind, Placebo-controlled Safety and Efficacy Study of Nabiximols as an add-on Therapy in Subjects With Spasticity Due to Multiple Sclerosis.

Primary Purpose

Spasticity, Multiple Sclerosis

Status
Withdrawn
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Sativex
Placebo
Sponsored by
Jazz Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Spasticity focused on measuring Spasticity, Multiple Sclerosis

Eligibility Criteria

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

Inclusion Criteria:

  • Willing and able to give written informed consent.
  • The subject is at least 18 years of age or older.
  • Diagnosed with any disease sub-type of multiple sclerosis of at least six months duration.
  • Spasticity due to multiple sclerosis of at least six months duration, which is not wholly relieved with current anti-spasticity therapy, and which is expected to remain stable for the duration of the study.
  • Subject must be receiving at least one of the following anti-spasticity therapies to be eligible: Baclofen, Tizanidine, Clonazepam, Diazepam, Dantrolene.
  • Subject is willing to maintain anti-spasticity medication at a stable dose for the duration of the study and should be stable for 30 days prior to screening.
  • If the subject is currently taking disease-modifying medication, this must be at a stable dose for at least three months prior to the screening visit; the dose must also remain stable for the duration of the study.

Exclusion Criteria:

  • Has previously used Nabiximols or Sativex.
  • The subject is currently using or has used cannabis or cannabinoid based medications within 30 days of study entry and is unwilling to abstain for the duration of the study.
  • Any history or immediate family history of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition.
  • In the opinion of the Investigator, any known or suspected history of a substance abuse disorder (including opiate abuse), current heavy alcohol consumption (more than 60g of pure alcohol per day for men, and more than 40g of pure alcohol per day for women), current use of an illicit drug or current non prescribed use of any prescription drug that should exclude the subject from participation.
  • Has poorly controlled epilepsy or recurrent seizures (i.e. one or more seizure during the last year).
  • Any known or suspected hypersensitivity to cannabinoids or any of the excipients of the study medication.
  • Has experienced myocardial infarction or clinically significant cardiac dysfunction within the last 12 months or has a cardiac disorder that, in the opinion of the investigator would put the subject at risk of a clinically significant arrhythmia or myocardial infarction.
  • Has significantly impaired renal function as evidenced by a creatinine clearance lower than 50mL/min at Visit 1.
  • Has significantly impaired hepatic function at Visit 1 (Alanine Aminotransferase >5 times upper limit of normal (ULN) or bilirubin (TBL) > 2 times ULN). If the Alanine Aminotransferase or Aspartate Aminotransferase >3 times ULN and the TBL >2 times ULN (or International Normalized Ratio >1.5), this subject should not enter the study.
  • Female subject of child-bearing potential and male subject whose partner is of child-bearing potential, unless willing to ensure that they or their partner use effective contraception or complete abstinence, for example, oral contraception, double barrier or intra-uterine device, during the study and for three months thereafter (however, a male condom should not be used in conjunction with a female condom as this may not prove effective).
  • Female subject who is pregnant, lactating or planning pregnancy during the course of the study and for three months thereafter.
  • Subjects who have received a non-approved investigational medicinal product within 30 days of Visit 1.
  • Any other significant disease or disorder which, in the opinion of the investigator or sponsor, may either put the subject at risk because of participation in the study, or may influence the result of the study, or the subject's ability to participate in the study.
  • Travel outside the country of residence planned during the study.
  • Subjects previously enrolled into this study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Sativex

    Placebo

    Arm Description

    Contains delta -9 tetrahydrocannabinol (THC), 27 mg/mL:cannabidiol (CBD), 25 mg/mL, in ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring. Subjects received study medication delivered in 100 microlitre actuations by a pump action oromucosal spray. Maximum permitted dose is 10 actuations per day. Each actuation delivers THC 2.7 mg and CBD 2.5 mg.

    Oromucosal spray, containing no active drug but ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring and colorants. Maximum permitted dose is 10 actuations per day.

    Outcomes

    Primary Outcome Measures

    Physician Global Impression of Change (PGIC) questionnaire
    Change in mean Modified Ashworth Scale score from baseline to the end of treatment period.
    All 20 muscle groups were assessed for spasticity (using a 0-4 scale): 0= no increase in muscle tone to 4=considerable increase in muscle tone, passive movement is difficult. The score for all 20 muscle groups were added to give a total score out of 80. A decrease in score indicates an improvement in condition.

    Secondary Outcome Measures

    Change in mean sleep disruption (0-10 NRS) score from baseline to the end of treatment (Part B)
    Change in mean spasm frequency (number of spasms per day) from baseline to the end of treatment (Part B).
    Subject global impression of change (SGIC) questionnaire
    At Visit 2 (i.e. prior to commencing any treatment) subjects were asked to write a brief description of their spasticity caused by multiple sclerosis and how it affected them emotionally, physically and their ability to function with day to day activities. If subjects were unable to write due to disability then the investigator staff could assist as necessary. Prior to answering the Subject global impression of change, subjects were given the description of their spasticity to aid their memory regarding their symptoms at the start of the study. They were then be asked to complete the global impression of change by answering the following question to be rated on a seven-point scale, "Please assess the change in your spasticity due to multiple sclerosis since immediately before receiving the first course of study treatment (Visit 2) using the scale below" with this anchors: Very much worse, Much worse, Minimally worse, No change, Minimally better, Much better, Very much better.
    Carer Global Impression of Change Questionnaire

    Full Information

    First Posted
    May 30, 2013
    Last Updated
    August 10, 2016
    Sponsor
    Jazz Pharmaceuticals
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01868048
    Brief Title
    Phase 3, 28-week, Randomized, Double-blind, Placebo-controlled Safety and Efficacy Study of Nabiximols as an add-on Therapy in Subjects With Spasticity Due to Multiple Sclerosis.
    Official Title
    A Phase 3 Dose Response Study to Assess the Safety and Efficacy of Nabiximols Oromucosal Spray (Sativex) in the Symptomatic Relief of Spasticity in Subjects With Spasticity Due to Multiple Sclerosis.
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    August 2016
    Overall Recruitment Status
    Withdrawn
    Study Start Date
    undefined (undefined)
    Primary Completion Date
    June 2017 (Anticipated)
    Study Completion Date
    undefined (undefined)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Jazz Pharmaceuticals

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study is to determine the effective dose range and to demonstrate a non-effective dose range of Sativex compared with placebo in relieving symptoms of spasticity due to multiple sclerosis.

    6. Conditions and Keywords

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

    7. Study Design

    Primary Purpose
    Supportive Care
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Sativex
    Arm Type
    Experimental
    Arm Description
    Contains delta -9 tetrahydrocannabinol (THC), 27 mg/mL:cannabidiol (CBD), 25 mg/mL, in ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring. Subjects received study medication delivered in 100 microlitre actuations by a pump action oromucosal spray. Maximum permitted dose is 10 actuations per day. Each actuation delivers THC 2.7 mg and CBD 2.5 mg.
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Oromucosal spray, containing no active drug but ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring and colorants. Maximum permitted dose is 10 actuations per day.
    Intervention Type
    Drug
    Intervention Name(s)
    Sativex
    Other Intervention Name(s)
    GW-1000-02, Nabiximols, THC/CBD spray
    Intervention Description
    Contains delta -9 tetrahydrocannabinol (THC), 27 mg/mL:cannabidiol (CBD), 25 mg/mL, in ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring. Subjects receive study medication delivered in 100 microlitre actuations by a pump action oromucosal spray. Maximum permitted dose is 10 actuations per day. Each actuation delivers THC 2.7 mg and CBD 2.5 mg.
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Other Intervention Name(s)
    GA0034
    Intervention Description
    Oromucosal spray, containing no active drug but ethanol:propylene glycol (50:50) excipients, with peppermint oil (0.05%) flavoring and colorants. Maximum permitted dose is 10 actuations per day.
    Primary Outcome Measure Information:
    Title
    Physician Global Impression of Change (PGIC) questionnaire
    Time Frame
    This is completed by the physician at each visit whilst using the study medication.
    Title
    Change in mean Modified Ashworth Scale score from baseline to the end of treatment period.
    Description
    All 20 muscle groups were assessed for spasticity (using a 0-4 scale): 0= no increase in muscle tone to 4=considerable increase in muscle tone, passive movement is difficult. The score for all 20 muscle groups were added to give a total score out of 80. A decrease in score indicates an improvement in condition.
    Time Frame
    The Modified Ashworth Scale will be performed at each visit of the study
    Secondary Outcome Measure Information:
    Title
    Change in mean sleep disruption (0-10 NRS) score from baseline to the end of treatment (Part B)
    Time Frame
    Recorded using IVRS daily diary every day
    Title
    Change in mean spasm frequency (number of spasms per day) from baseline to the end of treatment (Part B).
    Time Frame
    Recorded using the IVRS daily day every day
    Title
    Subject global impression of change (SGIC) questionnaire
    Description
    At Visit 2 (i.e. prior to commencing any treatment) subjects were asked to write a brief description of their spasticity caused by multiple sclerosis and how it affected them emotionally, physically and their ability to function with day to day activities. If subjects were unable to write due to disability then the investigator staff could assist as necessary. Prior to answering the Subject global impression of change, subjects were given the description of their spasticity to aid their memory regarding their symptoms at the start of the study. They were then be asked to complete the global impression of change by answering the following question to be rated on a seven-point scale, "Please assess the change in your spasticity due to multiple sclerosis since immediately before receiving the first course of study treatment (Visit 2) using the scale below" with this anchors: Very much worse, Much worse, Minimally worse, No change, Minimally better, Much better, Very much better.
    Time Frame
    To be completed by the patient at every visit during treatment
    Title
    Carer Global Impression of Change Questionnaire
    Time Frame
    To be completed by the carer at every visit during the treatment period.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Willing and able to give written informed consent. The subject is at least 18 years of age or older. Diagnosed with any disease sub-type of multiple sclerosis of at least six months duration. Spasticity due to multiple sclerosis of at least six months duration, which is not wholly relieved with current anti-spasticity therapy, and which is expected to remain stable for the duration of the study. Subject must be receiving at least one of the following anti-spasticity therapies to be eligible: Baclofen, Tizanidine, Clonazepam, Diazepam, Dantrolene. Subject is willing to maintain anti-spasticity medication at a stable dose for the duration of the study and should be stable for 30 days prior to screening. If the subject is currently taking disease-modifying medication, this must be at a stable dose for at least three months prior to the screening visit; the dose must also remain stable for the duration of the study. Exclusion Criteria: Has previously used Nabiximols or Sativex. The subject is currently using or has used cannabis or cannabinoid based medications within 30 days of study entry and is unwilling to abstain for the duration of the study. Any history or immediate family history of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition. In the opinion of the Investigator, any known or suspected history of a substance abuse disorder (including opiate abuse), current heavy alcohol consumption (more than 60g of pure alcohol per day for men, and more than 40g of pure alcohol per day for women), current use of an illicit drug or current non prescribed use of any prescription drug that should exclude the subject from participation. Has poorly controlled epilepsy or recurrent seizures (i.e. one or more seizure during the last year). Any known or suspected hypersensitivity to cannabinoids or any of the excipients of the study medication. Has experienced myocardial infarction or clinically significant cardiac dysfunction within the last 12 months or has a cardiac disorder that, in the opinion of the investigator would put the subject at risk of a clinically significant arrhythmia or myocardial infarction. Has significantly impaired renal function as evidenced by a creatinine clearance lower than 50mL/min at Visit 1. Has significantly impaired hepatic function at Visit 1 (Alanine Aminotransferase >5 times upper limit of normal (ULN) or bilirubin (TBL) > 2 times ULN). If the Alanine Aminotransferase or Aspartate Aminotransferase >3 times ULN and the TBL >2 times ULN (or International Normalized Ratio >1.5), this subject should not enter the study. Female subject of child-bearing potential and male subject whose partner is of child-bearing potential, unless willing to ensure that they or their partner use effective contraception or complete abstinence, for example, oral contraception, double barrier or intra-uterine device, during the study and for three months thereafter (however, a male condom should not be used in conjunction with a female condom as this may not prove effective). Female subject who is pregnant, lactating or planning pregnancy during the course of the study and for three months thereafter. Subjects who have received a non-approved investigational medicinal product within 30 days of Visit 1. Any other significant disease or disorder which, in the opinion of the investigator or sponsor, may either put the subject at risk because of participation in the study, or may influence the result of the study, or the subject's ability to participate in the study. Travel outside the country of residence planned during the study. Subjects previously enrolled into this study.

    12. IPD Sharing Statement

    Learn more about this trial

    Phase 3, 28-week, Randomized, Double-blind, Placebo-controlled Safety and Efficacy Study of Nabiximols as an add-on Therapy in Subjects With Spasticity Due to Multiple Sclerosis.

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