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Study of Nighttime Dosing of Sublingual Tizanidine (12 mg) in Multiple Sclerosis (MS) Patients With Significant Spasticity

Primary Purpose

Muscle Spasticity

Status
Completed
Phase
Phase 1
Locations
Israel
Study Type
Interventional
Intervention
Tizanidine (sublingual or oral)
Sponsored by
Teva GTC
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Muscle Spasticity focused on measuring Multiple Sclerosis, Spasticity, Sublingual Tizanidine, Ashworth Scores, Spasticity in Multiple Sclerosis Patients

Eligibility Criteria

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

Inclusion Criteria: Male and female patients between the ages of 20-65 Definitive diagnosis of MS, with Expanded Disability Status Scale (EDSS) less than 6.5 at screening Has significant spasticity (total Ashworth => 6) at screening Can maintain sleep regimens of at least 5 hours nightly for study duration May be allowed to take other anti-spasticity medication during study (including oral baclofen) as per individual dosing regimen, with the following qualifications: No dose after 6pm on any study day No dose at all on a clinic evaluation day (Visits 3, 4, 5) Females must agree to use a medically accepted form of birth control, be surgically sterile, or be two years post-menopausal. Oral contraception is contraindicated with tizanidine use. Exclusion Criteria: Acute MS exacerbation requiring treatment with steroids within 30 days of screening Initiation of discontinuation of interferon beta within 30 days of screening Use of baclofen pump Use of CYP1A2 inhibitors during study Taking medications that would potentially interfere with the actions of the study medication or outcome variables, including: sedatives, stimulants, anti-hypertensives, tricyclic antidepressants, etc. Previous diagnosis of a sleep disorder, distinct from MS, such as obstructive sleep apnea or narcolepsy Score >18 on Beck Depression Inventory at screening Changes in chronic oral medications within 2 weeks of baseline and during study Significant abnormalities in screening lab parameters (ex: ALT, AST, bilirubin > 2 x upper limit of normal [ULN]; creatinine > 2 mg/dl; white blood cell [WBC] < 2,300; platelets < 80,000). Previous history of dementia, unstable psychiatric disease, or current signs and symptoms of significant medical disorders such as severe, progressive, or uncontrolled renal, hepatic, hematological, endocrine, pulmonary, cardiac, neurological, or cerebral disease History of allergy to tizanidine or any inactive component (including lactose intolerance) of test or reference formulation History of substance abuse within the past 12 months Within 30 days of baseline, worked a rotating or nighttime shift Participation in another clinical trial within 30 days of baseline Patients who are uncooperative or unwilling to sign consent form

Sites / Locations

  • Tel Aviv Sourasky Medical Center- Neurology Department

Outcomes

Primary Outcome Measures

Clinical efficacy - improvement in next-day spasticity (Ashworth scores)
Safety - no increase in next-day somnolence (measured objectively using PVT psychomotor vigilance task monitoring) and subjectively, using Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS) questionnaires

Secondary Outcome Measures

Secondary clinical efficacy - objective measure of sleep (actigraphy measures)

Full Information

First Posted
July 27, 2006
Last Updated
January 20, 2009
Sponsor
Teva GTC
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1. Study Identification

Unique Protocol Identification Number
NCT00358293
Brief Title
Study of Nighttime Dosing of Sublingual Tizanidine (12 mg) in Multiple Sclerosis (MS) Patients With Significant Spasticity
Official Title
A Double-Blind, Randomized, Crossover Study to Evaluate the Clinical Efficacy and Safety of Oral Tizanidine HCl (12 mg) Versus Novel Sublingual Tizanidine HCl (12 mg) for the Treatment of Spasticity in MS Patients
Study Type
Interventional

2. Study Status

Record Verification Date
April 2007
Overall Recruitment Status
Completed
Study Start Date
December 2006 (undefined)
Primary Completion Date
undefined (undefined)
Study Completion Date
February 2007 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Teva GTC

4. Oversight

5. Study Description

Brief Summary
Nightly administration of 8 mg of a unique sublingual (under the tongue) formulation of tizanidine, a known anti-spasticity medication, has been shown in a previous study to improve next-day spasticity, about 12 hours following dosing in 20 multiple sclerosis (MS) patients. This improvement was statistically significant when compared to oral tizanidine dosing. The current study is being undertaken to see if increasing the dose to 12 mg once nightly will result in an even greater improvement, with a longer effect, i.e., next day improvement in spasticity both in the morning as well as in the late afternoon.
Detailed Description
Sublingual tizanidine, a novel test formulation of the known effective antispasticity agent, has been shown to have a unique pharmacokinetic profile [(i.e., nearly twice the bioavailability/AUC), but with little or no increase in peak plasma levels (Cmax) as compared to oral tizanidine (Zanaflex)]. When administered nightly to 20 MS patients, at a dose of 8 mg, it was shown to improve next-day spasticity (statistically significant improvement in Ashworth scores) about 12 hours post-dosing), improvement in nighttime (first quartile) sleep efficiency (as demonstrated by actigraphic measurement), and no increase in daytime somnolence. Current study is being undertaken to evaluate if increased dosing (12 mg once nightly) of sublingual tizanidine (vs. oral) will show a concomitant increase in clinical effect, i.e., longer improvement, with next-day spasticity score improvement both in AM (as previously) as well as at PM (late afternoon) evaluation, with no increase in daytime somnolence.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Muscle Spasticity
Keywords
Multiple Sclerosis, Spasticity, Sublingual Tizanidine, Ashworth Scores, Spasticity in Multiple Sclerosis Patients

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Crossover Assignment
Masking
Double
Allocation
Randomized
Enrollment
20 (false)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Tizanidine (sublingual or oral)
Primary Outcome Measure Information:
Title
Clinical efficacy - improvement in next-day spasticity (Ashworth scores)
Title
Safety - no increase in next-day somnolence (measured objectively using PVT psychomotor vigilance task monitoring) and subjectively, using Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS) questionnaires
Secondary Outcome Measure Information:
Title
Secondary clinical efficacy - objective measure of sleep (actigraphy measures)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patients between the ages of 20-65 Definitive diagnosis of MS, with Expanded Disability Status Scale (EDSS) less than 6.5 at screening Has significant spasticity (total Ashworth => 6) at screening Can maintain sleep regimens of at least 5 hours nightly for study duration May be allowed to take other anti-spasticity medication during study (including oral baclofen) as per individual dosing regimen, with the following qualifications: No dose after 6pm on any study day No dose at all on a clinic evaluation day (Visits 3, 4, 5) Females must agree to use a medically accepted form of birth control, be surgically sterile, or be two years post-menopausal. Oral contraception is contraindicated with tizanidine use. Exclusion Criteria: Acute MS exacerbation requiring treatment with steroids within 30 days of screening Initiation of discontinuation of interferon beta within 30 days of screening Use of baclofen pump Use of CYP1A2 inhibitors during study Taking medications that would potentially interfere with the actions of the study medication or outcome variables, including: sedatives, stimulants, anti-hypertensives, tricyclic antidepressants, etc. Previous diagnosis of a sleep disorder, distinct from MS, such as obstructive sleep apnea or narcolepsy Score >18 on Beck Depression Inventory at screening Changes in chronic oral medications within 2 weeks of baseline and during study Significant abnormalities in screening lab parameters (ex: ALT, AST, bilirubin > 2 x upper limit of normal [ULN]; creatinine > 2 mg/dl; white blood cell [WBC] < 2,300; platelets < 80,000). Previous history of dementia, unstable psychiatric disease, or current signs and symptoms of significant medical disorders such as severe, progressive, or uncontrolled renal, hepatic, hematological, endocrine, pulmonary, cardiac, neurological, or cerebral disease History of allergy to tizanidine or any inactive component (including lactose intolerance) of test or reference formulation History of substance abuse within the past 12 months Within 30 days of baseline, worked a rotating or nighttime shift Participation in another clinical trial within 30 days of baseline Patients who are uncooperative or unwilling to sign consent form
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arnon Karni, MD
Organizational Affiliation
Department of Neurology, Tel Aviv Sourasky Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tel Aviv Sourasky Medical Center- Neurology Department
City
Tel Aviv
Country
Israel

12. IPD Sharing Statement

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Study of Nighttime Dosing of Sublingual Tizanidine (12 mg) in Multiple Sclerosis (MS) Patients With Significant Spasticity

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