Pharmacological Treatment of Insomnia in Palliative Care

Insomnia Clinical Trial

Official title:

Pharmacological Treatment of Insomnia in Palliative Care: A Randomized, Double-blind, Placebo Controlled, Parallel-group, Multicenter Trial Investigating the Short Time Effect of Zopiclone on Self-reported Sleep Quality in Patients With Advanced Cancer Who Use Opioids and Who Report Insomnia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02807922
• Other study ID #: SleepRCT_270215
• Secondary ID: 2015-005306-11
• Status: Completed
• Phase: Phase 4
• Start date: November 15, 2016
• Est. completion date: July 13, 2021

Study information

• Verified date: July 2021
• Source: St. Olavs Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Sleep disturbance is frequent in patients with advanced cancer and decreases the tolerability of other symptoms and impairs quality of life. A detailed description of sleep disturbance and its association with other symptoms, and intervention studies on sleep medications are scarce in patients with advanced cancer. A well-designed randomized controlled trial is needed to determine the short time effectiveness of zopiclone on sleep quality, one of the currently available therapies of insomnia, and further to contribute to the clinical management of insomnia in patients with advanced cancer.

Description:

The clinical trial is a randomized, double-blind, placebo controlled, parallel-group, multicenter trial investigating the short time effectiveness of zopiclone on self-reported sleep quality in patients with advanced cancer who use opioids and who report insomnia. Patients with advanced cancer who use opioids and who report insomnia are randomized to either a hypnotic, zopiclone (Arm A) or placebo (Arm B) for six nights. For this study zopiclone Actavis 3.75 mg, 5 mg and 7.5 mg (active comparator) and placebo are defined as Investigational Medicinal Products. The initial dose is zopiclone/placebo 3.75 mg/day. Evaluation of sleep quality is performed in the morning after night 2 and 4 with evaluation of sleep quality by using a numerical rating scale 0-10 with the question "Please circle the number that best describes how you feel now" 0= Best sleep, 10= Worst possible sleep.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 43
• Est. completion date: July 13, 2021
• Est. primary completion date: July 13, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Histologically verified malignant disease

2. Presence of metastatic / disseminated disease

3. Presence of insomnia syndrome defined as:

1. Self-reported difficulty with initiating sleep (greater than 30 minutes to sleep onset) and/or difficulty maintaining sleep (greater than 30 minutes nocturnal waking time); and

2. Sleep difficulty at least 3 nights per week; and

3. Sleep difficulty that causes significant impairment of daytime functioning (The patient will be asked if sleep difficulty result in altered daytime function i.e. feeling tired, lack of energy)

4. Able to comply with all study procedures

5. Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to ICH GCP, and national/local regulations.

Exclusion Criteria:

1. On-going treatment or previous treatment (within last 4 weeks) for more than consecutive 3 days with medications given for insomnia

2. Adverse reactions to zopiclone

3. History of substance abuse

4. Concomitant use of rifampicin and erythromycin

5. Any other contraindication listed on the summary of product characteristics of the investigated medicinal product:

1. Myasthenia gravis

2. An established diagnosis of Severe impairment of respiratory function

3. An established diagnosis of Severe hepatic insufficiency.(Child-Pugh grade B or C)

4. An established diagnosis of sleep apnea

5. Known hypersensitivity to the drug or to any component in its formulation:

Lactose monohydrate, Calcium hydrogen phosphate, Maize starch, Croscarmellose sodium, Magnesium stearate, Titanium dioxide (E 171), Hypromellose, Iron oxide yellow/Iron oxide red (E 172) and Macrogol

6. Unfit for participation for any reason as judged by the investigator

7. Pregnancy or lactation

8. Women of reproductive age not willing or unable to employ an effective method of contraception (sterilization, using IUD or oral contraception)

9. Scheduled surgery within the next week

10. In the need of change in scheduled opioid dose at baseline (study visit 1)

11. Scheduled intravenous administration of chemotherapy during the study period (from baseline to day 8) or intravenous administration of chemotherapy during the last week

12. Change in corticosteroid dose last week before baseline or planned dose change in corticosteroid dose within 7 days from baseline

Related Conditions & MeSH terms

• Insomnia
• Sleep
• Sleep Initiation and Maintenance Disorders

Intervention

Drug:
• Zopiclone

• Placebo

Locations

Country	Name	City	State
Norway	Sunniva senter for lindrende behandling, Haraldsplass Diakonale sykehus	Bergen
Norway	sykehuset Levanger	Levanger
Norway	Helse Sør-Øst RHF, Sykehuset i Telemark,	Skien
Norway	Helse Sør-Øst RHF, Sykehuset i Vestfold,	Tønsberg
Norway	St. Olavs Hospital	Trondheim

Sponsors (2)

Lead Sponsor	Collaborator
St. Olavs Hospital	Norwegian University of Science and Technology

Country where clinical trial is conducted

Norway, 

References & Publications (1)

Jakobsen G, Engstrøm M, Paulsen Ø, Sjue K, Raj SX, Thronæs M, Hjermstad MJ, Kaasa S, Fayers P, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer: study protocol for a double-blind, randomized, placebo-controlled, clinical multicenter trial. Trials. 2018 Dec 27;19(1):707. doi: 10.1186/s13063-018-3088-3. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Patient-reported sleep quality	Primary endpoint is patient-reported sleep quality during the final study night (night six) assessed on a numerical rating scale (NRS) 0-10. 0= Best sleep, 10=Worst possible sleep.	Night six (last study night)
Secondary	Patient reported total sleep time		Night six (last study night)
Secondary	Patient reported sleep onset latency	Sleep onset latency (how long (minutes) it takes to fall asleep	Night six (last study night)