Switching From Oral Dopamine Agonists to Rotigotine

Restless Legs Syndrome Clinical Trial

— SWITCH  

Official title:

A Method to Switch From Oral Dopamine Agonists to Rotigotine in Patients With Restless Legs Syndrome

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01976871
• Other study ID #: MGH - 2013P000968
• Status: Active, not recruiting
• Phase: Phase 4
• First received: October 25, 2013
• Last updated: April 15, 2015
• Start date: August 2014

Study information

• Verified date: April 2015
• Source: Massachusetts General Hospital
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review BoardUnited States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

The primary objective is to demonstrate safety and tolerability of switching patients with Restless Legs Syndrome (RLS) from an oral dopamine agonist to rotigotine.

As a secondary objective, the investigators will evaluate control of RLS symptoms on rotigotine compared to the prior oral regimen.

Description:

The study will consist of 3 in-person visits and 4 scheduled telephone appointments over the course of approximately 6 weeks. The first visit will be the screening visit during which eligibility will be confirmed and informed consent obtained. After the first visit, subjects will continue their current oral dopamine agonist for a one-week baseline period during which they will record RLS symptoms daily.

The second visit will be the baseline visit. The IRLS scale, a commonly used measure of RLS symptoms, will be obtained. An individualized schedule for down-titration of oral dopamine agonist and concomitant up-titration of rotigotine will be provided. After the second visit, subjects will begin this cross-titration. This will entail a pre-determined incremental taper of the oral medication and flexible up-titration of rotigotine according to symptoms. During this time, subjects will keep diaries of RLS symptoms and will speak with the investigator over the phone a total of 3 times (visits 2a-2c) to discuss dosing of rotigotine.

After the titration is complete, subjects will enter the maintenance period, which will last 28 days. There will be another phone contact (2d) one week after the titration is complete to adjust the dose of rotigotine as needed. The subject will then continue the chosen dose for the next 3 weeks of the maintenance period. There will be one final phone contact (2e) 1 week prior to the end of the maintenance period to remind subjects to resume RLS symptom diaries during the final week of the maintenance period.

The third and final visit will take place at the end of the maintenance period. RLS symptoms will be discussed and the IRLS scale, Clinician Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), and Preference of Medication Scale (POMS) will be administered.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 20
• Est. primary completion date: December 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• A diagnosis of RLS, defined by International Restless Legs Study Group (IRLS) essential criteria:

1. An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.

2. The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying down or sitting.

3. The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.

4. The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night.

(Although some subjects may not meet these criteria on their current oral regimen, these symptoms must have been present prior to treatment.)

• Current treatment with either pramipexole (=1 mg total daily dose) or ropinirole (=4 mg total daily dose) with unchanged dose for the past 30 days. Patients also on other RLS medications will be allowed to participate if the dosing has been stable for the past 30 days and the subject agrees to maintain a stable dose for the duration of the trial.

• Inadequate symptom control or patient dissatisfaction with current oral regimen.

• Able to speak and read English.

• Able to provide informed consent.

• Able to learn and demonstrate appropriate patch application.

• Returns appropriately completed RLS symptom log at Visit 2.

• Confirms understanding of cross-titration schedule and is able to restate or summarize these instructions at Visit 2.

• Age =18 and =75.

• BMI =18 and =35

• History and/or clinical records document no change in medications active in the central nervous system (antidepressants, analgesics, antipsychotics, antiepileptics, hypnotics, etc.) for at least 30 days prior to visit 1.

• Able to understand study procedures and agrees to remain on stable medications during the period of the study.

• Women of childbearing potential must agree to use a medically accepted method of birth control. Acceptable forms of birth control include:

1. Condom + spermicide

• b. Diaphragm + spermicide

• c. Oral contraceptive pills, hormone implants (like Norplant),or injections (like Depo-Provera)

• Intrauterine Device

Exclusion Criteria:

• Known secondary cause of RLS, including end-stage renal disease, severe iron deficiency (ferritin <18), pregnancy.

• History of frequent symptomatic orthostatic hypotension.

• Current treatment with a dopamine antagonist medication.

• Another chronic pain syndrome that would, in the opinion of the investigator, interfere with evaluation of RLS symptoms or the response to the study medication.

• Plan to undergo a procedure that may require short or long-term opiates for pain control during the course of the trial.

• Women who are pregnant, lactating, or planning to become pregnant.

• Shift work or other commitments that do not allow for regular sleep at night.

• Known hypersensitivity or intolerance to rotigotine.

• Known allergy to sulfite-containing drugs.

• History of problematic skin hypersensitivity to adhesives.

• Previous or current clinically significant impulse control disorder, as determined by clinical interview.

• Anticipated change in psychiatric or neurologic status likely to require adjustment of CNS-active medications during the study period.

• Unwillingness of subject to remain on stable doses of CNS-active medications.

• Unwillingness of subject to refrain from as-needed use of RLS medications.

• Significant risk for suicide by clinical interview.

• History of severe mental illness or psychosis

• Current unstable medical illness.

• Any medical or psychiatric condition that, in the opinion of the investigator, would interfere with participation in the study.

Study Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Ekbom Syndrome
• Psychomotor Agitation
• Restless Legs Syndrome
• Syndrome
• Willis-Ekbom Disease

Intervention

Drug:
• Rotigotine
Rotigotine is FDA approved for the treatment of Restless Legs Syndrome at doses of 1 mg/24h, 2 mg/24h, and 3 mg/24h. The prescribed dose of rotigotine may be achieved using single or multiple patches. Subjects will titrate the dose based on discussions with the investigator.

Locations

Country	Name	City	State
United States	Massachusetts General Hospital	Boston	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
John Winkelman, MD, PhD

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Proportion of patients completing the switch and their adverse events	The primary endpoint will be the tolerability of switching from an oral dopamine agonist to rotigotine.	Participants will be monitored for the duration of the study, approximately 6-10 weeks depending upon scheduling of visits	Yes
Secondary	International Restless Legs Scale (IRLS)	The IRLS will be used to determine the overall efficacy of RLS symptom control on rotigotine	Study Visit 3 (approximately 28 days after the last dose of oral dopamine agonist)	No
Secondary	RLS-6 Scales	The RLS-6 scales will be used to determine the overall efficacy of RLS symptom control on rotigotine, calculated as a mean score for each scale during the final treatment week vs baseline.	Average of Baseline week (approximately days 1-7 of the study) vs. Average of Final Treatment week (approximately days 21-28 of the maintenance period)	No
Secondary	Preference of Medication Scale (POM)	The POM will be used to assess patient satisfaction with treatment	Study visit 3 (approximately 28 days after the last dose of oral dopamine agonist)	No
Secondary	The Patient Global Impression of Change scale	The Patient Global Impression of Change scale (PGIC) will be used to assess patient satisfaction with treatment.	Study visit 3 (approximately 28 days after the last dose of oral dopamine agonist)	No
Secondary	The Clinician Global Impression of Change Scale	The Clinician Global Impression of Change scale (CGIC) will be used to assess patient satisfaction with treatment.	Study visit 3 (approximately 28 days after the last dose of oral dopamine agonist)	No