Leg Spasticity Clinical Trial
Official title:
A Phase III, Multicentre, Double-blind, Prospective, Randomized, Placebo-controlled Study, Assessing the Efficacy and Safety of Dysport® Used for the Treatment of Lower-limb Spasticity in Adult Subjects With Hemiparesis Due to Stroke or Traumatic Brain Injury
| Verified date | September 2022 |
| Source | Ipsen |
| Contact | n/a |
| Is FDA regulated | No |
| Health authority | |
| Study type | Interventional |
The purpose of this research study is to assess the efficacy of Dysport® compared to placebo in improving muscle tone in hemiparetic subjects with lower limb spasticity due to stroke or traumatic brain injury.
| Status | Completed |
| Enrollment | 388 |
| Est. completion date | May 2014 |
| Est. primary completion date | December 2013 |
| Accepts healthy volunteers | No |
| Gender | All |
| Age group | 18 Years to 80 Years |
| Eligibility | Inclusion Criteria: - Subjects aged 18 to 80 years of age - Post stroke or brain injury - Intensity of muscle tone greater than or equal to 2, as measured on the Modified Ashworth Scale - Ambulatory patients Exclusion Criteria: - Fixed contractures - Physiotherapy initiated less than 4 weeks before entry - Previous surgery or previous treatment with phenol and/or alcohol in lower limb - Neurological/neuromuscular disorders which may interfere with protocol evaluations |
| Country | Name | City | State |
|---|---|---|---|
| Australia | Caulfield Hospital | Caulfield | |
| Australia | Saint Vincent's Hospital | Darlinghurst | |
| Australia | Saint Vincent's Hospital | Fitzroy | |
| Australia | St George Hospital | Kogarah | |
| Australia | Royal Melbourne Hospital | Parkville | |
| Australia | Epworth Healthcare | Richmond | |
| Australia | Epworth HealthCare | Richmond | Victoria |
| Australia | Westmead Hospital | Westmead | |
| Belgium | Université catholique de Louvain av Hippocrate 10 | Bruxelles | |
| Belgium | Clinique Universitaire | Yvoir | |
| Czechia | Neurologicka Klinika | Olomouc | |
| Czechia | Neurologicka Klinika, VFN | Praha | |
| France | CHU Jean MINJOZ | Besançon | |
| France | Service de Réeducation Fonctionnelle, CHU de Brest, Hôpital Morvan | Brest | |
| France | Centre de Réadaptation de Coubert | Coubert | |
| France | Centre Hospitalier Albert Chenevier | Créteil | |
| France | Hopital Raymond Poincarré | Garches | |
| France | Hôpital de L'Archet | Nice | |
| France | Hôpital Sébastopol | Reims | |
| France | Hôpital Sébastopol, Médecine Physique et Réadaptation, CHU Reims | Reims | |
| France | Nouvel Civil Hospital | Strasbourg | |
| France | Hopital Rangueil | Toulouse | |
| Hungary | National Institute for Medical Rehabilitation | Budapest | |
| Hungary | Szent János Hospital | Budapest | |
| Hungary | Uno Medical Trials | Budapest | |
| Hungary | Petz Aladar Country Hospital | Gyor | |
| Hungary | Batthyány Kázmér Hospital | Kisbér | |
| Italy | Azienda Ospedaliero | Catania | |
| Italy | SSD Neurofisiologia Riabilitativa | Fossano | |
| Italy | Servizio di Neurofisiologia Clinica-Ospedale San Raffaele | Milano | |
| Italy | Polo IRCCS Eugenio Medea La Nostra Famiglia | Treviso | |
| Poland | Specjalistyczna Praktyka Lekarska | Katowice | |
| Poland | Centrum Medyczne Plejady | Krakow | |
| Poland | Krakowska Akademia Neurologii | Krakow | |
| Poland | Malopolskie Centrum Medyczne | Krakow | |
| Poland | Nzoz Neuro - Card | Poznan | |
| Poland | Samodzielny Publiczny Centralny Szpital | Warsaw | |
| Portugal | Servicio de Rehabilitation de Adultos | Alcabideche | |
| Portugal | Centro Hospitalar Lisboa Norte | Lisbon | |
| Portugal | Centro Hospitalar São João | Porto | |
| Russian Federation | Treatments and Rehabilitation Center | Moscow | |
| Russian Federation | State Institution "Scientific Centre of Neurology of Russian Academy of Medical Sciences" | Saint Petersburg | |
| Russian Federation | St-Petersberg State Medical University | St Petersburg | |
| Slovakia | Neurologicka klinika, Univerzitna nemocnica Bratislava | Bratislava | |
| Slovakia | Univerzitna Nemocnica Bratislava | Bratislava | |
| United States | Parkinson's Disease & Movement Disorders Center of Boca Raton | Boca Raton | Florida |
| United States | University of North Carolina - Chapel Hill | Chapel Hill | North Carolina |
| United States | The University of Texas Southwestern Medical Center at Dallas | Dallas | Texas |
| United States | Rancho Los Amigos | Downey | California |
| United States | MossRehab & Albert Einstein | Elkins Park | Pennsylvania |
| United States | Associated Neurologists of Southern CT, PC | Fairfield | Connecticut |
| United States | University of North Texas HSC at Ben Hogan Center | Fort Worth | Texas |
| United States | Neurorehabilitation Specialist | Houston | Texas |
| United States | University of Texas - Houston | Houston | Texas |
| United States | Design Neuroscience | Miami Gardens | Florida |
| United States | Vanderbilt University | Nashville | Tennessee |
| United States | Mount Sinai School of Medicine | New York | New York |
| United States | Weill Cornell Medical College | New York | New York |
| United States | Pacific Neuroscience Medical Group | Oxnard | California |
| United States | University of Utah School of Medicine | Salt Lake City | Utah |
| United States | Mayo Clinic Arizona | Scottsdale | Arizona |
| United States | Wake Forest University Baptist Medical Center | Winston-Salem | North Carolina |
| Lead Sponsor | Collaborator |
|---|---|
| Ipsen |
United States, Australia, Belgium, Czechia, France, Hungary, Italy, Poland, Portugal, Russian Federation, Slovakia,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Other | Least Squares Mean Change From Baseline in MAS Score in the GSC (Knee Extended) at Weeks 1 and 12 | Muscle tone in the treated limb was assessed by MAS in the GSC (with the knee extended) at baseline, at Weeks 1, 4 and 12, at discretionary visits at Weeks 16, 20 and 24, and at end of study. The MAS consists of 6 grades: 0 (no increase in muscle tone), 1 (slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM), 1+ (slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM), 2 (more marked increase in muscle tone), 3 (considerable increase in muscle tone) or 4 (affected part(s) rigid in flexion or extension), and can be applied to muscles of both the upper and lower limbs. The least squares mean change from baseline at Weeks 1 and 12 are reported. | Baseline and Weeks 1 and 12 | |
| Other | Least Squares Mean Change From Baseline in MAS Score in the Soleus (Knee Flexed) at Weeks 1, 4 and 12 | Muscle tone in the treated limb was assessed by MAS in the soleus (with the knee flexed) at baseline, at Weeks 1, 4 and 12, at discretionary visits at Weeks 16, 20 and 24, and at end of study. The MAS consists of 6 grades: 0 (no increase in muscle tone), 1 (slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM), 1+ (slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM), 2 (more marked increase in muscle tone), 3 (considerable increase in muscle tone) or 4 (affected part(s) rigid in flexion or extension), and can be applied to muscles of both the upper and lower limbs. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | PGA of Treatment Response at Week 12 | An assessment of overall treatment response was conducted at Weeks 4 and 12, and discretionary visits at Weeks 16, 20 and 24 and at end of study by an investigator who had not assessed the MAS. The investigator rated the response to treatment in the subject's lower limb after injection of Dysport® relative to the status at the baseline. Answers were made on a 9 point rating scale: -4=markedly worse, -3=much worse, -2=worse, -1=slightly worse, 0=no change, +1=slightly improved, +2=improved, +3=much improved, +4=markedly improved. The mean PGA scores at Week 12 are reported. | At Week 12 | |
| Other | Least Squares Mean Change From Baseline in Comfortable Barefoot Walking Speed at Weeks 1 and 12 | Comfortable walking speed was assessed as a measure of functional ability and gait over 10 metres. Evaluations were made barefoot, without walking aids, at baseline and Weeks 1, 4 and 12 and discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1 and 12 are reported. | Baseline and Weeks 1 and 12 | |
| Other | Least Squares Mean Change From Baseline in Comfortable Walking Speed With Shoes at Weeks 1, 4 and 12 | Comfortable walking speed was assessed as a measure of functional ability and gait over 10 metres. Evaluations were made with shoes, without walking aids, at baseline and Weeks 1, 4 and 12 and discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Maximal Barefoot Walking Speed at Weeks 1, 4 and 12 | Maximal walking speed was assessed as a measure of functional ability and gait over 10 metres. Evaluations were made barefoot, without walking aids, at baseline and Weeks 1, 4 and 12 and discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Maximal Walking Speed With Shoes at Weeks 1, 4 and 12 | Maximal walking speed was assessed as a measure of functional ability and gait over 10 metres. Evaluations were made with shoes, without walking aids, at baseline and Weeks 1, 4 and 12 and discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Cadence With Comfortable Walking Speed With Shoes at Weeks 1, 4 and 12 | Cadence was assessed during the 10-metre walking speed test at comfortable walking speed and with shoes. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Average Step Length With Comfortable Walking Speed With Shoes at Weeks 1, 4 and 12 | Average step length was assessed during the 10-metre walking speed test at comfortable walking speed and with shoes. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Cadence With Comfortable Barefoot Walking Speed at Weeks 1, 4 and 12 | Cadence was assessed during the 10-metre walking speed test at comfortable walking speed and barefoot. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Average Step Length With Comfortable Barefoot Walking Speed at Weeks 1, 4 and 12 | Average step length was assessed during the 10-metre walking speed test at comfortable walking speed and barefoot. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Cadence With Maximal Walking Speed With Shoes at Weeks 1, 4 and 12 | Cadence was assessed during the 10-metre walking speed test at maximal walking speed and with shoes. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Average Step Length With Maximal Walking Speed With Shoes at Weeks 1, 4 and 12 | Average step length was assessed during the 10-metre walking speed test at maximal walking speed and with shoes. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Cadence With Maximal Barefoot Walking Speed at Weeks 1, 4 and 12 | Cadence was assessed during the 10-metre walking speed test at maximal walking speed and barefoot. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Average Step Length With Maximal Barefoot Walking Speed at Weeks 1, 4 and 12 | Average step length was assessed during the 10-metre walking speed test at maximal walking speed and barefoot. The evaluator walked beside the subject during the test and counted the number of steps taken during the 10-metre walk. The gait parameters were measured at baseline, Weeks 1, 4 and 12, discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in the Tardieu Scale in the GSC (Knee Extended) at Weeks 1, 4 and 12: Angle of Arrest (XV1), Angle of Catch (XV3) and Spasticity Angle (X) | The Tardieu Scale in the GSC was used to assess spasticity with the knee extended. Assessments were made at slow (V1) and fast (V3) speeds of stretch. Slow speed of muscle stretch measures the range of passive motion. During a slow stretching movement, the examiner determines the angle of movement arrest (XV1), either due to subject discomfort or a mechanical resistance. The same movement is repeated at a fast speed to determine the angle of catch and release (XV3). The spasticity angle (X) was calculated as the difference between XV1 and XV3. The Tardieu Scale ratings were made prior to the study treatment at baseline, and then after injection at Weeks 1, 4 and 12, and at discretionary visits if required at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in the Tardieu Scale in the GSC (Knee Extended) at Weeks 1, 4 and 12: Spasticity Grade (Y) | The Tardieu Scale in the GSC was used to assess spasticity with the knee extended. The spasticity grade (Y) assesses quality of muscle reaction on a 5-point scale (measured at fast speed): 0 = no resistance throughout passive movement; 1 = slight resistance throughout passive movement; 2 = clear catch at precise angle, interrupting passive movement, followed by release; 3 = fatigable clonus (less than 10 seconds when maintaining pressure) occurring at a precise angle, followed by release; 4 = unfatigable clonus (more than 10 seconds when maintaining pressure) occurring at precise angle. The Tardieu Scale ratings were made prior to the study treatment at baseline, and then after injection at Weeks 1, 4 and 12, and at discretionary visits if required at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline for spasticity grade at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in the Tardieu Scale in the Soleus (Knee Flexed) at Weeks 1, 4 and 12: Angle of Arrest (XV1), Angle of Catch (XV3) and Spasticity Angle (X) | The Tardieu Scale in the soleus was used to assess spasticity with the knee flexed. Assessments were made at slow (V1) and fast (V3) speeds of stretch. Slow speed of muscle stretch measures the range of passive motion. During a slow stretching movement, the examiner determines the angle of movement arrest (XV1), either due to subject discomfort or a mechanical resistance. The same movement is repeated at a fast speed to determine the angle of catch and release (XV3). The spasticity angle (X) was calculated as the difference between XV1 and XV3. The Tardieu Scale ratings were made prior to the study treatment at baseline, and then after injection at Weeks 1, 4 and 12, and at discretionary visits if required at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in the Tardieu Scale in the Soleus (Knee Flexed) at Weeks 1, 4 and 12: Spasticity Grade (Y) | The Tardieu Scale in the soleus was used to assess spasticity with the knee flexed. The spasticity grade (Y) assesses quality of muscle reaction on a 5-point scale (measured at fast speed): 0 = no resistance throughout passive movement; 1 = slight resistance throughout passive movement; 2 = clear catch at precise angle, interrupting passive movement, followed by release; 3 = fatigable clonus (less than 10 seconds when maintaining pressure) occurring at a precise angle, followed by release; 4 = unfatigable clonus (more than 10 seconds when maintaining pressure) occurring at precise angle. The Tardieu Scale ratings were made prior to the study treatment at baseline, and then after injection at Weeks 1, 4 and 12, and at discretionary visits if required at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline for spasticity grade at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in the Range of Active Dorsiflexion at Weeks 1, 4 and 12 (Knee Extended and Flexed) | Range of active dorsiflexion of the ankle joint, both with the knee flexed (90°) and extended (measured by goniometry) was used to assess treatment response. The measurements were made prior to the study treatment at baseline, and then after injection at Weeks 1, 4 and 12, and at discretionary visits when needed at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Other | Least Squares Mean Change From Baseline in Lower Limb Pain at Weeks 1, 4 and 12 | The intensity of lower limb pain was evaluated using the Scale of Pain Intensity (SPIN) which provided a pictorial representation of pain in a 6-point graphic scale with the degree of red shading inside a circle representing the intensity of pain. The bottom and top of the scale are anchored by two extremes: 'no pain' (circle with no red shading and scored as 0) and 'pain as bad as it could be' (circle completely red and scored as 5), marked with either verbal or visual cues. The intervening points are represented by red circles increasing proportionally in size. The subject marks the circle that best indicates their pain intensity. The SPIN assessments were obtained prior to the study treatment at baseline, and then after injection at Weeks 1, 4 and 12, and at discretionary visits when needed at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Weeks 1, 4 and 12 are reported. | Baseline and Weeks 1, 4 and 12 | |
| Primary | Least Squares Mean Change From Baseline to Week 4 in the MAS Score in the Gastrocnemius-soleus Complex (GSC) (Knee Extended) | Muscle tone in the treated limb was assessed by MAS in the GSC (with the knee extended) at baseline, at Weeks 1, 4 and 12, at discretionary visits at Weeks 16, 20 and 24, and at end of study. The MAS consists of 6 grades: 0 (no increase in muscle tone), 1 (slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion (ROM)), 1+ (slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM), 2 (more marked increase in muscle tone), 3 (considerable increase in muscle tone) or 4 (affected part(s) rigid in flexion or extension), and can be applied to muscles of both the upper and lower limbs. The least squares mean change from baseline at Week 4 is reported. | Baseline and Week 4 | |
| Secondary | Physician's Global Assesment (PGA) of Treatment Response at Week 4 | An assessment of overall treatment response was conducted at Weeks 4 and 12, and discretionary visits at Weeks 16, 20 and 24 and at end of study by an investigator who had not assessed the MAS. The investigator rated the response to treatment in the subject's lower limb after injection of Dysport® relative to the status at the baseline. Answers were made on a 9 point rating scale: -4=markedly worse, -3=much worse, -2=worse, -1=slightly worse, 0=no change, +1=slightly improved, +2=improved, +3=much improved, +4=markedly improved. The mean PGA score at Week 4 is reported. | At Week 4 | |
| Secondary | Least Squares Mean Change From Baseline to Week 4 in Comfortable Barefoot Walking Speed | Comfortable walking speed was assessed as a measure of functional ability and gait over 10 metres. Evaluations were made barefoot, without walking aids, at baseline and Weeks 1, 4 and 12 and discretionary visits at Weeks 16, 20 and 24 and at end of study. The least squares mean change from baseline at Week 4 is reported. | Baseline and Week 4 |