Safety and Effectiveness of Nabiximols Oromucosal Spray as Add-on Therapy in Participants With Spasticity Due to Multiple Sclerosis

Multiple Sclerosis (MS) Clinical Trial

— RELEASE MSS3  

Official title:

A Double-blind, Randomized, Placebo-controlled, Parallel-group Trial of the Efficacy and Safety of Nabiximols Oromucosal Spray as Add-on Therapy in Patients With Spasticity Due to Multiple Sclerosis

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04203498
• Other study ID #: GWSP18023
• Secondary ID: 2019-002623-14
• Status: Terminated
• Phase: Phase 3
• Start date: October 1, 2020
• Est. completion date: February 28, 2023

Study information

• Verified date: April 2024
• Source: Jazz Pharmaceuticals
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This trial is being conducted to demonstrate the efficacy of nabiximols, compared with placebo, when added to standard of care, in the treatment of muscle spasms associated with multiple sclerosis (MS).

Description:

This multicenter, double-blind, placebo-controlled trial includes a 28-day Baseline period, a 12-week treatment period (comprising a 2-week titration phase and a 10-week maintenance phase), and 2-week follow-up period.

Eligible participants will enter the 28-day baseline period. During baseline, participants will maintain their optimized oral MS antispasticity medication regimen and record spasm count using an electronic daily diary. At screening (Day 1), eligible participants will be randomized to either nabiximols or placebo in a 1:1 ratio.

Participants will be advised to titrate the investigational medicinal product (IMP), beginning with 1 spray/day, to an optimized dose or to a maximum of 12 sprays/day over the first 14 days of treatment. Participants may leave a gap between sprays of approximately 15 minutes. Participants should continue at the same dose level achieved at the end of the titration phase ±1 spray divided into a morning dose and an evening dose for the remainder of the treatment period.

Daily spasm count, the participant's symptom experiences, clinician's assessment of spasticity, functional outcomes, health-related quality of life, changes in mood, safety, tolerability, and pharmacokinetics will be evaluated during the treatment period.

Participants who complete the trial will participate for a total of approximately 18 weeks (127 days), including the 28-day baseline period. Participants will have a maximum duration of 85 (±7) days on IMP treatment.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 139
• Est. completion date: February 28, 2023
• Est. primary completion date: February 10, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Criteria at screening:

1. Participant is male or female aged 18 years or above.

2. Participant has had a diagnosis with any disease subtype of multiple sclerosis (MS), by revised 2017 McDonald criteria, for at least 12 months prior to screening and is expected to remain stable for the duration of the trial.

3. Participant has had treatment with at least 1 optimized oral antispasticity therapy prior to Visit 1 that must include either oral baclofen or oral tizanidine (monotherapy or combination therapy).

4. Participant is currently receiving optimized treatment with at least 1 oral antispasticity medication (baclofen, tizanidine, and/or dantrolene) and has been stable for at least 30 days prior to screening.

5. If the participant is currently receiving an approved MS disease-modifying therapy, it must be at a stable dose for at least 3 months prior to screening and is expected to remain stable for the duration of the trial.

Exclusion Criteria:

1. Participant has any concomitant disease or disorder that has spasticity-like symptoms or that may influence the participant's level of spasticity.

2. Participant has had a relapse of MS within the 60 days prior to screening (Visit 1).

3. Participant is currently using or has used cannabis or a cannabinoid-derived product for medicinal or recreational use (within 30 days of screening) and is unwilling to abstain for the duration of the trial.

4. Participant is currently using botulinum toxin injection for the relief of spasticity (within 6 months of screening) and is unwilling to abstain for the duration of the trial.

5. Participant has any known or suspected hypersensitivity to cannabinoids or any of the excipients of the IMP.

6. Participant is male and fertile unless willing to ensure that he uses male contraception or remains sexually abstinent during the trial and for 3 months thereafter.

7. Participant is female and of childbearing potential unless willing to ensure that she uses a highly effective method of birth control during the trial and for 3 months thereafter.

8. Participant is female and pregnant, lactating, or planning pregnancy during the course of the trial or within 3 months thereafter.

9. Participant has received an IMP within the 30 days prior to screening.

10. Participant has a history of severe psychiatric disorder that may be exacerbated by the use of a cannabinoid-containing product.

11. Participant has any known or suspected history of alcohol or substance abuse (including opiate abuse) or dependence within 1 year prior to screening.

12. Participant is currently taking drugs that are solely metabolized by UGT1A9 and UGT2B7.

13. Participant is currently taking strong currently taking strong CYP3A4 inducers (e.g., rifampicin, carbamazepine, phenytoin, phenobarbital, St John's Wort).

Related Conditions & MeSH terms

• Multiple Sclerosis
• Multiple Sclerosis (MS)
• Muscle Spasticity
• Sclerosis

Intervention

Drug:
• Nabiximols
Nabiximols is a complex botanical medicine formulated from extracts of the cannabis plant that contains the principal cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) and also contains minor constituents, including other cannabinoid and non-cannabinoid plant components, such as terpenes, sterols, and triglycerides.Nabiximols will be self-administered by participants as an oromucosal spray in the morning and evening, up to a maximum of 12 sprays per day for 12 weeks.
• Placebo
Placebo to match nabiximols will be presented as an oromucosal spray containing the excipients ethanol and propylene glycol (50% v/v) with colorings and flavored with peppermint oil (0.05% v/v). Each spray will deliver 100 microliters (µL) containing no active ingredients. Placebo will be self-administered by participants as an oromucosal spray in the morning and evening, up to a maximum of 12 sprays per day for 12 weeks.

Locations

Country	Name	City	State
Czechia	Poliklinika Chocen	Chocen	Pardubice
Czechia	Neurologie Taláb Radomír Doc. MUDr., CSc	Hradec Králové
Czechia	Nemocnice Jihlava	Jihlava
Czechia	Fakultní Nemocnice Královské Vinohrady	Praha 10
Czechia	Krajská Zdravotní - Nemocnice Teplice	Teplice
Poland	Centrum Medyczne Neuromed - Osrodek Badan Klinicznych	Bydgoszcz	Kujawsko-Pomorskie
Poland	Neuro-Medic Janusz Zbrojkiewicz	Katowice	Slaskie
Poland	RESMEDICA Poradnia Neurologiczna	Kielce	Swietokrzyskie
Poland	SP ZOZ Uniwersytecki Szpital Kliniczny Nr 1 im. Norberta Barlickiego w Lodzi	Lódz
Poland	Centrum Medyczne Oporów	Lublin
Poland	Neurologiczny NZOZ Centrum Leczenia SM Osrodek Badan Klinicznych im. dr n. med. Hanki Hertmanowskiej Witoslaw Cieslak	Plewiska
Poland	Niepubliczny Zaklad Opieki Zdrowotnej NEURO - KARD	Poznan	Wielkopolskie
Poland	Centrum Medyczne Neuroprotect	Warszawa	Mazowieckie
Poland	Centrum Medyczne Pratia - Warszawa	Warszawa	Mazowieckie
Poland	Wromedica Centrum Zdrowia	Wroclaw
Poland	Wromedica Centrum Zdrowia	Wroclaw	Dolnoslaskie
Poland	Wielospecjalistyczne Centrum Medyczne Ibismed	Zabrze	Slaskie
Romania	Centrul Medical Clubul Sanatatii	Câmpulung
Romania	Spitalul Municipal Caracal	Caracal
Romania	Spitalul Clinic Cai Ferate Constanta	Constanta
Romania	Spitalul Municipal Sf. Dr. Cosma si Damian Radauti	Radau?i
United Kingdom	Barts Health NHS Trust	London	England
United States	Shepherd Center	Atlanta	Georgia
United States	American Health Network of Indiana	Avon	Indiana
United States	University of Alabama at Birmingham School of Medicine	Birmingham	Alabama
United States	Neurology Clinic - Cordova	Cordova	Tennessee
United States	University of Texas Southwestern Medical Center	Dallas	Texas
United States	University of Cincinnati (UC) Health	Dayton	Ohio
United States	Hope Neurology	Knoxville	Tennessee
United States	Ochsner Medical Center	New Orleans	Louisiana
United States	Consultants in Neurology - Northbrook	Northbrook	Illinois
United States	Neurostudies - Port Charlotte	Port Charlotte	Florida
United States	Raleigh Neurology Associates - Raleigh Location	Raleigh	North Carolina
United States	Central Texas Neurology Consultants	Round Rock	Texas
United States	The Multiple Sclerosis Center For Innovations In Care	Saint Louis	Missouri
United States	Accel Research Sites - Enterprise	Tampa	Florida
United States	University of South Florida	Tampa	Florida

Sponsors (1)

Lead Sponsor	Collaborator
Jazz Pharmaceuticals

Countries where clinical trial is conducted

United States,  Czechia,  Poland,  Romania,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Average Daily Spasm Count From Baseline to Week 12 By 4-Week Period During the 12-Week Randomized Period	The change in the average daily spasm count was assessed compared to the baseline period.	Baseline to Week 12
Secondary	Change in Multiple Sclerosis Spasticity Scale (MSSS-88) Total Score	The MSSS-88 is a self-reported measure of the impact of spasticity (muscle stiffness and spasms) in MS. This 88-item scale captures the patient experience and impact of spasticity, including muscle stiffness, pain and discomfort, muscle spasms, effect on daily activities, ability to walk, body movement, patient feelings, and social functioning. Responses to individual questions can range from "1 - not at all bothered" to "4 - extremely bothered", ranging from 88 to 352 total score. Scores are summed and higher scores indicate poor clinical outcome. Least square means are being reported, with greater negative values indicating better outcome.	Week 8 and Week 12
Secondary	Number of Patients Reporting Any Treatment-emergent Adverse Events	A TEAE is an adverse event that started, or worsened in severity or seriousness, following the first dose of the investigational medicinal product.	From date of first dose of IMP up to 30 days after last dose, up to approximately 16 weeks
Secondary	Change From Baseline in Clinical Laboratory Test Values		Baseline up to Week 12
Secondary	Change From Baseline in Erythrocytes		Baseline up to Week 12
Secondary	Change From Baseline in Hemoglobin		Baseline up to Week 12
Secondary	Change From Baseline in Hematocrit Ratio	The hematocrit ratio measures the volume of red blood cells compared to the total blood volume.	Baseline up to Week 12
Secondary	Change From Baseline in Erythrocyte Mean Corpuscular Hemoglobin		Baseline up to Week 12
Secondary	Change From Baseline in Blood Pressure		Baseline up to Week 12
Secondary	Change From Baseline in Heart Rate		Baseline up to Week 12
Secondary	Change From Baseline in Electrocardiogram Parameters		Baseline up to Week 12
Secondary	Change From Baseline in Electrocardiogram Pulse Rate		Baseline up to Week 12
Secondary	Change From Baseline in Weight		Baseline up to Week 12
Secondary	Change in Body Mass Index		Baseline up to Week 12
Secondary	Number of Patients With Suicidal Ideation or Behavior Based on Columbia-Suicide Severity Rating Scale (C-SSRS)	The C-SSRS is a short questionnaire that is used to assess suicidal ideation (5 questions) and behavior (5 questions) since last patient visit. The questionnaire is completed by participants answering yes or no to each question.	Screening up to Week 12