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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT01324232
Other study ID # 11-AVR-130
Secondary ID
Status Completed
Phase Phase 2
First received
Last updated
Start date September 8, 2011
Est. completion date September 26, 2013

Study information

Verified date October 2021
Source Avanir Pharmaceuticals
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The objectives of the study are to evaluate the safety, tolerability, and efficacy of 3 doses of AVP-923 capsules in the treatment of central neuropathic pain in participants with multiple sclerosis.


Description:

The objectives of the study are to evaluate the safety, tolerability, and efficacy of 3 doses of AVP-923 (dextromethorphan [DM]/quinidine [Q]) capsules containing either 45 mg DM and 10 mg Q (AVP-923-45) or 30 mg DM and 10 mg Q (AVP-923-30) or 20 mg DM and 10 mg Q (AVP-923-20) compared to placebo, for the treatment of central neuropathic pain in a population of participants with multiple sclerosis (MS) over a 12-week period. The MS participant population enrolled includes participants with relapsing-remitting multiple sclerosis (RRMS) and participants with secondary progressive multiple sclerosis (SPMS).


Recruitment information / eligibility

Status Completed
Enrollment 209
Est. completion date September 26, 2013
Est. primary completion date September 26, 2013
Accepts healthy volunteers No
Gender All
Age group 18 Years to 85 Years
Eligibility Main Inclusion Criteria: Multiple Sclerosis (relapsing-remitting multiple sclerosis [RRMS] or secondary progressive multiple sclerosis [SPMS]), Clinical history and symptoms of central neuropathic pain (dysesthetic pain) for at least 3 months prior to screening, pain rating scale (PRS) baseline score = or > 4, No MS relapse within previous 30 days. Main Exclusion Criteria: Personal history of complete heart block, QT interval corrected for heart rate (QTc) prolongation, or torsades de pointes, family history of congenital QT interval prolongation syndrome, Myasthenia Gravis, Beck Depression Inventory Second Edition (BDI-II) score > 19

Study Design


Intervention

Drug:
AVP-923-45
AVP-923-45 (dextromethorphan 45 mg/quinidine 10 mg) capsules administered once daily for first 7 days followed by twice daily for 11 weeks of the study to complete 12 weeks of treatment.
AVP-923-30
AVP-923-30 (dextromethorphan 30 mg/quinidine 10 mg) capsules administered once daily for first 7 days followed by twice daily for 11 weeks of the study to complete 12 weeks of treatment.
AVP-923-20
AVP-923-20 (dextromethorphan 20 mg/quinidine 10 mg) capsules administered once daily for first 7 days followed by twice daily for 11 weeks of the study to complete 12 weeks of treatment.
Placebo
Matching placebo capsules administered once daily for first 7 days followed by twice daily for 11 weeks of the study to complete 12 weeks of treatment.

Locations

Country Name City State
Argentina Fundación Argentina Contra las Enfermedades Neurológicas del Envejecimiento - FACENE Buenos Aires
Argentina Hospital Churruca-Visca Buenos Aires
Argentina Hospital Britanico de Buenos Aires Ciudad Autonoma de Buenos Aires Buenos Aires
Argentina Instituto de Neurologia Cognitiva Ciudad Autonoma de Buenos Aires Buenos Aires
Argentina Medeos - Centro de Medicina Integral e Investigación Clínica Ciudad Autonoma de Buenos Aires
Argentina Hospital Italiano Ciudad Autónoma de Buenos Aires Buenos Aires
Argentina Instituto Argentino de Investigacion Neurologica Ciudad de Buenos Aires Buenos Aires
Argentina Instituto de Neurología y Neurorrehabilitación del Litoral Santa Fe
Czechia Fakultni nemocnice u sv. Anny v Brne Brno
Czechia Fakultni nemocnice Hradec Kralove Hradec Kralove
Czechia Nemocnice Jihlava, prispevkova organizace Jihlava
Czechia Fakultni Nemocnice Ostrava Ostrava
Czechia Vseobecna fakultni nemocnice v Praze Praha 2
Poland Szpital Powiatowy w Czeladzi Czeladz
Poland Pomorskie Centrum Traumatologii im. M. Kopernika w Gdansku Gdansk
Poland Diagnomed Clinical Research Sp. z.o.o. Katowice
Poland Niepubliczny Zaklad Opieki Zdrowotnej NEURO-MEDIC Katowice
Poland Niepubliczny Zaklad Opieki Zdrowotnej PROFILAKTYKA Katowice
Poland Zespol Opieki Zdrowotnej w Konskich Konskie
Poland Specjalistyczny Gabinet Neurologiczny Plewiska
Poland Niepubliczny Zaklad Opieki Zdrowotnej NEURO-KARD Ilkowski i Partnerzy Spolka Partnerska Lekarzy Poznan
Poland Osrodek Badan Klinicznych Indywidualnej Specjalistycznej Praktyki Lekarskiej Szczecin
Spain Hospital del Mar Barcelona Cataluña
Spain Hospital Vall D´Hebron Barcelona Cataluña
Spain Hospital Universitario Virgen de la Arrixaca El Palmar Murcia
Spain Hospital Universitari de Girona Dr. Josep Trueta Girona Cataluña
Spain Hospital Univ. Nuestra Sra. De La Candelaria Santa Cruz De Tenerife
Spain Hospital Universitario Vírgen Macarena Sevilla
United States Albany Medical Center Hospital Albany New York
United States Shepard Center Atlanta Georgia
United States University of Colorado Aurora Colorado
United States Johns Hopkins University School of Medicine Baltimore Maryland
United States Alta Bates Summit Medical Center Berkeley California
United States Beth Israel Deaconess Medical Center Boston Massachusetts
United States Carolinas Medical Center Charlotte North Carolina
United States Rush-Presbyterian St. Luke's Medical Center Chicago Illinois
United States Cleveland Clinic Foundation Cleveland Ohio
United States Michigan Neurology Associates, P.C. Clinton Township Michigan
United States North Central Neurology Associates PC Cullman Alabama
United States Henry Ford Health System Detroit Michigan
United States Wayne State University Detroit Michigan
United States Advanced Neurosciences Institute Franklin Tennessee
United States Advanced Neurology Specialists Great Falls Montana
United States Neurological Associates Henrico Virginia
United States Baylor College of Medicine Houston Texas
United States Josephson Wallack Munshower Neurology, P.C. Indianapolis Indiana
United States MidAmerica Neuroscience Institute Lenexa Kansas
United States Neurology Associates PC Lincoln Nebraska
United States Neurology Associates, PA Maitland Florida
United States Collier Neurologic Specialists Naples Florida
United States NYU-Hospital for Joint Diseases New York New York
United States Laszlo J. Mate, MD North Palm Beach Florida
United States Consultants in Neurology Northbrook Illinois
United States Oklahoma Medical Research Foundation Oklahoma City Oklahoma
United States University of California, Irvine Orange California
United States Neurology Associates of Ormond Beach Ormond Beach Florida
United States Drexel University College of Medicine Philadelphia Pennsylvania
United States St. Joseph's Hospital Medical Center Phoenix Arizona
United States Neurological Associates Pompano Beach Florida
United States Neurologique Foundation Ponte Vedra Beach Florida
United States University of Rochester Rochester New York
United States Suncoast Neuroscience Associates, Inc. Saint Petersburg Florida
United States Rocky Mountain MS Clinic Salt Lake City Utah
United States Coordinated Clinical Research San Diego California
United States University of California, San Francisco San Francisco California
United States Swedish Medical Center Seattle Washington
United States SUNY at Stony Brook Stony Brook New York
United States MultiCare Health System Tacoma Washington
United States University of South Florida Tampa Florida
United States Geodyssey Research, LLC Vero Beach Florida
United States MS Center of Greater Washington Vienna Virginia
United States Geisinger Health System Wilkes-Barre Pennsylvania

Sponsors (1)

Lead Sponsor Collaborator
Avanir Pharmaceuticals

Countries where clinical trial is conducted

United States,  Argentina,  Czechia,  Poland,  Spain, 

Outcome

Type Measure Description Time frame Safety issue
Other Change From Baseline in Modified Ashworth Scale (MAS) Scores MAS is not considered as a true endpoint. MAS scores were assessed at Baseline only. Change from Baseline could not be calculated because data for the later timepoints was not collected. Baseline; Day 85
Primary Association Between the Dextromethorphan Plasma Concentration and the Change From Baseline Pain Rating Scale (PRS) Score to the Average Pain Rating Scale Score During Days 57 Through 84 PRS required participants to rate their pain over the past 12 hours (hrs) on a scale of 0 to 10 (0=no pain; 10=worst possible pain). Baseline (B) PRS was defined as the average of the PRS scores in the last 7 days collected prior to the B visit. If participants did not have at least 4 PRS scores during the last 7 days prior to the B visit, then the average of up to 7 of the most recent PRS scores available prior to the B visit was used. Post-B PRS was the average of Days 57 through 84 values. For participants who did not have any PRS scores during Days 57 through 84, the average of the last 7 available post-B PRS scores was used. Change from B was calculated as the post-B score minus B score. The average logarithms of dextromethorphan plasma concentrations (Cmax) on Days 22 and 50 are reported in primary outcome measure #2 below. Pearson correlation was calculated between Cmax as one group of data across the reporting groups and Change from Baseline in PRS score. Baseline; Days 57 through 84 (PRS score); Days 22 and 50 (dextromethorphan plasma concentrations)
Primary Average Logarithms of Dextromethorphan (DM) Plasma Concentrations (Cmax) on Days 22 and 50 The average of the logarithms of the DM plasma concentrations on Days 22 and 50 were presented. 0 to 3 hours post-dose on Day 22 and 50
Secondary Comparison of the Adjusted Mean Change From Baseline PRS Score to the Average PRS Score During Days 57 Through 84 The PRS required participants to rate their pain over the past 12 hours on a scale of 0 to 10 (0=no pain; 10=worst possible pain) by circling the number that best described their pain on average over the past 12 hours. Baseline PRS was defined as the average of the PRS scores in the last 7 days collected prior to the Baseline visit. If participants did not have at least 4 PRS scores during the last 7 days prior to the Baseline visit, then the average of up to 7 of the most recent PRS scores available prior to the Baseline visit was used. Post-Baseline PRS was the average of the Day 57 through 84 values. For participants who did not have any PRS scores during Days 57 through 84, the average of the last 7 available post-Baseline PRS scores was used. Change from Baseline was calculated as the post-Baseline score minus the Baseline score. Baseline; Days 57 through 84
Secondary Mean Change From Baseline in Fatigue Severity Scale (FSS) Scores at Days 57 Through 84 The FSS questionnaire consisted of 9 statements that attempted to explore the severity of fatigue symptoms in participants with MS and other conditions, including chronic fatigue immune dysfunction syndrome and systemic lupus erythematosus, and was designed to differentiate fatigue from clinical depression because both share some of the same symptoms. Participants were asked to respond to each statement on a scale of 1 to 7, with 1 indicating "Strongly Disagree" and 7 indicating "Strongly Agree." Total score ranging from 9 to 63, was computed as the sum of the sub-scores for all 9 statements; a higher score indicated increasing fatigue. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. Post-Baseline FSS score was the average of Day 57 through 84 values. The analysis was carried out using an ANCOVA model, with the FSS change from Baseline to Days 85 as the dependent variable, Baseline; Days 57 through 84
Secondary Mean Change From Baseline in Expanded Disability Status Scale (EDSS) Scores at Days 22 and 85 The EDSS, a method of quantifying disability in participants with MS was based on neurological examination of 8 functional systems (FS) (pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, cerebral, and other) that allowed neurologists to assign a FS score to each of these systems. Neurological findings in each FS were scored on a scale of 0 (low level of problems) to 5 (high level of problems). The "other" category was not rated numerically but measured disability related to a particular issue, like motor loss. A total averaged EDSS score was then calculated on a scale of 0 (normal) to 10 (death from MS). The total EDSS score was determined by 2 factors: gait and FS scores. A higher score indicated greater disability. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. Baseline; Days 22 and 85
Secondary Mean Change From Baseline in Multiple Sclerosis Impact Scale-29 (MSIS-29) Scores at Day 85 MSIS-29, an instrument measuring the physical (20 items) and psychological (9 items) impact of MS from the participants' perspective was used to evaluate therapeutic effectiveness from the participants' perspective. Participants were asked to circle the response that best described the impact of MS on daily life on a scale of 0 (not at all) to 5 (extremely). The total MSIS-29 score ranged from 0 to 145, was calculated as the sum of the sub-scores for all 29 questions, with lower scores indicating better quality of life. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. The analysis was carried out using an ANCOVA model, with the MSIS-29 score change from Baseline to Day 85 as the dependent variable, treatment group as a fixed effect, and the Baseline MSIS-29 as a covariate. Baseline; Day 85
Secondary Mean Change From Baseline in Pittsburgh Sleep Quality Index (PSQI) Scores at Day 85 PSQI, a self-rated questionnaire was used to assess sleep quality and disturbances over a 1-month time interval. A total of 19 individual items generated 7 component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component was scored from 0 (no difficulty) to 3 (severe difficulty). The sum of the scores for the 7 components yielded 1 global score (ranging from 0 to 21). Higher PSQI score indicated worse quality of sleep. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. The analysis was carried out using an ANCOVA model, with the PSQI change from Baseline to Day 85 as the dependent variable, treatment group as a fixed effect, and the Baseline PQIS as a covariate. Baseline; Day 85
Secondary Mean Change From Baseline in MS Neuropsychological Screening Questionnaire (MSNQ) Scores at Day 85 MSNQ, a self-reporting, 15-item questionnaire was used to screen for cognitive impairment in participants with MS. Participants (or their informants) scored each item on a scale from 0 (not at all) to 4 (often and greatly interferes with life). The total MSNQ score was calculated as the sum of the sub-scores for all 15 questions and thus ranged from 0 to 60. A higher score indicated greater impairment. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. The analysis was carried out using an ANCOVA model, with the MSNQ score change from Baseline to Day 85 as the dependent variable, treatment group as a fixed effect, and the Baseline MSNQ as a covariate. Baseline; Day 85
Secondary Mean Change From Baseline in Beck Depression Inventory (BDI-II) Scores at Day 85 BDI-II, a 21-item, self-reported instrument was used to assess the existence and severity of symptoms of depression. Each item corresponded to a symptom of depression and as scored on a 4-point scale, ranging from 0 to 3. Participants were asked to consider each statement as it related to the way they have felt for the past 2 weeks. Each of the 21 items were summed to give a single score for the BDI-II (ranging from 0 to 63). A total score of 0 to 13 indicated minimal depression, a score of 14 to 19 indicated mild depression, a score of 20 to 28 indicated moderate depression, and a score of 29 to 63 indicated severe depression. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. The analysis was carried out using an ANCOVA model, with the BDI-II change from Baseline to Day 85 as the dependent variable, treatment group as a fixed effect, and the Baseline BDI-II as a covariate. Baseline; Day 85
Secondary Mean Change From Baseline in Symbol Digit Modalities Test (SDMT) Scores at Day 85 The SDMT assessed organic cerebral dysfunction in both children (8 years and older) and adults. The SDMT involved a simple substitution task that normal participants could easily perform. Using a reference key, the examinee had 90 seconds to pair specific numbers with given geometric figures. The SDMT score was the total correct response (not counting errors) in 90 seconds and ranged from 0 to 110. Lower scores indicated increased dysfunction. Baseline was defined as last non-missing measurement prior to dosing. Change from Baseline was calculated as the post-Baseline value minus the Baseline value. The analysis was carried out using an ANCOVA model, with the SDMT change from Baseline to Day 85 as the dependent variable, treatment group as a fixed effect, and the Baseline SDMT as a covariate. Baseline; Day 85
Secondary Mean Numerical Rating Scale (NRS) Scores at Days 22, 50, and 85 The NRS was an 11-point scale for participant self-reporting of pain. The overall scores ranged from 0 (no spasticity) to 10 (worst possible spasticity). Higher scores indicated increased aggression. Days 22, 50, and 85
Secondary Mean Overall Patient Global Impression of Change (PGIC) Scores at Day 85 The PGIC was a standard, validated 7-point categorical scale. The participant was asked to assess the overall change in his or her central neuropathic pain symptoms since entry into the study on a scale of 0 to 7 (0=much better; 7=much worse). Higher scores indicated worsening. Day 85
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