Ketamine for Treatment of MS Fatigue

Multiple Sclerosis Clinical Trial

Official title:

Ketamine for Treatment of Multiple Sclerosis-related Fatigue

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03500289
• Other study ID #: IRB00164017
• Status: Completed
• Phase: Phase 1/Phase 2
• Start date: August 10, 2018
• Est. completion date: August 30, 2019

Study information

• Verified date: July 2020
• Source: Johns Hopkins University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Multiple sclerosis (MS) is an inflammatory, demyelinating and degenerative disease of the central nervous system and, after trauma, is the most common cause of disability in young adults, affecting more than 400,000 individuals in the US. Of all the symptoms that can occur with MS, chronic fatigue is the most common and disabling, reported by at least 75% of patients at some point. Fatigue limits patients' daily activities, and challenges employment, resulting in substantial socioeconomic consequences. Despite this negative impact, fatigue treatments have been inconsistently studied, in part due to poorly understood underlying pathophysiological mechanisms. Yet to be defined biological processes and lack of clear treatment targets have also hampered the development of drugs for fatigue. As a result, there are no medications approved by the Food and Drug Administration (FDA) for the treatment of MS fatigue.

The investigators recently reported that riluzole, a medication with anti-glutamatergic effects, increased the fatigue severity in patients with relapsing MS who had participated in a clinical trial evaluating potential neuroprotective effects of riluzole versus placebo. Three other clinic trials which examined memantine effects on cognition in patient with MS also reported worsening fatigue as a major side effect. Memantine main mechanism of action is blocking the N-methyl D-aspartate (NMDA) glutamate receptor. These observations prompted the investigators that glutamatergic transmission probably plays an important role in fatigue pathogenesis and modulating these pathways could have potential therapeutic effect on MS-related fatigue. A recent paper reported that ketamine, an NMDA receptor blocker with different kinetics compared to memantine, had a strong and prolonged effect in reducing fatigue in bipolar patients who participated in a clinical trial, evaluating anti-depressive effects of ketamine versus placebo. Interestingly, the effect of ketamine on fatigue was independent of its antidepressant effects.

The primary objective of this study is to determine if modulating glutamatergic transmission with ketamine is safe and efficacious in improving MS-related fatigue. These objectives will be answered in a proof of concept, randomized controlled trial of ketamine versus an active placebo (midazolam) in patients with relapsing or progressive MS who have clinically significant fatigue.

18 patients with MS and reported fatigue, will be randomized 2:1 to one infusion of ketamine 0.5 mg/kg over 40 minutes versus one infusion of midazolam 0.05 mg/kg over 40 minutes. Midazolam is chosen as an active placebo to keep the participants blinded to participants' medication assignment. Primary outcome of the study will be Daily Fatigue Severity measured daily from day one through day seven post-infusion.

Secondary outcomes of the study include other fatigue questionnaires, depression and sleepiness. The length of study will be around 28 days.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 18
• Est. completion date: August 30, 2019
• Est. primary completion date: August 30, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Age between 18 years 65 years.

• Females of childbearing age must have a negative urine pregnancy test at baseline and use an effective method of contraception during the study.

• Diagnosis of MS (according to the 2010 McDonald criteria).

• Ambulatory (at least 20 feet using bilateral assistance).

• Fatigue reportedly present and screening modified fatigue impact scale (MFIS) score >33.

• Internet and email access and able to use a computer or tablet

Exclusion Criteria:

• Beck Depression Inventory (BDI) score of more than 30.

• Neurodegenerative disorders other than relapsing or progressive MS.

• Breastfeeding or pregnant.

• History of coronary artery disease or congestive heart failure.

• Uncontrolled hypertension at screening (history of high blood pressure and screening systolic blood pressure >160 or diastolic blood pressure>100).

• History of severe liver disease, including cirrhosis.

• Terminal medical conditions.

• Currently treated for active malignancy.

• Alcohol or substance abuse in the past year (except marijuana or other cannabinoids).

• A history of intolerance or allergic or anaphylactic reaction to ketamine or midazolam

• Clinically unstable medical or psychiatric disorders that require acute treatment as determined by the PI.

• History of severe or untreated coronary artery disease or history of congestive heart failure.

• History of prior ischemic or hemorrhagic stroke and cerebral vascular aneurysms.

• History of recurrent seizures or epilepsy.

• Taking any disallowed therapy(ies) as noted in Appendix 2 of the protocol.

Related Conditions & MeSH terms

• Fatigue
• Multiple Sclerosis
• Sclerosis

Intervention

Drug:
• Ketamine
One intravenous infusion of ketamine 0.5 mg/kg over 40 minutes
• Midazolam
One intravenous infusion of midazolam 0.05 mg/kg over 40 minutes

Locations

Country	Name	City	State
United States	Johns Hopkins University	Baltimore	Maryland

Sponsors (2)

Lead Sponsor	Collaborator
Johns Hopkins University	National Multiple Sclerosis Society

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Daily Fatigue Severity Score	It is a single item question: 'how much fatigue (tiredness, weariness, problems thinking clearly) have you felt today?' with responses from 0 'None at all' to 10 'Extreme Fatigue'. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: [(last day measure - baseline measure) / the number of days in the study].	Baseline (infusion visit) through day 7
Secondary	Change in Quality of Life in Neurological Disorders (NeuroQol) Fatigue Item Bank Score	T-score distributions rescale raw scores into standardized scores with a mean of 50 and a standard deviation (SD) of 10. Higher T-scores denote more severe fatigue. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: [(last day measure - baseline measure) / the number of days in the study].	Baseline (infusion visit) through day 28 post-infusion
Secondary	Change in Modified Fatigue Impact Scale (MFIS) Score	The total score of the MFIS ranges from 0 to 84. Higher scores denote more severe fatigue. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: [(last day measure - baseline measure) / the number of days in the study].	Baseline (infusion visit) through Day 28 post-infusion
Secondary	Change in Epworth Sleepiness Scale Score	The Epworth Sleepiness Scale score can range from 0 to 24. The higher the score, the higher that person's average sleep propensity in daily life (ASP), or their 'daytime sleepiness'. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: [(last day measure - baseline measure) / the number of days in the study].	Baseline (infusion visit) through day 28 post-infusion
Secondary	Change in Beck Depression Inventory (BDI) Score	The total score of the BDI ranges from 0 to 63. Higher scores denote more severe depressive symptoms. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: [(last day measure - baseline measure) / the number of days in the study].	Baseline (infusion visit) through day 28 post-infusion
Secondary	Change in Fatigue Severity Scale (FSS) Score	The total score of the FSS ranges from 9 to 63. Higher scores denote more severe fatigue. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: [(last day measure - baseline measure) / the number of days in the study].	Baseline (infusion visit) through day 28 post-infusion