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    Summary
    EudraCT Number:2009-011216-38
    Sponsor's Protocol Code Number:1.02.7001
    National Competent Authority:UK - MHRA
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2010-10-19
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedUK - MHRA
    A.2EudraCT number2009-011216-38
    A.3Full title of the trial
    Spasticity in Stroke – Randomized Study
    A randomized, controlled, open-label, parallel-group, multi-center study to compare the effect of Intrathecal Baclofen Therapy (ITB Therapy®) versus Best Medical Treatment (BMT) on spasticity in post-stroke patients after 6 months active treatment
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Spasticity in Stroke - Randomized Study
    A multi-center study comparing the effect of two treatments for spasticity in which patients are randomly assigned to one of the following treatment groups:
    1) Intrathecal Baclofen Therapy (ITB Therapy®) a therapy for spasticity whereby the drug, Lioresal Intrathecal, is delivered near the spine through an implantable drug infusion system
    2) Best Medical Treatment (BMT) includes oral medications for spasticity
    A.3.2Name or abbreviated title of the trial where available
    SISTERS
    A.4.1Sponsor's protocol code number1.02.7001
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorMedtronic International Trading
    B.1.3.4CountrySwitzerland
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportMedtronic International trading
    B.4.2CountrySwitzerland
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationMedtronic
    B.5.2Functional name of contact pointSenior Clinical Research Specialist
    B.5.3 Address:
    B.5.3.1Street AddressRoute du Molliau 31
    B.5.3.2Town/ cityTolochenaz
    B.5.3.3Post code1131
    B.5.3.4CountrySwitzerland
    B.5.4Telephone number41218027606
    B.5.5Fax number41798269676
    B.5.6E-mailjuergen.koch@medtronic.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Lioresal Intrathecal
    D.2.1.1.2Name of the Marketing Authorisation holderNovartis
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLioresal Intrathecal
    D.3.2Product code N/A
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntrathecal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNb-(aminomethyl)-p-chlorohydrocinnamic acid (= baclofen), a racemic mixtureof teh R, (-) and S, (+) isomers
    D.3.9.1CAS number N/A
    D.3.10 Strength
    D.3.10.1Concentration unit µg/ml microgram(s)/millilitre
    D.3.10.2Concentration typeup to
    D.3.10.3Concentration number2000
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy Yes
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Marketed antispasmodics
    D.2.1.2Country which granted the Marketing AuthorisationUnited Kingdom
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Post-stroke spasticity
    E.1.1.1Medical condition in easily understood language
    Post-stroke spasticity
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 17.0
    E.1.2Level PT
    E.1.2Classification code 10028335
    E.1.2Term Muscle spasticity
    E.1.2System Organ Class 10029205 - Nervous system disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To demonstrate that ITB therapy, compared to BMT, has superior efficacy in the treatment of spasticity in adult post-stroke patients with generalised spastic hypertonia who have not reached their therapy goal with other treatment interventions assessed by the Ashworth Scale (AS)
    E.2.2Secondary objectives of the trial
    To evaluate whether ITB therapy is superior to BMT on:

    - Function assessed by Fuctional Independence Measure (FIM), 10 meter timed walking test

    - Safety (Adverse Events (AE))

    - Pain assessed by Numeric Pain Rating Scale (NPRS)

    - Primary therapy goal achievement assessed by Goal Attainment Scale (GAS)

    - Quality of Life (QoL) assessed by QoL questionnaires: EuroQol group - 5 dimensional (EQ-5D) and Stroke Specific - Quality of Life (SS-QoL)

    - Satisfaction withthe therapy assessed by Likert Scale (patient and caregiver)

    - Healthcare resource utilisation.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    To be eligible for inclusion into this study, patients must fulfil all of the following criteria prior to study enrolment:

    1. Patient (or legal guardian) has been informed of the study procedures and has given written informed consent.

    2. 18 - 75 years of age

    3. Patieint experienced last stroke > 6 months prior to enrolment

    4. Patient presents spasticity in at least two extremities

    5. Patient presents an Ashworth score of at least 3 in a minimum of two of the affected muscle groups in the lower extremities

    6. Patient is eligible to receive ITB therapy following the Adult Spasticity Algorithm
    a. Patient does not reach his/her therapy goal with other treatment interventions

    7. Patient is medically stable:
    a. stable blood pressure:
    i. no change in hypertensive medication in the last month
    NOTE: ventriculo-peritoneal shunts and valves can be present

    8. If female, she must either:
    a. be post-menopausal or surgically sterilised; or
    b. use a hormonal contraceptive, intra-uterine device, diaphragm with spermicide,
    or condom with spermicide, for the duration of the study

    9. Patient/family is willing to comply with the study protocol including attending the study visits
    E.4Principal exclusion criteria
    To be eligible for inclusion in this study the patients must NOT meet any of the following criteria:

    1. Patient/family is considered by the physician to be unable or unwilling to participate in long-term ITB therapy management

    2. Patient has known hypersensitivity to baclofen

    3. Active systemic infection
    NOTE: pressure sores are not a contraindication unless they are present near the
    implant sites

    4. Presence of a cardiac pacemaker, ICD, implantable neurostimulator or drug delivery device

    5. Uncontrolled refractory epilepsy

    6. Use of oral vitamin K anatagonists e.g. warfarin or coumadin; unless the patient can switch to another accepted anticoagulant (e.g. heparin) for the period of ITB test and implant

    7. Patient is pregnant or breast feeding

    8. Patient received a Botulinum toxin injectin less than 4 months ago

    9. According to the investigator's opinion, the patient is not capable to comprehend the nature of the study and to give his/her informed consent him/herself
    E.5 End points
    E.5.1Primary end point(s)
    Primary Endpoints:
    The average AS will be calculated as an average of the S value on following lower extremities muscles: hip flexors, hip adductors, knee extensors, knee flexors and ankle dorsal flexors.



    E.5.1.1Timepoint(s) of evaluation of this end point
    Timepoint of evaluation of this endpoint:
    Change inthe average AS from baseline to 6 months visit.
    E.5.2Secondary end point(s)
    Secondary Endpoint:
    Secondary endpoints will be evaluated to assess improvements in function, pain, satisfaction with the therapy, primary therapy goal achievement, resource utilisation and quality of life in the ITB therapy arm compared to the BMT arm.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Timepoint of evaluation of this endpoint:
    Secondary endpoints will be evaluated at 6 months visit
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) Yes
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned2
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA18
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    United States
    E.8.7Trial has a data monitoring committee Yes
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last visit of the last patient
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years7
    E.8.9.1In the Member State concerned months
    E.8.9.1In the Member State concerned days
    E.8.9.2In all countries concerned by the trial years7
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero Information not present in EudraCT
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) Information not present in EudraCT
    F.1.1.3Newborns (0-27 days) Information not present in EudraCT
    F.1.1.4Infants and toddlers (28 days-23 months) Information not present in EudraCT
    F.1.1.5Children (2-11years) Information not present in EudraCT
    F.1.1.6Adolescents (12-17 years) Information not present in EudraCT
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 58
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 30
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    Patients who had a stroke and who are cognitively impaired
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state9
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 72
    F.4.2.2In the whole clinical trial 88
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    Patients enrolled in the ITB therapy will continue to receive ITB therapy. Patients enrolled in the BMT arm will continue to be followed per normal clinical practice
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2009-11-17
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2010-10-20
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2016-09-20
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