E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Multiple sclerosis is a chronic immune system disease, with neurological symptoms and signs such as tight or stiff muscles, pain, bladder dysfunction, impaired mobility, tiredness and muscle tremors |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10041416 |
E.1.2 | Term | Spasticity |
E.1.2 | System Organ Class | 100000004852 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To determine the change in Mean Spasticity in subjects treated with VSN16R as compared to subjects treated with placebo, measured by a NUMERICAL RATING SCALE (NRS) Score, from Baseline before Study Period III (V4) to End of Treatment (V7). |
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E.2.2 | Secondary objectives of the trial |
•To determine the relationship between the dose of VSN16R and the change in Spasticity, as measured by the NRS Score, from the Baseline before Study Period II (at V2) to the end of Study Period II, in at least the first 50 patients recruited.
•To evaluate change in Mean Spasticity in subjects treated with VSN16R compared to subjects treated with placebo, as measured by the modified ASHWORTH SCALE (mASH) from Baseline before Study Period III (V4) to End of Treatment (V7)
•To compare during Study Period II changes in Spasticity, as measured by the mASH, within each individual subject, from Baseline (time 0) to fixed times intervals (approx. 1, 3, and 6 hours after dosing), for each different dose level (100, 200, 400, and 800mg dose) in at least the first 50 patients recruited.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Be between 18 and 70 years of age, inclusive and having given written informed consent.
•Have a confirmed diagnosis of MS: either, relapsing remitting MS (RRMS), secondary progressive MS (SPMS) or primary progressive MS (PPMS) as per McDonald’s 2010 revised criteria (Polman, 2011).
•Have an Expanded Disability Status Scale (EDSS) ≤ than 6.5 at screening.
•Spasticity due to MS of at least 3 months duration, which is not wholly relieved with current anti-spasticity therapy, and which is expected to remain stable for the duration of the study.
•A minimum score ≥ 4 in the NRS for spasticity as rated by the subject at screening.
•A minimum mean score of ≥2 on the Ashworth spasticity scale in at least 2 lower extremity muscle groups and a total mASH score of, at least, 4 in the lower extremity muscles tested at screening.
•Normal renal function (estimated CrCl > 60ml/min). Normal hepatic function.
•Women of childbearing potential (i.e., those not postmenopausal or surgically sterile) may participate provided that they are using adequate birth control methods (including barrier methods, intrauterine device [IUD], and oral contraceptives) for the duration of the study. Women who are of child-bearing potential must continue to use contraception for at least 1 month after their last dose of study medication.
•Men must use barrier contraception for the duration of the study and continue to use it for at least 1 month after their last dose of study medication.
•Willing and able to perform all procedures related to the clinical trial and to provide informed consent.
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E.4 | Principal exclusion criteria |
•Acute MS relapse requiring treatment with steroids within 30 days of screening.
•Initiation or discontinuation of MS disease modifying treatment (DMT) within 30 days of screening.
•Receiving medications that would potentially interfere with the actions of the study medication or outcome variables, including antispastic medications like baclofen, tizanidine, botulinum toxin, cannabinoids, benzodiazepines, gabapentin, pregabalin, smoked cannabis etc.
•Any concomitant disease or disorder that has spasticity-like symptoms or that may influence the subject's level of spasticity.
•Changes in chronic oral medications within 4 weeks of baseline and during study
•Significant abnormalities in screening lab parameters (e.g., alanine aminotransferase [ALT], aspartate aminotransferase [AST], bilirubin > 2 ×upper limit of normal [ULN]; creatinine > 2mg/dl; white blood cell [WBC] < 2,300; platelets < 80,000).
•Previous history of dementia, unstable psychiatric disease, or current signs and symptoms of significant medical disorders such as severe, progressive, or uncontrolled renal, hepatic, haematological, endocrine, pulmonary, cardiac, neurological, or cerebral disease.
•Women who are pregnant or breastfeeding.
•History of substance abuse within the past 12 months.
•Participation in another clinical trial within 30 days of V1.
•Subjects who are uncooperative or unwilling to sign consent form. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Efficacy analysis by:
Numerical rating scale(Spasticity)
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary efficacy analysis for Study Period II of the study will be the modelling of the relationship between dose and change from baseline in NRS for individual participants.
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E.5.2 | Secondary end point(s) |
Modified Ashworth Scale
Modified Tardieu Scale (mTS)
Timed 10 metre walk (applicable up to EDSS 6.5 subjects)
Spasm count / Pain assessment
CGI-I, PGI-I |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
*A within subject comparison of NRS and the secondary efficacy outcome variables by dose level versus placebo in Period II of the study using the full analysis set in at least first 50 patients recruited.
*The comparison of the change in the secondary efficacy outcome variables during Sstudy Pperiod III (from V4 to V7) between the VSN16R treatment group and the placebo treatment group within the efficacy evaluable analysis set.
*The comparison of the number of responders at V7 and at V8 between the VSN16R treatment group and the placebo treatment group within the efficacy evaluable analysis set. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 6 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial 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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |