Safety and Efficacy of AVP-923 in PBA Patients With ALS or MS
- Conditions
- Pseudobulbar Affect (PBA)
- Interventions
- Registration Number
- NCT00573443
- Lead Sponsor
- Avanir Pharmaceuticals
- Brief Summary
Objectives of the study are to evaluate the safety, tolerability, and efficacy of two different doses of AVP-923 (capsules containing either 30 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate \[AVP-923-30\] or 20 mg of dextromethorphan hydrobromide and 10 mg of quinidine sulfate \[AVP-923-20\]) when compared to placebo, for the treatment of PBA in a population of patients with amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) over a 12-week period. An additional objective is to determine the pharmacokinetic parameters of the two different doses of AVP-923 in a subset of the study population.
Pseudobulbar Affect (PBA) is a condition characterized by involuntary, sudden and frequent episodes of laughing and/or crying out of proportion or incongruous to the underlying emotion of happiness or sadness Other terms used to describe this condition include emotional lability, emotionalism, emotional incontinence, emotional discontrol, excessive emotionalism, and pathological laughing and crying. The outbursts can occur spontaneously or in response to provocative stimuli such as questions or events.
A body of evidence suggests that PBA can be modulated through pharmacologic intervention.
Dextromethorphan (DM) is a low-affinity uncompetitive antagonist of the N-Methyl-D-aspartate (NMDA) receptor, reducing the level of excitatory activity. DM also acts at the phencyclidine-binding site, which is part of the NMDA receptor complex. DM is a sigma receptor agonist, suppressing the release of excitatory neurotransmitters.
Quinidine (Q) is a known potent inhibitor of cytochrome P450 2D6 (CYP2D6), that decreases the metabolism of dextromethorphan and helps to achieve sustained and therapeutic levels of this drug.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 326
- The patient has a diagnosis of Amyotrophic Lateral Sclerosis (according to El Escorial Criteria, WFN, 1998) and the time from diagnosis of ALS is not be longer than 30 months, or the patient has a diagnosis of multiple sclerosis or probable multiple sclerosis (according to McDonald criteria, 2001)
- The patient has a clinical history and clinical relevant symptoms of Pseudobulbar Affect (PBA)
- CNS-LS score at baseline is 13 or greater
Main
- Patients with myasthenia gravis
- Any personal history of complete heart block, QTc prolongation, or torsades de pointes
- Any family history of congenital QT interval prolongation syndrome
- Patients with known sensitivity to quinidine, dextromethorphan or opiate drugs (codeine, etc.)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description DM 30 mg/Q 10 mg dextromethorphan hydrobromide 30 mg and quinidine sulfate 10 mg AVP-923-30/10 Capsules (30 mg dextromethorphan/10 mg quinidine)administered once daily for 1 week and then twice daily for 11 weeks DM 20 mg/ Q 10 mg dextromethorphan hydrobromide 20 mg and quinidine sulfate 10 mg AVP-923-20/10 Capsules (20 mg dextromethorphan/10 mg quinidine)administered once daily for 1 week and then twice daily for 11 weeks Placebo Placebo Placebo Capsules once daily for 1 week and then twice daily for an additional 11 weeks
- Primary Outcome Measures
Name Time Method PBA Episode Rate Ratio (Post/Pre), Regression Adjusted Baseline to Day 84 Episodes were counted each day and recorded in a daily diary. The outcome measure is the ratio of the episode rate over the 84-day treatment period to the rate during the baseline period, adjusted for study site, and underlying disease using longitudinal negative binomial regression.
- Secondary Outcome Measures
Name Time Method Mean Change From Baseline in CNS-LS Total Score by Visit Baseline, Day 15, Day 29, Day 57, Day 84 Center for Neurologic Studies-Lability Scale (CNS-LS) is an instrument for the measurement of PBA that has been validated for the use in patients with ALS and MS. It is a 7-item self-report questionnaire that measures the frequency and severity of PBA episodes, including assessments of labile laughter and labile tearfulness,and provides a score for total PBA (total score can range from 7-35). The following 5-point scoring was used: 1=Applies never, 2=Applies rarely, 3=Applies occasionally, 4=Applies frequently, 5=Applies most of the time. A score of 13 or higher may suggest PBA, and the higher the score the more severe the episodes.
Mean Change From Baseline to Day 84 in Neuropsychiatric Inventory (NPI-Q) Frequency and Severity Score (ITT Population) Baseline to Day 84 The NPI is a retrospective (to 1 month) caregiver-informant interview assessing frequency and severity of 12 neuropsychiatric symptom domains. The NPI score is based on the sum of the severity ratings (0=absent, 1=mild, 3=severe). The 12 symptom domains include delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, euphoria/elation, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviors, nighttime behavioral disturbances, and appetite/eating abnormalities. The NPI severity score is based on severity ratings (0=absent, 1=mild to 3=severe).
Mean Change From Baseline at Day 84 in SF-36 (Short-Form) Health Survey Medical Outcome Score by Category Baseline and Day 84 The SF-36 is designed to examine a person's perceived health status. The SF-36 includes one multi-item scale measuring eight health concepts: vitality, physical functioning, bodily pain, general health perceptions, physical role-, emotional role-, social role functioning, and mental health. Answers to each question are scored and summed to produce raw scale scores for each health concept which are then transformed to a 0 - 100 scale, a high score defining a more favorable health state. An aggregate summary measure is calculated by averaging the scores from the eight health concepts.
Mean Change From Baseline at Day 84 in Beck Depression Inventory (BDI-II) Total Score Baseline and Day 84 The BDI-II is a 21-item self report instrument intended to assess the existence and severity of symptoms of depression, summed to give a single score. The BDI-II uses a 4-point for each item ranging from 0 to 3. A total score of 0-13 is considered minimal range, 14 to 19 is mild, 20 to 28 is moderate, and 29 to 63 is severe.
Mean Change From Baseline to Day 84 in Neuropsychiatric Inventory (NPI-Q) Frequency and Severity Score (EE Population) Baseline to Day 84 The NPI is a retrospective (to 1 month) caregiver-informant interview assessing frequency and severity of 12 neuropsychiatric symptom domains. The NPI score is based on the sum of the severity ratings (0=absent, 1=mild, 3=severe). The 12 symptom domains include delusions, hallucinations, agitation/aggression, dysphoria/depression, anxiety, euphoria/elation, apathy/indifference, disinhibition, irritability/lability, aberrant motor behaviors, nighttime behavioral disturbances, and appetite/eating abnormalities. The NPI severity score is based on severity ratings (0=absent, 1=mild to 3=severe).
Mean Change From Baseline to Day 84 in Pain Rating Scale (PRS) of MS Subjects Baseline, Day 15, Day 29, Day 57, Day 84 Subjects with MS were instructed to also record daily the pain they experienced using the PRS. After evaluating the subject's ability to comply with these requirements, the investigator determined if a caregiver should complete the study diary and assessments. Subjects rated their pain over the past 12 hours on a scale of 0 to 10 (0=none, 10=worst pain ever experienced).
Trial Locations
- Locations (62)
St. Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Neuromuscular Research Center
🇺🇸Scottsdale, Arizona, United States
South Coast Clinical Trials
🇺🇸Anaheim, California, United States
UCI Medical Center
🇺🇸Irvine, California, United States
Center for Neurologic Study
🇺🇸La Jolla, California, United States
UCLA School of Medicine
🇺🇸Los Angeles, California, United States
The Forbes Norris MDA/ALS Research Center - California Pacific Medical Center
🇺🇸San Francisco, California, United States
The ALS Center at UCSF
🇺🇸San Francisco, California, United States
University of Colorado at Denver & Health Science Center
🇺🇸Aurora, Colorado, United States
Neuroscience Center
🇺🇸Ft. Lauderdale, Florida, United States
Scroll for more (52 remaining)St. Joseph's Hospital and Medical Center🇺🇸Phoenix, Arizona, United States