Double-blind, Placebo-controlled, Randomized Study of the Safety and Tolerability of Isoxsuprine HCL Combined With High Dose Steroid Treatment of Multiple Sclerosis (MS) Relapse
Overview
- Phase
- Phase 1
- Intervention
- Isoxsuprine Hydrochloride
- Conditions
- Multiple Sclerosis
- Sponsor
- University of New Mexico
- Enrollment
- 2
- Locations
- 1
- Primary Endpoint
- Incidence of Treatment-Emergent Adverse Events in Subjects by Measuring Measuring Changes in Vital Signs
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
This is a proof of concept, randomized, double-blind, placebo-controlled, 2-arm, parallel group study of Isoxsuprine in MS subjects experiencing a typical relapse.
Evidence from preclinical stroke models and experimental allergic encephalomyelitis suggest that isoxsuprine hydrochloride may have neuroprotective activity and reduce disability in animal models. Given its potential neuroprotective effects in CNS injury models, the investigators propose to test it as a safe, tolerable add on treatment for acute relapses in patients with relapsing forms of MS.
Detailed Description
This is a proof of concept, randomized, double-blind, placebo-controlled, 2-arm, parallel group study of Isoxsuprine in MS subjects experiencing a typical relapse. All subjects will have a documented diagnosis of relapsing MS or a clinically isolated syndrome by international criteria. The relapse will be of sufficient severity that their physician recommends treatment with a high dose corticosteroid pulse. All subjects will have a physical examination and history with questions on drug sensitivities. Subjects experiencing the onset of objective neurological deficits consistent with relapse within 7 days of randomization are eligible for screening for this study. Those currently on MS disease modifying therapy will have received a stable regimen of the medications for at least 30 days prior to screening and will continue the same doses and regimens for the duration of their study participation. Consented subjects will be assessed for relapse criteria and those who meet study eligibility criteria and agree to be treated with a standard 3 to 5 day pulse of high dose corticosteroids, will be randomized with equal probability to 1 of 2 treatment groups: placebo capsule or active Isoxsuprine (ISX). The Screening Visit will take place within 7 days of relapse onset and within 48 hours of initiating high dose steroids. Subjects may start corticosteroids anytime during this 7 day window. During the screening period, subjects will be assessed with the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and cognitive testing prior to treatment with ISX or placebo (1:1 ratio). Safety Assessments during screening will include a physical exam, electrocardiogram, vital signs, weight and a urine pregnancy test for females of child bearing potential. At 7 (± 1) days following the completion of the 5-day ISX dosing, subjects will be re-assessed with the EDSS. Subjects will be evaluated for treatment response using the EDSS and other standard measures. Study drug will be administered as one (1) 10 mg capsule, 3 times daily for 5 days in conjunction with concomitant dosing with high dose corticosteroids. This can be any accepted regimen, including daily iv methylprednisolone 1000 mg/day or 600mg oral prednisone two times a day at approximately 8AM and noon, with food, as typically provided by UNM MS Specialty Clinic.
Investigators
Corey C Ford, MD, PhD
Senior Associate Dean for Research, Office of Research
University of New Mexico
Eligibility Criteria
Inclusion Criteria
- •Subjects must be adequately informed and understand the nature and risks of the study and must be able to provide a signature and date on the ICF;
- •Male or female subjects between 18 and 50 years of age, inclusive;
- •Confirmed diagnosis of Multiple Sclerosis or Clinically Isolated Syndrome (CIS) suggestive of MS, according to the 2010 Revised McDonald criteria.
- •On a stable regimen of medications taken specifically to treat MS for at least 30 days prior to screening, and willing to continue the same doses and regimens for the duration of study participation;
- •New neurological disability consistent with MS relapse no longer than 7 days prior to screening;
- •Screen visit and randomization must occur within 48 hours of subject initiating steroid treatment.
- •Maximum EDSS score during screening of 6.5;
- •Sufficient ambulatory ability (ambulatory aids acceptable if used consistently) to complete two trials of the Timed 25 Foot Walk (T25FW) at the screening visit with the two trials completed within 5 minutes of each other in accordance with the specific instructions provided by the National MS Society Functional Composite Manual.
- •Subject must be willing to take a high dose steroid (600mg oral prednisone two times a day (bid).
- •Subjects must have a mean systolic blood pressure ≤ 160 and greater than 100 mm Hg and a mean diastolic blood pressure of ≤ 100 and greater than 50 mm Hg determined by the average of 3 seated readings taken at least 5 minutes apart at the Screening Visit.
Exclusion Criteria
- •Subject is from a vulnerable population, as defined by the US CFR Title 45, Part 46, Section 46.111(b) and other local and national regulations, including but not limited to, employees (temporary, part-time, full time, etc) or a family member of the research staff conducting the study, or of the sponsor, or of the IRB.
- •Subject has only sensory, bowel/bladder, and/or cognitive symptoms of MS associated with the most recent relapse.
- •Subject has cognitive or behavioral impairment that in the opinion of the investigator would impair the ability of the subject to comply with study procedures.
- •Subject has any known contraindication(s) to the use of corticosteroids or isoxsuprine hydrochloride (ISX), including, but not limited to:
- •any current uncontrolled hypertension, primary adrenocortical insufficiency
- •Any current psychoses, infectious disease, or Cushing's syndrome.
- •Any current congestive heart failure (defined as New York Heart Association (Functional Class III to IV).
- •Peptic ulcer (within 24 weeks prior to the Screening Visit).
- •Recent major surgery (within 24 weeks prior to the Screening Visit).
- •Use of tizanidine any time in the past 30 days.
Arms & Interventions
Corticosteroid & Isoxsuprine HCL
Corticosteroid pulse of either daily iv methylprednisolone 1000 mg/day or 600mg oral prednisone two times a day at approximately 8AM and noon for 3 to 5 consecutive days and Isoxsuprine Hydrochloride one 10 mg Capsule 3 times daily for 5 consecutive days
Intervention: Isoxsuprine Hydrochloride
Corticosteroid & Isoxsuprine HCL
Corticosteroid pulse of either daily iv methylprednisolone 1000 mg/day or 600mg oral prednisone two times a day at approximately 8AM and noon for 3 to 5 consecutive days and Isoxsuprine Hydrochloride one 10 mg Capsule 3 times daily for 5 consecutive days
Intervention: Corticosteroid
Corticosteroid & Placebo
Corticosteroid pulse of either daily iv methylprednisolone 1000 mg/day or 600mg oral prednisone two times a day at approximately 8AM and noon for 3 to 5 consecutive day and placebo one Capsule 3 times daily for 5 consecutive days
Intervention: Placebo
Corticosteroid & Placebo
Corticosteroid pulse of either daily iv methylprednisolone 1000 mg/day or 600mg oral prednisone two times a day at approximately 8AM and noon for 3 to 5 consecutive day and placebo one Capsule 3 times daily for 5 consecutive days
Intervention: Corticosteroid
Outcomes
Primary Outcomes
Incidence of Treatment-Emergent Adverse Events in Subjects by Measuring Measuring Changes in Vital Signs
Time Frame: Baseline to Week 12
Vital Signs: Blood pressure greater than 140/90, pulse greater than 110 and temperature greater than 37.8 Celsius.
Secondary Outcomes
- Incidence of Adverse Event Expanded Disability Status Scale (EDSS)(Baseline to Week 12)