Combination Therapy With Dalfampridine and Locomotor Training for Chronic, Motor Incomplete Spinal Cord Injury

This study is currently recruiting participants. (see Contacts and Locations)
Verified December 2012 by Kessler Foundation
Sponsor:
Collaborators:
U.S. Department of Education
Acorda Therapeutics
Information provided by (Responsible Party):
Trevor Dyson-Hudson, M.D., Kessler Foundation
ClinicalTrials.gov Identifier:
NCT01621113
First received: June 12, 2012
Last updated: December 27, 2012
Last verified: December 2012
  Purpose

The purpose of this study is to determine the efficacy, safety, and tolerability of treatment with dalfampridine in combination with locomotor training in persons with chronic, motor incomplete SCI.


Condition Intervention Phase
Spinal Cord Injury
Drug: Dalfampridine
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Restoring Lost Functions After Spinal Cord Injury: Combination Therapy With Dalfampridine and Locomotor Training for Persons With Chronic, Motor Incomplete Spinal Cord Injury

Resource links provided by NLM:


Further study details as provided by Kessler Foundation:

Primary Outcome Measures:
  • Change in 6-Minute Walk Test (6MWT) Distance at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) Visits ] [ Designated as safety issue: No ]
    The 6MWT measures the distance (in meters) walked within 6 minutes. The test is a measure of endurance; however, can also be used to measure walking speed.


Secondary Outcome Measures:
  • Change in 10-Meter Walk Test (10MWT) Speed at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The 10MWT measures the time in seconds that it takes a person to walk 10m. The test is a measure of functional capacity and assesses short-duration walking speed.

  • Change in Timed 25-foot walk (T25FW) Speed at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The T25FW is a quantitative measure of lower extremity function in persons with multiple sclerosis. The T25FW was the primary outcome measure of efficacy used in MS studies of dalfampridine and is being performed in our study as a means of comparing results across studies and populations. The T25FW can be measured during the 10MWT.

  • Change in Walking Index for Spinal Cord Injury II (WISCI II) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The WISCI II is a walking scale specifically developed for use in clinical trials in persons with incomplete SCI. Walking ability is scored on a 21-point ordinal scale (0-20, where 0 indicates a person is unable to stand and/or participate in assisted walking and 20 indicates a person can walk more than 10m without walking aids or physical assistance), where a lower number indicates higher impairment.

  • Change in Spinal Cord Injury Functional Ambulation Index (SCI-FAI) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The SCI-FAI is an observational gait assessment instrument that addresses three key domains of walking function in individuals with SCI. The three SCI-FAI subscales are Gait, Assistive Device, and Walking Mobility. Parameters of the SCI-FAI are measured during the first 2 minutes of the 6MWT (see above).

  • Changes on International Standards for Neurological Classification of Spinal Cord Injury at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    Neurological examination will be performed using the International Standards for Neurological Classification. Sensory scores and lower extremity motor scores are derived at the time of this exam.

  • Change in Lower-Extremity Motor Scores (LEMS) at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The LEMS measures strength in five muscle groups bilaterally (hip flexors, knee flexors and extensors, and ankle dorsiflexors) with the modified British Medical Research Council scale and is performed during the International Standards examination.

  • Change in Berg Balance Scale (BBS) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The BBS is a 14-item instrument originally designed to assess the risk for falls in community.

  • Change in Modified Ashworth Scale (MAS) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    Spasticity assessments will be performed at each study visit using the modified Ashworth scale (MAS). Ashworth scores will be averaged across three muscle groups bilaterally: hip adductors, knee extensors, and knee flexors. The Ashworth Scale data will be collected on a 1-5 scale rather than the published 0-4 scale.

  • Change in Bowel Management Questionnaire Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The bowel management questionnaire uses a 6-point scale and requires the subject to rate the frequency (0, "Not at all"; 5, "Almost always") of ten items regarding bowel management over the past month.

  • Change in Bladder Management Questionnaire Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The bladder management questionnaire uses a 6-point scale and requires the subject to rate the frequency (0, "Not at all"; 5, "Always or almost always") of eight items regarding bladder management over the past month.

  • Change in Female Sexual Function Index (FSFI) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The FSFI is a multidimensional, self-report instrument used to assess female sexual function. Six domains are identified that include desire, subjective arousal, lubrication, orgasm, sexual satisfaction, and pain.

  • Change in International Index of Erectile Function (IIEF) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The IIEF is a 15-item questionnaire to assess male sexual function. Quality of male sexual function is assessed in 5 domains, with 6 items that assess erectile function, 2 items that address orgasmic function, 2 questions that assess sexual desire, 3 items that assess intercourse satisfaction, and 2 items that assess overall sexual satisfaction.

  • Changes in Pulmonary Function Tests at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    Pulmonary function testing will be performed (V max Spectra 29N, Carefusion, Yorba Linda, CA) to measure spirometric parameters, static lung volumes, cough strength, and maximal mouth expiratory and inspiratory pressures.

  • Changes in Autonomic Function at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    To assess changes in autonomic cardiovascular function, heart rate (3 lead ECG Ivy Biomedical Systems, Inc. Branford, CT) and blood pressure (Finometer Midi, Finapres Medical Systems, Amsterdam, Netherlands) will be continuously monitored at 5 minute intervals at rest and during locomotor training.

  • Changes on the International Spinal Cord Injury Pain Basic Data Set (ISCIPDS:B) at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The ISCIPDS:B contains core questions about clinically relevant information concerning SCI-related pain that can be collected by health-care professionals with expertise in SCI in various clinical settings. Each person is asked to describe the three worst pain problems he/she is currently experiencing.

  • Change in Spinal Cord Independence Measure III (SCIM III) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The SCIM is a measure of functional ability developed specifically for individuals with SCI to evaluate their performance of activities of daily living (ADL). The SCIM III is composed of 19 items in 3 sub-scales: (a) self-care (6 items, sub-score 0-20); (b) respiration and sphincter management (4 items, sub-score 0-40); and (c) mobility (9 items, sub-score 0-40). The total score ranges from 0 to 100.

  • Change in Spinal Cord Injury-Functional Index (SCI-FI) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The Spinal Cord Injury Functional Index (SCI-FI) is a comprehensive, SCI-specific measure to assess functional activities related to quality of life for individuals with SCI. The SCI-FI covers five distinct functional domains: Ambulation, Basic Mobility, Fine Motor Function, Self-Care (including bowel and bladder), and Wheeled Mobility.

  • Change in 12-Item Short Form Health Survey (SF-12) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The SF-12 is a generic health-status measure developed by RAND to assess outcomes of medical care and has been used previously by the SCI Model Systems.

  • Change in Satisfaction with Life Scale (SWLS) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The SWLS is a 5-item measure of the single concept of global life satisfaction. The SWLS is currently used in the SCI Model Systems dataset and normative data for individuals with SCI is available.

  • Change in Craig Handicap Assessment and Reporting Technique (CHART) Scores at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The CHART is a 32-item self-report measure of major domains of participation, which has also been utilized extensively by SCI Model System researchers. It assesses functioning in 6 domains of normative role functioning: Physical Independence, Mobility, Occupation, Social Integration, Cognitive Independence, & Economic Self-Sufficiency.

  • Change in Subject Global Impression (SGI) of Change at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The SGI of change is a subject-rated instrument that measures change in the subject's overall status on a 7-point scale. Scores range from 1 (very much improved) to 7 (very much worse).

  • Change in Clinician Global Impression (CGI) of Change at 10 Weeks [ Time Frame: Baseline, Mid-Point (Week 5), Final (Week 10), and Follow-up (Week 22) ] [ Designated as safety issue: No ]
    The study physician will rate on a 7-point scale the subject's overall clinical condition following treatment as compared to that at baseline. Scores range from 1 (very much improved) to 7 (very much worse).

  • Adverse Event Case Report Form [ Time Frame: Every two weeks for 10 weeks ] [ Designated as safety issue: Yes ]
    Adverse experience(s) will be recorded on the Adverse Event Case Report Form, including the date and time of onset, severity, the relationship to study intervention, the date of resolution, the action taken, and the outcome of the adverse experience. The responsible physician will make a causality assessment for every adverse experience.

  • Side Effects Record [ Time Frame: Every two weeks for 10 weeks ] [ Designated as safety issue: Yes ]
    Participants will be provided a list of side-effects associated with dalfampridine treatment. Three lines marked "other" for open-choice responses will accompany the selection of options for forced-choice side-effects. Participants will rate the severity (visual analog scale [VAS]; 0-100) and frequency ("never", "occasionally", "sometimes", "often" or "always") of side effects for each of the forced and open choice answers. Severity and frequency of side-effects will be rated by participants every 2 weeks during the intervention part of the study.


Estimated Enrollment: 46
Study Start Date: June 2012
Estimated Study Completion Date: October 2016
Estimated Primary Completion Date: October 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Locomotor Training + Dalfampridine
Subjects randomized to this group will undergo 10 weeks of double-blind treatment with extended release dalfampridine tablets (10 mg twice daily) while simultaneously receiving locomotor training therapy (5 sessions per week x 10 weeks = 50 sessions total).
Drug: Dalfampridine
Dalfampridine 10 mg tablet, twice-daily, for 10 weeks
Other Names:
  • Ampyra
  • Fampridine Sustained Release (Fampridine-SR)
  • 4-Aminopyridine (4-AP)
Placebo Comparator: Locomotor Training + Placebo
Subjects randomized to this group will undergo identical treatment, but will take placebo tablets while simultaneously receiving locomotor training therapy (5 sessions per week x 10 weeks = 50 sessions total).
Drug: Placebo
Placebo tablet, twice daily, for 10 weeks.

Detailed Description:

Research suggests that combining therapies could result in important gains in restoring function and improving quality of life in persons with spinal cord injury (SCI). Locomotor training is an activity-dependent rehabilitation therapy that provides repetitive stepping facilitated by manual assistance and body weight support on a treadmill. Recent studies report improvements in walking and standing in individuals with motor incomplete SCI that have undergone intensive standardized locomotor training therapy. Extended release dalfampridine (also known as fampridine or 4-aminopyridine [4-AP]) is a broad spectrum potassium channel blocker that has been shown in animal studies to increase conduction of action potentials in demyelinated axons. Dalfampridine was recently approved by the U.S. Food and Drug Administration (FDA) as a treatment to improve walking in persons with multiple sclerosis (MS). Demyelination is also a prominent feature of incomplete SCI that contributes to the clinical presentation of persons with these injuries.

The purpose of this study is to determine the efficacy, safety, and tolerability of treatment with dalfampridine in combination with locomotor training in persons with chronic, motor incomplete SCI. We hypothesize that persons undergoing combination therapy with dalfampridine and locomotor training will show significantly greater improvements in walking speed and other measures of SCI function than those receiving locomotor training alone.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18 to 70 years, inclusive;
  • Neurological impairment secondary to a traumatic spinal cord injury that occurred at least twelve (12) months prior to the screening visit;
  • Neurological level of the injury between C4 and T10, inclusive;
  • The injury is classified as motor incomplete (AIS grade C or D);
  • Able and willing to comply with the study protocol, including availability for all scheduled clinic visits and locomotor training sessions.

Exclusion Criteria:

  • The participant is a lactating female, or a female of childbearing potential who is sexually active, has not had a hysterectomy or oophorectomy, and is not using an approved birth control method (e.g. tubal ligation, implantable contraception device, oral or injectable contraceptive, barrier method, or sexual activity restricted to vasectomized partner);
  • The participant has a history of seizures or treatment for seizure disorders;
  • The participant has renal impairment (Creatinine Clearance < 80 mL/min);
  • The participant has a known allergy to pyridine-containing substances or any of the inactive ingredients of the dalfampridine;
  • The participant has a clinically significant abnormal laboratory values or an abnormal electrocardiogram (ECG);
  • The participant has evidence of significant, diffuse, or generalized lower motor neuron damage;
  • The participant has received new concomitant medication less than 3 weeks before the study or has a dose of current concomitant medication that is expected to change during study;
  • The participant has received botulinum toxin injection for spasticity within 4 months of the screening visit;
  • The participant has taken any other investigational drugs within 30 days before screening;
  • The participant is known to have been treated previously with dalfampridine (4 aminopyridine) in any formulation, whether through participation in a previous fampridine study or by self-medication.
  • The participant has received locomotor training therapy within 6 months of the screening visit;
  • The participant has a history of alcohol or drug abuse in the previous year;
  • The participant has a medical condition that would interfere with interpretation of study results or study conduct.

Note: Due to equipment and safety issues associated with locomotor training, participants must weigh less than 300 lbs.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01621113

Contacts
Contact: Gail F. Forrest, Ph.D. 973-324-3518 gforrest@kesslerfoundation.org
Contact: Trevor A. Dyson-Hudson, M.D. 973-324-3576 tdysonhudson@kesslerfoundation.org

Locations
United States, New Jersey
Kessler Institute for Rehabilitation Recruiting
West Orange, New Jersey, United States, 07052
Contact: Gail F. Forrest, Ph.D.    973-324-3518    gforrest@kesslerfoundation.org   
Contact: Trevor A. Dyson-Hudson, M.D.    973-324-3576    tdysonhudson@kesslerfoundation.org   
Principal Investigator: Steven C. Kirshblum, M.D.         
Principal Investigator: Gail F. Forrest, Ph.D.         
Sub-Investigator: Trevor A. Dyson-Hudson, M.D.         
Sub-Investigator: Monifa Brooks, M.D.         
Sponsors and Collaborators
Kessler Foundation
U.S. Department of Education
Acorda Therapeutics
Investigators
Principal Investigator: Steven C. Kirshblum, M.D. Kessler Institute for Rehabilitation
Principal Investigator: Gail F. Forrest, Ph.D. Kessler Foundation
Study Director: Trevor A. Dyson-Hudson, M.D. Kessler Foundation
  More Information

No publications provided

Responsible Party: Trevor Dyson-Hudson, M.D., Interim Director, Spinal Cord Injury Research, Kessler Foundation
ClinicalTrials.gov Identifier: NCT01621113     History of Changes
Other Study ID Numbers: D-732-12, H133N110020
Study First Received: June 12, 2012
Last Updated: December 27, 2012
Health Authority: United States: Food and Drug Administration
United States: Data and Safety Monitoring Board
United States: Institutional Review Board

Keywords provided by Kessler Foundation:
Spinal Cord Injuries
4-Aminopyridine
Physical Therapy Modalities
Randomized Controlled Trial
Rehabilitation
Walking

Additional relevant MeSH terms:
Spinal Cord Injuries
Spinal Cord Diseases
Central Nervous System Diseases
Nervous System Diseases
Trauma, Nervous System
Wounds and Injuries
4-Aminopyridine
Potassium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Cardiovascular Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on September 18, 2014