Safety and Efficacy of Oral Fampridine-Sustained Release (SR) for the Treatment of Spasticity Resulting From Spinal Cord Injury

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Acorda Therapeutics
ClinicalTrials.gov Identifier:
NCT01683838
First received: August 24, 2012
Last updated: January 6, 2014
Last verified: January 2014
  Purpose

Normally, nerve fibers carry electrical impulses through the spinal cord, providing communication between the brain and the arms and legs. In people with spinal cord injury, some fibers may be destroyed at the site of injury, while others remain connected but do not work correctly to carry electrical impulses. As a result, subjects with an incomplete spinal cord injury may have spasticity which is muscle spasms or muscle stiffness that makes movement difficult. Fampridine-SR is an experimental drug that increases the ability of the nerve to conduct electrical impulses. This study will examine the effects of Fampridine-SR on moderate to severe lower-limb spasticity, as well as the effects on bodily functions such as bladder control, bowel function and sexual function. The study will also examine the possible risks of taking Fampridine-SR.


Condition Intervention Phase
Spinal Cord Injury
Muscle Spasticity
Drug: Fampridine-SR
Drug: Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: Double-Blind, Placebo-Controlled, 12-Week Parallel Group Study to Evaluate Safety and Efficacy of Oral Fampridine-SR in Subjects With Moderate to Severe Spasticity Resulting From Chronic, Incomplete Spinal Cord Injury

Resource links provided by NLM:


Further study details as provided by Acorda Therapeutics:

Primary Outcome Measures:
  • Double-blind Change From Baseline in Ashworth Score Evaluating Spasticity [ Time Frame: Baseline (visits 2,3) average score days 7,14 and double-blind treatment period (visits 4-7) average score days 28-98 ] [ Designated as safety issue: No ]

    The Ashworth evaluates the functioning of two lower extremity muscle groups, the hamstring and quadriceps muscles, while in the supine position. The test measures extension of the right and left hamstring muscle and flexion of the right and left quadriceps muscle using the following 5-point grading scale:

    1=no increased tone; 2=slight increase in tone, giving a "catch" when the affected part is moved in flexion or extension; 3=more marked increase in tone, but affected part is easily flexed; 4=considerable increase in tone, passive movement is difficult; 5=affected part is rigid in flexion and extension.

    The Ashworth Score was determined by adding all individual scores for each muscle group and dividing by four. Higher Ashworth Scores indicated greater spasticity.


  • Double-blind Change From Baseline in Mean Subject's Global Impression (SGI) Scores [ Time Frame: Baseline (visits 2,3) average score days 7,14 and double-blind treatment period (visits 4-7) average score days 28-98 ] [ Designated as safety issue: No ]

    The SGI is a 7-unit ordinal scale used by the subject to evaluate the effects of study medication on his/her quality of life during the preceding week, with higher scores denoting greater satisfaction. A positive change score in SGI signifies improved outcome.

    The questionnaire consisted of one question (How do you feel about the effects of the investigational drug over the past 7 days?). The answer was based on a numerical rating scale where 1=terrible; 2=unhappy; 3=mostly dissatisfied; 4=neutral/mixed; 5=mostly satisfied; 6=pleased; 7=delighted.



Secondary Outcome Measures:
  • Double-blind Change From Baseline in Mean Spasm Frequency/Severity Scores [ Time Frame: Baseline (visits 2,3) average score days 7,14 and double-blind treatment period (visits 4-7) average score days 28-98 ] [ Designated as safety issue: No ]

    The Spasm Frequency score is the average rating by the clinician of the left and right arm(s) and leg(s), each evaluated on a 4-point scale (from 0=no spasms to 4=spontaneous spasms occurring more than ten times per hour), with higher scores denoting a greater degree of muscle spasms.

    The Spasm Severity score is the average rating of the left and right arm(s) and leg(s), each evaluated on a three-point scale (mild, moderate, or severe) as rated by the clinician on the basis of patient self-report.

    On both, a negative change in score signifies improvement in muscle spasms. The average Spasm Frequency/Spasm Severity Score was calculated as the average of the left and right non-missing scores.


  • Double-blind Change From Baseline in Mean Clinician's Global Impression (CGI) Scores [ Time Frame: Baseline (visits 2,3) average of days 7-14 and double-blind treatment period (visits 4-7) average of days 28-98) ] [ Designated as safety issue: No ]
    The supervising clinician rated the patient's neurological condition following treatment as compared to the screening visit on a seven-point scale (from 1=very much improved to 7=very much worse). The assessment was based on the clinician's overall impression of the patient's neurological status (specifically bowel, bladder, and sexual function; spasticity; and other neurological functions) and general state of health related to his or her participation in the study. Negative change scores indicated a change for the better.

  • Stable-dose Change From Baseline in Mean American Spinal Injury Association(ASIA) Total Motor Score [ Time Frame: Baseline (visits 2,3) average score days 7,14 and stable-dose treatment period (visits 5-7) average score days 56-98 ] [ Designated as safety issue: No ]
    Ten key muscle groups for the right and left sides were rated on a 0 (absent) to 5 (normal) scale, with a possible total score of 100. Higher positive change scores indicate improved motor function.

  • Change From Baseline in Mean International Index of Erectile Function (IIEF) Score [ Time Frame: Baseline (visit 1) average score obtained at day 1 and stable treatment period (visit 7) average score day 98 ] [ Designated as safety issue: No ]

    Male patients were asked to complete the IIEF questionnaire on sexual function. The IIEF is a brief, reliable, and valid self-administered questionnaire of 15 questions (items) that were categorized into five domains: Erectile Function (EF) scores: 0-6 Severe dysfunction, 7-12 Moderate dysfunction, 13-18 Mild to moderate dysfunction, 19-24 Mild dysfunction, 25-30 No dysfunction. Orgasmic Function (OF) score range: 0-2 Severe dysfunction to 9-10 No dysfunction, Sexual Desire (SD) score range: 0-2 Severe dysfunction to 9-10 No dysfunction, Intercourse Satisfaction (IS) score range: 0-3 Severe dysfunction to 13-15 No dysfunction, and Overall Satisfaction (OS) score range: 0-2 Severe dysfunction to 9-10 No dysfunction.

    Domain scores were derived by summing the individual items within a given domain. Final scale ranges from 0 (negative) to 5 (positive). A positive change in IIEF domain scores signifies improvement.


  • Change From Baseline in Mean Female Sexual Function Index (FSFI) Scores [ Time Frame: Baseline (visit 1) average score obtained at day 1 and stable treatment period (visits 4-7) average score days 28-98 ] [ Designated as safety issue: No ]

    The FSFI is a brief, reliable, and valid self-administered questionnaire of 19 questions (items). It contains six domains: Desire (2 items score range: 1 Very low or none at all to 5 Very high), Arousal (4 items score range: 0 No sexual activity to 5 Almost always or always), Lubrication (4 items score range: 0 No sexual activity to 5 Almost always or always), Orgasm (3 items score range: 0 No sexual activity to 5 Almost always or always), Satisfaction (3 items score range: 0 No sexual activity to 5 Very satisfied) and Pain (3 items score range: 0 Did not attempt intercourse to 5 Almost never or never).

    A positive change signifies improvement.


  • Adjusted Mean Change in Subject Bladder/Bowel Function Diary Scores [ Time Frame: Baseline (visit 1) average score obtained at day 1 and double-blind treatment period (visits 4-7) average score days 28-98 ] [ Designated as safety issue: No ]

    Bowel/bladder questions pertaining to the average number of times per day the patient experienced accidental urination/leakage and the average number of bowel movements per day were asked of all patients daily.

    A negative change in patient bladder/bowel function diary score signifies improvement.


  • Adjusted Mean Change in Subject Bowel Function Diary Scores [ Time Frame: Baseline (visit 1) average score obtained at day 1 and double-blind treatment period (visits 4-7) average score days 28-98 ] [ Designated as safety issue: No ]

    Bowel questions pertaining to the average number of minutes per day spent on bowel routine were asked of all patients daily.

    A negative change in patient bowel function diary score signifies improvement.



Enrollment: 204
Study Start Date: June 2002
Study Completion Date: February 2004
Primary Completion Date: November 2003 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: fampridine-SR 50mg/day Drug: Fampridine-SR
25mg bid (twice daily)
Placebo Comparator: Placebo Drug: Placebo
Placebo

  Eligibility

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

Inclusion Criteria:

  • Incomplete traumatic Spinal Cord Injury (at least 18 months prior and stable for 6 months)
  • Moderate to severe lower-limb spasticity
  • Able to give informed consent and willing to comply with protocol

Exclusion Criteria:

  • Pregnancy
  • History of seizures
  • Existing or history of frequent Urinary Tract Infections
  • History of drug or alcohol abuse
  • Allergy to pyridine-containing substances
  • Received a botox injection 4 months prior to study
  • Received an investigational drug within 30 days
  • Previously treated with 4-aminopyridine (4-AP)
  • Not on stable medication dosing in 3 weeks prior to study
  • Abnormal ECG or laboratory value at screening
  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: NCT01683838

  Hide Study Locations
Locations
United States, Alabama
UAB School of Medicine, 190 Spain Rehab Center
Birmingham, Alabama, United States, 35233
United States, California
Long Beach VA Medical Center
Long Beach, California, United States, 90822
University of California, Davis
Sacramento, California, United States, 95817
Santa Clara Valley Medical Center
San Jose, California, United States, 95128
United States, Colorado
Craig Hospital
Englewood, Colorado, United States, 80110
United States, Connecticut
Hospital for Special Care
New Britain, Connecticut, United States, 06503
United States, Illinois
Hines VA Hospital
Hines, Illinois, United States, 60141
United States, Massachusetts
Boston University Medical Center
Boston, Massachusetts, United States, 02118
United States, Michigan
University of Michigan
Ann Arbor, Michigan, United States, 48109
Rehabilitation Institute of Michigan
Detroit, Michigan, United States, 48201
United States, Minnesota
Minneapolis VA Hospital
Minneapolis, Minnesota, United States, 55417
United States, Missouri
University of Missouri
Columbia, Missouri, United States, 65212
St. Louis University
St. Louis, Missouri, United States, 63104
United States, New York
University of Rochester/Strong Memorial Hospital
Rochester, New York, United States, 14642
SUNY Upstate Clinical Trials Office
Syracuse, New York, United States, 13045
Helen Hayes Hospital
West Haverstraw, New York, United States, 13045
United States, North Carolina
Charlotte Institute of Rehabilitation
Charlotte, North Carolina, United States, 28203
Coastal AHEC
Wilmington, North Carolina, United States, 28402
United States, Ohio
Ohio State University
Columbus, Ohio, United States, 43210
Miami Valley Hospital- Rehabilitation Institute of Medicine
Dayton, Ohio, United States, 45409
United States, Pennsylvania
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States, 19107
United States, Texas
VA North Texas Health Care System
Dallas, Texas, United States, 75216
Southwestern Medical Center at Dallas
Dallas, Texas, United States, 75390
United States, Virginia
INOVA Institute of Research and Education
Falls Church, Virginia, United States, 22042
Medical College of Virginia/VCU
Richmond, Virginia, United States, 23298
United States, Washington
University of Washington Medical Center, Dept. of Rehabilitation
Seattle, Washington, United States, 98195
United States, Wisconsin
Wood VA Medical Center
Milwaukee, Wisconsin, United States, 53295
Canada, Manitoba
Health Sciences Centre
Winnipeg, Manitoba, Canada, R3A 1M4
Canada, Ontario
Chedoke-McMaster Hospital
Hamilton, Ontario, Canada, L8N 3Z5
St. Mary's of the Lake Hospital
Kingston, Ontario, Canada, K7L 5A2
Sponsors and Collaborators
Acorda Therapeutics
Investigators
Study Director: Andrew Blight, MD Acorda Therapeutics
  More Information

Additional Information:
No publications provided

Responsible Party: Acorda Therapeutics
ClinicalTrials.gov Identifier: NCT01683838     History of Changes
Other Study ID Numbers: SCI-F302
Study First Received: August 24, 2012
Results First Received: July 23, 2013
Last Updated: January 6, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Acorda Therapeutics:
spinal cord injury
muscle spasticity

Additional relevant MeSH terms:
Muscle Spasticity
Spinal Cord Injuries
Wounds and Injuries
Muscular Diseases
Musculoskeletal Diseases
Muscle Hypertonia
Neuromuscular Manifestations
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Spinal Cord Diseases
Central Nervous System Diseases
Trauma, Nervous System
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 15, 2014