Long-Term Efficacy and Safety of Ramelteon in Adults With Chronic Insomnia. - Full Text View

Sponsor:	Takeda Global Research & Development Centre (Europe) Ltd.
Information provided by:	Takeda Global Research & Development Center, Inc.
ClinicalTrials.gov Identifier:	NCT00247390

Purpose

The purpose of this study to determine the long-term efficacy and safety of ramelteon.

Condition	Intervention	Phase
Chronic Insomnia	Drug: Ramelteon Drug: Placebo	Phase III

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Safety/Efficacy Study
Official Title:	A Randomised, Double-blind, Placebo-controlled Study to Determine the Long-term Efficacy and Safety of Ramelteon in Adults With Chronic Insomnia.

Resource links provided by NLM:

Drug Information available for: Ramelteon

U.S. FDA Resources

Further study details as provided by Takeda Global Research & Development Center, Inc.:

Primary Outcome Measures:

Mean change in Latency to Persistent Sleep of 2-night polysomnogram. [ Time Frame: Months 3 and 6 or Final Visit ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Mean change in Total Sleep Time from polysomnogram, on 2 nights over 6 months. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Mean change in Subjective Sleep Latency by postsleep questionnaire on 2 nights over 6 months. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Mean change in Subjective Total Sleep Time by postsleep questionnaire on 2 nights over 6 months. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Mean change in Subjective Number of Awakenings by postsleep questionnaire. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Mean change in Subjective Sleep Quality by postsleep questionnaire. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Total Sleep Time in rapid eye movement (REM) sleep as determined by polysomnogram. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Total Sleep Time in stage 1 non-rapid eye movement (NREM) sleep as determined by polysomnogram. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Total Sleep Time in stage 2 non-rapid eye movement (NREM) sleep as determined by polysomnogram. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Total Sleep Time in stage 3/4 non-rapid eye movement (NREM) sleep as determined by polysomnogram. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Total Sleep Time in stage 1 sleep as determined by polysomnogram. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]
Latency to Rapid Eye Movement as determined by polysomnogram. [ Time Frame: Week 1 and Months 1, 3, 5 and 6 or Final Visit ] [ Designated as safety issue: No ]

Enrollment:	451
Study Start Date:	July 2005
Study Completion Date:	December 2006
Primary Completion Date:	December 2006 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental	Drug: Ramelteon Ramelteon 8 mg, tablets, orally, once daily for up to 42 weeks.
2: Placebo Comparator	Drug: Placebo Ramelteon placebo-matching tablets, orally, once daily for up to 42 weeks.

Detailed Description:

A vast majority of people are affected by chronic insomnia in the western world. Several studies have looked at this and have estimated that 30% to 48% of the general population is affected at some time in their life with a form of insomnia that goes on for several months, and about one third of those are described as severely affected. Daytime symptoms of insomnia include tiredness, lack of energy, difficulty concentrating, and irritability. Recent epidemiologic research focusing on the quality of life has identified significant insomnia-related conditions that relate to work productivity, health care utilization, and risk of depression. Insomnia is associated with diminished work output, absenteeism, and greater rates of accidents.

An ideal treatment for chronic insomnia would include administration of therapy for an extended period. Specifically, it should be safe and effective for a period longer than the 7 to 10 days to which use of the current drugs approved for short-term use are limited.

Because of the absence of evidence of residual effects in pre-clinical studies and phase 2 and 3 clinical trials, ramelteon may be a candidate for extended use. As chronic insomnia becomes more prevalent, there is a need to assess the long-term efficacy and safety of nightly dosing with ramelteon in the general population. Study participation is anticipated to be about 8 months and 3 weeks.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria

Females of childbearing potential who are sexually active must agree to use adequate contraception, and can neither be pregnant nor lactating from Screening throughout the duration of the study.
Body mass index between 18 and 34, inclusive.
Based on sleep history, has had chronic insomnia for at least 3 months.
Based on sleep history, reports a subjective sleep latency greater than or equal to 45 min and a subjective total sleep time less than or equal to 6.5 hours.
Based on sleep history, habitual bedtime is between 10:00 PM and 1:00 AM.
Mean latency to persistent sleep of greater than 20 minutes on two consecutive screening nights with neither night less than 15 minutes. Also, a mean of 60 minutes of wake time during the 480 minutes in bed across two nights with no night less than 45 minutes.
Based on sleep history, normally uses pharmacological assistance to sleep 0 to 4 times per week in the last 3 months.

Exclusion Criteria

Known hypersensitivity to ramelteon or related compounds, including melatonin, and melatonin related compounds.
Participated in any other investigational study and/or taken any investigational drug within 30 days or five half-lives prior to the first dose of single-blind study medication, whichever is longer.
Sleep schedule changes required by employment (eg, shift worker) within three months prior to the administration of single-blind study medication.
Flown across greater than three time zones within 7 days prior to or during screening.
Participated in a weight loss program or has substantially altered their exercise routine within 30 days prior to the administration of single-blind study medication.
Has ever had a history of seizures, sleep apnea, restless leg syndrome, periodic leg movement syndrome, chronic obstructive pulmonary disease or fibromyalgia.
History of psychiatric disorder within the past 6 months.
History of alcohol abuse within the past 12 months, as defined in Diagnostic & Statistical Manual of Mental Disorders, 4th Edition Revised, or regularly consumes more than 14 alcoholic drinks per week, or consumed any alcoholic drinks within 24 hours of any polysomnogram visits.
History of drug abuse within the past 12 months, as defined in Diagnostic & Statistical Manual of Mental Disorders, 4th Edition Revised.
Current significant hepatic, renal, endocrine, cardiovascular, gastrointestinal, pulmonary, hematologic, neurological, or metabolic disease, unless currently controlled and stable with protocol-allowed medication, within 30 days prior to the first night of single-blind study medication.
Apnea hypopnea index (per hour of sleep) greater than 10 as seen on the first polysomnogram screening night.
Periodic Leg Movement Syndrome with arousal index (per hour of sleep) greater than 10 as seen on the first polysomnogram screening night.
Positive urine drug screen at Screening Visit 1 or any of the polysomnogram assessment visits.
Positive breathalyzer test on any of the polysomnogram assessment visits.
Uses tobacco products (including nicotine gum and patch) or any other products that may interfere with the sleep wake cycle during nightly awakenings.
Used any central nervous system medication or other drugs or supplements known to affect sleep/wake function within 1 week (or 5 half lives of the drug, whichever is longer) prior to the administration of single-blind study medication. These medications must not have been used to treat psychiatric disorders.
Intends to continue taking any disallowed medication or any prescription medication or over the counter medication that is known to affect the sleep/wake function or otherwise interfere with evaluation of the study medication. The subject must report all prescription and over the counter medications taken in the three weeks prior to screening.
Is required to take or continues taking any disallowed medication, prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including:
- Anxiolytics
- Sedatives
- Hypnotics
- CNS active drugs (including herbal)
- Antidepressants
- Narcotic analgesics
- Anticonvulsants
- Beta blockers
- Sedating H1 antihistamines
- St. John's Wort
- Systemic steroids
- Kava-kava
- Respiratory stimulants
- Ginkgo-biloba
- Decongestants
- Over-the-counter and prescription stimulants
- Antipsychotics
- Over-the-counter and prescription diet aids
- Muscle Relaxants
- Melatonin and all other drugs or supplements known to affect sleep/wake function
Any additional condition(s) that in the Investigator's opinion would
- affect sleep/wake function
- prohibit the subject from completing the study
- indicate that continuation in the study would not be in the best interests of the subject.
History of hepatitis B or hepatitis C.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00247390

Show 49 Study Locations

Sponsors and Collaborators

Takeda Global Research & Development Centre (Europe) Ltd.

Investigators

Study Director:

Medical Director Clinical Science

Takeda Global Research & Development Center, Inc.

More Information

Additional Information:

Rozerem Package Insert This link exits the ClinicalTrials.gov site

FDA Safety Alerts and Recalls This link exits the ClinicalTrials.gov site

Publications:

Wang-Weigand S, Mayer G, Roth-Schechter B. Long-term efficacy and safety of ramelteon 8 mg treatment in adults with chronic insomnia: results of a six-month, double-blind, placebo-controlled, polysomnography trial. Sleep Biol Rhythms 2007;5(suppl 1):A156. Abstract PO525.

Mayer G, Wang-Weigand S, Roth-Schechter B, Lehmann R, Staner C, Partinen M. Efficacy and safety of 6-month nightly ramelteon administration in adults with chronic primary insomnia. Sleep. 2009 Mar 1;32(3):351-60.

Wang-Weigand S, McCue M, Ogrinc F, Mini L. Effects of ramelteon 8 mg on objective sleep latency in adults with chronic insomnia on nights 1 and 2: pooled analysis. Curr Med Res Opin. 2009 May;25(5):1209-13.

Responsible Party:	Takeda Global Research & Development Centre (Europe) Ltd. ( VP, Clinical Science )
Study ID Numbers:	TAK-375-EC302, 2004-004351-20
Study First Received:	October 28, 2005
Last Updated:	August 3, 2009
ClinicalTrials.gov Identifier:	NCT00247390 History of Changes
Health Authority:	United States: Food and Drug Administration; France: Ministry of Health

Keywords provided by Takeda Global Research & Development Center, Inc.:

Chronic Insomnia
Sleep Initiation and Maintenance Disorder
Drug Therapy

Additional relevant MeSH terms:

Sleep Initiation and Maintenance Disorders
Mental Disorders
Nervous System Diseases

Sleep Disorders
Dyssomnias
Sleep Disorders, Intrinsic

ClinicalTrials.gov processed this record on February 08, 2010