Amphetamine-Enhanced Stroke Recovery

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Duke University
ClinicalTrials.gov Identifier:
NCT01905371
First received: July 18, 2013
Last updated: NA
Last verified: July 2013
History: No changes posted
  Purpose

This is an NIH Pilot Clinical Trial Grant designed to provide data to permit the rationale design of a subsequent efficacy study. The purpose of this project is to determine the potential benefit of amphetamine combined with physical therapy in enhancing motor recovery in patients admitted for inpatient rehabilitation between 10 and 30 days after hemispheric ischemic stroke. The study hypotheses are: 1, The addition of treatment with d-amphetamine will result in at least a 12.6 point improvement in the Fugl-Meyer motor score 3 months after stroke. 2, There will be no clinically significant increase in the frequency of serious adverse events associated with treatment with d-amphetamine which would preclude further testing.


Condition Intervention Phase
Stroke
Drug: Dextroamphetamine
Other: Physical Therapy
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Amphetamine-Enhanced Stroke Recovery

Resource links provided by NLM:


Further study details as provided by Duke University:

Primary Outcome Measures:
  • Mean Change in Fugl-Meyer Score from Baseline to 90 days Poststroke [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    The Fugl-Meyer score was determined at baseline, immediately after treatment, and 90 days poststroke in order to assess voluntary movement in both the upper and lower limbs using an ordinal scale. The mean change from baseline will be calculated at each timepoint for each study arm.


Secondary Outcome Measures:
  • Mean Change in Ambulation Speed Score from Baseline to 90 Days Poststroke [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    Ambulation speed was measured at baseline, immediately after treatment, and 90 days poststroke to indirectly measure gait quality. Walking speed was measured by using a standardized 10 meter walk test. The mean change from baseline will be calculated at each timepoint for each study arm.

  • Mean Change in Ambulation Endurance Score from Baseline to 90 days Poststroke [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    Ambulation endurance was determined at baseline, immediately after treatment, and 90 days poststroke to indirectly measure gait quality. The poorer the gait quality the more effortful it is and the more easily patients fatigue. Ambulation endurance was assessed using the standardized 6 minute walk test. The mean change from baseline will be calculated at each timepoint for each study arm.

  • Mean Change in the Action Research Arm Test (ARAT) score from Baseline to 90 days Poststroke [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    The ARAT score was determined at baseline, immediately after treatment, and 90 days poststroke assess arm and hand function. It tests the ability to develop gross grasp and release of cubes and spheres of defined size and weight. Pincer grasp and opposition of thumb to 3rd and 4th fingers are tested by asking the patient to pick up a marble and a 0.24 inch diameter steel ball bearing. Functional wrist pronation-supination is tested by asking the patient to pour water from a standardized cup. More difficult finger prehension wrist rotation tasks involve picking up and placing metal cylinders over wooden pegs of matching size, and placing a washer over a metal bolt. The mean change from baseline will be calculated at each timepoint for each study arm.

  • Mean Change in the Mobility Subscale of the Functional Independence Measure from Baseline [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    The mobility subscale score was measured at baseline, immediately after treatment, and 90 days poststroke to assess the patient's ability to transfer to and from bed, chair, toilet, and tub. It also scores the patient's ability to walk and climb stairs. The mobility subscale score is computed from the more movement dependent portions of the FIM were assessed. The mean change from baseline will be calculated at each timepoint for each study arm.

  • Mean Change in the NIH Stroke Scale Score from Baseline [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    The NIH stroke scale score was measured at baseline, immediately after treatment, and at 90 days poststroke to provide a measure of stroke impairment. Analysis of change scores for the various domains of the NIH Stroke Scale permitted the detection of possible carry-over effects. The mean change from baseline will be calculated at each timepoint for each study arm.

  • Mean Change in Rankin Scale Score from Baseline [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    The Rankin Scale was determined at baseline, immediately after treatment, and 90 days poststroke to assess stroke-related handicap. The mean change from baseline will be calculated at each timepoint for each study arm.

  • Mean Change in Mini-Mental State Examination Score [ Time Frame: 90 days, Baseline ] [ Designated as safety issue: No ]
    The Mini-Mental State examination score was determined at baseline, immediately after treatment, and 90 days poststroke to provide a more detailed assessment of stroke-related cognitive impairments. The mean change from baseline will be calculated at each timepoint for each study arm.


Enrollment: 99
Study Start Date: April 2001
Study Completion Date: June 2007
Primary Completion Date: June 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Dextroamphetamine + Physical therapy (PT)

Treatment with d-amphetamine + physical therapy administered under two regimens administered sequentially:

10 mg of d-amphetamine combined with 1 hr PT session beginning 1 hr after drug administration every 4 days, for a total of 6 or 10 sessions

Drug: Dextroamphetamine
Other Name: D-amphetamine
Other: Physical Therapy
One hour of active physical therapy (PT) directed at a primary motor impairment. An outline indicating a range and level of physical therapy interventions will be provided to the therapists, and the level and of therapy will be recorded.
Placebo Comparator: Placebo + Physical Therapy (PT)

Treatment with placebo + physical therapy administered under two regimens administered sequentially:

Regimen 1: 10 mg of placebo combined with 1 hr PT session beginning 1 hr after placebo administration every 4 days, for a total of 6 or 10 sessions

Other: Physical Therapy
One hour of active physical therapy (PT) directed at a primary motor impairment. An outline indicating a range and level of physical therapy interventions will be provided to the therapists, and the level and of therapy will be recorded.
Drug: Placebo

Detailed Description:

The purpose of this Pilot Grant is to collect data critical for the design of a subsequent full-scale clinical trial testing the efficacy of treatment with amphetamine combined with physical therapy to facilitate poststroke motor recovery. When combined with task-relevant experience, a single dose of d amphetamine given 24 hr following a unilateral sensorimotor cortex ablation in the rat results in an enduring enhancement of motor recovery. This amphetamine effect extends to functional deficits that occur following focal lesions produced through a variety of mechanisms including ischemic brain injury, to lesions affecting other areas of the cortex, and to other behaviors. Laboratory studies not only show that certain drugs such as amphetamine may facilitate recovery, but that other classes of drugs may be harmful. Clinical studies suggest similar detrimental drug effects may occur in humans recovering from stroke. Three small studies of the impact of treatment with amphetamine on poststroke recovery have been carried out. Two found a beneficial effect and the third was negative. These studies differed in significant ways as reviewed in the referenced section of the proposal. The present study is designed based on these small studies. Using a multicenter, block-randomized, placebo-controlled design, this pilot study will:

  1. Refine the intervention strategy which has been developed for this Pilot Grant based on the best available laboratory and preliminary clinical data.
  2. Refine the target patient population.
  3. Gain information to permit an accurate sample size calculation (estimated for this pilot study) for a subsequent trial.
  4. Refine outcome measures, site monitoring techniques, data consistency protocols, and data management procedures.
  5. Obtain data to further support the safety of the proposed intervention.

This study has several hypotheses.

  1. Patients treated with d-amphetamine combined with physical therapy will have improved recovery of motor function as compared to similar patients treated with placebo combined with physical therapy measured 90 days after hemispheric ischemic stroke.
  2. There will not be a clinically significant increase in the frequency of serious adverse events associated with treatment with d-amphetamine which would preclude further testing of these regimens.

Secondary goals include:

  1. Refinement of the target patient population.
  2. Gain information to permit an accurate sample size calculation (estimated for this pilot study) for a subsequent trial.
  3. Refinement of outcome measures, site monitoring techniques, data consistency protocols, and data management procedures.
  Eligibility

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

Inclusion Criteria:

  1. Documented (including neuroimaging) ischemic hemispheric stroke
  2. Start treatment between 10-30 days after stroke
  3. Independent prior to index stroke (Rankin 0 or 1)
  4. Moderate or severe stroke-related motor impairment (Fugl-Meyer motor score <80)
  5. Patient (or legal representative) capable of giving informed consent
  6. Availability for follow-up evaluation
  7. Physically able to receive study drug/ placebo

Exclusion Criteria:

  1. Hypertension defined as systolic BP>160, or diastolic BP>100 mmHg at rest determined by 3 readings during the 24 hours prior to randomization. Patients with such elevations of blood pressure on admission who respond to antihypertensive medication before medication phase of the study is to start will be eligible to participate
  2. Index or remote intracerebral or subarachnoid hemorrhage
  3. History of or active psychosis or bipolar disorder
  4. Angina pectoris within the preceding 3 months
  5. Myocardial infarction within the preceding year
  6. Inducible myocardial ischemia based on exercise or pharmacological stress test if done within the prior year
  7. Clinically significant congestive heart failure defined as New York Heart Class 3 or 4
  8. Atrial or ventricular arrhythmias including atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, and Wolff Parkinson White by history, electrocardiogram, or Holter monitor if done
  9. History of seizures or seizures associated with index ischemic stroke
  10. Allergy to amphetamine
  11. Current treatment with L-dopa, other dopamine agonist, or MAO inhibitor
  12. Glaucoma
  13. Need for treatment with a drug/class thought to impair recovery based on laboratory and available clinical evidence (a1-adrenergic receptor antagonist, a2-adrenergic receptor agonist, benzodiazepine, dopamine receptor antagonist, phenobarbital, phenytoin)
  14. Hyperthyroidism
  15. Pregnancy
  16. Expected rehabilitation stay less than 3 weeks for regimen 1
  17. Mild stroke-related motor impairment (Fugl-Meyer motor score >80).
  18. Participation in another investigational protocol
  19. Any condition which in the view of the investigator would put the patient at risk through their participation in the study.
  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: NCT01905371

Locations
United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710
Sponsors and Collaborators
Duke University
Investigators
Principal Investigator: Larry B Goldstein, MD Duke University
  More Information

No publications provided

Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT01905371     History of Changes
Other Study ID Numbers: Pro00044966
Study First Received: July 18, 2013
Last Updated: July 18, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Duke University:
amphetamine
stroke recovery

Additional relevant MeSH terms:
Stroke
Cerebral Infarction
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Brain Infarction
Brain Ischemia
Amphetamine
Dextroamphetamine
Central Nervous System Stimulants
Physiological Effects of Drugs
Pharmacologic Actions
Central Nervous System Agents
Therapeutic Uses
Sympathomimetics
Autonomic Agents
Peripheral Nervous System Agents
Dopamine Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Adrenergic Agents
Adrenergic Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Dopamine Uptake Inhibitors

ClinicalTrials.gov processed this record on July 22, 2014