Xenazine in Late Dyskinetic Syndrome With Neuroleptics (Xeladys)
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| ClinicalTrials.gov Identifier: NCT01543321 |
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Recruitment Status :
Completed
First Posted : March 2, 2012
Last Update Posted : September 12, 2017
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Late dyskinetic syndrome with neuroleptics, or tardive dyskinesia, is the appearance of abnormal involuntary movements (AIM) in patients treated with antipsychotics for at least three months. This important public health issue arises for 15-20% of patients treated with neuroleptics, the most prescribed psychotropic drugs in mental disorders in France, and seriously impacts the patients' quality of life. In over 50% of cases, it is irreversible-that is to say that he will persist despite discontinuation of the offending drug.
Risk factors have been described: the age and female gender are established, a higher dosage of antipsychotic, a long-term treatment, a psychiatric condition other than schizophrenia are likely risk factors, intermittent treatment, previous acute dyskinesia, neuroleptics or powerful, longer term use of corrective treatments including anticholinergics are still discussed.
Apart from preventive treatment, which consists in using antipsychotics as being coerced, support is disappointing: the etiological treatment, which is to stop the offending antipsychotic, is effective only in less than 50% of cases, the syndrome is most often late irreversible. Must still have the possibility to interrupt the treatment, which is usually impossible in the risk of decompensation of the mental illness for which the neuroleptic was prescribed. Remains symptomatic treatment: functional neurosurgery is only for extreme cases, because it is not without risk, in terms of morbidity and mortality. So it's the medication that is most often offered: many drugs have been proposed, a direct result of the multiplicity of neurotransmitter systems implicated.
However, in the vast majority of cases, this approach is disappointing not to say ineffective. The only exception is the tetrabenazine, marketed under the name of Xenazine®. Empirically, neurologists specializing in pathology of the movement are almost unanimous: its efficiency is very good, with good tolerance. Some preliminary studies have reinforced this impression. However, their level of evidence remains low and that is why the investigators propose to implement a prospective multicenter clinical trial, double-blind with placebo which will include two groups of 27 patients.
| Condition or disease | Intervention/treatment | Phase |
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| Tardive Dyskinesia | Drug: Tetrabenazine Drug: Placebo | Phase 3 |
Tetrabenazine is classified as a central monoamine depleting agent. In vitro studies have shown that it is an inhibitor of the vesicular monamine transporter 2 (VMAT2), resulting in synaptic dopamine depletion. This effect explains the reduction of hyperkinetic movement disorders.
Although tetrabenazine enjoys a reputation of very good efficacy in tardive syndromes, with good tolerance, it is still yet to empiricism because studies are few andf most importantly, of low level of evidence according the criteria of Evidence Based Medicine.
This is a randomized, multicenter, parallel group, double-blind placebo (tetrabenazine/placebo: 1/1), in two comparative conditions before and after 10 weeks of treatment with tetrabenazine (5-week titration to a maximum dose of 200 mg/day and 5 weeks at stable dose).
Study enrollment is proposed to patients fulfilling inclusion criteria.
The study should process as follows:
- Patients give their informed consent for participation after presentation of the study by the investigator.
- Visit V0: Given the patient's signed consent, global clinical examination, blood sampling, vital signs (weight, height, arterial tension, ECG are performed as well as a neurological examination (MMS). For women in childbearing potential, a urinary pregnancy test will be realized. It is noteworthy that a psychiatric consultation dating less than one month is required.
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Visit V1: patient is randomized in one of the two arms: tetrabenazine or placebo. Some tests are performed at baseline:
- Neurologic: ESRS, AIMS, CGI, UPDRSIII, MMS;
- Quality of life auto-questionnaires: SF36, Epworth; The treatment is prescribed following a titration phase during 5 weeks, a stable dose during 5 weeks, and a wash-out period during 2 weeks.
- At V2 (1 week after V1), V3 (3 weeks after V1) and V5 (7 weeks after V1): global clinical examination is performed and prescription observance is checked.
- At V4 (5 weeks after V1), V6 (10 weeks after V1) and V7 (12 weeks after V1): neurological (ESRS, AIMS, CGI, UPDRSIII, auto questionnaire SF36, Epworth, neuropsychological examination (MADRS), psychiatric examination (only at V6), vital signs and prescription observance.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 54 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
| Primary Purpose: | Treatment |
| Official Title: | Study of Efficacy and Acceptability of Tetrabenazine in the Late Dyskinetic Syndrome With Neuroleptics: A Randomized, Parallel Group, Double-blind Placebo Controlled Multicentre Trial |
| Actual Study Start Date : | May 14, 2012 |
| Actual Primary Completion Date : | May 18, 2017 |
| Actual Study Completion Date : | August 2017 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: Tetrabenazine group
Tetrabenazine is a drug that is administered orally. This is 25 mg tablets, divisible into 2.
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Drug: Tetrabenazine
Treatment with tetrabenazine consists in:
The treatment will be blinded for patients and investigators Other Name: Xenazine (tetrabenazine) |
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Placebo Comparator: Plagebo group
Patients will receive a buccal tablet identical to the experimental product
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Drug: Placebo
Treatment with placebo consists in:
The treatment will be blinded for patients and investigators |
- Changes in ESRS: Extrapyramidal Symptoms Rating Scale [ Time Frame: 10 weeks after randomization ]Changes in ESRS from Baseline and V6 (10 weeks after randomization) are assessed at the end of the 10 weeks of treatment.
- Changes in Sub-score ESRS-II [ Time Frame: At baseline (V1), V4 (7 weeks after V1), V6 (10 weeks after V1) and V7 (14 weeks after V1) ]
ESRS-II is calculated as the ESRS total score minus ESRS sub-part II (worst score=0, best score=158).
The choice of this sub-score is justified because of the possibility of improving the total ESRS can be masked by the induction of parkinsonian syndrome represented by part II of the ESRS that we chose to subtract in order to achieve the ESRS 2.
- CGI amelioration [ Time Frame: At baseline (V1), V4 (7 weeks after V1), V6 (10 weeks after V1) and V7 (14 weeks after V1) ]Clinical Global Impression is an ordinal scale in eight categories: unevaluated = 0; much worsened = 7
- Tolerance [ Time Frame: within the 14 weeks of the patients' participation ]
Tolerance includes:
- neurological consultation
- global clinical examination: ECG (QT), BP, pulse, orthostatic hypotension, weight
- Changes in Quality of life [ Time Frame: At baseline (V1), V4 (7 weeks after V1), V6 (10 weeks after V1) and V7 (14 weeks after V1) ]Quality of life will be investigated with the SF36 questionnaire.
- AIMS improvement [ Time Frame: At baseline (V1), V4 (7 weeks after V1), V6 (10 weeks after V1) and V7 (14 weeks after V1) ]Expected reduction of dyskinesia during the study will be investigated with the Abnormal Involuntary Movement Scale (AIMS).
- Changes in intermediate ESRS and post-treatment ESRS [ Time Frame: 7 weeks after randomization and 14 weeks after randomization ]Changes in ESRS are assessed between baseline and the end of the titration period (7 weeks after randomization) and after the wash-out period (14 weeks after randomization).
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Adult (age over 18) or adult under judicial protection (tutor or curator).
- Patient with late dyskinetic syndrome with neuroleptics yielding functional disability and/or impact in every day's life, according to the investigator, and/or the patient and/or the patient's family.
- Patient with persistent late dyskinetic syndrome, even if the neuroleptic has been stopped for more than 6 months or patient with late dyskinetic syndrome under neuroleptic treatment unchanged for at least 3 months and which would a priori not need any dose variation during the study time.
- MADRS < 18
- QTc < 450 ms for men and < 470 for women.
Exclusion Criteria:
- Lack of social insurance
- Neuroleptic treatment less than 3 months
- Insanity according to the DSM IV and MMS < 24
- Predominant akathisia
- Psychiatric disease not stabilized for more than 6 months and/or which could require a neuroleptic treatment adaptation during study time.
- Pregnancy and lactating
- Women in genital activity without efficient contraception method (IUD or estrogen-progestin pill)
- Hypersensitivity to tetrabenazine
- Renal failure
- Drugs: Non-selective MAOIs, dopaminergic (or other antiparkinsonian)
- Other severe pathology
- Patient non compliant to protocol, at the investigator's appreciation
- Simultaneous participation to other clinical trial
- Congenital galactosemia, glucose malabsorption or lactase deficiency
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01543321
Show 19 study locations
| Principal Investigator: | Pierre Krystkowiak, MD-PhD | University Hopsital of Amiens |
| Responsible Party: | Centre Hospitalier Universitaire, Amiens |
| ClinicalTrials.gov Identifier: | NCT01543321 |
| Other Study ID Numbers: |
PI11-PR-KRYSTKOWIAK 2011-004211-23 ( EudraCT Number ) |
| First Posted: | March 2, 2012 Key Record Dates |
| Last Update Posted: | September 12, 2017 |
| Last Verified: | September 2017 |
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tetrabenazine movement disorders tardive disorders |
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Dyskinesias Tardive Dyskinesia Movement Disorders Central Nervous System Diseases Nervous System Diseases Neurologic Manifestations Dyskinesia, Drug-Induced Tetrabenazine |
Adrenergic Uptake Inhibitors Neurotransmitter Uptake Inhibitors Membrane Transport Modulators Molecular Mechanisms of Pharmacological Action Adrenergic Agents Neurotransmitter Agents Physiological Effects of Drugs |