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Oral Guanabenz for Multiple Sclerosis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02423083
Recruitment Status : Terminated
First Posted : April 22, 2015
Last Update Posted : December 12, 2019
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) )

Brief Summary:


- People with multiple sclerosis (MS) get lesions in their brain and spinal cord. These cause neurological symptoms and sometimes disability. Researchers want to see if a blood pressure drug called guanabenz can repair lesions and help people with MS.


- To see if guanabenz is safe and well tolerated in people with MS.


- People 18 55 years old with MS who have taken glatiramer acetate for the past year.


  • Participants will be screened in a separate protocol. For 2 months, they will be examined and have magnetic resonance imaging (MRI) scans. This will decide if they are in the Stable or Active MS study group.
  • The study will last 5 months. There will be up to 11 visits, 5 overnight.
  • Visit 1: overnight stay at the clinic:
  • Medical history and physical exam.
  • Health questionnaire
  • Bladder ultrasound scan
  • Brain MRI
  • Electrocardiogram (EKG) to measure heart electrical activity
  • Blood will be drawn through an intravenous (IV) line.
  • Participants may have tests of strength, muscle tone, and movement.
  • They will get their first dose of the study drug, a tablet taken once a day.
  • Participants will take the study drug at home and keep a medicine diary.
  • The dose will slowly increase. Each time, participants will stay overnight at the clinic. They will have a physical exam, EKG, MRI, and IV blood draw.
  • Visit 6: Participants will have a physical exam, MRI, and blood drawn. They will get a schedule to slowly lower their drug dose and stop taking guanabenz.
  • Participants will have 2 final visits. They will have a physical exam, EKG, MRI, and IV blood draw.

Condition or disease Intervention/treatment Phase
Multiple Sclerosis, Relapsing-Remitting Multiple Sclerosis Drug: Guanabenz Phase 1

Detailed Description:


This Phase 1 clinical study will aim to determine whether therapeutically adequate dosages of guanabenz are safe and well tolerated in patients with multiple sclerosis (MS). It will further provide pharmacokinetic data important for determination of optimal dosing schedule for possible future Phase 2 study.


Six patients, ages between 18-55 inclusive, and diagnosis of definite multiple sclerosis by 2010 Revised McDonald Diagnostic Criteria (Polman et al, 2010) will be enrolled. All patients will have been on treatment with glatiramer acetate, a Food and Drug Administration (FDA) approved disease-modifying therapy, for a minimum of year. Four of the patients will be clinically stable with no clinical relapse in the preceding year and no evidence of active inflammation by MRI during the 2-month screening period; 2 patients will be selected based on evidence of on-going, active inflammation seen by MRI during the screening period.


In this open-label, single site, dose escalation study, the maximum tolerated dose (MTD) of guanabenz in MS patients will be determined. Patients will be screened for participation under the existing MS natural history study 89-N-0045. Sequential patient enrollment will be spaced at least 6 weeks apart. Five study drug doses will be explored: 4mg, 8mg, 16mg, 32mg and 64mg. Dose escalation will ensue if the preceding dose is tolerated, defined both by patient-reported outcomes and objective clinical and imaging assessments. Patients will be maintained on lower doses (4mg-16mg) for 14 days and on higher doses (32 and 64mg) for 28 days.


The primary outcome is MTD, defined as the maximum dose that produces dose-limiting toxicity (DLT) in at most 2 out of the 6 participants. Secondary outcomes include patient-reported outcomes, objective clinical and imaging assessments at 32mg and 64mg, and pharmacokinetics.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 2 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I Study of Oral Guanabenz for Multiple Sclerosis
Study Start Date : April 21, 2015
Actual Primary Completion Date : October 30, 2017
Actual Study Completion Date : October 30, 2017

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Treatment arm Drug: Guanabenz

Primary Outcome Measures :
  1. Maximum tolerated dose (MTD) [ Time Frame: 3.5 months ]

Secondary Outcome Measures :
  1. Pharmacokinetics of guanabenz in MS patients [ Time Frame: 3.5 months ]

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
  • MS as defined by the 2010 Revised McDonald MS Diagnostic Criteria (19)
  • Age 18-55, inclusive, at the time of the first screening baseline visit
  • EDSS 1.0 to 6, inclusive, at the time of the first screening baseline visit
  • Able to provide informed consent
  • Willing and able to participate in all aspects of trial design and follow-up
  • Undergoing treatment with glatiramer acetate for a period of at least 1 year prior to enrollment in the study
  • For female patients, agreeing to commit to the use of a reliable/accepted method of birth control (i.e. hormonal contraception, including

birth control pills, injected hormones, and vaginal ring; intrauterine device; barrier methods with spermicide, including diaphragm and condom; or surgical sterilization, including hysterectomy, tubal ligation, and vasectomy) for the duration of the study


-Development of new T2 hyperintense or contrast enhancing lesions by MRI during the screening phase, but 3 such lesions on any single scan


  • Alternative diagnoses that better explain neurological disability and MRI findings
  • Clinically significant medical condition that, in the best judgment of the investigators, may expose the patient to undue risk of harm or prevent the patient from completing the study (examples include, but are not limited to, cerebrovascular disease, substance abuse, ischemic cardiomyopathy, clotting disorder, brittle diabetes, neurodegenerative disorder)
  • Undergoing treatment with medications that may interact with guanabenz, including anti-hypertensive agents and/or agents leading to increase in catecholamines (such as tricyclic antidepressants and monoamine oxidase inhibitors)
  • Medical contraindication to MRI
  • Determination, in the best judgment of the investigators, of the need to treat a prospective participant with steroids for management of MS during the screening period
  • Pregnant or breastfeeding woman
  • Abnormal screening/baseline blood tests exceeding any of the limits defined below:

A) Serum alanine transaminase or aspartate transaminase levels greater than 3 times the upper limit of normal values

B) Total white blood cell count < 3000/mm3

C) Platelet count < 85000/mm3

D) Serum creatinine level > 2.0 mg/dl and eGFR (estimated glomerular filtration rate) < 60


  • Evidence of 1 or more clearly documented MS relapses within the last 1 year
  • Development of more than 2 lesions per year relative to an MRI performed at least one year before the first screening MRI (the prior MRI can be an outside MRI)
  • Development of new T2 hyperintense or contrast-enhancing lesions by MRI during the screening phase

Information from the National Library of Medicine

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 identifier (NCT number): NCT02423083

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United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
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Principal Investigator: Irene CM Cortese, M.D. National Institute of Neurological Disorders and Stroke (NINDS)
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: National Institute of Neurological Disorders and Stroke (NINDS) Identifier: NCT02423083    
Other Study ID Numbers: 150117
First Posted: April 22, 2015    Key Record Dates
Last Update Posted: December 12, 2019
Last Verified: October 30, 2017
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) ):
Multiple Sclerosis
Clinical Trial
Safety and Tolerability
Additional relevant MeSH terms:
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Multiple Sclerosis
Multiple Sclerosis, Relapsing-Remitting
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases
Antihypertensive Agents
Adrenergic alpha-2 Receptor Agonists
Adrenergic alpha-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs