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A Study to Evaluate the Long-term Safety of Arbaclofen Extended-Release Tablets for Patients With Spasticity Due to MS (OS440-3005)

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.
ClinicalTrials.gov Identifier: NCT03319732
Recruitment Status : Completed
First Posted : October 24, 2017
Results First Posted : July 15, 2022
Last Update Posted : August 9, 2022
Osmotica Pharmaceutical US LLC
Information provided by (Responsible Party):
RVL Pharmaceuticals, Inc.

Brief Summary:
Spasticity is a common complication in MS and occurs in up to 84% of patients. The main sign of spasticity is resistance to passive limb movement characterized by increased resistance to stretching, clonus, and exaggerated deep reflexes. Osmotica Pharmaceutical is currently developing arbaclofen extended-release tablets (AERT) for the treatment of spasticity in patients with MS.

Condition or disease Intervention/treatment Phase
Multiple Sclerosis Spasticity, Muscle Drug: Arbaclofen Phase 3

Detailed Description:
This is a multicenter, open-label, long-term extension study to evaluate the safety and tolerability of oral AERT in patients with spasticity due to MS. Subjects from the double blind study (Study OS440-3004) may rollover into this open-label extension study, as well as de novo subjects. The maintenance dose will be 80 mg/day or the highest tolerated dose. Once the subject has reached the maintenance dose, they will remain on that dose for approximately 1 year.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 323 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Open-Label Study to Evaluate the Long-Term Safety of Arbaclofen Extended-Release Tablets in Multiple Sclerosis Patients With Spasticity (Study OS440-3005)
Actual Study Start Date : April 3, 2018
Actual Primary Completion Date : January 27, 2020
Actual Study Completion Date : June 11, 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: AERT 80 mg
Arbaclofen extended release tablet, 20 mg
Drug: Arbaclofen
Arbaclofen is the active R enantiomer of baclofen.
Other Name: AERT

Primary Outcome Measures :
  1. Number of Participants With Adverse Events, Change in Vital Signs, Clinical Laboratory Test Results, 12-lead ECGs, USP Questionnaire, and C-SSRS Results [ Time Frame: over 1 year ]
    Safety and tolerability will be assessed by the monitoring of adverse events volunteered, observed, and elicited by general questions in a non-suggestive manner. Changes in vital signs, clinical laboratory test results, 12-lead ECGs, the urinary symptom profile (USP) questionnaire, and the C-SSRS results will also be assessed.

Secondary Outcome Measures :
  1. Patient Global Impression of Change (PGIC) [ Time Frame: week 60 ]
    Patient Global impression of Change (PGIC) is a scale to evaluate the change in activity limitations, symptoms, emotions, and overall quality of life using scores from 1 to 7 with 1 being no change and 7 being a great deal better, and a considerable improvement that has made all the difference. Minimum value is 1 and the maximum value is 7.

  2. Total Numeric-transformed Modified Ashworth Scale Score or the Most Affected Limb (TNmAS-MAL) [ Time Frame: week 28 ]
    The abbreviated scale title is TNmAS. It is considered the primary clinical measure of muscle spasticity in subjects with neurological conditions. It is a useful 6-point rating scale (0 to 5) to measure abnormality in tone or the resistance to passive movements. Minimum value is 0 and maximum value is 5. A higher score means a worse outcome.

  3. Expanded Disability Status Scale (EDSS) [ Time Frame: week 60 ]
    Expanded Disability Status Scale (EDSS) is a method of quantifying disability in MS and monitoring changes in the level of disability over time. The EDSS scale ranges from 0 to 10 in 0.5-unit increments that represent higher levels of disability. A score of 0 represents a normal neurological exam, and 10 represents death due to MS.

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Subjects 18 to 65 years of age, inclusive.
  2. An established diagnosis per McDonald Criteria (Polman et al 2011) of MS (either relapsing-remitting [RR] or secondary-progressive [SP] course) that manifests a documented history of spasticity for at least 6 months prior to Baseline.
  3. Has participated in Study OS440-3004 or is a new US subject (ie, a de novo subject) who fulfills the inclusion/exclusion criteria.
  4. Is willing to continue on open-label treatment with AERT as described in this protocol.
  5. If receiving disease-modifying medications (eg, interferons approved for MS, glatiramer acetate, natalizumab, fingolimod, or mitoxantrone), there must be no change in dose for at least 3 months prior to Baseline, and the subject must be willing to maintain this treatment dose for the duration of the study. If receiving AMPYRA® (dalfampridine, fampridine, 4 amino pyridine), subject must be at a stable dose for at least 3 months prior to Baseline.
  6. Stable regimen for at least 1 month prior to Baseline for all medications and non pharmacological therapies that are intended to alleviate spasticity.

    a. De novo subjects being considered for enrollment and taking medications indicated for the treatment of spasticity (ie, baclofen, benzodiazepines, cannabinoids, carisoprodol, dantrolene, tizanidine, cyclobenzaprine, any neuroleptic, ropinoprole, tolperisone, and clonidine) must wash out from these medications for a minimum of 21 days by Baseline in order to be eligible for study treatment. De novo subjects found not to meet this criterion will be withdrawn from the study and will be considered screen failures.

  7. Absence of infections, peripheral vascular disease, painful contractures, advanced arthritis, or other conditions that hinder evaluation of joint movement.
  8. Creatinine clearance, as calculated by the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease Study (MDRD) formula, of >50 mL/minute.
  9. Use of a medically highly effective form of birth control (see Section 7.8 of the protocol) during the study and for 3 months thereafter for women of child-bearing potential (including female subjects).
  10. Willing to sign the informed consent form (ICF).

Exclusion Criteria:

  1. Any concomitant disease or disorder that has symptoms of spasticity or that may influence the subject's level of spasticity.
  2. Inability to rate their level of spasticity or distinguish it from other MS symptoms.
  3. Use of high dose oral or intravenous methylprednisolone, or equivalent, within 3 months before Baseline.
  4. History of allergy to baclofen or any inactive components of the test formulation.
  5. Concomitant use of medications that would potentially interfere with the actions of the study medication or outcome variables (Appendix 5).
  6. Pregnancy, lactation, or planned pregnancy during the course of the study and for 3 months after the final study visit.
  7. Recent history (within past 12 months) of any unstable psychiatric disease (or yes response to questions 1 or 2 on the Columbia Suicide Severity Rating Scale [C SSRS] at baseline), or current signs and symptoms of significant medical disorders such as severe, progressive, or uncontrolled pulmonary, cardiac, gastrointestinal, hepatic, renal, genitourinary, hematological, endocrine, immunologic, or neurological disease.
  8. History of epilepsy.
  9. Current significant cognitive deficit, severe or untreated anxiety, severe or untreated depression.
  10. Subjects with abnormal micturition that requires indwelling or intermittent catheterization or with lower urinary tract symptoms (LUTS) that result in a score >26 in the Baseline Urinary Symptom Profile - USP© (USP) questionnaire (Appendix 6). Subjects who are proficient in self-catheterization may be included in the study at the investigator's discretion.
  11. Current malignancy or history of malignancy that has not been in remission for more than 5 years, except effectively treated basal cell skin carcinoma.
  12. Subject has clinically significant abnormal laboratory values, in the opinion of the investigator at Baseline (at Visit 6 for rollover subjects).
  13. Any other significant disease, disorder, or significant laboratory finding, including clinically significant abnormal laboratory values or ongoing serious adverse events (SAEs) at Visit 6 (Final Visit) of Study OS440-3004, which, in the opinion of the investigator, puts the subject at risk because of participation, influences the result of the study, or affects the subject's ability to participate.
  14. Planned elective surgery or other procedures requiring general anesthesia during the course of the study.
  15. History of any illicit substance abuse (eg, alcohol, marijuana, cocaine) or prescription for long-acting opioids within the past 12 months (tramadol use will be allowed).
  16. Participation in another clinical research study (with the exception of Study OS440-3004) within 1 month of Baseline.

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 ClinicalTrials.gov identifier (NCT number): NCT03319732

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United States, California
Neuro Pain Medical Center
Fresno, California, United States, 93710
Sponsors and Collaborators
RVL Pharmaceuticals, Inc.
Osmotica Pharmaceutical US LLC
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Study Director: David Jacobs, MD Vice President
  Study Documents (Full-Text)

Documents provided by RVL Pharmaceuticals, Inc.:
Study Protocol  [PDF] April 12, 2018
Statistical Analysis Plan  [PDF] January 24, 2020

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Responsible Party: RVL Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT03319732    
Other Study ID Numbers: OS440-3005
First Posted: October 24, 2017    Key Record Dates
Results First Posted: July 15, 2022
Last Update Posted: August 9, 2022
Last Verified: February 2022

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Muscle Spasticity
Multiple Sclerosis
Pathologic Processes
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Nervous System Diseases
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases
Muscular Diseases
Musculoskeletal Diseases
Muscle Hypertonia
Neuromuscular Manifestations
Neurologic Manifestations