Ketamine for Treatment of MS Fatigue

NCT03500289 | Completed Phase 1 Results FDA Drug

• 1 other identifier: IRB00164017
• Study Type: interventional
• Target: 18
• Locations: 1 country
• Sites: 1

Brief Summary

Multiple sclerosis (MS) is an inflammatory, demyelinating and degenerative disease of the central nervous system and, after trauma, is the most common cause of disability in young adults, affecting more than 400,000 individuals in the US. Of all the symptoms that can occur with MS, chronic fatigue is the most common and disabling, reported by at least 75% of patients at some point. Fatigue limits patients' daily activities, and challenges employment, resulting in substantial socioeconomic consequences. Despite this negative impact, fatigue treatments have been inconsistently studied, in part due to poorly understood underlying pathophysiological mechanisms. Yet to be defined biological processes and lack of clear treatment targets have also hampered the development of drugs for fatigue. As a result, there are no medications approved by the Food and Drug Administration (FDA) for the treatment of MS fatigue. The investigators recently reported that riluzole, a medication with anti-glutamatergic effects, increased the fatigue severity in patients with relapsing MS who had participated in a clinical trial evaluating potential neuroprotective effects of riluzole versus placebo. Three other clinic trials which examined memantine effects on cognition in patient with MS also reported worsening fatigue as a major side effect. Memantine main mechanism of action is blocking the N-methyl D-aspartate (NMDA) glutamate receptor. These observations prompted the investigators that glutamatergic transmission probably plays an important role in fatigue pathogenesis and modulating these pathways could have potential therapeutic effect on MS-related fatigue. A recent paper reported that ketamine, an NMDA receptor blocker with different kinetics compared to memantine, had a strong and prolonged effect in reducing fatigue in bipolar patients who participated in a clinical trial, evaluating anti-depressive effects of ketamine versus placebo. Interestingly, the effect of ketamine on fatigue was independent of its antidepressant effects. The primary objective of this study is to determine if modulating glutamatergic transmission with ketamine is safe and efficacious in improving MS-related fatigue. These objectives will be answered in a proof of concept, randomized controlled trial of ketamine versus an active placebo (midazolam) in patients with relapsing or progressive MS who have clinically significant fatigue. 18 patients with MS and reported fatigue, will be randomized 2:1 to one infusion of ketamine 0.5 mg/kg over 40 minutes versus one infusion of midazolam 0.05 mg/kg over 40 minutes. Midazolam is chosen as an active placebo to keep the participants blinded to participants' medication assignment. Primary outcome of the study will be Daily Fatigue Severity measured daily from day one through day seven post-infusion. Secondary outcomes of the study include other fatigue questionnaires, depression and sleepiness. The length of study will be around 28 days.

Conditions

Multiple Sclerosis; Fatigue

Outcome Measures

Primary Outcomes (1)

• Change in Daily Fatigue Severity Score

  It is a single item question: 'how much fatigue (tiredness, weariness, problems thinking clearly) have you felt today?' with responses from 0 'None at all' to 10 'Extreme Fatigue'. Reported score changes are the average point/day score change. The mean score is reported based on this calculation: \[(last day measure - baseline measure) / the number of days in the study\].

  Baseline (infusion visit) through day 7

Secondary Outcomes (5)

• Change in Quality of Life in Neurological Disorders (NeuroQol) Fatigue Item Bank Score

  Baseline (infusion visit) through day 28 post-infusion

• Change in Modified Fatigue Impact Scale (MFIS) Score

  Baseline (infusion visit) through Day 28 post-infusion

• Change in Epworth Sleepiness Scale Score

  Baseline (infusion visit) through day 28 post-infusion

• Change in Beck Depression Inventory (BDI) Score

  Baseline (infusion visit) through day 28 post-infusion

• Change in Fatigue Severity Scale (FSS) Score

  Baseline (infusion visit) through day 28 post-infusion

Study Arms (2)

Ketamine

EXPERIMENTAL

Drug: Ketamine

Midazolam

PLACEBO COMPARATOR

Drug: Midazolam

Interventions

Ketamine DRUG

One intravenous infusion of ketamine 0.5 mg/kg over 40 minutes

Ketamine

Midazolam DRUG

One intravenous infusion of midazolam 0.05 mg/kg over 40 minutes

Midazolam

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age between 18 years 65 years.
• Females of childbearing age must have a negative urine pregnancy test at baseline and use an effective method of contraception during the study.
• Diagnosis of MS (according to the 2010 McDonald criteria).
• Ambulatory (at least 20 feet using bilateral assistance).
• Fatigue reportedly present and screening modified fatigue impact scale (MFIS) score \>33.
• Internet and email access and able to use a computer or tablet

You may not qualify if:

• Beck Depression Inventory (BDI) score of more than 30.
• Neurodegenerative disorders other than relapsing or progressive MS.
• Breastfeeding or pregnant.
• History of coronary artery disease or congestive heart failure.
• Uncontrolled hypertension at screening (history of high blood pressure and screening systolic blood pressure \>160 or diastolic blood pressure\>100).
• History of severe liver disease, including cirrhosis.
• Terminal medical conditions.
• Currently treated for active malignancy.
• Alcohol or substance abuse in the past year (except marijuana or other cannabinoids).
• A history of intolerance or allergic or anaphylactic reaction to ketamine or midazolam
• Clinically unstable medical or psychiatric disorders that require acute treatment as determined by the PI.
• History of severe or untreated coronary artery disease or history of congestive heart failure.
• History of prior ischemic or hemorrhagic stroke and cerebral vascular aneurysms.
• History of recurrent seizures or epilepsy.
• Taking any disallowed therapy(ies) as noted in Appendix 2 of the protocol.

Sponsors & Collaborators

• Johns Hopkins University: lead
• National Multiple Sclerosis Society: collaborator

Study Sites (1)

Johns Hopkins University

Baltimore, Maryland, 21287, United States

Location

MeSH Terms

Conditions

Multiple Sclerosis; Fatigue

Interventions

Ketamine; Midazolam

Condition Hierarchy (Ancestors)

Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Nervous System Diseases; Demyelinating Diseases; Autoimmune Diseases; Immune System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Cyclohexanes; Cycloparaffins; Hydrocarbons, Alicyclic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals; Benzodiazepines; Benzazepines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds

Results Point of Contact

• Title: Dr. Bardia Nourbakhsh
• Organization: Johns Hopkins University

bnourba1@jhmi.edu

4106141522

Study Officials

• Bardia Nourbakhsh, MD, MAS

  Johns Hopkins University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 4, 2018
• First Posted: April 18, 2018
• Study Start: August 10, 2018
• Primary Completion: August 30, 2019
• Study Completion: August 30, 2019
• Last Updated: August 18, 2020
• Results First Posted: August 4, 2020

Record last verified: 2020-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)