Clinical trial NCT02308137: Domperidone in Secondary Progressive Multiple Sclerosis (SPMS)
Official title: Open-label, Single-center, Single-arm Futility Trial Evaluating Oral Domperidone 10mg QID for Reducing Progression of Disability in Patients With Secondary Progressive Multiple Sclerosis (SPMS)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Multiple Sclerosis, Secondary Progressive
Lead sponsor: University of Calgary
Sponsor class: OTHER
Collaborators: name: Alberta Innovates Health Solutions
First posted: 2014-12-04
Enrollment: 64
Sex: ALL
Minimum age (years): 18
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this clinical trial is to determine if Domperidone in a dose of 40 mg daily can prevent worsening of walking ability in people secondary progressive MS. The number of participants in this study will be 62. A maximum of 75 people with secondary progressive MS will be included. Each patient will be followed for 12 months from inclusion. Domperidone is a medication which has been shown to increase levels of the hormone prolactin. The best understood function of prolactin is the stimulation of milk production in women after delivery. However, the increase in prolactin levels seen in patients treated with standard doses of Domperidone (in doses of up to 80mg per day) usually does not lead to clinical symptoms. Prolactin has been shown to improve myelin repair in mice. Domperidone therefore may also improve myelin repair in people with MS. Domperidone is currently approved in Canada to treat slow moving bowels and nausea, for instance in patients with Parkinson's Disease or Diabetes Mellitus, where too slowly moving bowels can cause constipation. Domperidone is available as a tablet that is usually taken four times per day. Doses up to 80mg per day may be used but we estimate that a dose of only 40mg daily will be needed to stimulate myelin repair. Domperidone is usually well tolerated.

Detailed description: Primary objective

To demonstrate non-futility of domperidone for reducing progression of disability, as measured with the timed 25 foot walk (T25FW), in secondary progressive Multiple Sclerosis (SPMS).

Secondary objectives

* To assess the safety of domperidone in the study population for the duration of the study.
* To assess the effect of domperidone on hand dexterity as measured with the 9HPT
* To assess the effect of domperidone on cognition, as measured with the SDMT
* To assess the effect of domperidone on health related quality of life, as measured with the MSQOL-54
* To assess the effect of domperidone on fatigue, as measured with the MFIS
* To establish the Simon-2-stage model as a study model in MS research. The application of this methodology to studies in progressive MS will have important consequences for the design and conduct of clinical and translational research in progressive MS, in particular for phase II trials in progressive MS

Eligibility criteria: Inclusion Criteria:

* written informed consent obtained
* with Multiple Sclerosis, and with secondary progressive disease course
* screening Expanded Disability Status Scale (EDSS) score between 4.0 and 6.5 inclusive
* screening timed 25 foot walk (average of two trials) lof 9 seconds or more

Exclusion Criteria:

* Long QT interval, defined as corrected QT interval of more than 470 msec in men and more than 450 msec in women on baseline ECG
* Patients with known long-QT syndrome
* Patients with known ventricular arrhythmia
* Patients with a known electrolyte disturbance
* Patients undergoing treatment with drugs that increase the QTc interval
* Patients undergoing treatment with drugs that inhibit CYP3A4, in particular: Ketoconazole, Fluconazole, Erythromycin, Clarithromycin, Ritonavir
* Patients with a history of breast cancer or carcinoma in situ
* Patients with known renal insufficiency
* Patients with known allergy or other intolerability to domperidone
* Patients currently using Fampridine or 4-aminopyridine
* Patients planning to start Fampridine or 4-aminopyridine during the study period
* Patients planning to start Baclofen or Tizanidine during the duration of the study
* Patients planning to increase or decrease their dose of Baclofen or Tizanidine during the study period
* Patients planning to receive treatment with Botulinum toxin in the leg muscles during the duration of the study
* Patients with a significiant hepatic impairment
* Patients with a prolactinoma
* Patients in whom gastrointestinal stimulation could be dangerous
* Patients using MAO inhibitors
* Patients with a history of breast cancer
* Pregnant or breast-feeding women

Primary outcomes:
measure: Timed 25-Foot Walk (T25W)
timeFrame: up to 12 months
Secondary outcomes:
measure: 9-Hole Peg Test
timeFrame: administered at baseline, one month, 6 months, and 12 months
measure: Symbol Digit Modalities Test
timeFrame: administered at baseline, one month, 6 months, and 12 months
measure: Functional Systems and Expanded Disability Status Scale (EDSS)
timeFrame: administered at baseline, one month, 6 months, and 12 months
measure: Modified Fatigue Impact Scale (MFIS)
timeFrame: administered at baseline, one month, 6 months, and 12 months
measure: Multiple Sclerosis Quality of Life Scale 54 item version
timeFrame: administered at baseline, one month, 6 months, and 12 months
Other outcomes:
Locations:
city: Calgary
country: Canada
facility: Calgary MS Clinic at Foothills Medical Centre
state: Alberta
Study officials:
affiliation: University of Calgary
name: Marcus W Koch, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med. 2000 Sep 28;343(13):938-52. doi: 10.1056/NEJM200009283431307. No abstract available.
citation: Nylander A, Hafler DA. Multiple sclerosis. J Clin Invest. 2012 Apr;122(4):1180-8. doi: 10.1172/JCI58649. Epub 2012 Apr 2.
citation: Weinshenker BG, Bass B, Rice GP, Noseworthy J, Carriere W, Baskerville J, Ebers GC. The natural history of multiple sclerosis: a geographically based study. 2. Predictive value of the early clinical course. Brain. 1989 Dec;112 ( Pt 6):1419-28. doi: 10.1093/brain/112.6.1419.
citation: Lassmann H, van Horssen J, Mahad D. Progressive multiple sclerosis: pathology and pathogenesis. Nat Rev Neurol. 2012 Nov 5;8(11):647-56. doi: 10.1038/nrneurol.2012.168. Epub 2012 Sep 25.
citation: Rovaris M, Confavreux C, Furlan R, Kappos L, Comi G, Filippi M. Secondary progressive multiple sclerosis: current knowledge and future challenges. Lancet Neurol. 2006 Apr;5(4):343-54. doi: 10.1016/S1474-4422(06)70410-0.
citation: Patrikios P, Stadelmann C, Kutzelnigg A, Rauschka H, Schmidbauer M, Laursen H, Sorensen PS, Bruck W, Lucchinetti C, Lassmann H. Remyelination is extensive in a subset of multiple sclerosis patients. Brain. 2006 Dec;129(Pt 12):3165-72. doi: 10.1093/brain/awl217. Epub 2006 Aug 18.
citation: Franklin RJ, ffrench-Constant C, Edgar JM, Smith KJ. Neuroprotection and repair in multiple sclerosis. Nat Rev Neurol. 2012 Nov 5;8(11):624-34. doi: 10.1038/nrneurol.2012.200. Epub 2012 Oct 2.
citation: Tselis A, Khan OA, Lisak RP. Approaches to neuroprotective strategies in multiple sclerosis. Expert Opin Pharmacother. 2010 Dec;11(17):2869-78. doi: 10.1517/14656566.2010.508070. Epub 2010 Aug 5.
citation: Zhornitsky S, Yong VW, Weiss S, Metz LM. Prolactin in multiple sclerosis. Mult Scler. 2013 Jan;19(1):15-23. doi: 10.1177/1352458512458555. Epub 2012 Aug 29.
citation: Rudick R, Antel J, Confavreux C, Cutter G, Ellison G, Fischer J, Lublin F, Miller A, Petkau J, Rao S, Reingold S, Syndulko K, Thompson A, Wallenberg J, Weinshenker B, Willoughby E. Recommendations from the National Multiple Sclerosis Society Clinical Outcomes Assessment Task Force. Ann Neurol. 1997 Sep;42(3):379-82. doi: 10.1002/ana.410420318.
citation: Koch MW, Sage K, Kaur S, Kim J, Cerchiaro G, Yong VW, Cutter GR, Metz LM. Repurposing Domperidone in Secondary Progressive Multiple Sclerosis: A Simon 2-Stage Phase 2 Futility Trial. Neurology. 2021 May 4;96(18):e2313-e2322. doi: 10.1212/WNL.0000000000011863. Epub 2021 Mar 23.