A Phase 4 interventional study of Nortriptyline and Duloxetine in Cryptogenic Sensory Polyneuropathy, sponsored by University of Kansas Medical Center. Completed at 46 sites in 2 countries. Open to participants aged 30 Years and older. Per ClinicalTrials.gov, last updated 2018-07-06.
Sponsored by University of Kansas Medical Center · Phase 4, Interventional, and Treatment
The purpose of this large comparative effectiveness study led by Richard J. Barohn, MD, of the University of Kansas Medical Center, is to learn about the safety and effectiveness of nortriptyline, duloxetine, pregabalin and mexiletine in treating cryptogenic sensory polyneuropathy (CSPN).
The goal of this research project is to find the best drug for the treatment of pain in patients with CSPN. While the pharmaceutical industry has focused attention on drugs for treating diabetic sensory neuropathy (DSPN), and two drugs are now FDA approved, there have not been any prospective trials in CSPN. And, because there are no studies with CSPN patients, insurance carriers often reject authorizing prescriptions for some drugs for patients with CSPN.
There are four drugs that will be tested in this study: nortriptyline, duloxetine, pregabalin and mexiletine. These drugs are not approved by the FDA for the treatment of CSPN and are considered "investigational" in this study.
There are two periods in this study: Screening/Baseline and Study Drug. During the Screening/Baseline period the researchers will determine eligibility for potential subjects. During the second period, eligible patients who consented to participate will take the study drug. Participants will be randomized to receive one of the four drugs in this study. Participants will know which drug they are taking. Participants will not be allowed to switch groups and receive a different drug during the study.
This study uses an adaptive study design. This means the study can enroll less participants and provide better conclusions. The study design allows the researchers the ability to make changes to the approach of the study or to stop the study early if there are strong results.
256 studies on the registry are indexed under Polyneuropathies; 50 are open to participants now.
This study's enrollment of 402 is above the median of 75 across 162 interventional studies indexed under Polyneuropathies.
Browse Polyneuropathies studies →University of Kansas Medical Center is the lead sponsor of 483 studies on the registry; 113 are open to participants now.
Of its 38 completed or terminated interventional studies of FDA-regulated products, 24 (63%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Nortriptyline - 25 mg daily for 1 week at bedtime, then 50 mg daily at bedtime for 1 week, then 75 mg daily at bedtime for the remainder of the study.
Drug: Nortriptyline
Duloxetine - 20 mg daily for 1 week, then 40 mg daily for 1 week, then 60 mg daily for the remainder of the study.
Drug: Duloxetine
Pregabalin - 100 mg at bedtime for 1 week, then 100 mg 2 times per day for 1 week, then 100 mg 3 times per day for the remainder of the study.
Drug: Pregabalin
Mexiletine - 200 mg at bedtime for 1 week, then 200 mg 2 times per day for 1 week, then 200 mg 3 times per day for the remainder of the study.
Drug: Mexiletine
Co-Primary Measures: Percent of Patients With at Least a 50% Decrease in Likert Pain Scale From Baseline to Week 12 Follow Up and Percent of Patients That Quit
The final outcome of the study is a combination of two endpoints, efficacy and quit or treatment discontinuation rates. The first endpoint was a patient responder-defined measure of efficacy. A patient was deemed efficacious if a 50% or more reduction was observed in the Likert pain-scale from the baseline visit to the 12 week visit (i.e. 6 at baseline to 3 or less at week 12). The second endpoint was the observed percentage of patients who discontinued treatment prior to the last follow up visit for any reason or were lost to follow up. The utility function, which combines efficacy and quit rates, was used to drive the adaptive randomization, stopping criteria, and final analysis conclusions.
Time frame: 12 weeks
SF12 Health Composite Scores
SF-12v2® Health Survey Standard The Optum™ SF-12v2® Health Survey is a shorter version of the SF-36v2® Health Survey that uses just 12 questions to measure functional health and well-being from the patient's point of view. Survey provides psychometrically-based physical component summary (PCS) and mental component summary (MCS) scores. Scores are calibrated so that 50 is the average score or norm, standard deviation = 10. Higher scores indicate better health for both mental and physical component summary scores.
Time frame: 12 weeks
PROMIS Pain Interference Short Form v1.0 8a T Score
Higher scores for pain interference represents worse outcome (more pain interference) T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.
Time frame: 12 weeks
PROMIS Fatigue Short Form v1.0 8a
Higher scores for fatigue represents worse outcome (more fatigue). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.
Time frame: 12 Weeks
PROMIS Sleep Disturbance Short Form v1.0 8a
Higher scores for sleep disturbance represents worse outcome (more sleep disturbance). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population. Higher scores equals more of the concept being measured
Time frame: 12 weeks
| Milestone | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| Started | 134 | 126 | 73 | 69 |
| Completed | 132 | 118 | 70 | 65 |
| Not completed | 2 | 8 | 3 | 4 |
| Withdrew: Lost to follow-up | 2 | 8 | 3 | 4 |
The final outcome of the study is a combination of two endpoints, efficacy and quit or treatment discontinuation rates. The first endpoint was a patient responder-defined measure of efficacy. A patient was deemed efficacious if a 50% or more reduction was observed in the Likert pain-scale from the baseline visit to the 12 week visit (i.e. 6 at baseline to 3 or less at week 12). The second endpoint was the observed percentage of patients who discontinued treatment prior to the last follow up visit for any reason or were lost to follow up. The utility function, which combines efficacy and quit rates, was used to drive the adaptive randomization, stopping criteria, and final analysis conclusions.
| Participants | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| Efficacious and Non-Quit | 34 | 29 | 11 | 14 |
| Non-Efficacious and Non-Quit | 49 | 50 | 31 | 15 |
| Quit | 51 | 47 | 31 | 40 |
SF-12v2® Health Survey Standard The Optum™ SF-12v2® Health Survey is a shorter version of the SF-36v2® Health Survey that uses just 12 questions to measure functional health and well-being from the patient's point of view. Survey provides psychometrically-based physical component summary (PCS) and mental component summary (MCS) scores. Scores are calibrated so that 50 is the average score or norm, standard deviation = 10. Higher scores indicate better health for both mental and physical component summary scores.
| Norm-Based Standardization Score | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| Mental Component Score | 51.0 ± 8.9 | 50.9 ± 9.9 | 47.2 ± 11.2 | 51.3 ± 10.8 |
| Physical Component Score | 42.8 ± 8.7 | 42.1 ± 9.5 | 40.0 ± 8.2 | 43.7 ± 9.6 |
Higher scores for pain interference represents worse outcome (more pain interference) T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.
| T-Score | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| PROMIS Pain Interference Short Form v1.0 8a T Score | 56.4 ± 8.4 | 56.5 ± 8.3 | 60.0 ± 7.5 | 54.5 ± 8.8 |
Higher scores for fatigue represents worse outcome (more fatigue). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.
| T-Score | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| PROMIS Fatigue Short Form v1.0 8a | 53.6 ± 9.5 | 55.4 ± 10.2 | 56.7 ± 10.6 | 51.6 ± 10.7 |
Higher scores for sleep disturbance represents worse outcome (more sleep disturbance). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population. Higher scores equals more of the concept being measured
| T-Score | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| PROMIS Sleep Disturbance Short Form v1.0 8a | 58.9 ± 2.5 | 58.9 ± 2.6 | 58.3 ± 2.3 | 59.1 ± 2.0 |
Collected over 12 Weeks Post Randomization. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Nortriptyline | 0/134 (0%) | 0/134 (0%) | 75/134 (56%) |
| Duloxetine | 0/126 (0%) | 0/126 (0%) | 59/126 (46.8%) |
| Pregabalin | 0/73 (0%) | 0/73 (0%) | 29/73 (39.7%) |
| Mexiletine | 0/69 (0%) | 0/69 (0%) | 27/69 (39.1%) |
| Event | Nortriptyline | Duloxetine | Pregabalin | Mexiletine |
|---|---|---|---|---|
| Dry MouthNervous system disorders | 27/134 | 3/126 | 1/73 | 3/69 |
| OtherNervous system disorders | 3/134 | 13/126 | 12/73 | 9/69 |
| Drowsiness/SleepinessNervous system disorders | 16/134 | 7/126 | 8/73 | 3/69 |
| InsomniaGeneral disorders | 5/134 | 12/126 | 1/73 | 2/69 |
| NauseaEar and labyrinth disorders | 3/134 | 11/126 | 1/73 | 6/69 |
| Bloating/ConstipationGastrointestinal disorders | 10/134 | 3/126 | 1/73 | 2/69 |
| FatigueNervous system disorders | 7/134 | 8/126 | 3/73 | 1/69 |
| HeadacheNervous system disorders | 4/134 | 2/126 | 2/73 | 1/69 |
| Age, Categorical(Participants) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 91 | 86 | 50 | 41 | 268 |
| >=65 years | 43 | 40 | 23 | 28 | 134 |
| Age, Continuous(years) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| Mean | 60.3 ± 12.7 | 59.9 ± 14.0 | 59.5 ± 13.6 | 60.7 ± 13.7 | 60.1 ± 13.4 |
| Sex: Female, Male(Participants) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| Female | 59 | 68 | 34 | 28 | 189 |
| Male | 75 | 58 | 39 | 41 | 213 |
| Ethnicity (NIH/OMB)(Participants) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| Hispanic or Latino | 8 | 6 | 4 | 3 | 21 |
| Not Hispanic or Latino | 126 | 119 | 68 | 66 | 379 |
| Unknown or Not Reported | 0 | 1 | 1 | 0 | 2 |
| Race (NIH/OMB)(Participants) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 1 | 0 | 0 | 0 | 1 |
| Asian | 6 | 4 | 4 | 3 | 17 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 10 | 11 | 4 | 1 | 26 |
| White | 113 | 104 | 62 | 64 | 343 |
| More than one race | 0 | 0 | 0 | 0 | 0 |
| Unknown or Not Reported | 4 | 7 | 3 | 1 | 15 |
| Region of Enrollment(Participants) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| United States | 134 | 126 | 73 | 69 | 402 |
| Patient-Reported Outcomes Measurement Information System (PROMIS) Scale T-Scores(T-Score) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| PROMIS Pain Interference T-Score | 63.1 ± 7.0 | 62.4 ± 6.8 | 63.3 ± 5.5 | 60.9 ± 7.9 | 62.5 ± 6.9 |
| PROMIS Fatigue T-Score | 59.6 ± 3.4 | 59.7 ± 3.3 | 59.1 ± 3.7 | 59.7 ± 3.2 | 59.6 ± 3.4 |
| PROMIS Sleep Disturbance T-Score | 59.1 ± 9.8 | 60.6 ± 8.3 | 59.8 ± 8.7 | 57.0 ± 11.4 | 59.3 ± 9.5 |
| SF12 Health Component Scores(Norm-Based Standardization Score) | Nortriptyline | Duloxetine | Pregabalin | Mexiletine | Total |
|---|---|---|---|---|---|
| Physical Component Score | 38.0 ± 9.3 | 38.5 ± 9.3 | 37.9 ± 9.1 | 41.1 ± 10.1 | 38.7 ± 9.4 |
| Mental Component Score | 48.0 ± 10.4 | 46.7 ± 10.1 | 46.8 ± 11.3 | 47.2 ± 11.1 | 47.2 ± 10.6 |
1 further baseline measures are reported on the registry.
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