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CompletedNCT03436199Updated Dec 21, 2021Results posted

Safety and Efficacy of ADS-5102 in Multiple Sclerosis Patients With Walking Impairment

A Phase 3 interventional study of ADS-5102, 137 mg and ADS-5102, 274 mg in Walking Impairment and Multiple Sclerosis, sponsored by Adamas Pharmaceuticals, Inc.. Completed at 84 sites in 2 countries. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2021-12-21.

Sponsored by Adamas Pharmaceuticals, Inc. · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
558
Allocation
Randomized
Ages
18 Years to 70 Years
Sex
All
01

Study summary

This study assessed the efficacy and safety of ADS-5102 (at daily doses of 137 mg or 274 mg) compared with placebo in MS patients with walking impairment.

Read the detailed description

This was a multicenter, 3-arm, randomized, placebo-controlled, double-blind, parallel-group study of ADS-5102 (amantadine) extended release capsules in MS subjects with walking impairment. The study consisted of a screening period (up to 3 weeks), a single-blind placebo run-in period (4 weeks; during which subjects were blinded to treatment), and a double-blind treatment period (12 weeks).

For at least 30 days prior to screening, all subjects were to have received a stable regimen of MS medications, both disease-modifying and symptomatic; these medications were to continue at the same doses and regimens for the duration of the subjects' participation in the study, to the extent compatible with good neurological care. Subjects were not to have used amantadine, dalfampridine, or any 4 aminopyridine or 2,4 diaminopyridine preparation within 30 days prior to screening.

Consented subjects who completed the screening period were to undergo a 4-week single-blind placebo run-in period during which they received placebo as 2 capsules once daily at bedtime.

Subjects who completed the single-blind placebo run-in period and continued to meet study eligibility criteria were randomized with equal probability to 1 of 3 treatment groups: placebo or ADS-5102 at a final dose of 137 mg/day or 274 mg/day. Study drugs were administered as 2 capsules once daily at bedtime.

Subjects were to return to the clinic for safety and efficacy assessments at Week 0 and Week 2 prior to randomization and at Weeks 4 (randomization and baseline visit), 6 (only safety), 8, 12, and 16 after randomization. In addition, telephone visits for safety assessments were conducted at Weeks 5 and 7. Subjects who withdrew from the study before Week 16 were to have an early termination visit that included safety follow-up and efficacy assessments, as appropriate.

02

Conditions studied

  • Walking Impairment
  • Multiple Sclerosis
03

Who can participate

Ages eligible
18 Years to 70 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Signed a current IRB-approved informed consent form
  • Male or female subjects between 18 and 70 years of age, inclusive, at the time of Screening
  • Confirmed diagnosis of MS according to the 2017 McDonald criteria
  • Current medication regimen must be stable for at least 30 days prior to screening, and subject must be willing to continue the same dosing regimen for the duration of study participation
  • Maximum Expanded Disability Status Scale (EDSS) score during screening of 6.5
  • Stable physical activity level (inclusive of prescribed physical therapy) for at least 30 days prior to screening and willing to continue without change for the duration of study participation
  • A score on each of two completed screening T25FW tests between 8 and 45 seconds, inclusive

Exclusion criteria

Exclusion Criteria:

  • Documented inability to tolerate amantadine
  • Clinically significant MS relapse with onset less than 30 days prior to screening
  • Receipt of dalfampridine (or any 4-aminopyridine or 2,4-diaminopyridine preparation) or amantadine within 30 days prior to screening
  • History of seizures within 3 years prior to screening
  • History of hallucinations (visual, auditory, or any other type) within 3 years prior to screening
  • History of bipolar disorder, schizophrenia, or psychosis, regardless of treatment
  • For subjects with a history of major depressive disorder, the presence of active depressive symptoms that, in the opinion of the investigator, would affect the subject's ability to complete study assessments, or which would not be in the subject's best interest to participate in the study
  • Presence of orthostatic hypotension at screening: a decrease in systolic blood pressure (at least 20 mm Hg) or diastolic blood pressure (at least 10 mm Hg) within 3 minutes of the subject standing up, compared to pressures obtained while sitting
  • If female, is pregnant or lactating
  • If a sexually active female, is not surgically sterile or at least 2 years post-menopausal, or does not agree to utilize a highly effective hormonal method of contraception (an IUD, or vasectomized male partner is also acceptable), in combination with a barrier method, from screening through at least 4 weeks after the completion of study treatment. If a sexually active male, does not agree to utilize condoms from screening through at least 4 weeks after the completion of study treatment.
  • Treatment with an investigational drug or device within 30 days prior to screening
  • Treatment with an investigational biologic within 6 months or 5 half-lives, whichever is longer, prior to screening
04

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
558 participants (actual)

Study arms

  • Experimental
    ADS-5102, 137 mg

    ADS-5102, administered once daily at bedtime from Week 4 through Week 16

    Drug: ADS-5102, 137 mg

  • Experimental
    ADS-5102, 274 mg

    ADS-5102, administered once daily at bedtime from Week 4 through Week 16

    Drug: ADS-5102, 274 mg

  • Other
    Placebo

    placebo, administered once daily at bedtime from Week 4 through Week 16

    Other: Placebo

Interventions

  • DrugADS-5102, 137 mg

    Oral capsules

    Also known as: ADS-5102, amantadine extended release

  • DrugADS-5102, 274 mg

    Oral capsules

    Also known as: ADS-5102, amantadine extended release

  • OtherPlacebo

    Oral capsules

05

What researchers measure

Primary outcomes

  1. Timed 25 Foot Walk (T25FW, Feet/Second): the Proportion of Subjects With a ≥ 20% Increase in Walking Speed (Measured by T25FW) From Baseline at Week 16 (Responder Analysis)

    The T25FW is a measure of lower extremity function. The subject is directed to a clearly marked 25-foot course and is instructed to walk 25 feet as quickly as possible, but safely. The task is immediately administered again by having the subject walk back the same distance. For this outcome measure, the result is reported as speed (feet per second). Improvement is indicated by an increase in speed.

    Time frame: 16 weeks

Secondary outcomes

  1. Timed 25 Foot Walk: Change From Baseline at Week 16

    The T25FW is a measure of lower extremity function. The subject is directed to a clearly marked 25-foot course and is instructed to walk 25 feet as quickly as possible, but safely. The task is immediately administered again by having the subject walk back the same distance. For this outcome measure, the result is reported as or speed (feet per second). Improvement is indicated by an increase in speed.

    Time frame: 16 weeks

  2. Timed Up and Go (TUG): Change From Baseline at Week 16

    The TUG is a measure of lower extremity strength, balance, and coordination. The subject stands up from a chair, walks 3 meters then turns around and walks back to the chair to sit down. The result is reported in seconds. Improvement is indicated by negative change scores.

    Time frame: 16 weeks

  3. 2-Minute Walk Test (2MWT): Change From Baseline at Week 16

    The 2MWT is a measure of lower extremity function. The subject is instructed to walk as far as possible in 2 minutes, and the distance is measured in meters. Improvement is indicated by positive change scores.

    Time frame: 16 weeks

06

Results

Posted Dec 21, 2021

Participant flow

Participant flow — Overall Study
MilestoneADS-5102 137 mgADS-5102 274 mgPlacebo
Started187185186
Completed165132174
Not completed225312
Withdrew: Adverse event15407
Withdrew: Withdrawal by subject4103
Withdrew: Lost to follow-up102
Withdrew: Protocol violation110
Withdrew: Physician decision010
Withdrew: Could not return to clinic100
Withdrew: Withdrawn per physician010

Outcome measures

PrimaryTimed 25 Foot Walk (T25FW, Feet/Second): the Proportion of Subjects With a ≥ 20% Increase in Walking Speed (Measured by T25FW) From Baseline at Week 16 (Responder Analysis)

The T25FW is a measure of lower extremity function. The subject is directed to a clearly marked 25-foot course and is instructed to walk 25 feet as quickly as possible, but safely. The task is immediately administered again by having the subject walk back the same distance. For this outcome measure, the result is reported as speed (feet per second). Improvement is indicated by an increase in speed.

Time frame:
16 weeks
Reported as:
Number · proportion of responders
Timed 25 Foot Walk (T25FW, Feet/Second): the Proportion of Subjects With a ≥ 20% Increase in Walking Speed (Measured by T25FW) From Baseline at Week 16 (Responder Analysis)
proportion of respondersADS-5102 137 mgADS-5102 274 mgPlacebo
Timed 25 Foot Walk (T25FW, Feet/Second): the Proportion of Subjects With a ≥ 20% Increase in Walking Speed (Measured by T25FW) From Baseline at Week 16 (Responder Analysis)0.1760.2110.113
Statistical analysis
  • ADS-5102 137 mg vs Placebo · Farrington-Manning score test · p = 0.0811 · Risk difference (rd): 0.064 · 95% CI -0.008 to 0.136The Miettinen-Nurminen method was used to obtain the 95% confidence intervals.
  • ADS-5102 274 mg vs Placebo · Farrington-Manning score test · p = 0.0104 · Risk difference (rd): 0.098 · 95% CI 0.023 to 0.174The Miettinen-Nurminen method was used to obtain the 95% confidence intervals.
SecondaryTimed 25 Foot Walk: Change From Baseline at Week 16

The T25FW is a measure of lower extremity function. The subject is directed to a clearly marked 25-foot course and is instructed to walk 25 feet as quickly as possible, but safely. The task is immediately administered again by having the subject walk back the same distance. For this outcome measure, the result is reported as or speed (feet per second). Improvement is indicated by an increase in speed.

Time frame:
16 weeks
Reported as:
Least squares mean · feet/second
Timed 25 Foot Walk: Change From Baseline at Week 16
feet/secondADS-5102 137 mgADS-5102 274 mgPlacebo
Timed 25 Foot Walk: Change From Baseline at Week 160.19 ± 0.0340.19 ± 0.0340.07 ± 0.033
Statistical analysis
  • ADS-5102 137 mg vs Placebo · Mixed Models Analysis · p = 0.0162 · Mean difference (net): 0.12 · 95% CI 0.02 to 0.21Mixed models analysis with repeated measures
  • Placebo · Mixed Models Analysis · p = 0.0142 · Mean difference (net): 0.12 · 95% CI 0.02 to 0.22Mixed models analysis with repeated measures
SecondaryTimed Up and Go (TUG): Change From Baseline at Week 16

The TUG is a measure of lower extremity strength, balance, and coordination. The subject stands up from a chair, walks 3 meters then turns around and walks back to the chair to sit down. The result is reported in seconds. Improvement is indicated by negative change scores.

Time frame:
16 weeks
Reported as:
Least squares mean · seconds
Timed Up and Go (TUG): Change From Baseline at Week 16
secondsADS-5102 137 mgADS-5102 274 mgPlacebo
Timed Up and Go (TUG): Change From Baseline at Week 16-1.35 ± 0.384-0.60 ± 0.415-0.56 ± 0.377
Statistical analysis
  • ADS-5102 137 mg vs Placebo · Mixed Models Analysis · p = 0.1424 · Mean difference (net): -0.79 · 95% CI -1.85 to 0.27Mixed models analysis with repeated measures
  • ADS-5102 274 mg vs Placebo · Mixed Models Analysis · p = 0.9467 · Mean difference (net): -0.04 · 95% CI -1.14 to 1.06Mixed models analysis with repeated measures
Secondary2-Minute Walk Test (2MWT): Change From Baseline at Week 16

The 2MWT is a measure of lower extremity function. The subject is instructed to walk as far as possible in 2 minutes, and the distance is measured in meters. Improvement is indicated by positive change scores.

Time frame:
16 weeks
Reported as:
Least squares mean · meters
2-Minute Walk Test (2MWT): Change From Baseline at Week 16
metersADS-5102 137 mgADS-5102 274 mgPlacebo
2-Minute Walk Test (2MWT): Change From Baseline at Week 166.306 ± 1.24225.692 ± 1.35372.163 ± 1.2158
Statistical analysis
  • ADS-5102 137 mg vs Placebo · Mixed Models Analysis · p = 0.0176 · Mean difference (net): 4.143 · 95% CI 0.726 to 7.560Mixed models analysis with repeated measures
  • ADS-5102 274 mg vs Placebo · Mixed Models Analysis · p = 0.0530 · Mean difference (net): 3.529 · 95% CI -0.046 to 7.104Mixed models analysis with repeated measures

Adverse events

Collected over 18 weeks. Non-serious events are listed at a 2% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
ADS-5102 137 mg0/187 (0%)5/187 (2.7%)105/187 (56.1%)
ADS-5102 274 mg0/185 (0%)11/185 (5.9%)140/185 (75.7%)
Placebo0/186 (0%)1/186 (0.5%)90/186 (48.4%)
Most frequent serious events
Showing 10 of 17
Most frequent serious events
EventADS-5102 137 mgADS-5102 274 mgPlacebo
Multiple sclerosis relapseNervous system disorders0/1872/1850/186
AppendicitisInfections and infestations1/1871/1850/186
Viral upper respiratory tract infectionInfections and infestations0/1871/1850/186
Facial spasmNervous system disorders0/1871/1850/186
Musculoskeletal stiffnessMusculoskeletal and connective tissue disorders0/1871/1850/186
OsteoarthritisMusculoskeletal and connective tissue disorders0/1871/1850/186
Hallucinations, mixedPsychiatric disorders0/1871/1850/186
Suicide attemptPsychiatric disorders0/1871/1850/186
Vision blurredEye disorders0/1871/1850/186
IleusGastrointestinal disorders0/1871/1850/186
Most frequent other events
Showing 10 of 36
Most frequent other events
EventADS-5102 137 mgADS-5102 274 mgPlacebo
Oedema peripheralGeneral disorders8/18729/1851/186
Dry mouthGastrointestinal disorders6/18725/1852/186
Urinary tract infectionInfections and infestations7/18716/18519/186
FallInjury, poisoning and procedural complications8/18716/18513/186
ConstipationGastrointestinal disorders8/18715/1851/186
InsomniaPsychiatric disorders3/18713/1850/186
DizzinessNervous system disorders5/1878/1854/186
TremorNervous system disorders2/1878/1851/186
FatigueGeneral disorders6/1878/1855/186
Vision blurredEye disorders2/1878/1851/186

Baseline characteristics

Age, Continuous
Age, Continuous(years)ADS-5102 137 mgADS-5102 274 mgPlaceboTotal
Mean54.7 ± 9.1354.0 ± 9.2754.5 ± 9.7554.4 ± 9.37
Sex: Female, Male
Sex: Female, Male(Participants)ADS-5102 137 mgADS-5102 274 mgPlaceboTotal
Female125124128377
Male626158181
Race (NIH/OMB)
Race (NIH/OMB)(Participants)ADS-5102 137 mgADS-5102 274 mgPlaceboTotal
American Indian or Alaska Native1023
Asian0000
Native Hawaiian or Other Pacific Islander0000
Black or African American24212368
White158160155473
More than one race1034
Unknown or Not Reported34310
Time since diagnosis of multiple sclerosis
Time since diagnosis of multiple sclerosis(years)ADS-5102 137 mgADS-5102 274 mgPlaceboTotal
Mean15.99 ± 9.86215.97 ± 9.65515.85 ± 9.47815.94 ± 9.649
07

Study locations

84 sites
  • Adamas Clinical Site
    Cullman, Alabama 35058, United States
  • Adamas Clinical Site
    Phoenix, Arizona 85032, United States
  • Adamas Clinical Site
    Scottsdale, Arizona 85251, United States
  • Adamas Clinical Site
    Tucson, Arizona 85704, United States
  • Adamas Clinical Site
    Carlsbad, California 92011, United States
  • Adamas Clinical Site
    Fresno, California 93710, United States
  • Adamas Clinical Site
    Fullerton, California 92835, United States
  • Adamas Clinical Site
    Long Beach, California 90806, United States
  • Adamas Clinical Site
    Newport Beach, California 92663, United States
  • Adamas Clinical Site
    Sacramento, California 95817, United States
  • Adamas Clinical Site
    Aurora, Colorado 80045, United States
  • Adamas Clinical Site
    Colorado Springs, Colorado 80907, United States
  • Adamas Clinical Site
    Denver, Colorado 80209, United States
  • Adamas Clinical Site
    Fort Collins, Colorado 80528, United States
  • Adamas Clinical Site
    Fairfield, Connecticut 06824, United States
  • Adamas Clinical Site
    New London, Connecticut 06320, United States
  • Adamas Clinical Site
    Washington, District of Columbia 20007, United States
  • Adamas Clinical Site
    Maitland, Florida 32751, United States
  • Adamas Clinical Site
    Miami, Florida 33136, United States
  • Adamas Clinical Site
    Naples, Florida 34105, United States
  • Adamas Clinical Site
    Orlando, Florida 32806, United States
  • Adamas Clinical Site
    Ormond Beach, Florida 32174, United States
  • Adamas Clinical Site
    Palm Coast, Florida 32164, United States
  • Adamas Clinical Site
    Port Charlotte, Florida 33952, United States
  • Adamas Clinical Site
    Sarasota, Florida 34233, United States
  • Adamas Clinical Site
    Tampa, Florida 33609, United States
  • Adamas Clinical Site
    Vero Beach, Florida 32960, United States
  • Adamas Clinical Site
    Atlanta, Georgia 30309, United States
  • Adamas Clinical Site
    Savannah, Georgia 31406, United States
  • Adamas Clinical Site
    Northbrook, Illinois 60062, United States
  • Adamas Clinical Site
    Indianapolis, Indiana 46256, United States
  • Adamas Clinical Site
    Kansas City, Kansas 66160, United States
  • Adamas Clinical Site
    Lenexa, Kansas 66214, United States
  • Adamas Clinical Site
    Overland Park, Kansas 66212, United States
  • Adamas Clinical Site
    Foxboro, Massachusetts 02035, United States
  • Adamas Clinical Site
    Lexington, Massachusetts 02421, United States
  • Admas Clinical Site
    Detroit, Michigan 48201, United States
  • Adamas Clinical Site
    Farmington Hills, Michigan 48334, United States
  • Adamas Clinical Site
    Golden Valley, Minnesota 55422, United States
  • Adamas Clinical Site
    Kansas City, Missouri 64111, United States
  • Adamas Clinical Site
    Saint Louis, Missouri 63110, United States
  • Adamas Clinical Site
    Great Falls, Montana 59405, United States
  • Adamas Clinical Site
    Lincoln, Nebraska 68506, United States
  • Adamas Clinical Site
    Omaha, Nebraska 68198, United States
  • Adamas Clinical Site
    Las Vegas, Nevada 89016, United States
  • Adamas Clinical Site
    Albuquerque, New Mexico 87131, United States
  • Adamas Clinical Site
    Amherst, New York 14226, United States
  • Adamas Clinical Site
    Lake Success, New York 11042, United States
  • Adamas Clinical Site
    New York, New York 10029, United States
  • Adamas Clinical Site
    Patchogue, New York 11772, United States
  • Adamas Clinical Site
    Plainview, New York 11803, United States
  • Adamas Clinical Site
    Rochester, New York 14642, United States
  • Adamas Clinical Site
    Staten Island, New York 10306, United States
  • Adamas Clinical Site
    Charlotte, North Carolina 28207, United States
  • Adamas Clinical Site
    Raleigh, North Carolina 27607, United States
  • Adamas Clinical Site
    Centerville, Ohio 45459, United States
  • Adamas Clinical Site
    Cleveland, Ohio 44195, United States
  • Adamas Clinical Site
    Columbus, Ohio 43214, United States
  • Adamas Clinical Site
    Oklahoma City, Oklahoma 73104, United States
  • Adamas Clinical Site
    Portland, Oregon 97225, United States
  • Adamas Clinical Site
    Philadelphia, Pennsylvania 19140, United States
  • Adamas Clinical Site
    Charleston, South Carolina 29406, United States
  • Adamas Clinical Site
    Greer, South Carolina 29650, United States
  • Adamas Clinical Site
    Indian Land, South Carolina 29707, United States
  • Adamas Clinical Site
    Spartanburg, South Carolina 29307, United States
  • Adamas Clinical Site
    Cordova, Tennessee 38018, United States
  • Adamas Clinical Site
    Franklin, Tennessee 37064, United States
  • Adamas Clinical Site
    Johnson City, Tennessee 37604, United States
  • Adamas Clinical Site
    Houston, Texas 77030, United States
  • Adamas Clinical Site
    Houston, Texas 77074, United States
  • Adamas Clinical Site
    Round Rock, Texas 78681, United States
  • Adamas Clinical Site
    Salt Lake City, Utah 84103, United States
  • Adamas Clinical Site
    Newport News, Virginia 23601, United States
  • Adamas Clinical Site
    Norfolk, Virginia 23502, United States
  • Adamas Clinical Site
    Kirkland, Washington 98034, United States
  • Adamas Clinical Site
    Seattle, Washington 98101, United States
  • Adamas Clinical Site
    Seattle, Washington 98122, United States
  • Adamas Clinical Site
    Milwaukee, Wisconsin 53215, United States
  • Adamas Clinical Site
    Edmonton, Alberta T6R 2B7, Canada
  • Adamas Clinical Site
    Lethbridge, Alberta T1J 0N9, Canada
  • Adamas Clinical Site
    Burnaby, British Columbia V5G 2X6, Canada
  • Adamas Clinical Site
    Greenfield Park, Quebec J4V 2J2, Canada
  • Adamas Clinical Site
    Montréal, Quebec H3A 2B4, Canada
  • Adamas Clinical Site
    Quebec City, Quebec G1J 1Z4, Canada
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Dec 5, 2019

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT03436199
Lead sponsor
Adamas Pharmaceuticals, Inc.
Responsible party
Sponsor
First posted
Feb 19, 2018
Start date
Mar 29, 2018
Primary completion
Dec 10, 2019
Completion
Dec 10, 2019
Results posted
Dec 21, 2021
Last update
Dec 21, 2021

Study contacts

Clinical Trials Director
study director · Adamas Pharmaceuticals

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
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