A Phase 3 interventional study of Nabiximols and Placebo in Multiple Sclerosis (MS), sponsored by Jazz Pharmaceuticals. Terminated at 37 sites in 5 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-05-08.
Sponsored by Jazz Pharmaceuticals · Phase 3, Interventional, and Treatment
This trial is being conducted to demonstrate the efficacy of nabiximols, compared with placebo, when added to standard of care, in the treatment of muscle spasms associated with multiple sclerosis (MS).
This multicenter, double-blind, placebo-controlled trial includes a 28-day Baseline period, a 12-week treatment period (comprising a 2-week titration phase and a 10-week maintenance phase), and 2-week follow-up period.
Eligible participants will enter the 28-day baseline period. During baseline, participants will maintain their optimized oral MS antispasticity medication regimen and record spasm count using an electronic daily diary. At screening (Day 1), eligible participants will be randomized to either nabiximols or placebo in a 1:1 ratio.
Participants will be advised to titrate the investigational medicinal product (IMP), beginning with 1 spray/day, to an optimized dose or to a maximum of 12 sprays/day over the first 14 days of treatment. Participants may leave a gap between sprays of approximately 15 minutes. Participants should continue at the same dose level achieved at the end of the titration phase ±1 spray divided into a morning dose and an evening dose for the remainder of the treatment period.
Daily spasm count, the participant's symptom experiences, clinician's assessment of spasticity, functional outcomes, health-related quality of life, changes in mood, safety, tolerability, and pharmacokinetics will be evaluated during the treatment period.
Participants who complete the trial will participate for a total of approximately 18 weeks (127 days), including the 28-day baseline period. Participants will have a maximum duration of 85 (±7) days on IMP treatment.
703 studies on the registry are indexed under Muscle Spasticity; 148 are open to participants now.
This study's enrollment of 139 is above the median of 36 across 524 interventional studies indexed under Muscle Spasticity.
Browse Muscle Spasticity studies →Jazz Pharmaceuticals is the lead sponsor of 167 studies on the registry; 20 are open to participants now.
Of its 39 completed or terminated interventional studies of FDA-regulated products, 28 (72%) have results posted.
Counted across the registry records on this site, refreshed daily.
Criteria at screening:
Exclusion Criteria:
Drug: Nabiximols
Drug: Placebo
Nabiximols is a complex botanical medicine formulated from extracts of the cannabis plant that contains the principal cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) and also contains minor constituents, including other cannabinoid and non-cannabinoid plant components, such as terpenes, sterols, and triglycerides.Nabiximols will be self-administered by participants as an oromucosal spray in the morning and evening, up to a maximum of 12 sprays per day for 12 weeks.
Also known as: GW-1000-02, Sativex
Placebo to match nabiximols will be presented as an oromucosal spray containing the excipients ethanol and propylene glycol (50% v/v) with colorings and flavored with peppermint oil (0.05% v/v). Each spray will deliver 100 microliters (μL) containing no active ingredients. Placebo will be self-administered by participants as an oromucosal spray in the morning and evening, up to a maximum of 12 sprays per day for 12 weeks.
Change in Average Daily Spasm Count From Baseline to Week 12 By 4-Week Period During the 12-Week Randomized Period
The change in the average daily spasm count was assessed compared to the baseline period.
Time frame: Baseline to Week 12
Change in Multiple Sclerosis Spasticity Scale (MSSS-88) Total Score
The MSSS-88 is a self-reported measure of the impact of spasticity (muscle stiffness and spasms) in MS. This 88-item scale captures the patient experience and impact of spasticity, including muscle stiffness, pain and discomfort, muscle spasms, effect on daily activities, ability to walk, body movement, patient feelings, and social functioning. Responses to individual questions can range from "1 - not at all bothered" to "4 - extremely bothered", ranging from 88 to 352 total score. Scores are summed and higher scores indicate poor clinical outcome. Least square means are being reported, with greater negative values indicating better outcome.
Time frame: Week 8 and Week 12
Number of Patients Reporting Any Treatment-emergent Adverse Events
A TEAE is an adverse event that started, or worsened in severity or seriousness, following the first dose of the investigational medicinal product.
Time frame: From date of first dose of IMP up to 30 days after last dose, up to approximately 16 weeks
Change From Baseline in Clinical Laboratory Test Values
Time frame: Baseline up to Week 12
Change From Baseline in Erythrocytes
Time frame: Baseline up to Week 12
Change From Baseline in Hemoglobin
Time frame: Baseline up to Week 12
Change From Baseline in Hematocrit Ratio
The hematocrit ratio measures the volume of red blood cells compared to the total blood volume.
Time frame: Baseline up to Week 12
Change From Baseline in Erythrocyte Mean Corpuscular Hemoglobin
Time frame: Baseline up to Week 12
Change From Baseline in Blood Pressure
Time frame: Baseline up to Week 12
Change From Baseline in Heart Rate
Time frame: Baseline up to Week 12
Change From Baseline in Electrocardiogram Parameters
Time frame: Baseline up to Week 12
Change From Baseline in Electrocardiogram Pulse Rate
Time frame: Baseline up to Week 12
Change From Baseline in Weight
Time frame: Baseline up to Week 12
Change in Body Mass Index
Time frame: Baseline up to Week 12
Number of Patients With Suicidal Ideation or Behavior Based on Columbia-Suicide Severity Rating Scale (C-SSRS)
The C-SSRS is a short questionnaire that is used to assess suicidal ideation (5 questions) and behavior (5 questions) since last patient visit. The questionnaire is completed by participants answering yes or no to each question.
Time frame: Screening up to Week 12
| Milestone | Nabiximols | Placebo |
|---|---|---|
| Started | 69 | 70 |
| Safety analysis set | 67 | 70 |
| Completed | 55 | 66 |
| Not completed | 14 | 4 |
| Withdrew: Decision by the investigator, gw, or authority | 0 | 1 |
| Withdrew: Withdrawal of patient consent | 7 | 2 |
| Withdrew: Adverse event | 4 | 1 |
| Withdrew: Drug not dispensed due to endpoint error | 1 | 0 |
| Withdrew: Did not receive imp | 2 | 0 |
The change in the average daily spasm count was assessed compared to the baseline period.
| daily spasm count | Nabiximols | Placebo |
|---|---|---|
| Week 1 to 4 | -2.23 ± 0.412 | -1.62 ± 0.394 |
| Week 5 to 8 | -3.42 ± 0.607 | -2.62 ± 0.583 |
| Week 9 to 12 | -3.84 ± 0.689 | -3.11 ± 0.659 |
The MSSS-88 is a self-reported measure of the impact of spasticity (muscle stiffness and spasms) in MS. This 88-item scale captures the patient experience and impact of spasticity, including muscle stiffness, pain and discomfort, muscle spasms, effect on daily activities, ability to walk, body movement, patient feelings, and social functioning. Responses to individual questions can range from "1 - not at all bothered" to "4 - extremely bothered", ranging from 88 to 352 total score. Scores are summed and higher scores indicate poor clinical outcome. Least square means are being reported, with greater negative values indicating better outcome.
| unit on a scale | Nabiximols | Placebo |
|---|---|---|
| Week 8 | -21.64 ± 5.775 | -26.11 ± 5.461 |
| Week 12 | -26.53 ± 5.807 | -23.18 ± 5.426 |
A TEAE is an adverse event that started, or worsened in severity or seriousness, following the first dose of the investigational medicinal product.
| Participants | Nabiximols | Placebo |
|---|---|---|
| Number of Patients Reporting Any Treatment-emergent Adverse Events | 47 | 32 |
| 10^9 cells/liter | Nabiximols | Placebo |
|---|---|---|
| Basophils | -0.009 ± 0.030 | 0.002 ± 0.037 |
| Eosinophils | -0.007 ± 0.110 | 0.006 ± 0.086 |
| Leukocytes | 0.146 ± 1.095 | 0.139 ± 1.881 |
| Lymphocytes | -0.056 ± 0.368 | 0.009 ± 0.315 |
| Monocytes | 0 ± 0.120 | 0.001 ± 0.126 |
| Neutrophils | 0.217 ± 1.004 | 0.083 ± 1.788 |
| Platelets | -0.085 ± 42.392 | 5.290 ± 49.972 |
| 10^12 cells/liter | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Erythrocytes | 0.010 ± 0.241 | -0.007 ± 0.251 |
| g/dL | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Hemoglobin | -0.025 ± 0.735 | -0.021 ± 0.726 |
The hematocrit ratio measures the volume of red blood cells compared to the total blood volume.
| ratio of packed cells to total volume | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Hematocrit Ratio | -0.002 ± 0.025 | -0.002 ± 0.027 |
| pg | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Erythrocyte Mean Corpuscular Hemoglobin | -0.156 ± 0.608 | -0.005 ± 0.881 |
| mmHg | Nabiximols | Placebo |
|---|---|---|
| Systolic Blood Pressure | -1.6 ± 10.95 | 2.6 ± 11.31 |
| Diastolic Blood Pressure | 0.3 ± 8.20 | 2.7 ± 13.38 |
| beats/minute | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Heart Rate | 2.5 ± 7.70 | 0.4 ± 10.14 |
| msec | Nabiximols | Placebo |
|---|---|---|
| PR interval, aggregate | 5.5 ± 20.51 | 1.3 ± 21.05 |
| QRS duration | 1.9 ± 9.89 | -6.5 ± 37.08 |
| QTcB interval | 1.5 ± 29.58 | -2.4 ± 33.29 |
| QTcF interval | 2.9 ± 26.69 | -3.2 ± 32.40 |
| beats/min | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Electrocardiogram Pulse Rate | -2.6 ± 10.21 | 0.5 ± 8.74 |
| kg | Nabiximols | Placebo |
|---|---|---|
| Change From Baseline in Weight | -0.338 ± 3.198 | -0.394 ± 3.578 |
| kg/m^2 | Nabiximols | Placebo |
|---|---|---|
| Change in Body Mass Index | -0.086 ± 1.052 | -0.159 ± 1.287 |
The C-SSRS is a short questionnaire that is used to assess suicidal ideation (5 questions) and behavior (5 questions) since last patient visit. The questionnaire is completed by participants answering yes or no to each question.
| Participants | Nabiximols | Placebo |
|---|---|---|
| Screening: Ideation, Wish to be dead | 1 | 1 |
| Screening: Ideation, Non-specific active thoughts | 1 | 1 |
| Screening: Ideation, Active any method no intent | 0 | 1 |
| Screening: Ideation, Active intent to act, no plan | 0 | 0 |
| Screening: Ideation, Active specific plan/intent | 0 | 0 |
| Screening: Behavior, Preparatory acts or behavior | 0 | 0 |
| Screening: Behavior, Aborted attempt | 0 | 0 |
| Screening: Behavior, Interrupted attempt | 0 | 0 |
| Screening: Behavior, Actual attempt | 0 | 1 |
| Screening: Behavior, Completed suicide | 0 | 0 |
| Screening: Suicidal ideation or behavior | 1 | 1 |
| Screening: Self-injurious behavior without suicidal intent | 0 | 0 |
| Baseline: Ideation, Wish to be dead | 0 | 0 |
| Baseline: Ideation, Non-specific active thoughts | 0 | 0 |
| Baseline: Ideation, Active any method no intent | 0 | 0 |
| Baseline: Ideation, Active intent to act, no plan | 0 | 0 |
| Baseline: Ideation, Active specific plan/intent | 0 | 0 |
| Baseline: Behavior, Preparatory acts or behavior | 0 | 0 |
| Baseline: Behavior, Aborted attempt | 0 | 0 |
| Baseline: Behavior, Interrupted attempt | 0 | 0 |
| Baseline: Behavior, Actual attempt | 0 | 0 |
| Baseline: Behavior, Completed suicide | 0 | 0 |
| Baseline: Suicidal ideation or behavior | 0 | 0 |
| Baseline: Self-injurious behavior without suicidal intent | 0 | 0 |
| Week 2: Ideation, Wish to be dead | 1 | 0 |
| Week 2: Ideation, Non-specific active thoughts | 0 | 0 |
| Week 2: Ideation, Active any method no intent | 0 | 0 |
| Week 2: Ideation, Active intent to act, no plan | 0 | 0 |
| Week 2: Ideation, Active specific plan/intent | 0 | 0 |
| Week 2: Behavior, Preparatory acts or behavior | 0 | 0 |
| Week 2: Behavior, Aborted attempt | 0 | 0 |
| Week 2: Behavior, Interrupted attempt | 0 | 0 |
| Week 2: Behavior, Actual attempt | 0 | 0 |
| Week 2: Behavior, Completed suicide | 0 | 0 |
| Week 2: Suicidal ideation or behavior | 1 | 0 |
| Week 2: Self-injurious behavior without suicidal intent | 0 | 0 |
| Week 4: Ideation, Wish to be dead | 0 | 0 |
| Week 4: Ideation, Non-specific active thoughts | 0 | 0 |
| Week 4: Ideation, Active any method no intent | 0 | 0 |
| Week 4: Ideation, Active intent to act, no plan | 0 | 0 |
| Week 4: Ideation, Active specific plan/intent | 0 | 0 |
| Week 4: Behavior, Preparatory acts or behavior | 0 | 0 |
| Week 4: Behavior, Aborted attempt | 0 | 0 |
| Week 4: Behavior, Interrupted attempt | 0 | 0 |
| Week 4: Behavior, Actual attempt | 0 | 0 |
| Week 4: Behavior, Completed suicide | 0 | 0 |
| Week 4: Suicidal ideation or behavior | 0 | 0 |
| Week 4: Self-injurious behavior without suicidal intent | 0 | 0 |
| Week 8: Ideation, Wish to be dead | 0 | 0 |
| Week 8: Ideation, Non-specific active thoughts | 0 | 0 |
| Week 8: Ideation, Active any method no intent | 0 | 0 |
| Week 8: Ideation, Active intent to act, no plan | 0 | 0 |
| Week 8: Ideation, Active specific plan/intent | 0 | 0 |
| Week 8: Behavior, Preparatory acts or behavior | 0 | 0 |
| Week 8: Behavior, Aborted attempt | 0 | 0 |
| Week 8: Behavior, Interrupted attempt | 0 | 0 |
| Week 8: Behavior, Actual attempt | 0 | 0 |
| Week 8: Behavior, Completed suicide | 0 | 0 |
| Week 8: Suicidal ideation or behavior | 0 | 0 |
| Week 8: Self-injurious behavior without suicidal intent | 0 | 0 |
| Week 12: Ideation, Wish to be dead | 0 | 0 |
| Week 12: Ideation, Non-specific active thoughts | 0 | 0 |
| Week 12: Ideation, Active any method no intent | 0 | 0 |
| Week 12: Ideation, Active intent to act, no plan | 0 | 0 |
| Week 12: Ideation, Active specific plan/intent | 0 | 0 |
| Week 12: Behavior, Preparatory acts or behavior | 0 | 0 |
| Week 12: Behavior, Aborted attempt | 0 | 0 |
| Week 12: Behavior, Interrupted attempt | 0 | 0 |
| Week 12: Behavior, Actual attempt | 0 | 0 |
| Week 12: Behavior, Completed suicide | 0 | 0 |
| Week 12: Suicidal ideation or behavior | 0 | 0 |
| Week 12: Self-injurious behavior without suicidal intent | 0 | 1 |
Collected over Adverse event data were collected from baseline up to 14 days after the end of treatment visit, up to Day 99 (safety follow up visit).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Nabiximols | 0/67 (0%) | 3/67 (4.5%) | 46/67 (68.7%) |
| Placebo | 0/70 (0%) | 5/70 (7.1%) | 19/70 (27.1%) |
| Event | Nabiximols | Placebo |
|---|---|---|
| COVID-19Infections and infestations | 2/67 | 2/70 |
| SARS-CoV-2 test positiveInvestigations | 0/67 | 2/70 |
| CellulitisInfections and infestations | 1/67 | 0/70 |
| Arthritis bacterialInfections and infestations | 0/67 | 1/70 |
| PneumoniaInfections and infestations | 0/67 | 1/70 |
| Event | Nabiximols | Placebo |
|---|---|---|
| DizzinessNervous system disorders | 14/67 | 5/70 |
| FatigueGeneral disorders | 8/67 | 2/70 |
| SomnolenceNervous system disorders | 7/67 | 2/70 |
| VertigoEar and labyrinth disorders | 6/67 | 0/70 |
| AstheniaGeneral disorders | 4/67 | 2/70 |
| Taste disorderNervous system disorders | 4/67 | 0/70 |
| NauseaGastrointestinal disorders | 3/67 | 4/70 |
| Urinary tract infectionInfections and infestations | 3/67 | 4/70 |
Baseline characteristics are reported from the Full Analysis Set defined as all patients from the Safety Analysis Set who signed the informed consent and are randomized by interactive response technology.
| Age, Continuous(years) | Nabiximols | Placebo | Total |
|---|---|---|---|
| Mean | 52.1 ± 10.4 | 53.0 ± 10.2 | 52.6 ± 10.2 |
| Age, Customized(Participants) | Nabiximols | Placebo | Total |
|---|---|---|---|
| <18 years | 0 | 0 | 0 |
| ≥18 years to <45 years | 14 | 15 | 29 |
| ≥45 years to <65 years | 44 | 46 | 90 |
| ≥65 years | 9 | 9 | 18 |
| Sex: Female, Male(Participants) | Nabiximols | Placebo | Total |
|---|---|---|---|
| Female | 43 | 52 | 95 |
| Male | 24 | 18 | 42 |
| Race/Ethnicity, Customized(Participants) | Nabiximols | Placebo | Total |
|---|---|---|---|
| White | 62 | 68 | 130 |
| Black or African American | 3 | 1 | 4 |
| Asian | 0 | 0 | 0 |
| American Indian or Alaska Native | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Other | 2 | 1 | 3 |
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Jazz Pharmaceuticals