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Multiple Sclerosis (MS) is the most frequent cause of non-traumatic disability in people under 55 years of age. Fatigue is the most frequent and disabling symptom in the disease, and for which there is no effective treatment. Among the proposed drugs, amantadine is the one that could be most useful, although up to now it has not been adequately demonstrated due to a lack of sufficiently powerful and methodologically appropriate clinical trials. Transcranial magnetic stimulation (TMS) has recently been proposed as a useful treatment for fatigue in MS in preliminary studies.
Multiple Sclerosis (MS) is the most frequent cause of non-traumatic disability in people under 55 years of age. Fatigue is the most frequent and disabling symptom in the disease, and for which there is no effective treatment. Among the proposed drugs, amantadine is the one that could be most useful, although up to now it has not been adequately demonstrated due to a lack of sufficiently powerful and methodologically appropriate clinical trials. Transcranial magnetic stimulation (TMS) has recently been proposed as a useful treatment for fatigue in MS in preliminary studies.
The main objective of the study is to evaluate the change in the severity of fatigue in MS patients undergoing treatment with amantadine, TMS and both in combination, compared to placebo. A randomized, placebo-controlled, crossover, double-blind clinical trial will be conducted. As secondary objectives, changes in cognition, depression and quality of life will be evaluated. For all this, the reference scales adequately validated for each of the objectives will be used.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Amantadine | Experimental |
| |
| Placebo | Placebo Comparator |
| |
| TMS | Experimental |
| |
| TMS sham | Sham Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transcranial Magnetic Stimulation | Device | TMS is a technique for electrical stimulation of brain tissue by generating a magnetic field, which modulates neural activity at the stimulation site and in interconnected neural networks. The treatment will be applied to the left dorsolateral prefrontal region. Each patient will receive 3 sessions per week of approximately 10 minutes for 6 weeks. In the case of TMS sham, a placebo coil will be used, which is indistinguishable from the therapeutic one. In addition, the sessions will be carried out with the same frequency, so the patient will be unaware of the treatment they are receiving. |
| Measure | Description | Time Frame |
|---|---|---|
| To assess the fatigue severity | To compare the effect of TMS and amantadine alone or in combination therapy compared with placebo on fatigue determined using the Modified Fatigue Impact Scale (Total MFIS score: Range from 0 to 84, from minimal to severe fatigue). | 6 weeks after starting treatment |
| Measure | Description | Time Frame |
|---|---|---|
| To assess the cognitive condition | To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on cognition determined by the Symbol Digit Modalities Test (SDMT). | 6 weeks after starting treatment |
| To assess the depression condition |
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Inclusion Criteria:
Exclusion Criteria:
Fatigue causing disease other than multiple sclerosis:
Secondary Epilepsy or neuropathic chronic pain which requires continuous treatment.
Contraindication for trial treatment:
Breastfeeding, pregnancy, or pregnancy planning phase in the next year. Of childbearing potential and willing to use an acceptable method of contraception during the study period.
Patient with a terminal disease with no more than one year life expectancy.
Patient has been treated for a maligned disease in the past three years.
A scheduled surgery in the course of the trials.
Any condition that a member of research team consider could affect to participation/follow up patient.
Alcoholic o toxics condition in the last year.
Major mental disorders
Poor communication skills or poor cognitive condition.
Other trial participation in the previous 4 month.
Use a chronic drug that could interfere in the clinical outcome.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jorge Matias-Guiu Guia, MD PhD | Contact | +34 913303000 | 3511 | matiasguiu@gmail.com |
| Jordi Matias-Guiu Antem, MD PhD | Contact | +34 913303000 | 3511 | jordimatiasguiu@hotmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Jorge Matias-Guiu Guia, MD PhD | Hospital San Carlos, Madrid | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital Puerta del Mar | Recruiting | Cadiz | 11009 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38176857 | Derived | Matias-Guiu JA, Gonzalez-Rosa J, Hernandez MA, Martinez-Gines ML, Portoles A, Perez-Macias N, Benito-Leon J, Padron I, Prieto J, Matias-Guiu J. Amantadine and/or transcranial magnetic stimulation for fatigue associated with multiple sclerosis (FETEM): study protocol for a phase 3 randomised, double-blind, cross-over, controlled clinical trial. BMJ Open. 2024 Jan 4;14(1):e078661. doi: 10.1136/bmjopen-2023-078661. |
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The data used will be deposited in a suitable repository that will be complied with the requirements of ISCIII and any other applicable national regulations. Due to the data collected retain their personal character and they can be traced back, they will be safeguarded maintaining their integrity and confidentiality. These data cannot be openly shared after the project's completion. The licenses and access permissions will be determined based on the following criteria before the project's completion: a) The guidelines or recommendations of ISCIII. b) The policies established by the data repository to which the data will be sent. c) Possible restrictions on data publication that may arise from applicable protection schemes for the project's results. In any case, the requirements set forth by ISCIII in the funding call received will be complied with, as well as those considered in other applicable regulations. The dataset used will be stored in a locked condition for a period of 5 years.
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D005221 | Fatigue |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
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| ID | Term |
|---|---|
| D050781 | Transcranial Magnetic Stimulation |
| D000547 | Amantadine |
| D008274 | Magnesium |
| ID | Term |
|---|---|
| D055909 | Magnetic Field Therapy |
| D013812 | Therapeutics |
| D000218 | Adamantane |
| D001952 | Bridged-Ring Compounds |
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All patients will receive all possible combinations (TMS+placebo, TMS+amantadine, TMS sham+amantadine, TMS sham+placebo), the only difference being the sequence in which they are administered.
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|
|
| Amantadine Hydrochloride 100 mg (milligrams) Oral Capsule | Drug | It will be used at a dose of 100 mg, 1 capsule a day for 1 week, followed by 2 daily doses of 100 mg until completing 6 weeks in total. After completing the treatment phase, the dose will be de-escalated (1 capsule a day for 5 days and discontinued). In the case of placebo amantadine capsules, they will have the same organoleptic characteristics as amantadine. The start, maintenance and de-escalation pattern will be identical. |
|
To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on depression measured using the Beck Depression Inventory Scale (BDI-II score: Range from 0 to 63, from minimal to severe depression). |
| 6 weeks after starting treatment |
| To assess the quality of life | To compare the effect of TMS and amantadine alone or in combination therapy compared to placebo on the quality of life determined by the Short Form 12 Mental Health scale (SF-12 score: Range from 0 to 100, from worse to better physical and mental health functioning). | 6 weeks after starting treatment |
| Safety assessment | Analyze the incidence of the adverse events detected in each of the branches, whether or not with multiple sclerosis | 6 months after randomization |
| Cost-effectivity assessment | Determine the cost-effectiveness of the different interventions. The total costs of hospitalization and treatment, as well as other health care, will be measured. | 6 weeks after starting treatment |
| Hospital General Gregorio Marañon | Recruiting | Madrid | 28007 | Spain |
|
| Hospital Clínico San Carlos | Recruiting | Madrid | 28040 | Spain |
|
| Hospitalario Universitario Nuestra Señora de la Candelaria | Recruiting | Santa Cruz de Tenerife | 38010 | Spain |
|
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006844 |
| Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D008673 | Metals, Alkaline Earth |
| D004602 | Elements |
| D007287 | Inorganic Chemicals |
| D019565 | Metals, Light |
| D008670 | Metals |