- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03306615
Peripheral Modulation of Muscle Stiffness and Spasticity
November 29, 2023 updated by: Johns Hopkins University
This is a single-center, double-blind, randomized, placebo-controlled, sequential Phase II trial of human recombinant hyaluronidase injections in individuals with post-stroke upper limb muscle stiffness.
The investigators will recruit 50 subjects, 25 males and 25 females, who will be randomized to receive either hyaluronidase plus saline (treatment arm, n=25) or normal saline (control arm, n=25) injections (first injection) in Phase 1 of the study over 5 visits that will test all 3 study aims.
Then subjects will join the Phase 2 to receive a second injection, where the treatment arm will receive the placebo and the placebo arm will receive the treatment.
It is expected that approximately 50 participants will be enrolled to produce 42 evaluable participants.
This design will ensure that all subjects receive the drug treatment, which will facilitate recruitment.
The injecting physician, the assessors, and the patients will be blind to group assignment.
Randomization will be initiated by the IDS pharmacy as per the study statistician.
All patients will be assessed at seven visits over 9 weeks of the study: Visit 1 - screening and baseline assessment of aims 1 and 2 (week 1-2); Visit 2 - pre-injection MRI for aim 3 (week 1-2); Visit 3 - first injection (week 2); Visit 4 - post-injection MRI (week 3-5); Visit 5 - post-injection follow up for aims 1 and 2 (week 3-5); CROSSOVER TO OPPOSITE TREATMENT ARM Visit 6 - Second injection (week 6); Visit 7 - post-injection follow-up for aims 1 and 2/ final study visit (week 7-9).
There will be no MRI assessment after the second injection as the technique is adequately sensitive to demonstrate changes with a small sample size.
The investigators will follow the patients for approximately 9 weeks in this study.
After obtaining informed consent, subjects will be screened to ensure that the subjects meet study criteria.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
- To test the effect of hyaluronidase injections on upper limb outcomes. The investigators will test the hypothesis that compared to placebo, human recombinant hyaluronidase injections will increase total passive ROM across the affected shoulder, elbow and forearm as measured by motion analysis (primary outcome), isometric muscle strength or force generation capacity using MVC on EMG, reduce upper limb motor impairment as measured by the Fugl-Meyer (FM) scale, and improve function as measured by the Wolf Motor Function Test (WMFT).
- To evaluate the effect of hyaluronidase on neural and non-neural components of muscle stiffness. The investigators will test the hypothesis that compared to placebo, IM hyaluronidase will modulate the passive and potentially also the active component of the stretch reflex, reduce stiffness and improve arm motor control.
- To determine the effect of hyaluronidase on intramuscular GAG content. The investigators will test the hypothesis that compared to placebo, IM hyaluronidase will reduce the T1rho relaxation times in the biceps and triceps muscles of the affected arm.
Study Type
Interventional
Enrollment (Estimated)
50
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Azin Etemadimanesh, MD
- Phone Number: 410-955-1347
- Email: aetemad2@jhmi.edu
Study Contact Backup
- Name: Robert Nickl, PhD
- Phone Number: 4109551381
- Email: rnickl1@jhmi.edu
Study Locations
-
-
Maryland
-
Baltimore, Maryland, United States, 21231
- Recruiting
- Paria Arfa Fatollahkhani, MD, M.Sc.
-
Contact:
- Paria Arfa Fatollahkhani, MD, MSc
- Email: parfafa1@jhmi.edu
-
Principal Investigator:
- Ning Cao, MD
-
Contact:
- Robert Nickl, PhD
- Phone Number: 410-955-1381
- Email: rnickl1@jhmi.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Ischemic or hemorrhagic stroke 4-180 months prior
- Moderately-severe muscle stiffness
- Lack of full passive and active range of motion in at least 2/4 areas (shoulder, elbow, forearm, wrist) in the hemiparetic upper limb;
- Willingness to have MRI, complete all clinical assessments, and comply with study protocols;
- Ability to give informed consent and HIPPA certifications; and
Exclusion Criteria:
- treatment of spasticity with Botulinum toxin or intrathecal baclofen within the past six months, phenol injections within the past 12 months, or ongoing adjustment of anti-spastic medications;
- other neurologic condition that may affect motor response (e.g., Parkinson's disease, ALS, MS);
- clinically significant cognitive dysfunction with score <19 on Folstein's Mini Mental Status Examination or depression with score >10 on the PHQ-9;
- pregnancy;
- known hypersensitivity to hyaluronidase;
- claustrophobia;
- standard contraindications for MRI
- Any condition that will preclude the patient from completing the protocol as determined by the PI
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment Arm
Hyaluronidase plus saline
|
HYLENEX recombinant, diluted with 0.9% Sodium Chloride Injection
Other Names:
|
Placebo Comparator: Control Arm
Normal Saline
|
0.9% Sodium Chloride Injection
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total upper limb passive range of motion
Time Frame: 9 weeks
|
passive range of motion in shoulder, elbow and forearm joints
|
9 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total upper limb active range of motion
Time Frame: 9 weeks
|
active range of motion in shoulder, elbow and forearm joints
|
9 weeks
|
Change in upper limb Fugl-Meyer Assessment Score
Time Frame: 9 weeks
|
measures motor impairment in the affected upper limb, Score range is 0-66, and a higher score indicates a better outcome
|
9 weeks
|
Change in Wolf-Motor Function Test (WMFT) Score
Time Frame: 9 weeks
|
Measures upper extremity function following stroke, Includes 6 items, with a 0-5 score range for each item, and a higher score indicates a better outcome
|
9 weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Ning Cao, MD, Johns Hopkins University
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 11, 2021
Primary Completion (Estimated)
November 16, 2024
Study Completion (Estimated)
November 16, 2024
Study Registration Dates
First Submitted
October 3, 2017
First Submitted That Met QC Criteria
October 9, 2017
First Posted (Actual)
October 11, 2017
Study Record Updates
Last Update Posted (Estimated)
December 1, 2023
Last Update Submitted That Met QC Criteria
November 29, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB00273264
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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