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Sativex Versus Placebo When Added to Existing Treatment for Central Neuropathic Pain in MS

A Double Blind, Randomised, Placebo Controlled, Parallel Group Study of Sativex When Added to the Existing Treatment Regimen, in the Relief of Central Neuropathic Pain in Subjects With Multiple Sclerosis

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00391079
Enrollment
339
Registered
2006-10-23
Start date
2006-09-30
Completion date
2008-09-30
Last updated
2013-06-24

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Multiple Sclerosis

Keywords

Central Neuropathic Pain

Brief summary

The purpose of this study is to find out if cannabis-based medicine compared to a dummy medicine (placebo that contains no active ingredient) can help the central neuropathic pain patients experience as a result of multiple sclerosis. This type of pain central neuropathic pain is described as shooting, stabbing, burning or searing like sensation, which is often worse at night.

Detailed description

GW has shown in phase II and III studies that Sativex has analgesic properties that are effective in relieving neuropathic pain. These studies suggested that Sativex is well tolerated and may also improve sleep and quality of life. GW is conducting this study to further demonstrate these effects.

Interventions

DRUGSativex

Containing D9 tetrahydrocannabinol (THC), 27 mg/ml: cannabidiol (CBD), 25 mg/ml, as extracts of Cannabis sativa L. Delivered in 100 µl actuations by a pump action oromucosal spray. Maximum dose within any 24-hour interval 12 sprays (THC 32.5 mg: CBD 30 mg.

DRUGPlacebo

Containing colourants and excipients. Delivered in 100 µl actuations by a pump action oromucosal spray. Maximum dose within any 24-hour interval 12 sprays.

Sponsors

GW Pharmaceuticals Ltd
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Any disease sub-type of MS of at least two years duration * Central neuropathic pain (CNP) of at least three months and expected to remain stable for the study duration * Moderate CNP defined by NRS pain score at baseline sum to at least 24 * Subject established on or previously tried and failed analgesic therapy for CNP * If receiving disease modifying medications, stable dose for 3 months and maintained for study duration

Exclusion criteria

* Subjects whose identified pain is likely to be nociceptive, musculoskeletal (including spasms) peripheral neuropathic or psychogenic in origin, or due to trigeminal neuralgia. * Other non central neuropathic pain of a severity which is likely to interfere with the patients assessment of CNP * medical history suggests subject is likely to relapse/remit during course of study * history of schizophrenia (including family history), other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with MS * known or suspected history of alcohol abuse, epilepsy or recurrent seizures or hypersensitivity to cannabinoids * travel outside of the country of residence planned during the study * significant cardiac, renal or hepatic impairment * subjects with current recreational cannabis, medicinal cannabis or synthetic cannabinoid based medications within 3 months prior to study entry and unwilling to abstain for the duration of the study

Design outcomes

Primary

MeasureTime frameDescription
Change in Mean Pain Due to MS NRS Score14 weeks: Baseline - End of Treatment (last 7 days of treatment)The pain NRS was completed at the same time each day, i.e. bedtime in the evening. The patient was asked on a scale of '0 to 10', please indicate the number that best describes your pain in the last 24 hours where 0 = no pain and 10 = pain as bad as you can imagine. No pain relates to the time prior to the onset of pain due to multiple sclerosis. A negative value indicates an improvement in pain score from baseline.
Number of Patients With at Least 30% Improvement in Numerical Rating Scale (NRS) Pain Score From Baseline14 weeks: Baseline - end of treatment (last 7 days)A positive 30% pain response is defined as a reduction of at least 30% in the mean NRS pain score from baseline to week 14 (last 7 days). The patient was asked on a scale of '0 to 10', please indicate the number that best describes your pain in the last 24 hours where 0 = no pain and 10 = pain as bad as you can imagine. No pain relates to the time prior to the onset of pain due to multiple sclerosis. The pain NRS was completed at the same time each day, i.e. bedtime in the evening.

Secondary

MeasureTime frameDescription
Change From Baseline to End of Treatment in Break-through Analgesia Usage14 weeks: baseline - end of treatment (last 7 days)Use of break through medication was recorded daily during the 14 weeks of the study as the number of paracetamol tablets taken. The change in mean daily quantities of tablets used was calculated from baseline to the last seven days of treatment.
Change in Subject Global Impression of Change (SGIC)Week 14A 7-point Likert-type scale was used, with the question: 'Please assess the status of your pain due to multiple sclerosis since entry into the study using the scale below' with the markers very much improved, much improved, slightly improved, no change, slightly worse, much worse or very much worse. At baseline subjects wrote a brief description of their pain caused by multiple sclerosis which was used at Week 14 to aid their memory regarding their symptoms at study start. For each of above markers the number of participants were reported.
Change in Sleep Disruption NRS14 weeks; Baseline to end of treatment (last 7 days)The sleep disruption NRS was completed at the same time each day, i.e. bedtime in the evening. The patient was asked on a scale of '0 to 10', please indicate how your pain disrupted your sleep last night? where 0 = did not disrupt sleep and 10 = completely disrupted (unable to sleep at all). A negative value indicates an improvement in sleep disruption score from baseline.
Change From Baseline to End of Treatment in BPI (Brief Pain Inventory) Short Form14 weeks: Baseline to end of treatment (last 7 days of treatment)The BPI-SF is a 14-item questionnaire that asks patients to rate pain over the prior week and the degree to which it interferes with activities on a 0 to 10 scale, where 0=no pain and 10=pain as bad as you can imagine. Severity is measured as worst pain, least pain, average pain, and pain right now. The severity composite score was calculated as the arithmetic mean of the four severity items(range 0-10). The minimum value is zero and maximum is 10. A higher score represents a poor outcome.
Change in Pain From Baseline to End of the Treatment Using the NPS (Neuropathic Pain Scale)14 weeks: Baseline - End of treatment (Week 14)The NPS score is 0-100 sum of 10 individual pain scores (0-10 NRS, 0= no pain to 10 = most pain imaginable). A negative change from baseline indicates an improvement in pain.

Countries

Canada

Participant flow

Participants by arm

ArmCount
Sativex
Range of 8 -12 sprays per day. Each actuation of oromucosal spray delivers 2.7 mg delta-9-tetrahydrocannabinol (THC) and 2.5 mg cannabidiol (CBD). Thus maximum daily dose is 32.4 mg THC and 30 mg CBD.
167
Placebo
Range of 8-12 sprays per day of placebo spray.
172
Total339

Baseline characteristics

CharacteristicSativexPlaceboTotal
Age Continuous48.42 years
STANDARD_DEVIATION 10.43
49.51 years
STANDARD_DEVIATION 10.5
48.97 years
STANDARD_DEVIATION 10.47
Baseline Pain Numerical Rating Scale (NRS) score6.55 Points on a scale
STANDARD_DEVIATION 1.35
6.61 Points on a scale
STANDARD_DEVIATION 1.29
6.58 Points on a scale
STANDARD_DEVIATION 1.32
Duration of Central Neuropathic Pain (CNP)5.59 years
STANDARD_DEVIATION 6.12
5.33 years
STANDARD_DEVIATION 4.8
5.46 years
STANDARD_DEVIATION 5.49
Duration of Multiple Sclerosis (MS)11.42 years
STANDARD_DEVIATION 8
12.53 years
STANDARD_DEVIATION 8.5
11.99 years
STANDARD_DEVIATION 8.26
Sex: Female, Male
Female
113 Participants117 Participants230 Participants
Sex: Female, Male
Male
54 Participants55 Participants109 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
99 / 16765 / 172
serious
Total, serious adverse events
3 / 1672 / 172

Outcome results

Primary

Change in Mean Pain Due to MS NRS Score

The pain NRS was completed at the same time each day, i.e. bedtime in the evening. The patient was asked on a scale of '0 to 10', please indicate the number that best describes your pain in the last 24 hours where 0 = no pain and 10 = pain as bad as you can imagine. No pain relates to the time prior to the onset of pain due to multiple sclerosis. A negative value indicates an improvement in pain score from baseline.

Time frame: 14 weeks: Baseline - End of Treatment (last 7 days of treatment)

Population: Change in mean daily NRS score

ArmMeasureValue (MEAN)Dispersion
SativexChange in Mean Pain Due to MS NRS Score-2.02 units on a scaleStandard Deviation 2.15
PlaceboChange in Mean Pain Due to MS NRS Score-1.89 units on a scaleStandard Deviation 2.33
Comparison: The change in pain NRS score from baseline to the end of study was analyzed using analysis of covariance (ANCOVA) with the baseline value as a covariate and centre group and treatment as factors.p-value: 0.46895% CI: [-0.62, 0.29]ANCOVA
Primary

Number of Patients With at Least 30% Improvement in Numerical Rating Scale (NRS) Pain Score From Baseline

A positive 30% pain response is defined as a reduction of at least 30% in the mean NRS pain score from baseline to week 14 (last 7 days). The patient was asked on a scale of '0 to 10', please indicate the number that best describes your pain in the last 24 hours where 0 = no pain and 10 = pain as bad as you can imagine. No pain relates to the time prior to the onset of pain due to multiple sclerosis. The pain NRS was completed at the same time each day, i.e. bedtime in the evening.

Time frame: 14 weeks: Baseline - end of treatment (last 7 days)

ArmMeasureValue (NUMBER)
SativexNumber of Patients With at Least 30% Improvement in Numerical Rating Scale (NRS) Pain Score From Baseline84 participants
PlaceboNumber of Patients With at Least 30% Improvement in Numerical Rating Scale (NRS) Pain Score From Baseline77 participants
Comparison: The proportions of responders were compared between the treatment groups using logistic regression with region and treatment groups as factors. The null hypothesis was that there was no difference between each Sativex and placebo.p-value: 0.233895% CI: [0.84, 2.038]Regression, Logistic
Secondary

Change From Baseline to End of Treatment in BPI (Brief Pain Inventory) Short Form

The BPI-SF is a 14-item questionnaire that asks patients to rate pain over the prior week and the degree to which it interferes with activities on a 0 to 10 scale, where 0=no pain and 10=pain as bad as you can imagine. Severity is measured as worst pain, least pain, average pain, and pain right now. The severity composite score was calculated as the arithmetic mean of the four severity items(range 0-10). The minimum value is zero and maximum is 10. A higher score represents a poor outcome.

Time frame: 14 weeks: Baseline to end of treatment (last 7 days of treatment)

Population: All subjects who completed the BPI-short form were included in the analysis. Four subjects from the sativex group and three subjects from the placebo group did not complete the form.

ArmMeasureValue (MEAN)Dispersion
SativexChange From Baseline to End of Treatment in BPI (Brief Pain Inventory) Short Form-1.5 Points on a scaleStandard Deviation 2.04
PlaceboChange From Baseline to End of Treatment in BPI (Brief Pain Inventory) Short Form-1.4 Points on a scaleStandard Deviation 2.09
p-value: 0.564395% CI: [-0.53, 0.29]ANCOVA
Secondary

Change From Baseline to End of Treatment in Break-through Analgesia Usage

Use of break through medication was recorded daily during the 14 weeks of the study as the number of paracetamol tablets taken. The change in mean daily quantities of tablets used was calculated from baseline to the last seven days of treatment.

Time frame: 14 weeks: baseline - end of treatment (last 7 days)

ArmMeasureValue (MEAN)Dispersion
SativexChange From Baseline to End of Treatment in Break-through Analgesia Usage-1.16 tabletsStandard Deviation 1.61
PlaceboChange From Baseline to End of Treatment in Break-through Analgesia Usage-1.02 tabletsStandard Deviation 2.07
Comparison: The change in average number of tablets taken daily from baseline to the end of study was analyzed using analysis of covariance (ANCOVA) with the baseline value as a covariate and centre group and treatment as factors.p-value: 0.156795% CI: [-0.57, 0.09]ANCOVA
Secondary

Change in Pain From Baseline to End of the Treatment Using the NPS (Neuropathic Pain Scale)

The NPS score is 0-100 sum of 10 individual pain scores (0-10 NRS, 0= no pain to 10 = most pain imaginable). A negative change from baseline indicates an improvement in pain.

Time frame: 14 weeks: Baseline - End of treatment (Week 14)

ArmMeasureValue (MEAN)Dispersion
SativexChange in Pain From Baseline to End of the Treatment Using the NPS (Neuropathic Pain Scale)-14.24 Points on a scaleStandard Deviation 18.17
PlaceboChange in Pain From Baseline to End of the Treatment Using the NPS (Neuropathic Pain Scale)-11.44 Points on a scaleStandard Deviation 17.86
Comparison: The change in NPS score from baseline to the end of study was analyzed using analysis of covariance (ANCOVA) with the baseline value as a covariate and centre group and treatment as factors.p-value: 0.310395% CI: [-5.39, 1.72]ANOVA
Secondary

Change in Sleep Disruption NRS

The sleep disruption NRS was completed at the same time each day, i.e. bedtime in the evening. The patient was asked on a scale of '0 to 10', please indicate how your pain disrupted your sleep last night? where 0 = did not disrupt sleep and 10 = completely disrupted (unable to sleep at all). A negative value indicates an improvement in sleep disruption score from baseline.

Time frame: 14 weeks; Baseline to end of treatment (last 7 days)

ArmMeasureValue (MEAN)Dispersion
SativexChange in Sleep Disruption NRS-1.97 points on a scaleStandard Deviation 2.21
PlaceboChange in Sleep Disruption NRS-2.02 points on a scaleStandard Deviation 2.29
p-value: 0.83395% CI: [-0.39, 0.48]ANCOVA
Secondary

Change in Subject Global Impression of Change (SGIC)

A 7-point Likert-type scale was used, with the question: 'Please assess the status of your pain due to multiple sclerosis since entry into the study using the scale below' with the markers very much improved, much improved, slightly improved, no change, slightly worse, much worse or very much worse. At baseline subjects wrote a brief description of their pain caused by multiple sclerosis which was used at Week 14 to aid their memory regarding their symptoms at study start. For each of above markers the number of participants were reported.

Time frame: Week 14

Population: All subjects who completed the question were included in the analysis. Two subjects from the Sativex group and six subjects from the placebo group did not complete the question.

ArmMeasureGroupValue (NUMBER)
SativexChange in Subject Global Impression of Change (SGIC)Slightly Improved32 percentage of subjects
SativexChange in Subject Global Impression of Change (SGIC)Slightly Worse5 percentage of subjects
SativexChange in Subject Global Impression of Change (SGIC)Much Improved18 percentage of subjects
SativexChange in Subject Global Impression of Change (SGIC)Much Worse2 percentage of subjects
SativexChange in Subject Global Impression of Change (SGIC)No Change29 percentage of subjects
SativexChange in Subject Global Impression of Change (SGIC)Very Much Worse1 percentage of subjects
SativexChange in Subject Global Impression of Change (SGIC)Very Much Improved13 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)Very Much Worse1 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)Very Much Improved8 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)Much Improved15 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)Slightly Improved25 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)No Change43 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)Slightly Worse5 percentage of subjects
PlaceboChange in Subject Global Impression of Change (SGIC)Much Worse2 percentage of subjects
p-value: 0.055295% CI: [0.991, 2.179]Regression, Logistic

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026