Aspirin for Treatment of Multiple Sclerosis-Related Fatigue

This study has been terminated.
(Interim analysis indicated treatment unlikely effective;slow recruitment)
Sponsor:
Collaborator:
National Multiple Sclerosis Society
Information provided by (Responsible Party):
Dean Wingerchuk, Mayo Clinic
ClinicalTrials.gov Identifier:
NCT00467584
First received: April 26, 2007
Last updated: May 15, 2014
Last verified: May 2014
  Purpose

The purpose of this study is to determine whether aspirin is effective for treatment of fatigue caused by multiple sclerosis (MS).


Condition Intervention Phase
Multiple Sclerosis
Fatigue
Drug: High Dose Aspirin (1300 mg/day)
Drug: Low Dose Aspirin (162 mg/day)
Drug: Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: Aspirin for Treatment of Multiple Sclerosis-Related Fatigue

Resource links provided by NLM:


Further study details as provided by Mayo Clinic:

Primary Outcome Measures:
  • Modified Fatigue Impact Scale Score [ Time Frame: Baseline, 8 weeks ] [ Designated as safety issue: No ]
    The Modified Fatigue Impact Scale is a list of 21 statements describing how fatigue may affect a person's functioning. Answers ranging from 0 (Never) to 4 (Almost always) were provided by the study subjects for the prior 4 week period. A total score was tallied from a possible 0 (no fatigue impact) to 84 (almost always impacted by fatigue). A lower total score indicates less fatigue-related impact while a higher total score indicates greater fatigue-related impact on a subject's functioning.


Enrollment: 62
Study Start Date: July 2007
Study Completion Date: September 2013
Primary Completion Date: September 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: High Dose Aspirin
High Dose Aspirin; 1300 milligrams of aspirin per day, taken by mouth as two tablets, twice per day for 8 weeks
Drug: High Dose Aspirin (1300 mg/day)
1300 milligrams per day (the equivalent of 4 regular aspirin tablets) taken by mouth as two tablets, twice a day in the morning and at noon for 8 weeks
Other Names:
  • acetylsalicylic acid
  • ASA
  • Aspirin
Active Comparator: Low Dose Aspirin
Low Dose Aspirin; 162 milligrams of aspirin per day (the equivalent of 2 baby aspirin tablets) taken by mouth as two tablets, twice a day in the morning and at noon for 8 weeks
Drug: Low Dose Aspirin (162 mg/day)
162 milligrams per day (the equivalent of 2 baby aspirin tablets) taken by mouth as two tablets, twice a day in the morning and at noon for 8 weeks
Other Names:
  • acetylsalicylic acid
  • ASA
  • Aspirin
Placebo Comparator: Placebo
Placebo tablets, matching the active aspirin tablets in appearance, taken by mouth twice per day for 8 weeks
Drug: Placebo
Placebo tablets matching the active aspirin tablets in appearance, taken as two tablets, twice per day for 8 weeks

Detailed Description:

Fatigue is the most common symptom of multiple sclerosis (MS), affecting up to 90% of people with the disease. MS-related fatigue can be disabling even when other features of MS are mild. It can interfere with physical activity, memory and thinking, social and family activities, and ability to work. Initial treatment consists of energy conservation techniques such as rest periods or naps but when these approaches fail doctors usually recommend a trial of medications. Amantadine, modafinil, and other stimulants are commonly used but help only about half of those who try them. It is unlikely that these drugs directly affect the cause of MS-related fatigue.

It has been difficult to develop new drug therapies for MS-related fatigue because we do not fully understand its causes and do not have precise ways to measure it. We rely on a person's self-report about their fatigue but individuals experience and report fatigue differently. Recent research has shown that some fatigue aspects, such as difficulty maintaining mental concentration ("cognitive fatigue") and physical activity ("motor fatigue"), can be measured more precisely and require further study.

We recently reported results from a study showing that people taking the equivalent of four regular aspirin tablets (1300 mg) daily had reduced MS-related fatigue compared with placebo (sugar pill). The current proposal will attempt to confirm the benefit of aspirin in a larger group of people and to determine if the benefit is related to inflammation. One hundred and thirty-five people with MS-related fatigue will participate at MS clinics at three Mayo Clinic sites. Participants will complete questionnaires that ask about the severity and impact of their fatigue, memory testing to assess cognitive fatigue, and have blood testing to measure markers of inflammation. At the Arizona site, participants will also do strength testing in a motor laboratory to assess motor fatigue. After obtaining two separate baseline evaluations, the participants will be randomly assigned treatment such that one-third will receive 1300 mg per day of aspirin, one-third will receive 162 mg per day of aspirin and one-third will receive a matching placebo. All participants will then return to the clinic on two more occasions over the next eight weeks to repeat the questionnaires, memory and strength testing, blood tests, and report any side-effects. At the end of the study, the results of one of the fatigue questionnaires will be analyzed to determine if aspirin significantly improved fatigue compared with the placebo. The results of other questionnaires and the memory and strength testing will be analyzed as supportive evidence.

If this study is successful, it will provide strong scientific evidence that aspirin helps MS-related fatigue. It will add an important new option for treatment of all MS patients that is also familiar, inexpensive, and has a good long-term safety record. At the same time, it will allow us to better understand the causes of MS-related fatigue and how to measure it more precisely. This information will be extremely useful for development of other therapies in the future.

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion criteria:

  • Confirmed relapsing-remitting or secondary progressive multiple sclerosis,
  • Ambulatory for distance of at least 100 meters without gait assistance,
  • Persistent fatigue for at least 8 weeks that is not attributable to causes other than MS, and
  • Will be able to complete questionnaires and cognitive testing.

Exclusion criteria:

  1. Other evident causes for fatigue:

    • Untreated depression or screening Center for Epidemiologic Studies Depression (CES-D) scale greater than 28
    • Significant cognitive impairment (Baseline Short Test of Mental Status score of less than 29/38)
    • Narcolepsy, uncontrolled sleep apnea, or other primary sleep disorder judged to be likely a major contributor to fatigue
    • Screening Epsworth Sleepiness Scale score greater than 15
    • Uncontrolled hypothyroidism or anemia
    • Other medical illness judged by the investigator to affect the participant's fatigue complaints including current viral, bacterial, mycobacterial, or fungal infection
  2. MS Disease Activity and Treatment:

    • Clinical exacerbations within 2 weeks prior to screening visit
    • Corticosteroid use within 4 weeks prior to screening visit
    • Beta-interferon, glatiramer acetate, immunosuppressant drugs (mitoxantrone, azathioprine, etc.) are permitted if a stable dose has been used for greater than or equal to 4 weeks and there is no temporal association of drug administration with perceived fatigue; elective on-study dose/regimen changes are not permitted
  3. Current or Recent Fatigue Therapy and Other Medications:

    • Use of more than two doses of ASA (aspirin) greater than 81 mg/d within 2 weeks of screening visit
    • Use of MS fatigue medications within 2 weeks of screening visit (including amantadine or Central Nervous System stimulants such as modafinil, methylphenidate, and pemoline)
    • Symptomatic medications (antidepressants, anti-spasticity agents, non-narcotic analgesics) are permitted if a stable dose has been used for >4 weeks prior to screening for antidepressants and >2 weeks prior to screening for other symptomatic therapies and there is no temporal association of drug administration with perceived fatigue; elective on-study dose changes are not permitted.
    • Current use of acetazolamide, antiplatelet agents or anticoagulants, COX-2 inhibitors, methotrexate, oral hypoglycemic medications
  4. Medical Contraindications to ASA use:

    • Allergy to ASA or Non-Steroidal Anti-Inflammatory drugs
    • Syndrome of asthma, rhinitis and nasal polyps
    • History of confirmed peptic ulcer or gastrointestinal or severe gynecological bleeding
  5. General Health Concerns:

    • Significant uncontrolled disease of cardiovascular, pulmonary, hepatic, renal, endocrine, rheumatological, neurological, gynecological, or gastrointestinal systems
    • Pregnancy or unwillingness to utilize contraception
    • History of alcohol or drug abuse within 6 months of screening or current alcohol intake >3 drinks/day
  6. Laboratory Exclusions (available values obtained within 8 weeks prior to screening visit are acceptable for all except the pregnancy test)

    • Positive pregnancy test
    • Hemoglobin less than 11.0 g/dL (women) or 13.0 g/dL (men)
    • Platelet count < 120, 000/μL
    • Serum creatinine level > 1.4 mg/dL (women) or 1.6 mg/dL (men)
    • Aspartate aminotransferase (AST/SGOT) or alanine aminotransferase (ALT/SGPT) level greater than 2.5 times the upper limit of normal
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00467584

Locations
United States, Arizona
Mayo Clinic
Scottsdale, Arizona, United States, 85259
Sponsors and Collaborators
Mayo Clinic
National Multiple Sclerosis Society
Investigators
Principal Investigator: Dean M. Wingerchuk, M.D., MSc Mayo Clinic
  More Information

No publications provided

Responsible Party: Dean Wingerchuk, Professor of Neurology, Mayo Clinic
ClinicalTrials.gov Identifier: NCT00467584     History of Changes
Other Study ID Numbers: 06-004850
Study First Received: April 26, 2007
Results First Received: April 17, 2014
Last Updated: May 15, 2014
Health Authority: United States: Institutional Review Board

Additional relevant MeSH terms:
Fatigue
Multiple Sclerosis
Sclerosis
Autoimmune Diseases
Autoimmune Diseases of the Nervous System
Demyelinating Autoimmune Diseases, CNS
Demyelinating Diseases
Immune System Diseases
Nervous System Diseases
Pathologic Processes
Signs and Symptoms
Aspirin
Analgesics
Analgesics, Non-Narcotic
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Antipyretics
Antirheumatic Agents
Cardiovascular Agents
Central Nervous System Agents
Cyclooxygenase Inhibitors
Enzyme Inhibitors
Fibrin Modulating Agents
Fibrinolytic Agents
Hematologic Agents
Molecular Mechanisms of Pharmacological Action
Peripheral Nervous System Agents
Pharmacologic Actions
Physiological Effects of Drugs
Platelet Aggregation Inhibitors

ClinicalTrials.gov processed this record on October 23, 2014