This is an open label, short placebo-controlled trial in Restless Legs Syndrome (RLS) patients inadequately treated with standard therapy. Investigators hypothesize that the study drug, sublingual apomorphine (Kynmobi), may improve RLS breakthrough symptoms. This study is designed to determine if sublingual apomorphine improves breakthrough symptoms in RLS patients, in addition to subjective responses.
This is an open label, with a short placebo-controlled portion trial using sublingual apomorphine (Kynmobi) in RLS patients inadequately treated with standard therapy, defined by an IRLS \> 15 and report of breakthrough symptoms. At the initial visit, subjects will undergo all baseline and exploratory assessments and be given their first drug dose of 10 mg. They will be monitored for 60 minutes after dose. Subjects orthostatic blood pressure will be taken before ingestion, then 10, 20, 30, and 45 minutes after ingestion. Over the next 4 weeks, subjects will titrate Kynmobi to find optimal dose. Subjects will be instructed to take at least 2 doses before determining if further titration is needed. At week 4, subjects will return for exploratory assessments. Subjects will be given a randomized study drug packet containing 2 placebos and 2 drug doses. Subjects will be told that 0-4 doses may be placebo or drug. Subjects will have 4 weeks to complete randomization doses. It is anticipated subjects will complete randomization sooner, so they will be given 23 doses of study drug (1 dose per 24 hours for 23 extra days until next visit). At week 8, subjects will return for exploratory assessments and be given an additional 74 dosed strips. They will return at week 16 for a final visit and undergo exploratory assessments, followed by a safety call two weeks later. From weeks 0-8, subjects are able to continue their scheduled RLS medications. From weeks 8-16, subjects may make changes to their RLS medications as mutually agreed upon with investigator. Several questionnaire assessments will be conducted throughout the study to monitor subjects. Subjects will complete the International RLS Rating Scale (IRLS), Restless Legs Syndrome - 6 Scale (RLS - 6), RLS Quality of Life Questionnaire (RLSQoL), RLS Augmentation Scale, Fatigue Severity Scale (FSS), Hamilton Depression Scale (HDS), Clinical Global Impressions (CGI), and Clinical Global Impressions-Change (CGI-C).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
16
Sublingual Apomorphine initial dose 10 mg, titrated depending on symptomatic response.
Placebo (sugar pill)
Houston Methodist Hospital
Houston, Texas, United States
Visual Analogue Scale of Improvement
Subjects will assess how they feel 30 minutes after taking four doses of drug or placebo.
Time frame: Weeks 4 - 8
International RLS Rating Scale (IRLS)
This is a subjective scale to measure the severity of RLS within the past week.
Time frame: Baseline, 4 weeks, 8 weeks, and 16 weeks
The Restless Legs Syndrome - 6 Scale (RLS-6)
This scale measures the severity of daytime versus nighttime RLS symptoms.
Time frame: Baseline, 4 weeks, 8 weeks, and 16 weeks
Restless Legs Syndrome Quality of Life Questionnaire (RLSQoL)
This scale assess the quality of life in RLS patients.
Time frame: Baseline, 4 weeks, 8 weeks, and 16 weeks
Hamilton Depression Scale (HDS)
This scale assess symptoms of depression.
Time frame: Baseline, 4 weeks, 8 weeks, and 16 weeks
Epworth Sleepiness Scale (ESS)
This is a subjective scale that measures a patient's sleepiness.
Time frame: Baseline, 4 weeks, 8 weeks, and 16 weeks
Clinical Global Impressions - Change
This scale assess how much a patients illness has improved or worsened when compared to a baseline state from the beginning of the intervention.
Time frame: 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 8 weeks, 12 weeks, 16 weeks, and 18-20 weeks
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