This is a phase II/exploratory clinical trial with a single-center, open-label design to evaluate the effect of modafinil on cognitive deficits in adult patients with multiple sclerosis and identify predictors of response using functional Magnetic Resonance Imaging (fMRI).
Multiple sclerosis (MS) is a neurodegenerative disease that affects the central nervous system. There are no commercially authorized therapeutic options available for the treatment of cognitive impairment in patients with multiple sclerosis. It is then necessary to conduct robust clinical trials to select better therapies. Modafinil is a drug approved by INFARMED and European Medicines Agency (EMA) for the treatment of excessive sleepiness associated with narcolepsy. Modafinil has been tested in 5 clinical trials in patients with multiple sclerosis and the results indicated a potential improvement in cognitive deficits in tasks that measure executive function, verbal memory, and/or working memory performance. Despite encouraging results, there is a huge variation in its effect in individual patients and a significant proportion of sub-optimal/non-responders. Therefore, it is important to identify personalized predictors of response to best tailor the treatment to each patient. This is a phase II/exploratory clinical trial with a single-center, open-label design to evaluate the effect of modafinil on cognitive deficits in adult patients with multiple sclerosis and identify predictors of response using functional Magnetic Resonance Imaging (fMRI). The primary objective of the clinical trial is to identify fMRI markers of response to modafinil. In other words, our aim is to analyse brain activity (using fMRI) before and after modafinil intake and select the features that can better differentiate between responders and non-responders. These patient groups will be determined according to the improvement rate in the Symbol digit modalities test (SDMT) - which will be evaluated at screening, baseline and at the end of treatment. The clinical trial will be conducted at Centro Clínico Académico - Braga, Associação (2CA-Braga), Unidade Local de Saúde de Braga (ULS Braga), E.P.E.. Participants will be recruited at the outpatient unit of the Neurology department of ULS de Braga. A total of 64 eligible patients will be enrolled to receive modafinil at a dose 200 mg (2 tablets of 100 mg) once per day in the morning for 3 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
64
All participants enrolled in the study will receive the study intervention drug (Modafinil Generis 100 mg). Dose 200 mg once per day (2 tablets of 100 mg) in the morning for 3 months (84 days), Oral administration
Clinical Academic Center - Braga (2CA-Braga)
Braga, Portugal
RECRUITINGAcute changes in brain fuction and connectivity measured using resting state fMRI.
Acute changes in brain functional connectivity at rest will be measured using resting-state fMRI through Echo-planar imaging (EPI) sequences.
Time frame: Day 1 (baseline): before and 3 hours (± 30 minutes) after modafinil administration.
Long-term changes in brain function and connectivity measured using resting state fMRI.
Long-term changes inbrain functional connectivity at rest will be measured using resting-state fMRI through Echo-planar imaging (EPI) sequences.
Time frame: Day 1 (baseline), 3 hours (± 30 minutes) after medication; and Day 84 (3 months after treatment with modafinil), 3 hours (±30 minutes) after medication.
Acute changes in brain function and connectivity measured using a Go/no-Go task fMRI.
Acute changes in brain activity during a Go/No-Go task, measured using task-based fMRI through Echo-planar imaging (EPI) sequences.
Time frame: Baseline (day 1): before and 3 hours (± 30 minutes) after modafinil administration.
Long-term changes in brain function and connectivity measured using a Go/no-Go task fMRI.
Long-term changes in brain activity during a Go/No-Go task, measured using task-based fMRI through Echo-planar imaging (EPI) sequences.
Time frame: Day 1 (baseline), 3 hours (± 30 minutes) after medication; and Day 84 (3 months after treatment with modafinil), 3 hours (±30 minutes) after medication.
SDMT score
Symbol Digit Modalities Test (SDMT) is a cognitive function test to assess visual attention and information processing speed, which involves a simple substitution task. The SDMT includes a reference key of 9 symbols, each paired with a single digit. Below the reference key are rows of symbols arranged randomly. The participant will have 90 seconds to say out loud the number that corresponds to each symbol. Answers are registered by the rater in the SDMT form and the score corresponds to the number of correct answers given within the 90-seconds interval. A decrease of 4 points from baseline on the SDMT is considered a meaningful worsening.
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Time frame: Day 1 (baseline) and Day 84 (3 months after treatment)
Stroop test
The Stroop test is a measure of executive function, including selective attention capacity, processing speed, behaviour inhibition and interference resistance. The performance in this test is measured by the interference index.
Time frame: Screening and Day 84 (3 months after treatment)
MS-QoL-54 total score
Multiple Sclerosis Quality of Life-54 (MS-QoL-54) is a multidimensional health-related quality of life (QoL) measure combining generic and MS-specific items into a single tool. MS-QoL-54 has a total of 54-items generating 12 subscales along with two summary scores, and two additional single-item measures. The subscales are: physical function, role limitations-physical, role limitations-emotional, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, overall QoL, and sexual function. The single item measures are satisfaction with sexual function and change in health. The summary scores are the physical health composite summary and the mental health composite summary. Scores range from 0 to 100, with higher values representing a better QoL.
Time frame: Screening and Day 84 (3 months after treatment).
WPAI:MS total score
The Work Productivity and Activity Impairment Questionnaire for MS is a 6-item questionnaire which measures the impact of MS on the patients' work productivity (including the duration of work time missed due to the disease and decrease in productivity when working while experiencing symptoms) and non-working activities (for example, childcare) during the past seven days.
Time frame: Screening and Day 84 (3 months after treatment).
MFIS total score
The Modified Fatigue Impact Scale (MFIS) is a 21-item tool used to rate the impact of fatigue during the last 4 weeks on a 5-point Likert scale, from "Never" (0) to "Almost always" (4). The total score is the sum of all items from 0 to 84, with higher scores indicating greater impact of fatigue.
Time frame: Screening and Day 84 (3 months after treatment).
PDQ total score
Perceived Deficits Questionnaire (PDQ) is a 20-items self-report measure to assess perceived cognitive impairment during the past 4 weeks. The total score ranges from 0 to 80, and higher scores reflect greater perceived cognitive impairment.
Time frame: Screening and Day 84 (3 months after treatment with modafinil)