Clinical trial

RECOVER-SLEEP: A Platform Protocol for Evaluation of Interventions for Sleep Disturbances in Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)

Name
Pro00112484_A
Description
The platform protocol is designed to be flexible so that it is suitable for a range of study settings and intervention types. Therefore, the platform protocol provides a general protocol structure that can be shared by multiple interventions and allows comparative analysis across the interventions. For example, objectives, measures, and endpoints are generalized in the platform protocol, but intervention-specific features are detailed in separate appendices. This platform protocol is a prospective, multi-center, multi-arm, randomized controlled platform trial evaluating potential interventions for PASC-mediated sleep disturbances. The hypothesis is that symptoms of sleep and circadian disorders that emerge in patients with PASC can be improved by phenotype-targeted interventions. Specific sleep and circadian disorders addressed in this protocol include sleep-related daytime impairment (referred to as hypersomnia) and complex PASC-related sleep disturbance (reflecting symptoms of insomnia and sleep-wake rhythm disturbance).
Trial arms
Trial start
2024-07-01
Estimated PCD
2025-11-01
Trial end
2025-11-01
Status
Not yet recruiting
Phase
Early phase I
Treatment
Modafinil
Modafinil is used off-label based on supporting published evidence in major depressive disorder (antidepressant augmentation), multiple sclerosis-related fatigue, Parkinson disease-related excessive daytime sleepiness, and severe cancer-related fatigue (in patients receiving active treatment). Doses up to 400 mg/day, given as a singleMode dose, have been well tolerated, but there is no consistent evidence that this dose confers additional benefit beyond that of the 200 mg dose. Study drug administration will total 10 weeks.
Arms:
Wake-promoting drug: Modafinil or solriamfetol
Modafinil Placebo
The placebo will be tooled to look similar to the modafinil tablet, but it will not contain the active ingredient. Modafinil placebo dosing will follow the same titration scheme as modafinil treatment. Unblinded study personnel will manage modafinil and placebo disbursement to maintain blinding among participants and blinded study personnel, including site investigators.
Arms:
Modafinil-matched placebo or solriamfetol-matched placebo
Solriamfetol
The proposed doses and the schedule of dose escalation are consistent with currently approved FDA labeling for solriamfetol for other disorders of excessive daytime sleepiness. Solriamfetol dosing will total 10 weeks, including 3 weeks for titration and 7 weeks of maintenance. Solriamfetol will be given as a 75 mg tablet (1 or 2 per day) in the morning. The 3-week titration will be facilitated by phone calls between the study team and participants. Titrations in dose will be dependent upon participants' symptoms and tolerance to solriamfetol, with a goal of participants taking the highest dose permitted by symptoms. This dose will be used for the maintenance phase.
Arms:
Wake-promoting drug: Modafinil or solriamfetol
Solriamfetol Placebo
The placebo tablet will be tooled to look similar to the solriamfetol tablet, but it will not contain the active ingredient. Solriamfetol placebo dosing will follow the solriamfetol dosing scheme and goal. Unblinded study personnel will manage solriamfetol and placebo disbursement to maintain blinding among participants and blinded study personnel, including site investigators.
Arms:
Modafinil-matched placebo or solriamfetol-matched placebo
Size
474
Primary endpoint
Change in total score of the PROMIS 8a SRI to assess sleep-related impairment
Baseline, End of Intervention (Day 77)
Eligibility criteria
Inclusion Criteria: • See NCT06404086 for RECOVER-SLEEP: Platform Protocol level inclusion criteria which applies to this appendix Exclusion Criteria: • See NCT06404086 for RECOVER-SLEEP: Platform Protocol level exclusion criteria which applies to this appendix (or sub-study) Additional Appendix A (Hypersomnia) Level Exclusion Criteria: 1. Self-reported sleep duration \<6 hours per night 2. Poorly controlled hypertension (systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg) 3. Moderate to severe hepatic impairment (ie, Child-Pugh class B or C)\* 4. Known estimated glomerular filtration rate \<30 mL/min/1.73 m2 and/or chronic dialysis\* 5. Recent myocardial infarction (\<1 year), unstable angina, serious cardiac arrhythmias, or other serious heart problems, at the discretion of the investigator 6. Current use of stimulant or wake-promoting medications, unless a washout is permitted 7. Regular use of prescribed hypnotics for sleep (≥3 times per week); washout period is permitted. * characterized by the screening labs: coagulation panel and CMP w/LFTs MODAFINIL EXCLUSION CRITERIA 1. Modafinil can affect drug metabolism given its effect on enzymes such as CYP3A4 and CYP2C19. To assess for drug interactions, investigators should use the Lexicomp Drug Interactions System that is available at most institutions. o If the search yields "D" - Consider Modifying Therapy or "X" - Avoid Combination, then the ACTION is to exclude the potential participant. An important example of this is steroid hormonal contraceptives. * If the search yields "C" - Monitor Therapy, then discuss with site PIs on a case-by-case basis. * If the search yields "A" - No Known Interaction or "B" - No Action Needed, then proceed to screen/include the potential participant. 2. Known severe left ventricular hypertrophy, mitral valve prolapse SOLRIAMFETOL EXCLUSION CRITERIA 1. Concurrent treatment with a monoamine oxidase inhibitor (MAOI) or use of an MAOI within the preceding 14 days 2. Current use of dopaminergic drugs
Protocol
{'studyType': 'INTERVENTIONAL', 'phases': ['PHASE2'], 'designInfo': {'allocation': 'RANDOMIZED', 'interventionModel': 'PARALLEL', 'interventionModelDescription': 'This platform protocol is designed to allocate participants into an intervention appendix based on their symptoms of sleep disturbance. Within the appendix, participants will be randomly assigned based on the appendix study design. Site investigators and personnel will be informed as to which study intervention appendix participants are assigned, but they will be blinded to whether participants are receiving the active study intervention or control, when possible. Similarly, participants will be blinded to active intervention or control, when possible. Randomization will be stratified by the study site; other stratification factors may be considered per appendix.', 'primaryPurpose': 'TREATMENT', 'maskingInfo': {'masking': 'TRIPLE', 'maskingDescription': 'Double blind', 'whoMasked': ['PARTICIPANT', 'CARE_PROVIDER', 'INVESTIGATOR']}}, 'enrollmentInfo': {'count': 474, 'type': 'ESTIMATED'}}
Updated at
2024-05-09

1 organization

Organization
Duke University