Trial of Ginkgo as a Treatment for Cognitive Problems in Multiple Sclerosis

US Department of Veterans Affairs (VA)

Status and phase

Completed

Phase 2

Conditions

Multiple Sclerosis

Cognitive Ability, General

Treatments

Drug: Ginkgo biloba

Drug: Placebo

Study type

Interventional

Funder types

Other U.S. Federal agency

Identifiers

NCT00841321

B4368-R

Details and patient eligibility

About

The purpose of this study is to see if treatment with Ginkgo improves cognitive function in people with multiple sclerosis who have cognitive problems.

Full description

Objectives:

Primary objective: Determine the difference between subjects treated with Ginkgo biloba (GB) and subjects treated with placebo for 12 weeks on the performance of a battery of neuropsychological tests that are frequently impaired in Multiple Sclerosis (MS): the Stroop test, the Paced Auditory Serial Addition Test (PASAT), the California Verbal Learning Test (CVLT-II), and the Controlled Oral Word Association Test (COWAT). Secondary objectives: Determine the difference between the two groups after treatment in the following outcomes: 1) incidence of treatment related side effects, 2) cognitive performance as reported by the subjects on the Perceived Deficits Questionnaire, 3) cognitive performance as reported by the subject's family members or caregivers as measured on the Multiple Sclerosis Neuropsychological Screening Questionnaire and 4) community integration as measured with the Community Integration Questionnaire.

Research plan:

This will be a randomized double blind placebo controlled trial of GB 120 mg twice a day for 12 weeks.

Methods:

One hundred fifty-eight subjects (79 per group) will be randomly assigned to placebo or GB. Subjects will be evaluated at baseline and exit with the cognitive test battery and the self report measures detailed above.

For the primary outcome, multivariate analysis of covariance (MANCOVA) will be used to analyze the changes in all the cognitive tests simultaneously. This analysis will be followed by the analysis of covariance (ANCOVA) for each of the cognitive tests in the battery. The sample size we selected has a power of 0.80 with an alpha level of 0.05 on the overall MANCOVA and for each of the ANCOVA's after Bonferroni's correction.

The self report measures will be analyzed using ANCOVA with baseline responses as covariates.

Safety evaluations will include complete blood count and metabolic panel as well as physical exams at baseline and at exit. The physical exam will include the Expanded Disability Scale (EDSS). Telephone follow-ups will be done monthly while on treatment and one month after exiting the study to review study procedures and assess side effects. Adverse reactions will be classified using the categories and grading in the Cancer Therapy Evaluation Program (CTEP) Common Toxicity Criteria (CTC) Version 3.0 and reported to the Institutional Review Board (IRB) following the institutions guidelines. A Data Safety Management Board (DSMB) will oversee the study.

Enrollment

120 patients

Sex

All

Ages

18 to 65 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

A diagnosis of multiple sclerosis by McDonald's criteria
Age 18 to 65 years, inclusive
A score minus one standard deviation below the mean on one or more of the following tests: PASAT, COWAT, CVLT-II, Stroop
EDSS 0 - 7.5, inclusive
No Ginkgo biloba in preceding 30 days
Native English speaker

Exclusion criteria

Current substance abuse disorder, psychosis, or significant depression (score on the Beck Depression Inventory II (BDI -II) greater than 28
Any significant uncontrolled medical problem including diabetes requiring insulin
Relapse of multiple sclerosis within the 30 days before screening
Abnormalities of coagulation or current use of anticoagulants or antiplatelet agents
Elective surgery planned for the study period or the following four weeks
Epilepsy or history of seizures
Use of nifedipine, nicardipine, Saint John's Wort, papaverine, mono amine oxidase inhibitors
Pregnancy or women not using a reliable form of contraception
Corrected binocular visual acuity worse than 20/50 or more than one error on binocular color vision testing with the Ishihara Color Plates or sustained nystagmus or diplopia on primary gaze
Inability to complete the neuropsychological test battery at the screening visit
History of alcohol abuse or illicit drug use in the prior six months