A Randomized, Controlled Trial of Ganaxolone in Patients With Infantile Spasms
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Purpose
The study is a two period (8-10 days/period), incomplete cross-over in which successive cohorts of 9 subjects are randomized, in a 2:1 ratio, to 1 of 2 sequences, A and B. In each cohort, Sequence A, comprised of 6 subjects, receives ascending doses of ganaxolone during period 1 and ganaxolone (at the maximal dose attained in period 1) and ascending doses of placebo during period 2. Sequence B, comprised of 3 subjects, receives ascending doses of placebo during period 1 and receives the maximum dose of placebo and ascending doses of ganaxolone during period 2. The dosing level in each subsequent cohort will be based upon experience gained from previous cohorts.
| Condition | Intervention | Phase |
|---|---|---|
|
Infantile Spasms |
Drug: Ganaxolone |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Crossover Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | A Double-blind, Placebo-controlled, Dose-ranging Clinical Study to Evaluate the Safety, Tolerability, and Antiepileptic Activity of Ganaxolone in Treatment of Patients With Infantile Spasms |
- Spasm frequency as measured by a 24-hour vEEG at Visit 5 (Day 9 ±1 day). [ Time Frame: 1 week ] [ Designated as safety issue: No ]
- Spasm frequency after two weeks of treatment, as determined by 24-hour vEEG. [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]
- Cessation of hypsarrhythmia, as determined by vEEG. [ Time Frame: 1 week, 2 weeks ] [ Designated as safety issue: No ]
- Investigator and caregiver global assessment of seizure severity and response to treatment at Weeks 1 and 2. [ Time Frame: 1 week, 2 weeks ] [ Designated as safety issue: No ]
- The number of subjects spasm-free and seizure-free (for at least 24 hours) at Weeks 1 and 2. [ Time Frame: 1 week, 2 weeks ] [ Designated as safety issue: No ]
- Responders (≥ 50% decrease in spasm frequency) at Weeks 1 and 2. [ Time Frame: 1 week, 2 weeks ] [ Designated as safety issue: No ]
- Reduction of other seizure types at Weeks 1 and 2. Parents/caregivers will maintain a spasm/seizure diary for clinical study subjects. [ Time Frame: 1 week, 2 weeks ] [ Designated as safety issue: No ]
- Investigators and caregivers assessment of the presence and absence of spasms in each subject following treatment. [ Time Frame: 1 week, 2 weeks ] [ Designated as safety issue: No ]
- Developmental assessment. [ Time Frame: 2 weeks ] [ Designated as safety issue: No ]
| Enrollment: | 56 |
| Study Start Date: | January 2007 |
| Study Completion Date: | May 2008 |
| Primary Completion Date: | May 2008 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Experimental: ganaxolone | Drug: Ganaxolone |
| Placebo Comparator: non-active drug | Drug: Ganaxolone |
Detailed Description:
Male or female, 4 to 24 months of age (inclusive) with a diagnosis of IS with a 24 hour video EEG (vEEG) recording confirming the diagnosis and previously treated with 3 or fewer antiepileptic drugs (AEDs) are eligible for the study. The subject is able to continue treatment with concomitant AEDs (no more than 2; adrenocorticotropic hormone [ACTH], corticosteroids, felbamate, and vigabatrin are not allowed concomitantly). A ketogenic diet is permitted if it can be maintained for the duration of the study.
There will be a total of three weekly 24-hr video EEGs (baseline, end of weeks 1 and 2 of treatment). Dosing titration begins the day after each video EEG during the inpatient stay. All subjects will be receiving ganaxolone the day after the second video EEG.
A Data Monitoring Board (DMB) will determine whether successive cohorts of subjects can be dosed at an increased dose level; up to a maximum of 6 cohorts.
Eligibility| Ages Eligible for Study: | 4 Months to 24 Months |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Be diagnosed with IS (regardless of etiology- except for a progressive neurologic illness). Diagnostic Criteria: Seizures consisting of single or repetitive short muscular contractions leading to flexion or extension. Spasms may be characterized as tonic or myoclonic contractions, may occur singly or in clusters, and typically occur bilaterally and symmetrically. The EEG pattern must be consistent with the diagnosis of IS (hypsarrhythmia, modified hypsarrhythmia, multifocal spike wave discharges, etc).
- Have a vEEG recording confirming the diagnosis of IS.
- Have had a magnetic resonance imaging (MRI) performed to determine any possible causes of IS.
- Have been previously treated with 3 or fewer AEDs.
If being treated with concomitant AEDs
- Current AEDs have been at a constant daily dose for at least 2 weeks; Note: Subjects with minor dose adjustments may be allowed to enter the study after shorter periods after detailed discussion with the medical monitor.
- Have a stable clinical response/plateau for at least 2 weeks
- Are able to continue treatment with no more than 2 concomitant AEDs (ACTH, corticosteroids, felbamate, and vigabatrin are not allowed concomitantly).
- A ketogenic diet is permitted if it can be maintained for the duration of the study.
- Be a male or female, 4 to 24 months of age (inclusive)
- Have a Parent/Guardian who is properly informed of the nature and risks of the clinical study, who is willing and capable of complying with all clinical study procedures, and has given informed consent in writing prior to entering the clinical study
- Be able to participate for the full term of the clinical study.
Exclusion Criteria:
- Treatment with corticosteroids, ACTH, vigabatrin, felbamate, or any AED not approved by Regulatory Agencies, 2 weeks prior to randomization.
- Treatment with more than two AEDs at baseline.
- Have an active CNS infection, demyelinating disease, degenerative neurological disease, or CNS disease deemed progressive (with the exception of tuberous sclerosis) as evaluated by brain imaging (MRI).
- Have any disease or condition (medical or surgical) at screening that might compromise the hematologic, cardiovascular, pulmonary, renal, gastrointestinal, or hepatic systems; or other conditions that might interfere with the absorption, distribution, metabolism, or excretion of the investigational product, or would place the subject at increased risk.
- Aspartate aminotransferase (AST), alanine aminotransferase (ALT), or total bilirubin greater than four times the upper limit of normal (ULN) or clinical laboratory value deemed clinically significant by the Investigator.
- History of recurrent status epilepticus.
- Have been exposed to any other investigational drug within 30 days prior to randomization.
Contacts and Locations| United States, California | |
| Children's Hospital of Los Angeles | |
| Los Angeles, California, United States, 90027 | |
| Mattel Children's Hospital at UCLA | |
| Los Angeles, California, United States, 90095 | |
| United States, District of Columbia | |
| Children's National Medical Center | |
| Washington, District of Columbia, United States, 20010 | |
| United States, Florida | |
| Miami Children's Hospital, The Brain Institute | |
| Miami, Florida, United States, 33155 | |
| Child Neurology Care Center of Northwest Florida | |
| Pensacola, Florida, United States, 32504 | |
| Child Neurology Center of Northwest Florida | |
| Pensacola, Florida, United States | |
| United States, Illinois | |
| University of Chicago Comer Children's Hospital | |
| Chicago, Illinois, United States, 60637 | |
| United States, Minnesota | |
| Minnesota Epilepsy Group, P.A. | |
| St. Paul, Minnesota, United States, 55102 | |
| United States, New York | |
| Montefiore Medical Center- Albert Einstein College of Medicine | |
| Bronx, New York, United States, 10467 | |
| United States, Tennessee | |
| Le Bonheur Children's Medical Center | |
| Memphis, Tennessee, United States, 38105 | |
| United States, Texas | |
| Dallas Pediatric Neurology Associates | |
| Dallas, Texas, United States, 75230 | |
| Texas Children's Hospital | |
| Houston, Texas, United States, 77030 | |
| United States, Virginia | |
| Virginia Commonwealth University Health System | |
| Richmond, Virginia, United States, 23298 | |
| United States, Washington | |
| Children's Hospital and Regional Medical Center | |
| Seattle, Washington, United States, 98105 | |
| United States, Wisconsin | |
| Children's Hospital of Wisconsin | |
| Milwaukee, Wisconsin, United States, 53201 | |
More Information
Additional Information:
No publications provided
| Responsible Party: | Julia Tsai/ Director Clinical Operations, Marinus Pharmaceutical, Inc |
| ClinicalTrials.gov Identifier: | NCT00441896 History of Changes |
| Other Study ID Numbers: | 1042-0500 |
| Study First Received: | February 27, 2007 |
| Last Updated: | October 29, 2009 |
| Health Authority: | United States: Food and Drug Administration |
Keywords provided by Marinus Pharmaceuticals:
|
infantile spasms anticonvulsant pediatric epilepsy West Syndrome epileptic spasms |
Additional relevant MeSH terms:
|
Spasm Spasms, Infantile Neuromuscular Manifestations Neurologic Manifestations Nervous System Diseases |
Signs and Symptoms Epilepsy, Generalized Epilepsy Brain Diseases Central Nervous System Diseases |
ClinicalTrials.gov processed this record on May 22, 2013