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Pharmacokinetic and Safety of Ramelteon Between Adolescents With Insomnia and Healthy Adults
This study has been completed.

First Received on June 3, 2009.   Last Updated on May 26, 2011   History of Changes
Sponsor: Takeda Global Research & Development Center, Inc.
Information provided by: Takeda Global Research & Development Center, Inc.
ClinicalTrials.gov Identifier: NCT00914862
  Purpose

The purpose of this study is to determine the pharmacokinetic profile, safety, and tolerability of ramelteon in adolescent subjects with insomnia, pediatric subjects with Attention Deficit Hyperactivity Disorder (ADHD) associated with insomnia and gender- and race-matched healthy adult subjects.


Condition Intervention Phase
Insomnia
Drug: Ramelteon
Phase I

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Pharmacokinetics Study
Intervention Model: Parallel Assignment
Masking: Open Label
Official Title: A Comparative Single Dose Pharmacokinetic and Safety Study of 4 mg or 8 mg Ramelteon in Adolescents With Insomnia Characterized by Difficulty With Sleep Onset, Children With Insomnia Associated With ADHD, and Healthy Adults.

Resource links provided by NLM:


Further study details as provided by Takeda Global Research & Development Center, Inc.:

Primary Outcome Measures:
  • Maximum observed serum concentration (Cmax) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Time to reach Cmax (Tmax) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Area under the serum concentration-time curve from time 0 to time of the last quantifiable concentration (AUC[0-tlqc]), [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Area under the serum concentration-time curve from time 0 to infinity (AUC[0-inf]) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Apparent clearance after oral administration (CL/F) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Terminal elimination rate constant (λz) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Terminal elimination half-life (T1/2) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]
  • Apparent volume of distribution (Vz/F) [ Time Frame: Day 1, Day 2 ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Adverse Events (AE) [ Time Frame: Day -28 to Day 15 ] [ Designated as safety issue: Yes ]
  • Clinical Laboratory Findings [ Time Frame: Screening, Day 1, Day 2 and Day 4 ] [ Designated as safety issue: Yes ]
  • Vital Signs [ Time Frame: Screening, Day 1, Day 2 and Day 4 ] [ Designated as safety issue: Yes ]
  • Electrocardiogram [ Time Frame: Screening, Day 2 and Day 4 ] [ Designated as safety issue: Yes ]
  • Physical Exam [ Time Frame: Screening, Day 1, Day 2 and Day 4 ] [ Designated as safety issue: Yes ]

Enrollment: 56
Study Start Date: November 2009
Study Completion Date: April 2011
Primary Completion Date: April 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cohort 1: Adolescents (12 yrs to 17 yrs old)
(with insomnia)
Drug: Ramelteon

Ramelteon 4 mg, tablets, orally for one day only.

Ramelteon 8 mg, tablets, orally for one day only.

Other Names:
  • TAK-375
  • Rozerem
Experimental: Cohort 1: Healthy Adults (18 yrs to 50 yrs old) Drug: Ramelteon
Ramelteon 8 mg, tablets, orally for one day only.
Other Names:
  • TAK-375
  • Rozerem
Experimental: Cohort 2: Pediatrics (6 yrs to 11 yrs old)
(with insomnia associated with ADHD)
Drug: Ramelteon

Ramelteon 4 mg, tablets, orally for one day only.

Ramelteon 8 mg, tablets, orally for one day only.

Other Names:
  • TAK-375
  • Rozerem
Experimental: Cohort 2: Healthy Adults (18 yrs to 50 yrs old) Drug: Ramelteon
Ramelteon 8 mg, tablets, orally for one day only.
Other Names:
  • TAK-375
  • Rozerem

Detailed Description:

Ramelteon is a treatment for insomnia approved for use in the United States (US) in July 2005 and in the Philippines and Indonesia in 2008. It is currently under development in the European Union (EU) and Japan. Ramelteon is marketed in the US as ROZEREM® for the treatment of insomnia characterized by difficulty with sleep onset in patients over 18 years of age.

In adolescents, the form of sleep onset and/or sleep maintenance insomnia, defined as psychophysiologic insomnia, is similar to adults, and more appropriate for treatment with pharmacological intervention when compared to insomnia in children younger than 12 years of age. In psychophysiologic insomnia, the individual develops conditioned anxiety around difficulty falling or staying asleep, which leads to heightened physiologic and emotional arousal and further compromises the ability to sleep. In children over the age of 12, insomnia is more likely to be persistent and have identifiable consequences. In addition, there is less variability in normative sleep data for this age group than in younger children.

Sleep disturbances are also common in children. Specifically, insomnia associated with ADHD in children is very common with a reported prevalence of 28% in medication-free children with ADHD.

This study is to characterize the pharmacokinetics (PK) and safety profile of a 4 or 8 mg dose of ramelteon in adolescents who are between 12 to 17 years of age (prior to the 18th birthday) with insomnia characterized by difficulty with sleep initiation, and in pediatrics who are between 6 to 11 years of age who have insomnia associated with ADHD. These profiles will be compared with those of healthy adult subjects aged 18 to 50 years who are matched by race and gender receiving an 8 mg dose of ramelteon. This open-label study is designed in accordance with the recommendations of the FDA and ICH guidances for pediatric PK studies.

  Eligibility

Ages Eligible for Study:   6 Years to 50 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

Inclusion criteria for adolescent and pediatric participants only:

  • 1. Is male or female between 12 and 17 years of age (less than 18 years of age on Day 1) with complaints of insomnia characterized by difficulty with sleep initiation OR a male or female between 6 to 11 years of age (less than 12 years of age on Day 1) with complaints of insomnia characterized by difficulty with sleep initiation associated with ADHD.
  • Has a body mass index within the 5th to 95th percentile of the appropriate body mass index designated charts based on stature-for-age and weight-for-age and by gender.
  • In the age group of 12 to 17 years, has a history of primary insomnia characterized by difficulty initiating sleep as defined by the Pharmacologic Management of Insomnia in Children and Adolescents: Consensus Statement OR in the age group of 6 to 11 years, has a history of insomnia characterized by difficulty with sleep initiation (as defined by the Pharmacologic Management of Insomnia in Children and Adolescents: Consensus Statement associated with ADHD.
  • There is agreement in the participant's parent or caregiver's opinion with the following:

    • The complaint involves significant difficulty in initiating sleep
    • The sleep disturbance does not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia.
    • The disturbance does not occur exclusively during the course of another mental disorder (eg, Major Depressive Disorder, Generalized Anxiety Disorder, and Delirium).
    • The disturbance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition.
  • Based on sleep history, reports a subjective sleep latency greater than or equal to 45 minutes for at least 1 month.
  • If taking concomitant medications, he/she has been on a stable dose or regimen of his/her medication for at least 30 days prior to Screening.

Inclusion criteria for gender- and race-matched adult subjects only:

  • Weighs at least 50 kg (110 pounds) and has a Screening body mass index between 18 and 30 kg/m2, inclusive.

Inclusion criteria for all subjects:

  • 13. A female subject of childbearing potential (defined as females aged ≥12 years old and younger girls who, at the discretion of the investigator, are deemed to be of reproductive potential) and males who are sexually active agree to routinely use adequate contraception from Screening throughout the duration of the study and through 30 days following the last dose of study medication.
  • Must have a negative urine test result for selected substances of abuse (including alcohol) at Screening and Day 1.
  • Has clinical laboratory results (including clinical chemistry, hematology, and complete urinalysis [fasted] within the reference range for the testing laboratory unless the results are deemed not clinically meaningful by the investigator or sponsor.
  • Has a negative test result for hepatitis B surface antigen and hepatitis C virus antibody, and no known history of human immunodeficiency virus.

Exclusion Criteria:

  • Is participating in another investigational study or has taken an investigational drug within 30 days (or 5 half-lives, whichever period is longer) prior to study Screening.
  • Has received ramelteon within 30 days of Screening.
  • Is a study site employee, or is an immediate family member (ie, spouse, parent, child, sibling) of a study site employee, involved in conduct of this study.
  • Has abnormal hematological parameters of hemoglobin and/or hematocrit (if these exceed +/- 2 points of the normal range for the age and sex appropriate values), or erythrocytes at Screening.
  • Has a known hypersensitivity to ramelteon or related compounds including melatonin.
  • Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse (defined as consumption of more than 4 alcoholic drinks per day) within 1 year prior to study Day 1.
  • Has had an acute, clinically significant illness within 30 days prior to Screening.
  • Has autistic spectrum disorders or other pervasive developmental disorder.
  • Has a history or clinical manifestations of significant metabolic (including diabetes mellitus, hypercholesterolemia, or dyslipidemia), hematologic, pulmonary, cardiovascular, gastrointestinal, neurologic, hepatic, renal, urologic, immunologic, musculoskeletal, or psychiatric disorder unless currently controlled and stable with protocol-allowed medication for at least 30 days prior to Screening (except for ADHD in the age group of 6 to 11 years).
  • Has sleep schedule changes required by employment, school and/or extra curricular activity (eg, shift worker) within 3 months prior to Screening, or has flown across greater than 3 time zones within 7 days prior to Screening.
  • Has a history or clinical manifestations of depression, seizures, sleep apnea, restless leg syndrome, or periodic leg movements during sleep.
  • Has a history of abdominal surgery (except laparoscopic cholecystectomy or uncomplicated appendectomy) or thoracic or nonperipheral vascular surgery within 6 months prior to study Day 1.
  • Has a history of cancer, other than basal cell carcinoma or Stage 1 squamous cell carcinoma of the skin that has not been in remission for at least 5 years prior to study Day 1.
  • Has used any tobacco (ie, nicotine) products (including but not limited to cigarettes, pipe, cigar, chewing tobacco, nicotine patch, or nicotine gum) within 6 weeks prior to Screening, or is unwilling to abstain from these products for the duration of the study.
  • Has poor peripheral venous access.
  • Has any clinically important abnormal finding as determined by a medical history, physical examination, ECG, or clinical laboratory tests, as determined by the investigator. Subjects with clinically significant abnormalities being considered for the study must be approved by both Takeda medical monitor or designee and the Principal Investigator.
  • Has any additional condition(s) that in the Investigator's opinion would: a) affect sleep/wake function, b) prohibit from completing the study, or c) not be in the best interest of to participate in the study.
  • Is required to take or intends to continue taking any disallowed medication, any prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including:

    • Anxiolytics
    • muscle relaxants
    • hypnotics
    • Over-the-counter and prescription diet aids
    • antidepressants
    • narcotic analgesics
    • anticonvulsants
    • beta blockers
    • sedating H1 antihistamines
    • systemic steroids
    • ginseng
    • kava kava
    • respiratory stimulants
    • ginkgo biloba
    • melatonin
    • decongestants
    • modafinil
    • antipsychotics
    • coumadin
    • heparin
    • potent CYP enzyme inhibitors such as ketoconazole, fluconazole and gemfibrozil
    • potent CYP enzyme inducers such as rifampin, carbamazepine and St. John's wort.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00914862

Locations
United States, Kansas
Overland Park, Kansas, United States
United States, Michigan
Kalamazoo, Michigan, United States
Sponsors and Collaborators
Takeda Global Research & Development Center, Inc.
Investigators
Study Director: Medical Director Takeda Global Research & Development Center, Inc.
  More Information

Additional Information:
No publications provided

Responsible Party: Sr. VP, Clinical Science, Takeda Global Research & Development Center, Inc.
ClinicalTrials.gov Identifier: NCT00914862     History of Changes
Other Study ID Numbers: TAK-375_110, U1111-1112-5188
Study First Received: June 3, 2009
Last Updated: May 26, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Takeda Global Research & Development Center, Inc.:
Sleep Initiation and Maintenance Disorders
Drug Therapy

Additional relevant MeSH terms:
Sleep Initiation and Maintenance Disorders
Sleep Disorders, Intrinsic
Dyssomnias
Sleep Disorders
Nervous System Diseases
Mental Disorders

ClinicalTrials.gov processed this record on February 09, 2012