A Randomized, Controlled Trial of Ganaxolone in Adult Uncontrolled Partial-Onset Seizures

A Double-blind, Randomized, Placebo-controlled Study to Evaluate the Safety, Tolerability, and Efficacy of Ganaxolone as add-on Therapy in Adult Subjects With Epilepsy Consisting of Uncontrolled Partial-onset Seizures.

The study will evaluate the effectiveness and safety of an investigational drug-ganaxolone - on partial seizure frequency in adults with epilepsy taking a maximum of 3 antiepileptic medications (AEDs). The study will also evaluate the effectiveness of ganaxolone in females with catamenial epilepsy.

Catamenial epilepsy refers to a relationship between seizure frequency and a woman's menstrual cycle, where the number of seizures increases around the time of a woman's menstrual cycle.

Study Overview

• Status: Completed
• Conditions: Partial Epilepsy; Catamenial Epilepsy
• Intervention / Treatment: Drug: Ganaxolone; Other: Placebo

Detailed Description

Subjects will undergo

• 8-week baseline seizure period
• Randomization to ganaxolone or placebo
• Dose titrate for 2 weeks followed by 8 weeks of maintenance.
• Eligible subjects will be offered participation in the open-label extension study.
• Those not entering open-label will undergo a 6-week dose de-escalation to gradually taper ganaxolone.

• Study Type: Interventional
• Enrollment (Actual): 147
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294-0021
      • University of Alabama
  • Arizona
    • Phoenix, Arizona, United States, 85013
      • Barrow Neurological Institute
  • Arkansas
    • Little Rock, Arkansas, United States, 72205
      • Arkansas Epilepsy Program
  • California
    • Los Angeles, California, United States, 90033
      • University of Southern California Adult Comprehensive Epilepsy Center
    • Sacramento, California, United States, 95817
      • University of California-Davis
  • Colorado
    • Aurora, Colorado, United States, 80010-0045
      • Anchutz Outpatient Pavillion Neurosciences Clinic/ University of Colorado Hospital
  • Connecticut
    • New Haven, Connecticut, United States, 06520
      • Yale University School of Medicine
  • Florida
    • Gainesville, Florida, United States, 32610-0236
      • University of Florida McKnight Brain Institute
    • Sarasota, Florida, United States, 34232
      • Intercoastal Medicine
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Emory Healthcare
  • Illinois
    • Springfield, Illinois, United States, 62702
      • Southern Illinois University Medical Center
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • University of Iowa Hospitals and Clinics
  • Kentucky
    • Lexington, Kentucky, United States, 40536
      • University of Kentucky, Dept. of Neurology
  • Maryland
    • Bethesda, Maryland, United States, 20817
      • Mid-Atlantic Epilepsy and Sleep Center
  • Michigan
    • Detroit, Michigan, United States, 48202
      • 2799 West Grand blvd. CFP 071
  • Minnesota
    • Saint Paul, Minnesota, United States, 55102-2383
      • Minnesota Epilepsy Group, PA
  • Missouri
    • Chesterfield, Missouri, United States, 63017
      • Comprehensive Epilepsy Care Center for Children and Adults
  • New Jersey
    • Hackensack, New Jersey, United States, 07601
      • Overlook Hospital and Hackensack Medical Center
  • New York
    • Albany, New York, United States, 12208
      • Neurosciences Institute at Albany Medical Center
    • Syracuse, New York, United States, 13210
      • SUNY Upstate Medical University
  • Ohio
    • Columbus, Ohio, United States, 43210
      • Ohio State University Medical Center
  • Pennsylvania
    • Media, Pennsylvania, United States, 19063
      • Riddle Health Care Center for Neuroscience
    • Philadelphia, Pennsylvania, United States, 19107
      • Thomas Jefferson University
    • Philadelphia, Pennsylvania, United States, 19102
      • Drexel University / Hahneman Hospital
  • Tennessee
    • Nashville, Tennessee, United States, 37232
      • Vanderbilt University Medical Ctr
  • Texas
    • Dallas, Texas, United States, 75230
      • Neurological Clinic of Texas, P.A.
  • Virginia
    • Richmond, Virginia, United States, 23298
      • Virginia Commonwealth University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 69 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

INCLUSION CRITERIA:

• Diagnosis of epilepsy with POS with or without secondary generalized seizures according to the International League Against Epilepsy [ILAE] Classification of Epileptic Seizures (1981). Diagnosis should have been established by clinical history and CT or MRI of the brain to rule out progressive structural lesions and EEG with results consistent with partial-onset epilepsy.
• During the 8 week baseline period preceding randomization visit (Visit 4), participants should have a documented seizure frequency of ≥ 3CPS per 4 weeks on average.
• Participants should not be seizure free for more than 28 consecutive days during treatment with a stable dose of AEDs [Note: Participants with historically sufficiently high seizure frequency who fall short 1 seizure in any 4 weeks period or with a seizure-free period > 28 consecutive days may be allowed to enter the study after discussion with the Medical Monitor. Prolongation of the screening period for questionable cases may also be allowed by the Medical Monitor.]
• Treatment with a stable dose of up to 3 (FDA approved) current AEDs for 1 month prior to screening.

• Maintenance of current AEDs without a change in dosing for the duration of study.

  • Concomitant vigabatrin not permitted;
  • Felbamate is allowed if the participant has been on felbamate for at least 18 months and has stable laboratory tests) for the course of the study. [Note: A shorter period for stable laboratory results may be allowed by the Medical Monitor, depending on the extent of dose change and the half-life of the AED.]
  • Participants receiving treatment with a vagal nerve stimulator (VNS) may be included as long as the VNS has been in place for at least 12 months prior to entry into the study, the VNS battery is not due for replacement during 0600 subject participation, and stimulation parameters have been kept constant for 1 month prior to screening. VNS will be counted as 1 of the 3 concomitant AEDs.
• Male or female, 18 to 69 years of age (inclusive). [Note: Participants who are > 69 years of age but are of good health condition may be allowed to enter the study after discussion with and approval by the Medical Monitor.]
• A 12-lead electrocardiogram (ECG) w/o clinically significant abnormalities.
• Be properly informed of the nature and risks of the study and give informed consent in writing, prior to entering the study.
• Able to participate for the full term of study.
• Able to keep a seizure & medication diary throughout the course of the study.
• Sexually active women of childbearing potential (WCBP) must be using a medically acceptable method of birth control and have a negative qualitative β-human chorionic growth hormone (β-HCG) pregnancy test result from a urine sample collected at the initial screening visit. A woman of childbearing potential is defined as a female who is biologically capable of becoming pregnant. A medically acceptable method of birth control includes intrauterine devices in place for at least 3 months, surgical sterilization, or adequate barrier methods (e.g., diaphragm and foam). An oral contraceptive alone is not considered adequate for the purpose of this study. Use of oral contraceptives in combination with another method (eg, a spermicidal cream) is acceptable.in participants who are not sexually active, abstinence is an acceptable form of birth control and serum β-HCG must be tested per protocol.
• Participants with a history of depression who are stable and may be taking 1 anti-depressant medication.

EXCLUSION CRITERIA:

• Presence of non-motor simple partial seizures only.
• History of pseudoseizures in the last 5 years.
• History of a primary generalized seizure in the last 5 years.
• Past use of vigabatrin without stable visual fields tested twice over the 12 months after the last dose of vigabatrin (Concomitant use of vigabatrin is not allowed).
• Seizures secondary to illicit drug or alcohol use, infection, neoplasia, demyelinating disease, degenerative neurological disease, or CNS disease deemed progressive, metabolic illness, or progressive degenerative disease.
• Status epilepticus within the last year prior to randomization.
• Clinically unstable psychiatric disorder within the last 2 years.
• Suicidal attempt within the last 5 years or current significant suicidal ideation.
• History of psychosis within the last 5 years. [Note: Participants who suffered a psychosis that can well be explained by exogenous factors may be allowed to enter the study after discussion with and approval by the Medical Monitor.]
• Current use of neuroleptics for psychosis.
• A significant medical or surgical condition at screening which might compromise the hematologic, cardiovascular, pulmonary, renal, gastrointestinal, or hepatic systems or other conditions that would place the subject at increased risk.
• Known sensitivity or allergy to progesterone or related steroid compounds.
• History of drug use or alcohol abuse within the past 5 years.
• Sexually active WCBP who are unwilling to use a double-barrier method and establish that they are currently not pregnant by submitting to a pregnancy test.
• Females who are currently breastfeeding.
• history of chronic noncompliance with drug regimens.
• Exposure to any other investigational drug or device within 30 days prior to screening.
• Alanine transferase (ALT; SGPT) or Aspartate transferase (AST; SGOT) levels > 3 times upper limits of normal (ULN) at screening.

• Benzodiazepines may be used intermittently for the control of seizure clustering as a one time rescue up to a maximum of 4 occasions as follows:

  • Participants who need benzodiazepines for control of seizures more than once per month or more than 4 times total during the Titration and Maintenance Phases will be discontinued.
  • Once during the Titration Phase
  • No more than once per month during the Maintenance Phase
  • Each occasion may be a period of 24 hours, during which up to 3 doses of benzodiazepine may be used.
  • If a participant is taking a benzodiazepine chronically for epilepsy and non-epilepsy conditions, it will be counted as 1 of the 3 AEDs and the dose cannot be changed during the study.
• Participant has history of repetitive seizures within the 12-month period preceding study entry where the individual seizures cannot be counted.
• Inability to withhold grapefruit and grapefruit juice from diet for the entire clinical trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ganaxolone; active study drug	Drug: Ganaxolone; Oral suspension 200-500 mg 3x/day
Placebo Comparator: non-active drug; placebo	Other: Placebo; non-active placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Weekly Log-transformed Seizure Frequency During Weeks 1 Through 10	Weekly seizure frequency, analyzed as mean weekly log-transformed seizure frequency [including partial-onset seizures (POS) with or without secondary generalization, but not non-motor simple partial seizure (SPS)] during Weeks 1 through 10.	Week 1 through Week 10

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Weekly Log-transformed Seizure Frequency During Weeks 3 Through 10	Weekly seizure frequency, analyzed as mean weekly log-transformed seizure frequency [including POS with or without secondary generalization, but not non-motor SPS] during the Weeks 3 through 10	Week 3 through Week 10
Change From Baseline in Mean Weekly Seizure Frequency During Weeks 1 Through 10	Summary of change from Baseline in mean weekly seizure frequency is presented. Baseline was defined as the Day 0 assessment before study drug infusion. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value.	Baseline and at Week 1 through Week 10
Change From Baseline in Mean Weekly Seizure Frequency During Weeks 3 Through 10	Summary of change from Baseline in mean weekly seizure frequency is presented. Baseline was defined as the Day 0 assessment before study drug infusion. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value.	Baseline and at Week 3 through Week 10
Percent Change From Baseline in Mean Weekly Seizure Frequency During Weeks 1 Through 10	Summary of percent change from Baseline in mean weekly seizure frequency is presented. Baseline was defined as the Day 0 assessment before study drug infusion. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value.	Baseline and at Week 1 through Week 10
Percent Change From Baseline in Mean Weekly Seizure Frequency During Weeks 3 Through 10	Summary of percent change from Baseline in mean weekly seizure frequency is presented. Baseline was defined as the Day 0 assessment before study drug infusion. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value.	Baseline and at Week 3 through Week 10
Mean Weekly Seizure Frequency for Each Week After Dosing During Weeks 1 to 10	Mean weekly Seizure Frequency for each week post-dosing During Weeks 1 to 10 is presented.	Weeks 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10
Percent Change From Baseline in Mean Weekly Seizure Frequency by Subtype During Weeks 1 Through 10	Seizure subtypes included Complex partial seizures (CPS), Generalized tonic-clonic seizure (GTCS), and Simple partial seizure (SPS)-motor. Percent Change from Baseline in Mean Weekly Seizure frequency by seizure subtype is presented. Baseline was defined as the Day 0 assessment before study drug infusion. Change from Baseline was calculated by subtracting Baseline value from the post-dose visit value.	Baseline and at Week 1 through Week 10
Number of Responders During Weeks 1 Through 10	Responders were defined as participants experiencing ≥50% of reduction in mean weekly seizure frequency from the Baseline. Baseline was defined as the Day 0 assessment before study drug infusion.	Baseline and at Week 1 through Week 10
Number of Responders During Weeks 3 Through 10	Responders were defined as participants experiencing ≥50% of reduction in mean weekly seizure frequency from the Baseline. Baseline was defined as the Day 0 assessment before study drug infusion.	Baseline and at Week 3 through Week 10
Number of Seizure-free Participants Up to Week 2	Number of seizure-free participants is presented.	Up to Week 2
Number of Seizure-free Participants During Weeks 3 Through 10	Number of seizure-free participants is presented.	Week 3 through Week 10
Number of Seizure-free Participants During Weeks 1 Through 10	Number of seizure-free participants is presented.	Week 1 through Week 10
Number of Seizure-free Days Up to Week 2	Summary of Seizure-Free days is presented.	Up to Week 2
Number of Seizure-free Days During Week 3 Through 10	Summary of Seizure-Free days is presented.	Week 3 through Week 10
Number of Seizure-free Days During Week 1 Through 10	Summary of Seizure-Free days is presented.	Week 1 through Week 10

Collaborators and Investigators

• Sponsor: Marinus Pharmaceuticals
• Investigators: Study Director: Joseph Hulihan, MD, Marinus Pharmaceuticals, Inc.

Publications and helpful links

General Publications

• Maguire MJ, Nevitt SJ. Treatments for seizures in catamenial (menstrual-related) epilepsy. Cochrane Database Syst Rev. 2021 Sep 16;9(9):CD013225. doi: 10.1002/14651858.CD013225.pub3.

Helpful Links

• information about ganaxolone

Study record dates

Study Major Dates

• Study Start: February 1, 2007
• Primary Completion (Actual): October 1, 2008
• Study Completion (Actual): November 1, 2008

Study Registration Dates

• First Submitted: April 24, 2007
• First Submitted That Met QC Criteria: April 24, 2007
• First Posted (Estimate): April 25, 2007

Study Record Updates

• Last Update Posted (Actual): March 15, 2023
• Last Update Submitted That Met QC Criteria: February 17, 2023
• Last Verified: February 1, 2023

More Information

Terms related to this study

• Keywords: Partial seizures; Partial onset seizures; Complex-partial seizures; Anticonvulsant; Catamenial epilepsy
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Epilepsy; Seizures; Epilepsies, Partial; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; GABA Modulators; GABA Agents; Neurosteroids; Ganaxolone
• Other Study ID Numbers: 1042-0600; V 1.3