Valproic Acid in Ambulant Adults With Spinal Muscular Atrophy (VALIANTSMA)

Prospective Controlled Trial of Valproic Acid in Ambulant Adults With Spinal Muscular Atrophy (VALIANTSMA) Study

The primary objective of this proposal is to determine whether oral VPA is effective in treating SMA in adult patients.

Study Overview

• Status: Completed
• Conditions: Spinal Muscular Atrophy
• Intervention / Treatment: Drug: Placebo; Drug: Valproic Acid (VPA)

Detailed Description

Participation in this study entails six visits and seven to eight blood draws over 13 months. Each visit entails a stay of two days and one night at the General Clinical Research Center (GCRC).

Subjects who live within driving distance will be allowed to participate in the study without an overnight stay through two consecutive outpatient visits. All subjects will be evaluated at two screening visits 2-4 weeks apart to determine eligibility for participation. Eligible subjects will be randomized to receive VPA or placebo for the first six months. At the six-month visit, patients will be evaluated and crossed over to the other regimen.

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Ohio
    • Columbus, Ohio, United States, 43210
      • Ohio State University Medical Center, Dept. of Neurology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Ambulatory adults with SMA 3 ages 18-60. The diagnosis of SMA must be documented by the homozygous deletion of both SMN1 genes on standard genetic tests for the disorder. Patients must be able to walk thirty feet without assistance (i.e. no canes, walkers).
2. Interest in participating and the ability to meet the study requirements.
3. Women of child bearing age are required to be on birth control or abstain while participating in the study.

Exclusion Criteria:

1. Non-ambulatory type 3 adults and all type 2 adults.
2. Patients with co-morbid conditions that preclude travel, testing or study medications.
3. Patients who have participated in a treatment trial for SMA in the 3 months prior to this trial, or plan on enrolling in any other treatment trial during the duration of this trial.
4. Patients who are, in the investigator's opinion, mentally or legally incapacitated from providing informed consent for the study, or are otherwise unable to meet study requirements or cooperate reliably with study procedures, especially strength testing.
5. Patients with a need for non-invasive ventilatory support (e.g. BiPAP) for > 12 hours/day
6. Transaminases, amylase or lipase > 3.0 x normal values, WBC < 3.0 or neutropenia < 1.0, platelet count < 100 K, or hematocrit < 30 persisting over a 30 day period
7. Use of medications or supplements which interfere with VPA metabolism and increase the potential risks of the medications, or are hypothesized to have a beneficial effect in SMA animal models or human neuromuscular disorders within 3 months of study enrollment. These agents include riluzole, creatine, butyrate derivatives, growth hormone, anabolic steroids, daily albuterol use, anticonvulsants, or other HDAC inhibitors.
8. Women who are pregnant or who intend to become pregnant while participating in the research study or who are breastfeeding.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: 1a; For six months, half of patients are randomized into placebo . After 6 months, all patients are on treatment.	Drug: Placebo; For six months, pts are randomized into placebo or treatment. After 6 months, all pts are on treatment
Active Comparator: 1b; Cohort 1b patients are randomized onto treatment. After 6 months, all patients are on drug.	Drug: Valproic Acid (VPA); Drug: Valproic Acid and Levocarnitine; capsules; Other Names: Depakote; Carnitor

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The primary outcome for the study is change in muscle strength from baseline to six months in muscle strength as assessed by MVICT using a fixed testing system.	13 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Change in SMAFRS	13 months
Change in strength assessed by hand-held dynamometer	13 months
Change in MUNE and CMAP	13 months
SMN2 copy number	13 months
Change in PFTs, including forced vital capacity (FVC) and negative inspiratory force (NIF)	13 months
Change in lean body mass through DEXA scanning	13 months
Change in distance walked in 6 minutes	13 months
Change in time to climb four standard stairs	13 months
Change in health-related QOL assessed through the modified sickness impact profile (SIP)	13 months

Collaborators and Investigators

• Sponsor: University of Utah
• Collaborators: Abbott; Families of Spinal Muscular Atrophy
• Investigators: Study Director: Sandra P Reyna, M.D., Families of Spinal Muscular Atrophy; Principal Investigator: John T Kissel, Ohio State University; Principal Investigator: Kathryn J Swoboda, M.D., University of Utah

Study record dates

Study Major Dates

• Study Start: July 1, 2007
• Primary Completion (Actual): December 1, 2009
• Study Completion (Actual): November 1, 2010

Study Registration Dates

• First Submitted: May 30, 2007
• First Submitted That Met QC Criteria: May 30, 2007
• First Posted (Estimate): June 1, 2007

Study Record Updates

• Last Update Posted (Estimate): December 6, 2016
• Last Update Submitted That Met QC Criteria: December 5, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: Adult; Spinal Muscular Atrophy
• Additional Relevant MeSH Terms: Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Neuromuscular Diseases; Neurodegenerative Diseases; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Spinal Cord Diseases; Motor Neuron Disease; Muscular Atrophy; Atrophy; Muscular Atrophy, Spinal; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Central Nervous System Depressants; Enzyme Inhibitors; Tranquilizing Agents; Psychotropic Drugs; GABA Agents; Anticonvulsants; Antimanic Agents; Valproic Acid
• Other Study ID Numbers: 2006H0249