Study of Idebenone in the Treatment of Mitochondrial Encephalopathy Lactic Acidosis & Stroke-like Episodes (MELAS)

A Phase IIa Double-Blind, Randomized, Placebo-Controlled, Dose-Finding Study of Idebenone in the Treatment of Mitochondrial Encephalopathy Lactic Acidosis and Stroke-like Episodes

The purpose of this study is to compare the efficacy of two (2) different doses of idebenone with that of a placebo over a one month period on cerebral lactate concentration as measured by magnetic resonance spectroscopy.

Study Overview

• Status: Completed
• Conditions: MELAS Syndrome
• Intervention / Treatment: Drug: Idebenone; Drug: Idebenone; Other: Placebo

Detailed Description

MELAS (Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes), a progressive and often devastating multisystem disorder, is most commonly associated with mitochondrial Deoxyribonucleic acid (mtDNA) point mutation at nucleotide 3243. Seizures, cognitive deterioration, and neurobehavioral abnormalities are frequent features of this disease which typically shortens life expectancy. Idebenone, an ATP production modulator and antioxidant, improves neurological function in Friedreich's ataxia, a disease also associated with mitochondrial dysfunction.

Given that there is no effective treatment for MELAS, the investigators propose a Phase II proof of concept trial of idebenone to study its preliminary efficacy in patients with MELAS and the A3243G mtDNA mutation, and to study its safety and tolerability in this patient group.

The investigators propose to evaluate 21 patients with the A3243G mitochondrial DNA mutation and MELAS (defined by a history of either seizures or stroke). Patients will receive idebenone (900 mg/day or 2250 mg/day) or matching placebo for one month. The primary outcome measure is cerebral lactate levels measured by Magnetic Resonance Spectroscopy (MRS), a biomarker associated with disease worsening. This study will help the investigators to determine if there is sufficient signal to proceed to efficacy studies. Also it will provide additional information on the safety and tolerability of two different doses of idebenone in MELAS.

• Study Type: Interventional
• Enrollment (Actual): 27
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10032
      • Columbia University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 63 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of MELAS with confirmed A3243G mtDNA mutation, or evidence of central nervous system involvement (cognitive problems, migraines, memory loss)
• Cerebral lactate level equal to or greater than 5.0 i.u. at baseline
• Patients at least 8 and < 65 years of age at baseline
• Patients with a body weight > 37 kg/82 lbs at baseline
• Stable co-medication/vitamins/supplements within 1 month prior to baseline
• Patients who in the opinion of the investigator are able to comply with the requirements of the study, including swallowing the study medication
• Negative urine pregnancy test at screening and baseline (female patients of childbearing potential)

Exclusion Criteria:

• Contraindication to MRS (e.g. metal implant, claustrophobia)
• Stroke like event within 2 months prior to baseline
• Treatment with idebenone at any dose, or coenzyme Q10 at doses above 100mg/d within 1 month prior to baseline
• Inadequate contraception use
• Pregnancy and/or breast-feeding
• Clinically significant abnormalities of clinical hematology or biochemistry including, but not limited to, elevations greater than 1.5 times the upper limit of normal of aspartate aminotransferase (AST), alanine aminotransferase (ALT) or creatinine
• Current abuse of drugs or alcohol
• Participation in a trial of another investigational drug within the last month
• Other factor that, in the investigator's opinion, excludes the patient from entering the study

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: placebo; Placebo	Other: Placebo; Placebo - No idebenone; Other Names: No active drug
Experimental: Idebenone 900 mg/day	Drug: Idebenone; 900 mg/day for 1 month; Other Names: active drug; Drug: Idebenone; 2250 mg/day for 1 month; Other Names: active drug
Experimental: Idebenone 2250 mg/day	Drug: Idebenone; 900 mg/day for 1 month; Other Names: active drug; Drug: Idebenone; 2250 mg/day for 1 month; Other Names: active drug

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Cerebral Lactate Concentration (as Measured by Magnetic Resonance Spectroscopy)	To compare the efficacy of 1 month treatment with 2 different doses of idebenone with that of placebo on cerebral lactate concentration as measured by magnetic resonance spectroscopy (MRS)	Up to 4 weeks from baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Change in Venous Lactate Concentration	To compare the efficacy of 1 month treatment with 2 different doses of idebenone with that of placebo on venous lactate concentration	Up to 4 weeks from baseline
Mean Change in Score on the Fatigue Severity Scale (FSS)	To assess changes following 1 month treatment with 2 different doses of idebenone with that of placebo in fatigue as assessed by the Fatigue Severity Scale (FSS). Scale score minimum is 9 (least fatigue) and maximum is 63 (maximum fatigue). Scores of 36 or less indicate possibility that patient may not be suffering from fatigue, while scores 36 and over suggest suffering from fatigue	Baseline and Week 4

Collaborators and Investigators

• Sponsor: Michio Hirano
• Collaborators: Santhera Pharmaceuticals

Study record dates

Study Major Dates

• Study Start: May 1, 2009
• Primary Completion (Actual): July 1, 2012
• Study Completion (Actual): July 1, 2012

Study Registration Dates

• First Submitted: April 23, 2009
• First Submitted That Met QC Criteria: April 23, 2009
• First Posted (Estimate): April 24, 2009

Study Record Updates

• Last Update Posted (Estimate): October 26, 2016
• Last Update Submitted That Met QC Criteria: September 20, 2016
• Last Verified: September 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Metabolic Diseases; Cerebrovascular Disorders; Central Nervous System Diseases; Nervous System Diseases; Genetic Diseases, Inborn; Musculoskeletal Diseases; Muscular Diseases; Neuromuscular Diseases; Metabolism, Inborn Errors; Brain Diseases, Metabolic; Mitochondrial Diseases; Brain Diseases, Metabolic, Inborn; Cerebral Small Vessel Diseases; Acid-Base Imbalance; Mitochondrial Encephalomyopathies; Mitochondrial Myopathies; Brain Diseases; MELAS Syndrome; Acidosis; Acidosis, Lactic; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Protective Agents; Micronutrients; Antioxidants; Ubiquinone; Idebenone
• Other Study ID Numbers: AAAC9240; SNT-II-007 (Other Identifier: Santhera)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No