Effects of Eslicarbazepine Acetate (Esl, Bia 2-093) on Cognitive Function in Children With Partial Onset Seizures

Effects of Eslicarbazepine Acetate (Esl, Bia 2-093) on Cognitive Function in Children With Partial Onset Seizures: an add-on, Double-blind, Randomised, Placebo-controlled, Parallel Group, Multicentre Clinical Trial

To evaluate the effects of eslicarbazepine acetate on cognition in comparison with placebo as adjunctive therapy in children aged 6 to 16 years old with refractory partial-onset seizures.

Study Overview

• Status: Completed
• Conditions: Partial Epilepsy
• Intervention / Treatment: Drug: Eslicarbazepine acetate (BIA 2-093); Drug: Placebo

Detailed Description

This will be a 2-part multicentre study in approximately 117 patients. Part I of the study will consist of a 4-week prospective observational baseline period, a 12-week double-blind period (4-week up-titration and 8-week maintenance), and a tapering-off period.

After the screening visit (V1), patients will enter the baseline period. At the end of the baseline period (V2), eligible patients will be randomised in a ratio of 2:1 to receive double-blind treatment with Eslicarbazepine acetate or Placebo in addition to concomitant therapy with 1 or 2 Anti-Epileptic Drugs (AEDs). Concomitant AED therapy will be kept stable during the whole study.

Initial dose of the study treatment will be 10 mg/kg/day. After 2-weeks on 10 mg/kg/day, the dose will be up-titrated to 20 mg/kg/day (maximum 1200 mg/day). After 2 weeks on 20 mg/kg/day, dose will be up-titrated to 30 mg/kg/day (maximum 1200 mg/day) and patients will receive this dose for 8 weeks. If intolerable adverse events (AEs) occur, the patient can be down-titrated to the previous dose (only 1 down-titration step will be allowed) or discontinued. After the 8-week maintenance period, the study treatment will be tapered off in 10 mg/kg/day 2 week steps. However, if a patient experiences an increase in seizure frequency (e.g. more than 100% increase vs. baseline) during tapering-off, the patient can proceed directly to the open-label part of the study (Part II).

After completion of the last 2-week 10 mg/kg/day step, patients will have the option to enter a 1 year open-label treatment (Part II) with Eslicarbazepine acetate (up to 30 mg/kg/day, maximum 1200 mg/day), or will have a 4 week observational follow-up period.

• Study Type: Interventional
• Enrollment (Actual): 123
• Phase: Phase 2

Contacts and Locations

Study Locations

• Italy
  • Ancona, Italy, 60123
    • Ospedale Salesi
  • Bari, Italy, 70126
    • Ospedale Pediatrico Giovanni XXII
  • Bologna, Italy, 40133
    • Ospedale Maggiore "C.A. Pizzardi"
  • Genova, Italy, 16146
    • Istituto Scientifico G. Gaslini
  • Mantova, Italy, 46100
    • Ospedale Carlo Poma
  • Messina, Italy, 98128
    • Policlinico Martino
  • Milano, Italy, 20121
    • Ospedale Fatebenefratelli
  • Napoli, Italy, 80131
    • Policlinico Seconda Università di Napoli
  • Pavia, Italy, 27100
    • Istituto Mondino
  • Roma, Italy, 00165
    • Ospedale Bambin Gesù
  • Torino, Italy, 10126
    • Azienda Ospedaliera O.I.R.M.- Sant'Anna
• Netherlands
  • Breda, Netherlands, 4819 EV
    • Amphia Ziekenhuis
  • Heeze, Netherlands, 5591 VE
    • Kempenhaeghe, location Heeze
• Poland
  • Gdansk, Poland, 80-952
    • Uniwersyteckie Centrum Kliniczne
  • Kielce, Poland, 25-316
    • Gabinet Lekarski Neurologii Dzieciecej i Leczenia Padaczki
  • Poznan, Poland, 60-355
    • AKADEMIA MEDYCZNA im. Karola Marcinkowskiego w Poznaniu Katedra I Klinika Neurologii Wieku Rozwojowego
  • Poznan, Poland, 60-311
    • Wielkopolskie Centrum Neurologii Dzieci i Mlodziezy
  • Warszawa, Poland, 04-730
    • Instytut "Pomnik-Centrum Zdrowia Dziecka"
• Russian Federation
  • Kazan, Russian Federation, 420138
    • State Medical Institution "Children Republic Clinical Hospital of Minzdrav of Republic Tatarstan"
  • Moscow, Russian Federation, 119620
    • Moscow State Healthcare Institution Scientific and Practical centre of medical help to children
  • Moscow, Russian Federation, 129110
    • State Institution "Moscow Regional Scientific and Research Clinical Institute named after M.F. Vladimirsky"
  • Novosibirsk, Russian Federation, 630091
    • OOO City Neurological Center "Sibneuromed"
  • Saint Petersburg, Russian Federation, 197376
    • Institution Russian Academy of Science Institute of human brain RAN
  • Saint-Petersburg, Russian Federation, 194100
    • Saint-Petersburg State Pediatric Medical Academy of Ministry of Health and Social development of Russian Federation
  • Saint-Petersburg, Russian Federation, 198205
    • Saint-Petersburg Sate Healthcare Institution "Children City Hospital #1"
  • Samara, Russian Federation, 443095
    • State Healthcare Institution "Samarskaya Regional Clinical Hosptital named after M.I.Kalinin"
  • St. Petersburg, Russian Federation, 194100
    • Saint-Petersburg State Pediatric Medical Academy of Ministry of Health and Social
  • St.-Petersburg, Russian Federation, 192019
    • Saint Petersburg Scientific and Research Psycho-Neurology Institute
  • Yaroslavl, Russian Federation, 150030
    • Yaroslavskay State Medical Academy of Roszdrav
• Ukraine
  • Donetsk, Ukraine, 83052
    • Donetsk Region Child Clinical Centre of Neuroreabilitation
  • Ivano-Frankivsk, Ukraine, 76014
    • Regional psycho-neurological hospital #3
  • Kharkov, Ukraine, 61018
    • chair of neuropathology and pediatric neurology of Kharkov Medical Academy
  • Lviv, Ukraine, 79010
    • Danylo Galytskyy Lviv National Medical University
  • Odesa, Ukraine, 65125
    • Communal institution "Child City Hospital #3"
  • Vinnitsa, Ukraine, 21005
    • Vinnytsya National Medical University,Vinnytsya Regional Psychoneurological Hospital
  • Zaporozhye, Ukraine, 69063
    • Zaporizhya Regional Clinical Children Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 16 years (CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

At visit 1 (screening), patient must be/have:

• written informed consent by parent or legal guardian and, where applicable, the patient;
• age 6 to 16 years, inclusive;
• a documented diagnosis of epilepsy for at least 12 months prior to screening;
• at least 2 partial onset seizures during the 4 weeks prior to screening despite treatment with 1 to 2 AEDs in a stable dose regimen;
• an Intelligence Quotient (IQ) of at least 70;
• current treatment with 1 to 2 AEDs (except oxcarbazepine, benzodiazepines other than clobazam and vagus nerve stimulation (VNS));
• excepting epilepsy, patient is judged to be in general good health based on medical history, physical examination and clinical laboratory tests;
• in the opinion of the investigator, able to complete the Cognitive Drug Research (CDR) test battery;
• in case of a girl of childbearing potential, patient presents a serum B-human chorionic gonadotropin (B hCG) test consistent with a non gravid state and agrees to remain abstinent or use reliable contraception (if used, hormonal contraception must be combined with a barrier method) starting at screening and continuing until at least the post-study visit (PSV).

At visit 2 (randomisation), patient must be/have:

• at least 2 partial-onset seizures during the 4 week baseline period prior to randomisation (documented in a diary);
• in case of a girl of childbearing potential, patient presents a urine B-hCG test consistent with a non-gravid state;
• stable dose regimen of concomitant AEDs during the 4 week baseline period;
• diaries satisfactorily completed by the patient or his/her caregiver during the baseline period;
• satisfactory compliance with the study requirements during the baseline period.

Exclusion Criteria:

At visit 1 (screening), patients must not be/have:

• only simple partial seizures with no motor symptomatology;
• primarily generalised seizures;
• known rapidly progressive neurological disorders (progressive brain disease, epilepsy secondary to progressive cerebral lesion);
• occurrence of seizures too close to count accurately;
• history of status epilepticus or cluster seizures (i.e., 3 or more seizures within 30 minutes) within the 3 months prior to screening; seizures of non-epileptic origin;
• Lennox-Gastaut syndrome;
• West syndrome;
• major psychiatric disorders;
• seizures of psychogenic origin within the last 2 years;
• history of schizophrenia or suicide attempt;
• history of attention deficit disorder or other diseases adversely affecting cognitive abilities;
• currently treated with oxcarbazepine, benzodiazepines other than clobazam (on a routine or chronic basis) and/or VNS;
• known hypersensitivity to carboxamide derivatives (oxcarbazepine or carbamazepine);
• uncontrolled cardiac, renal, hepatic, endocrine, gastrointestinal, metabolic, haematological or oncology disorder;
• second or third degree atrioventricular blockade;
• relevant clinical laboratory abnormalities;
• estimated creatinine clearance (CLCR) <60 mL/min;
• pregnancy or nursing;
• treatment with eslicarbazepine acetate in any previous study;
• participation in other drug clinical trial within the last 2 months;
• not ensured capability to perform the trial;
• any other condition or circumstance that, in the opinion of the investigator, may compromise the patient's ability to comply with the study protocol.

At visit 2 (randomisation), patients must not be / have:

• any condition or circumstance that, in the opinion of the investigator, may compromise the patient's ability to comply with the study protocol.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
PLACEBO_COMPARATOR: Placebo	Drug: Placebo; Treatments will be administered by oral route, once-daily, in the evening.
EXPERIMENTAL: Eslicarbazepine acetate (BIA 2-093)	Drug: Eslicarbazepine acetate (BIA 2-093); Eslicarbazepine acetate (ESL) tablets 200 mg and the matching placebo will be supplied. Treatments will be administered by oral route, once-daily, in the evening. The dose will be rounded to the nearest 100 mg unit. Half tablets may be used for dose adjustment if necessary.; Other Names: Eslicarbazepine acetate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Power of Attention Score to the End of the Double Blind (DB) Period	Power of Attention was defined as the sum of the reaction time measures from the attentional tasks (simple [dominant hand only] reaction time, choice reaction time and digit vigilance speed) in order to assess information processing speed and attention/psychomotor speed.Change from baseline to the end of the double-blind period in Power of Attention will be compared between the treatment groups using an ANCOVA. Non-inferiority of ESL vs Placebo will be assessed by comparing the 95% CI's upper bound of the difference of Least Squares Mean (LSmeans) between treatment groups (ESL-placebo) with 121 ms. If the upper bound is greater than 121 ms then the null hypothesis that the change from baseline in the Power of Attention score in ESL group is at least 121 ms inferior than the placebo group will be rejected. Single Values were calculated the average of post treatment visits (visits 5 and 7or EDV) minus average of baseline visits (visits 1 and 2)	Visit 1 (-4 weeks for training), Visit 2 (Day 1), Visit 5 (6 weeks), Visit 7 (12 weeks) or at early discontinuation visit (EDV)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Standardized Seizure Frequency - Part I		Baseline; Titration Period (4 Weeks: V2-V3-V4)
Change From Baseline in Seizure Frequency During the One-year Open-Label (OL)	Overall Change from Baseline in Seizure Frequency per week for the One-Year Open-Label Period	Weeks 1 to ≥ 41 weeks

Collaborators and Investigators

• Sponsor: Bial - Portela C S.A.

Publications and helpful links

General Publications

• Mintz M, Pina-Garza JE, Wolf SM, McGoldrick PE, Jozwiak S, Grinnell T, Cantu D, Costa R, Moreira J, Li Y, Blum D. Safety and Tolerability of Adjunctive Eslicarbazepine Acetate in Pediatric Patients (Aged 4-17 Years) With Focal Seizures. J Child Neurol. 2020 Mar;35(4):265-273. doi: 10.1177/0883073819890997. Epub 2019 Dec 26.

Study record dates

Study Major Dates

• Study Start: August 1, 2010
• Primary Completion (ACTUAL): March 1, 2012
• Study Completion (ACTUAL): May 1, 2013

Study Registration Dates

• First Submitted: February 3, 2012
• First Submitted That Met QC Criteria: February 3, 2012
• First Posted (ESTIMATE): February 7, 2012

Study Record Updates

• Last Update Posted (ESTIMATE): October 24, 2014
• Last Update Submitted That Met QC Criteria: October 23, 2014
• Last Verified: October 1, 2014

More Information

Terms related to this study

• Keywords: Children; Partial Epilepsy; eslicarbazepine acetate
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Epilepsy; Seizures; Epilepsies, Partial; Molecular Mechanisms of Pharmacological Action; Membrane Transport Modulators; Anticonvulsants; Voltage-Gated Sodium Channel Blockers; Sodium Channel Blockers; Eslicarbazepine acetate
• Other Study ID Numbers: BIA-2093-208