GWPCARE2 A Study to Investigate the Efficacy and Safety of Cannabidiol (GWP42003-P) in Children and Young Adults With Dravet Syndrome

A Randomized, Double-blind, Placebo-controlled Study to Investigate the Efficacy and Safety of Cannabidiol (GWP42003-P) in Children and Young Adults With Dravet Syndrome.

To investigate the potential antiepileptic effects of cannabidiol (GWP42003-P) in children and young adults with Dravet syndrome.

Study Overview

• Status: Completed
• Conditions: Epilepsy; Dravet Syndrome
• Intervention / Treatment: Drug: GWP42003-P; Drug: Placebo Control

Detailed Description

This study was a 2:2:1:1 randomized, double-blind, 14-week comparison of two dose levels of GWP42003-P (10 milligram/kilogram [mg/kg]/day and 20 mg/kg/day) versus placebo (10 mg/kg/day dose-volume equivalent and 20 mg/kg/day dose-volume equivalent; presented as pooled placebo in the study). A 28-day screening period prior to randomization (to establish baseline parameters) preceded the treatment period, which consisted of a 2-week titration period followed by a 12-week maintenance period. The study aimed to determine the efficacy, safety, and tolerability of GWP42003-P compared with placebo. 20 mg/kg/day was recommended by the Data Safety Monitoring Committee (DSMC) after assessment of safety and pharmacokinetic data from Part A of study GWEP1332 (NCT02091206). The first participant did not enroll into this study until the DSMC reviewed the safety data from Part A of study GWEP1332 (NCT02091206).

Following study completion, all participants were invited to continue to receive GWP42003-P in a separate open-label extension study (GWEP1415; NCT02224573).

• Study Type: Interventional
• Enrollment (Actual): 199
• Phase: Phase 3

Contacts and Locations

Study Locations

• Australia
  • Heidelberg, Australia, 3084
  • Randwick, Australia, NSW 2031
• Israel
  • Ramat Gan, Israel, 52621
• Netherlands
  • Heeze, Netherlands, 5591 VE
  • Zwolle, Netherlands, 8025 BV
• Poland
  • Kraków, Poland, 30-363
  • Warszawa, Poland, 04-730
  • Łódź, Poland, 93-271
• Spain
  • Barcelona, Spain, 08022
  • Madrid, Spain, 28034
  • Madrid, Spain, 28222
  • Madrid, Spain, 28009
  • Pamplona, Spain, 31008
  • Sevilla, Spain, 41013
  • Valencia, Spain, 46026
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233
  • Arkansas
    • Little Rock, Arkansas, United States, 72202
  • California
    • Los Angeles, California, United States, 90027
    • Sacramento, California, United States, 95816
  • Connecticut
    • Hartford, Connecticut, United States, 06106
  • Florida
    • Miami, Florida, United States, 33155
  • Georgia
    • Savannah, Georgia, United States, 31404
  • Illinois
    • Chicago, Illinois, United States, 60611
  • Kentucky
    • Lexington, Kentucky, United States, 40536-0284
    • Louisville, Kentucky, United States, 40202
  • Minnesota
    • Saint Paul, Minnesota, United States, 55102
  • Missouri
    • Saint Louis, Missouri, United States, 63141
  • Nebraska
    • Omaha, Nebraska, United States, 68106
  • New Hampshire
    • Lebanon, New Hampshire, United States, 03756
  • New York
    • Buffalo, New York, United States, 14203
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27599
  • Oregon
    • Portland, Oregon, United States, 97239
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104-4399
  • South Carolina
    • Charleston, South Carolina, United States, 29425
  • Texas
    • Austin, Texas, United States, 78723
    • Fort Worth, Texas, United States, 76104
  • Virginia
    • Richmond, Virginia, United States, 23298-0211
  • Washington
    • Seattle, Washington, United States, 98105

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 7 months to 16 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Key Inclusion Criteria:

• Participant must have been male or female, aged between 2 and 18 years (inclusive).
• Participant must have had a documented history of Dravet syndrome that was not completely controlled by current antiepileptic drugs.
• Participant must have been taking 1 or more antiepileptic drugs at a dose that had been stable for at least 4 weeks.
• All medications or interventions for epilepsy (including ketogenic diet and vagus nerve stimulation) must have been stable for 4 weeks prior to screening and participant was willing to maintain a stable regimen throughout the study.

Key Exclusion Criteria:

• Participant had clinically significant unstable medical conditions other than epilepsy.
• Participant had clinically relevant symptoms or a clinically significant illness in the 4 weeks prior to screening or randomization, other than epilepsy.
• Participant was currently using or had in the past used recreational cannabis, medicinal cannabis, or synthetic cannabinoid-based medications (including Sativex®) within the 3 months prior to study entry and was unwilling to abstain for the duration for the study.
• Participant had any known or suspected hypersensitivity to cannabinoids or any of the excipients of the investigational medicinal products.
• There were plans for the participant to travel outside their country of residence during the study.
• Any history of suicidal behavior or any suicidal ideation of type four or five on the Columbia-Suicide Severity Rating Scale (Children's) at screening.

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
Experimental: 10 mg/kg/day GWP42003-P; GWP42003-P oral solution (100 mg/milliliter [mL] cannabidiol in sesame oil with anhydrous ethanol with added sweetener [sucralose] and strawberry flavoring). The 10 mg/kg/day dose was defined as 50% of the 20 mg/kg/day dose.	Drug: GWP42003-P; Other Names: Cannabidiol; CBD; Epidiolex
Experimental: 20 mg/kg/day GWP42003-P; GWP42003-P oral solution (100 mg/mL cannabidiol in sesame oil with anhydrous ethanol with added sweetener [sucralose] and strawberry flavoring). The 20 mg/kg/day dose was recommended by the DSMC after assessment of safety and pharmacokinetic data from Part A of study GWEP1332 (NCT02091206).	Drug: GWP42003-P; Other Names: Cannabidiol; CBD; Epidiolex
Placebo Comparator: Placebo Control; Excipients only. Participants were pooled from 2 placebo cohorts, half receiving 10 mg/kg/day dose-volume equivalent and half receiving 20 mg/kg/day dose-volume equivalent.	Drug: Placebo Control; Other Names: Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change In Convulsive Seizures During The Treatment Period Compared To Baseline	Convulsive seizures were defined as tonic-clonic, tonic, clonic, or atonic. Participants or their caregivers recorded the number and type of convulsive seizures each day from screening until completion of dosing using an interactive voice response system (IVRS) diary. The primary endpoint was analyzed using negative binomial regression on the sum of the convulsive seizure counts during the treatment period, based on the ITT analysis set. Baseline included all available data prior to Day 1. Data reported as the ratio of geometric least squares mean in convulsive seizures and expressed as a percentage reduction.	Baseline to Day 99 or Early Termination (ET)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change In Total Seizures During The Treatment Period Compared To Baseline	Total seizures were defined as the combination of convulsive and non-convulsive seizures. Convulsive seizures were defined as tonic-clonic, tonic, clonic, or atonic seizures. Non-convulsive seizures were defined as myoclonic, countable partial, other partial, or absence seizures. Participants or their caregivers recorded the number and type of convulsive seizures and non-convulsive seizures each day from screening until completion of dosing using an IVRS diary. Change compared to baseline was calculated as per the primary outcome measure. Data reported as the ratio of geometric least squares mean in total seizures and expressed as a percentage reduction.	Baseline to Day 99 or ET
Participants With A ≥50% Reduction From Baseline In Convulsive Seizure Frequency During The Treatment Period	Convulsive seizures were defined as tonic-clonic, tonic, clonic, or atonic. Participants or their caregivers recorded the number and type of convulsive seizures each day from screening until completion of dosing using an IVRS diary. Baseline included all available data prior to Day 1 (28-day average). Percentage change from baseline was calculated as: ([frequency during the treatment period - frequency during baseline]/frequency during baseline) x 100. The frequency during each period was based on 28-day averages and calculated as: (number of seizures in the period/number of reported days in the IVRS period) x 28. Baseline included all available data prior to Day 1 (28-day average).	Baseline to Day 99 or ET
Caregiver Global Impression Of Change (CGIC) At The Last Visit	On Day 1 (prior to receiving study drug), the caregiver was asked to write a brief description of the participant's overall condition as a memory aid for the CGIC questionnaire at subsequent visits. The CGIC questionnaire comprised the following question, to be rated on a 7-point scale: Since your child started treatment, please assess the status of your child's overall condition (comparing their condition now to their condition before treatment) using the scale below. The markers were: "Very Much Improved"; "Much Improved"; "Slightly Improved"; "No Change"; "Slightly Worse"; "Much Worse"; "Very Much Worse". The CGIC response/score, recorded at each visit, was summarized, on both a categorical and continuous scale, by treatment group. The scores at the last scheduled visit (not including the end of taper or safety follow-up visits) at which participant's last evaluation was performed were analyzed using ordinal logistic regression.	Baseline to Last Visit

Collaborators and Investigators

• Sponsor: Jazz Pharmaceuticals

Publications and helpful links

General Publications

• Madan Cohen J, Checketts D, Dunayevich E, Gunning B, Hyslop A, Madhavan D, Villanueva V, Zolnowska M, Zuberi SM. Time to onset of cannabidiol treatment effects in Dravet syndrome: Analysis from two randomized controlled trials. Epilepsia. 2021 Sep;62(9):2218-2227. doi: 10.1111/epi.16974. Epub 2021 Jul 15.
• Miller I, Scheffer IE, Gunning B, Sanchez-Carpintero R, Gil-Nagel A, Perry MS, Saneto RP, Checketts D, Dunayevich E, Knappertz V; GWPCARE2 Study Group. Dose-Ranging Effect of Adjunctive Oral Cannabidiol vs Placebo on Convulsive Seizure Frequency in Dravet Syndrome: A Randomized Clinical Trial. JAMA Neurol. 2020 May 1;77(5):613-621. doi: 10.1001/jamaneurol.2020.0073. Erratum In: JAMA Neurol. 2020 May 1;77(5):655.

Study record dates

Study Major Dates

• Study Start (Actual): April 13, 2015
• Primary Completion (Actual): April 9, 2018
• Study Completion (Actual): April 9, 2018

Study Registration Dates

• First Submitted: August 21, 2014
• First Submitted That Met QC Criteria: August 22, 2014
• First Posted (Estimate): August 25, 2014

Study Record Updates

• Last Update Posted (Actual): September 28, 2022
• Last Update Submitted That Met QC Criteria: September 22, 2022
• Last Verified: September 1, 2022

More Information

Terms related to this study

• Keywords: CBD; GWP42003-P; Cannabidiol; Epidiolex
• Additional Relevant MeSH Terms: Pathologic Processes; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Epilepsy, Generalized; Epileptic Syndromes; Disease; Epilepsy; Epilepsies, Myoclonic; Syndrome; Anticonvulsants; Cannabidiol
• Other Study ID Numbers: GWEP1424; 2014-002939-34 (EudraCT Number)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No