Hydroxychloroquine Administration for Reduction of Pexophagy (HARP)

A series of N-of-1, crossover, randomized, placebo-controlled, double-blinded trial. Hydroxychloroquine (HCQ) and a crossover to placebo (order is randomized and blinded) will be administered in liquid suspension for 84 days (12 weeks) each with an 84 day washout in between. We hypothesize that HCQ will reduce peroxisomal turnover, which will arrest ongoing injury in PBDs caused by PEX1, PEX6 or PEX26.

Study Overview

• Status: Completed
• Conditions: Zellweger Syndrome; Peroxisome Biogenesis Disorders
• Intervention / Treatment: Drug: Hydroxychloroquine; Drug: Placebo

Detailed Description

HARP is a phase II/III, double-blind, placebo-controlled, randomized, crossover series N-of-1 study of the effect of hydroxychloroquine (HCQ) in patients with peroxisomal biogenesis disorders (PBD-ZSD). Patients eligible for the study must have a laboratory diagnosis of PEX1, PEX6 or PEX26 dependent PBD-ZSD from a CLIA or SCC-certified clinical laboratory, a history of abnormal VLCFA levels, and must be at least 84 days from their last HCQ dose. Patients will be excluded for known sensitivity to HCQ, known glucose-6-phosphate dehydrogenase deficiency, if they have an expected survival of less than 9 months or if they are participating in another interventional clinical trial.

HCQ will be administered at a dose of 4mg/kg/day divided into two doses, as a liquid suspension that can be given orally or through nasogastric or gastric tube. Within the study, HCQ or placebo will be given for 84 days, followed by a washout period of 84 days followed by an 84 day crossover to the alternative therapy to assess the effect the study measures.

Study measures will be completed at four intervals (initiation, end of period 1, start of period 2, end of trial). Ophthalmological monitoring of patients has three components, electroretinogram (ERG), visual acuity testing and optical coherence tomography (OCT). Plasma levels of very long-chain fatty acids (VLCFA), plasmalogen and phytanic acid will be assessed. Parents will also be administered The Pediatric Inventory for Parents (PIP), a questionnaire that was developed to evaluate the stress associated with parenting a seriously ill child, at the end of period 1 and period 2.

• Study Type: Interventional
• Enrollment (Actual): 3
• Phase: Phase 2

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5G1X8
      • The Hospital for Sick Children

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 months to 40 years (ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosed with a peroxisomal defect due to PEX1, PEX6 or PEX26 through a SCC or CLIA-certified clinical genetic testing laboratory.
• Abnormal plasma very-long-chain fatty acid levels.
• All therapies available in Canada have been considered and ruled out, have failed or were justified as being unsuitable for the patient. We note that there are no therapies available.
• At least 84 days from last HCQ dose

Exclusion Criteria:

• Known sensitivity to HCQ.
• Known Glucose-6-phosphate dehydrogenase deficiency.
• Expected survival is less than six months.
• The patient does not provide informed consent.
• The patient is participating in another interventional clinical trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: CROSSOVER
• Masking: QUADRUPLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Hydroxychloroquine; Hydroxychloroquine: liquid suspension, 4mg/kg/day by mouth, divided bid for 84 days.	Drug: Hydroxychloroquine; Hydroxychloroquine: 4mg/kg/day, divided bid.; Other Names: Plaquenil; Apo-Hydroxyquine
PLACEBO_COMPARATOR: Placebo; Liquid suspension compounded to mimic the taste, appearance and texture of the investigational agent.	Drug: Placebo; Liquid suspension compounded to mimic the active hydroxycholoquine interventional agent.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Electroretinogram (ERG) voltage changes.	Electroretinograms are a diagnostic test that measures the electric activity within cells in response to stimulus. ERG voltages are depressed in peroxisomal disease, and the quantitative evaluation of ERG voltage is another measure that has been used as an endpoint for clinical trials in peroxisomal disease. Change in b-wave voltage before and after treatment period.	12 week. Measurements at Day 0, Day 84(+/-7 days) of each treatment arm.
Change in the red blood cell levels of plasmalogen.	Change in the red blood cell levels of plasmalogen (18:0 dimethylacetals/18:0 ratio).	12 week. Measurements at Day 0, Day 84(+/-7 days) of each treatment arm.
Change in the plasma levels of phytanic acid.	Change in the plasma levels of phytanic acid.	12 week. Measurements at Day 0, Day 84(+/-7 days) of each treatment arm.
Change in the plasma levels of very-long chain fatty acids.	Change in the plasma levels of very-long chain fatty acids (C26/C22).	12 week. Measurements at Day 0, Day 84(+/-7 days) of each treatment arm.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Eye examination: Optical Coherence Tomography	Optical coherence tomography is an imaging study of the retina. OCT is routinely performed in clinical management of patients with peroxisomal disease.	12 week. Measurements at Day 0, Day 84(+/-7 days) of each treatment arm.
Eye examination: Visual Acuity	Visual acuity testing evaluates the visual performance of patients using the reading of a logMAR chart. Visual acuity testing is routinely performed in clinical management of patients with peroxisomal disease.	12 week. Measurements at Day 0, Day 84(+/-7 days) of each treatment arm.
Pediatric Inventory for Parents (PIP) following the treatment arms.	The PIP is a validated measure of parental stress related to the care for children with chronic illness.	36 week. Measurements following each treatment arm.

Collaborators and Investigators

• Sponsor: The Hospital for Sick Children
• Investigators: Principal Investigator: Neal Sondheimer, MD, The Hospital for Sick Children

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 11, 2019
• Primary Completion (ACTUAL): May 5, 2020
• Study Completion (ACTUAL): May 5, 2020

Study Registration Dates

• First Submitted: November 5, 2018
• First Submitted That Met QC Criteria: February 26, 2019
• First Posted (ACTUAL): February 27, 2019

Study Record Updates

• Last Update Posted (ACTUAL): December 17, 2020
• Last Update Submitted That Met QC Criteria: December 15, 2020
• Last Verified: December 1, 2020

More Information

Terms related to this study

• Keywords: PBD, Zellweger spectrum, PBD-ZSD
• Additional Relevant MeSH Terms: Digestive System Diseases; Metabolic Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Kidney Diseases; Urologic Diseases; Congenital Abnormalities; Liver Diseases; Genetic Diseases, Inborn; Metabolism, Inborn Errors; Brain Diseases, Metabolic; Brain Diseases, Metabolic, Inborn; Abnormalities, Multiple; Peroxisomal Disorders; Zellweger Syndrome; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Antirheumatic Agents; Antiprotozoal Agents; Antiparasitic Agents; Antimalarials; Hydroxychloroquine
• Other Study ID Numbers: 1000061385

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes