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Epidiolex Trial for Presymptomatic Treatment of Sturge-Weber Syndrome (Epi-Pre)
Epidiolex Pilot Trial for Presymptomatic Treatment of Sturge-Weber Syndrome
Patients with Sturge-Weber syndrome (SWS) are frequently affected by seizures, and seizures are associated with poorer neurological outcomes. To date there is no established means of predicting or preventing seizure onset. Cannabidiol (Epidiolex) was well tolerated in an open label study in this population. This trial will evaluate whether Epidiolex in presymptomatic Sturge-Weber patients may delay the onset of seizures and improve neurological outcome.
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
This is an open-label, prospective dose escalation study to determine the safety and tolerability of presymptomatic treatment of SWS patients with Epidiolex. The investigators hypothesize that Epidiolex will be well tolerated and delay seizure onset in SWS patients. The total number of subjects to be consented for this safety study=10 babies with SWS; the initial funded phase will be with 6 subjects. Interim analysis will be completed after 6 subjects; the remaining 4 will be enrolled as warranted for 6 months on Epidiolex. Subjects will be dosed as recommended clinically (starting at 2.5 mg/kg/day divided bid, with weekly increases over the next 4 weeks to a maximum dose of 20 mg/kg/day) as tolerated. Neurologic visits during the trial, the bloodwork, EEGs, and motor assessments will be done as research procedures. Once the first dose of the study drug is administered, a blood draw will be done at 4-hour and 12-hour post study drug administration. A mini-PK will be similarly performed once the maximum maintenance dose is achieved.
Studietype
Inschrijving (Geschat)
Fase
- Fase 2
Contacten en locaties
Studiecontact
- Naam: Anne Comi, MD
- Telefoonnummer: 443-923-9172
- E-mail: comi@kennedykrieger.org
Studie Contact Back-up
- Naam: Brenna Keam, BS
- Telefoonnummer: 443-923-9127
- E-mail: keam@kennedykrieger.org
Studie Locaties
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Maryland
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Baltimore, Maryland, Verenigde Staten, 21205
- Werving
- Kennedy Krieger Institute
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Contact:
- Anne Comi, MD
- Telefoonnummer: 443-923-9172
- E-mail: comi@kennedykrieger.org
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Contact:
- Brenna Keam, BS
- Telefoonnummer: 443-923-9127
- E-mail: keam@kennedykrieger.org
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Hoofdonderzoeker:
- Ryan Felling, MD, PhD
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Beschrijving
Inclusion Criteria:
- Clinical diagnosis of Sturge-Weber Syndrome.
- Age 1 to 18 months of age, inclusive.
- Neuroimaging demonstrating involvement of 3 or more lobes, or bilateral involvement.
- No history of seizures.
- Patient's parent or legal guardian provides written informed consent prior to treatment initiation.
Exclusion Criteria:
Any severe and/or uncontrolled medical conditions at randomization including, but not limited to the following:
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Liver disease such as cirrhosis, decompensated liver disease, and chronic hepatitis (i.e. quantifiable HBVDNA and/or positive HbsAg, quantifiable HCV-RNA). Specifically the patient should not have either AST or ALT more than 1.5 times the upper limit of normal. The Child- Pugh Score must be A (mild) which is a score of 5-6 (minimum/normal score=5). Child-Turcotte-Pugh (CTP) Calculator - Clinical Calculators - Hepatitis C Online (uw.edu)
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Uncontrolled diabetes as defined by fasting serum glucose > 1.5 ULN
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Active (acute or chronic) or uncontrolled severe infections
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Active, bleeding diathesis
- Any other neurological diagnosis that increases the risk of seizure or neurodevelopmental disability.
- Patients who have had a major surgery or significant traumatic injury within 4 weeks of study entry, patients who have not recovered from the side effects of any major surgery (defined as requiring general anesthesia), or patients that may require major surgery during the course of the study.
- Prior treatment with any investigational drug or use of any other cannabis product within the preceding 4 weeks prior to study entry.
- Use of aspirin.
- Allergic reaction/hypersensitivity to Epidiolex or other forms of cannabidiol.
- Concern for non-compliance to medical regimens, or concern that the patient will not be able to complete the entire study, whether due to reliability or logistical barriers. This includes those in foster care, or those unable to keep follow-up appointments, maintain close contact with Principal Investigator, or complete all necessary studies to maintain safety.
- Use of any seizure medication (whether for seizures or any other reason) (e.g. valproate, clobazam).
- Use of chronic medications other than a multi-vitamin and/or vitamin D supplements.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: NVT
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: Presymptomatic Epidiolex Treatment
Epidiolex will be started at 2.5 mg/kg/day divided twice daily. The dose will increase weekly as tolerated over the next 5 weeks to a target dose of 20 mg/kg/day. |
Epidiolex is a prescription form of cannabidiol used to treat seizures. Epidiolex will be started at 2.5 mg/kg/day divided twice daily. The dose will increase weekly as tolerated over the next 5 weeks to a target dose of 20 mg/kg/day.
Andere namen:
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
|---|---|
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Safe completion as assessed by the number of participants with no significant side effects
Tijdsspanne: 6 months
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6 months
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Safe completion as assessed by the number of participants with no seizure onset
Tijdsspanne: 6 months
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6 months
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Sturge-Weber Syndrome Neuroscore (SWS-NRS)
Tijdsspanne: baseline, week 5, week 12, and week 24
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Neuroscore is a published SWS ordinal score that incorporates domains of visual field cut (0-2), hemiparesis (0-4), seizure frequency (0-4), and cognitive function (0-5). Total score is sum of 4 ratings with a total score from 0-15. Higher score worse impairment. This will be obtained at each study visit. |
baseline, week 5, week 12, and week 24
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Milestone checklist
Tijdsspanne: baseline, week 5, week 12, and week 24
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A publicly available milestone checklist from Pathways.org will be completed at every study visit. The checklist is personalized based on age. Does not use a numerical or point based scoring system. It uses a pass/fail or completed/not-completed checklist tracking format related to Motor, Sensory, Communication, and Feeding abilities. |
baseline, week 5, week 12, and week 24
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Modified Early Motor Questionnaire (EMQ)
Tijdsspanne: Baseline, week 24
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The Modified EMQ will be performed at baseline and at week 24. The EMQ evaluates abilities in three domains: Gross Motor skills, Fine Motor Skills, and Perception-Action Integration. It uses a 5-point scale including -2 = Sure that child does NOT show behavior, -1 = Child probably does NOT show behavior yet, 0 = Unsure whether child could do this or not, 1 = Child probably shows this behavior, and 2 = Sure that child shows this behavior and remember a particular instance. Minimum total score is -200. Maximum total score is 200. Higher score means higher certainty in the child's behaviors. |
Baseline, week 24
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Modified Erhardt Developmental Prehension Assessment (EDPA)
Tijdsspanne: Baseline, week 24
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The Modified EDPA will be performed at baseline and at week 24. The EDPA will evaluate hand skills and arm-hand movements at baseline and in response to the study drug. Both right and left hands are tested. Individual test components are scored by a well-established pattern (+), pattern not yet achieved (-), and temporary pattern to be replaced by a more mature pattern (++). Maximum score would be a well-established pattern (+) for all EDPA items. Higher score better, means a greater number of well-established hand skills and arm-hand movements. |
Baseline, week 24
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Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)
Tijdsspanne: Baseline, week 24
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The PEDI-CAT will be performed at baseline and at week 24. The PEDI-CAT will evaluate abilities in four functional domains: Daily Activities, Mobility, Social/Cognitive, and Responsibility. The PEDI-CAT uses a 4-point scale including 1 = Unable, 2 = Hard, 3 = A Little Hard, and 4 = Easy. Minimum scaled score is 20. Maximum scaled score is 80. Higher total score means better functional ability. |
Baseline, week 24
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Ryan Felling, MD, PhD, Johns Hopkins School of Medicine
Studie record data
Bestudeer belangrijke data
Studie start (Werkelijk)
Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Werkelijk)
Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Cerebrovasculaire aandoeningen
- Hersenziekten
- Ziekten van het centrale zenuwstelsel
- Ziekten van het zenuwstelsel
- Vaatziekten
- Hart-en vaatziekten
- Pathologische processen
- Herseninfarct
- Ischemie van de hersenen
- Infarct
- Necrose
- Ischemie
- Hartinfarct
- Pathologische aandoeningen, tekenen en symptomen
- Hersenstaminfarcten
- Organische chemicaliën
- Farmaceutische voorbereidingen
- Koolwaterstoffen
- Terpenen
- Cannabinoïden
- Cannabidiol
- Oplossingen
Andere studie-ID-nummers
- IRB00326943
Plan Individuele Deelnemersgegevens (IPD)
Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?
Beschrijving IPD-plan
Demographics, baseline assessments, completion assessments, adverse events.
IPD-tijdsbestek voor delen
July 1, 2028 until July 1, 2029
IPD-toegangscriteria voor delen
Supplemental data with paper when published. Other interested parties can reach out to comi@kennedykrieger.org to discuss other arrangements.
IPD delen Ondersteunend informatietype
- SAP
Informatie over medicijnen en apparaten, studiedocumenten
Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel
Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct
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