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Efficacy of RAD001/Everolimus in Autism and NeuroPsychological Deficits in Children With Tuberous Sclerosis Complex (RAPIT)

Primary Purpose

Tuberous Sclerosis Complex, TSC Related Cognitive Disability, TSC Related Autism

Status
Unknown status
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
Everolimus
Placebo
Sponsored by
Erasmus Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tuberous Sclerosis Complex focused on measuring Tuberous Sclerosis Complex, TSC, Autism, Learning problems, Everolimus, RAD001, Treatment, Cognition, Intellectual disability

Eligibility Criteria

4 Years - 15 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Children with a definite diagnosis of TSC between 4 and 15 years.
  • With an IQ estimated <80 and/or special schooling and/or autism spectrum disorder and/or learning disability requiring remedial teaching.
  • Written informed consent by parents/care-takers, and the patient if he or she is 12 years or older and cognitively able to consent.
  • In girls after menarche, appropriate contraception must be used or abstinence practiced.

Exclusion Criteria:

  • Hepatic dysfunction
  • Surgery <6wk
  • Current infection at time of inclusion
  • Developmental age estimated below 3.5 years
  • Intractable epilepsy with more than 1 seizure/week
  • Inability to comply with the treatment protocol
  • Additional diseases or disorders that may influence the endpoints, including:

    • SEGA requiring treatment
    • Uncontrolled diabetes mellitus
    • Known impaired lung function
  • Allergy for any of the components of the study medication
  • Prior treatment with mTOR inhibitors
  • HIV seropositivity
  • Bleeding diathesis or oral anti-vitamin K medication
  • Serum creatinine > 1.5 x ULN
  • Uncontrolled hyperlipidemia (fasting serum cholesterol > 7.75 mmol/L, fasting serum triglycerides > 2.5 x ULN)
  • Use of investigational drug within 30 days prior to inclusion
  • History of myocardial infarction, angina or stroke related to atherosclerosis, organ transplantation, malignancy in the past 2 years
  • Pregnancy or breastfeeding
  • Children at risk for Hepatitis B (HB), unless hepatitis B serology is normal. Risk groups are children who have lived in Asia, Africa, Central and South America, Eastern Europe, Spain, Portugal, and Greece, children with known or suspected past or current hepatitis B infection, current or prior IV illicit drug use, current or prior dialysis, household contact with hepatitis B infected patient(s), current or prior high-risk sexual activity, body piercing or tattoos, mother known to have hepatitis B history. If vaccinated, presence of HBs Ab is normal.
  • Known or suspected hepatitis C infection, unless hepatitis C serology is normal.

Sites / Locations

  • Erasmus Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Everolimus

Placebo

Arm Description

Everolimus once daily for 1 year, titration to trough levels of 5-10 ng/ml

Placebo treatment for 1 year. Tablets will be identical to everolimus tablets.

Outcomes

Primary Outcome Measures

Cognitive ability measured by IQ
Assessed by Wechsler scales: Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III NL) and Wechsler Intelligence Scale for Children (WISC-III-NL)

Secondary Outcome Measures

Autistic features
Assessed by Autism Diagnostic Observation Schedule (ADOS)
Social and communicational skills
Assessed by social responsiveness scale (SRS) and Dutch Children's Communication Checklist (CCC-2-NL) questionnaires
Working memory and attention, information processing
Assessed by Cambridge Neuropsychological Test Automated Battery (CANTAB)
Visual-motor integration
Assessed by BEERY Visual-Motor Integration (BEERY VMI), grooved pegboard
Child behavior
Assessed by Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) questionnaires
Executive functioning
Assessed by Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire Dutch version
Sleeping problems
Assessed by Sleep Disturbance Scale for Children (SDSC) questionnaire
Child health
Assessed by Child Health Questionnaire Parent Form (CHQ-PF50) questionnaire
Sensory related difficulties
Assessed by Short Sensory Profile (SSP) questionnaire
Epilepsy
Comparison of epilepsy frequency during month previous to study start and last month of trial participation. EEG abnormalities

Full Information

First Posted
October 26, 2012
Last Updated
May 4, 2015
Sponsor
Erasmus Medical Center
Collaborators
Utrecht University
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1. Study Identification

Unique Protocol Identification Number
NCT01730209
Brief Title
Efficacy of RAD001/Everolimus in Autism and NeuroPsychological Deficits in Children With Tuberous Sclerosis Complex
Acronym
RAPIT
Official Title
Efficacy of RAD001/Everolimus in Autism and NeuroPsychological Deficits in Children With Tuberous Sclerosis Complex
Study Type
Interventional

2. Study Status

Record Verification Date
May 2015
Overall Recruitment Status
Unknown status
Study Start Date
November 2012 (undefined)
Primary Completion Date
November 2015 (Anticipated)
Study Completion Date
November 2016 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Erasmus Medical Center
Collaborators
Utrecht University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Tuberous sclerosis complex (TSC) is a genetic disease that leads to mental retardation in over 50% of patients, and to learning problems, behavioral problems, autism and epilepsy in up to 90% of patients. The underlying deficit of TSC, loss of inhibition of the mammalian target of rapamycin (mTOR) protein due to dysfunction of the tuberin/hamartin protein complex, can be rescued by everolimus. Everolimus has been registered as treatment for renal cell carcinoma and giant cell astrocytoma (SEGA). Evidence in human and animal studies suggests that mTOR inhibitors improve learning and development in patients with TSC.
Detailed Description
Randomized double-blind placebo controlled intervention study in children with TSC between age 4 and 15 years with an intelligence quotient (IQ) estimated <80 and/or special schooling and/or autism spectrum disorder and/or learning disability requiring remedial teaching. Patients are randomised to receive everolimus or placebo during a period of 12 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tuberous Sclerosis Complex, TSC Related Cognitive Disability, TSC Related Autism, TSC Related Learning Problems
Keywords
Tuberous Sclerosis Complex, TSC, Autism, Learning problems, Everolimus, RAD001, Treatment, Cognition, Intellectual disability

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Everolimus
Arm Type
Experimental
Arm Description
Everolimus once daily for 1 year, titration to trough levels of 5-10 ng/ml
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo treatment for 1 year. Tablets will be identical to everolimus tablets.
Intervention Type
Drug
Intervention Name(s)
Everolimus
Other Intervention Name(s)
RAD001, Votubia
Intervention Description
Everolimus once daily titrated to trough levels of 5-10 ng/ml.
Intervention Type
Drug
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Cognitive ability measured by IQ
Description
Assessed by Wechsler scales: Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III NL) and Wechsler Intelligence Scale for Children (WISC-III-NL)
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Autistic features
Description
Assessed by Autism Diagnostic Observation Schedule (ADOS)
Time Frame
12 Months
Title
Social and communicational skills
Description
Assessed by social responsiveness scale (SRS) and Dutch Children's Communication Checklist (CCC-2-NL) questionnaires
Time Frame
12 Months
Title
Working memory and attention, information processing
Description
Assessed by Cambridge Neuropsychological Test Automated Battery (CANTAB)
Time Frame
6 and 12 Months
Title
Visual-motor integration
Description
Assessed by BEERY Visual-Motor Integration (BEERY VMI), grooved pegboard
Time Frame
12 Months
Title
Child behavior
Description
Assessed by Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) questionnaires
Time Frame
12 Months
Title
Executive functioning
Description
Assessed by Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire Dutch version
Time Frame
12 Months
Title
Sleeping problems
Description
Assessed by Sleep Disturbance Scale for Children (SDSC) questionnaire
Time Frame
12 Months
Title
Child health
Description
Assessed by Child Health Questionnaire Parent Form (CHQ-PF50) questionnaire
Time Frame
12 Months
Title
Sensory related difficulties
Description
Assessed by Short Sensory Profile (SSP) questionnaire
Time Frame
12 Months
Title
Epilepsy
Description
Comparison of epilepsy frequency during month previous to study start and last month of trial participation. EEG abnormalities
Time Frame
12 Months
Other Pre-specified Outcome Measures:
Title
School level
Description
Assessed by the school CITO (centraal instituut voor toetsontwikkeling) scores or reading and arithmetic scores
Time Frame
12 Months
Title
Pharmacokinetics
Description
Assessed by measuring trough levels of everolimus
Time Frame
12 Months
Title
Safety
Description
Levels of and abnormalities in blood control values
Time Frame
12 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
4 Years
Maximum Age & Unit of Time
15 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Children with a definite diagnosis of TSC between 4 and 15 years. With an IQ estimated <80 and/or special schooling and/or autism spectrum disorder and/or learning disability requiring remedial teaching. Written informed consent by parents/care-takers, and the patient if he or she is 12 years or older and cognitively able to consent. In girls after menarche, appropriate contraception must be used or abstinence practiced. Exclusion Criteria: Hepatic dysfunction Surgery <6wk Current infection at time of inclusion Developmental age estimated below 3.5 years Intractable epilepsy with more than 1 seizure/week Inability to comply with the treatment protocol Additional diseases or disorders that may influence the endpoints, including: SEGA requiring treatment Uncontrolled diabetes mellitus Known impaired lung function Allergy for any of the components of the study medication Prior treatment with mTOR inhibitors HIV seropositivity Bleeding diathesis or oral anti-vitamin K medication Serum creatinine > 1.5 x ULN Uncontrolled hyperlipidemia (fasting serum cholesterol > 7.75 mmol/L, fasting serum triglycerides > 2.5 x ULN) Use of investigational drug within 30 days prior to inclusion History of myocardial infarction, angina or stroke related to atherosclerosis, organ transplantation, malignancy in the past 2 years Pregnancy or breastfeeding Children at risk for Hepatitis B (HB), unless hepatitis B serology is normal. Risk groups are children who have lived in Asia, Africa, Central and South America, Eastern Europe, Spain, Portugal, and Greece, children with known or suspected past or current hepatitis B infection, current or prior IV illicit drug use, current or prior dialysis, household contact with hepatitis B infected patient(s), current or prior high-risk sexual activity, body piercing or tattoos, mother known to have hepatitis B history. If vaccinated, presence of HBs Ab is normal. Known or suspected hepatitis C infection, unless hepatitis C serology is normal.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
M.C.Y. de Wit, MD. PhD.
Phone
+31 10 703 6956
Email
tubereuzesclerose@erasmusmc.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
M.C.Y. de Wit, MD. PhD.
Organizational Affiliation
Erasmus Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Erasmus Medical Center
City
Rotterdam
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
M.C.Y. de Wit, MD. PhD.
Phone
+31 10 703 6956
Email
tubereuzesclerose@erasmusmc.nl
First Name & Middle Initial & Last Name & Degree
M.C.Y. de Wit, MD. PhD.
First Name & Middle Initial & Last Name & Degree
I.E. Overwater, MSc

12. IPD Sharing Statement

Citations:
PubMed Identifier
31217257
Citation
Overwater IE, Rietman AB, Mous SE, Bindels-de Heus K, Rizopoulos D, Ten Hoopen LW, van der Vaart T, Jansen FE, Elgersma Y, Moll HA, de Wit MY; ENCORE Expertise Centre for Neurodevelopmental Disorders. A randomized controlled trial with everolimus for IQ and autism in tuberous sclerosis complex. Neurology. 2019 Jul 9;93(2):e200-e209. doi: 10.1212/WNL.0000000000007749. Epub 2019 Jun 19.
Results Reference
derived

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Efficacy of RAD001/Everolimus in Autism and NeuroPsychological Deficits in Children With Tuberous Sclerosis Complex

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