Clinical Study to Evaluate the Efficacy and Safety of Givinostat in Ambulant Patients With Becker Muscular Dystrophy
Primary Purpose
Becker Muscular Dystrophy
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
givinostat
placebo
Sponsored by
About this trial
This is an interventional treatment trial for Becker Muscular Dystrophy
Eligibility Criteria
Inclusion Criteria:
- Ambulant patients with BMD diagnosis confirmed by genetic testing.
- Able and willing to give informed consent in writing.
- Able to perform 6MWT at screening with a minimum distance of 200 m and maximum distance of 450 m.
- If in treatment with systemic corticosteroids and/or angiotensin-converting-enzyme (ACE) inhibitor , and/or β or α adrenergic receptor blocker, no significant change in dosage or dosing regimen (excluding changes related to body weight change) for a minimum of 6 months immediately prior to start of study treatment.
- Patients must be willing to use adequate contraception. Contraceptive methods must be used from Randomization through 3 months after the last dose of study treatment.
Exclusion Criteria:
- Exposure to another investigational drug within 3 months prior to the start of study treatment.
- Use of any pharmacologic treatment, other than corticosteroids, that might have an effect on muscle strength or function within 3 months prior to the start of study treatment (e.g., growth hormone). Vitamin D, calcium, and any other supplements will be allowed.
- Surgery that might affect muscle strength or function within 3 months before study entry or planned surgery at any time during the study.
- Presence of other clinically significant disease that in the Investigator's opinion could adversely affect the safety of the patient, making it unlikely that the course of treatment or follow-up is completed, or could impair the assessment of study results.
- A diagnosis of other neurological diseases or presence of relevant somatic disorders that are not related to BMD.
- Platelet count, WBC count and hemoglobin at screening < Lower Limit of Normal (LLN). If laboratory screening results are < LLN, platelet count, WBC count and hemoglobin are to be repeated once, and if again < LLN become exclusionary.
- Symptomatic cardiomyopathy or heart failure (New York Heart Association Class III or IV) or left ventricular ejection fraction < 50% at screening or with heart transplant.
- Current liver disease or impairment, including but not limited to elevated total bilirubin (> 1.5 x ULN), unless secondary to Gilbert's disease or pattern consistent with Gilbert's disease.
- Inadequate renal function, as defined by serum Cystatin C > 2 x the upper limit of normal (ULN). If the value is > 2 x ULN, serum Cystatin C will be repeated once, and if again > 2 x ULN becomes exclusionary.
- Positive test for hepatitis B surface antigen, hepatitis C antibody, or human immunodeficiency virus at screening.
- Baseline corrected QTcF > 450 msec, (as the mean of 3 consecutive readings 5 minutes apart) or history of additional risk factors for torsades de pointes (e.g., heart failure, hypokalemia, or family history of long QT syndrome).
- Current psychiatric illness/social situations rendering the potential patient unable to understand and comply with the muscle function tests and/or with the study protocol procedures.
- Hypersensitivity to the components of study medication.
- Sorbitol intolerance or sorbitol malabsorption, or the hereditary form of fructose intolerance.
- Contraindications to muscle biopsy.
- Contraindications to MRI/MRS (e.g., claustrophobia, metal implants, or seizure disorder).
- Hypertrygliceridemia (<1.5 per upper limit of normal)* * at screening, patient with hypertrygliceridemia can be enrolled if in stable treatment and with controlled level of tryglicerides (i.e. within normal range) for at least 6 months
Sites / Locations
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, UOS
- Leiden University Medical Center LUMC
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
givinostat
placebo
Arm Description
Givinostat oral suspension (10 mg/mL) twice daily in a fed state
Placebo oral suspension (10 mg/mL) twice daily in a fed state
Outcomes
Primary Outcome Measures
Mean change in total fibrosis (%)
Mean change in total fibrosis (%) comparing the histology of muscle biopsies before and after 12 months of treatment with givinostat versus placebo
Secondary Outcome Measures
Mean change in fat fraction of vastus lateralis and soleus
Evaluation will be performed comparing Magnetic Resonance Spectroscopy (MRS) before and after 12 months of treatment with givinostat versus placebo.
Mean change in fat fraction of pelvic girdle and lower limb muscles
Evaluation will be performed comparing Magnetic Resonance Imaging (MRI) before and after 12 months of treatment with givinostat versus placebo
Mean CSA of pelvic girdle and lower limb muscles
Evaluation will be performed comparing MRI before and after 12 months of treatment with givinostat versus placebo
Mean change in other histology parameters (e.g. Muscle Fibers Area Fraction [MFAF]%, % of total fibrosis, regenerative fibers)
Evaluation will be performed comparing the histology biopsies before and after 12 months of treatment with givinostat
Mean change in Motor Function Measurement (MFM)
Evaluation will be performed using the Motor Function Measurement scale before and after 12 months of treatment with givinostat versus placebo
Mean change in 6 Minute Walking Test (6MWT)
Evaluation will be performed before and after 12 months of treatment with givinostat versus placebo
Proportion of patients with < 10% worsening in 6MWT at the end of study.
Proportion of patients with < 10% worsening in 6MWT at the end of study.
Proportion of patients who lose the ability to rise from floor (Baseline through end of study).
Proportion of patients who lose the ability to rise from floor (Baseline through
Proportion of patients who lose ambulation during the study
Proportion of patients who lose ambulation during the study
Mean change in muscle strength evaluated by knee extension, elbow flexion as measured by Hand Held Myometry (HHM),
Evaluation will be performed before and after 12 months of treatment with givinostat versus placebo
Mean changes in quality of life (assessed by the 36-item Short Form survey [SF36])
Evaluation will be performed before and after 12 months of treatment with givinostat as compared to placebo
Number of patients experiencing treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) from Baseline through end of study (EOS).
Number of patients experiencing treatment-emergent adverse events (TEAEs)
Type, incidence, and severity of TEAEs and SAEs (Baseline through EOS).
Type, incidence, and severity of TEAEs and SAEs (Baseline through EOS).
Changes from baseline to end of study of vital sign and clinical laboratory tests
number of participants with abnormal laboratory values
Changes from baseline to end of study of physical examination
number of participants with abnormal physical examination assessments
Mean change in Time Function Test
Evaluation will be performed before and after 12 months of treatment with givinostat as compared to placebo
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT03238235
Brief Title
Clinical Study to Evaluate the Efficacy and Safety of Givinostat in Ambulant Patients With Becker Muscular Dystrophy
Official Title
A Randomised, Double Blind, Placebo Controlled Study to Evaluate the Micro-macroscopic Effects on Muscles, the Safety and Tolerability, and the Efficacy of Givinostat in Patients With Becker Muscular Dystrophy (BMD)
Study Type
Interventional
2. Study Status
Record Verification Date
January 2022
Overall Recruitment Status
Completed
Study Start Date
December 12, 2017 (Actual)
Primary Completion Date
March 19, 2021 (Actual)
Study Completion Date
March 19, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Italfarmaco
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is a phase 2, randomised, double-blind, placebo controlled study to evaluate the micro-macroscopic effects on muscles, the safety and tolerability, and the efficacy of givinostat in patients with Becker Muscular Dystrophy. Approximately 48 eligible patients will be randomized in a 2:1 ratio to be treated with givinostat or placebo for a period of 12 months.
Detailed Description
Givinostat or placebo oral suspension (10 mg/mL) will be administered orally as 2 oral doses daily while the subject is in fed state, according to the subject's weight.
Study drug should be permanently stopped if any of the following occur:
severe drug-related diarrhoea;
any drug-related Serious Adverse Event (SAE);
QTcorrected by Fridericia's formulas (QTcF) >500 msec;
platelets (PLT) count ≤50 x 1.000.000.000/L (10E9/L);
White blood cell (WBC) ≤ 2.0 x 10E9/L;
Hemoglobin (Hb) ≤ 8.0 g/dL.
Study drug should be temporarily stopped if any of the following occur:
PLT count <75 x 10E9/L but >50 x 10E9/L;
WBC < 3.0 x 10E9/L but > 2.0 x 10E9/L;
Hb < 10.0 g/dL but > 8.0 g/dL;
moderate or severe diarrhoea.
tryglicerides >300 mg/dL In case the study drug was temporarily stopped, the study drug can be resumed at a level 20% smaller than the dose at which the Adverse Event leading to temporary stop occurred, once platelets and/or WBC and/or Hb and/or tryglicerides are normalized or when diarrhoea is mild
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Becker Muscular Dystrophy
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
51 (Actual)
8. Arms, Groups, and Interventions
Arm Title
givinostat
Arm Type
Active Comparator
Arm Description
Givinostat oral suspension (10 mg/mL) twice daily in a fed state
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
Placebo oral suspension (10 mg/mL) twice daily in a fed state
Intervention Type
Drug
Intervention Name(s)
givinostat
Other Intervention Name(s)
Active Comparator: givinostat
Intervention Description
suspension of givinostat (10 mg/mL)
Intervention Type
Drug
Intervention Name(s)
placebo
Other Intervention Name(s)
Placebo Comparator: placebo
Intervention Description
suspension manufactured to mimic givinostat
Primary Outcome Measure Information:
Title
Mean change in total fibrosis (%)
Description
Mean change in total fibrosis (%) comparing the histology of muscle biopsies before and after 12 months of treatment with givinostat versus placebo
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Mean change in fat fraction of vastus lateralis and soleus
Description
Evaluation will be performed comparing Magnetic Resonance Spectroscopy (MRS) before and after 12 months of treatment with givinostat versus placebo.
Time Frame
12 months
Title
Mean change in fat fraction of pelvic girdle and lower limb muscles
Description
Evaluation will be performed comparing Magnetic Resonance Imaging (MRI) before and after 12 months of treatment with givinostat versus placebo
Time Frame
12 months
Title
Mean CSA of pelvic girdle and lower limb muscles
Description
Evaluation will be performed comparing MRI before and after 12 months of treatment with givinostat versus placebo
Time Frame
12 months
Title
Mean change in other histology parameters (e.g. Muscle Fibers Area Fraction [MFAF]%, % of total fibrosis, regenerative fibers)
Description
Evaluation will be performed comparing the histology biopsies before and after 12 months of treatment with givinostat
Time Frame
12 months
Title
Mean change in Motor Function Measurement (MFM)
Description
Evaluation will be performed using the Motor Function Measurement scale before and after 12 months of treatment with givinostat versus placebo
Time Frame
12 months
Title
Mean change in 6 Minute Walking Test (6MWT)
Description
Evaluation will be performed before and after 12 months of treatment with givinostat versus placebo
Time Frame
12 months
Title
Proportion of patients with < 10% worsening in 6MWT at the end of study.
Description
Proportion of patients with < 10% worsening in 6MWT at the end of study.
Time Frame
12 months
Title
Proportion of patients who lose the ability to rise from floor (Baseline through end of study).
Description
Proportion of patients who lose the ability to rise from floor (Baseline through
Time Frame
12 months
Title
Proportion of patients who lose ambulation during the study
Description
Proportion of patients who lose ambulation during the study
Time Frame
12 months
Title
Mean change in muscle strength evaluated by knee extension, elbow flexion as measured by Hand Held Myometry (HHM),
Description
Evaluation will be performed before and after 12 months of treatment with givinostat versus placebo
Time Frame
12 months
Title
Mean changes in quality of life (assessed by the 36-item Short Form survey [SF36])
Description
Evaluation will be performed before and after 12 months of treatment with givinostat as compared to placebo
Time Frame
12 months
Title
Number of patients experiencing treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) from Baseline through end of study (EOS).
Description
Number of patients experiencing treatment-emergent adverse events (TEAEs)
Time Frame
12 months
Title
Type, incidence, and severity of TEAEs and SAEs (Baseline through EOS).
Description
Type, incidence, and severity of TEAEs and SAEs (Baseline through EOS).
Time Frame
12 months
Title
Changes from baseline to end of study of vital sign and clinical laboratory tests
Description
number of participants with abnormal laboratory values
Time Frame
12 months
Title
Changes from baseline to end of study of physical examination
Description
number of participants with abnormal physical examination assessments
Time Frame
12 months
Title
Mean change in Time Function Test
Description
Evaluation will be performed before and after 12 months of treatment with givinostat as compared to placebo
Time Frame
12 months
10. Eligibility
Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Ambulant patients with BMD diagnosis confirmed by genetic testing.
Able and willing to give informed consent in writing.
Able to perform 6MWT at screening with a minimum distance of 200 m and maximum distance of 450 m.
If in treatment with systemic corticosteroids and/or angiotensin-converting-enzyme (ACE) inhibitor , and/or β or α adrenergic receptor blocker, no significant change in dosage or dosing regimen (excluding changes related to body weight change) for a minimum of 6 months immediately prior to start of study treatment.
Patients must be willing to use adequate contraception. Contraceptive methods must be used from Randomization through 3 months after the last dose of study treatment.
Exclusion Criteria:
Exposure to another investigational drug within 3 months prior to the start of study treatment.
Use of any pharmacologic treatment, other than corticosteroids, that might have an effect on muscle strength or function within 3 months prior to the start of study treatment (e.g., growth hormone). Vitamin D, calcium, and any other supplements will be allowed.
Surgery that might affect muscle strength or function within 3 months before study entry or planned surgery at any time during the study.
Presence of other clinically significant disease that in the Investigator's opinion could adversely affect the safety of the patient, making it unlikely that the course of treatment or follow-up is completed, or could impair the assessment of study results.
A diagnosis of other neurological diseases or presence of relevant somatic disorders that are not related to BMD.
Platelet count, WBC count and hemoglobin at screening < Lower Limit of Normal (LLN). If laboratory screening results are < LLN, platelet count, WBC count and hemoglobin are to be repeated once, and if again < LLN become exclusionary.
Symptomatic cardiomyopathy or heart failure (New York Heart Association Class III or IV) or left ventricular ejection fraction < 50% at screening or with heart transplant.
Current liver disease or impairment, including but not limited to elevated total bilirubin (> 1.5 x ULN), unless secondary to Gilbert's disease or pattern consistent with Gilbert's disease.
Inadequate renal function, as defined by serum Cystatin C > 2 x the upper limit of normal (ULN). If the value is > 2 x ULN, serum Cystatin C will be repeated once, and if again > 2 x ULN becomes exclusionary.
Positive test for hepatitis B surface antigen, hepatitis C antibody, or human immunodeficiency virus at screening.
Baseline corrected QTcF > 450 msec, (as the mean of 3 consecutive readings 5 minutes apart) or history of additional risk factors for torsades de pointes (e.g., heart failure, hypokalemia, or family history of long QT syndrome).
Current psychiatric illness/social situations rendering the potential patient unable to understand and comply with the muscle function tests and/or with the study protocol procedures.
Hypersensitivity to the components of study medication.
Sorbitol intolerance or sorbitol malabsorption, or the hereditary form of fructose intolerance.
Contraindications to muscle biopsy.
Contraindications to MRI/MRS (e.g., claustrophobia, metal implants, or seizure disorder).
Hypertrygliceridemia (<1.5 per upper limit of normal)* * at screening, patient with hypertrygliceridemia can be enrolled if in stable treatment and with controlled level of tryglicerides (i.e. within normal range) for at least 6 months
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Giacomo Comi, MD
Organizational Affiliation
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano
Official's Role
Principal Investigator
Facility Information:
Facility Name
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, UOS
City
Milan
ZIP/Postal Code
20122
Country
Italy
Facility Name
Leiden University Medical Center LUMC
City
Leiden
ZIP/Postal Code
ZH 2300 RC
Country
Netherlands
12. IPD Sharing Statement
Learn more about this trial
Clinical Study to Evaluate the Efficacy and Safety of Givinostat in Ambulant Patients With Becker Muscular Dystrophy
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