Oral Ifetroban in Subjects With Duchenne Muscular Dystrophy (DMD)
Primary Purpose
Duchenne Muscular Dystrophy Cardiomyopathy, Cardiomyopathy, Dilated
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ifetroban
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Duchenne Muscular Dystrophy Cardiomyopathy
Eligibility Criteria
Inclusion criteria:
- Males 7 years of age and older with the diagnosis of DMD, defined as phenotype consistent with DMD and either positive genotype, first degree relative with positive genotype, or confirmatory muscle biopsy.
- Stable dose of oral corticosteroids for at least 8 weeks or has not received corticosteroids for at least 30 days.
- Stable cardiac function defined as change in left ventricular ejection fraction (LVEF) of < 15% and no heart failure admission over the last 12 months; LVEF 35% or greater by cine cardiac magnetic resonance imaging (MRI) or echocardiography; myocardial damage in one or more left ventricular segments evident by late gadolinium enhancement allowed; concurrent angiotensin-converting enzyme inhibitors (ACEI), beta-blocker (BB) or angiotensin receptor blocker (ARB) therapy allowed (selection of which dictated by clinical care) if started three months or greater from first dose of IMP without change in dose. Aldosterone receptor antagonists (eg. Spironolactone or eplerenone) allowed if started 12 months or greater from first dose of Investigational Medicinal Product (IMP). No changes throughout the study allowed, except in the event of a decline in left ventricular ejection fraction (LVEF) >5% following the baseline CMR as measured by a subsequent CMR at the same center. Should this occur, changes in cardiac medications are allowed on the study.
- Subjects aged 18 years and older, informed consent obtained directly. For subjects ages 7-17 years old (yo), both assent from the subject and permission from a parent or guardian.
Exclusion criteria:
- Clinically significant illness other than DMD
- Clinically significant laboratory abnormality not associated with DMD
- Major surgery within six weeks prior to the first dose of study drug, or planned surgery during this study which would interfere with the ability to perform study procedures
- Require antiarrhythmic therapy and/or initiation of diuretic therapy for management of acute heart failure in the last 6 months
- A LVEF of < 35% by Cardiac Magnetic Resonance Imaging (CMR) and/or fractional shortening of < 15% based on echocardiography (ECHO) during screening
- A known bleeding disorder or has received anticoagulant treatment within 2 weeks of study entry
Allergy to gadolinium contrast or known renal insufficiency defined as abnormal cystatin C or creatinine above the upper limit of normal for age. The male serum reference ranges as follows:
- Age 7-9 years - 0.2-0.6 mg/dL
- Age 10-11 years - 0.3-0.7 mg/dL
- Age 12-13 years - 0.4-0.8 mg/dL
- Age 14-15 years - 0.5-0.9 mg/dL
- Age 16 years or older - 0.8-1.3 mg/dL
- Non-MR compatible implants (e.g. neurostimulator, automatic implantable cardioverter-defibrillator [AICD])
- Subjects who participated in a therapeutic clinical trial within 30 days or five half-lives (whichever is longer) of study entry
- Any other condition that could interfere with the subject's participation
Sites / Locations
- Arkansas Children's HospitalRecruiting
- Mattel Children's HospitalRecruiting
- Children's National HospitalRecruiting
- Children's Healthcare of AtlantaRecruiting
- Lurie Children's HospitalRecruiting
- Riley Children's HospitalRecruiting
- Kennedy Krieger InstituteRecruiting
- Saint. Louis Children's HospitalRecruiting
- Cincinnati Children's Hospital Medical CenterRecruiting
- Monroe Carrell Jr. Children's Hospital at Vanderbilt
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Placebo Comparator
Arm Label
Oral Ifetroban - Low Dose
Oral Ifetroban - High Dose
Placebos
Arm Description
Weight based, once daily oral ifetroban
Weight based, once daily oral ifetroban
Matching Placebo
Outcomes
Primary Outcome Measures
Incidence of Treatment-Emergent Adverse Events (safety & tolerability)
Percentage of subjects with one or more treatment emergent adverse event
Secondary Outcome Measures
Pharmacokinetics Area under the curve
Measurements of Area under the curve concentration of ifetroban and its acyl glucuronide metabolite
Pharmacokinetics maximum serum concentration (Cmax)
Measurements of maximum serum concentration (Cmax) of ifetroban and its acyl glucuronide metabolite
Pharmacokinetics time to reach Cmax (Tmax) concentration
Measurement of time to reach Cmax (Tmax) concentration of ifetroban and its acyl glucuronide metabolite
Pharmacokinetics plasma terminal half-life concentration
Measurement of plasma terminal half-life concentration of ifetroban and its acyl glucuronide metabolite
Change from baseline in left ventricular ejection fraction
There should be no change in left ventricular ejection fraction. Patients with DMD have a decline.
Change from baseline in pulmonary function
Change from baseline in forced expiratory volume in 1 second
Change from baseline in quality-of-life
The 23 items Pediatric Quality of Life Inventory (PedQL) questionnaire measures these core dimensions of health as delineated by the World Health Organization, as well as role (school) functioning. Items measured include 1) Physical Functioning (8 items), 2) Emotional Functioning (5 items), 3) Social Functioning (5 items), and 4) School Functioning (5 items). Each item is measured on a 5 point Likert scale with 0 indicating never and 4 indicating almost always.The Likert scores are reversed scored and linearly transform to a 0-100 scale with 0=100, 1-75, 2=50, 5=25, and 4=0. A higher score indicates better health-related quality of life.
Full Information
NCT ID
NCT03340675
First Posted
November 3, 2017
Last Updated
September 21, 2023
Sponsor
Cumberland Pharmaceuticals
Collaborators
Vanderbilt University Medical Center
1. Study Identification
Unique Protocol Identification Number
NCT03340675
Brief Title
Oral Ifetroban in Subjects With Duchenne Muscular Dystrophy
Acronym
DMD
Official Title
A Randomized, Double-Blind, Placebo-Controlled, Multiple Dose Study With an Open-Label Extension to Determine the Safety, Pharmacokinetics and Efficacy of Oral Ifetroban in Subjects With Duchenne Muscular Dystrophy
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 19, 2020 (Actual)
Primary Completion Date
August 31, 2024 (Anticipated)
Study Completion Date
August 31, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cumberland Pharmaceuticals
Collaborators
Vanderbilt University Medical Center
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Duchenne muscular dystrophy (DMD) is a devastating X-linked disease which leads to loss of ambulation between ages 7 and 13, respiratory failure and cardiomyopathy (CM) at any age, and inevitably premature death of affected young men in their late twenties. DMD is the most common fatal genetic disorder diagnosed in childhood. It affects approximately 1 in every 3,500 live male births across all races and cultures, and results in 20,000 new cases each year worldwide.Significant advances in respiratory care have unmasked CM as the leading cause of death. As there are yet no specific cardiac treatments to extend life, the current study aims to address this unmet medical need using a new therapeutic strategy for patients with DMD.
Funding Source - FDA OOPD
Detailed Description
This is a phase 2 randomized, double-blind, placebo-controlled, multiple dose study with an optional open-label extension to determine the safety, pharmacokinetics (PK) and efficacy of two doses of oral ifetroban in subjects with DMD. DMD patients who meet the inclusion criteria and none of the exclusion criteria will receive oral ifetroban or placebo once daily for 12 months. Subjects will be enrolled onto one of three treatment groups, low-dose ifetroban, high-dose ifetroban or placebo. Each dose level will be evaluated by eight subjects with early stage (LVEF > 45%) DMD-associated cardiomyopathy and eight subjects with more advanced stage (LVEF 35-45%) cardiac disease as there may be differences in the treatment effect based on cardiac involvement. Each subject treated will be evaluated for first-dose and steady-state exposure PK. All subjects who receive treatment will be assessed for safety. All subjects with at least one efficacy assessment post-baseline will be evaluated for efficacy. Blood and urine will be collected for standard and novel cardiac biomarkers. Target enrollment met for early-stage subjects (LVEF > 45%) and cohort is closed; enrollment remains open for the late-stage cohort (LVEF 35-45%).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Duchenne Muscular Dystrophy Cardiomyopathy, Cardiomyopathy, Dilated
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomized, placebo-controlled, double-blind, dose-ranging
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Each individual bottle is labelled with a unique numeric code that identifies the contents to the unblinded sponsor representative.
Allocation
Randomized
Enrollment
48 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Oral Ifetroban - Low Dose
Arm Type
Experimental
Arm Description
Weight based, once daily oral ifetroban
Arm Title
Oral Ifetroban - High Dose
Arm Type
Experimental
Arm Description
Weight based, once daily oral ifetroban
Arm Title
Placebos
Arm Type
Placebo Comparator
Arm Description
Matching Placebo
Intervention Type
Drug
Intervention Name(s)
Ifetroban
Intervention Description
Weight based, once daily oral ifetroban
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matching oral placebo
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse Events (safety & tolerability)
Description
Percentage of subjects with one or more treatment emergent adverse event
Time Frame
Baseline through 12 months
Secondary Outcome Measure Information:
Title
Pharmacokinetics Area under the curve
Description
Measurements of Area under the curve concentration of ifetroban and its acyl glucuronide metabolite
Time Frame
Day 0 and Day 7
Title
Pharmacokinetics maximum serum concentration (Cmax)
Description
Measurements of maximum serum concentration (Cmax) of ifetroban and its acyl glucuronide metabolite
Time Frame
Day 0 and Day 7
Title
Pharmacokinetics time to reach Cmax (Tmax) concentration
Description
Measurement of time to reach Cmax (Tmax) concentration of ifetroban and its acyl glucuronide metabolite
Time Frame
Day 0 and Day 7
Title
Pharmacokinetics plasma terminal half-life concentration
Description
Measurement of plasma terminal half-life concentration of ifetroban and its acyl glucuronide metabolite
Time Frame
Day 0 and Day 7
Title
Change from baseline in left ventricular ejection fraction
Description
There should be no change in left ventricular ejection fraction. Patients with DMD have a decline.
Time Frame
Baseline through 12 months
Title
Change from baseline in pulmonary function
Description
Change from baseline in forced expiratory volume in 1 second
Time Frame
Baseline through 12 months
Title
Change from baseline in quality-of-life
Description
The 23 items Pediatric Quality of Life Inventory (PedQL) questionnaire measures these core dimensions of health as delineated by the World Health Organization, as well as role (school) functioning. Items measured include 1) Physical Functioning (8 items), 2) Emotional Functioning (5 items), 3) Social Functioning (5 items), and 4) School Functioning (5 items). Each item is measured on a 5 point Likert scale with 0 indicating never and 4 indicating almost always.The Likert scores are reversed scored and linearly transform to a 0-100 scale with 0=100, 1-75, 2=50, 5=25, and 4=0. A higher score indicates better health-related quality of life.
Time Frame
Baseline through 12 months
10. Eligibility
Sex
Male
Minimum Age & Unit of Time
7 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria:
Males 7 years of age and older with the diagnosis of DMD, defined as phenotype consistent with DMD and either positive genotype, first degree relative with positive genotype, or confirmatory muscle biopsy.
Stable dose of oral corticosteroids for at least 8 weeks or has not received corticosteroids for at least 30 days.
Stable cardiac function defined as change in left ventricular ejection fraction (LVEF) of < 15% and no heart failure admission over the last 12 months; LVEF 35% or greater by cine cardiac magnetic resonance imaging (MRI) or echocardiography; myocardial damage in one or more left ventricular segments evident by late gadolinium enhancement allowed; concurrent angiotensin-converting enzyme inhibitors (ACEI), beta-blocker (BB) or angiotensin receptor blocker (ARB) therapy allowed (selection of which dictated by clinical care) if started three months or greater from first dose of IMP without change in dose. Aldosterone receptor antagonists (eg. Spironolactone or eplerenone) allowed if started 12 months or greater from first dose of Investigational Medicinal Product (IMP). No changes throughout the study allowed, except in the event of a decline in left ventricular ejection fraction (LVEF) >5% following the baseline CMR as measured by a subsequent CMR at the same center. Should this occur, changes in cardiac medications are allowed on the study.
Subjects aged 18 years and older, informed consent obtained directly. For subjects ages 7-17 years old (yo), both assent from the subject and permission from a parent or guardian.
Exclusion criteria:
Clinically significant illness other than DMD
Clinically significant laboratory abnormality not associated with DMD
Major surgery within six weeks prior to the first dose of study drug, or planned surgery during this study which would interfere with the ability to perform study procedures
Require antiarrhythmic therapy and/or initiation of diuretic therapy for management of acute heart failure in the last 6 months
A LVEF of < 35% by Cardiac Magnetic Resonance Imaging (CMR) and/or fractional shortening of < 15% based on echocardiography (ECHO) during screening
A known bleeding disorder or has received anticoagulant treatment within 2 weeks of study entry
Allergy to gadolinium contrast or known renal insufficiency defined as abnormal cystatin C or creatinine above the upper limit of normal for age. The male serum reference ranges as follows:
Age 7-9 years - 0.2-0.6 mg/dL
Age 10-11 years - 0.3-0.7 mg/dL
Age 12-13 years - 0.4-0.8 mg/dL
Age 14-15 years - 0.5-0.9 mg/dL
Age 16 years or older - 0.8-1.3 mg/dL
Non-MR compatible implants (e.g. neurostimulator, automatic implantable cardioverter-defibrillator [AICD])
Subjects who participated in a therapeutic clinical trial within 30 days or five half-lives (whichever is longer) of study entry
Any other condition that could interfere with the subject's participation
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ines M Macias-Perez, PhD
Phone
6159795778
Email
imaciasperez@cumberlandpharma.com
First Name & Middle Initial & Last Name or Official Title & Degree
Ingrid Anderson, PhD, CCRP
Phone
615-255-0068
Ext
250
Email
ianderson@cumberlandpharma.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Larry Markham, MD
Organizational Affiliation
Riley Children's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Arkansas Children's Hospital
City
Little Rock
State/Province
Arkansas
ZIP/Postal Code
72202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Annette Guy
Phone
501-364-3380
Email
GuyEA@archildrens.org
First Name & Middle Initial & Last Name & Degree
Markus Renno, MD
Facility Name
Mattel Children's Hospital
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Emilie Douine-Barthelemy
Phone
310-991-2674
Email
EDouine@mednet.ucla.edu
Facility Name
Children's National Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Carlos Carhuas
Phone
202-476-6152
Email
ccarhuas@childrensnational.org
Facility Name
Children's Healthcare of Atlanta
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30341
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Melissa Burnett
Phone
404-785-0381
Email
melissa.burnett@choa.org
Facility Name
Lurie Children's Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kathleen Van't Hof
Email
kvanthof@luriechildrens.org
First Name & Middle Initial & Last Name & Degree
Pedro Lara
Email
plara@luriechildrens.org
First Name & Middle Initial & Last Name & Degree
Katheryn Gambetta, MD
Facility Name
Riley Children's Hospital
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jennifer Howell
Phone
317-278-7818
Email
jemrich@iu.edu
Facility Name
Kennedy Krieger Institute
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21205
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Genila Bibat, MD
Email
bibat@kennedykrieger.org
First Name & Middle Initial & Last Name & Degree
Georgina D'Sanson
Email
dsanson@kennedyKrieger.org
First Name & Middle Initial & Last Name & Degree
Doris Leung, MD
Facility Name
Saint. Louis Children's Hospital
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jessie Schwieterman, PT, CCRP
Email
j.schwieterman@wustl.edu
First Name & Middle Initial & Last Name & Degree
Craig Zaidman, MD
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kenneth Mucheck
Email
Kenneth.Mucheck@cchmc.org
First Name & Middle Initial & Last Name & Degree
Remesha Palmer
Email
Remesha.Palmer@cchmc.org
First Name & Middle Initial & Last Name & Degree
Chet Villa, MD
Facility Name
Monroe Carrell Jr. Children's Hospital at Vanderbilt
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States
Individual Site Status
Active, not recruiting
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
34048282
Citation
Mitchell R, Frederick NE, Holzman ER, Agobe F, Allaway HCM, Bagher P. Ifetroban reduces coronary artery dysfunction in a mouse model of Duchenne muscular dystrophy. Am J Physiol Heart Circ Physiol. 2021 Jul 1;321(1):H52-H58. doi: 10.1152/ajpheart.00180.2021. Epub 2021 May 28.
Results Reference
derived
Learn more about this trial
Oral Ifetroban in Subjects With Duchenne Muscular Dystrophy
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