Randomized, Double-Blind Study to Evaluate Efficacy and Safety of Cenobamate Adjunctive Therapy in PGTC Seizures
Primary Generalized Epilepsy
About this trial
This is an interventional treatment trial for Primary Generalized Epilepsy focused on measuring Primary Generalized Tonic-Clonic Seizures, PGTC, Idiopathic Generalized Epilepsy, Generalized Tonic-Clonic Seizures
Eligibility Criteria
Inclusion Criteria:
- Subject is male or female and aged ≥12 years.
- Written informed consent signed by the subject or legal guardian, or legally authorized representative (LAR), prior to entering the study, in accordance with the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) guidelines. Age- appropriate assent will be obtained for adolescents. If the written informed consent is provided by the legal guardian because the subject is unable to do so, a written or verbal assent from the subject must also be obtained. As required by country-specific regulations, only the subject may sign the Informed Consent Form (ICF) in accordance with ICH guidelines.
- Female subjects of childbearing potential are willing to use an acceptable form of birth control
- Subject has a clinical diagnosis of PGTC seizures (with or without other subtypes of generalized seizures) in the setting of idiopathic generalized epilepsy.
- Subject experiences at least 5 PGTC seizures in 12 weeks during the Pre-Randomization Period.
- Subject has had a routine electroencephalogram (EEG) within 5 years prior to Visit1 (Screening/Baseline) or during the Pre-Randomization Period with electroencephalographic features consistent with idiopathic generalized epilepsy; other concomitant anomalies must be explained by adequate past medical history.
- Subject has undergone computed tomography (CT) or magnetic resonance imaging (MRI) within 10 years prior to Visit 1 (Screening/Baseline) or during the Pre-Randomization Period that ruled out a progressive cause of epilepsy.
Subject is currently receiving 1 to a maximum of 3 concomitant AEDs with fixed dosing regimens for a minimum of 30 days prior to Visit 1 (Screening/Baseline).
- Benzodiazepines (except diazepam, see Exclusion Criterion No.7) taken at least once per week during the 30 days prior to Visit 1 (Screening/Baseline) for epilepsy, anxiety, or sleep disorder will be counted as 1 AED and the dosage must be continued unchanged throughout the study. Therefore, only a maximum of 2 additional approved AEDs will be allowed. (See Exclusion Criterion No. 10 for intermittent benzodiazepine rescue parameters.)
- Subjects receiving felbamate as a concomitant AED must meet the following criteria: i. Have a 2-year history of felbamate use and a history of a fixed dosing regimen for a minimum of 60 days prior to Visit 1 (Screening/Baseline). ii. No prior or known history of hepatotoxicity or hematologic disorder due to felbamate.
- Subject with an implanted vagal nerve or deep brain stimulator will be allowed if the stimulator was implanted at least 5 months prior to Visit 1 (Screening/Baseline) and the stimulator parameters are not changed for 30 days prior to Visit 1 and for the duration of the study.
- Subject taking a ketogenic diet will be allowed as long as the diet has been stable for at least 3 months prior to Visit 1 (Screening/Baseline) and will remain stable for the duration of the study.
Exclusion Criteria:
- Female subjects who are pregnant (or planning to become pregnant during the study), lactating, or breast-feeding.
- Subject has a history o f status epilepticus that required hospitalization within 12 months prior to Visit 1 (Screening/Baseline).
- Subject has PGTC seizure clusters where individual seizures cannot be counted or classified.
- Subject has a history of non-epileptic psychogenic seizures.
- Subject has a concomitant diagnosis of Partial Onset Seizures (POS).
- Subject has a clinical diagnosis of Lennox-Gastaut syndrome.
- Subject is currently taking (within the 30 days prior to Visit 1 [Screening/Baseline]) any of the following medications: diazepam (for any reason other than as intermittent benzodiazepine rescue medication), phenytoin, mephenytoin, fosphenytoin, phenobarbital, primidone, ethotoin, clopidogrel, fluvoxamine, amitriptyline, clomipramine, bupropion, methadone, ifosfamide, cyclophosphamide, or efavirenz.
- Subject has participated in previous cenobamate clinical studies.
Subject has a history of vigabatrin use within 5months prior to Visit 1 (Screening/Baseline), or the subject plans to begin treatment with vigabatrin during the study.
a) A subject with a history of vigabatrin use that ended more than 5 months prior to Visit1 may be enrolled after documented evidence of no vigabatrin-associated clinically significant abnormality in an automated visual perimetry test.
- Subject has a history of intermittent use of rescue benzodiazepines (i.e., 1 to 2 doses over a 24-hour period is considered a 1-time rescue) 4 or more times within the 30 days prior to Visit 1 (Screening/Baseline).
- Subject has received an investigational drug or device within 30 days prior to Visit 1 (Screening/Baseline).
- Subject has a history of drug or alcohol dependency or abuse within 2 years prior to Visit 1 (Screening/Baseline).
- Subject tests positive, via urine drug screen at Visit 1 (Screening/Baseline), for illicit drugs not legalized in your region/state, or for a drug that has not been prescribed (e.g., certain opiates).
- Subject has a history of any serious drug-induced hypersensitivity reaction (including, but not limited to, Stevens Johnson syndrome, toxic epidermal necrolysis, or DRESS) or any drug-related rash requiring hospitalization.
- History of AED-associated rash that involved conjunctiva or mucosae.
- History of more than one non-serious drug-related hypersensitivity reaction that required discontinuation of the medication.
- Subject has evidence of clinically significant abnormalities or disease (e.g., psychiatric, cardiac, respiratory, gastrointestinal, hepatic [aspartate aminotransferase (AST) or alanine aminotransferase (ALT) more than 2 times the upper limit of normal (ULN), or total or direct bilirubin not more than ULN], or renal disease) that, in the opinion of the Principal Investigator, could affect the subject's safety or conduct of the study.
- Presence of congenital short QT syndrome or relevant replicated change in QT/QTc interval less than 340 msec on ECG.
- Subject has any significant active Central Nervous System (CNS) infection, demyelinating disease, degenerative neurologic disease or any CNS disease deemed to be progressive during the course of the study that may confound the interpretation of the study results.
- Subject has a creatinine clearance less than 50 mL/min, as calculated by Cockcroft-Gault equation.
- Subject has an absolute neutrophil count less than 1500/µL.
- Subject has platelet count lower than 80,000/µL in subjects treated with valproate.
- Subject has a history of positive antibody/antigen test for hepatitis A, hepatitis B, hepatitis C, or HIV.
- Subject has any suicidal ideation (with intent with or without a plan) at Visit 1 (Screening/Baseline) or Visit 4 (Randomization) (i.e., answering YES to Question 4 and/or Question 5 on the Suicidal Ideation section of the C-SSRS).
- Subject has more than 1 lifetime suicide attempt.
- Subject is a staff member or immediate family member of study staff.
- Previous exposure to cenobamate or sensitivity/allergy to components of the oral suspension.
Any potential exception to the inclusion as well as exclusion criteria allowing de minimis (clinically trivial and meaningless) variations must be approved by the Medical Monitor.
Sites / Locations
- Neuro Pain Medical Center
- Colorado Springs Neurological Associates
- Children's Hospital of ColoradoRecruiting
- Brainstorm Research
- Florida Hospital Medical Group
- University of South FloridaRecruiting
- Hawaii Pacific Neuroscience
- Consultants in Epilepsy and Neurology
- Rush UniversityRecruiting
- Indiana University
- PMG Research of McFarland Clinic
- University of Kentucky
- Maine Medical Center
- Mid-Atlantic Epilepsy and Sleep CenterRecruiting
- Michigan State University
- Minneapolis Clinic of Neurology Golden ValleyRecruiting
- University of Missouri Health CareRecruiting
- JFK Medical Center- The Neuroscience Institute
- Northeast Regional Epilepsy GroupRecruiting
- New York Presbyterian Hospital
- UBMD Neurology
- Five Towns Neuroscience Research
- Duke University Children's Health CenterRecruiting
- Ohio Health Research and Innovation Institute
- University of ToledoRecruiting
- Hospital of the University of Pennsylvania
- Thomas Jefferson University
- Temple University Lewis Katz School of Medicine
- LeBonheur Children's Medical CenterRecruiting
- Vanderbilt University Medical Center
- Child Neurology Consultants of AustinRecruiting
- ANRC ResearchRecruiting
- Baylor College of Medicine
- Carilion Clinic
- Valley Medical Center
- MultiCare Institute for Research and Innovation
- Children's Health Queensland HospitalRecruiting
- MHAT Sv. Ivan Rilski Gorna Oryahovitsa EOOD
- Multiprofile Hospital for Active Treatment Puls AD
- UMHAT Kanev AD
- MHAT Lyulin EAD
- Acibadem City Clinic MHAT Tokuda EAD
- Diagnostic Consultative Center Neoclinic EAD
- Diagnostic Consultative Center Equita EOOD
- Medical Center Medica Plus OOD
- Fakultní nemocnice v Motole
- Fakultni nemocnice u sv. Anny v Brne, 1. Neurologicka klinika
- Nestatni zdravotnicke zarizeni, privatni ordinance neurologie
- Cerebrovaskularni poradna, s.r.o.
- Cerebovaskularni poradna s.r.o.
- Forbeli s.r.o., Neurologicka ordinace
- Vestra Clinics, s.r.o.
- Neurologicka ambulance MUDr.Monika Zahumenska
- Charite - Universitätsmedizin Berlin - Sozialpädiatrisches ZentrumRecruiting
- Universitätsklinikum JenaRecruiting
- Sächsisches Epilepsiezentrum Kleinwachau gGmbHRecruiting
- Semmelweis EgyetemRecruiting
- Debreceni Egyetem Klinikai Központ, Gyermekgyógyászati Intézet Nagyerdei krt. 98Recruiting
- Csongrád Megyei Egészségügyi Elláto Központ Ideggyógyászati Osztály
- Chungbuk National University HospitalRecruiting
- CHA Bundang Medical CenterRecruiting
- SMG-SNU Boramae Medical CenterRecruiting
- Keimyung University Dongsan HospitalRecruiting
- Ajou University HospitalRecruiting
- NZOZ Poradnia Zdrowia Psychicznego Antonijczuk Boleslaw
- Centrum Medyczne Oporów
- Centrum Opieki Zdrowotnej Orkan-Med Stec-Michalska S.J.
- Instytut Medycyny Wsi im. Witolda Chodzki w Lublinie
- Centrum Medyczne PlejadyRecruiting
- Wojewódzki Specjalistyczny Szpital Dziecięcy im. sw. Ludwika sw KrakowieRecruiting
- Centrum Leczenia Padaczki i Migreny
- Centrum Medyczne Warszawa Pratia s.a
- Gornoslaskie Centrum Medyczne - Samodzielny Publiczny Szpital Kliniczny Number 7
- Centrum Medyczne Pratia Katowice
- M.A. LEK A.M. Maciejowscy S.C Centrum Terapii SM
- Niepubliczny Zaklad Opieki Zdrowotnej Novo-Med
- Gyncentrum Clinic Sp. z.o.o
- Niepubliczny Zakład Opieki Zdrowotnej - Centrum Neurologii Dziecięcej i Leczenia PadaczkiRecruiting
- Wojewodzki Szpital Specjalistyczny w Olsztynie
- Clinical Research Center Spolka z Ograniczona Odpowiedzialnoscia Medic-R sp. k
- Konzílium, s.r.oRecruiting
- MUDr. Beata Dupejova, neurologická ambulncia, s.r.o
- IN MEDIC s.r.oRecruiting
- Narodny Ustav Detskych ChorobRecruiting
- MEDBAJ, s.r.o., Neurologicka ambulancia, Nemocnicna 1944/10
- NEURES, s.r.o.-Neurologická Ambulancia
- Hospital Clínico San CarlosRecruiting
- Hospital Regional Universitario de MalagaRecruiting
- Hospital Universitario La Fe
- Municipal Non-profit Enterprise City Clinical Hospital No.16 of Dnipro City Council, Department of Neurology
- Communal Enterprise Dnipropetrovsk Regional Clinical Hospital n.a. I.I. Mechnykov of Dnipropetrovsk Regional Council, Regional Center of Psychosomatic Disorders based on Psychoneurology Department
- Kyiv City Psychoneurological Hospital №2
- Municipal Non-Profit Enterprise Odesa Regional Clinical Hospital of Odesa Regional Council, Department of Cerebro-Vascular Diseases with Neurosurgery
- Municipal Non-profit Enterprise Regional Clinical Center of Neurosurgery and Neurology of Zakarpattia Regional Council, Department of Neurosurgery #2
- Municipal Non-Profit Enterprise Zaporizhzhia Regional Clinical Hospital Of Zaporizhzhia Regional Council
- Communal Enterprise Dnipropetrovsk Regional Clinical Hospital n.a. I.I. Mechnykov of Dnipropetrovsk Regional Council
- Municipal Non-profit Enterprise Prykarpattia Regional Clinical Center for Mental Health of Ivano-Frankivsk Regional Council
- Communal Non-Commercial Enterprise of Kharkiv Regional Council Regional Clinical Psychiatric Hospital #3
- Communal Non-Profit Enterprise of Lviv Regional Council Lviv Regional Clinical Hospital, Neurological Department, Antiepileptic Center
- Communal Non-Profit Enterprise Odesa Regional Medical Centre of Mental Health Odesa Regional Council, Department #2
- Odessa Regional Psychiatric Hospital No. 2,
- Communal Enterprise Poltava Regional Clinical Psychiatric Hospital named after O.F. Maltsev of Poltava Regional Council
- Municipal Non-Profit Enterprise Ternopil Regional Clinical Psychoneurological Hospital of Ternopil Regional Council, Department of Neurology #2
- Municipal Non-profit Enterprise Vinnytsia Regional Clinical Psychoneurological Hospital named after Acad. O.I. Yushchenko of Vinnytsia Regional Council, Department of Neurology #3
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Cenobamate
Placebo
Cenobamate 12.5 mg tablet once a day for two weeks, 25 mg tablet once a day for two weeks, 50 mg tablet once a day for two weeks, 100 mg tablets once a day for two weeks, 150 mg tablets once a day for two weeks and 200 mg tablets once a day for twelve weeks. The adolescent subjects will follow the same regimen in an oral suspension adolescent equivalent dose based on weight.
Matching placebo