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Micronised Resveratrol as a Treatment for Friedreich Ataxia

Primary Purpose

Friedreich Ataxia

Status
Active
Phase
Phase 2
Locations
Australia
Study Type
Interventional
Intervention
Resveratrol
Sponsored by
Murdoch Childrens Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Friedreich Ataxia focused on measuring Resveratrol, Frataxin

Eligibility Criteria

16 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Age ≥16 years.
  2. Diagnosis of FRDA, genetically documented to be due to homozygosity for a GAA repeat expansion in intron 1 of FXN.
  3. Functional stage on the Ataxia subscale of the full FARS of 1 or higher (a score of 1 is assigned if the subject has "Minimal signs detected by the physician during screening. Can run or jump without loss of balance. No disability."), and total mFARS score of ≤ 65.
  4. Adequate end organ function defined as follows: (i) total bilirubin <2x upper limit of normal unless attributable to Gilbert disease, (ii) ALT and AST <1.5x upper limit of normal, (iii) Creatinine <2x upper limit of normal, (iv) neutrophils >1.5x10^9/L, (v) platelets >10^6/μL.
  5. Written informed consent provided.

Exclusion Criteria:

  1. Non-elective hospitalisation within the past 60 days that could be of concern in the investigator's judgment. Any hospitalisation in the previous 60 days will be assessed and if in the investigator's judgement it could compromise the individual or the study, that person will not be recruited. Examples include if the individual is hospitalised for management of cardiac morbidity such as uncontrolled arrhythmia or angina or for orthopaedic surgery for a lower limb fracture.
  2. Women who are pregnant or lactating or men and women of childbearing potential who are unwilling to use contraception for the duration of the study.
  3. FRDA due to compound heterozygosity for an expanded GAA repeat and a point mutation/ deletion in the FXN gene.
  4. Current or recent (in last 12 months) arrhythmias including: atrial fibrillation, atrial flutter, sinus tachycardia >120/min, sinus bradycardia <50/min. Symptomatic paroxysmal arrhythmia which is recurring frequently. Cardiac insufficiency (by New York Heart Association >2). Reduced LV ejection fraction (<50%) in the last six months.
  5. Medical illness that in the judgment of the investigator would jeopardise the safe completion of the study. Examples include cancer, chronic inflammatory disease, severe diabetes (type I or II, HbA1c >8%), chronic liver insufficiency, epilepsy, thrombocytosis.
  6. Evidence of end organ dysfunction through failure to meet one or more parameters in inclusion criterion number 4.
  7. Prior invasive cancer (excluding localised basal cell or squamous cell skin cancer).
  8. Known hypersensitivity to resveratrol.
  9. Use of any investigational agent within 30 days of enrolment.
  10. Use of antioxidants such as vitamin E, coenzyme Q10 or idebenone within 30 days prior to enrolment.
  11. Concomitant use of medications with potential for clinically relevant drug interactions. This includes medications with a narrow therapeutic range that are metabolised by the cytochrome P450 3A4, 2D6 or 2C9 systems e.g. warfarin, amiodarone.

Sites / Locations

  • Royal North Shore Hospital
  • University of Queensland Centre for Clinical Research
  • Murdoch Children's Research Institute
  • Royal Perth Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Resveratrol followed by placebo

Placebo followed by Resveratrol

Arm Description

1g micronised resveratrol twice daily for 24 weeks, a wash-out period of 4 weeks, followed by twice daily placebo for 24 weeks.

Twice daily placebo for 24 weeks, a wash-out period of 4 weeks, followed by 1g micronised resveratrol twice daily for 24 weeks

Outcomes

Primary Outcome Measures

Modified Friedreich Ataxia Rating Scale
Change in the Modified Friedreich Ataxia Rating Scale score (score range 0-99) at 24 weeks compared with baseline. Higher scores are indicative of more severe disease.

Secondary Outcome Measures

Nine-Hole Peg Test
Change in the Nine-Hole Peg Test at 24 weeks compared with baseline.
Berg Balance Scale
Change in the Berg Balance Scale (score range 0-56) at 24 weeks compared with baseline. A higher score indicates lower fall risk.
Ataxia Instrumented Measure-Spoon
Change in the Ataxia Instrumented Measure-Spoon at 24 weeks compared with baseline.
Friedreich Ataxia Impact Scale
Change in the Friedreich Ataxia Impact Scale at 24 weeks compared with baseline. The Friedreich Ataxia Impact Scale comprises 8 subscales (score range 0-100) that are scored independently. A higher score indicates greater impact of Friedreich ataxia on health and well-being.
Modified Fatigue Impact Scale
Change in the Modified Fatigue Impact Scale (score range 0-24) at 24 weeks compared with baseline. Higher scores indicate a greater impact of fatigue on an individual's activities.
Measures of speech
Change in measures of speech (reading a paragraph, produce a prolonged vowel sound for 5 seconds, count from one to 20, and produce a 1-minute monologue on a pre-specified topic) at 24 weeks compared with baseline.
Measures of hearing
Change in measures of hearing using the Listening in Spatialized Noise Test (LiSN-S) at 24 weeks compared with baseline.
Cardiac parameters measured by echocardiography
Change in left ventricular global longitudinal strain at 24 weeks compared to baseline.
Cardiac parameters measured by ECG
Change in QRS duration at lead V5 at 24 weeks compared to baseline.
Frataxin levels
Change in frataxin levels at 24 weeks compared to baseline.
mRNA levels
Change in PGC-1α mRNA levels and Nrf2 mRNA levels at 24 weeks compared to baseline.
Plasma F2-isoprostane levels
Change in plasma F2-isoprostane levels at 24 weeks compared to baseline.

Full Information

First Posted
April 16, 2019
Last Updated
August 14, 2023
Sponsor
Murdoch Childrens Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT03933163
Brief Title
Micronised Resveratrol as a Treatment for Friedreich Ataxia
Official Title
A Randomised Placebo-controlled Crossover Trial of Micronised Resveratrol as a Treatment for Friedreich Ataxia
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
May 23, 2019 (Actual)
Primary Completion Date
February 2024 (Anticipated)
Study Completion Date
February 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Murdoch Childrens Research Institute

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of this study is to assess the efficacy of micronised resveratrol as a treatment for FRDA, in terms of reducing the severity of ataxia symptoms at 24 weeks, through a randomised blinded, placebo controlled crossover trial.
Detailed Description
Friedreich ataxia (FRDA) is the most common hereditary ataxia, with an estimated prevalence in Caucasians of 1 in 30,000. Neurological features of FRDA are progressive gait and limb ataxia, absent lower limb reflexes, and loss of position and vibration sense. There are currently no treatments proven to alter the natural history of FRDA. Resveratrol is a naturally occurring compound found in red wine, berries, and nuts. It is postulated to have wide-ranging health benefits, including antioxidant, anticarcinogenic, antidiabetic and neuroprotective properties. The study will be a double-blinded, placebo-controlled randomised 2-period crossover trial of 2g/day of micronised resveratrol in FRDA over 24 weeks. The study will enrol 40 patients with FRDA from 3 sites. The primary outcome measure is the change in modified Friedreich Ataxia Rating Scale (mFARS) score from baseline to 24 weeks.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Friedreich Ataxia
Keywords
Resveratrol, Frataxin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
Double-blind, randomised, placebo-controlled 2-period crossover trial of 2g/day of micronised resveratrol versus placebo. Participants will be randomised in terms of the order in which they received micronised resveratrol and placebo.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Participants will be randomised between receiving resveratrol in period 1 and placebo in period 2, or placebo in period 1 and resveratrol in period 2.
Allocation
Randomized
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Resveratrol followed by placebo
Arm Type
Other
Arm Description
1g micronised resveratrol twice daily for 24 weeks, a wash-out period of 4 weeks, followed by twice daily placebo for 24 weeks.
Arm Title
Placebo followed by Resveratrol
Arm Type
Other
Arm Description
Twice daily placebo for 24 weeks, a wash-out period of 4 weeks, followed by 1g micronised resveratrol twice daily for 24 weeks
Intervention Type
Drug
Intervention Name(s)
Resveratrol
Intervention Description
Drug name: Micronised resveratrol. Dosage form: 500mg capsules. Alternate name: 1,3-Benzenediol, 5-[2-(4-hydroxyphenyl)ethenyl]-, (E). Ingredients: 99.50% pure trans-resveratrol. Placebo capsules will be identical in terms of taste, smell, and appearance.
Primary Outcome Measure Information:
Title
Modified Friedreich Ataxia Rating Scale
Description
Change in the Modified Friedreich Ataxia Rating Scale score (score range 0-99) at 24 weeks compared with baseline. Higher scores are indicative of more severe disease.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
Nine-Hole Peg Test
Description
Change in the Nine-Hole Peg Test at 24 weeks compared with baseline.
Time Frame
24 weeks
Title
Berg Balance Scale
Description
Change in the Berg Balance Scale (score range 0-56) at 24 weeks compared with baseline. A higher score indicates lower fall risk.
Time Frame
24 weeks
Title
Ataxia Instrumented Measure-Spoon
Description
Change in the Ataxia Instrumented Measure-Spoon at 24 weeks compared with baseline.
Time Frame
24 weeks
Title
Friedreich Ataxia Impact Scale
Description
Change in the Friedreich Ataxia Impact Scale at 24 weeks compared with baseline. The Friedreich Ataxia Impact Scale comprises 8 subscales (score range 0-100) that are scored independently. A higher score indicates greater impact of Friedreich ataxia on health and well-being.
Time Frame
24 weeks
Title
Modified Fatigue Impact Scale
Description
Change in the Modified Fatigue Impact Scale (score range 0-24) at 24 weeks compared with baseline. Higher scores indicate a greater impact of fatigue on an individual's activities.
Time Frame
24 weeks
Title
Measures of speech
Description
Change in measures of speech (reading a paragraph, produce a prolonged vowel sound for 5 seconds, count from one to 20, and produce a 1-minute monologue on a pre-specified topic) at 24 weeks compared with baseline.
Time Frame
24 weeks
Title
Measures of hearing
Description
Change in measures of hearing using the Listening in Spatialized Noise Test (LiSN-S) at 24 weeks compared with baseline.
Time Frame
24 weeks
Title
Cardiac parameters measured by echocardiography
Description
Change in left ventricular global longitudinal strain at 24 weeks compared to baseline.
Time Frame
24 weeks
Title
Cardiac parameters measured by ECG
Description
Change in QRS duration at lead V5 at 24 weeks compared to baseline.
Time Frame
24 weeks
Title
Frataxin levels
Description
Change in frataxin levels at 24 weeks compared to baseline.
Time Frame
24 weeks
Title
mRNA levels
Description
Change in PGC-1α mRNA levels and Nrf2 mRNA levels at 24 weeks compared to baseline.
Time Frame
24 weeks
Title
Plasma F2-isoprostane levels
Description
Change in plasma F2-isoprostane levels at 24 weeks compared to baseline.
Time Frame
24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥16 years. Diagnosis of FRDA, genetically documented to be due to homozygosity for a GAA repeat expansion in intron 1 of FXN. Functional stage on the Ataxia subscale of the full FARS of 1 or higher (a score of 1 is assigned if the subject has "Minimal signs detected by the physician during screening. Can run or jump without loss of balance. No disability."), and total mFARS score of ≤ 65. Adequate end organ function defined as follows: (i) total bilirubin <2x upper limit of normal unless attributable to Gilbert disease, (ii) ALT and AST <1.5x upper limit of normal, (iii) Creatinine <2x upper limit of normal, (iv) neutrophils >1.5x10^9/L, (v) platelets >10^6/μL. Written informed consent provided. Exclusion Criteria: Non-elective hospitalisation within the past 60 days that could be of concern in the investigator's judgment. Any hospitalisation in the previous 60 days will be assessed and if in the investigator's judgement it could compromise the individual or the study, that person will not be recruited. Examples include if the individual is hospitalised for management of cardiac morbidity such as uncontrolled arrhythmia or angina or for orthopaedic surgery for a lower limb fracture. Women who are pregnant or lactating or men and women of childbearing potential who are unwilling to use contraception for the duration of the study. FRDA due to compound heterozygosity for an expanded GAA repeat and a point mutation/ deletion in the FXN gene. Current or recent (in last 12 months) arrhythmias including: atrial fibrillation, atrial flutter, sinus tachycardia >120/min, sinus bradycardia <50/min. Symptomatic paroxysmal arrhythmia which is recurring frequently. Cardiac insufficiency (by New York Heart Association >2). Reduced LV ejection fraction (<50%) in the last six months. Medical illness that in the judgment of the investigator would jeopardise the safe completion of the study. Examples include cancer, chronic inflammatory disease, severe diabetes (type I or II, HbA1c >8%), chronic liver insufficiency, epilepsy, thrombocytosis. Evidence of end organ dysfunction through failure to meet one or more parameters in inclusion criterion number 4. Prior invasive cancer (excluding localised basal cell or squamous cell skin cancer). Known hypersensitivity to resveratrol. Use of any investigational agent within 30 days of enrolment. Use of antioxidants such as vitamin E, coenzyme Q10 or idebenone within 30 days prior to enrolment. Concomitant use of medications with potential for clinically relevant drug interactions. This includes medications with a narrow therapeutic range that are metabolised by the cytochrome P450 3A4, 2D6 or 2C9 systems e.g. warfarin, amiodarone.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Martin B Delatycki, PhD, MBBS
Organizational Affiliation
Murdoch Children's Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Royal North Shore Hospital
City
St Leonards
State/Province
New South Wales
ZIP/Postal Code
2065
Country
Australia
Facility Name
University of Queensland Centre for Clinical Research
City
Herston
State/Province
Queensland
ZIP/Postal Code
4029
Country
Australia
Facility Name
Murdoch Children's Research Institute
City
Parkville
State/Province
Victoria
ZIP/Postal Code
3052
Country
Australia
Facility Name
Royal Perth Hospital
City
Perth
State/Province
Western Australia
ZIP/Postal Code
6000
Country
Australia

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The de-identified data set collected for analysis of the study will be available six months after publication of the primary outcome. The study protocol, analysis plan and consent forms will also be available. The data may be obtained from the Murdoch Children's Research Institute by contacting martin.delatycki@vcgs.org.au.
IPD Sharing Time Frame
6 months after publication of primary outcome
IPD Sharing Access Criteria
Prior to releasing any data the following are required: a data access agreement must be signed between relevant parties and there must be an agreement around appropriate acknowledgement and any additional costs involved must be covered. Data will only be shared with a recognised research institution which has approved the proposed analysis plan.

Learn more about this trial

Micronised Resveratrol as a Treatment for Friedreich Ataxia

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