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Investigation of Cognitive Outcomes With Cannabidiol Oral Solution (EPI-COG)

Primary Purpose

Lennox-Gastaut Syndrome

Status
Withdrawn
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
GWP42003-P
Sponsored by
Jazz Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lennox-Gastaut Syndrome focused on measuring GWP42003-P, EPIDIOLEX®, cannabidiol, CBD, cognition

Eligibility Criteria

3 Years - 10 Years (Child)All SexesDoes not accept healthy volunteers

Key Inclusion Criteria:

  • Participant is male or female aged 3-10 years.
  • Participants' parent(s)/legal representative is willing and able to give informed consent for participation in the trial; where the participant possesses adequate understanding, informed assent should also be taken.
  • Participant and their caregiver are willing and able (in the investigator's opinion) to comply with all trial requirements.
  • Participant must have a clinical diagnosis of Lennox-Gastaut Syndrome (LGS), with onset within the last 5 years. This includes certification from the investigator of prior electroencephalogram (EEG) documenting slow spike wave (< 3 Hertz [Hz]) during the participant's history and evidence of more than 1 type of generalized seizure, including drop seizures (atonic, tonic, or tonic-clonic), for at least 6 months.
  • Investigator can confirm that the addition of GWP42003-P to the participant's existing antiepileptic drug (AED) regimen is warranted.
  • Participant must have at least 1 drop seizure each week during the first 28 days of the baseline period.
  • A minimum level of general intellectual functioning as assessed at screening with the Peabody Picture Vocabulary Test
  • Participant's parent(s)/legal representative is willing to allow the responsible authorities to be notified of participation in the trial, if mandated by local law.
  • Participant's parent(s)/legal representative is willing to allow his or her primary care practitioner (if they have one) and consultant (if they have one) to be notified of participation in the trial, if the primary care practitioner/consultant is different to the investigator.

Key Exclusion Criteria:

  • Participant has clinically significant unstable medical conditions other than epilepsy.
  • Participant experiences > 300 total seizures within the first 28 days of the baseline period.
  • Participant has any prior exposure to GWP42003-P.
  • Participant has initiated felbamate within the last 12 months.
  • Participant has initiated mammalian target of rapamycin (mTOR) inhibitors for epilepsy within the last 4 weeks.
  • Participant is currently using or has in the past used recreational or medicinal cannabis or synthetic cannabinoid-based medications (including Sativex®) within the 3 months prior to trial entry.
  • Participant has had clinically relevant symptoms or a clinically significant illness, other than epilepsy, in the 4 weeks prior to screening or Visit 2.
  • Participant has laboratory values at screening or Visit 2 that are clinically significantly abnormal in the investigator's opinion.
  • Participant tests positive for Δ9-tetrahydrocannabinol (THC) or cannabidiol (CBD) at screening.
  • Participant has any known or suspected hypersensitivity to cannabinoids or any of the excipients of GWP42003-P.
  • Participant has significantly impaired hepatic function at the screening visit, defined as any of the following:

    • Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 5 × upper limit of normal (ULN);
    • Serum ALT or AST > 3 × ULN and (total bilirubin [TBL] > 2 × ULN or international normalized ratio [INR] > 1.5);
    • Serum ALT or AST > 3 × ULN with the presence of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, and/or eosinophilia (> 5%).
  • Participant has received an investigational medical product within the 3 months prior to the screening visit.
  • Participant has any other significant disease or disorder, which, in the opinion of the investigator, may either put the participant at risk because of participation in the trial, may influence the result of the trial, or may affect the participant's ability to take part in the trial.
  • Any abnormalities identified following a physical examination of the participant that, in the opinion of the investigator, would jeopardize the safety of the participant if he/she took part in the trial
  • Participant has been previously enrolled into this trial.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    GWP42003-P

    Arm Description

    For the first 7 days of the treatment period, participants are to take GWP42003-P at a dose of 5 milligrams per kilogram per day (mg/kg/day), administered as 2 equally divided doses (i.e., 2.5 mg/kg in the morning and 2.5 mg/kg in the evening). On Day 8, participants are to increase the dose to 10 mg/kg/day, administered as 2 equally divided doses (i.e., 5 mg/kg in the morning and 5 mg/kg in the evening). The 10 mg/kg/day dose should be maintained for the remainder of the treatment period; however, per labeling, investigators may increase the dose to a maximum of 20 mg/kg/day if clinically warranted by titrating an additional 5 mg/kg/day each week until reaching the maximum dose. GWP42003-P will be taken b.i.d. (morning and evening).

    Outcomes

    Primary Outcome Measures

    Change from Baseline to end of treatment (Day 181 [Visit 5]) in processing speed on the National Institutes of Health Toolbox Cognition Battery (NIHTCB)

    Secondary Outcome Measures

    Change from Baseline to Day 91 (Visit 4) in processing speed on the NIHTCB
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in executive function and attention on the NIHTCB
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in episodic memory on the NIHTCB
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in language on the NIHTCB
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the NIHTCB Childhood Composite Score
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) or BRIEF, Preschool (BRIEF-P) for participants aged 5 years or younger
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in weekly seizure frequency
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in behavior using the Aberrant Behavior Checklist, Second Edition Community Forms (ABC-2-3)
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in sleep characteristics using the Children's Sleep Habits Questionnaire (CSHQ)
    Change from Baseline to Day 181 (end of treatment; Visit 5) in quality of life using the Pediatric Quality of Life Inventory (PEDS-QL4)
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in generic health status using the EQ-5D-Y Proxy Version 1
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the Caregiver Global Impression of Change (CGIC) score
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in Patient-Reported Outcomes Measurement Information System (PROMIS®) - Parent Proxy Short Form Anxiety and Depression Subscales
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in Parenting Stress Index, Fourth Edition (PSI-4)
    Change from Baseline to Day 181 (end of treatment; Visit 5) in the participant's ability to perform day-to-day tasks
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the Physician Global Impression of Change (PGIC) score
    Number of participants with the indicated type of adverse event
    Number of participants with clinically significant changes in laboratory parameter values
    Number of participants with clinically significant changes in physical examination findings
    Number of participants with clinically significant changes in vital sign values

    Full Information

    First Posted
    October 17, 2019
    Last Updated
    August 31, 2022
    Sponsor
    Jazz Pharmaceuticals
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04133480
    Brief Title
    Investigation of Cognitive Outcomes With Cannabidiol Oral Solution
    Acronym
    EPI-COG
    Official Title
    An Open-Label Exploratory Investigation of Cognitive Outcomes With Cannabidiol Oral Solution (EPIDIOLEX®; GWP42003-P)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    August 2022
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    The decision to withdraw the study was based on pandemic-related concerns of conducting a Phase IV study requiring multiple clinic visits when medication is commercially available. The study was withdrawn before any participants were recruited.
    Study Start Date
    October 2020 (Anticipated)
    Primary Completion Date
    December 2021 (Anticipated)
    Study Completion Date
    December 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Jazz Pharmaceuticals

    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.
    No

    5. Study Description

    Brief Summary
    This study is being conducted to evaluate the effects of GWP42003-P on cognition in pediatric participants, aged 3 to 10 years, with Lennox-Gastaut Syndrome (LGS).
    Detailed Description
    This trial is a 30-week (4-week baseline period; 26-week treatment period) open-label exploratory investigation of the effects of GWP42003-P on cognitive abilities in participants with LGS who reside in the United States.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Lennox-Gastaut Syndrome
    Keywords
    GWP42003-P, EPIDIOLEX®, cannabidiol, CBD, cognition

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    GWP42003-P
    Arm Type
    Experimental
    Arm Description
    For the first 7 days of the treatment period, participants are to take GWP42003-P at a dose of 5 milligrams per kilogram per day (mg/kg/day), administered as 2 equally divided doses (i.e., 2.5 mg/kg in the morning and 2.5 mg/kg in the evening). On Day 8, participants are to increase the dose to 10 mg/kg/day, administered as 2 equally divided doses (i.e., 5 mg/kg in the morning and 5 mg/kg in the evening). The 10 mg/kg/day dose should be maintained for the remainder of the treatment period; however, per labeling, investigators may increase the dose to a maximum of 20 mg/kg/day if clinically warranted by titrating an additional 5 mg/kg/day each week until reaching the maximum dose. GWP42003-P will be taken b.i.d. (morning and evening).
    Intervention Type
    Drug
    Intervention Name(s)
    GWP42003-P
    Other Intervention Name(s)
    Cannabidiol, CBD, Epidiolex
    Intervention Description
    oral solution of 100 milligrams per milliliter (mg/mL) cannabidiol (CBD)
    Primary Outcome Measure Information:
    Title
    Change from Baseline to end of treatment (Day 181 [Visit 5]) in processing speed on the National Institutes of Health Toolbox Cognition Battery (NIHTCB)
    Time Frame
    Baseline; Day 181
    Secondary Outcome Measure Information:
    Title
    Change from Baseline to Day 91 (Visit 4) in processing speed on the NIHTCB
    Time Frame
    Baseline; Day 91
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in executive function and attention on the NIHTCB
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in episodic memory on the NIHTCB
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in language on the NIHTCB
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the NIHTCB Childhood Composite Score
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) or BRIEF, Preschool (BRIEF-P) for participants aged 5 years or younger
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in weekly seizure frequency
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in behavior using the Aberrant Behavior Checklist, Second Edition Community Forms (ABC-2-3)
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in sleep characteristics using the Children's Sleep Habits Questionnaire (CSHQ)
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 181 (end of treatment; Visit 5) in quality of life using the Pediatric Quality of Life Inventory (PEDS-QL4)
    Time Frame
    Baseline; Day 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in generic health status using the EQ-5D-Y Proxy Version 1
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the Caregiver Global Impression of Change (CGIC) score
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in Patient-Reported Outcomes Measurement Information System (PROMIS®) - Parent Proxy Short Form Anxiety and Depression Subscales
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in Parenting Stress Index, Fourth Edition (PSI-4)
    Time Frame
    Baseline; Days 91 and 181
    Title
    Change from Baseline to Day 181 (end of treatment; Visit 5) in the participant's ability to perform day-to-day tasks
    Time Frame
    Baseline; Day181
    Title
    Change from Baseline to Day 91 (Visit 4) and Day 181 (end of treatment; Visit 5) in the Physician Global Impression of Change (PGIC) score
    Time Frame
    Baseline; Days 91 and 181
    Title
    Number of participants with the indicated type of adverse event
    Time Frame
    up to Day 219
    Title
    Number of participants with clinically significant changes in laboratory parameter values
    Time Frame
    Baseline; up to Day 191
    Title
    Number of participants with clinically significant changes in physical examination findings
    Time Frame
    Baseline; up to Day 191
    Title
    Number of participants with clinically significant changes in vital sign values
    Time Frame
    Baseline; up to Day 191

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    3 Years
    Maximum Age & Unit of Time
    10 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Key Inclusion Criteria: Participant is male or female aged 3-10 years. Participants' parent(s)/legal representative is willing and able to give informed consent for participation in the trial; where the participant possesses adequate understanding, informed assent should also be taken. Participant and their caregiver are willing and able (in the investigator's opinion) to comply with all trial requirements. Participant must have a clinical diagnosis of Lennox-Gastaut Syndrome (LGS), with onset within the last 5 years. This includes certification from the investigator of prior electroencephalogram (EEG) documenting slow spike wave (< 3 Hertz [Hz]) during the participant's history and evidence of more than 1 type of generalized seizure, including drop seizures (atonic, tonic, or tonic-clonic), for at least 6 months. Investigator can confirm that the addition of GWP42003-P to the participant's existing antiepileptic drug (AED) regimen is warranted. Participant must have at least 1 drop seizure each week during the first 28 days of the baseline period. A minimum level of general intellectual functioning as assessed at screening with the Peabody Picture Vocabulary Test Participant's parent(s)/legal representative is willing to allow the responsible authorities to be notified of participation in the trial, if mandated by local law. Participant's parent(s)/legal representative is willing to allow his or her primary care practitioner (if they have one) and consultant (if they have one) to be notified of participation in the trial, if the primary care practitioner/consultant is different to the investigator. Key Exclusion Criteria: Participant has clinically significant unstable medical conditions other than epilepsy. Participant experiences > 300 total seizures within the first 28 days of the baseline period. Participant has any prior exposure to GWP42003-P. Participant has initiated felbamate within the last 12 months. Participant has initiated mammalian target of rapamycin (mTOR) inhibitors for epilepsy within the last 4 weeks. Participant is currently using or has in the past used recreational or medicinal cannabis or synthetic cannabinoid-based medications (including Sativex®) within the 3 months prior to trial entry. Participant has had clinically relevant symptoms or a clinically significant illness, other than epilepsy, in the 4 weeks prior to screening or Visit 2. Participant has laboratory values at screening or Visit 2 that are clinically significantly abnormal in the investigator's opinion. Participant tests positive for Δ9-tetrahydrocannabinol (THC) or cannabidiol (CBD) at screening. Participant has any known or suspected hypersensitivity to cannabinoids or any of the excipients of GWP42003-P. Participant has significantly impaired hepatic function at the screening visit, defined as any of the following: Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 5 × upper limit of normal (ULN); Serum ALT or AST > 3 × ULN and (total bilirubin [TBL] > 2 × ULN or international normalized ratio [INR] > 1.5); Serum ALT or AST > 3 × ULN with the presence of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, and/or eosinophilia (> 5%). Participant has received an investigational medical product within the 3 months prior to the screening visit. Participant has any other significant disease or disorder, which, in the opinion of the investigator, may either put the participant at risk because of participation in the trial, may influence the result of the trial, or may affect the participant's ability to take part in the trial. Any abnormalities identified following a physical examination of the participant that, in the opinion of the investigator, would jeopardize the safety of the participant if he/she took part in the trial Participant has been previously enrolled into this trial.

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    Investigation of Cognitive Outcomes With Cannabidiol Oral Solution

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