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Study of AD128 Versus Placebo in Obstructive Sleep Apnea

Primary Purpose

Obstructive Sleep Apnea

Status
Completed
Phase
Phase 2
Locations
Italy
Study Type
Interventional
Intervention
AD128
Placebo
Sponsored by
Istituto Auxologico Italiano
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Obstructive Sleep Apnea focused on measuring Obstructive Sleep Apnea, Apnea Hypopnea Index

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients who are able to understand the nature of the study and to give free informed consent
  • AHI ≥ 15 on screening/baseline PSG
  • Any of the following conditions should be met:

    1. Documented prior PSG within 1 year demonstrating AHI of 15 or higher
    2. Documented Continuous Positive Airway Pressure (CPAP) intolerance or poor compliance (compliance is defined as self-reported use of CPAP 4 hours per night for 70% of nights) or CPAP-naïve.
    3. Patients who have been using CPAP at least 4 hours nightly for at least 70% of the nights are eligible only if CPAP is not used for 2 weeks prior to the screening/study baseline PSG.
  • Epworth Sleepiness Scale (ESS) score ≥ 4 for patients not using CPAP
  • Previous surgical treatment for OSA is allowed if ≥ 1 year prior to enrollment.
  • BMI between 18.5 and 40.0 kg/m2, inclusive

Exclusion Criteria:

  • History of narcolepsy.
  • Clinically significant craniofacial malformation.
  • Clinically significant cardiac disease or hypertension requiring more than 3 medications for control.
  • Clinically significant neurological disorder, including epilepsy/convulsions
  • History of schizophrenia, schizoaffective disorder or bipolar disorder according to - Diagnostic and Statistical Manual of Mental Disorders-V (DSM V) or International Classification of Disease X edition criteria.
  • History of attempted suicide or suicidal ideation within 1 year prior to screening, or current suicidal ideation.
  • Positive history for abuse of drugs or substance use disorder as defined in DSM-V within 12 months prior to Screening Visit.
  • A significant illness or infection requiring medical treatment in the past 30 days.
  • Clinically significant cognitive dysfunction.
  • Untreated narrow angle glaucoma.
  • Women who are pregnant or nursing.
  • History of using oral or nasal devices for the treatment of OSA may enroll as long as the devices are not used during participation in the study.
  • History of using devices to affect participant sleeping position for the treatment of OSA, e.g. to discourage supine sleeping position, may enroll as long as the devices are not used during participation in the study.
  • History of oxygen therapy.
  • Use of medications from the list of disallowed concomitant medications.
  • Treatment with strong cytochrome P450 3A4 (CYP3A4) inhibitors, or monoamine oxidase inhibitors (MAOI) or linezolid within 14 days of the start of treatment, or concomitant with treatment.
  • Use of another investigational agent within 30 days or 5 half-lives, whichever is longer, prior to dosing.
  • Central apnea index > 5/hour on baseline PSG
  • Any condition that in the investigator's opinion would present an unreasonable risk to the participant, or which would interfere with their participation in the study or confound study interpretation.
  • Patients considered by the investigator, for any reason, unsuitable candidates to receive AD128 treatment or unable or unlikely to understand or comply with the dosing schedule or study evaluations.

Sites / Locations

  • Istituto Auxologico Italiano,Ospedale San Luca

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Treatment Group 1

Treatment Group 2

Arm Description

AD128 for 7 days, then, after a wash-out period of 7-10 days, placebo for 7 days

Placebo for 7 days, then, after a wash-out period of 7-10 days, AD128 for 7 days

Outcomes

Primary Outcome Measures

Change in Apnea-Hypopnea Index (AHI)
The percentage change of mean AHI will be compared between treatment groups.

Secondary Outcome Measures

AHI decrease ≥50%
The proportion of patients with AHI decrease ≥50% will be calculated.
AHI<15/hour
The number of patients with AHI <15/hour measured during the inpatient night Polysomnography will be compared between treatment groups.
Change in Epworth Sleepiness Scale (ESS)
The ESS is a self-administered questionnaire which measures the daytime sleepiness. The ESS score can range from 0 to 24. The change will be measured in terms of difference from baseline and between treatment groups.
Change in Karolinska Sleepiness Scale (KSS)
The KSS is a self-reported 9-points scale which measure the subjective level of sleepiness at a particular time during the day. The change will be measured in terms of difference from baseline and between treatment groups.
Patient Global Impression of OSA Severity (PGI-S)
The PGI-S is a single question asking the patient to rate on a scale, ranging from 0 to 4, the severity of the OSA condition at that time.
Change in Psychomotor Vigilance Test (PVT)
PVT is a chronometric measure of a patient's reaction time to a visual stimulus. PVT reaction times/lapses and failures to react will be measured. The change will be measured in terms of difference from baseline and between treatment groups.
Change in Oxygen Desaturation Index (ODI) 3%
The number of times per hour of sleep that the blood's oxygen level drops by 3% from baseline will be measured by means of a CE marked oximeter capable of nightly recording and storage of data for the entire at-home period. The change in mean value from baseline will be compared between treatment groups.
Change in total time with Oxygen Saturation (SaO2) <90%
Change in mean SaO2
Change in minimum SaO2
Change in arousal index
The number of arousals will be registered during the polysomnography and reported as a frequency per hour of sleep. The change in mean value from baseline will be compared between treatment groups.
Change in periodic limb movement
The number of periodic limb movements will be measured during the polysomnography. The change in mean value from baseline will be compared between treatment groups.
Oxygen Desaturation Index 4%
The number of times per hour of sleep that the blood's oxygen level drops by 4% or more from baseline will be measured by means of a CE marked oximeter capable of nightly recording and storage of data. The average numbers will be compared between treatment groups.
Adverse Events (AE)
All adverse events occurring to patients after recruitment in the study will be recorded. The total number of AEs, their severity and their seriousness will be compared between treatment groups.

Full Information

First Posted
June 23, 2020
Last Updated
September 21, 2021
Sponsor
Istituto Auxologico Italiano
Collaborators
YGHEA, CRO Division of Ecol Studio spa, STM Pharma PRO srl, Apnimed Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04449133
Brief Title
Study of AD128 Versus Placebo in Obstructive Sleep Apnea
Official Title
Crossover, Double-blind, Phase 2 Study of AD128 Versus Placebo in Obstructive Sleep Apnea
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Completed
Study Start Date
July 3, 2020 (Actual)
Primary Completion Date
October 30, 2020 (Actual)
Study Completion Date
October 31, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Istituto Auxologico Italiano
Collaborators
YGHEA, CRO Division of Ecol Studio spa, STM Pharma PRO srl, Apnimed Inc.

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
Obstructive Sleep Apnea (OSA) is the most common and serious of the sleep disorders. Long-term, OSA is associated with increased morbidity and mortality, with a number of adverse cardiovascular, neurocognitive, metabolic, and daytime functioning consequences. No drugs are currently approved for OSA treatment. This is a randomized, double blind, placebo controlled, cross-over, inpatient phase 2 clinical trial to examine the efficacy and the safety of a fixed dose level of AD128 in patients with OSA.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obstructive Sleep Apnea
Keywords
Obstructive Sleep Apnea, Apnea Hypopnea Index

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
Patients who meet the eligibility criteria will be assigned alternatively to the the treatment with a AD128 or matching placebo. After 7 days of treatment and a washout period, the patients will crossover to the other arm for 7 days.
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment Group 1
Arm Type
Experimental
Arm Description
AD128 for 7 days, then, after a wash-out period of 7-10 days, placebo for 7 days
Arm Title
Treatment Group 2
Arm Type
Experimental
Arm Description
Placebo for 7 days, then, after a wash-out period of 7-10 days, AD128 for 7 days
Intervention Type
Drug
Intervention Name(s)
AD128
Intervention Description
Oral administration of two capsules before sleep for 7 days.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Oral administration of two capsules before sleep for 7 days.
Primary Outcome Measure Information:
Title
Change in Apnea-Hypopnea Index (AHI)
Description
The percentage change of mean AHI will be compared between treatment groups.
Time Frame
From the screening/baseline to the last day of treatment (7 days after the start of each treatment period).
Secondary Outcome Measure Information:
Title
AHI decrease ≥50%
Description
The proportion of patients with AHI decrease ≥50% will be calculated.
Time Frame
From screening/baseline to the last day of treatment (7 days after the start of each treatment period).
Title
AHI<15/hour
Description
The number of patients with AHI <15/hour measured during the inpatient night Polysomnography will be compared between treatment groups.
Time Frame
From screening/baseline to the last day of treatment (7 days after the start of each treatment period).
Title
Change in Epworth Sleepiness Scale (ESS)
Description
The ESS is a self-administered questionnaire which measures the daytime sleepiness. The ESS score can range from 0 to 24. The change will be measured in terms of difference from baseline and between treatment groups.
Time Frame
From screening/baseline to the last day of treatment (7 days after the start of each treatment period).
Title
Change in Karolinska Sleepiness Scale (KSS)
Description
The KSS is a self-reported 9-points scale which measure the subjective level of sleepiness at a particular time during the day. The change will be measured in terms of difference from baseline and between treatment groups.
Time Frame
From screening/baseline to the last day of treatment (7 days after the start of each treatment period).
Title
Patient Global Impression of OSA Severity (PGI-S)
Description
The PGI-S is a single question asking the patient to rate on a scale, ranging from 0 to 4, the severity of the OSA condition at that time.
Time Frame
From screening/baseline to the last day of treatment (7 days after the start of each treatment period).
Title
Change in Psychomotor Vigilance Test (PVT)
Description
PVT is a chronometric measure of a patient's reaction time to a visual stimulus. PVT reaction times/lapses and failures to react will be measured. The change will be measured in terms of difference from baseline and between treatment groups.
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Change in Oxygen Desaturation Index (ODI) 3%
Description
The number of times per hour of sleep that the blood's oxygen level drops by 3% from baseline will be measured by means of a CE marked oximeter capable of nightly recording and storage of data for the entire at-home period. The change in mean value from baseline will be compared between treatment groups.
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Change in total time with Oxygen Saturation (SaO2) <90%
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Change in mean SaO2
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Change in minimum SaO2
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Change in arousal index
Description
The number of arousals will be registered during the polysomnography and reported as a frequency per hour of sleep. The change in mean value from baseline will be compared between treatment groups.
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Change in periodic limb movement
Description
The number of periodic limb movements will be measured during the polysomnography. The change in mean value from baseline will be compared between treatment groups.
Time Frame
From screening/baseline to last day of treatment (7 days after the start of each treatment period).
Title
Oxygen Desaturation Index 4%
Description
The number of times per hour of sleep that the blood's oxygen level drops by 4% or more from baseline will be measured by means of a CE marked oximeter capable of nightly recording and storage of data. The average numbers will be compared between treatment groups.
Time Frame
For the entire at home treatment period: days 1-7 (before crossover) and days 15-20 (after crossover)
Title
Adverse Events (AE)
Description
All adverse events occurring to patients after recruitment in the study will be recorded. The total number of AEs, their severity and their seriousness will be compared between treatment groups.
Time Frame
From screening/baseline to 4 weeks after last day of treatment.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients who are able to understand the nature of the study and to give free informed consent AHI ≥ 15 on screening/baseline PSG Any of the following conditions should be met: Documented prior PSG within 1 year demonstrating AHI of 15 or higher Documented Continuous Positive Airway Pressure (CPAP) intolerance or poor compliance (compliance is defined as self-reported use of CPAP 4 hours per night for 70% of nights) or CPAP-naïve. Patients who have been using CPAP at least 4 hours nightly for at least 70% of the nights are eligible only if CPAP is not used for 2 weeks prior to the screening/study baseline PSG. Epworth Sleepiness Scale (ESS) score ≥ 4 for patients not using CPAP Previous surgical treatment for OSA is allowed if ≥ 1 year prior to enrollment. BMI between 18.5 and 40.0 kg/m2, inclusive Exclusion Criteria: History of narcolepsy. Clinically significant craniofacial malformation. Clinically significant cardiac disease or hypertension requiring more than 3 medications for control. Clinically significant neurological disorder, including epilepsy/convulsions History of schizophrenia, schizoaffective disorder or bipolar disorder according to - Diagnostic and Statistical Manual of Mental Disorders-V (DSM V) or International Classification of Disease X edition criteria. History of attempted suicide or suicidal ideation within 1 year prior to screening, or current suicidal ideation. Positive history for abuse of drugs or substance use disorder as defined in DSM-V within 12 months prior to Screening Visit. A significant illness or infection requiring medical treatment in the past 30 days. Clinically significant cognitive dysfunction. Untreated narrow angle glaucoma. Women who are pregnant or nursing. History of using oral or nasal devices for the treatment of OSA may enroll as long as the devices are not used during participation in the study. History of using devices to affect participant sleeping position for the treatment of OSA, e.g. to discourage supine sleeping position, may enroll as long as the devices are not used during participation in the study. History of oxygen therapy. Use of medications from the list of disallowed concomitant medications. Treatment with strong cytochrome P450 3A4 (CYP3A4) inhibitors, or monoamine oxidase inhibitors (MAOI) or linezolid within 14 days of the start of treatment, or concomitant with treatment. Use of another investigational agent within 30 days or 5 half-lives, whichever is longer, prior to dosing. Central apnea index > 5/hour on baseline PSG Any condition that in the investigator's opinion would present an unreasonable risk to the participant, or which would interfere with their participation in the study or confound study interpretation. Patients considered by the investigator, for any reason, unsuitable candidates to receive AD128 treatment or unable or unlikely to understand or comply with the dosing schedule or study evaluations.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elisa Perger, MD
Organizational Affiliation
Istituto Auxologico Italiano
Official's Role
Principal Investigator
Facility Information:
Facility Name
Istituto Auxologico Italiano,Ospedale San Luca
City
Milano
Country
Italy

12. IPD Sharing Statement

Citations:
PubMed Identifier
34543665
Citation
Perger E, Taranto Montemurro L, Rosa D, Vicini S, Marconi M, Zanotti L, Meriggi P, Azarbarzin A, Sands SA, Wellman A, Lombardi C, Parati G. Reboxetine Plus Oxybutynin for OSA Treatment: A 1-Week, Randomized, Placebo-Controlled, Double-Blind Crossover Trial. Chest. 2022 Jan;161(1):237-247. doi: 10.1016/j.chest.2021.08.080. Epub 2021 Sep 20.
Results Reference
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Study of AD128 Versus Placebo in Obstructive Sleep Apnea

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