Open-label Extension Study in Paediatric Patients Who Have Completed the MEX-NM-301 Study.
Primary Purpose
Myotonic Disorders
Status
Recruiting
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Mexiletine
Sponsored by
About this trial
This is an interventional treatment trial for Myotonic Disorders
Eligibility Criteria
Inclusion Criteria:
- Patients previously completed the parent study PIP study 4 (MEX-NM-301) and tolerated the Mexiletine in the study.
- Able and willing to provide assent to study participation and a parent or legal guardian willing to sign written informed consent prior to study entry.
Patients continue to meet inclusion criteria of parent study (MEX-NM-301):
- No significant cardiac abnormalities as determined by a cardiologist's assessment of the ECG and Echocardiogram
- No history or evidence of any significant liver disorder Laboratory investigations for haematology, biochemistry, and urinalysis at screening are within normal range, or showing no clinically relevant abnormal values, as judged by the Investigator
- Female patients of childbearing potential must be using an acceptable form of birth control as determined by the Investigator (e.g., oral contraception, implantable, injectable/transdermal hormonal contraception, intrauterine device (IUD), barrier methods), tubal ligation or have a vasectomized partner or are practicing abstinence
Exclusion Criteria:
- Clinically significant laboratory abnormality, ECG or other clinical findings on physical examination indicative of a clinically significant exclusionary disease as determined by the investigator
Any contra-indication to mexiletine (as described in the Namuscla Summary of Product Characteristics [SmPC])
- Hypersensitivity to the active substance, or to any of the excipients
- Hypersensitivity to any local anaesthetic
- Ventricular tachyarrhythmia
- Complete heart block (i.e., third-degree atrioventricular block) or any heart block susceptible to evolve to complete heart block (first-degree atrioventricular block with markedly prolonged PR interval (≥ 200 ms) and/or wide QRS complex (≥ 120 ms), second-degree atrioventricular block, bundle branch block, bifascicular and trifascicular block),
- QT interval > 450ms
- Myocardial infarction (acute or past), or abnormal Q-waves
- Symptomatic coronary artery disease
- Heart failure with ejection fraction <50%
- Atrial tachyarrhythmia, fibrillation or flutter
- Sinus node dysfunction (including sinus rate < 50 bpm)
- Co-administration with medicinal products inducing torsades de pointes (class Ia, Ic, III antiarrhythmics): Co-administration of mexiletine and antiarrhythmics inducing torsades de pointes (class Ia: quinidine, procainamide, disopyramide, ajmaline; class Ic: encainide, flecainide, propafenone, moricizine; class III: amiodarone, sotalol, ibutilide, dofetilide, dronedarone, vernakalant) increases the risk of potentially lethal torsades de pointes.
- Co-administration with medicinal products with narrow therapeutic index
- Co- administration with antiarrhythmics
- Any other neurological or psychiatric condition that might affect the assessment of the study measurements
- Any concurrent illness, or medications which could affect the muscle function
- Seizure disorder, diabetes mellitus requiring treatment by insulin
- Pregnant or breastfeeding
- Concurrent participation in any other clinical trial.
Sites / Locations
- Hôpital Necker-Enfants-MaladesRecruiting
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
Cohort 1 and 2
Arm Description
7 patients aged 12 to < 18 years , inclusive in cohort-1 7 patients aged 6 to < 12 years, inclusive in cohort-2
Outcomes
Primary Outcome Measures
Assess the long-term safety and tolerability of mexiletine by AEs
Assess the long-term safety and tolerability of mexiletine in paediatric patients by number and frequency of AEs/SAEs, throughout the study while on treatment
Assess the long-term safety and tolerability of mexiletine by hand relaxation
Mean time (in seconds) to relaxation of hand muscles and reduction in relaxation time from the first to the fifth contraction
Assess the long-term safety and tolerability of mexiletine measurement of AESI
Assess the long-term safety and tolerability of mexiletine in paediatric patients by Incidence of adverse events of special interest (AESI),
Assess the long-term safety and tolerability of mexiletine by changes in ECG
Assess the long-term safety and tolerability of mexiletine in paediatric patients by changes in ECG assessments from baseline, repeated at each study visit
Assess the long-term safety and tolerability of mexiletine by muscle stiffness
Score for muscle stiffness (myotonia severity) as self-reported by the patients on a Visual Analog Scale (VAS) or Faces scale
Secondary Outcome Measures
Mean change in VAS
Mean change in VAS (8 to < 18 years) or Faces (6 to < 8 years) score for severity of muscle stiffness (if not a primary endpoint) pain, weakness and fatigue (every 3 months).
Clinical myotonia assessment
Mean change in time to open the eyes after forced eye closure as measured on a stopwatch (when eyelid myotonia present)
Mean change in health-related quality-of-life
Mean change in health-related quality-of-life as measured by the Paediatric Quality of Life (PedsQL) score (secondary endpoint for patients aged 6 years to <18 years; every 6 months).
Clinical Global Impression (CGI) scores
Clinical Global Impression (CGI) scores (efficacy and tolerability) evaluated by the patient, a parent or proxy and by the investigator. Measured every 6 months
Mean change in Myotonia Behaviour Scale (MBS) scores
Mean change in Myotonia Behaviour Scale (MBS) scores (for patients aged 6 years to < 18 years; measured every 6 months).
Mean change in time to perform Timed-up and go (TUG) test
Mean change in time to perform Timed-up and go (TUG) test (patients aged 6 to <18 years only)
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04622553
Brief Title
Open-label Extension Study in Paediatric Patients Who Have Completed the MEX-NM-301 Study.
Official Title
Open-label Extension Study to Evaluate the Long-term Safety and Efficacy of Mexiletine in Paediatric Patients With Myotonic Disorders Who Have Completed the MEX-NM-301 Study.
Study Type
Interventional
2. Study Status
Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 5, 2021 (Actual)
Primary Completion Date
January 26, 2026 (Anticipated)
Study Completion Date
March 12, 2026 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Lupin Ltd.
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
Open-label Extension Study to Evaluate the Long-term Safety and Efficacy of Mexiletine in Paediatric Patients with Myotonic Disorders Who Have Completed the MEX-NM-301 study.
Detailed Description
This is an open-label extension study evaluating the long-term efficacy and safety of mexiletine in paediatric patients with myotonic disorders who have completed the initial parent paediatric study with mexiletine (Protocol No. MEX-NM-301 (PIP Study 4) for children and adolescents aged 6 to < 18 years and who continue to meet the eligibility criteria.
Patients who meet the eligibility criteria and provide consent for this study will be enrolled sequentially by decreasing age groups. Patients aged 12 to < 18 years will enter first as this is the first cohort expected to complete the parent study PIP Study 4 based on top down recruiting. Once initial pharmacokinetics (PK), safety and efficacy are confirmed in this population, patients aged 6 to <12 years will be first enrolled in PIP Study 4 and subsequently this study (PIP Study 7).
Enrolled patients will receive mexiletine at a dose determined in the parent study. Dosing is determined according to body weight and tolerability.
The study includes 9 clinic visits - V1 (baseline), and V2 to V9 every 3 months, approximately, thereafter.
The total duration of study will be 24 months per patient. End-of-treatment (EOT) visit will occur at 24 months or in accordance with the availability of product. The overall study duration would be approximately 5 years.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myotonic Disorders
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
The aim of this study is to obtain additional information regarding the long-term safety and efficacy of mexiletine for the symptomatic treatment of myotonia in paediatric subjects who have completed the initial paediatric study MEX-NM-301.
Masking
None (Open Label)
Allocation
N/A
Enrollment
14 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Cohort 1 and 2
Arm Type
Other
Arm Description
7 patients aged 12 to < 18 years , inclusive in cohort-1 7 patients aged 6 to < 12 years, inclusive in cohort-2
Intervention Type
Drug
Intervention Name(s)
Mexiletine
Other Intervention Name(s)
Namuscla ™
Intervention Description
Patients will be enrolled sequentially into 2 cohorts.
Cohort 1 - (patients aged 12 to < 18 years):
approximately 8 weeks - 4 weeks of dose titration period + 4 weeks of maintenance period.
Cohort 2- (patients aged 6 to < 12 years,):
approximately 8 weeks - 4 weeks of dose titration period + 4 weeks of maintenance period. Enrolment for Cohort 2 will begin after initial pharmacokinetics (PK), safety and efficacy are confirmed in this population, of patients in Cohort 1
Primary Outcome Measure Information:
Title
Assess the long-term safety and tolerability of mexiletine by AEs
Description
Assess the long-term safety and tolerability of mexiletine in paediatric patients by number and frequency of AEs/SAEs, throughout the study while on treatment
Time Frame
Approximately 24 months
Title
Assess the long-term safety and tolerability of mexiletine by hand relaxation
Description
Mean time (in seconds) to relaxation of hand muscles and reduction in relaxation time from the first to the fifth contraction
Time Frame
Approximately 24 months
Title
Assess the long-term safety and tolerability of mexiletine measurement of AESI
Description
Assess the long-term safety and tolerability of mexiletine in paediatric patients by Incidence of adverse events of special interest (AESI),
Time Frame
Approximately 24 months
Title
Assess the long-term safety and tolerability of mexiletine by changes in ECG
Description
Assess the long-term safety and tolerability of mexiletine in paediatric patients by changes in ECG assessments from baseline, repeated at each study visit
Time Frame
Approximately 24 months
Title
Assess the long-term safety and tolerability of mexiletine by muscle stiffness
Description
Score for muscle stiffness (myotonia severity) as self-reported by the patients on a Visual Analog Scale (VAS) or Faces scale
Time Frame
Approximately 24 months
Secondary Outcome Measure Information:
Title
Mean change in VAS
Description
Mean change in VAS (8 to < 18 years) or Faces (6 to < 8 years) score for severity of muscle stiffness (if not a primary endpoint) pain, weakness and fatigue (every 3 months).
Time Frame
Approximately 24 months
Title
Clinical myotonia assessment
Description
Mean change in time to open the eyes after forced eye closure as measured on a stopwatch (when eyelid myotonia present)
Time Frame
Approximately 24 months
Title
Mean change in health-related quality-of-life
Description
Mean change in health-related quality-of-life as measured by the Paediatric Quality of Life (PedsQL) score (secondary endpoint for patients aged 6 years to <18 years; every 6 months).
Time Frame
Approximately 24 months
Title
Clinical Global Impression (CGI) scores
Description
Clinical Global Impression (CGI) scores (efficacy and tolerability) evaluated by the patient, a parent or proxy and by the investigator. Measured every 6 months
Time Frame
Approximately 24 months
Title
Mean change in Myotonia Behaviour Scale (MBS) scores
Description
Mean change in Myotonia Behaviour Scale (MBS) scores (for patients aged 6 years to < 18 years; measured every 6 months).
Time Frame
Approximately 24 months
Title
Mean change in time to perform Timed-up and go (TUG) test
Description
Mean change in time to perform Timed-up and go (TUG) test (patients aged 6 to <18 years only)
Time Frame
Approximately 24 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients previously completed the parent study PIP study 4 (MEX-NM-301) and tolerated the Mexiletine in the study.
Able and willing to provide assent to study participation and a parent or legal guardian willing to sign written informed consent prior to study entry.
Patients continue to meet inclusion criteria of parent study (MEX-NM-301):
No significant cardiac abnormalities as determined by a cardiologist's assessment of the ECG and Echocardiogram
No history or evidence of any significant liver disorder Laboratory investigations for haematology, biochemistry, and urinalysis at screening are within normal range, or showing no clinically relevant abnormal values, as judged by the Investigator
Female patients of childbearing potential must be using an acceptable form of birth control as determined by the Investigator (e.g., oral contraception, implantable, injectable/transdermal hormonal contraception, intrauterine device (IUD), barrier methods), tubal ligation or have a vasectomized partner or are practicing abstinence
Exclusion Criteria:
Clinically significant laboratory abnormality, ECG or other clinical findings on physical examination indicative of a clinically significant exclusionary disease as determined by the investigator
Any contra-indication to mexiletine (as described in the Namuscla Summary of Product Characteristics [SmPC])
Hypersensitivity to the active substance, or to any of the excipients
Hypersensitivity to any local anaesthetic
Ventricular tachyarrhythmia
Complete heart block (i.e., third-degree atrioventricular block) or any heart block susceptible to evolve to complete heart block (first-degree atrioventricular block with markedly prolonged PR interval (≥ 200 ms) and/or wide QRS complex (≥ 120 ms), second-degree atrioventricular block, bundle branch block, bifascicular and trifascicular block),
QT interval > 450ms
Myocardial infarction (acute or past), or abnormal Q-waves
Symptomatic coronary artery disease
Heart failure with ejection fraction <50%
Atrial tachyarrhythmia, fibrillation or flutter
Sinus node dysfunction (including sinus rate < 50 bpm)
Co-administration with medicinal products inducing torsades de pointes (class Ia, Ic, III antiarrhythmics): Co-administration of mexiletine and antiarrhythmics inducing torsades de pointes (class Ia: quinidine, procainamide, disopyramide, ajmaline; class Ic: encainide, flecainide, propafenone, moricizine; class III: amiodarone, sotalol, ibutilide, dofetilide, dronedarone, vernakalant) increases the risk of potentially lethal torsades de pointes.
Co-administration with medicinal products with narrow therapeutic index
Co- administration with antiarrhythmics
Any other neurological or psychiatric condition that might affect the assessment of the study measurements
Any concurrent illness, or medications which could affect the muscle function
Seizure disorder, diabetes mellitus requiring treatment by insulin
Pregnant or breastfeeding
Concurrent participation in any other clinical trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Nikki Adetoro
Phone
443-447-4534
Email
NikkiAdetoro@lupin.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christine Barnérias, MD
Organizational Affiliation
Hopital universitaire Necker-Enfants Malades
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hôpital Necker-Enfants-Malades
City
Paris
Country
France
Individual Site Status
Recruiting
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Open-label Extension Study in Paediatric Patients Who Have Completed the MEX-NM-301 Study.
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