Effect of Oral Cimetidine in the Protoporphyrias
Primary Purpose
Erythropoietic Protoporphyria, X-linked Protoporphyria
Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cimetidine
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Erythropoietic Protoporphyria focused on measuring Erythropoietic Protoporphyria, X-linked Protoporphyria, EPP, Cimetidine, Photosensitivity
Eligibility Criteria
Inclusion Criteria:
- Prior enrollment or co-enrollment in the Longitudinal Study of the Porphyrias (PC Study 7201) with a confirmed diagnosis of EPP or XLP
- Male or female age ≥15 years at screening
- Characteristic history of non-blistering cutaneous photosensitivity
- Onset of prodromal symptoms (burning, tingling, itching, or stinging) within 30 minutes of strong light exposure
- Willing and capable of giving informed consent and following procedures described in the protocol
Exclusion Criteria:
- Participants not willing to expose themselves to light to the point of prodromal symptoms at least weekly
- History of liver or bone marrow transplant or clinically significant liver dysfunction as determined by the Investigator
- Known or suspected allergy or intolerance to cimetidine
- Use of any other experimental therapy in the past 3 months at screening
- Use of cimetidine within the past 3 months at screening
- Individuals with elevations of porphyrins in plasma or erythrocytes due to other diseases (i.e., secondary porphyrinemia) such as liver and bone marrow diseases
- Patients with any clinically significant comorbid conditions, which in the opinion of the Investigator, precludes participation
- Treatment with any drugs or supplements (Appendix 1) that in the opinion of the Investigator can interfere with subject safety or the objectives of the study
- The participant either does not have a smartphone or is not willing to use his/her smartphone for the study
- Women who are pregnant, breastfeeding, or actively planning to become pregnant
- Individuals with moderate to severe renal insufficiency
Sites / Locations
- Massachusetts General HospitalRecruiting
- Atrium Health Wake Forest Baptist Medical CenterRecruiting
- University of Texas Medical BranchRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Cimetidine
Placebo
Arm Description
Cimetidine 800mg orally twice daily
Placebo capsule orally twice daily
Outcomes
Primary Outcome Measures
Erythrocyte total protoporphyrin level
Percent change in erythrocyte total protoporphyrin level post-treatment relative to pre-treatment
Secondary Outcome Measures
Time to prodrome
Time to prodrome measured as prodrome-free outdoor exposure time
Patient-reported quality of life
Patient-reported quality of life as measured by Patient-Reported Outcomes Measurement Information System-57 (PROMIS-57) scale [0-100, where 100 is the best quality of life]
Phototoxic episodes
The number and severity of sunlight-induced pain events (phototoxic episodes)
Light dose
Light dose required for time to prodrome
Full Information
NCT ID
NCT05020184
First Posted
July 26, 2021
Last Updated
December 20, 2022
Sponsor
Amy K. Dickey, M.D.
Collaborators
University of Texas, Wake Forest University Health Sciences
1. Study Identification
Unique Protocol Identification Number
NCT05020184
Brief Title
Effect of Oral Cimetidine in the Protoporphyrias
Official Title
Effect of Oral Cimetidine in the Protoporphyrias
Study Type
Interventional
2. Study Status
Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 14, 2022 (Actual)
Primary Completion Date
February 2025 (Anticipated)
Study Completion Date
September 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Amy K. Dickey, M.D.
Collaborators
University of Texas, Wake Forest University Health Sciences
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) result from genetic defects of heme biosynthesis that cause life-long, painful cutaneous sensitivity to light. The objective of this study is to determine the efficacy and safety of oral cimetidine administration for treatment of the protoporphyrias. Efficacy will be based on protoporphyrin levels, photosensitivity, and quality of life questionnaires.
Funding Source- FDA OOPD
Detailed Description
Erythropoietic protoporphyria (EPP) and X-linked protoporphyria (XLP) are genetic defects of heme biosynthesis that cause life-long, painful cutaneous sensitivity to light. EPP and XLP, collectively called the protoporphyrias, result in the accumulation of the light-sensitive molecule protoporphyrin IX initially in the bone marrow during hemoglobin synthesis and secondarily in erythrocytes, plasma, and the liver. In addition to photosensitivity, protoporphyria can also result in anemia, gallstones, and liver failure. No therapy has been demonstrated to reduce protoporphyrin levels or prevent the potentially life-threatening complications of EPP. Cimetidine has gained attention as a possible treatment for human porphyrias because of a potential off-target effect of inhibition of delta-aminolevulinate synthase (ALAS), the first enzyme of heme biosynthesis. This inhibition was first described in vitro; however, case reports of benefit in EPP have been anecdotal and uncontrolled. Therefore, the objective of this study is to determine the efficacy and safety of oral cimetidine administration in the protoporphyrias. Efficacy will be based on protoporphyrin levels, photosensitivity, and quality of life questionnaires. If the results are positive, this would be the first study providing quality evidence for an agent acting as a disease-modifying therapy for EPP. The study is also attractive because it repurposes an already approved drug with few side effects to treat a rare human disease.
The study design is a prospective, blinded, randomized, 2x2 cross-over design comparing cimetidine to placebo in patients with protoporphyria. Eligible protoporphyria patients will be randomized with equal allocation to one of two treatment sequences that will be administered over two 3-month study periods. Randomization will be stratified by site and permuted block randomization will be used to prevent chronological bias. Patients randomized to sequence 1 will receive placebo during period 1 and cimetidine during period 2. Patients randomized to sequence 2 will receive cimetidine during period 1 and placebo during period 2. Between periods, to eliminate any carry-over effects from the treatment administered in period 1, a wash-out period of 3 months will occur in which all patients receive neither cimetidine nor placebo. Three months was selected for each study period and for the wash-out period because of the rapid decline in protoporphyrin in red cells over the lifespan of the red cell (120 days), as well as to account for the time frame needed to measure light sensitivity in EPP.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Erythropoietic Protoporphyria, X-linked Protoporphyria
Keywords
Erythropoietic Protoporphyria, X-linked Protoporphyria, EPP, Cimetidine, Photosensitivity
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Model Description
The study design is a multicenter, prospective, randomized, double-blind, placebo-controlled, crossover trial of oral cimetidine 800mg twice daily versus placebo
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
randomized, double-blind, placebo-controlled
Allocation
Randomized
Enrollment
20 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Cimetidine
Arm Type
Active Comparator
Arm Description
Cimetidine 800mg orally twice daily
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo capsule orally twice daily
Intervention Type
Drug
Intervention Name(s)
Cimetidine
Other Intervention Name(s)
Tagament
Intervention Description
Oral Cimetidine 800mg twice daily.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo twice daily
Primary Outcome Measure Information:
Title
Erythrocyte total protoporphyrin level
Description
Percent change in erythrocyte total protoporphyrin level post-treatment relative to pre-treatment
Time Frame
Before and after each 3-month treatment period
Secondary Outcome Measure Information:
Title
Time to prodrome
Description
Time to prodrome measured as prodrome-free outdoor exposure time
Time Frame
Last 2 months of each treatment period
Title
Patient-reported quality of life
Description
Patient-reported quality of life as measured by Patient-Reported Outcomes Measurement Information System-57 (PROMIS-57) scale [0-100, where 100 is the best quality of life]
Time Frame
Before and after each 3-month treatment period
Title
Phototoxic episodes
Description
The number and severity of sunlight-induced pain events (phototoxic episodes)
Time Frame
Last 2 months of each treatment period
Title
Light dose
Description
Light dose required for time to prodrome
Time Frame
Last 2 months of each treatment period
10. Eligibility
Sex
All
Minimum Age & Unit of Time
15 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Prior enrollment or co-enrollment in the Longitudinal Study of the Porphyrias (PC Study 7201) with a confirmed diagnosis of EPP or XLP
Male or female age ≥15 years at screening
Characteristic history of non-blistering cutaneous photosensitivity
Willing and capable of giving informed consent and following procedures described in the protocol
Exclusion Criteria:
Participants not willing to expose themselves to light to the point of prodromal symptoms at least weekly
History of liver or bone marrow transplant or clinically significant liver dysfunction as determined by the Investigator
Known or suspected allergy or intolerance to cimetidine
Use of any other experimental therapy in the past 3 months at screening
Use of cimetidine within the past 3 months at screening
Individuals with elevations of porphyrins in plasma or erythrocytes due to other diseases (i.e., secondary porphyrinemia) such as liver and bone marrow diseases
Patients with any clinically significant comorbid conditions, which in the opinion of the Investigator, precludes participation
Treatment with any drugs or supplements (Appendix 1) that in the opinion of the Investigator can interfere with subject safety or the objectives of the study
The participant either does not have a smartphone or is not willing to use his/her smartphone for the study
Women who are pregnant, breastfeeding, or actively planning to become pregnant
Individuals with moderate to severe renal insufficiency
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Amy K Dickey, MD
Phone
617-726-1721
Email
adickey@mgh.harvard.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Paul Y Jiang
Email
pyjiang@mgh.harvard.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amy K Dickey, MD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Karl Anderson, MD
Organizational Affiliation
University of Texas
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amy K Dickey, MD
Facility Name
Atrium Health Wake Forest Baptist Medical Center
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Herbert Bonkovsky, MD
Facility Name
University of Texas Medical Branch
City
Galveston
State/Province
Texas
ZIP/Postal Code
77555
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Karl Anderson, MD
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
Individual participant data that underlie the results reported in the published article, as well as the study protocol and statistical analysis plan, may be shared, after de-identification (text, tables, figures, and appendices), if meeting the time frame and access criteria listed below.
IPD Sharing Time Frame
Beginning 9 months and ending 36 months following article publication
IPD Sharing Access Criteria
With whom: Researchers who provide a methodologically sound proposal that is approved by the study investigators For what type of analysis: To achieve the aims of the approved proposal. By what mechanisms will the data be available: Proposals should be directed to adickey@mgh.harvard.edu . To gain access, data requestors will need to sign a data access agreement.
Learn more about this trial
Effect of Oral Cimetidine in the Protoporphyrias
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