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A Study of Possible Drug-drug Interactions Between Stiripentol or Valproate and Cannabidiol in Patients With Epilepsy

Primary Purpose

Epilepsy

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
GWP42003-P
Placebo
Sponsored by
Jazz Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Epilepsy focused on measuring Cannabidiol, GWP42003-P, Epidiolex, Stiripentol, Valproate

Eligibility Criteria

16 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Note: Participants who enroll in Sweden must be aged 18-55 years.

Key Inclusion Criteria:

  • Participant must be taking STP (for the STP arm) or VPA (for the VPA arm) and no more than 2 other antiepileptic drugs (AEDs) during the blinded period of the trial.

    • In the VPA arm only, the participant must not be receiving STP (VPA allowed in STP arm).
  • AED doses, including STP or VPA, must be stable for 4 weeks prior to screening and regimen must remain stable throughout the duration of the blinded period of the trial.
  • Participant must have a documented magnetic resonance imaging/computerized tomography of the brain that ruled out a progressive neurologic condition.
  • Participant must have experienced at least 1 countable uncontrolled seizure of any type (i.e., tonic-clonic, tonic, clonic, atonic, partial onset or focal: focal seizures with retained consciousness and a motor component, focal seizures with impaired consciousness, focal seizures evolving to bilateral secondary generalization) within 2 months prior to randomization.
  • Intervention with vagus nerve stimulation and/or ketogenic diet must be stable for 4 weeks prior to baseline and the participant must be willing to maintain a stable regimen during the blinded period of the trial.
  • Participant must abstain from alcohol during the blinded period of the trial.

Key Exclusion Criteria:

  • Participant has clinically significant unstable medical conditions other than epilepsy.
  • Participant has a history of symptoms related to a drop in blood pressure due to postural changes (e.g., dizziness, light-headedness, blurred vision, palpitations, weakness, syncope).
  • Participant has a QT interval, corrected for heart rate with Bazett's formula (QTcB), greater than:

    • 450 msec for males.
    • 470 msec for females.
    • 480 msec if right bundle branch block is present.
  • Participant has any history of suicidal behavior or any suicidal ideation of type 4 or 5 on the C-SSRS in the last month or at screening.
  • Participant has had clinically relevant symptoms or a clinically significant illness in the 4 weeks prior to screening or enrollment, other than epilepsy.
  • Participant is currently using felbamate and has been taking it for less than 12 months prior to screening.
  • Participant has consumed alcohol during the 7 days prior to enrollment and is unwilling to abstain during the blinded phase of the trail.
  • 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 any known or suspected history of any drug abuse or addiction.
  • Participant is unwilling to abstain from recreational or medicinal cannabis, or synthetic cannabinoid based medications (including Sativex) for the duration for the study.
  • Participant has consumed grapefruit or grapefruit juice 7 days prior to enrollment and is unwilling to abstain from drinking grapefruit juice within 7 days of pharmacokinetic visits.
  • Participant has any known or suspected hypersensitivity to cannabinoids or any of the excipients of the Investigational Medicinal Product (IMP), e.g., sesame oil.
  • Participant has received an IMP within the 12 weeks prior to the screening visit.
  • Participant has significantly impaired hepatic function at the screening or randomization visit, defined as any of the following:

    • Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 5 × upper limit of normal (ULN).
    • ALT or AST > 3 × ULN and total bilirubin (TBL) > 2 × ULN or international normalized ratio (INR) > 1.5.
    • ALT or AST > 3 × ULN with the presence of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, and/or eosinophilia (> 5%).

Sites / Locations

  • SEIN - Epilepsy Institute in the Netherlands Foundation
  • Hospital Universitari Vall d'Hebron
  • Hospital Ruber Internacional
  • Hospital Universitario Virgen del Rocio
  • Sahlgrenska University Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Placebo Comparator

Experimental

Placebo Comparator

Arm Label

STP + GWP42003-P

STP + Placebo

VPA + GWP42003-P

VPA + Placebo

Arm Description

Administered orally, twice daily (morning and evening; immediately after the participant's STP dose), commencing with up-titration of 100 mg/mL GWP42003-P to a maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the open-label-extension (OLE) phase or who withdraw early. STP Arm: Last patient completion October 2018

Administered orally, twice daily (morning and evening; immediately after the participant's STP dose), commencing with up-titration of placebo to an equivalent maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the OLE phase or who withdraw early. STP Arm: Last patient completion February 2018

Administered orally, twice daily (morning and evening; immediately after the participant's VPA dose), commencing with up-titration of 100 mg/mL GWP42003-P to a maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the OLE phase or who withdraw early. VPA Arm: Last patient completion February 2018

Administered orally, twice daily (morning and evening; immediately after the participant's VPA dose), commencing with up-titration of placebo to an equivalent maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the OLE phase or who withdraw early. VPA Arm: Last patient completion January 2018

Outcomes

Primary Outcome Measures

Maximum plasma concentration (Cmax) of STP, VPA, cannabidiol (CBD).
The Cmax of STP, VPA and CBD is presented.
Time to the maximum plasma concentration (Tmax) of STP, VPA and CBD.
The Tmax of STP, VPA and CBD is presented.
Area under the curve (AUC) from zero to final time of positive detection (0-t) of STP, VPA and CBD.
The AUC(0-t) of STP, VPA and CBD is presented.
Area under the plasma concentration time curve over a dosing interval, where tau is the dosing interval [AUCtau].
The AUC(tau) of STP, VPA, and CBD is presented.

Secondary Outcome Measures

Number of participants who experienced an adverse event.
The number of participants who experienced an adverse event during the trial is presented.
Number of participants with a clinically significant change in 12-lead electrocardiogram (ECG).
The number of participants with a clinically significant change in ECG is presented.
Number of participants with a clinically significant change in serum biochemistry.
The number of participants with a clinically significant change in serum biochemistry is presented.
Number of participants with a clinically significant change in hematology.
The number of participants with a clinically significant change in hematology is presented.
Number of participants with a clinically significant change in urinalysis.
The number of participants with a clinically significant change in urinalysis is presented.
Number of participants with a clinically significant change in vital signs.
The number of participants with a clinically significant change in vital signs (systolic blood pressure, diastolic blood pressure, pulse rate) is presented.
Number of participants with a clinically significant change in physical examination.
The number of participants with a clinically significant change in physical examination is presented.
Number of participants with a treatment-emergent suicidality flag.
Suicidality was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS). The number of participants with a treatment-emergent flag is presented.
Seizure frequency by subtype.
The frequency of each subtype of seizure at baseline and end of treatment is presented.
Number of participants with a treatment-emergent finding indicative of drug abuse liability.
Abuse liability was assessed through monitoring of triggering adverse events of interest and study medication accountability discrepancies. Any findings were assigned to an appropriate classification by the investigator. The number of participants with a treatment-emergent finding indicative of drug abuse liability is presented.
Cmax of 4-ene-VPA, clobazam (CLB), N-desmethylclobazam (N-CLB), levetiracetam (LEV), and topiramate (TOP).
The Cmax of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
Tmax of 4-ene-VPA, CLB, N-CLB, LEV, and TOP.
The Tmax of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
AUC(0-t) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP.
The AUC(0-t) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
AUC(tau) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP.
The AUC(tau) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.

Full Information

First Posted
November 16, 2015
Last Updated
December 19, 2022
Sponsor
Jazz Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02607891
Brief Title
A Study of Possible Drug-drug Interactions Between Stiripentol or Valproate and Cannabidiol in Patients With Epilepsy
Official Title
A Phase 2, Double-blind, Randomized, Placebo-controlled Pharmacokinetic Trial in 2 Parallel Groups to Investigate Possible Drug-drug Interactions Between Stiripentol or Valproate and GWP42003-P in Patients With Epilepsy
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Completed
Study Start Date
November 9, 2016 (Actual)
Primary Completion Date
September 11, 2018 (Actual)
Study Completion Date
October 2, 2018 (Actual)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This trial consists of 2 parts: a double-blinded phase and an open-label extension phase. The blinded phase only will be described in this record. Participants will be randomized in a 4:1 ratio to receive GWP42003-P or matching placebo. The hypothesis is that levels of stiripentol (STP) or valproate (VPA) may be altered (increased or decreased) as a result of using GWP42003-P.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epilepsy
Keywords
Cannabidiol, GWP42003-P, Epidiolex, Stiripentol, Valproate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
35 (Actual)

8. Arms, Groups, and Interventions

Arm Title
STP + GWP42003-P
Arm Type
Experimental
Arm Description
Administered orally, twice daily (morning and evening; immediately after the participant's STP dose), commencing with up-titration of 100 mg/mL GWP42003-P to a maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the open-label-extension (OLE) phase or who withdraw early. STP Arm: Last patient completion October 2018
Arm Title
STP + Placebo
Arm Type
Placebo Comparator
Arm Description
Administered orally, twice daily (morning and evening; immediately after the participant's STP dose), commencing with up-titration of placebo to an equivalent maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the OLE phase or who withdraw early. STP Arm: Last patient completion February 2018
Arm Title
VPA + GWP42003-P
Arm Type
Experimental
Arm Description
Administered orally, twice daily (morning and evening; immediately after the participant's VPA dose), commencing with up-titration of 100 mg/mL GWP42003-P to a maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the OLE phase or who withdraw early. VPA Arm: Last patient completion February 2018
Arm Title
VPA + Placebo
Arm Type
Placebo Comparator
Arm Description
Administered orally, twice daily (morning and evening; immediately after the participant's VPA dose), commencing with up-titration of placebo to an equivalent maintenance dose of 20 mg/kg/day over 11 days. Participants remain on the maintenance dose for a further 14 days. Dosing is tapered (10% each day) for participants who do not enter the OLE phase or who withdraw early. VPA Arm: Last patient completion January 2018
Intervention Type
Drug
Intervention Name(s)
GWP42003-P
Other Intervention Name(s)
Cannabidiol, CBD, Epidiolex
Intervention Description
Clear, colorless to yellow solution containing cannabidiol dissolved in the excipients sesame oil and anhydrous ethanol with added sweetener (sucralose) and strawberry flavoring.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Clear, colorless to yellow solution containing the excipients sesame oil and anhydrous ethanol with added sweetener (sucralose) and strawberry flavoring.
Primary Outcome Measure Information:
Title
Maximum plasma concentration (Cmax) of STP, VPA, cannabidiol (CBD).
Description
The Cmax of STP, VPA and CBD is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Title
Time to the maximum plasma concentration (Tmax) of STP, VPA and CBD.
Description
The Tmax of STP, VPA and CBD is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Title
Area under the curve (AUC) from zero to final time of positive detection (0-t) of STP, VPA and CBD.
Description
The AUC(0-t) of STP, VPA and CBD is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Title
Area under the plasma concentration time curve over a dosing interval, where tau is the dosing interval [AUCtau].
Description
The AUC(tau) of STP, VPA, and CBD is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Secondary Outcome Measure Information:
Title
Number of participants who experienced an adverse event.
Description
The number of participants who experienced an adverse event during the trial is presented.
Time Frame
Up to 11 weeks.
Title
Number of participants with a clinically significant change in 12-lead electrocardiogram (ECG).
Description
The number of participants with a clinically significant change in ECG is presented.
Time Frame
Up to 7 weeks.
Title
Number of participants with a clinically significant change in serum biochemistry.
Description
The number of participants with a clinically significant change in serum biochemistry is presented.
Time Frame
Up to 7 weeks.
Title
Number of participants with a clinically significant change in hematology.
Description
The number of participants with a clinically significant change in hematology is presented.
Time Frame
Up to 7 weeks.
Title
Number of participants with a clinically significant change in urinalysis.
Description
The number of participants with a clinically significant change in urinalysis is presented.
Time Frame
Up to 7 weeks.
Title
Number of participants with a clinically significant change in vital signs.
Description
The number of participants with a clinically significant change in vital signs (systolic blood pressure, diastolic blood pressure, pulse rate) is presented.
Time Frame
Up to 7 weeks.
Title
Number of participants with a clinically significant change in physical examination.
Description
The number of participants with a clinically significant change in physical examination is presented.
Time Frame
Up to 7 weeks.
Title
Number of participants with a treatment-emergent suicidality flag.
Description
Suicidality was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS). The number of participants with a treatment-emergent flag is presented.
Time Frame
Up to 7 weeks.
Title
Seizure frequency by subtype.
Description
The frequency of each subtype of seizure at baseline and end of treatment is presented.
Time Frame
Up to 6 weeks.
Title
Number of participants with a treatment-emergent finding indicative of drug abuse liability.
Description
Abuse liability was assessed through monitoring of triggering adverse events of interest and study medication accountability discrepancies. Any findings were assigned to an appropriate classification by the investigator. The number of participants with a treatment-emergent finding indicative of drug abuse liability is presented.
Time Frame
Up to 7 weeks.
Title
Cmax of 4-ene-VPA, clobazam (CLB), N-desmethylclobazam (N-CLB), levetiracetam (LEV), and topiramate (TOP).
Description
The Cmax of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Title
Tmax of 4-ene-VPA, CLB, N-CLB, LEV, and TOP.
Description
The Tmax of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Title
AUC(0-t) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP.
Description
The AUC(0-t) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.
Title
AUC(tau) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP.
Description
The AUC(tau) of 4-ene-VPA, CLB, N-CLB, LEV, and TOP is presented.
Time Frame
0, 0.25, 0.5, 1, 1.5, 2, 4, 6, and 12 hours post-dose.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Note: Participants who enroll in Sweden must be aged 18-55 years. Key Inclusion Criteria: Participant must be taking STP (for the STP arm) or VPA (for the VPA arm) and no more than 2 other antiepileptic drugs (AEDs) during the blinded period of the trial. In the VPA arm only, the participant must not be receiving STP (VPA allowed in STP arm). AED doses, including STP or VPA, must be stable for 4 weeks prior to screening and regimen must remain stable throughout the duration of the blinded period of the trial. Participant must have a documented magnetic resonance imaging/computerized tomography of the brain that ruled out a progressive neurologic condition. Participant must have experienced at least 1 countable uncontrolled seizure of any type (i.e., tonic-clonic, tonic, clonic, atonic, partial onset or focal: focal seizures with retained consciousness and a motor component, focal seizures with impaired consciousness, focal seizures evolving to bilateral secondary generalization) within 2 months prior to randomization. Intervention with vagus nerve stimulation and/or ketogenic diet must be stable for 4 weeks prior to baseline and the participant must be willing to maintain a stable regimen during the blinded period of the trial. Participant must abstain from alcohol during the blinded period of the trial. Key Exclusion Criteria: Participant has clinically significant unstable medical conditions other than epilepsy. Participant has a history of symptoms related to a drop in blood pressure due to postural changes (e.g., dizziness, light-headedness, blurred vision, palpitations, weakness, syncope). Participant has a QT interval, corrected for heart rate with Bazett's formula (QTcB), greater than: 450 msec for males. 470 msec for females. 480 msec if right bundle branch block is present. Participant has any history of suicidal behavior or any suicidal ideation of type 4 or 5 on the C-SSRS in the last month or at screening. Participant has had clinically relevant symptoms or a clinically significant illness in the 4 weeks prior to screening or enrollment, other than epilepsy. Participant is currently using felbamate and has been taking it for less than 12 months prior to screening. Participant has consumed alcohol during the 7 days prior to enrollment and is unwilling to abstain during the blinded phase of the trail. 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 any known or suspected history of any drug abuse or addiction. Participant is unwilling to abstain from recreational or medicinal cannabis, or synthetic cannabinoid based medications (including Sativex) for the duration for the study. Participant has consumed grapefruit or grapefruit juice 7 days prior to enrollment and is unwilling to abstain from drinking grapefruit juice within 7 days of pharmacokinetic visits. Participant has any known or suspected hypersensitivity to cannabinoids or any of the excipients of the Investigational Medicinal Product (IMP), e.g., sesame oil. Participant has received an IMP within the 12 weeks prior to the screening visit. Participant has significantly impaired hepatic function at the screening or randomization visit, defined as any of the following: Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 5 × upper limit of normal (ULN). ALT or AST > 3 × ULN and total bilirubin (TBL) > 2 × ULN or international normalized ratio (INR) > 1.5. ALT or AST > 3 × ULN with the presence of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, and/or eosinophilia (> 5%).
Facility Information:
Facility Name
SEIN - Epilepsy Institute in the Netherlands Foundation
City
Zwolle
Country
Netherlands
Facility Name
Hospital Universitari Vall d'Hebron
City
Barcelona
Country
Spain
Facility Name
Hospital Ruber Internacional
City
Madrid
Country
Spain
Facility Name
Hospital Universitario Virgen del Rocio
City
Sevilla
Country
Spain
Facility Name
Sahlgrenska University Hospital
City
Göteborg
Country
Sweden

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32350749
Citation
Ben-Menachem E, Gunning B, Arenas Cabrera CM, VanLandingham K, Crockett J, Critchley D, Wray L, Tayo B, Morrison G, Toledo M. A Phase II Randomized Trial to Explore the Potential for Pharmacokinetic Drug-Drug Interactions with Stiripentol or Valproate when Combined with Cannabidiol in Patients with Epilepsy. CNS Drugs. 2020 Jun;34(6):661-672. doi: 10.1007/s40263-020-00726-4.
Results Reference
derived

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A Study of Possible Drug-drug Interactions Between Stiripentol or Valproate and Cannabidiol in Patients With Epilepsy

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