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Cannabidiol in Children and Young Adults With Rare Disease-associated Severe Epilepsy (CBD_RE)

Primary Purpose

Epilepsy, Rare Diseases

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Cannabidiol oral solution
Sponsored by
Meyer Children's Hospital IRCCS
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Epilepsy focused on measuring drug resistant epilepsy, rare epilepsy, cannabidiol

Eligibility Criteria

2 Years - 25 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Male or female; Children (age 2-18 years) and young adults (18-25 years), as of the day of the Screening Visit; Subject with rare disease-associated severe epilepsy. Subject has been certified by the National Health System as affected by a rare disease listed in https://www.malattierare.gov.it Patient has severe epilepsy, with at least 4 motor (generalized, focal, or both) seizures per month during baseline period, despite 2 or more current or prior ASMs; Previous treatment with at least 2 ASMs; Currently taking at least 1 other ASMs or between one and four ASMs, with a stable antiseizure treatment for the previous 4 weeks (including ketogenic diet and vagal nerve stimulation); Subject's parent/caregiver has been informed of the nature of the study and informed consent has been obtained from the legally responsible parent/guardian; Subject's parent/caregiver is willing and able to be compliant with diary completion, visit schedule and study drug accountability in the opinion of the investigator Exclusion Criteria: Age <2 years; Known hypersensitivity to CBD or any of the excipients in the study formulation; Progressive neurological disease; Clinically significant unstable medical conditions other than epilepsy that may place patient's safety at risk; Any other significant disease or disorder which, in the opinion of the investigator, may either put the patient at risk because of participation in the study, may influence the result of the study, or affect the patient's ability to participate in the study; Impaired hepatic function at screening defined as any of the following: alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 3 times the upper limit of normal (ULN) and total bilirubin (TBL) greater than 2 times the ULN; Subject taking more than four concurrent ASMs; Subject has taken corticotropins in the six months prior to screening; Subjects taking felbamate, and they have been taking it for less than one year prior to screening; Inadequate supervision by parents and/or caregivers as judged by the investigator; Subject has been part of a clinical trial involving another investigational medicinal product in the previous six months; Current or past use of recreational or medicinal cannabis, or cannabinoid-based medications, within the three months prior to screening and is unwilling to abstain for the duration for the study; Female patients who are pregnant; Female patients of childbearing potential or male patient whose partner is of childbearing potential, unless willing to ensure that they or their partner use a highly effective method of birth control during the study and for three months thereafter.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Cannabidiol treatment

    Arm Description

    Outcomes

    Primary Outcome Measures

    Change in number of generalized and/or focal motor-onset seizure frequency
    percentage change per 28 days from the 4-week baseline period in generalized and/or focal motor-onset seizure frequency during the 24-week treatment period
    Change in severity of generalized and/or focal motor-onset seizure frequency
    a score will be established for each patient, based on review and comparison of all baseline-EEG/7-weeks control-EEG and baseline-EEG/15-weeks control-EEG, with values ranging from 0 (= worsened EEG), to a maximum of 2 (= improved); 1 will be assigned if the EEG trace is unmodified

    Secondary Outcome Measures

    Incidence of adverse events
    Adverse events reporting according to Common Terminology Criteria for Adverse Events (CTCAE) from 1 (mild) to 5 (death)
    Body weight
    Measurement of body weight for tolerability monitoring
    Maximum Plasma Concentraion [Cmax] of concurrent ASMs
    blood levels of concurrent ASMs will be taken at baseline and every 4 weeks
    Number of subjects considered treatment responders
    Number of subjects with a ≥25%, ≥50% ≥75% reduction in motor (generalized, focal, or both) seizures from baseline
    Number of subjects who are free of motor (generalized, focal, or both) seizures
    Number of subjects who are free of motor (generalized, focal, or both) seizures
    Longest period of seizure freedom
    Longest period of seizure freedom
    Number of patients experiencing a >25% worsening, -25 to +25% no change, 25-50% improvement, 50-75% improvement or >75% improvement in total seizures from baseline
    Number of patients experiencing a >25% worsening, -25 to +25% no change, 25-50% improvement, 50-75% improvement or >75% improvement in total seizures from baseline
    Changes from baseline in number of inpatient hospitalizations due to epilepsy
    Changes from baseline in number of inpatient hospitalizations due to epilepsy
    Change in severity of seizures will be assessed using a pediatric adaptation of the Chalfont Seizure Severity Scale
    Change in severity of seizures will be assessed using a pediatric adaptation of the Chalfont Seizure Severity Scale (from 1 minimum severity to >100 max severity)
    Change from baseline to 6-months after treatment initiation in number of seizure-free days
    Change from baseline to 6-months after treatment initiation in number of seizure-free days

    Full Information

    First Posted
    February 28, 2023
    Last Updated
    April 14, 2023
    Sponsor
    Meyer Children's Hospital IRCCS
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05803434
    Brief Title
    Cannabidiol in Children and Young Adults With Rare Disease-associated Severe Epilepsy
    Acronym
    CBD_RE
    Official Title
    Open-label Pilot Study to Assess the Efficacy and Safety of Cannabidiol Oral Solution as an Adjunctive Treatment for Children and Young Adults With Rare Disease-associated Severe Epilepsy
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    April 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    June 1, 2023 (Anticipated)
    Primary Completion Date
    March 1, 2025 (Anticipated)
    Study Completion Date
    March 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Meyer Children's Hospital IRCCS

    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
    This is a pilot, open-label, phase II study. The main objective of the study is to demonstrate that Cannabidiol (CBD), used in addition to current anti-seizure medications (ASMs) reduces the number and/or severity of motor (generalized, focal, or both) seizures in children and young adults with rare disease-associated severe epilepsy. Secondary objectives include assessment of safety and tolerability, changes in behaviour, cognition and sleep, pharmacokinetic interaction with concurrent ASMs.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Epilepsy, Rare Diseases
    Keywords
    drug resistant epilepsy, rare epilepsy, cannabidiol

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    30 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Cannabidiol treatment
    Arm Type
    Experimental
    Intervention Type
    Drug
    Intervention Name(s)
    Cannabidiol oral solution
    Intervention Description
    Cannabidiol will be administered orally twice daily into equally divided doses. The starting dose is 2.5 mg/kg twice daily. The dose can be gradually increased to 5 mg/kg twice daily, which is the recommended maintenance dose, up to a maximum dose of 10 mg/kg twice daily, according to tolerability and clinical response. Following titration, subjects will continue treatment over a 20-week maintenance period. The total treatment duration from the beginning of the titration period till the end of the maintenance period will be 24 weeks.
    Primary Outcome Measure Information:
    Title
    Change in number of generalized and/or focal motor-onset seizure frequency
    Description
    percentage change per 28 days from the 4-week baseline period in generalized and/or focal motor-onset seizure frequency during the 24-week treatment period
    Time Frame
    24 weeks
    Title
    Change in severity of generalized and/or focal motor-onset seizure frequency
    Description
    a score will be established for each patient, based on review and comparison of all baseline-EEG/7-weeks control-EEG and baseline-EEG/15-weeks control-EEG, with values ranging from 0 (= worsened EEG), to a maximum of 2 (= improved); 1 will be assigned if the EEG trace is unmodified
    Time Frame
    24 weeks
    Secondary Outcome Measure Information:
    Title
    Incidence of adverse events
    Description
    Adverse events reporting according to Common Terminology Criteria for Adverse Events (CTCAE) from 1 (mild) to 5 (death)
    Time Frame
    24 weeks
    Title
    Body weight
    Description
    Measurement of body weight for tolerability monitoring
    Time Frame
    24 weeks
    Title
    Maximum Plasma Concentraion [Cmax] of concurrent ASMs
    Description
    blood levels of concurrent ASMs will be taken at baseline and every 4 weeks
    Time Frame
    24 weeks
    Title
    Number of subjects considered treatment responders
    Description
    Number of subjects with a ≥25%, ≥50% ≥75% reduction in motor (generalized, focal, or both) seizures from baseline
    Time Frame
    24 weeks
    Title
    Number of subjects who are free of motor (generalized, focal, or both) seizures
    Description
    Number of subjects who are free of motor (generalized, focal, or both) seizures
    Time Frame
    24 weeks
    Title
    Longest period of seizure freedom
    Description
    Longest period of seizure freedom
    Time Frame
    24 weeks
    Title
    Number of patients experiencing a >25% worsening, -25 to +25% no change, 25-50% improvement, 50-75% improvement or >75% improvement in total seizures from baseline
    Description
    Number of patients experiencing a >25% worsening, -25 to +25% no change, 25-50% improvement, 50-75% improvement or >75% improvement in total seizures from baseline
    Time Frame
    24 weeks
    Title
    Changes from baseline in number of inpatient hospitalizations due to epilepsy
    Description
    Changes from baseline in number of inpatient hospitalizations due to epilepsy
    Time Frame
    24 weeks
    Title
    Change in severity of seizures will be assessed using a pediatric adaptation of the Chalfont Seizure Severity Scale
    Description
    Change in severity of seizures will be assessed using a pediatric adaptation of the Chalfont Seizure Severity Scale (from 1 minimum severity to >100 max severity)
    Time Frame
    24 weeks
    Title
    Change from baseline to 6-months after treatment initiation in number of seizure-free days
    Description
    Change from baseline to 6-months after treatment initiation in number of seizure-free days
    Time Frame
    24 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    2 Years
    Maximum Age & Unit of Time
    25 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Male or female; Children (age 2-18 years) and young adults (18-25 years), as of the day of the Screening Visit; Subject with rare disease-associated severe epilepsy. Subject has been certified by the National Health System as affected by a rare disease listed in https://www.malattierare.gov.it Patient has severe epilepsy, with at least 4 motor (generalized, focal, or both) seizures per month during baseline period, despite 2 or more current or prior ASMs; Previous treatment with at least 2 ASMs; Currently taking at least 1 other ASMs or between one and four ASMs, with a stable antiseizure treatment for the previous 4 weeks (including ketogenic diet and vagal nerve stimulation); Subject's parent/caregiver has been informed of the nature of the study and informed consent has been obtained from the legally responsible parent/guardian; Subject's parent/caregiver is willing and able to be compliant with diary completion, visit schedule and study drug accountability in the opinion of the investigator Exclusion Criteria: Age <2 years; Known hypersensitivity to CBD or any of the excipients in the study formulation; Progressive neurological disease; Clinically significant unstable medical conditions other than epilepsy that may place patient's safety at risk; Any other significant disease or disorder which, in the opinion of the investigator, may either put the patient at risk because of participation in the study, may influence the result of the study, or affect the patient's ability to participate in the study; Impaired hepatic function at screening defined as any of the following: alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 3 times the upper limit of normal (ULN) and total bilirubin (TBL) greater than 2 times the ULN; Subject taking more than four concurrent ASMs; Subject has taken corticotropins in the six months prior to screening; Subjects taking felbamate, and they have been taking it for less than one year prior to screening; Inadequate supervision by parents and/or caregivers as judged by the investigator; Subject has been part of a clinical trial involving another investigational medicinal product in the previous six months; Current or past use of recreational or medicinal cannabis, or cannabinoid-based medications, within the three months prior to screening and is unwilling to abstain for the duration for the study; Female patients who are pregnant; Female patients of childbearing potential or male patient whose partner is of childbearing potential, unless willing to ensure that they or their partner use a highly effective method of birth control during the study and for three months thereafter.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Renzo Guerrini, MD, FRCP, FAES
    Phone
    00390555662573
    Email
    renzo.guerrini@meyer.it
    First Name & Middle Initial & Last Name or Official Title & Degree
    Simona Balestrini, MD, PhD
    Phone
    00390555662718
    Email
    simona.balestrini@meyer.it

    12. IPD Sharing Statement

    Learn more about this trial

    Cannabidiol in Children and Young Adults With Rare Disease-associated Severe Epilepsy

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