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Intranasal Oxytocin vs. Placebo for the Treatment of Hyperphagia in Prader-Willi Syndrome

Primary Purpose

Prader-Willi Syndrome, Hyperphagia

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Intranasal Oxytocin (IN-OXT)
Matched Placebo
Sponsored by
Montefiore Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prader-Willi Syndrome focused on measuring Prader-Willi Syndrome, Hyperphagia

Eligibility Criteria

5 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female pediatric outpatients aged 5 to 17 years
  2. Must be in PWS nutritional phase 2b or 3 as determined by PI
  3. Must be on growth hormone treatment and have been receiving stable doses of growth hormone treatment for at least 3 months prior to screening date. Treatment cannot have been interrupted for more than one week within 3 months of screening.
  4. Diagnosis of PWS confirmed by patient medical records.
  5. A score of at least moderate severity on the Hyperphagia Questionnaire for Clinical Trials at both screening and baseline visits.
  6. Stable dosages of hormone treatments (including testosterone and estrogen supplements) for 4 weeks prior to randomization and for the duration of the study.
  7. Stable dosages of metabolic treatments that could affect appetite (including metformin) for 4 weeks prior to randomization and for the duration of the study.
  8. Physical exam and laboratory results that are within the normal range for individuals with PWS.
  9. Presence of a parent/caregiver/guardian that is able to consent for their participation and complete assessments regarding the child's development and behavior change throughout the study.

Exclusion Criteria:

  1. Exposure to any investigational agent in the 30 days prior to randomization.
  2. Child not receiving growth hormone treatment
  3. Children weighing less than 40 lbs
  4. Children with unstable Type 2 Diabetes confirmed by Hemoglobin A1C levels at screening
  5. Children with unstable medical co-morbidities at baseline.
  6. Children with active upper respiratory infections at screening.
  7. A primary psychiatric diagnosis other than ASD, including bipolar disorder, psychosis, schizophrenia, PTSD or MDD. These patients will be excluded due to potential confounding results.
  8. Pregnant or lactating patients or patients who will not agree to use a double barrier method of contraception. IN-OXT has not been studied in pregnant or lactating women.
  9. Females using an estrogen-based contraceptive. As an alternative to an estrogen based contraceptive, subjects will be counseled to use progesterone-based contraceptives; cervical cap; cervical sponges; or spermicidal foam in combination with a condom. Subjects will need to use a double barrier method to be in the study.
  10. A medical condition that might interfere with the conduct of the study, confound interpretation of study results or endanger the subject's well-being.
  11. A known diagnosis of Rett's Syndrome of Childhood Disintegrative Disorder or marked sensory impairment such as deafness or blindness.
  12. Subjects who have changes in allied health therapies, behavioral or educational interventions within four weeks prior to randomization other than those associated with school holidays.
  13. Subjects who have had changes in medications or medication doses of risperidone, aripiprazole, other antipsychotic medications, clonidine, guanfacine, stimulants or anti-convulsants within four weeks of randomization.

Sites / Locations

  • Montefiore Medical Center, Albert Einstein College of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Experimental: Intranasal Oxytocin (IN-OXT)

Placebo Comparator: Matched Placebo

Arm Description

Syntocinon (synthetic oxytocin) will be used in this protocol. Each subject will receive a dose of 16 IU QD and will be instructed to inhale 2 puffs per nostril (4 IU each).

Each subject will receive a dose of 16 IU QD, and will be instructed to inhale 2 puffs per nostril (4 IU each).

Outcomes

Primary Outcome Measures

Hyperphagia Questionnaire for Clinical Trials
Assesses Eating Behaviors and Hyperphagia in PWS. Repeated Measures Analysis.

Secondary Outcome Measures

Repetitive Behavior Scale Revised (RBS-R)
Change in Repetitive Behavior Scale (RBS-R) from baseline to endpoint
BMI
Change in BMI from baseline to endpoint
Body Composition
Change in Body Composition (measured via bioelectrical impedance analysis) from baseline to endpoint
World Health Organization Quality of Life Questionnaire (WHOQOL)
Change in World Health Organization Quality of Life Questionnaire from baseline to endpoint
Aberrant Behavior Checklist
Change in Aberrant Behavior Checklist (ABC) from baseline to Endpoint.
Salivary Oxytocin Concentration
Change in Salivary Oxytocin Concentration from baseline to endpoint
Caregiver Strain Questionnaire
Change in Caregiver Strain Questionnaire from baseline to endpoint
Montefiore-Einstein Rigidity Scale-Revised PWS (MERS-PWS):
Change in three domains of rigid behavior from baseline to endpoint

Full Information

First Posted
June 19, 2017
Last Updated
August 19, 2022
Sponsor
Montefiore Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT03197662
Brief Title
Intranasal Oxytocin vs. Placebo for the Treatment of Hyperphagia in Prader-Willi Syndrome
Official Title
Phase 2 Study: Intranasal Oxytocin vs. Placebo for the Treatment of Hyperphagia in Children and Adolescents With Prader-Willi Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Recruiting
Study Start Date
April 11, 2018 (Actual)
Primary Completion Date
August 31, 2023 (Anticipated)
Study Completion Date
August 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Montefiore Medical Center

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
This study is a phase 2 randomized double blind 8-week treatment trial of intranasal OXT vs. placebo in 50 subjects aged 5 to 17 years with PWS in order to assess IN-OXT's affect on measurements of (1) eating behaviors (2) repetitive behaviors (3) weight and body composition (4) quality of life (5) salivary OXT and hormone levels (including ghrelin, pancreatic polypeptide, peptide YY, GLP-1, insulin, glucagon, testosterone, and estrogen). If superior to placebo, this data will add to the current knowledge that OXT is an effective treatment for hyperphagia as well as other symptoms of PWS. Funding Source- FDA OOPD
Detailed Description
Prader-Willi Syndrome (PWS) is a rare neurodevelopmental disorder caused by lack of expression of paternally derived imprinted material on chromosome 15q11-q13. PWS is characterized by mild to moderate intellectual disabilities, repetitive/compulsive behaviors and rigidity, social cognition deficits and severe hypotonia at birth, followed by the onset of hyperphagia later in life. Obesity is responsible for the majority of the morbidity and mortality associated with PWS, and compulsive eating behaviors are most responsible for diminishing the quality of life for caregivers and family members. Oxytocin has been implicated in the pathophysiology of PWS and there have been small studies of intranasal oxytocin (IN-OXT) in this population. To date, however, studies have not been adequately powered to detect significance in target symptoms of hyperphagia and associated symptoms of individuals with PWS. The primary goal of this study is to examine the safety and efficacy of IN-OXT on hyperphagia, as measured by the Hyperphagia Questionnaire-Clinical Trails, from baseline to week 8. Currently, there are no effective treatments available to manage hyperphagia in patients with PWS. STUDY DESIGN: This is an 8-week double-blind, randomized study in 50 children with PWS aged 5-17. Participation involves 2 in-person visits to our program and 5 remote visits. Travel expenses will be reimbursed to participating families.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prader-Willi Syndrome, Hyperphagia
Keywords
Prader-Willi Syndrome, Hyperphagia

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Experimental: Intranasal Oxytocin (IN-OXT)
Arm Type
Experimental
Arm Description
Syntocinon (synthetic oxytocin) will be used in this protocol. Each subject will receive a dose of 16 IU QD and will be instructed to inhale 2 puffs per nostril (4 IU each).
Arm Title
Placebo Comparator: Matched Placebo
Arm Type
Placebo Comparator
Arm Description
Each subject will receive a dose of 16 IU QD, and will be instructed to inhale 2 puffs per nostril (4 IU each).
Intervention Type
Drug
Intervention Name(s)
Intranasal Oxytocin (IN-OXT)
Other Intervention Name(s)
Syntocinon
Intervention Description
Each subject will receive a dose of 16 IU QD, and will be instructed to inhale 2 puffs per nostril every day (4 IU each). If needed, treatment will be titrated due to side effects or non-response.
Intervention Type
Drug
Intervention Name(s)
Matched Placebo
Intervention Description
Each subject will receive a dose of 16 IU QD, and will be instructed to inhale 2 puffs per nostril every day (4 IU each). If needed, treatment will be titrated due to side effects or non-response.
Primary Outcome Measure Information:
Title
Hyperphagia Questionnaire for Clinical Trials
Description
Assesses Eating Behaviors and Hyperphagia in PWS. Repeated Measures Analysis.
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Secondary Outcome Measure Information:
Title
Repetitive Behavior Scale Revised (RBS-R)
Description
Change in Repetitive Behavior Scale (RBS-R) from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
BMI
Description
Change in BMI from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Body Composition
Description
Change in Body Composition (measured via bioelectrical impedance analysis) from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
World Health Organization Quality of Life Questionnaire (WHOQOL)
Description
Change in World Health Organization Quality of Life Questionnaire from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Aberrant Behavior Checklist
Description
Change in Aberrant Behavior Checklist (ABC) from baseline to Endpoint.
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Salivary Oxytocin Concentration
Description
Change in Salivary Oxytocin Concentration from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Caregiver Strain Questionnaire
Description
Change in Caregiver Strain Questionnaire from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Montefiore-Einstein Rigidity Scale-Revised PWS (MERS-PWS):
Description
Change in three domains of rigid behavior from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Other Pre-specified Outcome Measures:
Title
Automated, Self-Administered, 24 Hour Recall Diary System
Description
Change in ASA 24: Automated, Self-Administered, 24 Hour Recall Diary System from baseline to endpoint
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Relationship between weight-based dosing and hyperphagia treatment response
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)
Title
Hormone levels (Ghrelin, pancreatic polypeptide, peptide YY, GLP-1, insulin, glucagon, testosterone, and estrogen)
Description
Change in hormone levels (ghrelin, pancreatic polypeptide, peptide YY, GLP-1, insulin, glucagon, testosterone, and estrogen) from baseline to endpoint.
Time Frame
From Randomization at Baseline until Endpoint at Week 8 (Change over 8 weeks)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
5 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female pediatric outpatients aged 5 to 17 years Must be in PWS nutritional phase 2b or 3 as determined by PI Must be on growth hormone treatment and have been receiving stable doses of growth hormone treatment for at least 3 months prior to screening date. Treatment cannot have been interrupted for more than one week within 3 months of screening. Diagnosis of PWS confirmed by patient medical records. A score of at least moderate severity on the Hyperphagia Questionnaire for Clinical Trials at both screening and baseline visits. Stable dosages of hormone treatments (including testosterone and estrogen supplements) for 4 weeks prior to randomization and for the duration of the study. Stable dosages of metabolic treatments that could affect appetite (including metformin) for 4 weeks prior to randomization and for the duration of the study. Physical exam and laboratory results that are within the normal range for individuals with PWS. Presence of a parent/caregiver/guardian that is able to consent for their participation and complete assessments regarding the child's development and behavior change throughout the study. Exclusion Criteria: Exposure to any investigational agent in the 30 days prior to randomization. Child not receiving growth hormone treatment Children weighing less than 40 lbs Children with unstable Type 2 Diabetes confirmed by Hemoglobin A1C levels at screening Children with unstable medical co-morbidities at baseline. Children with active upper respiratory infections at screening. A primary psychiatric diagnosis other than ASD, including bipolar disorder, psychosis, schizophrenia, PTSD or MDD. These patients will be excluded due to potential confounding results. Pregnant or lactating patients or patients who will not agree to use a double barrier method of contraception. IN-OXT has not been studied in pregnant or lactating women. Females using an estrogen-based contraceptive. As an alternative to an estrogen based contraceptive, subjects will be counseled to use progesterone-based contraceptives; cervical cap; cervical sponges; or spermicidal foam in combination with a condom. Subjects will need to use a double barrier method to be in the study. A medical condition that might interfere with the conduct of the study, confound interpretation of study results or endanger the subject's well-being. A known diagnosis of Rett's Syndrome of Childhood Disintegrative Disorder or marked sensory impairment such as deafness or blindness. Subjects who have changes in allied health therapies, behavioral or educational interventions within four weeks prior to randomization other than those associated with school holidays. Subjects who have had changes in medications or medication doses of risperidone, aripiprazole, other antipsychotic medications, clonidine, guanfacine, stimulants or anti-convulsants within four weeks of randomization.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Bonnie Taylor, PhD
Phone
718-839-7530
Email
botaylor@montefiore.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eric Hollander, MD
Organizational Affiliation
Albert Einstein College of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Montefiore Medical Center, Albert Einstein College of Medicine
City
Bronx
State/Province
New York
ZIP/Postal Code
10461
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Bonnie Taylor, PhD
Phone
718-839-7530
Email
botaylor@montefiore.org
First Name & Middle Initial & Last Name & Degree
Eric Hollander, MD

12. IPD Sharing Statement

Learn more about this trial

Intranasal Oxytocin vs. Placebo for the Treatment of Hyperphagia in Prader-Willi Syndrome

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