Safety and Efficacy Study of Oral Glycopyrrolate Liquid for the Treatment of Pathologic (Chronic Moderate to Severe) Drooling in Pediatric Patients 3 to 18 Years of Age With Cerebral Palsy or Other Neurologic Conditions
Primary Purpose
Cerebral Palsy, Neurological Conditions, Mental Retardation
Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Oral Glycopyrrolate Liquid
Sponsored by
About this trial
This is an interventional treatment trial for Cerebral Palsy focused on measuring Mental Retardation, Neurological Impairment, Cerebral Palsy, Drooling, Neurological Conditions
Eligibility Criteria
Inclusion Criteria:
To be included in this study, patients must meet the following criteria:
- Male or female, weighing at least 13 kilograms (27 pounds), aged 3 through 18 years
- Diagnosis of cerebral palsy and/or mental retardation or any other neurologic impairment or condition (cognitively capable and cognitively impaired patients may be enrolled)
- Chronic drooling in the absence of treatment to the extent that the chin or clothing becomes wet on most days by confirming the Modified Teacher's Drooling Scale score ≥ 5
- Must be living in a situation where reliable parents/caregivers are willing and capable of administering medications, as determined by the investigator
- Written informed consent signed by the parent or legally acceptable representative
- Written assent signed by the age-appropriate patient if mentally capable, as determined by the investigator, and required by the site's Institutional Review Board
- If female of childbearing potential, the patient must have a negative pregnancy test at screening and Visit 2
- If female of childbearing potential and sexually active, she must use a medically acceptable form of contraception
Exclusion Criteria:
Patients are excluded from this study if they meet any of the following criteria:
- Patients who used glycopyrrolate within approximately 24 hours prior to the start of the baseline period, which began on Day -2
- Patients who used prohibited medications within 5 plasma half-lives of the medication prior to the start of the baseline period
- Patients injected with intrasalivary gland botulinum toxin within 10 months prior to the start of the baseline period
- Patients using intraoral devices or prosthetics for the treatment of drooling within 1 week prior to the start of the baseline period
- Patients receiving acupuncture for the treatment of drooling or who have received acupuncture for the treatment of drooling within 3 months prior to the start of the baseline period
- Patients who have medical conditions contraindicating anticholinergic therapy including gastrointestinal reflux, narrow-angle glaucoma, obstructive uropathy, obstructive disease of the gastrointestinal tract (i.e., delayed gastric emptying, pyloroduodenal stenosis, etc.), paralytic ileus, intestinal atony, vesicoureteral reflux, reactive airway disease, myasthenia gravis, hyperthyroidism, cardiac arrhythmias and/or tachycardia, and/or clinically significant electrocardiogram abnormalities, as determined by the investigator
- Patients who have a known contraindication to the study medication, including allergy to the study medication or any of its components
- Patients who have poorly controlled seizures defined as daily seizures
- Patients who have a history of obstructive disease of the gastrointestinal tract (i.e., intestinal obstruction)
- Patients who have clinically significant hepatic or renal impairment, at the discretion of the investigator
- Patients who are pregnant or breastfeeding
- Patients who have received any investigational drugs within 30 days of study entry
- Patient, families, or parents/caregivers who are expected to be non-compliant with the study procedures, as judged by the investigator
- Patients who are unable to meet the requirements of the study for any reason, as determined by the investigator
- Patients who have unstable mental disease, as determined by the investigator
Sites / Locations
- Rocky Mountain Pediatrics
- Child Neurology Associates, PC
- St. Mary's for Children
- Akron's Childrens
- Hattie Larltham Center for Children with Disabilities
- The Children's Center
- Alamo City Clinical Research
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
Patients with Chronic Drooling
Arm Description
Arm receiving study drug
Outcomes
Primary Outcome Measures
Proportion of Responders According to the Modified Teacher's Drooling Scale (mTDS)
The primary efficacy variable was patient's response status using the change from baseline to Week 24 evaluations of the mTDS assessment. Each patient was classified as a responder or non-responder according to the change in their mean mTDS rating from baseline to Week 24. Responders were patients who had at least a 3-point decrease in mTDS rating from baseline
Secondary Outcome Measures
Parent/Caregiver's Assessment of the Extent of Drooling Using Visual Analog Scale (VAS)
Parents/caregivers were to complete a 10 cm "Parent/Caregiver's Assessment of Extent of Drooling for the Day" VAS assessment (0 = normal; 10 = extremely wet) to provide an overall assessment of the extent of drooling for that day.
Parent/Caregiver's Assessment of the Extent of Drooling Using VAS
Parents/caregivers were to complete a 10 cm "Parent/Caregiver's Assessment of Extent of Drooling for the Day" VAS assessment (0 = normal; 10 = extremely wet) to provide an overall assessment of the extent of drooling for that day.
Parent/Caregiver's Global Assessment of Treatment
The parent/caregiver performed an overall evaluation of glycopyrrolate liquid for the treatment of drooling, benefits, and side effects over the duration of the study. The parent/caregiver selected one of the following choices to assess if 'This is a worthwhile treatment': 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, 5 = strongly disagree. A dichotomous global assessment was also performed and summarized with the categories 'responder' (strongly agree and agree responses aggregated) and 'non-responder'(neutral, disagree, and strongly disagree responses aggregated)
Investigator's Global Assessment of Treatment
The investigator performed an overall evaluation of glycopyrrolate liquid for the treatment of drooling, benefits, and side effects over the duration of the study. The investigator selected one of the following choices to assess if 'This is a worthwhile treatment': 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, 5 = strongly disagree. A dichotomous global assessment was also performed and summarized with the categories 'responder' (strongly agree and agree responses aggregated) and 'non-responder' (neutral, disagree, and strongly disagree responses aggregated)
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT00491894
Brief Title
Safety and Efficacy Study of Oral Glycopyrrolate Liquid for the Treatment of Pathologic (Chronic Moderate to Severe) Drooling in Pediatric Patients 3 to 18 Years of Age With Cerebral Palsy or Other Neurologic Conditions
Official Title
A Six-Month, Multi-Center, Open-Label Study to Assess the Safety and Efficacy of Oral Glycopyrrolate Liquid for the Treatment of Pathologic (Chronic Moderate to Severe) Drooling in Pediatric Patients 3 to 18 Years of Age With Cerebral Palsy or Other Neurologic Conditions
Study Type
Interventional
2. Study Status
Record Verification Date
April 2012
Overall Recruitment Status
Completed
Study Start Date
March 2007 (undefined)
Primary Completion Date
May 2008 (Actual)
Study Completion Date
June 2008 (Actual)
3. Sponsor/Collaborators
Name of the Sponsor
Shionogi
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is an open-label clinical research study of an oral glycopyrrolate liquid for the treatment of chronic moderate to severe drooling in patients with cerebral palsy or other neurological conditions. Patients participating in the study will receive oral glycopyrrolate liquid (1 mg/5 ml) three times a day (TID) for study duration of 24 weeks. After a washout, screening, and 2-day baseline period, patients will be enrolled in a 4-week dose titration period. Glycopyrrolate liquid doses will be titrated using dose levels in the Dose Titration Schedule. Titration will begin at 0.02 mg/kg per dose TID and sequentially increased in 0.02 mg/kg per dose increments TID every 5-7 days during the first four weeks until optimal individualized response is obtained for each patient or a maximum dose of 0.1 mg/kg TID is reached, not exceeding 3 mg TID or Dose-level 5 in the Dose Titration Schedule, whichever is lesser. Optimal dose for each patient is the dose at which he/she is receiving the maximum benefit from the study drug (greatest improvement in drooling) while experiencing minimum side effects. All patients will receive close attention by study staff throughout the study.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cerebral Palsy, Neurological Conditions, Mental Retardation, Sialorrhea
Keywords
Mental Retardation, Neurological Impairment, Cerebral Palsy, Drooling, Neurological Conditions
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
137 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Patients with Chronic Drooling
Arm Type
Other
Arm Description
Arm receiving study drug
Intervention Type
Drug
Intervention Name(s)
Oral Glycopyrrolate Liquid
Intervention Description
Study medication is administered three times a day at 7-8 AM, 1-2 PM, and 7-8 PM by the parent/caregiver
Primary Outcome Measure Information:
Title
Proportion of Responders According to the Modified Teacher's Drooling Scale (mTDS)
Description
The primary efficacy variable was patient's response status using the change from baseline to Week 24 evaluations of the mTDS assessment. Each patient was classified as a responder or non-responder according to the change in their mean mTDS rating from baseline to Week 24. Responders were patients who had at least a 3-point decrease in mTDS rating from baseline
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Parent/Caregiver's Assessment of the Extent of Drooling Using Visual Analog Scale (VAS)
Description
Parents/caregivers were to complete a 10 cm "Parent/Caregiver's Assessment of Extent of Drooling for the Day" VAS assessment (0 = normal; 10 = extremely wet) to provide an overall assessment of the extent of drooling for that day.
Time Frame
Baseline
Title
Parent/Caregiver's Assessment of the Extent of Drooling Using VAS
Description
Parents/caregivers were to complete a 10 cm "Parent/Caregiver's Assessment of Extent of Drooling for the Day" VAS assessment (0 = normal; 10 = extremely wet) to provide an overall assessment of the extent of drooling for that day.
Time Frame
Week 24
Title
Parent/Caregiver's Global Assessment of Treatment
Description
The parent/caregiver performed an overall evaluation of glycopyrrolate liquid for the treatment of drooling, benefits, and side effects over the duration of the study. The parent/caregiver selected one of the following choices to assess if 'This is a worthwhile treatment': 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, 5 = strongly disagree. A dichotomous global assessment was also performed and summarized with the categories 'responder' (strongly agree and agree responses aggregated) and 'non-responder'(neutral, disagree, and strongly disagree responses aggregated)
Time Frame
Week 24
Title
Investigator's Global Assessment of Treatment
Description
The investigator performed an overall evaluation of glycopyrrolate liquid for the treatment of drooling, benefits, and side effects over the duration of the study. The investigator selected one of the following choices to assess if 'This is a worthwhile treatment': 1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree, 5 = strongly disagree. A dichotomous global assessment was also performed and summarized with the categories 'responder' (strongly agree and agree responses aggregated) and 'non-responder' (neutral, disagree, and strongly disagree responses aggregated)
Time Frame
Week 24
10. Eligibility
Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
To be included in this study, patients must meet the following criteria:
Male or female, weighing at least 13 kilograms (27 pounds), aged 3 through 18 years
Diagnosis of cerebral palsy and/or mental retardation or any other neurologic impairment or condition (cognitively capable and cognitively impaired patients may be enrolled)
Chronic drooling in the absence of treatment to the extent that the chin or clothing becomes wet on most days by confirming the Modified Teacher's Drooling Scale score ≥ 5
Must be living in a situation where reliable parents/caregivers are willing and capable of administering medications, as determined by the investigator
Written informed consent signed by the parent or legally acceptable representative
Written assent signed by the age-appropriate patient if mentally capable, as determined by the investigator, and required by the site's Institutional Review Board
If female of childbearing potential, the patient must have a negative pregnancy test at screening and Visit 2
If female of childbearing potential and sexually active, she must use a medically acceptable form of contraception
Exclusion Criteria:
Patients are excluded from this study if they meet any of the following criteria:
Patients who used glycopyrrolate within approximately 24 hours prior to the start of the baseline period, which began on Day -2
Patients who used prohibited medications within 5 plasma half-lives of the medication prior to the start of the baseline period
Patients injected with intrasalivary gland botulinum toxin within 10 months prior to the start of the baseline period
Patients using intraoral devices or prosthetics for the treatment of drooling within 1 week prior to the start of the baseline period
Patients receiving acupuncture for the treatment of drooling or who have received acupuncture for the treatment of drooling within 3 months prior to the start of the baseline period
Patients who have medical conditions contraindicating anticholinergic therapy including gastrointestinal reflux, narrow-angle glaucoma, obstructive uropathy, obstructive disease of the gastrointestinal tract (i.e., delayed gastric emptying, pyloroduodenal stenosis, etc.), paralytic ileus, intestinal atony, vesicoureteral reflux, reactive airway disease, myasthenia gravis, hyperthyroidism, cardiac arrhythmias and/or tachycardia, and/or clinically significant electrocardiogram abnormalities, as determined by the investigator
Patients who have a known contraindication to the study medication, including allergy to the study medication or any of its components
Patients who have poorly controlled seizures defined as daily seizures
Patients who have a history of obstructive disease of the gastrointestinal tract (i.e., intestinal obstruction)
Patients who have clinically significant hepatic or renal impairment, at the discretion of the investigator
Patients who are pregnant or breastfeeding
Patients who have received any investigational drugs within 30 days of study entry
Patient, families, or parents/caregivers who are expected to be non-compliant with the study procedures, as judged by the investigator
Patients who are unable to meet the requirements of the study for any reason, as determined by the investigator
Patients who have unstable mental disease, as determined by the investigator
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Shionogi Clinical Trials Administrator Clinical Support Help Line
Organizational Affiliation
Shionogi
Official's Role
Study Director
Facility Information:
Facility Name
Rocky Mountain Pediatrics
City
Lakewood
State/Province
Colorado
ZIP/Postal Code
80214
Country
United States
Facility Name
Child Neurology Associates, PC
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30342
Country
United States
Facility Name
St. Mary's for Children
City
Bayside
State/Province
New York
ZIP/Postal Code
11360
Country
United States
Facility Name
Akron's Childrens
City
Akron
State/Province
Ohio
ZIP/Postal Code
44308
Country
United States
Facility Name
Hattie Larltham Center for Children with Disabilities
City
Mantua
State/Province
Ohio
ZIP/Postal Code
44255
Country
United States
Facility Name
The Children's Center
City
Bethany
State/Province
Oklahoma
ZIP/Postal Code
73008
Country
United States
Facility Name
Alamo City Clinical Research
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78258
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
22298950
Citation
Zeller RS, Lee HM, Cavanaugh PF, Davidson J. Randomized Phase III evaluation of the efficacy and safety of a novel glycopyrrolate oral solution for the management of chronic severe drooling in children with cerebral palsy or other neurologic conditions. Ther Clin Risk Manag. 2012;8:15-23. doi: 10.2147/TCRM.S26893. Epub 2012 Jan 25.
Results Reference
derived
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Safety and Efficacy Study of Oral Glycopyrrolate Liquid for the Treatment of Pathologic (Chronic Moderate to Severe) Drooling in Pediatric Patients 3 to 18 Years of Age With Cerebral Palsy or Other Neurologic Conditions
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