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Single Blind Study of Ergoloid Mesylates, 5-HTP and the Combination in Adult Males With Fragile X Syndrome

Primary Purpose

Fragile X Syndrome

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
5-Hydroxytryptophan / Vitamin B6
Ergoloid Mesylate
Placebo
Sponsored by
Elizabeth Berry-Kravis
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Fragile X Syndrome

Eligibility Criteria

18 Years - 45 Years (Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male aged 18 to 45 years, inclusive.
  2. Participant has Fragile X Syndrome with a molecular genetic confirmation of the full Fragile X Mental Retardation (FMR1) mutation (≥200 CGG repeats).
  3. Current treatment with no more than 3 prescribed psychotropic medications. Anti-epileptic medications are permitted and are not counted as psychotropic medications if they are used for treatment of seizures. Anti-epileptics for other indications, such as the treatment of mood disorders, count towards the limit of permitted medications.
  4. Permitted concomitant psychotropic medications must be at a stable dose and dosing regimen for at least 2 weeks prior to Screening and must remain stable during the period between Screening and the commencement of study medication.
  5. Anti-epileptic medications must be at a stable dose and dosing regimen for 12 weeks prior to Screening and must remain stable during the period between Screening and the commencement of study medication.
  6. Participants with a history of seizure disorder who are currently receiving treatment with anti-epileptics must have been seizure-free for 3 months preceding screening, or must be seizure-free for 3 years if not currently receiving anti-epileptics.
  7. Behavioral and therapy treatments/interventions must be stable for 4 weeks prior to Screening and must remain stable during the period between Screening and the commencement of study medication, and throughout the study. Minor changes in hours or times of therapy that are not considered clinically significant will not be exclusionary. Changes in therapies provided through a school program, due to school vacations, are allowed.
  8. Participant must be willing to practice barrier methods of contraception while on study, if sexually active. Abstinence is also considered a reasonable form of birth control in this study population.
  9. Participant has a parent, legal authorized guardian or consistent caregiver.
  10. Participant and caregiver are able to attend the clinic regularly and reliably.
  11. Participant is able to swallow capsules.
  12. For participants who are not their own legal guardian, participant's parent/legal authorized guardian is able to understand and sign an informed consent form to participate in the study.
  13. If participant is his own legal guardian, he can understand and sign informed consent to participate in the study.
  14. If participant is not their own legal guardian, the participant provides assent for participation in the study, if the participant has the cognitive ability to provide assent.

Exclusion Criteria:

  1. History of, or current cardiovascular, renal, hepatic, respiratory, gastrointestinal, psychiatric, neurologic, cerebrovascular, or other systemic disease that would place the participant at risk or potentially interfere with the interpretation of the safety, tolerability, or efficacy of the study medication.

    Common diseases such as mild hypertension, well-controlled type 2 diabetes mellitus (hemoglobin A1C [Hgb A1C] <6.5%), etc. are allowed per the investigator's judgment as long as they are stable and controlled by medical therapy that is constant for at least 4 weeks before randomization.

  2. Clinically significant abnormalities, in the investigator's judgment, in safety laboratory tests, vital signs, as measured during Screening.
  3. History of substance abuse within the past year, according to investigator assessment.
  4. Use of CYP3A4 inhibitors, beta-blockers, MAO inhibitors or triptans at any time during participation in the study.
  5. Significant hearing or visual impairment that may affect the participant's ability to complete the test procedures.
  6. Concurrent major psychiatric condition (e.g., Major Depressive Disorder, Schizophrenia or Bipolar Disorder) as diagnosed by the investigator. Participants with additional diagnosis of Autism Spectrum Disorder or Anxiety Disorder will be allowed as these are characteristics of FXS.
  7. Participant has active diseases that would interfere with participation, such as acquired immunodeficiency disorder, hepatitis C, hepatitis B, or tuberculosis.
  8. Participant is planning to commence psychotherapy or cognitive behavior therapy (CBT) during the period of the study or had begun psychotherapy or CBT within 4 weeks prior to Screening.
  9. Participant has participated in another clinical trial within the 30 days preceding Screening.

Sites / Locations

  • Rush University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Placebo Comparator

Experimental

Experimental

Arm Label

Ergoloid mesylates (EM) and 5-hydroxytryptophan (5-HTP)

Placebo

Ergoloid mesylates (EM) and placebo

5-hydroxytryptophan (5-HTP) and placebo

Arm Description

Ergoloid mesylates (EM) 1 mg three times daily and 5-hydroxytryptophan (5-HTP) 100 mg three times daily for 4 weeks

2 placebo capsules three times daily for 4 weeks

Ergoloid mesylates (EM) 1 mg three times daily and 1 placebo capsule three times daily for 4 weeks.

5-hydroxytryptophan (5-HTP) 100 mg three times daily and 1 placebo capsule three times daily for 4 weeks.

Outcomes

Primary Outcome Measures

Safety and tolerability
To evaluate the safety and tolerability of EM, 5-HTP, and EM + 5-HTP in fragile X syndrome. Safety and Tolerability Endpoints: ● Adverse events as assessed at each visit by Clinical Trials Common Toxicity Criteria (CTCAE)

Secondary Outcome Measures

KiTAP Executive Battery
Computerized executive battery with assessments of alertness (reaction time), distractibility, go/nogo (impulsiveness), and flexibility
Clinical Global Impression Severity
Investigator rated (CGI-S) Standardized ranking scale with 7 rankings
Clinical Global Impression Improvement
Investigator rated (CGI-I): Standardized ranking scale with 7 rankings
Visual Analog Scale (VAS)
Parent/caregiver-rated assessment of participant-specific behavioral anchors: Domains of daily functioning, anxiety/irritability and language.
Aberrant Behavior Checklist (ABC)
Parent/caregiver-rated scale with six subscales to assess irritability, social avoidance, lethargy, hyperactivity, inappropriate speech and social avoidance, using ABC-FX factoring system.
Anxiety, Depression, and Mood Scale (ADAMS)
Parent/caregiver rated scale with a total score and five sub-scores to assess manic/hyperactive behavior, depressed mood, social avoidance, general anxiety, and obsessive/compulsive behavior.
Vineland-3 Adaptive Behavior Scale
Clinician-administered standardized interview yielding adaptive behavior composite score and domain standard scores in domains of: communication (receptive, expressive, and written adaptive language functions), daily living skills (personal, domestic, and community skills), socialization (interpersonal relationships, play and leisure time, and coping abilities), and motor skills (gross and fine motor skills).
NIH Toolbox Cognitive Battery Modified for Intellectual Disabilities (NIH-TCB)
Cognitive battery assessing different domains of cognition, administered using an iPad
Event Related Potentials (ERP)
Event Related Potentials (ERP) Resting state delta power (electrical activity in the brain) will be measured from an EEG (electroencephalogram)
Eye Tracking
Eye Tracking = Measure of gaze aversion (social anxiety) and pupilometry (autonomic function) on computer based system
Eye Tracking - Gaze Aversion
The amount of time (in seconds) spent looking at, and away from, a visual image on a computer screen will be measured.
Eye Tracking - Pupilometry
Measure of pupilometry (pupil size) on a computer based system. The pupil size, in millimeters, will be measured in response to a visual image on a computer screen.

Full Information

First Posted
August 5, 2021
Last Updated
June 19, 2023
Sponsor
Elizabeth Berry-Kravis
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1. Study Identification

Unique Protocol Identification Number
NCT05030129
Brief Title
Single Blind Study of Ergoloid Mesylates, 5-HTP and the Combination in Adult Males With Fragile X Syndrome
Official Title
An Exploratory Single Blind Study of Ergoloid Mesylates, 5-Hydroxytryptophan, and the Combination in Adult Males With Fragile X Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Completed
Study Start Date
October 7, 2021 (Actual)
Primary Completion Date
January 19, 2023 (Actual)
Study Completion Date
January 19, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Elizabeth Berry-Kravis

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
A preliminary assessment of the safety, tolerability and efficacy of Ergoloid mesylates (EM) and 5-hydroxytryptophan (5-HTP) and the combination (EM + 5-HTP) compared to placebo in males aged 18-45 years old with Fragile X Syndrome.
Detailed Description
This single-center, Phase 2, single-blind, 4-period sequential study will obtain a preliminary assessment of the effects of Ergoloid mesylates (EM) 1 mg TID and 5-hydroxytryptophan (5-HTP) 100 mg TID and the combination compared to a placebo period in males aged 18-45 years old with Fragile X Syndrome. The study will consist of a Screening period of up to 28 days prior to initial study drug administration, followed by four 4 week single-blind treatment periods (up to 21 weeks total). The screening and baseline visits may occur at the same time, provided the results of safety labs can be obtained. A final follow-up visit or phone contact for safety is planned one week after the conclusion of Period 4. Safety and tolerability assessments will include adverse event monitoring, vital signs, blood chemistry and hematology, and urinalysis. Brief cognitive and behavioral assessments will be performed during each clinic visit. Eligible participants will progress through each of 4 periods (arms) on study. The periods are not listed sequentially here in order to preserve the single blind for participants. Throughout all 4 periods, participants will take two identical capsules three times a day. If only taking one over-encapsulated drug, they will take one over-encapsulated placebo pill with the drug at each dose, and when in period 4 they will take two over-encapsulated placebo pills at each dose.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Fragile X Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
Participant
Allocation
Non-Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ergoloid mesylates (EM) and 5-hydroxytryptophan (5-HTP)
Arm Type
Experimental
Arm Description
Ergoloid mesylates (EM) 1 mg three times daily and 5-hydroxytryptophan (5-HTP) 100 mg three times daily for 4 weeks
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
2 placebo capsules three times daily for 4 weeks
Arm Title
Ergoloid mesylates (EM) and placebo
Arm Type
Experimental
Arm Description
Ergoloid mesylates (EM) 1 mg three times daily and 1 placebo capsule three times daily for 4 weeks.
Arm Title
5-hydroxytryptophan (5-HTP) and placebo
Arm Type
Experimental
Arm Description
5-hydroxytryptophan (5-HTP) 100 mg three times daily and 1 placebo capsule three times daily for 4 weeks.
Intervention Type
Dietary Supplement
Intervention Name(s)
5-Hydroxytryptophan / Vitamin B6
Intervention Description
5-hydroxytryptophan, also known as 5-HTP has a nutraceutical status and has never been approved as a drug for any indication, but as a dietary supplement has been used extensively for several disorders for many years such as in the therapy of depression, fibromyalgia, obesity, insomnia and chronic headache
Intervention Type
Drug
Intervention Name(s)
Ergoloid Mesylate
Intervention Description
Ergoloid Mesylates, trade name Hydergine, is a mixture of the methanesulfonate salts of three dihydrogenated ergot alkaloids, dihydroergocristine, dihydroergocornine, and alpha- and beta-dihydroergocryptine. Ergot alkaloids are dopamine agonists which activate dopamine receptors (in the basal ganglia and other parts of the brain involved in motor function) and a prolactin inhibitor. Ergot is a strong vasoconstrictor and thus helps to reduce bleeding by narrowing of the blood vessels.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Placebo capsules
Primary Outcome Measure Information:
Title
Safety and tolerability
Description
To evaluate the safety and tolerability of EM, 5-HTP, and EM + 5-HTP in fragile X syndrome. Safety and Tolerability Endpoints: ● Adverse events as assessed at each visit by Clinical Trials Common Toxicity Criteria (CTCAE)
Time Frame
Up to 21 weeks
Secondary Outcome Measure Information:
Title
KiTAP Executive Battery
Description
Computerized executive battery with assessments of alertness (reaction time), distractibility, go/nogo (impulsiveness), and flexibility
Time Frame
Up to 21 weeks
Title
Clinical Global Impression Severity
Description
Investigator rated (CGI-S) Standardized ranking scale with 7 rankings
Time Frame
Up to 21 weeks
Title
Clinical Global Impression Improvement
Description
Investigator rated (CGI-I): Standardized ranking scale with 7 rankings
Time Frame
Up to 21 weeks
Title
Visual Analog Scale (VAS)
Description
Parent/caregiver-rated assessment of participant-specific behavioral anchors: Domains of daily functioning, anxiety/irritability and language.
Time Frame
Up to 21 weeks
Title
Aberrant Behavior Checklist (ABC)
Description
Parent/caregiver-rated scale with six subscales to assess irritability, social avoidance, lethargy, hyperactivity, inappropriate speech and social avoidance, using ABC-FX factoring system.
Time Frame
Up to 21 weeks
Title
Anxiety, Depression, and Mood Scale (ADAMS)
Description
Parent/caregiver rated scale with a total score and five sub-scores to assess manic/hyperactive behavior, depressed mood, social avoidance, general anxiety, and obsessive/compulsive behavior.
Time Frame
Up to 21 weeks
Title
Vineland-3 Adaptive Behavior Scale
Description
Clinician-administered standardized interview yielding adaptive behavior composite score and domain standard scores in domains of: communication (receptive, expressive, and written adaptive language functions), daily living skills (personal, domestic, and community skills), socialization (interpersonal relationships, play and leisure time, and coping abilities), and motor skills (gross and fine motor skills).
Time Frame
Up to 21 weeks
Title
NIH Toolbox Cognitive Battery Modified for Intellectual Disabilities (NIH-TCB)
Description
Cognitive battery assessing different domains of cognition, administered using an iPad
Time Frame
Up to 21 weeks
Title
Event Related Potentials (ERP)
Description
Event Related Potentials (ERP) Resting state delta power (electrical activity in the brain) will be measured from an EEG (electroencephalogram)
Time Frame
Up to 21 weeks
Title
Eye Tracking
Description
Eye Tracking = Measure of gaze aversion (social anxiety) and pupilometry (autonomic function) on computer based system
Time Frame
Up to 21 weeks
Title
Eye Tracking - Gaze Aversion
Description
The amount of time (in seconds) spent looking at, and away from, a visual image on a computer screen will be measured.
Time Frame
Up to 21 weeks
Title
Eye Tracking - Pupilometry
Description
Measure of pupilometry (pupil size) on a computer based system. The pupil size, in millimeters, will be measured in response to a visual image on a computer screen.
Time Frame
Up to 21 weeks

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
45 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male aged 18 to 45 years, inclusive. Participant has Fragile X Syndrome with a molecular genetic confirmation of the full Fragile X Mental Retardation (FMR1) mutation (≥200 CGG repeats). Current treatment with no more than 3 prescribed psychotropic medications. Anti-epileptic medications are permitted and are not counted as psychotropic medications if they are used for treatment of seizures. Anti-epileptics for other indications, such as the treatment of mood disorders, count towards the limit of permitted medications. Permitted concomitant psychotropic medications must be at a stable dose and dosing regimen for at least 2 weeks prior to Screening and must remain stable during the period between Screening and the commencement of study medication. Anti-epileptic medications must be at a stable dose and dosing regimen for 12 weeks prior to Screening and must remain stable during the period between Screening and the commencement of study medication. Participants with a history of seizure disorder who are currently receiving treatment with anti-epileptics must have been seizure-free for 3 months preceding screening, or must be seizure-free for 3 years if not currently receiving anti-epileptics. Behavioral and therapy treatments/interventions must be stable for 4 weeks prior to Screening and must remain stable during the period between Screening and the commencement of study medication, and throughout the study. Minor changes in hours or times of therapy that are not considered clinically significant will not be exclusionary. Changes in therapies provided through a school program, due to school vacations, are allowed. Participant must be willing to practice barrier methods of contraception while on study, if sexually active. Abstinence is also considered a reasonable form of birth control in this study population. Participant has a parent, legal authorized guardian or consistent caregiver. Participant and caregiver are able to attend the clinic regularly and reliably. Participant is able to swallow capsules. For participants who are not their own legal guardian, participant's parent/legal authorized guardian is able to understand and sign an informed consent form to participate in the study. If participant is his own legal guardian, he can understand and sign informed consent to participate in the study. If participant is not their own legal guardian, the participant provides assent for participation in the study, if the participant has the cognitive ability to provide assent. Exclusion Criteria: History of, or current cardiovascular, renal, hepatic, respiratory, gastrointestinal, psychiatric, neurologic, cerebrovascular, or other systemic disease that would place the participant at risk or potentially interfere with the interpretation of the safety, tolerability, or efficacy of the study medication. Common diseases such as mild hypertension, well-controlled type 2 diabetes mellitus (hemoglobin A1C [Hgb A1C] <6.5%), etc. are allowed per the investigator's judgment as long as they are stable and controlled by medical therapy that is constant for at least 4 weeks before randomization. Clinically significant abnormalities, in the investigator's judgment, in safety laboratory tests, vital signs, as measured during Screening. History of substance abuse within the past year, according to investigator assessment. Use of CYP3A4 inhibitors, beta-blockers, MAO inhibitors or triptans at any time during participation in the study. Significant hearing or visual impairment that may affect the participant's ability to complete the test procedures. Concurrent major psychiatric condition (e.g., Major Depressive Disorder, Schizophrenia or Bipolar Disorder) as diagnosed by the investigator. Participants with additional diagnosis of Autism Spectrum Disorder or Anxiety Disorder will be allowed as these are characteristics of FXS. Participant has active diseases that would interfere with participation, such as acquired immunodeficiency disorder, hepatitis C, hepatitis B, or tuberculosis. Participant is planning to commence psychotherapy or cognitive behavior therapy (CBT) during the period of the study or had begun psychotherapy or CBT within 4 weeks prior to Screening. Participant has participated in another clinical trial within the 30 days preceding Screening.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elizabeth Berry-Kravis, MD, PhD
Organizational Affiliation
Rush University Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rush University Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Single Blind Study of Ergoloid Mesylates, 5-HTP and the Combination in Adult Males With Fragile X Syndrome

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