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Study of Safety and Efficacy of MGCND00EP1 as an Add on Treatment in Children and Adolescents With Resistant Epilepsies

Primary Purpose

Resistant Epilepsy, Drug, Adolescent Epilepsy, Children Epilepsy

Status
Not yet recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
MGCND00EP1
Placebo
ECG
EEG
Blood and urine collection
Sponsored by
MGC Pharmaceuticals d.o.o
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Resistant Epilepsy, Drug focused on measuring epilepsy, resistant epilepsy, adolescents, children

Eligibility Criteria

1 Year - 18 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient has documented clinically confirmed diagnosis of epilepsy;
  • Patient did not respond to at least 2 AED's therapy given in adequate doses;
  • Patients current therapy is considered inadequate (not completely controlled by AEDs); patients had four or more countable seizures with a motor component per 4 week period;
  • Patient is aged 1 year - 18 years inclusive at screening age;
  • Patient took one or more AEDs treatment at dose which has been stable for at least 4 weeks before enrolment;
  • Females of childbearing potential can only participate in the study if willing to use acceptable, effective methods of contraception during the trial and for three month after end of trial participation as defined in point 7.10 of this protocol;
  • Patient/parent is able to read/understand informed consent.
  • Male patients must either be surgically sterile or he and his female spouse/partner who is of childbearing potential must be willing to use highly effective methods of contraception consisting of 2 forms of birth control (1 of which must be a barrier method) starting at screening and continuing throughout the study.
  • All medications or interventions for epilepsy (including ketogenic diet and vagus nerve stimulation (VNS) were stable for four weeks prior to screening and participants were willing to maintain a stable regimen throughout the study. The ketogenic diet and VNS treatments are not counted as an AED.

Exclusion Criteria:

  • Known history or presence of clinically significant unstable medical condition other that epilepsy which, in the opinion of the Investigator, would jeopardize the safety of the subject or impact the validity of the study results.
  • Known history or presence of serious cardiovascular disease
  • Known or suspected history or family history of: schizophrenia, or other psychotic illness, severe personality disorder or other significant psychiatric disorder.
  • Known or suspected allergy hypersensitivity or idiosyncratic reaction to cannabinoids or any other drug substances with similar activity or to any of the excipients of the IMP.
  • Participant has clinically relevant abnormalities in the 12-lead electrocardiogram measured at screening or randomisation.
  • Patients were currently using or had in the past used recreational or medicinal cannabis or synthetic CBD based medications or preparations within last 3 months or had previous or current treatment with cannabis-based therapy within last 3 months.
  • History of drug or alcohol addiction requiring treatment.
  • History of malabsorption within the last year or presence of clinically significant gastrointestinal disease or surgery that may affect drug bioavailability, including but not limited to cholecystectomy.
  • Presence of hepatic or renal dysfunction.
  • Females who: are pregnant (serum hCG level consistent with pregnancy diagnosis); or are lactating;
  • Participation in a clinical trial that involved administration of an investigational medicinal product within 90 days prior to drug administration, or recent participation in a clinical investigation that, in the opinion of the Investigator, would jeopardize subject safety or the integrity of the study results;
  • Participant has clinically significant abnormal laboratory values (e.g. liver enzymes);
  • Participant has clinically significant findings from a physical examination (fever);
  • In case of ketogenic diet or VNS; the diet need to be stable for at least 4 weeks, and VNS ramping needs to be stable at least 12 weeks before enrolment.

Sites / Locations

  • Schneider Children's Medical Center of Israel
  • University Children's Hospital Ljubljana University Medical Centre Ljubljana

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

MGCND00EP1

PLACEBO

Arm Description

Participants who will assigned to receive add on MGCND00EP1 will receive carrier oil containing THC and CBD in ratio 20:1, (10% of cannabidiol and 0.5 % and (-)-trans-Δ9-tetrahydrocannabinol) . Titration Dose: 1 to 2 mg/kg body weight/day. dose will be increased every week by 2 mg/kg body weight/day up to a maximum 25 mg/kg body weigh/day or maximum daily dose 800 mg (the smaller of those 2 values) (divided into two daily doses). After titration, patients will be receiving a stable maintenance dose of IMP (up to 25 mg/kg BW per day or maximum daily dose 800 mg (whichever smaller)) for 6 weeks period. During forth treatment period participants will commence a 2 weeks down-titration taper period, followed by 4 weeks observational follow up period of previous standard AE treatment without IMP.

Participants who are assigned to receive add on PLACEBO will be administered the carrier oil (without the active ingredients). Titration Dose: 1 to 2 mg/kg body weight/day. dose will be increased every week by 2 mg/kg body weight/day up to a maximum 25 mg/kg body weigh/day or maximum daily dose 800 mg (the smaller of those 2 values) (divided into two daily doses). After titration, patients will be receiving a stable maintenance dose of IMP (up to 25 mg/kg BW per day or maximum daily dose 800 mg (whichever smaller)) for 6 weeks period. During forth treatment period participants will commence a 2 weeks down-titration taper period, followed by 4 weeks observational follow up period of previous standard AE treatment without IMP.

Outcomes

Primary Outcome Measures

The proportion of patients showing a >50% reduction in frequency of seizures at week 12 of the study, in the treatment versus placebo groups
study drug overall efficiency as a seizure reducing treatment compared to placebo group
Change in number of epileptic seizures as documented by patient diaries (Visit 2 level compared to Visit 3 level and Visit 4) in treatment and placebo group.
study drug overall efficiency as a seizure reducing treatment

Secondary Outcome Measures

The incidence of adverse events will be summarized by organ class, severity and duration on weeks 12 and 18 of the study.
Adverse events assessment
Any change in physical examination, vital signs, lab tests results, ect will be collected and analyzed.
Improvement in vital signs, lab test results and physical examination
Change in duration of epileptic seizures as documented by patient diaries (Visit 2 level compared to Visit 3 level and Visit 4 level compared to Visit 2 level) by treatment group.
seizure frequency assessment
Change in score from Quality of Life in Childhood Epilepsy Questionnaire 55 (QOLCE-55 questionnaire) scoring 0-100 points, higher scoring indicates better condition. scoring will be compared between Visit 2 level and Visit 4 level.
QoL questionnaire assessment
Change in Clinical Global Impressions Scale (CGI scale) scoring 1-7 points, low scoring indicates better condition. Visit 2 level compared to Visit 4 level by treatment group.
CGI improvement by treatment group
Percentage of MGCND00EP1-treated patients who will develop a response to MGCND00EP1 (response will be defined as a reduction of seizures frequency by at least 25 % ) as compared between Visit 2 level and Visit 4 level
response to MGCND00EP1
Proportion of seizure-free patients between the placebo and treatment group on week 12 of treatment (including titration).
Proportion of seizure-free patients
Change in form of new seizures and emergency of new forms will be monitored during the trial
New seizure or seizure form emergency

Full Information

First Posted
May 17, 2020
Last Updated
March 14, 2023
Sponsor
MGC Pharmaceuticals d.o.o
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1. Study Identification

Unique Protocol Identification Number
NCT04406948
Brief Title
Study of Safety and Efficacy of MGCND00EP1 as an Add on Treatment in Children and Adolescents With Resistant Epilepsies
Official Title
Randomized, Double Blind, Placebo Controlled, Parallel Design Phase II b Study of Safety and Efficacy of MGCND00EP1 as an Add on Treatment in Children and Adolescents With Resistant Epilepsies
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
August 2023 (Anticipated)
Primary Completion Date
August 2024 (Anticipated)
Study Completion Date
September 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
MGC Pharmaceuticals d.o.o

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
EudraCT: 2018-003887-29 Objective:To evaluate the safety and efficacy of: MGCND00EP1 from MGC PHARMACEUTICALS d.o.o. Study Design: Randomized, double blind, placebo controlled parallel grouped study Sample Size: 103 subjects Study Population: Children from 1 year to 18 years of age Comparator Product :Placebo solution, oral IMP Product : MGCND00EP1 (each ml of solution containing 100 mg of cannabidiol and 5 mg of (-)-trans-Δ9- tetrahydrocannabinol as active substance) from MGC PHARMACEUTICALS D.O.O. According to dosing scheme up to 25 mg/kg BW per day or maximum daily dose 800 mg (whichever smaller) for 6 weeks titration and 6 weeks of treatment, oral administration
Detailed Description
Subjects on regular therapy with anti-epileptic medications who have evidence from clinical monitoring that current therapy is insufficient, following failure of at least two AEDs for at least during the last 2 months will be enrolled into this study. Upon subjects/parents have consented to participation in the study and after baseline examinations, subjects will continue with current antiepileptic treatment, as clinically needed, for another 28 days at the same dose as before entering the study; drug accountability will be performed for verification of treatment compliance, and diary will be used to record data on epileptic seizures. After that, participating patients will be randomly assigned to MGCND00EP1 or placebo and take it as add on to previous treatment for 6 weeks as titration period and 6 weeks at maintenance dose, and then titrated down during next two weeks. Patients will continue previous anti- epileptic treatment throughout all the periods of the study. Day one - Screening and Enrollment Visit : Total 103 patients: Obtain informed consent from legal guardian. Screen potential subjects by inclusion and exclusion criteria. Visit 1: obtain medical and medication history, vital signs, physical and neurological exam, blood and urine tests, ECG, EEG, concomitant medications, questionnaires. Weeks 1-4 - AED Stabilization Period : Visit 2: vital signs, weight, physical and neurological exam, blood and urine tests, concomitant medications, questionnaires, monitor AEs, PK blood collection (subset of patients), randomize and dispense study drugs Patients will be randomized and will either get placebo or MGCND00EP1 (3:1 active:placebo) Weeks 5-10 - Dose titration period: Dose escalations (2 mg/kg body weight/day increments), as required, up to 25 mg/kg/day or 800 mg/day, the lower of the two, until stable dose is reached. Visit 3: vital signs, weight, physical and neurological exam, blood and urine tests, concomitant medications, questionnaires, collect and issue diaries, dispense study drug, monitor AEs Weeks 11-16 - Maintenance Period : Visit 4: vital signs,weight, physical and neurological exam, blood and urine tests, concomitant medications, questionnaires, PK sample collection (subset of patients), collect and issue diaries, dispense study drug, EEG, monitor AEs Weeks 17-18 - Tapering-off and Follow-up Period: Weekly phone call to determine taper dose at physician's discretion Visit 5: vital signs,weight, physical and neurological exam, blood and urine tests, concomitant medications, questionnaires, monitor AEs, collect diaries and unused drug Weeks 19-20 - Follow-up Period: Weekly phone calls Visits 6: vital signs,weight, physical and neurological exam, concomitant medications, monitor AEs, collect diaries .

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Resistant Epilepsy, Drug, Adolescent Epilepsy, Children Epilepsy, Children and Adolescents With Resistant Epilepsies
Keywords
epilepsy, resistant epilepsy, adolescents, children

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Treatment with current antiepileptic therapy 28 days - Various combinations of anti-epileptic (AE) medications Add on treatment 42 days (6 weeks) - titration period - MGCND00EP1 or placebo in addition to AE medications. Add on treatment 42 days (6 weeks) Maintenance stable treatment period - MGCND00EP1 or placebo in addition to AE medications Add on treatment 14 days (2 weeks)- taper - down titration period - MGCND00EP1 or placebo in addition to AE medications Follow up 28 days - Standard/ previous AE treatment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
103 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
MGCND00EP1
Arm Type
Experimental
Arm Description
Participants who will assigned to receive add on MGCND00EP1 will receive carrier oil containing THC and CBD in ratio 20:1, (10% of cannabidiol and 0.5 % and (-)-trans-Δ9-tetrahydrocannabinol) . Titration Dose: 1 to 2 mg/kg body weight/day. dose will be increased every week by 2 mg/kg body weight/day up to a maximum 25 mg/kg body weigh/day or maximum daily dose 800 mg (the smaller of those 2 values) (divided into two daily doses). After titration, patients will be receiving a stable maintenance dose of IMP (up to 25 mg/kg BW per day or maximum daily dose 800 mg (whichever smaller)) for 6 weeks period. During forth treatment period participants will commence a 2 weeks down-titration taper period, followed by 4 weeks observational follow up period of previous standard AE treatment without IMP.
Arm Title
PLACEBO
Arm Type
Placebo Comparator
Arm Description
Participants who are assigned to receive add on PLACEBO will be administered the carrier oil (without the active ingredients). Titration Dose: 1 to 2 mg/kg body weight/day. dose will be increased every week by 2 mg/kg body weight/day up to a maximum 25 mg/kg body weigh/day or maximum daily dose 800 mg (the smaller of those 2 values) (divided into two daily doses). After titration, patients will be receiving a stable maintenance dose of IMP (up to 25 mg/kg BW per day or maximum daily dose 800 mg (whichever smaller)) for 6 weeks period. During forth treatment period participants will commence a 2 weeks down-titration taper period, followed by 4 weeks observational follow up period of previous standard AE treatment without IMP.
Intervention Type
Drug
Intervention Name(s)
MGCND00EP1
Other Intervention Name(s)
Cannabis oil
Intervention Description
Patients will take cannabis oil during the study
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Patient will take carrier oil during the study
Intervention Type
Diagnostic Test
Intervention Name(s)
ECG
Intervention Description
A standard 12-lead ECG will be recorded using digital ECG recording equipment provided to the investigational site. The ECG has to be performed prior to laboratory samplings at time points indicated in the Schedule of Assessments. The ECG recording will be reviewed by investigator and case of need consultation with cardiologist will be performed. The investigator has the final decision on the clinical significance of the ECG results.
Intervention Type
Diagnostic Test
Intervention Name(s)
EEG
Intervention Description
An EEG is an electrophysiological monitoring method that records the electrical activity and measures voltage fluctuations resulting from ionic current within the neurons of the brain. In clinical contexts, EEG refers to the recording of the brain's spontaneous electrical activity over a period of time.
Intervention Type
Diagnostic Test
Intervention Name(s)
Blood and urine collection
Other Intervention Name(s)
blood tests
Intervention Description
safety blood tests - hematology\blood count and biochemistry standard blood tests urinalysis - urine test analysis
Primary Outcome Measure Information:
Title
The proportion of patients showing a >50% reduction in frequency of seizures at week 12 of the study, in the treatment versus placebo groups
Description
study drug overall efficiency as a seizure reducing treatment compared to placebo group
Time Frame
12 weeks
Title
Change in number of epileptic seizures as documented by patient diaries (Visit 2 level compared to Visit 3 level and Visit 4) in treatment and placebo group.
Description
study drug overall efficiency as a seizure reducing treatment
Time Frame
16 weeks
Secondary Outcome Measure Information:
Title
The incidence of adverse events will be summarized by organ class, severity and duration on weeks 12 and 18 of the study.
Description
Adverse events assessment
Time Frame
12-18 weeks
Title
Any change in physical examination, vital signs, lab tests results, ect will be collected and analyzed.
Description
Improvement in vital signs, lab test results and physical examination
Time Frame
18 weeks
Title
Change in duration of epileptic seizures as documented by patient diaries (Visit 2 level compared to Visit 3 level and Visit 4 level compared to Visit 2 level) by treatment group.
Description
seizure frequency assessment
Time Frame
12-18 weeks
Title
Change in score from Quality of Life in Childhood Epilepsy Questionnaire 55 (QOLCE-55 questionnaire) scoring 0-100 points, higher scoring indicates better condition. scoring will be compared between Visit 2 level and Visit 4 level.
Description
QoL questionnaire assessment
Time Frame
18 weeks
Title
Change in Clinical Global Impressions Scale (CGI scale) scoring 1-7 points, low scoring indicates better condition. Visit 2 level compared to Visit 4 level by treatment group.
Description
CGI improvement by treatment group
Time Frame
18 weeks
Title
Percentage of MGCND00EP1-treated patients who will develop a response to MGCND00EP1 (response will be defined as a reduction of seizures frequency by at least 25 % ) as compared between Visit 2 level and Visit 4 level
Description
response to MGCND00EP1
Time Frame
18 weeks
Title
Proportion of seizure-free patients between the placebo and treatment group on week 12 of treatment (including titration).
Description
Proportion of seizure-free patients
Time Frame
12 weeks
Title
Change in form of new seizures and emergency of new forms will be monitored during the trial
Description
New seizure or seizure form emergency
Time Frame
18 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient has documented clinically confirmed diagnosis of epilepsy; Patient did not respond to at least 2 AED's therapy given in adequate doses; Patients current therapy is considered inadequate (not completely controlled by AEDs); patients had four or more countable seizures with a motor component per 4 week period; Patient is aged 1 year - 18 years inclusive at screening age; Patient took one or more AEDs treatment at dose which has been stable for at least 4 weeks before enrolment; Females of childbearing potential can only participate in the study if willing to use acceptable, effective methods of contraception during the trial and for three month after end of trial participation as defined in point 7.10 of this protocol; Patient/parent is able to read/understand informed consent. Male patients must either be surgically sterile or he and his female spouse/partner who is of childbearing potential must be willing to use highly effective methods of contraception consisting of 2 forms of birth control (1 of which must be a barrier method) starting at screening and continuing throughout the study. All medications or interventions for epilepsy (including ketogenic diet and vagus nerve stimulation (VNS) were stable for four weeks prior to screening and participants were willing to maintain a stable regimen throughout the study. The ketogenic diet and VNS treatments are not counted as an AED. Exclusion Criteria: Known history or presence of clinically significant unstable medical condition other that epilepsy which, in the opinion of the Investigator, would jeopardize the safety of the subject or impact the validity of the study results. Known history or presence of serious cardiovascular disease Known or suspected history or family history of: schizophrenia, or other psychotic illness, severe personality disorder or other significant psychiatric disorder. Known or suspected allergy hypersensitivity or idiosyncratic reaction to cannabinoids or any other drug substances with similar activity or to any of the excipients of the IMP. Participant has clinically relevant abnormalities in the 12-lead electrocardiogram measured at screening or randomisation. Patients were currently using or had in the past used recreational or medicinal cannabis or synthetic CBD based medications or preparations within last 3 months or had previous or current treatment with cannabis-based therapy within last 3 months. History of drug or alcohol addiction requiring treatment. History of malabsorption within the last year or presence of clinically significant gastrointestinal disease or surgery that may affect drug bioavailability, including but not limited to cholecystectomy. Presence of hepatic or renal dysfunction. Females who: are pregnant (serum hCG level consistent with pregnancy diagnosis); or are lactating; Participation in a clinical trial that involved administration of an investigational medicinal product within 90 days prior to drug administration, or recent participation in a clinical investigation that, in the opinion of the Investigator, would jeopardize subject safety or the integrity of the study results; Participant has clinically significant abnormal laboratory values (e.g. liver enzymes); Participant has clinically significant findings from a physical examination (fever); In case of ketogenic diet or VNS; the diet need to be stable for at least 4 weeks, and VNS ramping needs to be stable at least 12 weeks before enrolment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Nadia Lisovoder
Phone
+972529573063
Email
nadyal@galilee-cbr.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rubi Zomer
Organizational Affiliation
MGC Pharmacuticals
Official's Role
Study Director
Facility Information:
Facility Name
Schneider Children's Medical Center of Israel
City
Petach Tikvah
State/Province
Central District
ZIP/Postal Code
4920235
Country
Israel
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dror Kraus
Phone
+972523302002
Facility Name
University Children's Hospital Ljubljana University Medical Centre Ljubljana
City
Ljubljana
ZIP/Postal Code
1000
Country
Slovenia
Facility Contact:
First Name & Middle Initial & Last Name & Degree
David Neubauer, MD, PhD
Phone
+386 1 522 9231

12. IPD Sharing Statement

Plan to Share IPD
No
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Study of Safety and Efficacy of MGCND00EP1 as an Add on Treatment in Children and Adolescents With Resistant Epilepsies

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