search
Back to results

Trial of Oral Valproic Acid for Retinitis Pigmentosa (VPA)

Primary Purpose

Retinitis Pigmentosa

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Valproic Acid
Placebo
Sponsored by
Foundation Fighting Blindness
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Retinitis Pigmentosa focused on measuring retinitis pigmentosa, valproic acid, visual field

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Understand/sign the IRB-approved study informed consent document.
  2. Age greater than or equal to 18 years, no upper age limit
  3. Males and non-child bearing females must weigh ≥40 Kg and ≤158.9 Kg; Females of child bearing potential must weigh ≥40 Kg and ≤74.9 Kg.
  4. Diagnosis of Retinitis Pigmentosa (RP).
  5. Visual acuity of greater than or equal to 35 letters in at least one eye as measured by the EVA-ETDRS (equivalent to 20/200 on a Snellen chart).
  6. Genotyped as autosomal dominant form of RP.
  7. Female subjects of childbearing potential and male subjects able to father children must have (or have a partner who has) had a hysterectomy or vasectomy, be completely abstinent from intercourse or must commit to practice at least two acceptable methods of contraception to minimize the chance of pregnancy during the study and for the 13 week period after stopping the study drug.
  8. Female subjects of childbearing potential must have a negative urine pregnancy test at study entry and throughout the duration of the study.
  9. Willingness to comply with the protocol.

Exclusion Criteria:

  1. Medical problems that make consistent follow-up over the treatment period unlikely (e.g. stroke, severe MI, end stage malignancy), or in general a poor medical risk because of other systemic diseases or active uncontrolled infections.
  2. Other retinal diseases: Glaucoma, retinal inflammatory disease (CME is allowable), cataract worse than +2 NS, or herpes simplex virus of the eye.
  3. Intact visual field of 5⁰ or less.
  4. Subject unable to provide reliable perimetry measurements in both eyes for both static and kinetic visual field, as determined by the Reading Center.
  5. Diabetes.
  6. History of cancer (other than non-melanoma skin cancer) diagnosed, or requiring treatment within the past 2 years.
  7. A hemoglobin concentration, a platelet count or an absolute neutrophil count below the lower limit of normal at study entry.
  8. Suspected liver dysfunction determined by having liver function values elevated above the upper limit of normal.
  9. History of pancreatitis by clinical features and/or laboratory abnormalities in the last 12 months.
  10. Renal dysfunction based on serum creatinine,(MDRD) equation.
  11. Urea cycle disorders.
  12. History of neurological conditions including epilepsy, history of brain injury, encephalitis, or any organic brain syndrome.
  13. History of schizophrenia, schizoaffective disorder, bipolar disorder, suicidality or organic mental disorders.
  14. Currently receiving valproic acid or other anti-convulsants.
  15. Sensitive to or have ever had an allergic reaction to valproic Acid.
  16. Sensitive to or have ever had an allergic reaction to peanuts as peanut oil is an inactive ingredient in valproic acid capsules and the placebo.
  17. Has taken one of the disallowed drugs at least 2 weeks prior to randomization.
  18. Pregnant women.
  19. Lactating mothers who are breast feeding their babies.
  20. RP patients involved in other clinical trials within the last 3 months.
  21. Require enrollment by consent of a legally authorized representative.
  22. Persons who are unable to read are not allowed to consent for themselves or others to participate in this study.
  23. The potential participant lives in the same household as a current participant in this protocol.

Sites / Locations

  • University of Miami, Bascom Palmer Eye Institute
  • University of Michigan, Ann Arbor
  • Oregon Health & Science University
  • University of Tennessee, Hamilton Eye Institute
  • Retina Foundation of the Southwest
  • University of Utah School of Medicine, Moran Eye Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Valproic Acid

Placebo

Arm Description

Subjects who receive valproic acid

Subjects who receive placebo

Outcomes

Primary Outcome Measures

Mean Change in Visual Field Area From Baseline to 52 Weeks--III4e Isopter
Mean change in visual field area from baseline to 52 weeks. Visual field area is measured with semi-automated kinetic perimetry (SKP) using the Octopus 900 (Haag-Streit) with the III4e target size for each eye and done at least twice to ensure reliable sessions; the visual field area measurements are averaged over the two sessions. Analysis performed with linear mixed model

Secondary Outcome Measures

Mean Change in Visual Field Area From Baseline to 52 Weeks--I4e Isopter
Mean change in visual field area from baseline to 52 weeks. Visual field area is measured with semi-automated kinetic perimetry (SKP) using the Octopus 900 (Haag-Streit) with the I4e target size for each eye and done at least twice to ensure reliable sessions; the visual field area measurements are averaged over the two sessions. Analysis performed with linear mixed model
Static Perimetry by Treatment Arm--Full Field Hill of Vision
Mean change from baseline at week 52 for Full field Hill of Vision (Static perimetry)
Static Perimetry Volume--30 Degree Hill of Vision
Mean Change from baseline to week 52 for Static Perimetry Volume --30 Degree Hill of Vision. Full field static perimetry protocol was followed using the Octopus 900 (Haag-Streit) for a single session for each eye.
Mean Change From Baseline in Best Corrected Visual Acuity
Mean change in best corrected visual acuity as assessed by ETDRS (Early Treatment Diabetic Retinopathy Study) method from baseline to week 52

Full Information

First Posted
November 1, 2010
Last Updated
October 24, 2017
Sponsor
Foundation Fighting Blindness
Collaborators
United States Department of Defense
search

1. Study Identification

Unique Protocol Identification Number
NCT01233609
Brief Title
Trial of Oral Valproic Acid for Retinitis Pigmentosa
Acronym
VPA
Official Title
A Phase II Multiple Site, Randomized, Placebo-Controlled Trial of Oral Valproic Acid for Autosomal Dominant Retinitis Pigmentosa
Study Type
Interventional

2. Study Status

Record Verification Date
October 2017
Overall Recruitment Status
Completed
Study Start Date
November 2010 (undefined)
Primary Completion Date
December 2015 (Actual)
Study Completion Date
December 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Foundation Fighting Blindness
Collaborators
United States Department of Defense

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objectives of this study are to evaluate the efficacy of Valproic Acid (VPA) to both slow the progression of visual function loss and/or to restore visual function in patients with Autosomal Dominant Retinitis Pigmentosa (RP) and to collect safety and tolerability information.
Detailed Description
Retinitis Pigmentosa (RP) is an incurable and untreatable group of heterogeneous retinal degenerative diseases that cause severe visual loss. There is currently no therapeutic that substantially slows the progression of this disease, and certainly none that can restore vision in RP patients. The Valproic Acid (VPA) study is designed as a six-site, interventional, prospective, randomized, placebo controlled, double-blinded study of 90 participants to evaluate the efficacy of oral Valproic Acid to both slow the progression of visual function loss and/or to restore visual function in patients with an Autosomal Dominant RP genetic mutation and to collect safety and tolerability information. Patients that participate in the study will be randomized to either placebo or VPA in a 1:1 ratio.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Retinitis Pigmentosa
Keywords
retinitis pigmentosa, valproic acid, visual field

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Valproic Acid
Arm Type
Active Comparator
Arm Description
Subjects who receive valproic acid
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Subjects who receive placebo
Intervention Type
Drug
Intervention Name(s)
Valproic Acid
Other Intervention Name(s)
Valproate
Intervention Description
One to four 250mg softgels by mouth daily (dose determined by body weight)
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Dosage per subject weight- same schedule as the active comparator
Primary Outcome Measure Information:
Title
Mean Change in Visual Field Area From Baseline to 52 Weeks--III4e Isopter
Description
Mean change in visual field area from baseline to 52 weeks. Visual field area is measured with semi-automated kinetic perimetry (SKP) using the Octopus 900 (Haag-Streit) with the III4e target size for each eye and done at least twice to ensure reliable sessions; the visual field area measurements are averaged over the two sessions. Analysis performed with linear mixed model
Time Frame
baseline to week 52
Secondary Outcome Measure Information:
Title
Mean Change in Visual Field Area From Baseline to 52 Weeks--I4e Isopter
Description
Mean change in visual field area from baseline to 52 weeks. Visual field area is measured with semi-automated kinetic perimetry (SKP) using the Octopus 900 (Haag-Streit) with the I4e target size for each eye and done at least twice to ensure reliable sessions; the visual field area measurements are averaged over the two sessions. Analysis performed with linear mixed model
Time Frame
baseline to week 52
Title
Static Perimetry by Treatment Arm--Full Field Hill of Vision
Description
Mean change from baseline at week 52 for Full field Hill of Vision (Static perimetry)
Time Frame
baseline to week 52
Title
Static Perimetry Volume--30 Degree Hill of Vision
Description
Mean Change from baseline to week 52 for Static Perimetry Volume --30 Degree Hill of Vision. Full field static perimetry protocol was followed using the Octopus 900 (Haag-Streit) for a single session for each eye.
Time Frame
baseline to week 52
Title
Mean Change From Baseline in Best Corrected Visual Acuity
Description
Mean change in best corrected visual acuity as assessed by ETDRS (Early Treatment Diabetic Retinopathy Study) method from baseline to week 52
Time Frame
baseline to week 52

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Understand/sign the IRB-approved study informed consent document. Age greater than or equal to 18 years, no upper age limit Males and non-child bearing females must weigh ≥40 Kg and ≤158.9 Kg; Females of child bearing potential must weigh ≥40 Kg and ≤74.9 Kg. Diagnosis of Retinitis Pigmentosa (RP). Visual acuity of greater than or equal to 35 letters in at least one eye as measured by the EVA-ETDRS (equivalent to 20/200 on a Snellen chart). Genotyped as autosomal dominant form of RP. Female subjects of childbearing potential and male subjects able to father children must have (or have a partner who has) had a hysterectomy or vasectomy, be completely abstinent from intercourse or must commit to practice at least two acceptable methods of contraception to minimize the chance of pregnancy during the study and for the 13 week period after stopping the study drug. Female subjects of childbearing potential must have a negative urine pregnancy test at study entry and throughout the duration of the study. Willingness to comply with the protocol. Exclusion Criteria: Medical problems that make consistent follow-up over the treatment period unlikely (e.g. stroke, severe MI, end stage malignancy), or in general a poor medical risk because of other systemic diseases or active uncontrolled infections. Other retinal diseases: Glaucoma, retinal inflammatory disease (CME is allowable), cataract worse than +2 NS, or herpes simplex virus of the eye. Intact visual field of 5⁰ or less. Subject unable to provide reliable perimetry measurements in both eyes for both static and kinetic visual field, as determined by the Reading Center. Diabetes. History of cancer (other than non-melanoma skin cancer) diagnosed, or requiring treatment within the past 2 years. A hemoglobin concentration, a platelet count or an absolute neutrophil count below the lower limit of normal at study entry. Suspected liver dysfunction determined by having liver function values elevated above the upper limit of normal. History of pancreatitis by clinical features and/or laboratory abnormalities in the last 12 months. Renal dysfunction based on serum creatinine,(MDRD) equation. Urea cycle disorders. History of neurological conditions including epilepsy, history of brain injury, encephalitis, or any organic brain syndrome. History of schizophrenia, schizoaffective disorder, bipolar disorder, suicidality or organic mental disorders. Currently receiving valproic acid or other anti-convulsants. Sensitive to or have ever had an allergic reaction to valproic Acid. Sensitive to or have ever had an allergic reaction to peanuts as peanut oil is an inactive ingredient in valproic acid capsules and the placebo. Has taken one of the disallowed drugs at least 2 weeks prior to randomization. Pregnant women. Lactating mothers who are breast feeding their babies. RP patients involved in other clinical trials within the last 3 months. Require enrollment by consent of a legally authorized representative. Persons who are unable to read are not allowed to consent for themselves or others to participate in this study. The potential participant lives in the same household as a current participant in this protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Patricia Zilliox, PhD
Organizational Affiliation
Foundation Fighting Blindness
Official's Role
Study Director
Facility Information:
Facility Name
University of Miami, Bascom Palmer Eye Institute
City
Miami
State/Province
Florida
ZIP/Postal Code
33136
Country
United States
Facility Name
University of Michigan, Ann Arbor
City
Ann Arbor
State/Province
Michigan
ZIP/Postal Code
48105
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
University of Tennessee, Hamilton Eye Institute
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38163
Country
United States
Facility Name
Retina Foundation of the Southwest
City
Dallas
State/Province
Texas
ZIP/Postal Code
75231
Country
United States
Facility Name
University of Utah School of Medicine, Moran Eye Center
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
12202526
Citation
Berson EL, Rosner B, Weigel-DiFranco C, Dryja TP, Sandberg MA. Disease progression in patients with dominant retinitis pigmentosa and rhodopsin mutations. Invest Ophthalmol Vis Sci. 2002 Sep;43(9):3027-36.
Results Reference
background
PubMed Identifier
8614514
Citation
Bryant AE 3rd, Dreifuss FE. Valproic acid hepatic fatalities. III. U.S. experience since 1986. Neurology. 1996 Feb;46(2):465-9. doi: 10.1212/wnl.46.2.465.
Results Reference
background
PubMed Identifier
3976802
Citation
Berson EL, Sandberg MA, Rosner B, Birch DG, Hanson AH. Natural course of retinitis pigmentosa over a three-year interval. Am J Ophthalmol. 1985 Mar 15;99(3):240-51. doi: 10.1016/0002-9394(85)90351-4.
Results Reference
background
PubMed Identifier
17850978
Citation
Chen PS, Wang CC, Bortner CD, Peng GS, Wu X, Pang H, Lu RB, Gean PW, Chuang DM, Hong JS. Valproic acid and other histone deacetylase inhibitors induce microglial apoptosis and attenuate lipopolysaccharide-induced dopaminergic neurotoxicity. Neuroscience. 2007 Oct 12;149(1):203-12. doi: 10.1016/j.neuroscience.2007.06.053. Epub 2007 Jul 28.
Results Reference
background
PubMed Identifier
15145530
Citation
Delyfer MN, Leveillard T, Mohand-Said S, Hicks D, Picaud S, Sahel JA. Inherited retinal degenerations: therapeutic prospects. Biol Cell. 2004 May;96(4):261-9. doi: 10.1016/j.biolcel.2004.01.006.
Results Reference
background
PubMed Identifier
16600518
Citation
Dragunow M, Greenwood JM, Cameron RE, Narayan PJ, O'Carroll SJ, Pearson AG, Gibbons HM. Valproic acid induces caspase 3-mediated apoptosis in microglial cells. Neuroscience. 2006 Jul 21;140(4):1149-56. doi: 10.1016/j.neuroscience.2006.02.065.
Results Reference
background
PubMed Identifier
18950246
Citation
Gaby AR. Nutritional therapies for ocular disorders: Part Three. Altern Med Rev. 2008 Sep;13(3):191-204.
Results Reference
background
PubMed Identifier
11742974
Citation
Gottlicher M, Minucci S, Zhu P, Kramer OH, Schimpf A, Giavara S, Sleeman JP, Lo Coco F, Nervi C, Pelicci PG, Heinzel T. Valproic acid defines a novel class of HDAC inhibitors inducing differentiation of transformed cells. EMBO J. 2001 Dec 17;20(24):6969-78. doi: 10.1093/emboj/20.24.6969.
Results Reference
background
PubMed Identifier
17113430
Citation
Hartong DT, Berson EL, Dryja TP. Retinitis pigmentosa. Lancet. 2006 Nov 18;368(9549):1795-809. doi: 10.1016/S0140-6736(06)69740-7.
Results Reference
background
PubMed Identifier
14624229
Citation
Henry TR. The history of valproate in clinical neuroscience. Psychopharmacol Bull. 2003;37 Suppl 2:5-16.
Results Reference
background
PubMed Identifier
15059710
Citation
Hoffman DR, Locke KG, Wheaton DH, Fish GE, Spencer R, Birch DG. A randomized, placebo-controlled clinical trial of docosahexaenoic acid supplementation for X-linked retinitis pigmentosa. Am J Ophthalmol. 2004 Apr;137(4):704-18. doi: 10.1016/j.ajo.2003.10.045.
Results Reference
background
PubMed Identifier
9804150
Citation
Jacobson SG, Cideciyan AV, Huang Y, Hanna DB, Freund CL, Affatigato LM, Carr RE, Zack DJ, Stone EM, McInnes RR. Retinal degenerations with truncation mutations in the cone-rod homeobox (CRX) gene. Invest Ophthalmol Vis Sci. 1998 Nov;39(12):2417-26.
Results Reference
background
PubMed Identifier
17371805
Citation
Kim HJ, Rowe M, Ren M, Hong JS, Chen PS, Chuang DM. Histone deacetylase inhibitors exhibit anti-inflammatory and neuroprotective effects in a rat permanent ischemic model of stroke: multiple mechanisms of action. J Pharmacol Exp Ther. 2007 Jun;321(3):892-901. doi: 10.1124/jpet.107.120188. Epub 2007 Mar 19.
Results Reference
background
PubMed Identifier
11448327
Citation
Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD; National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001 Jul;119(7):1050-8. doi: 10.1001/archopht.119.7.1050.
Results Reference
background
PubMed Identifier
18378578
Citation
Noorwez SM, Ostrov DA, McDowell JH, Krebs MP, Kaushal S. A high-throughput screening method for small-molecule pharmacologic chaperones of misfolded rhodopsin. Invest Ophthalmol Vis Sci. 2008 Jul;49(7):3224-30. doi: 10.1167/iovs.07-1539. Epub 2008 Mar 31.
Results Reference
background
PubMed Identifier
15996734
Citation
Nowomiejska K, Vonthein R, Paetzold J, Zagorski Z, Kardon R, Schiefer U. Comparison between semiautomated kinetic perimetry and conventional Goldmann manual kinetic perimetry in advanced visual field loss. Ophthalmology. 2005 Aug;112(8):1343-54. doi: 10.1016/j.ophtha.2004.12.047.
Results Reference
background
PubMed Identifier
19094165
Citation
Nowomiejska K, Vonthein R, Paetzold J, Zagorski Z, Kardon R, Schiefer U. Reaction time during semi-automated kinetic perimetry (SKP) in patients with advanced visual field loss. Acta Ophthalmol. 2010 Feb;88(1):65-9. doi: 10.1111/j.1755-3768.2008.01407.x. Epub 2009 Dec 16.
Results Reference
background
PubMed Identifier
16164485
Citation
Peterson GM, Naunton M. Valproate: a simple chemical with so much to offer. J Clin Pharm Ther. 2005 Oct;30(5):417-21. doi: 10.1111/j.1365-2710.2005.00671.x. No abstract available.
Results Reference
background
PubMed Identifier
18706104
Citation
Wong R, Khan J, Adewoyin T, Sivaprasad S, Arden GB, Chong V. The ChromaTest, a digital color contrast sensitivity analyzer, for diabetic maculopathy: a pilot study. BMC Ophthalmol. 2008 Aug 17;8:15. doi: 10.1186/1471-2415-8-15.
Results Reference
background
PubMed Identifier
29879277
Citation
Birch DG, Bernstein PS, Iannacone A, Pennesi ME, Lam BL, Heckenlively J, Csaky K, Hartnett ME, Winthrop KL, Jayasundera T, Hughbanks-Wheaton DK, Warner J, Yang P, Fish GE, Teske MP, Sklaver NL, Erker L, Chegarnov E, Smith T, Wahle A, VanVeldhuisen PC, McCormack J, Lindblad R, Bramer S, Rose S, Zilliox P, Francis PJ, Weleber RG. Effect of Oral Valproic Acid vs Placebo for Vision Loss in Patients With Autosomal Dominant Retinitis Pigmentosa: A Randomized Phase 2 Multicenter Placebo-Controlled Clinical Trial. JAMA Ophthalmol. 2018 Aug 1;136(8):849-856. doi: 10.1001/jamaophthalmol.2018.1171. Erratum In: JAMA Ophthalmol. 2018 Dec 1;136(12):1432.
Results Reference
derived
Links:
URL
http://www.blindness.org/index.php?option=com_content&view=section&id=7&itemid=101
Description
Click here for more information about this study: Clinical Trial page of the Foundation Fighting Blindness Website.

Learn more about this trial

Trial of Oral Valproic Acid for Retinitis Pigmentosa

We'll reach out to this number within 24 hrs