EPI-743 for Metabolism or Mitochondrial Disorders

NCT01642056 | Completed Phase 1 Results FDA Drug

• 2 other identifiers: 12016112-HG-0161
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

Background:

• Mitochondria are the parts of cells that help produce energy. Metabolism is the process by which the body uses energy to help cells grow and reproduce. Metabolic and mitochondrial disorders affect the body s ability to produce and store energy. These disorders can cause a wide variety of problems, but most often they affect the muscles and the brain, where energy requirements are high. Treatment is difficult because the exact source of the problem is hard to detect.
• EPI-743 is a new drug that is based on vitamin E. Tests have shown that it can help improve the function of cells with mitochondrial problems. It may be able to treat people with genetic disorders that affect metabolism and mitochondria. Objectives: \- To see if EPI-743 can improve energy production and use in people with mitochondrial or metabolic disorders. Eligibility: \- Children between 2 and 11 years of age who have metabolic or mitochondrial problems. Design:
• Participants will be screened with a physical exam and medical history. Blood and urine samples will be collected.
• The study will last about 13 months. Participants will have seven 3- to 5-day inpatient study visits about 3 months apart.
• Participants will take either EPI-743 or a placebo for the first 6 months of the study. After 6 months, there will be a 1-month rest period. Then, those who received EPI-743 in the first 6 months will take the placebo for the next 6 months. Those who had the placebo will take EPI-743.
• During each inpatient study visit, participants will have a physical exam. A 24-hour urine collection will be obtained. Blood samples will also be taken. Imaging studies and other tests may be performed as directed by the study researchers.

Conditions

Mitochondrial Disease; Neurology; Myopathy

Keywords

Oxidative Stress; Oxidative Phosphorylation; Mitochondrial Disease

Outcome Measures

Primary Outcomes (4)

• Newcastle Paediatric Mitochondrial Disease Scale (NPMDS) Part I-III, Baseline

  NPMDS is a semi-quantitative clinical rating scale that evaluates the progression of mitochondrial disease in pediatric patients. The NPMDS scale provides an assessment of the progression of mitochondrial disease. Scores from Parts I-III are added to get a value between 0 and 130, with higher scores representing more severe disease.

  Baseline - Day 0

• Newcastle Paediatric Mitochondrial Disease Scale (NPMDS) Part I-III, 6 Months

  NPMDS is a semi-quantitative clinical rating scale that evaluates the progression of mitochondrial disease in pediatric patients. The NPMDS scale provides an assessment of the progression of mitochondrial disease. Scores from Parts I-III are added to get a value between 0 and 130, with higher scores representing more severe disease.

  6 months

• Newcastle Paediatric Mitochondrial Disease Scale (NPMDS) Part I-III, Post Washout

  NPMDS is a semi-quantitative clinical rating scale that evaluates the progression of mitochondrial disease in pediatric patients. The NPMDS scale provides an assessment of the progression of mitochondrial disease. Scores from Parts I-III are added to get a value between 0 and 130, with higher scores representing more severe disease.

  8 month - Post washout

• Newcastle Paediatric Mitochondrial Disease Scale (NPMDS) Part I-III, 14 Months

  NPMDS is a semi-quantitative clinical rating scale that evaluates the progression of mitochondrial disease in pediatric patients. The NPMDS scale provides an assessment of the progression of mitochondrial disease. Scores from Parts I-III are added to get a value between 0 and 130, with higher scores representing more severe disease.

  14 months

Study Arms (2)

EPI-743, then Placebo

EXPERIMENTAL

Received EPI-743, 15mg/kg up to a maximum dose of 200 mg orally or via gastric tube three times daily with meals, then placebo three times daily orally or via gastric tube with meals. EPI-743 is structurally related to Vitamin E and can be broadly classified as an antioxidant.

Drug: EPI-743; Drug: Placebo

Placebo, then EPI-743

PLACEBO COMPARATOR

Received Placebo three times daily orally or via gastric tube with meals, then EPI-743, 15mg/kg up to a maximum dose of 200 mg three times daily orally or via gastric tube with meals. EPI-743 is structurally related to Vitamin E and can be broadly classified as an antioxidant.

Drug: EPI-743; Drug: Placebo

Interventions

EPI-743 DRUG

This medication is used to treat disorders of energy metabolism such as mitochondrial diseases. It does not correct the inherited disorder of energy metabolism or mitochondrial diseases. EPI-743 is structurally related to Vitamin E and can be broadly classified as an antioxidant.

EPI-743, then Placebo; Placebo, then EPI-743

Placebo DRUG

EPI-743, then Placebo; Placebo, then EPI-743

Eligibility Criteria

• Age: 2 Years - 11 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Be 2-11 years of age
• Manifest clinical findings of a neuromuscular disease with a component of impaired energy or oxidation/reduction. Typical symptoms would include hypotonia, dystonia, or seizures.
• Have a disorder that is untreatable or poorly treatable.
• Have cultured fibroblasts that exhibit reduced viability under conditions of oxidative stress, compared to age matched control fibroblasts.
• Have cultured fibroblasts that achieve at least 80% viability rescue with EPI-743 at 1micromolar upon exposure to oxidative stress and that have a half maximal effective concentration of EPI-743 of less than or equal to 50 nanomolar.
• Be willing to abstain from initiating the use of dietary supplements and nonprescribed medications, foods or beverages or bars fortified with coenzyme Q(10), vitamin E, super fortified functional foods or beverages, and idebenone.
• Be able to travel to the Clinical Center for at least 8 visits.

You may not qualify if:

• Age \< 2 years or \>11 years
• Diagnosis of mitochondrial diseases benefiting from treatment and at risk from being moved to placebo
• Allergy to EPI-743 or sesame oil
• Hepatic insufficiency with liver function tests greater than 3-times the upper limit of normal
• Renal insufficiency requiring dialysis
• Significant malabsorption of fats precluding drug absorption
• Allergy to vitamin E
• Significant coagulation abnormalities as evidenced by abnormal PT/PTT tests
• Severe end-organ hypo-perfusion syndrome secondary to cardiac failure resulting in lactic acidosis
• Ventilator-dependence
• Chronic pancreatitis
• Clinical history of bleeding requiring ongoing medical management
• Abnormal red cell parameters requiring ongoing medical management besides iron supplementation
• A platelet disorder
• Neutrophils less than 500 mm3

Sponsors & Collaborators

• National Human Genome Research Institute (NHGRI): lead

Study Sites (1)

National Institutes of Health Clinical Center, 9000 Rockville Pike

Bethesda, Maryland, 20892, United States

Location

Related Publications (2)

• Shrader WD, Amagata A, Barnes A, Enns GM, Hinman A, Jankowski O, Kheifets V, Komatsuzaki R, Lee E, Mollard P, Murase K, Sadun AA, Thoolen M, Wesson K, Miller G. alpha-Tocotrienol quinone modulates oxidative stress response and the biochemistry of aging. Bioorg Med Chem Lett. 2011 Jun 15;21(12):3693-8. doi: 10.1016/j.bmcl.2011.04.085. Epub 2011 Apr 24.

  PMID: 21600768 BACKGROUND

• Sadun AA, Chicani CF, Ross-Cisneros FN, Barboni P, Thoolen M, Shrader WD, Kubis K, Carelli V, Miller G. Effect of EPI-743 on the clinical course of the mitochondrial disease Leber hereditary optic neuropathy. Arch Neurol. 2012 Mar;69(3):331-8. doi: 10.1001/archneurol.2011.2972.

  PMID: 22410442 BACKGROUND

Related Links

• NIH Clinical Center Detailed Web Page

MeSH Terms

Conditions

Mitochondrial Diseases; Muscular Diseases

Interventions

alpha-tocotrienol quinone

Condition Hierarchy (Ancestors)

Metabolic Diseases; Nutritional and Metabolic Diseases; Musculoskeletal Diseases; Neuromuscular Diseases; Nervous System Diseases

Limitations and Caveats

All 20 randomized patients were included in the model to assess baseline characteristics. Of the 20 randomized, 19 provided 6-month outcomes (10 placebo, 9 treatment), who then crossed over their treatments and provided 8-month baseline scores. Of these, 16 provided 14-month outcomes (8 who had crossed over to treatment, and 8 who had crossed over to placebo).

Results Point of Contact

• Title: Gahl, William
• Organization: National Human Genome Research Institute

gahlw@mail.nih.gov

+1 301 402 2739

Study Officials

• William A Gahl, M.D.

  National Human Genome Research Institute (NHGRI)

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NON RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: NIH
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 14, 2012
• First Posted: July 17, 2012
• Study Start: September 1, 2012
• Primary Completion: September 24, 2019
• Study Completion: September 24, 2019
• Last Updated: April 14, 2021
• Results First Posted: April 14, 2021

Record last verified: 2019-12-09

Locations

US (1)