A Long-term Safety Study of Cannabidiol Oral Solution (GWP42003-P, CBD-OS) in Patients With Rett Syndrome

NCT04252586 | Terminated Phase 3 Results FDA Drug

• 2 other identifiers: GWND190022019-001605-24
• Study Type: interventional
• Target: 21
• Locations: 6 countries
• Sites: 31

Brief Summary

This study will be conducted to evaluate the long-term safety of cannabidiol oral solution (GWP42003-P, CBD-OS) in participants with Rett syndrome.

Conditions

Rett Syndrome; RTT

Keywords

Cannabidiol; CBD; Epidiolex; GWP42003-P

Outcome Measures

Primary Outcomes (10)

• Number of Participants With Any Treatment-emergent Adverse Events (TEAEs), Discontinuations Due to AEs, Serious AEs, and Treatment-related AEs

  Adverse events (AEs) were defined as any new unfavorable/unintended signs/symptoms (including abnormal laboratory findings when relevant) or diagnosis or worsening of a pre-existing condition that occurs during the study. TEAEs were defined as the AEs that started or worsened in severity or seriousness following the first dose of GWP42003-P. A serious AE was defined as any AE that results in any of the following outcomes: death, life-threatening adverse experience, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability/incapacity, congenital anomaly/birth defect, or cancer, any other experience that suggests a significant hazard, contraindication, side effect or precaution that may require medical or surgical intervention to prevent one of the outcomes listed above, or an event that changes the risk/benefit ratio of the study.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 16 (Day 767) in the OLE

• Number of Participants With Treatment-emergent Clinical Laboratory Parameters From the Baseline at Any Time Post-dose

  Treatment-emergent clinical parameters were defined as the following: Treatment-emergent alanine transferase (ALT) \> 3×upper limit of normal (ULN), \> 5×ULN and \> 8×ULN; Treatment-emergent aspartate aminotransferase (AST) \> 3×ULN, \> 5×ULN and \> 8×ULN; Treatment-emergent ALT or AST \> 3×ULN, \> 5×ULN and \> 8×ULN; Treatment-emergent ALT or AST \> 3×ULN and either bilirubin \> 2×ULN or international normalized ratio (INR) \> 1.5.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Number of Participants With Potentially Clinically Significant Changes in Vital Sign Values of Blood Pressure From the Baseline at Any Time Post-dose

  Potentially clinically significant vital sign values of blood pressure (BP) were defined as sitting systolic BP (mmHg) change: \< -20 or \> 20 mmHg and sitting diastolic BP change: \< -10 or \> 10 mmHg. Vital sign measurements were taken in a sitting position at rest for 5 minutes. Blood pressure readings were recorded using the same arm throughout the trial, when possible.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 15 (Day 739) in the OLE

• Number of Participants With Clinically Significant Changes in the Vital Sign Values of Pulse Rate From the Baseline at Any Time Post-dose

  Potentially clinically significant vital sign values of pulse rate were defined as pulse rate change: \< -10 or \> 10 beats per minute. Vital sign measurements were taken in a sitting position at rest for 5 minutes.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 15 (Day 739) in the OLE

• Number of Participants With Clinically Significant Percent Change in Body Weight From the Baseline at Any Time Post-dose

  Clinically significant body weight changes were defined as the percent change in body weight (≤7% change or ≥7% change).

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Number of Participants With At Least One Post Open Label Extension Baseline Flagged ECG Result

  Electrocardiogram assessments were performed for QTcB and QTcF \>450 msec, \>480 msec, and \>500 msec. QTcB = corrected QT interval with Bazette correction. QTcF = QTc corrected by Fridericia.

  Visit 4 (Day 29) up to Visit 15 (Day 739) in the OLE

• Number of Participants With Any Changes In Menstruation Cycle at Any Time Post-dose

  Participants were evaluated for any changes to typical menstrual cycles, duration of menstrual cycles, and typical strength of the menstrual cycles during the study.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Number of Participants With Suicidal Ideation or Behavior at the Baseline and at Any Time Post-dose

  Suicidal ideation and behavior was assessed by the investigator via a clinical interview with the caregiver. The questionnaire included following questions: Has the child expressed any wish to be dead?, Has the child made any suicide attempts?, Has the child shown any non-suicidal self-injurious behavior? The responses were recorded as Yes/No.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Mean Change From Baseline in Insulin-like Growth Factor-1 (IGF-1) Levels at End of Treatment

  Blood samples were collected to assess changes in serum IGF-1 levels. A negative mean change from baseline indicates a reduction in IGF-1 levels.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Number of Participants With Changes in Tanner Staging at the Baseline and at End of Treatment

  Pubic hair growth and breast development of all adolescents were assessed by the investigator or caregiver using Tanner Staging categorization from 1 to 5. Stage 1- No glandular tissue; areola follows skin contours of chest; No pubic hair Stage 2- Breast bud forms; areola begins to widen; a small amount of long, downy hair with slight pigmentation on labia majora Stage 3- Breast begins to become more elevated and extends beyond borders of the areola, which continues to widen but remains in contour with surrounding breast; Hair becomes more coarse and curly and begins to extend laterally Stage 4- Increased breast size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast; Adult-like hair quality, extending across pubis but sparing medial thighs Stage 5- Breast reaches final adult size; areola returns to the contour of the surrounding breast, with a projecting central papilla; Hair extends to medial surface of the thigh.

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

Secondary Outcomes (5)

• Mean Change From Baseline in Rett Syndrome Behaviour Questionnaire (RSBQ) Overall Score at End of Treatment

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Mean Clinical Global Impressions-Improvement (CGI-I) Continuous Score at End of Treatment

  Visit 14 (Day 729) in the OLE

• Mean Clinician Global Impressions - Severity Scale (CGI-S) Continuous Score at End of Treatment

  Visit 14 (Day 729) in the OLE

• Mean Change From Baseline in Children's Sleep Habits Questionnaire (CSHQ) Total Score at End of Treatment

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

• Mean Change From Baseline in 9-item Motor Behavioral Assessment (MBA-9) Total Score at End of Treatment

  Baseline of randomized controlled trial (RCT) Visit 1 (Day 1) up to Visit 14 (Day 729) in the OLE

Study Arms (1)

GWP42003-P

EXPERIMENTAL

100 milligrams per milliliter (mg/mL) GWP42003-P oral solution, taken twice daily (morning and evening).

Drug: GWP42003-P

Interventions

GWP42003-P DRUG

GWP42003-P presented as an oral solution containing cannabidiol in the excipients sesame oil with anhydrous ethanol, sweetener (sucralose), and strawberry flavoring

Also known as: Cannabidiol, CBD, Epidiolex, CBD-OS

GWP42003-P

Eligibility Criteria

• Age: 2 Years - 18 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Participant has completed all scheduled visits of the treatment phase of the randomized controlled trial (RCT), GWND18064 (NCT03848832), and has transitioned to open-label extension (OLE) by the point of RCT follow-up
• Participant (if possessing adequate understanding, in the investigator's opinion) and/or the participant(s)/legal representative is willing and able to give informed consent/assent for participation in the trial.
• Participant and the participant's caregiver are willing and able (in the investigator's opinion) to comply with all trial requirements (including the completion of all caregiver assessments by the same caregiver throughout the trial).
• Ability to swallow the investigational medicinal product (IMP) provided as a liquid solution, or the ability for the IMP to be delivered via gastrostomy (G) or nasogastric (NG) feeding tube (only G- or NG-tubes made from polyurethane or silicon are allowed).
• Participant and/or parent(s)/legal representative is willing to allow the responsible authorities to be notified of participation in the trial, if mandated by local law.
• Participant and/or parent(s)/legal representative is willing to allow the participant's primary care practitioner (if the participant has one) and consultant (if the participant has one) to be notified of participation in the trial, if the primary care practitioner/consultant is different from the investigator.

You may not qualify if:

• Participant meets the withdrawal criteria (including clinically significant abnormal laboratory values), in the investigator's opinion.
• Participant met during the RCT the criteria for permanent IMP discontinuation (unless in the case of an adverse event \[AE\], if the AE was not considered related with the IMP; participants that met alanine aminotransferase (ALT)/aspartate aminotransferase (AST) elevations discontinuation criteria must be excluded).
• Females of childbearing potential, unless willing to ensure that they or their partner use a highly effective method of birth control (e.g., combined \[estrogen and progestogen containing\] hormonal contraception associated with inhibition of ovulation \[oral, intravaginal, or transdermal\], progestogen-only hormonal contraception associated with inhibition of ovulation \[oral, injectable, or implantable\], intrauterine devices/hormone-releasing systems, bilateral tubal occlusion, vasectomized partner, sexual abstinence during the trial and for 3 months after the last dose
• Participant has been previously enrolled and dosed in this trial.
• Participant is unwilling to abstain from donation of blood during the trial.
• Male participants who are fertile (i.e., after puberty unless permanently sterile by bilateral orchidectomy) and with a partner of childbearing potential unless agree to ensure that they use male contraception (e.g., condom) or remain sexually abstinent during the trial and for 3 months after the last dose

Sponsors & Collaborators

• Jazz Pharmaceuticals: lead
• GW Pharmaceuticals Ltd: collaborator

Study Sites (31)

Clinical Trial Site

Birmingham, Alabama, 35294-0021, United States

Location

Clinical Trial Site

La Jolla, California, 92093, United States

Location

Clinical Trial Site

Aurora, Colorado, 80045, United States

Location

Clinical Trial Site

Chicago, Illinois, 60612, United States

Location

Clinical Trial Site

Baltimore, Maryland, 21205, United States

Location

Clinical Trial Site

Boston, Massachusetts, 02115, United States

Location

Clinical Trial Site

Saint Paul, Minnesota, 55101, United States

Location

Clinical Trial Site

St Louis, Missouri, 63110-1093, United States

Location

Clinical Trial Site

The Bronx, New York, 10467, United States

Location

Clinical Trial Site

Cincinnati, Ohio, 45229, United States

Location

Clinical Trial Site

Philadelphia, Pennsylvania, 19104, United States

Location

Clinical Trial Site

Greenwood, South Carolina, 29646, United States

Location

Clinical Trial Site

Nashville, Tennessee, 37232, United States

Location

Clinical Trial Site

Houston, Texas, 77030, United States

Location

Clinical Trial Site

Perth, Australia

Location

Clinical Trial Site

South Brisbane, Australia

Location

Clinical Trial Site

Toronto, Canada

Location

Clinical Trial Site

Vancouver, Canada

Location

Clinical Trial Site

Genova, Italy

Location

Clinical Trial Site

Messina, Italy

Location

Clinical Trial Site

Milan, Italy

Location

Clinical Trial Site

Rome, Italy

Location

Clinical Trial Site

Siena, Italy

Location

Clinical Trial Site #1

Barcelona, Spain

Location

Clinical Trial Site #2

Barcelona, Spain

Location

Clinical Trial Site #1

Madrid, Spain

Location

Clinical Trial Site #2

Madrid, Spain

Location

Clinical Trial Site

Valencia, Spain

Location

Clinical Trial Site

Edinburgh, United Kingdom

Location

Clinical Trial Site

Liverpool, United Kingdom

Location

Clinical Trial Site

London, United Kingdom

Location

MeSH Terms

Conditions

Rett Syndrome

Interventions

Cannabidiol

Condition Hierarchy (Ancestors)

X-Linked Intellectual Disability; Intellectual Disability; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Genetic Diseases, X-Linked; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Heredodegenerative Disorders, Nervous System

Intervention Hierarchy (Ancestors)

Cannabinoids; Terpenes; Hydrocarbons; Organic Chemicals

Limitations and Caveats

This trial was terminated due to enrollment challenges and the COVID-19 pandemic. Due to early termination and participants withdrawal, the number of participants was small and the length of treatment was reduced.

Results Point of Contact

• Title: Clinical Trial Disclosure & Transparency
• Organization: Jazz Pharmaceuticals

ClinicalTrialDisclosure@JazzPharma.com

215-832-3750

Publication Agreements

• PI is Sponsor Employee: No
• Restriction Type: OTHER
• Restrictive Agreement: Yes

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 30, 2020
• First Posted: February 5, 2020
• Study Start: February 28, 2020
• Primary Completion: June 9, 2021
• Study Completion: June 9, 2021
• Last Updated: August 8, 2022
• Results First Posted: August 8, 2022

Record last verified: 2022-07

Data Sharing

• IPD Sharing: Will not share

Locations

GB (3); AU (2); CA (2); IT (5); ES (5); US (14)