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4-Aminopyridine in Episodic Ataxia Type 2 (4AP in EA2)

This study is enrolling participants by invitation only.
Sponsor:
Collaborators:
University of Rochester
University of South Florida
Information provided by (Responsible Party):
Joanna C. Jen, University of California, Los Angeles
ClinicalTrials.gov Identifier:
NCT01543750
First received: May 27, 2011
Last updated: February 7, 2013
Last verified: February 2013
History of Changes
  Purpose

Episodic ataxia type 2 (EA2) is a rare familial neurological condition characterized by debilitating episodes of vertigo and imbalance. Since the serendipitous discovery of dramatic response of EA2 to acetazolamide, acetazolamide has been the first-line treatment for EA2. Yet, for those patients who do not respond to or cannot tolerate acetazolamide, there is no alternative treatment. The purpose of this randomized trial is to test whether 4-aminopyridine may reduce the ataxia episodes in EA2 as an alternative to acetazolamide.


Condition Intervention Phase
Episodic Ataxia Type 2
 Drug: 4AP
Drug: Placebo
 Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Phase 2 Study of 4-Aminopyridine for the Treatment of Episodic Ataxia Type 2

Resource links provided by NLM:

U.S. FDA Resources

Further study details as provided by University of California, Los Angeles:

Primary Outcome Measures:
  • the frequency of ataxia episodes [ Time Frame: 11 months ] [ Designated as safety issue: No ]
    Trial participants have frequent episodes of ataxia at baseline. The participants will document daily whether ataxia events occurred during the 2-month screening period and the 9-month study period by calling a toll-free number and participating in an Interactive Voice Response (IVR) system.


Secondary Outcome Measures:
  • impact on daily activities [ Time Frame: 11 months ] [ Designated as safety issue: No ]

    Participants will use IVR to log the impact (on a scale of 0-3) of ataxia events, if any, on their daily activities:

    • (0) No impact
    • (1) Mild
    • (2) Moderate
    • (3) Severe

  • duration of ataxia episodes [ Time Frame: 11 months ] [ Designated as safety issue: No ]
    Study Participants will use IVR daily to log the duration of ataxia events, if any, in hours.

  • severity of ataxia episodes [ Time Frame: 11 months ] [ Designated as safety issue: No ]

    Study Participants will use IVR daily to log the severity of ataxia events, if any, on a scale of 1-9:

    (1) mild (9) very severe


  • treatment satisfaction [ Time Frame: 9 months ] [ Designated as safety issue: No ]
    The study participant will respond by phone interview to the 11-item Treatment Satisfaction Questionnaire for Medication (TSQM Version 2) at the end of each of the four treatment periods.

  • Toxicity [ Time Frame: 9 months ] [ Designated as safety issue: Yes ]
    The study participant will be interviewed by phone regarding toxicity using the [Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0] at two different time points (4 weeks, 8 weeks) of each 8-week Treatment Period. Spectrum and severity of toxicity and the prevalence among study participants will be documented.

  • Side Effects [ Time Frame: 9 months ] [ Designated as safety issue: Yes ]
    The study participant will log side effects as they occur (reporting the seizures or other severe side effects immediately to Investigators) and will be interviewed by phone regarding side effects at two different time points (4 weeks, 8 weeks) of each 8-week Treatment Period. Spectrum of side effects and the prevalence among those treated will be documented.


Estimated Enrollment: 20
Study Start Date: April 2013
Estimated Study Completion Date: April 2014
Estimated Primary Completion Date: April 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 4AP Drug: 4AP
4-aminopyridine extended release (dalfampradine) 10mg twice daily for 8 weeks
Experimental: Placebo Drug: Placebo
Placebo

Detailed Description:

This study aims to determine whether 4-aminopyridine (4AP) can reduce attacks of ataxia in patients with episodic ataxia type 2 (EA2), a rare but often debilitating condition. Episodic ataxia (EA) is a group of inherited disorders characterized by recurrent, discrete episodes of vertigo and ataxia variably associated with progressive ataxia. EA2, the most common and the best characterized of all the EA syndromes, is caused by heterozygous mutations in CACNA1A, which encodes the main subunit of a neuronal voltage-gated calcium channel, Cav2.1.

Although observational data suggest symptomatic resolution with acetazolamide in many EA2 patients, the investigators found in our patient databases that at least a third of the EA2 patients continue to suffer debilitating ataxia attacks, either because of incomplete control while on acetazolamide or because of intolerability or hypersensitivity to acetazolamide. For these patients there is no alternative intervention. 4-Aminopyridine (4AP) has been found to be helpful in a handful of patients with EA2. Recently, dalfampridine, an extended release formulation of 4AP (AMPYRA) by Acorda Therapeutics, received FDA approval to improve gait in multiple sclerosis.

In collaboration with Acorda, the investigators plan to recruit 20 subjects with genetically defined EA2 who suffer frequent ataxia episodes (at least 3 episodes a month) to conduct a randomized trial of 4AP to examine its efficacy and tolerability in EA2. Study subjects will be recruited at UCLA and the University of Rochester to participate in a randomized, double-blind, double-crossover trial of 4AP.Each treatment period is 2-months with a 1-week wash-out period in between each treatment period. Participating subjects will undergo standardized history and physical examination at the time of enrollment. Participants will log their ataxia attacks daily by interactive voice response (IVR) system and will be interviewed monthly for events and side effects/toxicity. Study visits will occur at the beginning and the end of the study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Patients will be included if they:

  • Have EA2 genetically confirmed to harbor mutations in CACNA1A
  • Are ≥ 18 years of age
  • Are not taking acetazolamide (because of intolerance, poor response, or allergy)
  • Are able to maintain a daily log of ataxia episode(s) and report daily by using an Interactive Voice Recording System (IVR) throughout the study
  • Experience ≥ 3 ataxia episodes per month during the two-month screening period to qualify for randomization

Exclusion Criteria:

Patients will be excluded if they:

  • Have seizures or a history of seizures
  • Have first-degree relatives with EA2 and seizures
  • Have renal disease with impaired function (Creatinine clearance CrCl≤50ml/min)
  • Are pregnant or breast feeding (women of childbearing age will be tested for pregnancy and must be using birth control)
  • Are unable to comply with the study requirement
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01543750

Locations
United States, California
University of California, Los Angeles (UCLA)
Los Angeles, California, United States, 90095
United States, Florida
University of South Florida
Tampa, Florida, United States, 33612
United States, New York
University of Rochester School of Medicine
Rochester, New York, United States, 14642
Sponsors and Collaborators
University of California, Los Angeles
University of Rochester
University of South Florida
Investigators
Principal Investigator: Joanna C Jen, MD PhD University of California, Los Angeles
  More Information

Additional Information:
Consortium for the Clinical Investigation of Neurological Channelopathies (CINCH)  This link exits the ClinicalTrials.gov site
AMPYRA Product Label & Prescribing Information  This link exits the ClinicalTrials.gov site

Publications:

Responsible Party: Joanna C. Jen, Professor, University of California, Los Angeles
ClinicalTrials.gov Identifier: NCT01543750     History of Changes
Other Study ID Numbers: CINCH-EA2, R01 FD003923
Study First Received: May 27, 2011
Last Updated: February 7, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by University of California, Los Angeles:
episodic ataxia
CACNA1A mutations

Additional relevant MeSH terms:
Ataxia
Spinocerebellar Ataxias
Nystagmus, Pathologic
Dyskinesias
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Cerebellar Ataxia
Cerebellar Diseases
Brain Diseases
Central Nervous System Diseases
Spinocerebellar Degenerations
Spinal Cord Diseases
 Heredodegenerative Disorders, Nervous System
Neurodegenerative Diseases
Genetic Diseases, Inborn
Ocular Motility Disorders
Cranial Nerve Diseases
Eye Diseases
4-Aminopyridine
Potassium Channel Blockers
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Cardiovascular Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on May 16, 2013