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Trial record 1 of 1 for:    NCT01777542
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Treatment of Rett Syndrome With Recombinant Human IGF-1

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ClinicalTrials.gov Identifier: NCT01777542
Recruitment Status : Completed
First Posted : January 29, 2013
Results First Posted : March 26, 2018
Last Update Posted : March 26, 2018
Sponsor:
Collaborator:
International Rett Syndrome Foundation
Information provided by (Responsible Party):
Mustafa Sahin, Harvard Medical School

Brief Summary:
Investigators are recruiting children for a clinical trial using the medication recombinant human IGF-1 (a.k.a. mecasermin or INCRELEX) to see if it improves the health of children with Rett syndrome (RTT). While IGF-1 is approved by the Food & Drug Administration (FDA) for certain use in children, it is considered an investigational drug in this trial because it has not previously been used to treat RTT. Information from this study will help determine if IGF-1 effectively treats RTT but will not necessarily lead to FDA approval of IGF-1 as a treatment for RTT.

Condition or disease Intervention/treatment Phase
Rett Syndrome Drug: Recombinant Human Insulin Growth Factor 1 (rhIGF-1) Drug: Placebo Phase 2

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary Purpose: Treatment
Official Title: Pharmacological Treatment of Rett Syndrome by Stimulation of Synaptic Maturation With Recombinant Human IGF-1(Mecasermin [rDNA] Injection)
Study Start Date : January 2013
Actual Primary Completion Date : July 2016
Actual Study Completion Date : November 2016


Arm Intervention/treatment
Active Comparator: Treatment Period 1
One half of subjects will be randomly assigned to receive Recombinant Human Insulin Growth Factor 1 (rhIGF-1) , and the other half of subjects will be randomly assigned to receive placebo.
Drug: Recombinant Human Insulin Growth Factor 1 (rhIGF-1)
Subjects will receive twice daily subcutaneous injections of IGF-1.
Other Names:
  • mecasermin [rDNA] injection
  • Increlex
Drug: Placebo
Subjects will receive twice daily subcutaneous injections of a saline solution (placebo).
Other Name: saline
Placebo Comparator: Treatment Period 2
Subjects that initially received Recombinant Human Insulin Growth Factor 1 (rhIGF-1) will now receive placebo, and subjects that initially received placebo will now receive Recombinant Human Insulin Growth Factor 1 (rhIGF-1).
Drug: Recombinant Human Insulin Growth Factor 1 (rhIGF-1)
Subjects will receive twice daily subcutaneous injections of IGF-1.
Other Names:
  • mecasermin [rDNA] injection
  • Increlex
Drug: Placebo
Subjects will receive twice daily subcutaneous injections of a saline solution (placebo).
Other Name: saline



Primary Outcome Measures :
  1. Rett Syndrome Behavior Questionnaire (RSBQ) - Fear/Anxiety Subscale [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The RSBQ is an informant/parent-completed measure of abnormal behaviors typically observed in individuals with RTT, which is completed by a parent/caregiver/LAR. Each item, grouped into eight domains/factors: General mood, Breathing problems, Body rocking and expressionless face, Hand behaviors, Repetitive face movements, Night-time behaviors, Fear/anxiety and Walking/standing), is scored on a Likert scale of 0-2, according to how well the item describes the individual's behavior. A score of "0" indicates the described item is "not true," a score of "1" indicates the described item is "somewhat or sometimes true," and a score of "2" indicates the described item is "very true or often true."

    The total sum of items in each subscale is reported.

    For the fear/anxiety subscale, the sum total could be between 0-8. The higher the sum total score, the greater the frequency of fear/anxiety behaviors.


  2. Anxiety, Depression, and Mood Scale (ADAMS) - Social Avoidance Subscale [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The ADAMS is completed by the parent/caregiver/LAR and consists of 29 items which are scored on a 4-point rating scale that combines frequency and severity ratings. The instructions ask the rater to describe the individual's behavior over the last six months on the following scale: "0" if the behavior has not occurred, "1" if the behavior occurs occasionally or is a mild problem, "2" if the behavior occurs quite often or is moderate problem, or "3" if the behavior occurs a lot or is a severe problem.

    The Social Avoidance subscale of the ADAMS will be used as a primary outcome measure for this trial. The range for this subscale is 0-21. The higher the subscale score, the more problematic the behavior.


  3. Clinical Global Impression - Severity (CGI-S) [ Time Frame: Every 10 weeks during each of the two 20-week treatment periods ]

    This scale is used to judge the severity of the subject's disease prior to entry into the study. The clinician will rate the severity of behavioral symptoms at baseline on a 7-point scale from not impaired to the most impaired.

    The scores that correspond to each possible grouping are as follows: 1=Normal, not at all impaired; 2=Borderline impaired; 3=Mildly impaired; 4=Moderately impaired; 5=Markedly impaired; 6=Severely impaired; 7=The most impaired.

    The possible range for reported scores is 1-7.


  4. Clinical Global Impression - Improvement (CGI-I) [ Time Frame: Every 10 weeks during each of the two 20-week treatment periods ]

    Each time the patient was seen after the study intervention was initiated, the clinician compared the patient's overall clinical condition to the CGI-S score obtained at the baseline (visit 1) visit. Based on information collected, the clinician determined if any improvement occurred on the following 7-point scale: 1=Very much improved since the initiation of treatment; 2=Much improved; 3=Minimally improved; 4=No change from baseline (the initiation of treatment); 5=Minimally worse; 6=Much worse; 7=Very much worse since the initiation of treatment.

    The possible range for reported scores is 1-7.


  5. Parental Global Impression - Severity (PGI-S) [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The PGI-S is the parent version of the CGI-S. Parents/caregivers/LAR are asked to rate the severity of their child's symptoms at baseline on a 7-point scale from not at all impaired to the most impaired. The parents/caregivers/LAR will complete the PGI-S at each study visit.

    The scores that correspond to each possible grouping are as follows:

    1=Normal, not at all impaired; 2=Borderline impaired; 3=Mildly impaired; 4=Moderately impaired; 5=Markedly impaired; 6=Severely impaired; 7=The most impaired.

    The possible range for reported scores is 1-7.


  6. Parental Global Impression - Improvement (PGI-I) [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    As part of each visit after the study intervention was initiated, the parent/caregiver was asked to compare the patient's overall clinical condition to the score obtained at the baseline (visit 1) visit. Based on information collected, the clinician determined if any improvement occurred on the following 7-point scale: 1=Very much improved since the initiation of treatment; 2=Much improved; 3=Minimally improved; 4=No change from baseline (the initiation of treatment); 5=Minimally worse; 6=Much worse; 7=Very much worse since the initiation of treatment.

    The possible range for reported scores is 1-7.


  7. Parent Targeted Visual Analog Scale (PTSVAS) - Scale 1 [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The parent or caretaker identifies the three most troublesome, RTT-specific, "target" symptoms, such as inattention or breath-holding. This allows the problems that are of concern to parents and the family to be targeted in the trial. In this study the caregiver will choose three target symptoms at baseline and then rate changes in severity of each target symptom on a visual analog scale (VAS).

    The VAS is a 10 cm line, where a target symptom is anchored on one end with the description "the best it has ever been" and on the other with the description "the worst it has ever been." The parent was asked to marked on the line where they felt their child's symptoms currently fit best. This mark was measured as recorded as a numeric value from 0.00-10.00 cm. The higher the value, the worse the symptom.


  8. Parent Targeted Visual Analog Scale (PTSVAS) - Scale 2 [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The parent or caretaker identifies the three most troublesome, RTT-specific, "target" symptoms, such as inattention or breath-holding. This allows the problems that are of concern to parents and the family to be targeted in the trial. In this study the caregiver will choose three target symptoms at baseline and then rate changes in severity of each target symptom on a visual analog scale (VAS).

    The VAS is a 10 cm line, where a target symptom is anchored on one end with the description "the best it has ever been" and on the other with the description "the worst it has ever been." The parent was asked to marked on the line where they felt their child's symptoms currently fit best. This mark was measured as recorded as a numeric value from 0.00-10.00 cm. The higher the value, the worse the symptom.


  9. Parent Targeted Visual Analog Scale (PTSVAS) - Scale 3 [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The parent or caretaker identifies the three most troublesome, RTT-specific, "target" symptoms, such as inattention or breath-holding. This allows the problems that are of concern to parents and the family to be targeted in the trial. In this study the caregiver will choose three target symptoms at baseline and then rate changes in severity of each target symptom on a visual analog scale (VAS).

    The VAS is a 10 cm line, where a target symptom is anchored on one end with the description "the best it has ever been" and on the other with the description "the worst it has ever been." The parent was asked to marked on the line where they felt their child's symptoms currently fit best. This mark was measured as recorded as a numeric value from 0.00-10.00 cm. The higher the value, the worse the symptom.


  10. Kerr Clinical Severity Scale [ Time Frame: At the start and end of each 20-week treatment period ]

    The Kerr clinical severity scale (Kerr scale) is a quantitative measure of global disease severity. The Kerr scale is a summation of individual items related to Rett syndrome phenotypic characteristics. The items are based on the severity or degree of abnormality of each characteristic on a discrete scale (0, 1, 2) with the highest level corresponding to the most severe or most abnormal presentations.

    The possible range of scores is 0-48. The higher the score, the more severe the symptoms.



Secondary Outcome Measures :
  1. Rett Syndrome Behavior Questionnaire (RSBQ) [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The RSBQ is a parent-completed measure of abnormal behaviors typically observed in individuals with RTT. Each item, grouped into eight subscales, is scored on a Likert scale of 0-2, according to how well the item describes the individual's behavior. A score of "0" indicates the described item is "not true," a score of "1" indicates the described item is "somewhat or sometimes true," and a score of "2" indicates the described item is "very true or often true."

    The total sum of each subscale is reported. The higher the score, the more severe the symptoms of that subscale in the participant.

    The range for each subscale is as follows:

    General Mood: 0-16 Body rocking and expressionless face: 0-14 Hand behaviors: 0-12 Breathing Problems: 0-10 Repetitive Face Movements: 0-8 Night-time behaviors: 0-6 Walking Standing: 0-4

    The fear/anxiety subscale was used as a primary outcome measure in this study and results can be found in that section.


  2. Anxiety, Depression, and Mood Scale (ADAMS) [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    Remaining subscales of the ADAMS that are not primary outcome measures include: Manic/hyperactive, Depressed mood, General anxiety, Obsessive/compulsive behavior.

    The range for each subscale is as follows:

    Manic/Hyperactive Behavior: 0-15 Depressed Mood: 0-21 General Anxiety: 0-21 Obsessive/Compulsive Behavior: 0-9

    The higher the score for each subscale, the more problematic the behavior.


  3. Mullen Scales of Early Learning (MSEL) [ Time Frame: At the start and end of each 20-week treatment period ]

    The MSEL is a standardized developmental test for children ages 3 to 68 months consisting of five subscales: gross motor, fine motor, visual reception, expressive language, and receptive language.

    The raw score is reported for each subscale domain. The potential score ranges are as follows:

    Visual Reception: 33 items, score range=0-50, Fine Motor: 30 items, score range= 0-49, Receptive Language: 33 items, score range= 0-48, Expressive Language: 28 items, score range= 0-50. The gross motor subscale was not included in this population.

    A higher raw score indicates more advanced abilities in that section.


  4. Vineland Adaptive Behavior Scales, Second Edition (VABS-II) [ Time Frame: At the start and end of each 20-week treatment period ]

    The VABS-II is a survey designed to assess personal and social functioning. Within each domain (Communication, Daily Living Skills, Socialization, and Motor Skills), items can given a score of "2" if the participant successfully performs the activity usually; a "1" if the participant successfully performs the activity sometimes, or needs reminders; a "0" if the participant never performs the activity, and a "DK" if the parent/caregiver is unsure of the participant's ability for an item.

    The raw scores in each sub-domain are reported and the ranges for these are as follows: [Communication Domain], Receptive Language=0-40, Expressive Language=0-108, Written Language=0-50; [Daily Living Skills Domain], Personal=0-82, Domestic=0-48, Community=0-88; [Socialization Domain], Interpersonal Relationships=0-76, Play and Leisure Time=0-62, Coping Skills=0-60; [Motor Skills Domain]: Gross Motor Skills=0-80, Fine Motor Skills=0-72.

    A higher score indicates more advanced abilities.


  5. Communication and Symbolic Behavior Scales - Developmental Profile (CSBS-DP) [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The CSBS-DP was designed to measure early communication and symbolic skills in infants and young children (that is, functional communication skills of 6 month to 2 year olds). The CSBS-DP measures skills from three composites: (a) Social (emotion, eye gaze, and communication); (b) Speech (sounds and words); and (c) Symbolic (understanding and object use) and asks about developmental milestones. The data reported are the composite scores for these three categories.

    The possible scores for the three composite categories are as follows:

    Social Composite = 0-48; Speech Composite = 0-40; Symbolic Composite = 0-51.

    A higher score indicates more advanced abilities in that area.


  6. Aberrant Behavior Checklist - Community Edition (ABC-C) [ Time Frame: Every 5 weeks during each of the two 20-week treatment periods, and once 4 weeks after final treatment ends ]

    The ABC-C is a global behavior checklist implemented for the measurement of drug and other treatment effects in populations with intellectual disability. Behavior based on 58 items that describe various behavioral problems.

    Each item is rated on the parents perceived severity of the behavior. The answer options for each item are:

    0 = Not a problem

    1. = Problem but slight in degree
    2. = Moderately serious problem
    3. = Severe in degree

    The measure is broken down into the following subscales with individual ranges as follows:

    Subscale I (Irritability): 15 items, score range = 0-45 Subscale II (Lethargy): 16 items, score range = 0-48 Subscale III (Stereotypy): 7 items, score range = 0-21 Subscale IV (Hyperactivity): 16 items, score range = 0-48 Subscale V (Inappropriate Speech) was not included in the breakdown because it was not applicable (no participants in the study had verbal language).


  7. Quantitative Measures of Respiration: Apnea Index [ Time Frame: Every 10 weeks during each of the two 20-week treatment periods ]

    Respiratory data was collected using non-invasive respiratory inductance plethysmography from a BioCapture® recording device. BioCapture® is a child-friendly measurement device that can record from 1 to 12 physiological signal transducers in a time-locked manner. It can be configured with the pediatric chest and abdominal plethysmography bands and the 3 lead ECG signals we plan to use for monitoring cardiac safety throughout the study. Each transducer is placed on the patient independently to provide a customized fit that yields the highest signal quality for each patient irrespective of body shape and proportion. The transducer signals captured by the BioCapture® are transmitted wirelessly to a laptop computer where all signals are displayed in real-time.

    The apnea index is given as apneas/hour. Data on apneas greater than or equal to 10 seconds are displayed below. The higher the frequency of apnea, the more severe the breathing abnormality.




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   2 Years to 10 Years   (Child)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diagnosis of "classic" (or "typical") Rett Syndrome
  • Genetic documentation of MECP2 mutation
  • Subject must be post-regression (Hagberg Stage 2)
  • Subject and caregiver's primary language must be English
  • Subject must reside in North America (US and Canada)
  • Caregiver must have internet access and be able to complete questionnaires online and communicate via email
  • Subject is stable on current medications for at least 4 weeks
  • Subject's regimen of non-pharmacological interventions (physical therapy, speech therapy, etc.) is stable for at least 90 days

Exclusion Criteria:

  • Severe scoliosis (curvature >40 degrees)
  • Bone-age greater than 11 years
  • Cardiomegaly (enlarged heart)
  • Tanner stage 2 or higher breast development
  • Allergy to IGF-1
  • Prior use of IGF-1, growth hormone, or sex steroids

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01777542


Locations
United States, Massachusetts
Boston Children's Hospital
Boston, Massachusetts, United States, 02215
Sponsors and Collaborators
Boston Children’s Hospital
International Rett Syndrome Foundation
Investigators
Principal Investigator: Mustafa Sahin, MD, PhD Boston Children’s Hospital

Publications:

Responsible Party: Mustafa Sahin, Associate Professor of Neurology, Harvard Medical School
ClinicalTrials.gov Identifier: NCT01777542     History of Changes
Other Study ID Numbers: IRB-P00005610
First Posted: January 29, 2013    Key Record Dates
Results First Posted: March 26, 2018
Last Update Posted: March 26, 2018
Last Verified: March 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Mustafa Sahin, Harvard Medical School:
Rett syndrome
RTT
IGF-1
autism spectrum disorder

Additional relevant MeSH terms:
Syndrome
Rett Syndrome
Disease
Pathologic Processes
Mental Retardation, X-Linked
Intellectual Disability
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Genetic Diseases, X-Linked
Genetic Diseases, Inborn
Heredodegenerative Disorders, Nervous System
Insulin, Globin Zinc
Insulin
Mitogens
Mecasermin
Hypoglycemic Agents
Physiological Effects of Drugs
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Growth Substances