Acceptability Study of a New Paediatric Form of Vigabatrin in Infants and Children With Infantile Spasms or Pharmacoresistant Partial Epilepsy (SoluWest)

• ClinicalTrials.gov Identifier: NCT02220114
• Recruitment Status: Completed
• First Posted: August 19, 2014
• Last Update Posted: April 24, 2018
• Sponsor: Orphelia Pharma
• Collaborators: Institut National de la Santé Et de la Recherche Médicale, France; Hospices Civils de Lyon; National Research Agency, France
• Information provided by (Responsible Party): Orphelia Pharma

Study Description

Brief Summary:

The sponsor is developing a new paediatric formulation of vigabatrin to better adjust the dose to body weight and to limit waste of unused drug. The currently marketed vigabatrin (Sabril™) form only exists as 500 mg film coated tablets (for adults and children above 6 years) and 500 mg granules for oral solution sachets (for infants and children below 6 years). Sabril™ is not adapted for administration to infants when a fraction of the sachet is needed. Manual splitting of the sachet or lengthy and error-prone dilutions are often required.

This study is a descriptive, non-randomized, open label multi-centric acceptability study in infants and children affected with infantile spasms. The primary objective is to describe the adherence to the new formulation. Secondary objectives include:

• evaluation of the palatability and user-friendliness of the new treatment,
• evaluation of the pharmacokinetic parameters of the new formulation,
• PK parameters,
• evaluation of the tolerance,
• measurement of taurine plasma levels. This study will recruit up to 40 patients with infantile spasms and pharmacoresistant partial epilepsy aged 1 month to 6 years in 23 clinical sites in France.

Condition or disease	Intervention/treatment	Phase
Infantile Spasms	Drug: Vigabatrin: Vigabatrin new ST formulation then Sabril®	Not Applicable

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 38 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Acceptability Study of a New Paediatric Form of Vigabatrin in Infants and Children With Infantile Spasms or Pharmacoresistant Partial Epilepsy. Observational, Descriptive, Open-label, Multi-centric, Non-randomized Study
• Study Start Date: May 2014
• Actual Primary Completion Date: December 2016
• Actual Study Completion Date: December 2016

Arms and Interventions

Arm

Intervention/treatment

Vigabatrin: Vigabatrin new ST formulation then Sabril®; Sabril®: sachet for oral solution 500 mg, 50 to 100mg/Kg/day, twice a day, 14 days. Vigabatrin new ST formulation: Soluble tablets 100 or 500 mg, 50 to 100mg/Kg/day, twice a day, 12 weeks.

Drug: Vigabatrin: Vigabatrin new ST formulation then Sabril®; first "treatment" phase (V1/D1-V3/D84), in which patients already under Sabril® "granules for oral solution" and naive patients start the new ST formulation; patients already under Sabril® will start at the same dose and regimen as their usual Sabril®. Dose and regimen for naive patients will be chosen according to SPC.; second "treatment" phase (V3/D84-V4/D98) in which the patient is switched to Sabril® "granules for oral solution" (supplied by sponsor) for 15 days at the same dose as under the new ST formulation. Dose and treatment regimen should be maintained as in first treatment phase. - At V4/D98, patients who received Sabril® "granules for oral solution" (supplied by sponsor) continue with marketed Sabril® treatment (or switches to another AED, according to the natural evolution of the patient's condition and upon investigator decision).

Outcome Measures

Primary Outcome Measures :

1. Individual adherence to the new Soluble Tablets (ST) formulation of Vigabatrin (VGB) using Medication Event Monitoring System (MEMS) [ Time Frame: from V1 (day 1) to V3 (day 84), continuous assessment. ]
   Adherence will be assessed by measurement of the dosing history of patients using an electronic Medication Event Monitoring System (MEMS).The date and time of each opening will be recorded

Secondary Outcome Measures :

1. Adherence to the new ST formulation and to Sabril® granules for oral solution, by treatment unit accountability [ Time Frame: VGB-ST: V1 (day 1) to V3 (day 84). Sabril®:V3 (day 85) to V4 (day 98) ]
   Accountability of used and unused treatment units, retrieved by the patient at V3 and V4
2. palatability of the new ST formulation and of Sabril® "granules for oral solution". [ Time Frame: during 7 consecutive days: from D90 to D96 under Sabril® and from D29 to D35 under the new ST formulation ]
   Palatability of the treatment will be evaluated using a two face visual hedonic scale filled in by the parents and/or by the child, if feasible, on a daily basis. Each "face" of the scale will be assigned a score (1 to 2), and the average score will be calculated for the group. Palatability will be considered good if the average score for the group is at least 1.5 (out of a maximum of 2; Motte et al. 2005).
3. Ease of use of the new ST formulation and of Sabril® "granules for oral solution". [ Time Frame: during 7 consecutive days: from D90 to D96 under Sabril® and from D29 to D35 under the new ST formulation. ]
   Ease of use will be evaluated using diaries filled by the parents or care-givers during 7 consecutive days: . Time required for preparation of both new ST formulation and Sabril® administrations will be averaged and compared, together with the global use satisfaction.
4. Safety and tolerance [ Time Frame: Results of electroretinogram: when available from D1 to D126; Blood assessment: at D1 & D84; Vital signs at D1, D28, D84, D98 & D126; Adverse events, serious adverse events: evaluated for the duration of study participation (at D1, D28, D84, D98 & D126) ]
   VGB safety profile is well known. The new ST formulation is expected to be bioequivalent to Sabril®, and since the new formulation does not contain excipients known to have a recognized action or effect at the dose used, the safety of the new formulation should be similar to that of Sabril®. Hence no other measures specific to the new ST formulation are included in the clinical acceptability study.
5. pharmacokinetic parameters for the new ST formulation (1 sample). Pharmacokinetic parameters for the new ST formulation (population PK) : Area under the curve (AUC), Tmax, Cmax, T½, Ka, V/F, Cl/F [ Time Frame: PK D84: 1 sample before treatment. ]
   The objective is to better characterize the developmental PK of vigabatrin during childhood.
6. Evaluation of the taurine plasma levels in children treated by vigabatrin. Taurine plasma concentration will be measured and a relationship between vigabatrin exposition and taurine plasma levels will be sought. [ Time Frame: 1 sample will be drawn at V3 (day 84): just before treatment when patient is fasting. ]

Eligibility Criteria

• Ages Eligible for Study: 1 Month to 6 Years (Child)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Patients with diagnosed infantile spasms (IS) or pharmacoresistant partial onset seizures (POS).
• Infants > 1 month and < 6 months; infants > 6 months and < 2 years; and children > 2 years and < 6 years.
• Patients under Sabril® or naive patients.
• Patients under a twice-a-day posology of Sabril® or patients for whom vigabatrin will be given twice daily.

Non inclusion Criteria:

• Use of more than 2 other antiepileptic drugs as concomitant treatment (including steroids). Ketogenic diet can be in addition to these 2 other antiepileptic drugs.
• Subjects receiving vigabatrin through a gastric tube.
• Weight < 1.750 Kgs.
• Any planned major surgery within the duration of the trial.
• Participation in any other clinical trial within 3 months prior to V1.

Contacts and Locations

Locations

France

Service de neurologie pédiatrique - CHU

Amiens, France, 80054

Service de neurologie pédiatrique - CHU

Angers, France, 49033²

Service de neuropédiatrie - CHU Pellegrin Enfants

Bordeaux, France, 33076

Service de neurologie infantile - Hôpital Salengro

Lille, France, 59037

Service de nuerologie pédiatrique - Hôpital Femme Mère Enfant

Lyon, France, 69677

Service de neurologie pédiatrique - Hôpital de la Timone

Marseille, France, 13385

Service de neurologie pédiatrique - Hôpital Necker Enfants Malades

Paris, France, 75015

Service de neuropédiatrie - Hôpital Robert Debré

Paris, France, 75019

Service de neurologie pédiatrique - Hôpital Sud

Rennes, France, 35203

Centre référent des épilepsies rares pédiatrique associé - Hôpital de Hautepierre

Strasbourg, France, 67098

Service de neuropédiatrie - Hôpital Purpan

Toulouse, France, 331059

Service de neuropédiatrie - Hôpital de Clocheville

Tours, France, 37044

Sponsors and Collaborators

Orphelia Pharma

Institut National de la Santé Et de la Recherche Médicale, France

Hospices Civils de Lyon

National Research Agency, France

Investigators

• Principal Investigator: Rima NABBOUT; Hôpital Necker Enfants Malades - APHP

More Information

• Responsible Party: Orphelia Pharma
• ClinicalTrials.gov Identifier: NCT02220114
• Other Study ID Numbers: TGO-VGB-III-01
• First Posted: August 19, 2014
• Last Update Posted: April 24, 2018
• Last Verified: April 2018

Keywords provided by Orphelia Pharma:

Infantile spasms; vigabatrin; soluble tablets; acceptability; adherence; pharmacokinetics

Additional relevant MeSH terms:

Muscle Cramp; Epilepsy; Spasm; Epilepsies, Partial; Spasms, Infantile; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neuromuscular Manifestations; Neurologic Manifestations; Muscular Diseases; Musculoskeletal Diseases; Epilepsy, Generalized; Epileptic Syndromes; Vigabatrin; Anticonvulsants; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; GABA Agents; Neurotransmitter Agents; Physiological Effects of Drugs