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Validation of Macimorelin as a Test for Adult Growth Hormone Deficiency

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ClinicalTrials.gov Identifier: NCT02558829
Recruitment Status : Completed
First Posted : September 24, 2015
Results First Posted : February 9, 2018
Last Update Posted : April 10, 2018
Sponsor:
Information provided by (Responsible Party):
AEterna Zentaris

Brief Summary:
The Macimorelin Growth Hormone Stimulation Test (GHST) will be compared with the Insulin Tolerance Test (ITT) in an open-label, randomized, 2-way crossover Trial. The trial will include subjects suspected to have adult growth hormone deficiency (AGHD) and a group of healthy control subjects.

Condition or disease Intervention/treatment Phase
Growth Hormone Deficiency With Pituitary Anomalies Drug: Macimorelin Drug: Insulin Phase 3

Detailed Description:

Trial subjects will be assigned to groups of descending likelihood of having AGHD:

Group A, B, C: High, intermediate, and low likelihood of GHD, respectively; Group D: Healthy control subjects matching Group A subjects .

The sequential order of the GHSTs for suspected AGHD subjects (Group A-C) will be determined by stratified randomization; healthy control subjects (Group D) will be tested in the same sequence as the matched Group A subjects.

Serum concentrations of GH will be measured at pre-defined time points before and after GHST with macimorelin or insulin. A peak GH value below the GHST-specific cut-off value will be considered 'test positive'. The ITT will be considered as comparator (non-reference standard) to assess positive and negative agreement of both GHSTs, based on the predefined cut-off values.

The following cut-off values for simulated GH levels were used for both GHST tests to be compared: macimorelin-GHST: GH: 2.8 ng/mL, ITT: GH: 5.1 ng/mL.

Amendment no. 1 (repeatability extension): had been issued for selected sites in Europe to obtain exploratory data on the repeatability of the MAC in a subset of subjects (planned N=30, 10 per Group) that had completed the core study.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 157 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Masking Description: This was an open label trial. No masking with regard to the Growth Hormone Stimulation Tests (GHSTs) performed was done. However, Data Review Committee/Sponsor/Project Management was masked towards the Growth Hormone (GH) values as results fo both tests. GH values were provided to the investigator only after both GHSTs had been performed, to avoid bias.
Primary Purpose: Diagnostic
Official Title: Confirmatory Validation of Oral Macimorelin as a Growth Hormone (GH) Stimulation Test (ST) for the Diagnosis of Adult Growth Hormone Deficiency (AGHD) in Comparison With the Insulin Tolerance Test (ITT)
Actual Study Start Date : December 3, 2015
Actual Primary Completion Date : November 29, 2016
Actual Study Completion Date : November 29, 2016


Arm Intervention/treatment
Experimental: GHST Sequence A
1st Macimorelin-GHST, 2nd Insulin Tolerance Test
Drug: Macimorelin
macimorelin acetate, 0.5 mg/kg body weight, drinking solution, single dose
Other Name: Macimorelin-GHST (MAC)

Drug: Insulin
Insulin, 0.10 U/kg (0.15 U/kg if BMI > 30 kg/m2), intravenous injection, single dose
Other Name: Insulin Tolerance Test (ITT)

Experimental: GHST Sequence B
1st Insulin Tolerance Test, 2nd Macimorelin-GHST
Drug: Macimorelin
macimorelin acetate, 0.5 mg/kg body weight, drinking solution, single dose
Other Name: Macimorelin-GHST (MAC)

Drug: Insulin
Insulin, 0.10 U/kg (0.15 U/kg if BMI > 30 kg/m2), intravenous injection, single dose
Other Name: Insulin Tolerance Test (ITT)




Primary Outcome Measures :
  1. Co-primary Efficacy Variables: Percent Positive and Percent Negative Agreement of Macimorelin-GHST (MAC) With ITT [ Time Frame: 90 minutes ]

    In the primary efficacy analysis, the estimated percentages of the agreements and the two-sided 95% confidence interval (or one-sided 97.5% confidence interval) of the percent agreement based on Clopper-Pearson are presented. The probability for a "Negative Agreement" equals the sum of the probability of both tests being correct (negative test results for both tests for subjects with "true non-AGHD") and the probability of both tests being wrong (negative test results for both tests for subjects with "true AGHD").

    The performance of the GHST with Macimorelin was considered to be acceptable if the lower bound of the two-sided 95% confidence interval (or lower bound of the one-sided 97.5% confidence interval) for the primary efficacy variables was 75% or higher for 'percent negative agreement', and 70% or higher for the 'percent positive agreement'.

    The following cut-off values for stimulated GH levels were used: - MAC: GH: 2.8 ng/mL, - ITT: GH: 5.1 ng/mL.



Secondary Outcome Measures :
  1. Overall Agreements (Positive/ Negative) for MAC and ITT [ Time Frame: 90 minutes ]
    As part of the secondary efficacy analysis, the percent of overall agreement was analyzed, using the same methodology described for the analyses for the primary efficacy variables.

  2. Number of Participants With Any Test Emergent Adverse Event (TEAE), With Any TEAE Likely or Possibly Related, and With Any Test Emergent Severe AE [ Time Frame: up to 70 days ]
    GHST ('Test') emergent AEs (TEAEs): AEs occurring or observed from the day of first GHST (administration of an IMP) throughout End-of-Study (EOS) visit or Early Termination, whichever occurred first. TEAEs were analyzed and compared for both GHSTs. Detailed listings are presented in the Adverse Events section. The frequencies presented in this section refer to number of subjects with any TEAE, each subject was counted only once within each category.

  3. ECG: Change in Heart Rate From Baseline at 60 Minutes Post-dose [ Time Frame: 60 minutes ]
    During the GHSTs, ECGs were measured at pre-dose (up to 15 min before) and 60 minutes post-dose. Furthermore, ECGs were measured at screening and at End-of-Study (EOS) Visit.


Other Outcome Measures:
  1. Sensitivity and Specificity of the MAC, GH: 2.8 ng/mL [ Time Frame: 90 minutes ]
    Exploratory evaluation of sensitivity and specificity of the MAC as performance characteristic, based on test outcome in Group A and Group D subjects.

  2. Agreement (Positive/Negative) for MAC Core Study Part and MAC Repeatability Extension (Amendment 1) [ Time Frame: 90 minutes ]
    Amendment no 1 (repeatability extension) had been issued for selected sites in Europe to obtain exploratory data on the repeatability of the MAC in a subset of subjects that had completed the core study. Pre-defined MAC cut-off point GH: 2.8 ng/mL. Agreements were calculated with two-sided 95% confidence intervals.



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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Suspected growth hormone deficiency (GHD), based on either of the following:

    • structural hypothalamic or pituitary disease, or
    • surgery or irradiation in these areas, or
    • head trauma as an adult, or
    • evidence of other pituitary hormone deficiencies, or
    • idiopathic childhood onset GHD (without known hypothalamic or pituitary lesion or injury).
  • Healthy* control subjects, matching a 'high likelihood GHD' subjects

Exclusion Criteria:

  • GH therapy within 1 month prior to anticipated first GHST within this trial (within 3 months in case of long-acting GH formulation).
  • GHST within 7 days prior to the anticipated first test day within the trial.
  • Subjects with a medical history and clinical signs of a not adequately treated thyroid dysfunction or subjects who had a change in thyroid therapy within 30 days prior to anticipated first test day within the trial.
  • Untreated hypogonadism or not on a stable substitution treatment within 30 days prior to anticipated first test day within the trial.
  • Treatment with drugs directly affecting the pituitary secretion of somatotropin (e.g. somatostatin analogues, clonidine, levodopa, and dopamine agonists) or provoking the release of somatostatin; antimuscarinic agents (atropine).
  • Concomitant use of a CYP3A4 inducer (e.g., carbamazepine, phenobarbital, phenytoin, pioglitazone, rifabutin, rifampin, St. John's Wort).
  • Medical history of ongoing clinically symptomatic severe psychiatric disorders.
  • Parkinson's disease.
  • Cushing disease or patients on supraphysiologic glucocorticoid therapy within 30 days prior to the anticipated first test day within the trial.
  • Type 1 diabetes or untreated or poorly controlled Type 2 diabetes, as defined by HbA1c > 8%.
  • Body mass index (BMI) ≥ 40.0 kg/m2.
  • Participation in a trial with any investigational drug within 30 days prior to trial entry.
  • Vigorous physical exercise within 24 hours prior to each GHST within this trial.
  • Known hypersensitivity to macimorelin or insulin, or any of the constituents of either preparation.
  • Clinically significant cardiovascular or cerebrovascular disease.
  • Prolonged ECG QT interval, defined as corrected QT interval (QTc) > 500 msec.
  • Concomitant treatment with any drugs that might prolong QT/QTc.
  • Elevation of laboratory parameters indicating hepatic or renal dysfunction or damage (aspartate amino transferase (ASAT), alanine aminotransferase (ALAT), gamma-glutamyl transpeptidase (GGT)> 2.5 x ULN; ), creatinine, or bilirubin > 1.5x ULN).
  • Medical history of seizure disorders.
  • Known immunosuppression.
  • Current active malignancy other than non-melanoma skin cancer.
  • Breastfeeding or positive urine pregnancy test (for women of childbearing potential only).
  • Women of childbearing age without contraception, such as hormonal contraception or use of condom and spermicides or use of diaphragm and spermicides or Intra Uterine Device (IUD).
  • Lack of ability or willingness to give informed consent.
  • Anticipated non-availability for trial visits/procedures.

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): NCT02558829


Locations
United States, California
Harbor UCLA Medical Center
Torrance, California, United States, 90509
United States, Texas
Texas Diabetes and Endocrinology
Austin, Texas, United States, 78731
Baylor College of Medicine-Endocrinology
Houston, Texas, United States, 77030
United States, Washington
VA Puget Sound Health Care System
Seattle, Washington, United States, 98108
Swedish Medical Center - Cherry Hill
Seattle, Washington, United States, 98122
Austria
Krankenanstalt Rudolfstiftung
Vienna, Austria, 1030
Medical University & General Hospital of Vienna, AKH,
Vienna, Austria, 1090
France
CHU de Lyon HCL-GH Est
Bron Cedex, France, 69677
GHU Paris-Sud - Hôpital de Bicêtre
Le Kremlin-Bicêtre, France, 94270
Hôpital Haut-Lévêque
Pessac, France, 33600
Germany
Klinikum der LMU München
Muenchen, Bayern, Germany, 80336
Max Planck Institut
Muenchen, Bayern, Germany, 80804
University Hospital Marburg
Marburg, Hessen, Germany, 35033
RWTH Aachen University Hospital
Aachen, Nordrhein-Westfalen, Germany, 52074
Klinik für Endokrinologie, Diabetes und Ernährungsmedizin der Charité
Berlin, Germany, 10117
Italy
San Luca Hospital
Milano, Italy, 20149
Poland
Centrum Kliniczno-Badawcze
Elblag, Poland, 82-300
Centrum Medyczne Angelius Provita
Katowice, Poland, 40-611
Phase I - MTZ Clinical Research Sp. z o.o.
Warszawa, Poland, 02-106
Wromedica
Wrocław, Poland, 51-685
Serbia
Clinical Centre of Serbia
Belgrad, Serbia, 11000
Clinical Centre of Vojvodina
Novi Sad, Serbia, 21000
Spain
Hospital de Sant Pau
Barcelona, Spain, 08026
Hospital Universitari Vall d' Hebron
Barcelona, Spain, 08035
Hospital de Conxo
Santiago de Compostela, Spain, 15706
United Kingdom
St Bartholomew's Hospital
London, United Kingdom, EC1A 7BE
The Christie NHS Foundation Trust
Manchester, United Kingdom, M20 4BX
Sponsors and Collaborators
AEterna Zentaris
Investigators
Study Chair: Jose M Garcia, MD PhD Baylor College of Medicine, Houston, TX, U.S.

Responsible Party: AEterna Zentaris
ClinicalTrials.gov Identifier: NCT02558829     History of Changes
Other Study ID Numbers: AEZS-130-052
2015-002337-22 ( EudraCT Number )
First Posted: September 24, 2015    Key Record Dates
Results First Posted: February 9, 2018
Last Update Posted: April 10, 2018
Last Verified: March 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by AEterna Zentaris:
Adult Growth Hormone Deficiency

Additional relevant MeSH terms:
Endocrine System Diseases
Dwarfism, Pituitary
Septo-Optic Dysplasia
Dwarfism
Bone Diseases, Developmental
Bone Diseases
Musculoskeletal Diseases
Bone Diseases, Endocrine
Hypopituitarism
Pituitary Diseases
Hypothalamic Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Nervous System Malformations
Congenital Abnormalities
Insulin, Globin Zinc
Insulin
Hormones
Hypoglycemic Agents
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists