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Metformin in Patients With Fragile X

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ClinicalTrials.gov Identifier: NCT04141163
Recruitment Status : Recruiting
First Posted : October 28, 2019
Last Update Posted : October 31, 2019
Sponsor:
Collaborators:
FRAXA Research Foundation
University of Pennsylvania
Information provided by (Responsible Party):
Sean McBride, M.D., Ph.D., Rowan University

Brief Summary:
The purpose of this trial is to investigate the use of metformin in the treatment of Fragile X syndrome (FXS) patients. Metformin is an FDA approved compound with an established safety profile and minimal side effects that specifically targets and normalizes multiple aspects of the pathophysiology in FXS. This is a randomized double-blind placebo-controlled 2-arm parallel group design study of the drug metformin and placebo in FXS subjects with a primary outcome measure of safety/tolerability and secondary outcome measures on cognition, attention, anxiety, sleep, and physiologic and biochemical biomarkers.

Condition or disease Intervention/treatment Phase
Fragile X Syndrome Drug: Metformin Drug: Placebo oral tablet Phase 1 Phase 2

Detailed Description:

This trial will be a randomized placebo controlled, double-blind, parallel group design study of treatment with metformin on the primary outcome of safety/tolerance with secondary outcome measurements of the effects on cognition (encompassing social and repetitive behavior), attention, anxiety, and physiological and biochemical biomarkers of patients with FXS. FXS represents a well-defined population of ASD in which to test a specific targeted treatment looking at a well-defined set of cognitive and bioassay measures.

Trial length is designed to have a chance at seeing if the medication can improve cognitive outcome measures. The study duration includes the screening period and a 24-week single-blind drug/placebo phase.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Parallel Group Design Randomized Double-Blind Trial of Metformin Treatment in Patients With Fragile X Syndrome on Safety and Effects on Cognition, Anxiety, Attention and Biomarkers
Actual Study Start Date : October 29, 2019
Estimated Primary Completion Date : March 2021
Estimated Study Completion Date : March 2021


Arm Intervention/treatment
Experimental: Metformin
Subjects randomized to metformin will start at 500mg once a day for 7 days and increase as is tolerated to 500mg twice a day for 7 days, then to 1000mg in the morning and 500mg at dinner for 7 days and then to the target dose of 1,000mg twice a day.
Drug: Metformin
Metformin, 1,1 dimethylbiguanide, or systematic (IUPAC) name N,N-dimethylimidodicarbonimidic diamide, is an oral anti-diabetic medicine approved in the US by the FDA in 1994. It is marketed alone under the names metformin (generic), Glucophage XR, Riomet, Fortamet, Glumetza, Obimet, Gluformin, Dianben, Diabex, and Diaformin and in combination with other drugs under the names Actoplus Met, Metaglip, Glucovance, Janumet, Kombiglyze XR, and PrandiMet
Other Name: glucophage

Placebo Comparator: Placebo
Subjects randomized to placebo will start at 500mg once a day for 7 days and increase as is tolerated to 500mg twice a day for 7 days, then to 1000mg in the morning and 500mg at dinner for 7 days and then to the target dose of 1,000mg twice a day.
Drug: Placebo oral tablet
No therapeutic effect




Primary Outcome Measures :
  1. The safety and tolerability of metformin in patients with Fragile X Syndrome as assessed by the number of adverse events reported during the course of the study. [ Time Frame: 1-2 years ]
    measured by the number of reported adverse events, assessed using the Safety Monitoring Uniform Report Form (SMURF), modified for metformin use


Secondary Outcome Measures :
  1. Patients taking Metforming have improved cognition, sleep, attention or anxiety from baseline to the end of the study [ Time Frame: 1-2 years ]
    measured by a variety of questionnaires and assessments done throughout the length of the study



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 50 Years   (Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Male between the ages of 16-50 years old at the time of consent
  • Diagnosis of full mutation FXS.
  • Stable on any psychoactive medication for at least 4 weeks before receiving study drug, including antidepressants, stimulants, antipsychotics, and mood stabilizers.
  • Seizure free for at least the past 3 months.
  • No major health issues or diseases expected to interfere with the study
  • No history of diabetes
  • Not currently taking metformin at the time of enrollment
  • Average basal blood glucose HgbA1c < 7.0
  • Study partner with frequent contact with patient willing to accompany patient to visits and complete caretaker/partner study forms
  • No contraindication to metformin
  • Willing to complete all baseline assessments and study procedures

Exclusion Criteria:

  • Has a medical condition that would make treatment unsafe such as diabetes, pancreatic disease, liver or kidney disease, a history of epilepsy or seizure disorder that is not controlled, as well as any other medical condition as determined by the study doctor.
  • Has an eating disorder that has been clinically diagnosed, predisposing them to low BMI.
  • Has received any investigational compound within 30 days prior to the first dose of study medication.
  • Has received metformin in a previous clinical study or as a therapeutic agent.
  • Is an immediate family member, study site employee, or in a dependent relationship with a study site employee who is involved in the conduct of this study (e.g., spouse, parent, child, sibling), or may consent under duress.
  • Has uncontrolled, clinically significant neurological, cardiovascular, pulmonary, hepatic, renal, metabolic, gastrointestinal, or endocrine disease or other abnormality which may impact the ability of the participant to participate or potentially confound the study results.
  • Has a known hypersensitivity to any component of the formulation of metformin.
  • Has a history of drug abuse (defined as any illicit drug use) or a history of alcohol abuse within 6 months prior to the screening visit or is unwilling to agree to abstain from alcohol and drugs throughout the study.
  • Currently taking any excluded medication, supplements, or food products, or has taken any in the 3 weeks preceding Visit 1. This includes carbonic anhydrase inhibitors and the medication topamax.
  • Has evidence of current cardiovascular, hepatic, hematopoietic disease, renal dysfunction, metabolic or endocrine dysfunction, serious allergy, asthma hypoxemia, hypertension or allergic skin rash. There is any finding in the participant's medical history, physical examination, or safety laboratory tests giving reasonable suspicion of a disease that would contraindicate taking metformin or a similar drug in the same class, or that might interfere with the conduct of the study. This includes, but is not limited to uncontrolled seizure disorders, and cardiac arrhythmias.
  • History of any surgical intervention known to impact absorption (e.g., bariatric surgery or bowel resection).
  • Compromised renal function at screening as determined by creatinine levels >1.5mg/dL and/or creatinine clearance <45mL/min based on Cockcroft-Gault calculation.
  • Liver dysfunction at screening as evidenced by alanine transaminase (ALT/SGPT) values > 2X upper limit of normal or aspartate transaminase (AST/SGOT) values > 3X upper limit of normal or total bilirubin > 2X upper limit of normal.
  • Has donated or lost 450 mL or more of his blood volume (including plasmapheresis), or had a transfusion of any blood product within 3 months prior to Day 1.
  • Has a history of abnormal (clinically significant) electrocardiogram (ECG). Entry of any participant with an abnormal (not clinically significant) ECG must be approved, and documented by signature by the principal investigator.
  • Has abnormal Screening or Day 1 vital sign values that suggest a clinically significant underlying disease.
  • Is at risk of suicide, has made a suicide attempt within the last year or has current active suicidal ideation. In accordance with previous FDA regulated studies on patients with FXS this determination will include asking 3 questions. 1) Has the subject made a suicide attempt? 2) Has the subject expressed any (active) suicidal thoughts or intent to harm him/herself or others? 3) Has there been a significant increase in the severity or frequency of self-injurious behaviors, or harm toward others, such that continued safety is a concern?
  • Laboratory abnormalities in B12, or other common lab parameters that might contribute to cognition or participation in study
  • In the opinion of the investigator or sponsor, the participant is unsuitable for inclusion in the study.

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): NCT04141163


Contacts
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Contact: Lauren Fedor 856-566-6003 fedor@rowan.edu

Locations
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United States, New Jersey
Rowan University School of Osteopathic Medicine Recruiting
Stratford, New Jersey, United States, 08084
Contact: Lauren Fedor    856-566-6003    fedor@rowan.edu   
Sponsors and Collaborators
Rowan University
FRAXA Research Foundation
University of Pennsylvania
Investigators
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Principal Investigator: Sean McBride, MD, PhD Rowan University

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Responsible Party: Sean McBride, M.D., Ph.D., Associate Professor, Rowan University
ClinicalTrials.gov Identifier: NCT04141163     History of Changes
Other Study ID Numbers: Pro2018000310
First Posted: October 28, 2019    Key Record Dates
Last Update Posted: October 31, 2019
Last Verified: October 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Fragile X Syndrome
Syndrome
Disease
Pathologic Processes
Mental Retardation, X-Linked
Intellectual Disability
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Sex Chromosome Disorders
Chromosome Disorders
Congenital Abnormalities
Genetic Diseases, Inborn
Genetic Diseases, X-Linked
Heredodegenerative Disorders, Nervous System
Metformin
Hypoglycemic Agents
Physiological Effects of Drugs