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Research on Cognitive Effect of Cannabidiol on Dravet Syndrome and Lennox-Gastaut SyndromeGastaut Syndrome

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ClinicalTrials.gov Identifier: NCT04611438
Recruitment Status : Recruiting
First Posted : November 2, 2020
Last Update Posted : November 2, 2020
Sponsor:
Information provided by (Responsible Party):
Yonsei University

Brief Summary:

The clinical trial "A Prospective Single-Center Single-Arm Clinical Trial on Cognitive Effect of Cannabidiol (CBD-OS®) on Dravet syndrome and Lennox-Gastaut Syndrome" is a single-group phase III study done in single tertiary referral center in Seoul, Korea.

Chief investigator is Dr. Hoon-Chul Kang of Severance Hospital, Yonsei University College of Medicine. Associate investigators are Dr. Heung Dong Kim, Joon Soo Lee, Se Hee Kim, Han Som Choi, Ji Hoon Na, Dong Hwa Yang, and Hee Jung Kang, of Severance Hospital, Yonsei University College of Medicine.

The aim of the study is to evaluate the effect of cannabidiol (CBD-OS®) on cognitive functions in patients aged from 2 to 18 years old diagnosed with Dravet syndrome or Lennox-Gastaut syndrome. The duration of study is planned as one year, after patient recruitment of 6 months. The intervention period in each patient is 24 weeks, with 2 weeks of medication titration, stabilization period of 10 weeks, and maintenance period of 12 weeks. The recruitment goal of patient number is 104, considering the study power of 90 percent.

Primary outcomes are improvement of cognitive and development and improvement of seizure outcome. Secondary outcomes are improvement in behavior and quality of life.

Safety monitoring criteria are adverse event profiles and physician's and caregiver's global assessment.

Statistical analysis of outcomes is subject only to the patients who completed the 24-week medication and 2 times of tests before and after treatment of cannabidiol. Evaluation of seizure outcomes would include all patients who completed the 24-week medication and those who dropped out of the study, either by follow-up loss or discontinuation of medication due to incomplete seizure control or adverse effect of the medication.

To evaluate safety, the investigators would measure adverse events and dropout rates by percentage. The investigators would analyze overall evaluation of the caregivers and investigator. Serious adverse events would be noted after causality evaluation.


Condition or disease Intervention/treatment Phase
Dravet Syndrome Lennox Gastaut Syndrome Drug: Cannabidiol Phase 3

Detailed Description:

Selection criteria of the patients are as below:

  1. Age: 2 years old to 18 years old
  2. Investigation center: Severance hospital, Yonsei University College of Medicine, Seoul, Korea
  3. A) Diagnosed as Dravet syndrome by clinical manifestations and/or genetic test B) Diagnosed as Lennox-Gastaut syndrome by clinical manifestations and electroencephalography
  4. The diagnosed patients by criteria 3-(1) or 3-(2) with intractable seizures after using over two antiepileptic medications
  5. Patients and caregivers who agreed to participation in this trial

Exclusion criteria of the patients are as below:

  1. Patients with possibility of progressive central nervous system disease other systemic disease
  2. The patients who started additional antiepileptic medication during the investigation period, with exception of short-term acute treatment of seizures (e.g. benzodiazepine for rescue therapy)
  3. Patients with alanine and aspartate aminotransferase and/or total bilirubin levels over 2 times of the normal range, or blood urea nitrogen and creatinine ratio over 3 times of the normal range
  4. Patient with hypersensitivity or allergic reactions to cannabidiol
  5. patients who are incapable of executing cognitive tests, or cases whom the investigators consider inappropriate to be enrolled in the trial Overall trial schedule for each patient is as follows:

A) Baseline Phase (2 weeks)

  • Baseline Phase starts from the screening visit, where the patient and caregiver write permission to the trial and goes through laboratory, electroencephalography, and neuropsychological tests.

B) Treatment Period : Titration(2 weeks) + stabilization period (10 weeks) + maintenance period (12 weeks)

  • Titration: cannabidiol titration up to 10mg/kg/day with the caregiver monitoring the patient's tolerability
  • Stabilization: caregiver monitoring the patient's tolerability, with no change in medication dosage
  • Maintenance: no change in medication dosage
  • Statistical analysis of outcomes would be done as follows:

T-test would be done to compare each test before and after cannabidiol treatment. For multiple results along the intervention time period, repeated data analyses would be done. Continuous variables would be evaluated by repeated measures analysis of variance or generalized estimating equations. Nominal variables would be evaluation by chi-squared test or trend test.

Evaluation of seizure outcomes would include all patients who completed the 24-week medication and those who dropped out of the study, either by follow-up loss or discontinuation of medication due to incomplete seizure control or adverse effect of the medication.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 107 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: Patients would be from 2 to 18 years old diagnosed with Dravet syndrome or Lennox-Gastaut syndrome, who are intractable to more than 2 antiepileptic medications. Caregivers would purchase cannabidiol and give it to the patient according to titration schedule. Patients would go through laboratory, neuropsychologic, and electroencephalographic tests before, during and after the intervention.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective Multi-Center Single-Arm Clinical Trial on Cognitive Effect of Cannabidiol (CBD-OS®) on Dravet Syndrome and Lennox-Gastaut Syndrome
Actual Study Start Date : March 30, 2020
Estimated Primary Completion Date : March 2021
Estimated Study Completion Date : June 2021


Arm Intervention/treatment
Experimental: CBD
The patient would be on cannabidiol for 24 weeks and would go through laboratory, electroencephalography, and neuropsychological tests before, during, and after intervention.
Drug: Cannabidiol

Intervention schedule for each patient is as follows:

  1. Baseline Phase (2 weeks) Baseline Phase starts from the screening visit, where the patient and caregiver write permission to the trial and goes through laboratory, electroencephalography, and neuropsychological tests.
  2. Treatment Period: Titration (2 weeks) + stabilization period (10 weeks) + maintenance period (12 weeks)

    • Titration: The patient would start cannabidiol on 5mg/kg/mg for 1 week and titrate dosage up to 10mg/kg/day for second week with the caregiver monitoring the patient's tolerability
    • Stabilization: caregiver monitoring the patient's tolerability, with no change in medication dosage
    • Maintenance: no change in medication dosage




Primary Outcome Measures :
  1. development assessment [ Time Frame: 24 weeks ]
    Assessment of cognition and development would be done by Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence, Wechsler Intelligence Scale for Children, Developmental Test of Visual-Motor Integration, and CCTT according to the patient's age and capability.

  2. Seizure outcome [ Time Frame: 24 weeks ]
    Caregivers would report seizure outcome by Caregiver Global Impression of Change in Seizure Duration or Caregiver/patient Global Impression of Change. (CGIC)


Secondary Outcome Measures :
  1. Behavior assessment [ Time Frame: 24 weeks ]
    Behavior would be evaluated by Child Behavior Checklist (K-CBCL)

  2. Quality of life assessment [ Time Frame: 24 weeks ]
    Tool for evaluation quality of life is Quality of Life in Childhood Epilepsy questionnaire(K-QOLCE).



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Ages Eligible for Study:   2 Years to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age: 2 years old to 18 years old
  2. Investigation center: Severance hospital, Yonsei University College of Medicine, Seoul, Korea
  3. (1) Diagnosed as Dravet syndrome by clinical manifestations and/or genetic test (2) Diagnosed as Lennox-Gastaut syndrome by clinical manifestations and electroencephalography
  4. The diagnosed patients by criteria 3-(1) or 3-(2) with intractable seizures after using over two antiepileptic medications
  5. Patients and caregivers who agreed to participation in this trial

Exclusion Criteria:

  1. Patients with possibility of progressive central nervous system disease other systemic disease
  2. The patients who started additional antiepileptic medication during the investigation period, with exception of short-term acute treatment of seizures (e.g. benzodiazepine for rescue therapy)
  3. Patients with alanine and aspartate aminotransferase and/or total bilirubin levels over 2 times of the normal range, or blood urea nitrogen and creatinine ratio over 3 times of the normal range
  4. Patient with hypersensitivity or allergic reactions to cannabidiol
  5. patients who are incapable of executing cognitive tests, or cases whom the investigators consider inappropriate to be enrolled in the trial

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): NCT04611438


Contacts
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Contact: Hoon-Chul Kang, MD, Ph.D +82-2-2228-2050 hipo0207@yuhs.ac

Locations
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Korea, Republic of
Severance Hospital, Yonsei University College of Medicine Recruiting
Seoul, Korea, Republic of
Contact: Hoon-Chul Kang, MD    82-2-2228-2050    hipo0207@yuhs.ac   
Sponsors and Collaborators
Yonsei University
Publications of Results:
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Responsible Party: Yonsei University
ClinicalTrials.gov Identifier: NCT04611438    
Other Study ID Numbers: 4-2020-0120
First Posted: November 2, 2020    Key Record Dates
Last Update Posted: November 2, 2020
Last Verified: October 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by Yonsei University:
cannabidiol
pediatric
Dravet syndrome
Lennox-Gastaut syndrome
Additional relevant MeSH terms:
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Epilepsies, Myoclonic
Lennox Gastaut Syndrome
Syndrome
Disease
Pathologic Processes
Epilepsy, Generalized
Epilepsy
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Epileptic Syndromes
Genetic Diseases, Inborn
Epidiolex
Anticonvulsants