Acetazolamide Efficacy in Ataxia in PMM2-CDG

• ClinicalTrials.gov Identifier: NCT04679389
• Recruitment Status: Active, not recruiting
• First Posted: December 22, 2020
• Last Update Posted: May 16, 2023
• Sponsor: Mayo Clinic
• Collaborators: Seattle Children's Hospital; Children's Hospital of Philadelphia
• Information provided by (Responsible Party): Eva Morava-Kozicz, Mayo Clinic

Study Description

Brief Summary:

Objective 1 (Primary): To determine the efficacy of acetazolamide in improving ataxia in patients with PMM2-CDG.

Objective 2 (Secondary): To evaluate for any adverse events related to longer term acetazolamide administration.

Objective 3 (Secondary): To examine the effect of acetazolamide on PMM2 biomarkers including carbohydrate deficient transferrin results, electrolytes (Na, K, Cl, CO2), VBG (pH, pCO2, PO2, CO2, Base excess), liver function tests (AST, ALT, GGT, indirect and direct bilirubin, total protein, albumin, alkaline phosphatase), kidney function tests (BUN, Creatinine, Urinalysis, urine calcium/creatinine ratio, urine protein/creatinine ratio), growth (height, weight, head circumference), vital signs (blood pressure, respiratory rate, heart rate), PROMIS scores, dysarthria using the PATA score, and NPCRS score.

Objective 4 (Secondary): To explore characteristics of individuals with PMM2-CDG who do not respond to acetazolamide.

Condition or disease	Intervention/treatment	Phase
Pmm2-CDG; CDG1A	Drug: Placebo; Drug: Acetazolamide	Phase 2; Phase 3

Detailed Description:

This study is double-blind, placebo-controlled, 1:1 randomized clinical therapeutic trial of acetazolamide for the treatment of ataxia in patients with PMM2-CDG. Clinical history and screening data will be reviewed to determine subject eligibility. Potential subjects who have a molecularly and/or biochemical confirmed diagnosis of PMM2-CDG will be consented. Baseline data will be collected prior to randomization and at treatment initiation. Subjects who meet all inclusion criteria and none of the exclusion criteria will be enrolled into the study. Each subject who meets all the inclusion and none of the exclusion criteria will then be randomized to placebo or acetazolamide. They will be administered weight-dependent doses of acetazolamide or an equivalent volume of placebo twice daily by mouth. Initial dose of acetazolamide is 8 mg/kg/day if subjects are taking the liquid formulation, or as per Table 1b if they are taking the capsule formulation. If taking the liquid formulation, the dose of study drug will be increased by 7 mg/kg/day to a maximum of 22 mg/kg/day (not to exceed 1000 mg/day) if well tolerated with no treatment related SAEs or abnormal pH. If the pH is <7.32, the dose will be reduced by 7 mg/kg/day. The dose will be adjusted similarly according to Table 1b if taking the capsule formulation. Subjects will be randomized after Visit 1, will initiate blinded therapy within the first week, and will continue on prescribed/adjusted blinded treatment until Visit 4. Of note, the concentration of the liquid formulation and the amount of milligrams of acetazolamide per capsule will stay constant, and the volume or number of capsules will be adjusted based on tolerance as assessed by symptoms and laboratories. If an individual is randomized to the placebo arm, the initial volume will be equivalent to 7 mg/kg/day or the initial number of capsules as per Table 1, and volume or number of capsules will also be adjusted based on symptoms and laboratory values each time dose adjustment is planned. Open label period will then begin after Visit 4 up to Visit 9 (see Figure 1 and Table 3). As both the subject and investigator do not know if the subject received placebo or acetazolamide, the dose of acetazolamide will be started at Visit 4 at 8 mg/kg/day and titrated upwards in the same manner in Visits 5 and 6 (remote) as in Visits 2 and 3 (remote). Subjects will have the option to withdraw from the study any time after Visit 4 if they do not wish to proceed onto or continue with the open label phase.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 26 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Randomized, double blind, placebo controlled, with optional extension period
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Masking Description: Double blind
• Primary Purpose: Treatment
• Official Title: A Randomized, Double-blind, Placebo-controlled Study Evaluating Acetazolamide Efficacy in Ataxia in PMM2-CDG
• Actual Study Start Date: March 17, 2021
• Estimated Primary Completion Date: January 2024
• Estimated Study Completion Date: January 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: Acetazolamide; Acetazolamide administered via capsule or liquid suspension. Capsule would be 250 mg oral capsules encapsulated by gelatin capsule and filled with lactose to match placebo. Liquid suspension would be 25 mg/mL oral suspension but adding 125 mg Acetazolamide tablets to suspending agent Ora-blend	Drug: Acetazolamide; administered orally or enterally; Other Name: Diamox
Placebo Comparator: Placebo; Placebo administered via capsule or liquid suspension. Capsule would be a gelatin capsule filled with lactose powder to match Acetazolamide. Liquid suspension would be Ora-blend.	Drug: Placebo; administered orally or enterally; Other Name: Gelatin, lactose, and Ora-blend

Outcome Measures

Primary Outcome Measures :

1. Efficacy of Acetazolamide on ataxia measured via Miniature International Cooperative Ataxia Rating Scale (mini-ICARS) [ Time Frame: baseline-6 months ]
   To achieve this goal, we will compare the change of Mini-ICARS score from baseline to after six months of treatment between the placebo and active treatment groups. Minimal score is 0, maximum score is 100, higher score indicates greater impairment. Each subscale has an ordinal scale with a 0 indicating normal and the higher score indicating greater impairment or that the patient was unable to complete the task.

Secondary Outcome Measures :

1. Percentage of participants with assessed adverse events of long term acetazolamide administration as seen on blood pH value [ Time Frame: through study completion, an average of three years ]
   Blood pH level will be assessed through venous blood gas test. Percentage of patients treated with Acetazolamide who experience a drug related adverse event related to abnormal blood pH value.
2. Percentage of participants with assessed adverse events of long term acetazolamide administration as seen on electrolyte balance testing [ Time Frame: through study completion, an average of three years ]
   Electrolyte balance will be assessed through combination testing on concentration of potassium, sodium, chloride, bicarbonate, magnesium, calcium, and phosphate. Percentage of patients treated with Acetazolamide who experience a drug related adverse event related to abnormal electrolyte balance.
3. Percentage of participants with assessed adverse events of long term acetazolamide administration as seen on urine calcium excretion testing. [ Time Frame: through study completion, an average of three years ]
   Urine calcium excretion is measured by mg excreted per day. Percentage of patients treated with Acetazolamide who experience a drug related adverse event related to abnormal excretion of calcium.
4. Examine effect of Acetazolamide on PMM2 biomarker carbohydrate deficient transferrin [ Time Frame: baseline and 6 months ]
   Carbohydrate deficient transferrin is reported by ratio. Number of patients with abnormal ratio result will be recorded to understand the effect acetazolamide has on this biomarker
5. Examine effect of Acetazolamide on Patient Reported Outcomes Measuremen Information System (PROMIS) Score [ Time Frame: baseline and 6 months ]
   PROMIS score measures physical activity, strength impact, fatigue, mobility, pain interference, upper extremity coordination, global health, mobility, anxiety, depression, peer relationships, and pain intensity. These are patient reported scores. Higher score means more or the concept being measured (example: high score on Fatigue scale means high level of fatigue).
6. Examine effect of Acetazolamide on dysarthria as measured by the PATA score [ Time Frame: baseline and 6 months ]
   PATA test measures the number of times a patient can say the word "PATA" in a 10 second time period. Number of "PATA"s spoken in 10 seconds indicates level of dysarthria.
7. Examine effect of Acetazolamide on disease progression as measured by the Nijmegen Pediatric CDG Rating Scale (NPCRS) [ Time Frame: baseline and 6 months ]
   The NPCRS is a scale that evaluates the patient's current function, system specific involvement, and current clinical assessment. A mild score is 0-14, moderate score is 15-25, and severe is a score >26.

Eligibility Criteria

• Ages Eligible for Study: 4 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Molecularly and/or enzymatically-confirmed PMM2-CDG,
• Age ≥4 years old, and
• Affected with ataxia evidenced by mini International Cooperative Ataxia Rating Scale (Mini-ICARS) score >0 at baseline.

Exclusion Criteria:

• Hepatic impairment defined as AST/ALT >5x ULN in the last 12 months
• Renal impairment defined as serum creatinine: > 0.5 mg/dL (<6 years); > 0.7 mg/dL (7-10 years); > 1.24 mg/dL (> 11 years)- Hypersensitivity to acetazolamide
• Hypersensitivity to any of the components of the placebo
• History of treatment with experimental drug within 28 days of Visit 1
• Currently taking Mecamylamine, Sodium Phosphates, Salicylates, Mefloquine, Methenamine and other Carbonic Anhydrase Inhibitors

Contacts and Locations

Locations

United States, Minnesota

Mayo Clinic

Rochester, Minnesota, United States, 55905

United States, Pennsylvania

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States, 19104

United States, Washington

Seattle Children's Hospital

Seattle, Washington, United States, 98105

Sponsors and Collaborators

Mayo Clinic

Seattle Children's Hospital

Children's Hospital of Philadelphia

Investigators

• Principal Investigator: Eva Morava-Kozicz, MD, PhD; Mayo Clinic

More Information

Additional Information:

Mayo Clinic Clinical Trials 

• Responsible Party: Eva Morava-Kozicz, Principal Investigator, Mayo Clinic
• ClinicalTrials.gov Identifier: NCT04679389
• Other Study ID Numbers: 20-000634
• First Posted: December 22, 2020
• Last Update Posted: May 16, 2023
• Last Verified: May 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No
• Plan Description: De-identified data may be shared amongst member of the consortium FCDGC and with the NIH.

• 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:

Congenital Disorders of Glycosylation; Carbohydrate Metabolism, Inborn Errors; Metabolism, Inborn Errors; Genetic Diseases, Inborn; Metabolic Diseases; Acetazolamide; Anticonvulsants; Carbonic Anhydrase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Diuretics; Natriuretic Agents; Physiological Effects of Drugs