Phase 2 Study of Triheptanoin (UX007) for the Treatment of Glucose Transporter Type 1 Deficiency Syndrome (Glut1 DS)

• ClinicalTrials.gov Identifier: NCT01993186
• Recruitment Status: Completed
• First Posted: November 25, 2013
• Results First Posted: May 29, 2020
• Last Update Posted: June 19, 2020
• Sponsor: Ultragenyx Pharmaceutical Inc
• Information provided by (Responsible Party): Ultragenyx Pharmaceutical Inc

Tracking Information

• First Submitted Date: October 31, 2013
• First Posted Date: November 25, 2013
• Results First Submitted Date: May 12, 2020
• Results First Posted Date: May 29, 2020
• Last Update Posted Date: June 19, 2020
• Actual Study Start Date: February 28, 2014
• Actual Primary Completion Date: September 20, 2017 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: June 8, 2020)

• Percent Reduction From Baseline to Week 8 in Frequency of Total Seizures (Normalized to a 4-Week Rate) [ Time Frame: Baseline, Week 8 ]
  Reduction from baseline to Week 8 in frequency of seizures (normalized to a 4-week rate): observable seizures measured for 6 weeks after 2-week titration by diary and absence seizures measured overnight by EEG. Observable seizures from the diary include generalized tonic-clonic, generalized tonic, generalized clonic, generalized atonic, partial/focal with secondary generalization, myoclonic, myoclonic (astatic) atonic, myoclonic tonic, complex partial/focal, simple partial/focal motor, simple partial/focal sensory, and simple partial/focal psychological. Absence seizures from EEG include absence awake (>=10 sec), absence sleep (>=10 sec), indeterminate absence awake (3-10 sec), and indeterminate absence sleep (3-10 sec). A negative value indicates an increase in frequency.
• Number of Participants With Treatment-Emergent Adverse Events (TEAEs), Serious TEAEs and Discontinuations Due to TEAEs During the Placebo-Controlled Period [ Time Frame: Weeks 0 to 8 ]
  An adverse event (AE) was defined as any untoward medical occurrence, whether or not considered drug related. A serious AE was defined as an AE or suspected adverse reaction that at any dose resulted in any of the following outcomes: death, a life-threatening AE, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, a congenital anomaly/birth defect, or an important medical event that may have jeopardized the subject and may have required medical or surgical intervention to prevent one of the outcomes listed in the definition. An AE was considered a TEAE if it occurred or worsened in severity on or after the date of the first dose of study drug. An AE was considered a UX007 emergent adverse event if it occurred or worsened in severity on or after the first date of first dose of UX007 during the study.
• Number of Participants With TEAEs, Serious TEAEs and Discontinuations Due to TEAEs During the Extension Period [ Time Frame: Weeks 9 to 52 plus 30 days ]
  An AE was defined as any untoward medical occurrence, whether or not considered drug related. A serious AE was defined as an AE or suspected adverse reaction that at any dose resulted in any of the following outcomes: death, a life-threatening AE, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions, a congenital anomaly/birth defect, or an important medical event that may have jeopardized the subject and may have required medical or surgical intervention to prevent one of the outcomes listed in the definition. An AE was considered a TEAE if it occurred or worsened in severity on or after the date of the first dose of study drug. An AE was considered a UX007 emergent adverse event if it occurred or worsened in severity on or after the first date of first dose of UX007 during the study.

Original Primary Outcome Measures (submitted: November 18, 2013)

• Evaluate the efficacy of UX007 compared to placebo, between Weeks 2 and 8 of treatment, as measured by the reduction from baseline in frequency of generalized or partial-onset seizures [ Time Frame: 52 weeks ]
• Evaluate the safety of UX007 via adverse event (AE) rates, laboratory values, and electrocardiogram (ECG) [ Time Frame: 52 weeks ]

Current Secondary Outcome Measures (submitted: June 8, 2020)

• Percent Reduction From Baseline to Week 8 in Frequency of Observable Seizures (Normalized to a 4-Week Rate) [ Time Frame: Baseline, Week 8 ]
  Reduction from baseline to Week 8 in frequency of seizures (normalized to a 4-week rate): observable seizures measured for 6 weeks after 2-week titration by diary. Observable seizures from the diary include generalized tonic-clonic, generalized tonic, generalized clonic, generalized atonic, partial/focal with secondary generalization, myoclonic, myoclonic (astatic) atonic, myoclonic tonic, complex partial/focal, simple partial/focal motor, simple partial/focal sensory, and simple partial/focal psychological. A negative value indicates an increase in frequency.
• Percent Reduction From Baseline to Week 8 in Frequency of Absence Seizures (Normalized to a 4-Week Rate) [ Time Frame: Baseline, Week 8 ]
  Reduction from baseline to Week 8 in frequency of absence seizures measured overnight by EEG. Absence seizures from EEG include absence awake (>=10 sec), absence sleep (>=10 sec), indeterminate absence awake (3-10 sec), and indeterminate absence sleep (3-10 sec). A negative value indicates an increase in frequency.
• Percentage of Participants With at Least a 50% Reduction From Baseline to Week 8 in Frequency of Total Seizures [ Time Frame: Baseline, Week 8 ]
  Seizure response, defined as the percentage of participants with at least 50% reduction from randomization to Week 8 in frequency of total seizures. Includes observable generalized and partial-onset seizures measured for 6 weeks by diary and absence seizures measured overnight by EEG. Observable seizures from the diary include generalized tonic-clonic, generalized tonic, generalized clonic, generalized atonic, partial/focal with secondary generalization, myoclonic, myoclonic (astatic) atonic, myoclonic tonic, complex partial/focal, simple partial/focal motor, simple partial/focal sensory, and simple partial/focal psychological. Absence seizures from EEG include absence awake (>=10 sec), absence sleep (>=10 sec), indeterminate absence awake (3-10 sec), and indeterminate absence sleep (3-10 sec).
• Percentage of Participants With at Least 50% Reduction From Baseline to Week 8 in Frequency of Observable Seizures [ Time Frame: Baseline, Week 8 ]
  Observable seizure response, defined as the percentage of participants with at least 50% reduction from randomization to Week 8 in frequency of observable seizures. Observable seizures from the diary include generalized tonic-clonic, generalized tonic, generalized clonic, generalized atonic, partial/focal with secondary generalization, myoclonic, myoclonic (astatic) atonic, myoclonic tonic, complex partial/focal, simple partial/focal motor, simple partial/focal sensory, and simple partial/focal psychological.
• Percentage of Participants With at Least 50% Reduction From Baseline to Week 8 in Frequency of Absence Seizures [ Time Frame: Baseline, Week 8 ]
  Absence seizure response, defined as the percentage of participants with at least 50% reduction from randomization to Week 8 in frequency of absence seizures. Absence seizures from EEG include absence awake (>=10 sec), absence sleep (>=10 sec), indeterminate absence awake (3-10 sec), and indeterminate absence sleep (3-10 sec).
• Change From Baseline to Week 8 in Cambridge Neuropsychological Test Automated Battery (CANTAB), Reaction Time (RTI) Scores, Generalized Estimating Equation (GEE) [ Time Frame: Baseline, Week 8 ]
  CANTAB measures neuropsychological function using a standardized, computerized battery of tests designed to assess visual memory, working memory, new learning and reaction time. RTI Simple choice reaction time standard deviation (RTISRTSD) assesses the cognitive domain of attention, with scores on a continuous range from 0 to 5000; lower scores indicate better function. RTI median simple choice reaction time (RTIMDSRT) assesses the cognitive domain of reaction time, with scores on a continuous range from 100 to 5100; lower scores indicate better function. RTI median 5-choice reaction time (RTIMDFRT) assesses the cognitive domain of reaction time, with scores on a continuous range from 100 to 5100; lower scores indicate better function. GEE statistical model.
• Change From Baseline to Week 8 in CANTAB, Paired Associates Learning (PAL) Scores, GEE [ Time Frame: Baseline, Week 8 ]
  CANTAB measures neuropsychological function using a standardized, computerized battery of tests designed to assess visual memory, working memory, new learning and reaction time. PAL total errors adjusted (PALTEA) assesses the cognitive domain of episodic memory/new learning, with scores on a discrete, ordinal scale from 0 to 137; lower scores indicate better function. PAL first trial memory score (PALFTMS) assesses the cognitive domain of episodic memory, with scores on a discrete, ordinal scale from 0 to 27; higher scores indicate better function. GEE statistical model.
• Change From Baseline to Week 8 in CANTAB, Spatial Span (SSP) Span Length Scores, GEE [ Time Frame: Baseline, Week 8 ]
  CANTAB measures neuropsychological function using a standardized, computerized battery of tests designed to assess visual memory, working memory, new learning and reaction time. SSP Span Length (SSPSLF) assesses the cognitive domain of sequential memory, with scores on a discrete, ordinal scale from 2 to 9; higher scores indicate better function. GEE statistical model.
• Change From Baseline to Week 8 in CANTAB, Spatial Working Memory (SWM) Scores, GEE [ Time Frame: Baseline, Week 8 ]
  CANTAB measures neuropsychological function using a standardized, computerized battery of tests designed to assess visual memory, working memory, new learning and reaction time. SWM between errors (SWMBE48) assesses the cognitive domain of working memory, with scores on a discrete, ordinal scale from 0 to 360; lower scores indicate better function. SWM strategy (SWMS68) assesses the cognitive domain of executive function/strategy, with scores on a discrete, ordinal scale from 4 to 28; lower scores indicate better function. GEE statistical model.
• Change From Baseline to Week 8 in Distance Traveled (in Meters) as Measured by 6-Minute Walk Test (6MWT) [ Time Frame: Baseline, Week 8 ]
  Participants were instructed to walk the length of a pre-measured 20-30 meter course in a hallway for 6 consecutive minutes. The total distance walked (meters) in a 6 minute period was recorded.
• Change From Baseline to Week 8 in Distance Traveled (in Percent Predicted) as Measured by 6MWT [ Time Frame: Baseline, Week 8 ]
  Participants were instructed to walk the length of a pre-measured 20-30 meter course in a hallway for 6 consecutive minutes. The total distance walked (meters) in a 6 minute period was recorded. The percent of predicted normal distance walked was determined based on published normative data.
• Time (in Minutes) to Onset of Paroxysmal Exertional Dyskinesia (PED) as Measured During 6MWT Over Time Through Week 8 [ Time Frame: Baseline, Week 4, Week 8 ]
  For the 6MWT, subjects were instructed to walk the length of a pre-measured 20-30 meter course in a hallway for 6 consecutive minutes. The total distance walked (meters) in a 6 minute period was recorded. PED occurring during the 6MWT was assessed. (PED is characterized by transient abnormal, involuntary movements primarily affecting the legs and feet, and typically precipitated by prolonged exertion.)
• Change From Baseline to Week 8 in Gross Motor Function Measure-88 (GMFM-88) Total Score [ Time Frame: Baseline, Week 8 ]
  The GMFM-88 is a standardized observational measure of abilities that includes the following 5 domains: lying/rolling, sitting, crawling/kneeling, standing, and walking/running/jumping. The GMFM-88 scores include the following:

  • Lying & Rolling Score, Range 0-100%, higher is better
  • Sitting Score, Range 0-100%, higher is better
  • Crawling & Kneeling Score, Range 0-100%, higher is better
  • Standing Score, Range 0-100%, higher is better
  • Walking, Running & Jumping Score, Range 0-100%, higher is better
  • Total Score = (Sum of 5 Above Scores) / 5, Range 0-100%, higher is better.
• Percent Reduction From Baseline Over Time in Frequency of Total Seizures (Normalized to a 4-Week Rate) [ Time Frame: Baseline, Week 26, Week 31 ]
  Reduction from baseline over time in frequency of seizures (normalized to a 4-week rate): observable seizures measured for 6 weeks after 2-week titration by diary and absence seizures measured overnight by EEG. Observable seizures from the diary include generalized tonic-clonic, generalized tonic, generalized clonic, generalized atonic, partial/focal with secondary generalization, myoclonic, myoclonic (astatic) atonic, myoclonic tonic, complex partial/focal, simple partial/focal motor, simple partial/focal sensory, and simple partial/focal psychological. Absence seizures from EEG include absence awake (>=10 sec), absence sleep (>=10 sec), indeterminate absence awake (3-10 sec), and indeterminate absence sleep (3-10 sec). A negative value indicates an increase in frequency.
• Percent Reduction From Baseline Over Time in Frequency of Observable Seizures (Normalized to a 4-Week Rate) [ Time Frame: Baseline, Week 26, Week 31, Week 36, Week 52 ]
  Reduction from baseline over time in frequency of seizures (normalized to a 4-week rate): observable seizures measured for 6 weeks after 2-week titration by diary. Observable seizures from the diary include generalized tonic-clonic, generalized tonic, generalized clonic, generalized atonic, partial/focal with secondary generalization, myoclonic, myoclonic (astatic) atonic, myoclonic tonic, complex partial/focal, simple partial/focal motor, simple partial/focal sensory, and simple partial/focal psychological. A negative value indicates an increase in frequency.
• Percent Reduction From Baseline Over Time in Frequency of Absence Seizures (Normalized to a 4-week Rate) [ Time Frame: Baseline, Week 26, Week 31 ]
  Reduction from baseline to Week 8 in frequency of absence seizures measured overnight by EEG. Absence seizures from EEG include absence awake (>=10 sec), absence sleep (>=10 sec), indeterminate absence awake (3-10 sec), and indeterminate absence sleep (3-10 sec). A negative value indicates an increase in frequency.

Original Secondary Outcome Measures (submitted: November 18, 2013)

• Seizure response rate, defined as the percentage of subjects with at least 50% reduction from baseline in generalized or partial-onset seizures [ Time Frame: 52 weeks ]
• Change from baseline in frequency of seizure activity as measured by electroencephalography (EEG) abnormalities [ Time Frame: 52 weeks ]
• Change from baseline in cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB) [ Time Frame: 52 weeks ]
• Change from baseline in distance walked as measured by 6 Minute Walk Test (6MWT) [ Time Frame: 52 weeks ]
• Time to onset of paroxysmal exertional dyskinesia (PED) as measured during 6 minute walk test (6MWT) [ Time Frame: 52 weeks ]
• Change from baseline in gross motor function using the Gross Motor Function Measure-88 (GMFM-88) [ Time Frame: 52 weeks ]

• Current Other Pre-specified Outcome Measures: Not Provided

Original Other Pre-specified Outcome Measures (submitted: November 18, 2013)

• Change from baseline in neurological function using the Columbia Neurological Score (CNS) [ Time Frame: 52 weeks ]
• Change from baseline in physician global impression of change in clinical status using the Clinical Global Impression - Severity scale (CGI-S) and Clinical Global Impression - Improvement scale (CGI-I) [ Time Frame: 52 weeks ]
• Change from baseline in receptive vocabulary using the Peabody Picture Vocabulary Test (PPVT) [ Time Frame: 52 weeks ]
• Change from baseline in patient or caregiver-reported quality of life using Short Form-10™ (SF-10) Health Survey for Children [ Time Frame: 52 weeks ]
• Change from baseline in functional disability by caregiver report using the Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) [ Time Frame: 52 weeks ]
• Change from baseline in gait, using gait analysis by computerized mat [ Time Frame: 52 weeks ]
• Pharmacokinetics (PK) properties of UX007 Plasma Peak [ Time Frame: 52 weeks ]
  PK blood draws will be collected at screening, randomization and weeks 8, 26 and 52 (or early termination) and analyzed by a central lab. AUC and Cmax will be measured and descriptive statistics will be calculated for the plasma UX007 concentrations.
• Pharmacokinetics (PK) properties of UX007 Metabolites [ Time Frame: 52 weeks ]
  PK blood draws will be collected at screening, randomization, weeks 8, 26, 52 (or early termination) and analyzed by a central lab. AUC and Cmax will be measured and descriptive statistics will be calculated for the Plasma levels of UX007 metabolites: C4 ketone (BHB), C5 ketones (beta-hydroxypentanoate [BHP] and beta-ketopentanoate [BKP]), and heptanoate.

Descriptive Information

• Brief Title: Phase 2 Study of Triheptanoin (UX007) for the Treatment of Glucose Transporter Type 1 Deficiency Syndrome (Glut1 DS)
• Official Title: A Randomized, Double-blind, Placebo-controlled, Parallel-group, Study to Assess the Safety and Efficacy of UX007 in Subjects With Glucose Transporter Type 1 Deficiency Syndrome
• Brief Summary: The primary objectives of the study are to evaluate the efficacy of UX007 compared to placebo as measured by the reduction from randomization to Week 8 in frequency of seizures and to evaluate the safety of UX007 via adverse event (AE) rates, laboratory values, and electrocardiogram (ECG).
• Detailed Description: Not Provided
• Study Type: Interventional
• Study Phase: Phase 2
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor); Primary Purpose: Treatment
• Condition: Glucose Transporter Type 1 Deficiency Syndrome (Glut1 DS)

Intervention

• Drug: UX007
  oral liquid
  Other Names:

  • C7 oil
  • triheptanoin
  • glycerol triheptanoate
  • glycerol trienanthate
  • 1, 2, 3-trienanthoylglycerol
  • trienanthin
  • 2,3-di(heptanoyloxy)propyl heptanoate
• Drug: Placebo
  oral liquid

Study Arms

• Experimental: UX007

  Participants randomized to receive UX007 enter a 2-week dose titration period to achieve study drug treatment comprising up to 35% of total daily calories or to the maximum tolerated dose level and maintained at the 35% total daily calorie dose level for a 6-week treatment period.

  Following completion of the Week 8 study visit, participants continue treatment with open-label UX007 at the 35% dose level for an additional 44 weeks (Weeks 8-52).

  Intervention: Drug: UX007
• Placebo Comparator: Placebo

  Participants randomized to receive placebo enter a 2-week dose titration period to achieve study drug treatment comprising up to 35% of total daily calories or to the maximum tolerated dose level and maintained at the 35% total daily calorie dose level for a 6-week treatment period.

  Following completion of the Week 8 study visit, placebo participants continue treatment with open-label UX007 at the 35% dose level for an additional 44 weeks (Weeks 8-52).

  Intervention: Drug: Placebo

• Publications *: Striano P, Auvin S, Collins A, Horvath R, Scheffer IE, Tzadok M, Miller I, Kay Koenig M, Lacy A, Davis R, Garcia-Cazorla A, Saneto RP, Brandabur M, Blair S, Koutsoukos T, De Vivo D. A randomized, double-blind trial of triheptanoin for drug-resistant epilepsy in glucose transporter 1 deficiency syndrome. Epilepsia. 2022 Jul;63(7):1748-1760. doi: 10.1111/epi.17263. Epub 2022 May 21.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: October 31, 2017): 36
• Original Estimated Enrollment (submitted: November 18, 2013): 50
• Actual Study Completion Date: September 20, 2017
• Actual Primary Completion Date: September 20, 2017 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

1. Diagnosis of Glut1 DS confirmed by SLC2A1 mutation
2. Males and females at least 1 of age at the time of informed consent
3. Average of at least 2 observable seizures (generalized or partial-onset [simple partial motor, complex partial, absence, or secondarily generalized seizures) in 4 weeks over the last 24 weeks, by subject or caregiver report
4. At least 2 observable seizures (generalized or partial-onset [simple partial motor, complex partial, or secondarily generalized seizures) in 4 weeks during the Baseline Period, with no 3-week seizure-free period during the Baseline Period OR absence seizures documented on Screening electroencephalogram (EEG)
5. Continuing to have seizures despite a prior or current use of at least 1 antiepileptic drug (AED)
6. Allowed to be on up to 3 concomitant AEDs that must have been stable in dose at least 2 weeks prior to the beginning of screening and anticipated to remain stable in dose through the end of the 8-week, placebo-controlled Treatment Period
7. Not on, or not fully compliant with a prescribed diet plan (e.g. KD)
8. Plasma level of beta-hydroxybutyrate (BHB) ≤ 1 mmol/L (non-fasting) at Screening
9. Provide written or verbal assent (if possible) and written informed consent by a legally authorized representative after the nature of the study has been explained, and prior to any research-related procedures
10. Must, in the opinion of the investigator, be willing and able to complete all aspects of the study, comply with accurate completion of the seizures diary, and likely to complete the 8 week, placebo-controlled, Treatment Period
11. Females of childbearing potential must have a negative pregnancy test at Screening, be willing to use an acceptable method of contraception, and have additional pregnancy tests during the study. Females considered not of childbearing potential include those who have not reached menarche, had total hysterectomy, have been in menopause for at least two years, or have had tubal ligation at least one year prior to Screening.

Exclusion Criteria:

1. Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels exceeding 3 times the upper limit of normal at Screening
2. Any known hypersensitivity to triheptanoin or safflower oil that, in the judgment of the investigator, places the subject at increased risk for adverse effects
3. Prior use of triheptanoin within 30 days prior to Screening
4. History of, or current suicidal ideation, behavior and/or attempts
5. Pregnant and/or breastfeeding an infant at Screening
6. Participants unwilling or unable to discontinue use of a prohibited medication or other substance that may confound study objectives
7. Use of any investigational product (drug or supplement, including medium chain triglyceride [MCT] oil) within 30 days prior to Screening, or at any time during the study
8. Has a condition of such severity and acuity, in the opinion of the investigator, that it warrants immediate surgical intervention or other treatment
9. Has a concurrent disease or condition, or laboratory abnormality that, in the view of the investigator, places the subject at high risk of poor treatment compliance or of not completing the study, or would interfere with study participation or introduces additional safety concerns (e.g., diabetes mellitus, other concurrent neurological or psychiatric disorders)

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 1 Year to 100 Years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Australia, France, Israel, Italy, Spain, United Kingdom, United States
• Removed Location Countries: Hungary

Administrative Information

• NCT Number: NCT01993186
• Other Study ID Numbers: UX007G-CL201
• Has Data Monitoring Committee: Yes
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Current Responsible Party: Ultragenyx Pharmaceutical Inc
• Original Responsible Party: Same as current
• Current Study Sponsor: Ultragenyx Pharmaceutical Inc
• Original Study Sponsor: Same as current
• Collaborators: Not Provided

Investigators

• Study Director: Medical Director; Ultragenyx Pharmaceutical Inc

• PRS Account: Ultragenyx Pharmaceutical Inc
• Verification Date: June 2020