E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Epilepsy :
1) Partial-Onset Seizures (POS)
2) Primary Generalized Tonic-Clonic Seizures (PGTC) |
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E.1.1.1 | Medical condition in easily understood language |
1) Fits that affect one part of your brain called a “partial seizure”
2) Certain fits that affect all of your brain from the start called “generalised seizures" and cause convulsions/staring spells |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | HLT |
E.1.2 | Classification code | 10018101 |
E.1.2 | Term | Generalised tonic-clonic seizures |
E.1.2 | System Organ Class | 100000004852 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the safety and tolerability of perampanel oral suspension when administered as an adjunctive therapy in children (ages 4 to <12 years) with inadequately controlled POS or PGTC |
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E.2.2 | Secondary objectives of the trial |
To characterize PK of perampanel and relationship between perampanel plasma concentrations, efficacy and safety using population PK/PD modeling; evaluate effects of perampanel on cognition, behavior, visuomotor skills and growth & development in children during short-term (23 weeks) & long-term (up to 52 weeks) treatment; evaluate frequency of EEG abnormalities during awake & sleep state during 52 weeks of treatment; evaluate suicidal ideation and behavior in children 6 to <12 years as measured by C-SSRS during 52 weeks of treatment; evaluate efficacy of perampanel as measured by median percent change per 28 days in seizure frequency by proportion of responders (>=25%, >=50% and >=75%) and by proportion of subjects who are seizure-free for POS, PGTC, & GTC seizures; evaluate, in Japanese subjects, efficacy of perampanel on POS in this study compared to Placebo in Study E2007-J000-335; assess effects of perampanel on Clinical Global Impression (CGI), as measured by CGI of change (CGIC) |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Have a diagnosis of epilepsy with POS with or without secondarily generalized seizures or PGTC according to the International League Against Epilepsy’s (ILAE) Classification of Epileptic Seizures (1981). Diagnosis should have been established at least 6 months prior to Visit 1 by clinical history and an electroencephalography (EEG) that is consistent with the diagnosis; normal interictal EEGs will be allowed provided that the subject meets the other diagnosis criterion (ie, clinical history)
2. Male or female subject, from age 4 to <12 years at the time of informed consent/assent.
3. Have a minimum weight of 16 kilogram (kg) (35 pound [lb])
4. Have had a brain imaging (e.g., magnetic resonance imaging [MRI) scan or computed tomography [CT]) before Visit 1 that ruled out a progressive cause of epilepsy
5. During the 12 weeks +-3 days (4 weeks +-3 days in Japan only) before Visit 2, subjects must have had equal or greater than (>=) 1 POS or 1 PGTC seizure. Only simple POS with motor signs, complex POS, and complex POS with secondary generalization are counted toward this inclusion for POS
6. Are currently being treated with stable doses of 1 to a maximum of 3 approved antiepileptic drug (AEDs) Doses must be stable for at least 4 weeks before Visit 1; in the case where a new AED regimen has been initiated for a subject, the dose must be stable for at least 8 weeks prior to Visit 1. Only 1 enzyme inducing antiepileptic drug (EIAED) (defined as carbamazepine, phenytoin, oxcarbazepine, or eslicarbazepine) out of the maximum of 3 AEDs is allowed (A vagal nerve stimulator [VNS] will be counted as one of the 3 allowed AEDs) |
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E.4 | Principal exclusion criteria |
1. Females who are breastfeeding/pregnant at Screening/Baseline. A separate baseline assessment required if a negative screening pregnancy test was obtained >72 hours before 1st dose of study drug
2. Females of childbearing potential who:
o Had unprotected sexual intercourse within 30 days before study entry & who do not agree to use a highly effective method of contraception in the study period or for 28 days after study drug discontinuation. If a highly effective method is not appropriate or acceptable for subject, then subject may use a medically effective method.
o Are currently abstinent, and do not agree to use a double-barrier method or refrain from sexually active during study period or for 28 days after study drug discontinuation
o Are using hormonal contraceptives but are not on a stable dose of the same hormonal contraceptive product for at least 4 weeks before dosing & who do not agree to use same contraceptive during the study or for 28 days after study drug discontinuation
3. Current or history of pseudo-seizures within approximately 5 years before Visit 1
4. History of status epilepticus that required hospitalization during 6 months before Visit 1
5. Have an unstable psychiatric diagnosis that may confound subjects’ ability to participate in the study or that may prevent completion of the protocol specified tests
6. Any suicidal ideation with intent with or without a plan within 6 months before Visit 2 in subjects >= 6 years
7. Are scheduled and/or confirmed to have epilepsy surgery within 6 months after Visit 1; however, those who have previously documented “failed” epilepsy surgery will be allowed
8. Evidence of clinically significant disease (e.g. cardiac, respiratory, gastrointestinal, renal disease) that in opinion of the investigators could affect subject’s safety or interfere with the study assessments
9. Evidence of moderate or severe renal insufficiency
10. Evidence of significant active hepatic disease. Stable elevation of liver enzymes, ALT and AST due to concomitant medication(s), will be allowed if they are less than 3 times the ULN
11. Evidence of significant active hematological disease
12. Clinically significant ECG abnormality, including prolonged corrected QT interval
13. Have a progressive central nervous system disease, including degenerative CNS diseases and progressive tumors
14. Multiple drug allergies or a severe drug reaction to an AED, including dermatological, hematological,or organ toxicity
15. Concomitant use of felbamate as an AED for <2 years or where the dose has not been stable for at least 8 weeks before Visit 1. If subjects received felbamate in past, it must have been discontinued 8 weeks before Visit 1
16. Concomitant use of vigabatrin: Subjects who took vigabatrin in past must be off vigabatrin for at least 5 months before Visit 1 & with documentation showing no evidence of a vigabatrin associated clinically significant abnormality in a visual perimetry test
17. Concomitant use of cannabinoids
18. Used benzodiazepines for epilepsy during which dose has not been stable for >4 weeks prior to Visit 1 Benzodiazepines use as rescue medication for seizure control is allowed; however, intermittent use of benzodiazepines for any other indication is prohibited
19. A VNS implanted <5 months before Visit 1 or changes in parameter <4 weeks before Visit 1 (or thereafter during study)
20. On a ketogenic diet for which diet is not stable regimen for at least 4 weeks before Visit 1
21. History of or a concomitant medical condition that in opinion of investigator(s) would preclude subject's participation in a clinical study or compromise the subject's ability to safely complete study
22. Have previously been exposed to perampanel in a clinical trial or by prescription for >2 months or discontinued for AEs
23. Have participated in a study involving administration of an investigational drug or device within 4 weeks before Visit 1, or within approximately 5 half-lives of the previous investigational compound, whichever is longer
24. With rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption |
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E.5 End points |
E.5.1 | Primary end point(s) |
Safety and tolerability, which include incidence of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs), laboratory parameters, vital signs, and electrocardiogram (ECG) parameters, of perampanel oral suspension in children (ages 4 to <7 years and >=7 years to <12 years) with POS or PGTC.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
At the end of the core phase and the extension phase |
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E.5.2 | Secondary end point(s) |
1. The relationship between plasma levels of perampanel and efficacy endpoints (that is, change in average seizure frequency over 28 days, responder probability, and the proportion of subjects who are seizure-free in the Maintenance Period of the Core Study) separately for each seizure type
2. The relationship between plasma levels of perampanel and cognition endpoints including change from baseline in A-B neuropsycological assessment schedule (ABNAS), Child Behavior Checklist (CBCL), and Lafayette Grooved Pegboard Test (LGPT). In addition, depending on the AE data, the relationship between plasma levels of perampanel and select AEs will be assessed
3. Change from baseline at Week 23 and Week 52 in ABNAS, CBCL, and LGPT
4. Changes from baseline at Week 23 and Week 52 in growth and development parameters (height, weight, thyroid, and insulin like growth factor-1 [IGF-1])
5. Change from baseline in Electroencephalography (EEG) and the frequency of EEG abnormalities during awake and sleep state
6. Proportion of subjects (aged 6 or older at time of consent/assent) with any treatment-emergent reports of suicidal ideation and behavior on the C-SSRS and intensity of these behaviors assessed using C-SSRS scores
7. The median percent change in seizure frequency per 28 days during Treatment Phase (Titration Period and Maintenance Period) of the Core Study, and during the long-term treatment (up to 52 weeks) relative to the Pretreatment Phase. Seizure frequency will be based on the number of seizures per 28 days, calculated as the number of seizures over the entire time interval divided by the number of days in the interval and multiplied by 28
8. Proportion of responders (25 percent [%] responders defined as a decrease in 28-day seizure frequency of equal or >25% compared to baseline seizure frequency; 50% responders defined as a decrease in 28-day seizure frequency of >=50% compared to baseline seizure frequency; 75% responders defined as a decrease in 28-day seizure frequency of >=75% compared to baseline seizure frequency) during Maintenance Period of Core Study, and during the long term treatment (up to 52 weeks)
9. Proportion of subjects who are seizure-free during Maintenance Period of Core Study, and during the long term treatment (up to 52 weeks)
10. CGI of change |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
At the end of the core phase and the extension phase |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | No |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Exposure-Efficacy relationship |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
Will this trial be conducted at a single site globally?
| No |
E.8.4 | Will this trial be conducted at multiple sites globally? | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |
Canada |
Japan |
Korea, Republic of |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Last visit of the last subject (LVLS) |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 8 |