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    Clinical Trial Results:
    A Phase 2, Fixed-Sequence, Open-Label, Switch-Over Study of the Safety and Tolerability of HPN-100 Compared to Sodium Phenylbutyrate in Children 6-17 Years of Age with Urea Cycle Disorders, with a Long-Term Safety Extension

    Summary
    EudraCT number
    2014-003247-36
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    27 Jul 2011

    Results information
    Results version number
    v1(current)
    This version publication date
    10 Jun 2016
    First version publication date
    10 Jun 2016
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    HPN-100-005
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00947544
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Horizon Therapeutics Inc.
    Sponsor organisation address
    150 S. Saunders Road, Lake Forest , United States, 60045
    Public contact
    Elizabeth Robinson, Horizon Therapeutics Inc., clinicaltrials@horizonpharma.com
    Scientific contact
    Tom Vescio, MD, Horizon Therapeutics Inc., clinicaltrials@horizonpharma.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-000297-PIP02-12
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    27 Jul 2011
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Jul 2011
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Protocol HPN-100-005 was the first study of HPN-100 in pediatric subjects with urea cycle disorders (UCDs) and was a fixed-sequence, open-label, switch over study of HPN-100 with a long-term (12 month) safety extension designed to assess the safety of HPN-100 and to prospectively assess its ability to control blood ammonia as compared with Sodium Phenylbutyrate (NaPBA). Upon DSMB review of the first ten subjects who completed the switch over part of the study, and with DSMB approval, up to an additional 20 subjects were enrolled into the safety extension part of the study. HPN-100 is a triglyceride that has a similar mechanism of action as NaPBA. It is a liquid with minimal taste and odor. Three teaspoons of HPN-100 (~17.4mL) delivers an equivalent amount of PBA to 40 tablets of NaPBA.
    Protection of trial subjects
    The protocol and consent/assent forms were submitted by each investigator to a Independent Ethics Committee (IEC) or Institutional Review Board (IRB) for review and approval before study initiation. The study was conducted in accordance with legal and regulatory requirements including Guidance for Good Clinical Practice (International Conference on Harmonization [ICH] 1996), and the Declaration of Helsinki (World Medical Association 2008). Only participants who met the inclusion criteria and none of the exclusion criteria were enrolled to this study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Mar 2010
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Canada: 1
    Country: Number of subjects enrolled
    United States: 16
    Worldwide total number of subjects
    17
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    11
    Adolescents (12-17 years)
    6
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    The study was to assess if HPN-100 could control blood ammonia compared with NaPBA. Subjects received NaPBA three times daily with meals during the first week and the same PBA mole equivalent dose of HPN-100 during the second week. Participants entered the safety extension part of the study and continued receiving open-label HPN-100 for 12 months.

    Period 1
    Period 1 title
    Safety-Extension Period (12 months) (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Switch Over and Safety Extension
    Arm description
    After the switch over, participants entered the safety extension part of the study and continued receiving open-label HPN-100 for up to 12 months.
    Arm type
    Experimental

    Investigational medicinal product name
    Glycerol phenylbutyrate
    Investigational medicinal product code
    HPN-100
    Other name
    GT4P, Glyceryl tri-(4-phenylbutyrate)
    Pharmaceutical forms
    Oral liquid
    Routes of administration
    Oral use
    Dosage and administration details
    g/mL gram(s) millitre 3 teaspoons of HPN-100 (approximately 17.4mL). For subjects who completed the switch-over phase, the starting dose in the safety extension was the same HPN-100 dose that was received while in the switch-over phase. For new subjects, the starting dose was the HPN-100 equivalent dose calculated from the subject's NaPBA dose: NaPBA dose (g) x 0.95/1.1 = total daily HPN-100 dose (mL).

    Arm title
    Safety Extension Only
    Arm description
    Subjects entered the safety extension part of the study only, and received open-label HPN-100 for up to 12 months.
    Arm type
    Experimental

    Investigational medicinal product name
    Glycerol Phenylbutyrate
    Investigational medicinal product code
    HPN-100
    Other name
    GT4P, Glyceryl tri-(4-phenylbutyrate)
    Pharmaceutical forms
    Oral liquid
    Routes of administration
    Other use
    Dosage and administration details
    g/mL gram(s) millitre 3 teaspoons of HPN-100 (approximately 17.4mL) Subjects dosed three times daily with meals. Subjects received open-label HPN-100 for up to 12 months.

    Number of subjects in period 1
    Switch Over and Safety Extension Safety Extension Only
    Started
    11
    6
    Completed
    10
    6
    Not completed
    1
    0
         Consent withdrawn by subject
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Safety-Extension Period (12 months)
    Reporting group description
    -

    Reporting group values
    Safety-Extension Period (12 months) Total
    Number of subjects
    17 17
    Age Categorical
    Units: participants
        <=18 years
    17 17
        Between 18 and 65 years
    0 0
        >=65 years
    0 0
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    10 ( 3.482 ) -
    Gender, Male/Female
    Units: participants
        Female
    14 14
        Male
    3 3
    Region of Enrollment
    Units: Subjects
        United States
    16 16
        Canada
    1 1

    End points

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    End points reporting groups
    Reporting group title
    Switch Over and Safety Extension
    Reporting group description
    After the switch over, participants entered the safety extension part of the study and continued receiving open-label HPN-100 for up to 12 months.

    Reporting group title
    Safety Extension Only
    Reporting group description
    Subjects entered the safety extension part of the study only, and received open-label HPN-100 for up to 12 months.

    Subject analysis set title
    Safety Extension (HPN-100)
    Subject analysis set type
    Full analysis
    Subject analysis set description
    There were 11 subjects who completed the switch over part of the study and 6 new subjects were enrolled in the safety extension part of the study due to DSMB approval.

    Subject analysis set title
    HPN-100
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Patients treated with HPN-100 who completed SF-15 at baseline and Month 12

    Primary: Rate of Adverse Events during the safety extension part of the study

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    End point title
    Rate of Adverse Events during the safety extension part of the study [1]
    End point description
    To evaluate the safety and PK characteristics of HPN-100 compared with sodium phenylbutyrate (NaPBA) in pediatric patients with urea cycle disorders.
    End point type
    Primary
    End point timeframe
    One year (12 months) on HPN-100.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Data are summarized for this endpoint per protocol.
    End point values
    Safety Extension (HPN-100)
    Number of subjects analysed
    17
    Units: subjects
        number (not applicable)
    16
    No statistical analyses for this end point

    Secondary: Number and causes of hyperammonemic events (safety extension)

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    End point title
    Number and causes of hyperammonemic events (safety extension)
    End point description
    Number of Subjects with at Least One Hyperammonemic Crisis. Hyperammonemic crisis is defined as follows: • Clinical symptoms associated with ammonia of ≥ 100 µmol/L
    End point type
    Secondary
    End point timeframe
    1 year
    End point values
    Safety Extension (HPN-100)
    Number of subjects analysed
    17
    Units: subjects
    number (not applicable)
        Number of subjects with at least 1 HAC
    3
        Number of Crises
    3
    No statistical analyses for this end point

    Secondary: Quality of life assessed by the SF-15 questionnaire

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    End point title
    Quality of life assessed by the SF-15 questionnaire
    End point description
    Change from baseline to Month 12. The SF 15 questionnaire consists of 15 questions that assess the following: • Physical functioning (5 questions) • Emotional functioning (4 questions) • Social functioning (3 questions) • School functioning (3 questions) Items were scored on a 5-point Likert scale from 0 (never) to 4 (almost always) or a 3-point scale (0 [not at all], 2 [sometimes], or 4 [a lot] for the young child self-report). Items were reverse-scored and linearly transformed to a 0–100 scale as follows: 0=100, 1=75, 2=50, 3=25, and 4=0. Total score was 0-100 scale (averaged from each functional areas). In the 0-100 scale, 0 is the worst score and 100 is best score. Improved quality of life was shown by increased total score from baseline to Month 12.
    End point type
    Secondary
    End point timeframe
    1 year
    End point values
    HPN-100
    Number of subjects analysed
    15
    Units: score on a scale
        arithmetic mean (standard deviation)
    4 ( 10.67 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Safety Extension period only (from Day 15 to 1 year)
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    12.1
    Reporting groups
    Reporting group title
    HPN-100
    Reporting group description
    HPN-100: Patient treated with HPN-100

    Serious adverse events
    HPN-100
    Total subjects affected by serious adverse events
         subjects affected / exposed
    3 / 17 (17.65%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Psychiatric disorders
    Aggression
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    gastroenteritis
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    hyperammonemia
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    HPN-100
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 17 (23.53%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Catheter site erythema
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Fatigue
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Asthma
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Epistaxis
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Oropharyngeal pain
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Psychiatric disorders
    Food aversion
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Insomnia
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Intentional self-injury
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Aggression
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Investigations
    ALT increased
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    AST increased
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Anion gap increased
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Blood bilirubin increased
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Blood potassium decreased
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Body temperature increased
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Electrocardiogram abnormal
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Lymphocyte count decreased
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Vitamin D decreased
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    White blood cell count increased
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Excoriation
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Hand fracture
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Joint sprain
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Migraine
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Thrombocytopenia
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Eye disorders
    Blepharospasm
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    4 / 17 (23.53%)
         occurrences all number
    4
    Abdominal pain upper
         subjects affected / exposed
    3 / 17 (17.65%)
         occurrences all number
    3
    Nausea
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Flatulence
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Diarrhoea
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Chapped lips
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Hepatobiliary disorders
    Hepatomegaly
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Skin odour abnormal
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Dermatitis
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Psoriasis
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Rash
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Renal and urinary disorders
    Renal mass
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Infections and infestations
    Upper respiratory tract infection
         subjects affected / exposed
    4 / 17 (23.53%)
         occurrences all number
    4
    Nasopharyngitis
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Sinusitis
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Body tinea
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Bronchitis
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Conjunctivitis infective
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Ear Infection
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Gastroenteritis
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Pharyngitis streptococcal
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Respiratory tract infection
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Viral infection
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    2 / 17 (11.76%)
         occurrences all number
    2
    Hyperammonemia
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1
    Hypokalemia
         subjects affected / exposed
    1 / 17 (5.88%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? No

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/24144944
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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