E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
SUPER-REFRACTORY STATUS EPILEPTICUS (SRSE) |
SUPERREFRAKTÆR STATUS EPILEPTICUS |
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E.1.1.1 | Medical condition in easily understood language |
STATUS EPILEPTICUS NOT RESPONDING TO ANY OF THE CONVENTIONAL THERAPY REGIMEN |
STATUS EPILEPTICUS IKKE RESPONDEREDE PÅ KONVENTIONELL BEHANDLING |
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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 | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10041962 |
E.1.2 | Term | Status epilepticus |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To determine the response to a 144-hour (6 day) continuous intravenous infusion of SAGE-547 compared to placebo administered to support the weaning of all third-line agents in adult and pediatric subjects with SRSE, and for the response to endure at least 24 hours after cessation of the SAGE-547 or placebo infusion (primary response). |
At påvise respons på en 144 timers (6 dages) kontinuerlig, intravenøs infusion af SAGE-547 sammenlignet med placebo administreret som støtte til udtrapning af alle 3. linje stoffer hos voksne og pædiatriske forsøgspersoner med SRSE, og at responset varer ved i mindst 24 timer efter afslutningen på infusionen af SAGE-547 eller placebo (primære respons). |
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E.2.2 | Secondary objectives of the trial |
To compare between SAGE-547 and placebo: time between meeting primary response endpoint and re-institution of any third-line agent for seizure or burst suppression up to V12; secondary response, (success of weaning the subject off all third-line agents before end of the first infusion; time between meeting the secondary response endpoint and re-institution of any third-line agent for seizure or burst suppression up to V12; Change in the Clinical Global Impression scale up to V12; number of days after the end of the first infusion of study drug that the subject does not have status epilepticus, up to V12; number of days after end of the first infusion of study drug that the subject does not have seizures (convulsive and non-convulsive) up to V12; number of separate episodes of status epilepticus occurring up to V12; the proportion of subjects with a new diagnosis of epilepsy after V11. To determine safety and tolerability of a 144-hour infusion of SAGE-547. |
At sammenligne SAGE-547 og placebo: hvor lang tid der går fra, at det primære endepunkt for respons opnås, indtil eventuelle 3. linje stoffer for anfald eller burst-suppression genoptages indtil B12; vellykket udtrapning af alle forsøgspersonens 3. linje stoffer inden afslutningen på den første infusion SAGE-547 eller placebo; hvor lang tid der går fra, at det sekundære endepunkt defineret ovenfor opnås, indtil eventuelle 3. linje stoffer for anfald eller burst-suppression genoptages indtil B12; ændringen i CGI-skala indtil B12; at bestemme det antal dage efter afslutningen på den første infusion forsøgslægemiddel, som forsøgspersonen ikke har status epilepticus indtil B12 og, som forsøgspersonen ikke har anfald indtil B12; antallet af separate episoder af status epilepticus, som forekommer indtil B12; forsøgspersoner med en ny epilepsidiagnose efter B11; At påvise sikkerheden og tolerabiliteten af en 144-timers infusion af SAGE-547 |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Pharmacogenomic sub-study. Included in the main study protocol version amendment 4 dated 18 August 2016.
The objective of this research is to collect and store blood sample for possible DNA extraction and exploratory research into how genes or specific genetic variation may influence response (i.e. distribution, safety, tolerability, and efficacy) to SAGE-547. |
Farmakogenomisk sub-studie. Inkluderet i hovedundersøgelsen protokolversion ændringsforslag 4 af 18. august 2016.
Formålet med denne forskning er at indsamle og opbevare blodprøve for mulig DNA-ekstraktion og sonderende forskning i, hvordan gener eller specifik genetisk variation kan påvirke respons (dvs. distribution, sikkerhed, tolerabilitet og effekt) til SAGE-547 |
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E.3 | Principal inclusion criteria |
1. Subjects eighteen (18) years of age and older. 2. Subjects who have: • Failed to respond to the administration of at least one first-line agent (e.g., benzodiazepine or other emergent initial AED treatment), according to institution standard of care, and; • Failed to respond to at least one second-line agent (e.g., phenytoin, fosphenytoin, valproate, phenobarbital, levetiracetam or other urgent control AED), according to institution standard of care, and; • Not previously been administered a third-line agent but have been admitted to an intensive care unit with the intent of administering at least one third-line agent for at least 24 hours; or who have previously failed zero or more wean attempts from third-line agents and are now on continuous intravenous infusions of one or more third-line agent and in an EEG burst or seizure suppression pattern; or who have previously failed one or more wean attempts from third-line agents and are now either not on a continuous intravenous infusion of at least one third-line agent or are on a continuous intravenous infusion of one or more third-line agent but not in an EEG burst or seizure suppression pattern. |
1.Forsøgspersonen er atten (18) år gammel eller derover. 2.Forsøgspersoner, som: •Ikke responderede på administrationen af mindst et 1. linje stof (f.eks. benzodiazepin eller anden ny førstegangs AED-behandling) i henhold til hospitalets standardpleje og •Ikke responderede på mindst ét 2. linje stof (f.eks. phenytoin, fosphenytoin, valproat, phenobartial, levetiracetam eller andet akut kontrol-AED) i henhold til hospitalets standardpleje • Ikke tidligere har fået administreret et 3. linje stof, men er blevet indlagt på en intensivafdeling med henblik på at få administreret mindst ét 3. linje stof i mindst 24 timer, eller som har et eller flere tidligere mislykkede udtrapningsforsøg fra 3. linje stoffer, og som nu er på kontinuerlige, intravenøse infusioner af et eller flere 3. linje stoffer og er i et EEG burst eller konvulsioner suppressionsmønster, eller for hvem et eller flere tidligere forsøg på udtrapning af et 3. linje stof ikke er lykkedes og nu enten ikke er på en kontinuerlig, intravenøs infusion af mindst ét 3. linje stof, eller som nu er på en kontinuerlig, intravenøs infusion af et eller flere 3. linje stoffer, men ikke er i et EEG burst eller konvulsioner suppressionsmønster. |
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E.4 | Principal exclusion criteria |
1. Subjects who are pregnant. 2. Subjects with a known allergy to progesterone or allopregnanolone. 3. Subjects with SRSE due to anoxic/hypoxic encephalopathy, with highly malignant/malignant EEG features (Westhall, Rossetti et al. 2016) 4. Subjects who have any of the following: -GFR low enough to warrant dialysis but for whatever reason, dialysis that would not adequately remove Captisol®is not planned; -severe cardiogenic or vasodilatory shock requiring two or more pressors that is not related to third-line agent use; -fulminant hepatic failure; -no reasonable expectation of recovery (for instance, a likely outcome is persistent vegetative state) or life-expectancy, in the experience of the investigator, is less than 30 days; 5. Subjects who are being administered more than three third-line agents concomitantly or for whom the qualifying wean cannot be completed within 24 hours or who are being administered a third-line agent for indications such as raised intra-cranial pressure that would preclude weaning according to this protocol. 6.Subjects with a living will that does not allow heroic measures. 7. Subjects who have been exposed to an investigational medication or device within 30 days; the exception to this is that participation in the Established Status Epilepticus Treatment Trial or ESETT within 30 days of screening for the 547-SSE-301 trial is allowed. 8. Subjects who have been treated or randomized in this trial or any other trial employing SAGE-547 previously (i.e., subjects may not have received study drug/placebo and then re-enroll). |
1.Forsøgspersoner, som er gravide. 2.Forsøgspersoner med kendt overfølsomhed over for progesteron eller allopregnanolon eller et eller flere af hjælpestofferne i SAGE-547. 3.Forsøgspersoner med SRSE, som skyldes anoksisk/hypoksisk encefalopati, med meget maligne / maligne EEG funktioner (Westhall, Rossetti et al. 2016) 4.Forsøgspersoner, som har et eller flere af følgende: a. Et GFR, der er lavt nok til berettige dialyse uanset grund, men dialyse som ikke i tilstrækkelig grad vil kunne fjerne Captisol® er ikke planlagt b.Svært kardiogent eller vasodilatorisk shock, som kræver to eller flere pressorstoffer, som ikke er relateret til brugen af 3. linje stoffer c.Fulminant leversvigt d.Ingen rimelig forventning om bedring (et sandsynligt udfald kunne f.eks. være persisterende vegetativ tilstand), eller at forsøgspersonens forventede levetid, ifølge investigatorens faglige skøn, er mindre end 30 dage 5.Forsøgspersoner, som får administreret mere end tre 3. linje stoffer samtidigt, eller for hvem den kvalificerende udtrapning ikke kan gennemføres på 24 timer, eller som får administreret et 3. linje stof for andre indikationer, f.eks. behandling af forhøjet intrakranielt tryk, som kunne udelukke udtrapning i henhold til denne protokol. 6.Forsøgspersoner med et livstestamente, som ikke ønsker genoplivning. 7.Forsøgspersoner, som har været eksponeret for et forsøgslægemiddel eller -instrument inden for 30 dage, dog undtagen deltagelse i forsøget ESETT (Established Status Epilepticus Treatment Trial) inden for 30 dage fra screening for 547-SSE-301-forsøget, hvilket er tilladt. 8.Forsøgspersoner, som tidligere har været behandlet eller randomiseret i dette forsøg eller et andet forsøg, som brugte SAGE-547 (dvs. forsøgspersoner kan ikke har modtaget undersøgelsens lægemiddel eller placebo og derefter blive inkluderet igen). |
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E.5 End points |
E.5.1 | Primary end point(s) |
Success or failure, with success defined as weaning the subject off all third-line agents before completion of the first blinded infusion of SAGE-547 or placebo, and not having to re-institute any third-line agent for seizure or burst suppression during the 24 hours after the end of the first infusion of SAGE-547 or placebo, and concurrent signs of physiologic brain activity as determined by EEG (primary response).
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Succes eller fiasko, hvor succes er defineret som udtrapning af forsøgspersonen fra alle 3. linje stoffer, inden den første infusion blindet SAGE-547 eller placebo er færdig, og uden at et 3. linje stof for kramper eller burst-suppression skal genoptages i 24 timer efter afslutningen på den første infusion SAGE-547 eller placebo, og samtidige tegn på fysiologisk hjerneaktivitet påvist ud fra EEG (primære respons) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
24 hours after the end of study drug infusion. |
24 timer efter afslutningen af infusionen forsøgsmedicinen. |
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E.5.2 | Secondary end point(s) |
1. The time between meeting the primary response endpoint and the re-institution of any third-line agent for seizure or burst suppression up to Visit 12; 2. Secondary response, defined as success of weaning the subject off all third-line agents before the end of the first SAGE-547 or placebo infusion; 3. The time between meeting the secondary response endpoint, defined in (2) above, and the re-institution of any third-line agent for seizure or burst suppression up to Visit 12; 4. The assessment of clinical status as measured by change in the CGI from Visit 1 (Screening) and to Visit 12; 5. The number of days after the end of the first study drug infusion that the subject does not have status epilepticus, up to Visit 12; 6. The number of days after the end of the first study drug infusion that the subject does not have seizures (convulsive and non-convulsive) up to Visit 12; 7. The number of separate episodes of status epilepticus occurring up to Visit 12; 8. The proportion of subjects with a new diagnosis of epilepsy after Visit 11.
Safety endpoints: 1.Adverse events and medications; 2.Laboratory testing (hematology, serum chemistry, and urinalysis); 3.Vital signs (blood pressure, heart rate, temperature, and weight); 4.ECG parameters; 5.Mortality.
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1.Hvor lang tid der går fra, at det primære endepunkt for respons opnås, og indtil eventuelle 3. linje stoffer for kramper eller burst-suppression genoptages indtil Besøg 12. 2.Sekundært respons, defineret som vellykket udtrapning af alle 3. linje stoffer inden afslutningen på den første infusion SAGE-547 eller placebo. 3.Hvor lang tid der går fra, at det sekundære endepunkt for respons opnås, defineret i (2) ovenfor, indtil eventuelle 3. linje stoffer for anfald eller burst-suppression genoptages indtil Besøg 12. 4.Vurderingen af klinisk status, som måles ud fra ændringen i CGI fra Besøg 1 (Screening) til Besøg 12. 5.Antal dage efter afslutningen på den første infusion af forsøgslægemidlet, som forsøgspersonen ikke har status epilepticus indtil Besøg 12. 6.Antal dage efter afslutningen på den første infusion af forsøgslægemidlet, som forsøgspersonen ikke har anfald (konvulsive og ikke-konvulsive) indtil Besøg 12. 7.Antal separate episoder af status epilepticus, som forekommer indtil Besøg 12. 8.Andelen af forsøgspersoner med en ny epilepsidiagnose efter Besøg 11. Sikkerhedsmæssige endepunkter: 1.Utilsigtede hændelser og lægemidler 2.Laboratorieprøver (hæmatologi, serumkemi og urinanalyse) 3.Vitale værdier (blodtryk, hjertefrekvens, temperatur og vægt) 4.EKG-parametre 5.Mortalitet.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Efficacy: up to visit 12 or after visit 11 for end-point # 8. Safety: AEs and medications: V1-V12 ECG and vital signs: V1, V3-V10 Lab tests: V1, V3, V4, V6, V8, V10,V11 Mortality: V12
Retreatment period: AE and medications: V3R-V12R ECG and vital signs: V3R-V10R Lab tests: V3R, V4R, V6R, V8R, V10R, V11R Mortality: V12R |
Effekt: op til at besøge 12 eller efter besøg 11 til end-point # 8. sikkerhed: AES og medicin: B1-B12 EKG og vitale tegn: B1, B3-B10 Laboratorieundersøgelser: B1, B3, B4, B6, B8, B10, B11: Dødelighed: B12 |
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
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 | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | Yes |
E.6.13 | Others | No |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
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 | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 60 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Austria |
Belgium |
Canada |
Denmark |
Estonia |
Finland |
France |
Germany |
Hungary |
Israel |
Italy |
Netherlands |
Serbia |
Spain |
Sweden |
United Kingdom |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |