E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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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 | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10021750 |
E.1.2 | Term | Infantile spasms |
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 |
Pilot Phase:
•To determine the maximum safe, tolerable dose and dosing regimen of GWP42003-P in infants with IS, to be utilized in the pivotal phase and open-label extension (OLE).
•To assess the number and proportion of patients considered treatment responders, defined as those free of spasms and have resolution of hypsarrhythmia at the end of the 2-week treatment period.
Pivotal Phase:
•To assess the number and proportion of patients considered treatment responders, defined as those free of spasms and have resolution of hypsarrhythmia, at the end of the 2-week blinded treatment period versus placebo.
OLE:
•To assess the long term safety of GWP42003-P in infants with IS.
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E.2.2 | Secondary objectives of the trial |
All Phases:
•To assess the number and proportion of patients who are free of clinical spasms at the end of the treatment period •To assess the number and proportion of patients who have resolution of hypsarrhythmia at the end of the treatment period •To assess changes in spasms and seizure subtypes by caregiver observation during the treatment period•To determine time to cessation of spasms during the treatment period.
Pivotal Phase Only
•To assess the safety and tolerability of GWP42003-P.
•To determine the population pharmacokinetics (POPPK) of CBD and its metabolites. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
For inclusion in the trial, patients must fulfil ALL of the following criteria:
•Patient’s parent(s)/legal representative is willing and able to give informed consent for the patient’s participation in the trial.
•Patient and their caregiver are willing and able (in the investigator’s opinion) to comply with all trial requirements.
•Patient is diagnosed with IS
•Patient has failed to respond adequately following treatment with 1 or more approved IS therapies
•Patient’s parent(s)/legal representative is willing to allow the responsible authorities to be notified of participation in the trial, if mandated by local law.
•Patient’s parent(s)/legal representative is willing to allow the patient’s primary care practitioner (if they have one) and consultant (if they have one) to be notified of participation in the trial, if the primary care practitioner/consultant is different to the investigator.
•All non-pharmacological interventions for epilepsy must have been stable for 2 weeks prior to screening.
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E.4 | Principal exclusion criteria |
The patient may not enter the trial if ANY of the following apply:
•Patient is currently taking or has taken clobazam or any oral mammalian target of rapamycin (mTOR) inhibitor within the 2 weeks prior to the screening visit.
•Patient has a QT interval, corrected for heart rate with Bazett’s formula (QTcB), of > 460 msec on ECG.
•Patient’s caregiver is currently giving or has given recreational or medicinal cannabis, or synthetic cannabinoid-based medications, within the 1 month prior to the screening visit, as determined by investigator interview with patient’s caregiver.
•Patient’s caregiver is unwilling to abstain from giving the patient (including the patient’s mother abstaining themselves, if breastfeeding) recreational or medicinal cannabis, or synthetic cannabinoid-based medications (other than the study IMP), during the trial, as determined by investigator interview with patient’s caregiver.
•Patient has any known or suspected hypersensitivity to cannabinoids or any of the excipients of the IMP(s), such as sesame oil.
•Patient has significantly impaired hepatic function at the screening visit.
•Patient has received an IMP as part of a clinical trial within a minimum of 5 half-lives prior to the screening visit.
•Patient has any other significant disease or disorder which, in the opinion of the investigator, may either put the patient at risk because of participation in the trial, may influence the result of the trial, or may affect the patient’s ability to take part in the trial.
•Any abnormalities identified following a physical examination of the patient that, in the opinion of the investigator, would jeopardize the safety of the patient or confound assessment of efficacy if they took part in the trial.
•Patient has been previously included in the pilot or pivotal phase of this trial.
•Patient has travel outside the country and/or United States state of residence planned during the trial, unless the patient has confirmation that the IMP is permitted in the destination country/state.
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E.5 End points |
E.5.1 | Primary end point(s) |
Pilot Phase:
•To assess the safety as determined by AEs, clinical laboratory tests, ECG, vital signs and physical examinations during the treatment period.
•To assess the number and proportion of patients who are free of spasms and have resolution of hypsarrhythmia at the end of the 2-week treatment period
Pivotal Phase:
•The number and proportion of patients who are free of spasms and have resolution of hypsarrhythmia at the end of the 2- week treatment period.
OLE:
•To assess the long term safety as determined by AEs, clinical laboratory tests, ECG, vital signs and physical examinations during the treatment period.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Pilot Phase: At visits 2, 3 and 4
Pivotal Phase: At visit 4
Open Label Extension Phase: At visits 4 to safety follow up |
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E.5.2 | Secondary end point(s) |
All Phases:
•The number and proportion of patients who are free of clinical spasms at the end of the treatment period.
•The number and proportion of patients who have resolution of hypsarrhythmia at the end of the treatment period.
Pivotal Phase Only:
•Safety and tolerability as determined by AEs, clinical laboratory tests, ECG, physical examinations and vital signs.
•Measurement, where possible, of plasma concentrations of CBD and its metabolites will be investigated using a sparse sampling approach, with the aim to define a POPPK model.
OLE Only:
•The number and proportion of patients who are free of spasms and have resolution of hypsarrhythmia after 3, 6, 9 and 12 months treatment.
•Number and proportion of patients with relapse of spasms, and the time to relapse, as determined by caregiver diaries.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Pilot Phase: At visits 2, 3 and 4
Pivotal Phase: At visits 2, 3 and 4
Open Label Extension Phase: At visits 4 to safety follow up |
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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 | 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 | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
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 | 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 | 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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
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 |
Hungary |
Italy |
Poland |
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 | 2 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |