E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
DeltaF508 Homozygous Cystic Fibrosis |
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E.1.1.1 | Medical condition in easily understood language |
Cystic Fibrosis (the most common genotype, which causes a particularly severe disease) |
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E.1.1.2 | Therapeutic area | Diseases [C] - Respiratory Tract Diseases [C08] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10011762 |
E.1.2 | Term | Cystic fibrosis |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic 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 |
In two cohorts of patients (adult and paediatric) with a particular genetic cause of cystic fibrosis (deltaF 508, the most common and one of the most severe types), can patients tolerate an existing medicine (cysteamine) while taking a food supplement (EGCG). The primary outcome measure is discontinuation of the cysteamine. There are well known adverse effects for cysteamine. We also want to capture the suspected ADRs from this medication. |
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E.2.2 | Secondary objectives of the trial |
For a subgroup of patients, we want to measure blood levels of cysteamine, to ensure we are dosing appropriately. In addition, in all the participants, we want to repeat the tests of effectiveness (sweat test), as they have only been done in a small population before, and not in children. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Adult Inclusion Criteria
1. Patient managed by respiratory team at Leeds General Infirmary 2. Patient has homozygous ΔF508 Cystic Fibrosis 3. 18-30 years old at screening visit 4. Written informed consent obtained from patient. This person must understand the contents of the consent, requirements of the study and have had an opportunity to review questions with a medically trained member of the site study team. 5. Patient must have a good understanding of the English language, in which the consent forms are available, and understand the requirements for reporting of any AE to the Investigator. 6. If female, be willing to have a pregnancy test and use one or more of the following methods of highly effective contraception: Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation Oral Intravaginal Transdermal Progestogen-only hormonal contraception associated with inhibition of ovulation Oral Injectable Implantable Intrauterine device (IUD) Intrauterine hormone-releasing system ( IUS) Bilateral tubal occlusion Vasectomised partner Sexual abstinence 7. Patient willing and able to comply with protocol including swallowing capsules and venepuncture/cannulation weekly for 6 weeks
Paediatric Inclusion Criteria
8. Patient managed by respiratory team at Alder Hey Children’s NHS Foundation Trust 9. Patient has homozygous ΔF508 Cystic Fibrosis 10. 5-17 years at screening visit 11. Written informed consent from parent/legal guardian if patient <16 years or from patient if ≥16 years. This person must understand the contents of the consent, requirements of the study and have had an opportunity to review questions with a medically trained member of the site study team. 12. Verbal or written age appropriate assent from the patient. 13. Patient and parent/legal guardian must have a good understanding of the English language, in which the consent/assent forms are available, and understand the requirements for reporting of any AE to the Investigator. 14. If female, and peri/post pubertal, must be willing to have a pregnancy test and use one or more of the following methods of highly effective contraception: Sexual abstinence Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation Oral Intravaginal Transdermal Progestogen-only hormonal contraception associated with inhibition of ovulation Oral Injectable Implantable Intrauterine device (IUD) Intrauterine hormone-releasing system ( IUS) Bilateral tubal occlusion Vasectomised partner 15. Patient and parent/legal guardian willing and able to comply with protocol including swallowing capsules and venepuncture/cannulation weekly for 6 weeks
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E.4 | Principal exclusion criteria |
Adult Exclusion Criteria
1. Use of EGCG, or drinking green tea within 2 weeks of the first dose of study and during study period 2. Use of Ivacaftor, Lumacaftor or other mutations specific therapy 3. Drinking black tea within 2 weeks of the first dose of study drugs, and during the study period 4. Known hypersensitivity to Cysteamine, EGCG, or penicillamine 5. Known hypersensitivity to the excipients of the study drugs (i.e. microcrystalline cellulose, pregelatinized starch, magnesium stearate/sodium lauryl sulfate, colloidal silicon dioxide, croscarmellose sodium gelatin, titanium dioxide, black ink on hard capsules containing E172). 6. Recent infective exacerbation of CF. Patient must not have had oral antibiotics within 4 weeks of screening or IV antibiotics within 6 weeks of screening 7. Any clinically significant acute illness within 4 weeks of the start of dose administration. 8. Any clinically significant medical condition, other than CF that in the opinion of the Investigator may increase the risk of participating in the study or interfere with the interpretation of safety or efficacy evaluations (e.g., severe reflux, psychiatric condition or behavioural disorder). 9. Patient on regular itraconazole 10. Liver function tests deemed too abnormal by a clinician experienced in the management of cystic fibrosis. 11. Renal function abnormal for age. 12. Significantly low red cell folate level 13. Pregnant or breastfeeding 14. Written consent not obtained. 15. The patient is deemed unsuitable at the discretion of the investigator. 16. Patients unable to swallow tablets/capsule by mouth
Paediatric Exclusion Criteria
1. Use of EGCG, or drinking green tea within 2 weeks of the first dose of study and during study period 2. Use of Ivacaftor, Lumacaftor or other mutations specific therapy 3. Drinking black tea within 2 weeks of the first dose of study drugs, and during the study period 4. Known hypersensitivity to cysteamine or EGCG 5. Known hypersensitivity to the excipients of the study drugs (i.e. microcrystalline cellulose, pregelatinized starch, magnesium stearate/sodium lauryl sulfate, colloidal silicon dioxide, croscarmellose sodium gelatin, titanium dioxide, black ink on hard capsules containing E172). 6. Recent infective exacerbation of CF. Patient must not have had oral antibiotics within 4 weeks of screening or IV antibiotics within 6 weeks of screening 7. Any clinically significant acute illness within 4 weeks of the start of dose administration. 8. Any clinically significant medical condition, other than CF that in the opinion of the Investigator may increase the risk of participating in the study or interfere with the interpretation of safety or efficacy evaluations (e.g., severe reflux, psychiatric condition or behavioural disorder). 9. Patient on regular itraconazole 10. Liver function tests deemed too abnormal by a clinician experienced in the management of cystic fibrosis. 11. Renal function abnormal for age. 12. Significantly low red cell folate level 13. Pregnant or breastfeeding 14. Written consent not obtained. 15. Participant who understands the study (judged on case by case basis, from approximately age 7) declines assent. 16. The patient is deemed unsuitable at the discretion of the investigator. 17. Patients unable to swallow tablets/capsule by mouth
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Discontinuation of the study drug 2. Adverse effects of cysteamine in homozygous ∆508 cystic fibrosis adult and paediatric patients
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The study will last for 6 weeks. This comprises 4 weeks where the cysteamine dose is increased (as per usual dosing in cystinosis) while a single dose of EGCG is administered. On week 5, the participants remain on the dose of cysteamine, but a single dose increase in EGCG is undertaken. In the final week, no medications are used.
Patients will have weekly review to ensure they are able to take the medications, and to assess for adverse effects of the medications. Safety bloods will also be undertaken weekly. |
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E.5.2 | Secondary end point(s) |
1. Plasma concentration of cysteamine and EGCG at set time points in ∆F508 cystic fibrosis patients. 2. Change in sweat test chloride result with each dose escalation of cysteamine 3. Change in sweat test chloride result with cysteamine used in combination with multiple daily dose EGCG
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
A subset of patients (10 per cohort) will have additional blood taken for PK analysis at their weekly reviews.
All participants will have a weekly sweat test, as a means to replicate the reduction in sweat chloride seen in adult patients and establish if this occurs in paediatric patients. |
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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 | Yes |
E.6.13.1 | Other scope of the trial description |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
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 |
Tolerability and Adverse effect |
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E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
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 | No |
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) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
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 | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
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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The last medical review and safety assessment on D42 |
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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 | 0 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 3 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 3 |