Clinical Trials Register

Summary
EudraCT Number:	2018-000358-23
Sponsor's Protocol Code Number:	CMS-001
National Competent Authority:	Italy - Italian Medicines Agency
Clinical Trial Type:	EEA CTA
Trial Status:	Prematurely Ended
Date on which this record was first entered in the EudraCT database:	2018-12-05
Trial results	View results

Index
A. PROTOCOL INFORMATION
B. SPONSOR INFORMATION
C. APPLICANT IDENTIFICATION
D. IMP IDENTIFICATION
D.8 INFORMATION ON PLACEBO
E. GENERAL INFORMATION ON THE TRIAL
F. POPULATION OF TRIAL SUBJECTS
G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
P. END OF TRIAL

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A. Protocol Information

A.1

Member State Concerned

Italy - Italian Medicines Agency

A.2

EudraCT number

2018-000358-23

A.3

Full title of the trial

A phase 3, multicenter, double-blind, placebo-controlled, randomized, outpatient two-period two-treatment crossover study to evaluate the efficacy and safety of amifampridine phosphate (3,4 diaminopyridine phosphate) in patients with Congenital Myasthenic Syndromes (CMS)

Studio di crossover di fase 3, multicentrico, in doppio cieco, controllato con placebo, randomizzato, a due periodi e due trattamenti con pazienti ambulatoriali per valutare l’efficacia e la sicurezza dell’amifampridina fosfato (3,4-diaminopiridina fosfato) in pazienti con sindromi miasteniche congenite (SMC)

A.3.1

Title of the trial for lay people, in easily understood, i.e. non-technical, language

Study to evaluate the efficacy and safety of amifampridine phosphate drug in patients with Congenital Myasthenic Syndromes (CMS)

Studio che valuta l'efficacia e la sicurezza del farmaco amifampridina fosfato in pazienti con Sindromi Miasteniche Congenite (SMC)

A.3.2

Name or abbreviated title of the trial where available

CMS-001

A.4.1

Sponsor's protocol code number

CMS-001

A.5.2

US NCT (ClinicalTrials.gov registry) number

NCT02562066

A.5.4

Other Identifiers

Name:

IND

Number:

106263

A.7

Trial is part of a Paediatric Investigation Plan

A.8

EMA Decision number of Paediatric Investigation Plan

B. Sponsor Information
B.Sponsor: 1
B.1.1	Name of Sponsor	CATALYST PHARMACEUTICALS INC.
B.1.3.4	Country	United States
B.3.1 and B.3.2	Status of the sponsor	Commercial
B.4 Source(s) of Monetary or Material Support for the clinical trial:
B.4.1	Name of organisation providing support	Catalyst Pharmaceuticals Inc.
B.4.2	Country	United States
B.5 Contact point designated by the sponsor for further information on the trial
B.5.1	Name of organisation	Catalyst Pharmaceuticals Inc.
B.5.2	Functional name of contact point	Gary Ingenito
B.5.3	Address:
B.5.3.1	Street Address	355 Alhambra Circle, Suite 1250
B.5.3.2	Town/ city	Coral Gables
B.5.3.3	Post code	FL 33134
B.5.3.4	Country	United States
B.5.4	Telephone number	(305) 420-3200
B.5.5	Fax number	(305) 420-3200
B.5.6	E-mail	gingenito@catalystpharma.com

D. IMP Identification
D.IMP: 1
D.1.2 and D.1.3	IMP Role	Test
D.2	Status of the IMP to be used in the clinical trial
D.2.1	IMP to be used in the trial has a marketing authorisation	Yes
D.2.1.1.1	Trade name	FIRDAPSE - 10 MG - COMPRESSE - USO ORALE - BLISTER(ALU/PVC/PVDC) 100 X 1 COMPRESSE
D.2.1.1.2	Name of the Marketing Authorisation holder	BIOMARIN EUROPE LTD
D.2.1.2	Country which granted the Marketing Authorisation	Italy
D.2.5	The IMP has been designated in this indication as an orphan drug in the Community	No
D.2.5.1	Orphan drug designation number
D.3 Description of the IMP
D.3.1	Product name	Amifampridine phoshate
D.3.4	Pharmaceutical form	Tablet
D.3.4.1	Specific paediatric formulation	No
D.3.7	Routes of administration for this IMP	Oral use
D.3.8 to D.3.10 IMP Identification Details (Active Substances)
D.3.8	INN - Proposed INN	AMIFAMPRIDINA
D.3.9.1	CAS number	446254-47-3
D.3.9.2	Current sponsor code	DAPP or 3,4-DAP Phosphate
D.3.9.3	Other descriptive name	AMIFAMPRIDINA
D.3.9.4	EV Substance Code	SUB28846
D.3.10	Strength
D.3.10.1	Concentration unit	mg milligram(s)
D.3.10.2	Concentration type	equal
D.3.10.3	Concentration number	10
D.3.11 The IMP contains an:
D.3.11.1	Active substance of chemical origin	Yes
D.3.11.2	Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP)	No
	The IMP is a:
D.3.11.3	Advanced Therapy IMP (ATIMP)	No
D.3.11.3.1	Somatic cell therapy medicinal product	No
D.3.11.3.2	Gene therapy medical product	No
D.3.11.3.3	Tissue Engineered Product	No
D.3.11.3.4	Combination ATIMP (i.e. one involving a medical device)	No
D.3.11.3.5	Committee on Advanced therapies (CAT) has issued a classification for this product	No
D.3.11.4	Combination product that includes a device, but does not involve an Advanced Therapy	No
D.3.11.5	Radiopharmaceutical medicinal product	No
D.3.11.6	Immunological medicinal product (such as vaccine, allergen, immune serum)	No
D.3.11.7	Plasma derived medicinal product	No
D.3.11.8	Extractive medicinal product	No
D.3.11.9	Recombinant medicinal product	No
D.3.11.10	Medicinal product containing genetically modified organisms	No
D.3.11.11	Herbal medicinal product	No
D.3.11.12	Homeopathic medicinal product	No
D.3.11.13	Another type of medicinal product	No

D.8 Information on Placebo
D.8 Placebo: 1
D.8.1	Is a Placebo used in this Trial?	Yes
D.8.3	Pharmaceutical form of the placebo	Tablet
D.8.4	Route of administration of the placebo	Oral use

E. General Information on the Trial

E.1 Medical condition or disease under investigation

E.1.1

Medical condition(s) being investigated

Congenital myasthenic syndromes

Sindromi miasteniche congenite

E.1.1.1

Medical condition in easily understood language

Congenital myasthenic syndromes

Sindromi miasteniche congenite

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	PT
E.1.2	Classification code	10028424
E.1.2	Term	Myasthenic syndrome
E.1.2	System Organ Class	10029205 - Nervous system disorders

E.1.2 Medical condition or disease under investigation

E.1.2	Version	20.0
E.1.2	Level	LLT
E.1.2	Classification code	10028425
E.1.2	Term	Myasthenic syndromes in diseases classified elsewhere
E.1.2	System Organ Class	10029205 - Nervous system disorders

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 characterize the overall safety and tolerability of amifampridine phosphate compared with placebo in patients with CMS;
- To assess the clinical efficacy of amifampridine phosphate compared with placebo in patients with CMS, based on improvement in subject global impression (SGI) and motor function measure (MFM 20 or 32) scores

- Caratterizzare la sicurezza e la tollerabilità complessive dell’amifampridina fosfato rispetto al placebo in pazienti con sindromi miasteniche congenite;
- Valutare l’efficacia clinica dell’amifampridina fosfato rispetto al placebo in pazienti con SMC sulla base del miglioramento del punteggio relativo all’impressione globale del soggetto (SGI) e alla misurazione della funzione motoria (MFM 20 o 32)

E.2.2

Secondary objectives of the trial

There are no secondary objectives

Non sono previsti obiettivi secondari

E.2.3

Trial contains a sub-study

E.3

Principal inclusion criteria

- Patient or parent willing and able to provide written informed consent after the nature of the study has been explained and before the start of any research-related procedures, or the patient’s legal guardian or caregiver with durable power of attorney can provide written informed consent. An assent form must also be signed if in the judgement of the IRB/IEC/REB the children are capable of providing assent
- Male or female age 2 years and above
- Body weight ≥10 kg
- Genetically-confirmed CMS involving acetylcholine receptor defect, Rapsyn deficiency, MuSK deficiency, Dok-7 deficiency, SYT2 mutations, SNAP25B deficiency, and fast channel syndrome
- In patients who are naïve to 3,4-DAP or amifampridine phosphate, MFM 20 or 32 score equal or less than 48 or 76, respectively, at Screening
- In patients who are naïve to 3,4-DAP or amifampridine phosphate, improvement of >20% in MFM 20 or MFM 32 scores after open label period of uptitration of dose
- In patients who are previously stabilized on 3,4-DAP or amifampridine phosphate, a history of meaningful improvement in motor function (in the opinion of the investigator)
- Willingness of patients receiving pyridostigmine, albuterol, ephedrine, or fluoxetine to remain on a stable dose of these medications throughout the study interval
- Female patients of childbearing potential must have a negative pregnancy test (serum human chorionic gonadotropin [HCG] at Screening); and must practice effective, reliable contraceptive regimen during the study. Acceptable methods of contraception include hormonal contraception (i.e., birth control pills, injected hormones, dermal patch or vaginal ring), intrauterine device, barrier methods (diaphragm, condom) with spermicide, or surgical sterilization (tubal ligation)
- Ability to participate in the study based on overall health of the patient and disease prognosis, as applicable, in the opinion of the investigator; and able to comply with all requirements of the protocol

- Il/la paziente o il genitore disponibile e in grado di fornire un consenso informato scritto dopo che la natura dello studio sia stata loro spiegata e prima dell’inizio di qualsiasi procedura di ricerca, oppure il tutore legale o il caregiver del/della paziente con procura duratura possono fornire il consenso informato scritto. Dovrà essere inoltre firmato un modulo di assenso se, a giudizio del CE indipendente, i bambini partecipanti sono in grado di fornire il proprio assenso
- Soggetti di sesso maschile o femminile di età pari o superiore ai 2 anni
- Peso corporeo ≥10 kg
- SMC confermata geneticamente con difetto del recettore dell’acetilcolina, deficit di Rapsyn, deficit di MuSK, deficit di Dok-7, mutazioni in SYT2, deficit di SNAP25B e sindrome del canale rapido
- Allo screening, punteggio MFM 20 o 32 uguale o inferiore a 48 o 76 in pazienti naïve, rispettivamente, a 3,4-DAP o ad amifampridina fosfato
- Miglioramento superiore al 20% nei punteggi MFM 20 o MFM 32 dopo il periodo in aperto di incremento della titolazione della dose in pazienti naïve a 3,4-DAP o ad amifampridina fosfato
- Anamnesi di miglioramento significativo della funzione motoria (secondo l’opinione dello sperimentatore) in pazienti precedentemente stabilizzati con 3,4-DAP o amifampridina fosfato
- Disponibilità dei pazienti trattati con piridostigmina, albuterolo, efedrina o fluoxetina a rimanere a una dose stabile di tali farmaci durante tutto il periodo dello studio
- Le pazienti di sesso femminile in età fertile devono presentare un test di gravidanza negativo (gonadotropina corionica umana [hCG] nel siero allo screening) e devono praticare un regime anticoncezionale efficace e affidabile durante lo studio. I metodi contraccettivi accettabili comprendono: contraccezione ormonale (ovvero, pillole contraccettive, ormoni iniettabili, cerotto transdermico o anello vaginale), dispositivo intrauterino, metodi barriera (diaframma, preservativo) con spermicida o sterilizzazione chirurgica (chiusura delle tube)
- Capacità di partecipare allo studio basata sulla salute generale del/della paziente e sulla prognosi della malattia, a seconda dei casi, secondo l’opinione dello sperimentatore; e capacità di rispettare tutti i requisiti del protocollo

E.4

Principal exclusion criteria

- CMS subtype diagnosis of acetylcholinesterase deficiency, slow-channel syndrome, LRP4 deficiency, and plectin deficiency
- Cardiac conduction defects on Screening electrocardiogram (ECG)
- Seizure disorder
- Clinically significant abnormal laboratory values at Screening, in the opinion of the investigator
- Pregnancy or breastfeeding at Screening or planning to become pregnant at any time during the study
- Any systemic bacterial or other infection, which is clinically significant in the opinion of the investigator and has not been treated with appropriate antibiotics
- Treatment with an investigational drug (other than 3,4-DAP or amifampridine phosphate), device, or biological agent within 30 days before Screening or while participating in this study
- Any other medical condition that, in the opinion of the investigator, might interfere with the patient’s participation in the study, poses an added risk for the patient, or confounds the assessment of the patient
- History of drug allergy to any pyridine-containing substances or any amifampridine phosphate excipient(s)

- Diagnosi di sottotipo di SMC con deficit di acetilcolinesterasi, sindrome del canale lento, deficit di LRP4 e deficit di plectina
- Difetti di conduzione cardiaca all’elettrocardiogramma (ECG) allo screening
- Epilessia
- Valori di laboratorio anormali clinicamente significativi allo screening, secondo l’opinione dello sperimentatore
- In gravidanza o in allattamento allo screening o che pianifica una gravidanza in qualsiasi momento durante lo studio
- Qualsiasi infezione batterica sistemica o altra infezione clinicamente significativa, secondo l’opinione dello sperimentatore, che non è stata trattata con gli antibiotici appropriati
- Trattamento con un farmaco (diverso da 3,4-DAP o da amifampridina fosfato), un dispositivo o un agente biologico sperimentale entro i 30 giorni precedenti allo screening o durante la partecipazione a questo studio
- Qualsiasi altra condizione medica che, secondo l’opinione dello sperimentatore, potrebbe interferire con la partecipazione del/della paziente allo studio, potrebbe rappresentare un rischio aggiuntivo per il/la paziente o potrebbe confondere la valutazione del/della paziente
- Anamnesi di allergia farmacologica a qualsiasi sostanza contenente piridina o a qualsiasi eccipiente dell’amifampridina fosfato

E.5 End points

E.5.1

Primary end point(s)

The efficacy of amifampridine phosphate will be assessed by comparison
of amifampridine phosphate versus placebo for: - Improvement of the
score of the Subject Global Impression (SGI) and MFM 20 or 32 scales
(MFM 20 (individual <7 years) and MFM 32 (individual ≥ 7 years)); -
Clinical Global Impression-Severity (CGI-S); and - Clinical Global
Impression-Improvement (CGI-I). Optional tests to be performed are; -
Stimulated single fiber electromyogram (SFEMG) - "Slurp" test.

The safety of amifampridine phosphate will be assessed by the incidence of
treatment-emergent adverse events (TEAEs), including serious adverse
events (SAEs). vital signs, 12-lead ECGs, clinical laboratory tests,
physical examination, and concomitant medications will also be
evaluated.

L’efficacia di amifampridina fosfato sarà valutata tramite confronto tra amifampridina fosfato e placebo per:
- miglioramento del punteggio relativo all’impressione globale del soggetto (SGI) e alla misurazione della funzione motoria (MFM 20 o 32) (MFM 20 [individuo <7 anni] e MFM 32 [individuo ≥7 anni]);
- miglioramento del punteggio della scala Impressione clinica globale-Gravità (CGI-S); -miglioramento del punteggio della scala Impressione clinica globale-Miglioramento
(CGI-I).
- test facoltativi: - Elettromiografia di singola fibra (SFEMG) stimolata - “Slurp” test.

La sicurezza dell’amifampridina fosfato sarà valutata tramite l’incidenza degli eventi avversi emergenti dal trattamento (TEAE), compresi gli eventi avversi seri (SAE). Saranno valutati anche i parametri vitali, gli ECG a 12 derivazioni, i test clinici di laboratorio, l’esame obiettivo e i farmaci concomitanti.

E.5.1.1

Timepoint(s) of evaluation of this end point

The efficacy endpoint will be assessed after 56 days from the start of the study treatment. Safety endpoint: The study period during which all non-serious AEs will be reported begins after informed consent is obtained and the first administration of study drug through the last visit. After informed consent but prior to initiation of study treatment, only SAEs associated with any protocol-imposed interventions will be reported.

L'endpoint di efficacia sarà valutato dopo 56 giorni dall'inizio del trattamento sperimentale. Gli eventi avversi non seri saranno registrati dalla prima dose di farmaco sperimentale fino alla visita di fine trattamento. Nel periodo compreso tra la sottoscrizione del consenso informato e l’inizio del trattamento sperimentale saranno registrati solo gli eventi avversi seri (SAE) correlati ad una procedura prevista dal protocollo. I SAE saranno registrati fino a 4 settimane dopo l’ultima dose di farmaco sperimentale.

E.5.2

Secondary end point(s)

There are no secondary endpoints

Non sono previsti endpoint secondari

E.5.2.1

Timepoint(s) of evaluation of this end point

There are no secondary endpoints

Non sono previsti enpoint secondari

E.6 and E.7 Scope of the trial

E.6

Scope of the trial

E.6.1

Diagnosis

E.6.2

Prophylaxis

E.6.3

Therapy

Yes

E.6.4

Safety

Yes

E.6.5

Efficacy

Yes

E.6.6

Pharmacokinetic

E.6.7

Pharmacodynamic

E.6.8

Bioequivalence

E.6.9

Dose response

E.6.10

Pharmacogenetic

E.6.11

Pharmacogenomic

E.6.12

Pharmacoeconomic

E.6.13

Others

E.7

Trial type and phase

E.7.1

Human pharmacology (Phase I)

E.7.1.1

First administration to humans

E.7.1.2

Bioequivalence study

E.7.1.3

Other

E.7.1.3.1

Other trial type description

E.7.2

Therapeutic exploratory (Phase II)

E.7.3

Therapeutic confirmatory (Phase III)

Yes

E.7.4

Therapeutic use (Phase IV)

E.8 Design of the trial

E.8.1

Controlled

Yes

E.8.1.1

Randomised

Yes

E.8.1.2

Open

E.8.1.3

Single blind

E.8.1.4

Double blind

Yes

E.8.1.5

Parallel group

E.8.1.6

Cross over

Yes

E.8.1.7

Other

E.8.2

Comparator of controlled trial

E.8.2.1

Other medicinal product(s)

E.8.2.2

Placebo

Yes

E.8.2.3

Other

E.8.2.4

Number of treatment arms in the trial

E.8.3

The trial involves single site in the Member State concerned

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

E.8.5

The trial involves multiple Member States

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

Information not present in EudraCT

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

Canada

Italy

United States

E.8.7

Trial has a data monitoring committee

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

LVLS

E.8.9 Initial estimate of the duration of the trial

E.8.9.1

In the Member State concerned years

E.8.9.1

In the Member State concerned months

E.8.9.1

In the Member State concerned days

E.8.9.2

In all countries concerned by the trial years

E.8.9.2

In all countries concerned by the trial months

E.8.9.2

In all countries concerned by the trial days

F. Population of Trial Subjects

F.1 Age Range

F.1.1

Trial has subjects under 18

Yes

F.1.1

Number of subjects for this age range:

F.1.1.1

In Utero

F.1.1.2

Preterm newborn infants (up to gestational age < 37 weeks)

F.1.1.3

Newborns (0-27 days)

F.1.1.4

Infants and toddlers (28 days-23 months)

F.1.1.5

Children (2-11years)

Yes

F.1.1.5.1

Number of subjects for this age range:

F.1.1.6

Adolescents (12-17 years)

Yes

F.1.1.6.1

Number of subjects for this age range:

F.1.2

Adults (18-64 years)

Yes

F.1.2.1

Number of subjects for this age range:

F.1.3

Elderly (>=65 years)

Yes

F.1.3.1

Number of subjects for this age range:

F.2 Gender

F.2.1

Female

Yes

F.2.2

Male

Yes

F.3 Group of trial subjects

F.3.1

Healthy volunteers

F.3.2

Patients

Yes

F.3.3

Specific vulnerable populations

Yes

F.3.3.1

Women of childbearing potential not using contraception

F.3.3.2

Women of child-bearing potential using contraception

Yes

F.3.3.3

Pregnant women

F.3.3.4

Nursing women

F.3.3.5

Emergency situation

F.3.3.6

Subjects incapable of giving consent personally

Yes

F.3.3.6.1

Details of subjects incapable of giving consent

Minors. Subjects aged 18 or older incapable of giving consent (the informed consent will be obtained by the patient’s legal guardian)

Minori. Soggetti maggiorenni incapaci di dare il proprio consenso (il consenso informato sarà sottoscritto dal rappresentante legale)

F.3.3.7

Others

F.4 Planned number of subjects to be included

F.4.1

In the member state

F.4.2

For a multinational trial

F.4.2.1

In the EEA

F.4.2.2

In the whole clinical trial

F.5

Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)

The open-label CMS-002 clinical trial will be activated in which the subjects who have shown to benefit from amifampridine phosphate will be enrolled and which will allow the continuity of therapy to the patients who participated in this study (CMS-001).

Sarà attivata la sperimentazione clinica in aperto CMS-002 alla quale potranno partecipare i soggetti che hanno dimostrato di avere beneficio dalla amifampridina fosfato e che potrà consentire la continuità terapeutica ai pazienti che hanno partecipato a questo studio (CMS-001).

G. Investigator Networks to be involved in the Trial

N. Review by the Competent Authority or Ethics Committee in the country concerned

Competent Authority Decision

Authorised

Date of Competent Authority Decision

2019-02-06

Ethics Committee Opinion of the trial application

Favourable

Ethics Committee Opinion: Reason(s) for unfavourable opinion

Date of Ethics Committee Opinion

2018-12-12

P. End of Trial
P.	End of Trial Status	Prematurely Ended

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