E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Pearson and Kearns-Sayre syndrome. |
Sindrome di Pearson e Sindrome di Kearns-Sayre. |
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E.1.1.1 | Medical condition in easily understood language |
Pearson and Kearns-Sayre syndrome. |
Sindrome di Pearson e Sindrome di Kearns-Sayre. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
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 | 10058799 |
E.1.2 | Term | Mitochondrial encephalomyopathy |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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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 | 10058799 |
E.1.2 | Term | Mitochondrial encephalomyopathy |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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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 | 10051403 |
E.1.2 | Term | Mitochondrial DNA deletion |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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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 | 10051403 |
E.1.2 | Term | Mitochondrial DNA deletion |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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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 | 10074070 |
E.1.2 | Term | Mitochondrial encephalopathy |
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 |
To evaluate the clinical effects of folinic acid in patients with PS/KSS syndromes on: disease severity as assessed by the Newcastle Pediatric/Adult Mitochondrial Disease Scale (NPMDS) Sections 1-3 |
Valutare gli effetti clinici dell’acido folinico, in pazienti affetti da sindrome PS/KSS, su: gravità della malattia stabilita tramite il punteggio del questionario Newcastle Pediatric/Adult Mitochondrial Disease Scale (NPMDS/NAMDS) per le sezioni 1-3 |
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E.2.2 | Secondary objectives of the trial |
To evaluate the effects of folinic acid in patients with PS/KSS syndromes on: 1. Neuromuscular function as assessed by: a. 6-minute walk test; b. 30 sec sit to stand test; c. Caregiver burden scale d. New muscle endurance test e. Int Adult Mitoch Disease Sc f. Timed test
2. Quality of life as assessed by: a. PedsQL child-self report b. PedsQL parent-proxy report c. SF-36 for patients> 18 years d. WHO-QOL bref for parents e. Sec. 4 of NPMDS
3. Electrophysio test (VEP/ERG)
4. Disease morbidity and mortality as assessed by: a. Mortality b. Total num of medical encounters c. Total hospitalizations and hospital days d. Weight
5. Metabolomics analysis in blood and urine 6. Glutathione cycle biomarkers in blood 7. Reduced Glutathione (GSH) in the brain 8. Interferon Signature in blood and CSF immunophenotyping
To examine the safety of folinic acid in children with PS/KSS syndromes by examining drug-related adverse and serious adverse events |
Valutare effetti acido folinico in pazienti affetti da sindrome PS/KSS 1.Funz neurouscolare valutata dai seguenti tests: a.Test del cammino di 6 minuti; b.Il sit to stand test di 30 secondi; c.Quest sul grado di impegno del caregiver: d.Nuovo test di resist musc; e.Int Adult Mitochondrial Disease Scale f.Test a tempo.
2. Qual della vita valutata da: a.Quest PedsQL bamb b.Quest PedsQL genit c.Quest SF-36 per il paz maggiore d.Quest breve WHO-QOL per i genitori e.Sez 4 sulla QoL del questionario NPMDS
3. Test elettrofisiologici (VEP/ERG)
4. Morbilità e Mortalità valutate da: a.Mortalità b.N. tot di visite mediche c.N. tot delle ospedalizzazioni e giorni di ospedale d.Peso
5. An. di metabolomica del sangue 6. Biomarker del glutatione nel sangue 7. Gutatione ridotto (GSH) nel cervello 8. Val fima interferonica nel sangue e analisi immunofenotipica nel CSF
Valutare la sicurezza dell’ac folinico attraverso la raccolta e l’analisi delle reazioni avverse, serie e non serie, correlate |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Diagnosis of PS/KSS syndromes with confirmed genetic mutations associated PS/KSS syndromes. Diagnosis will be performed on review of muscle/skin biopsies, presence of mtDNa deletion on mtDNA samples from peripheral blood lymphocytes, urinary tract cells in urine, or muscle (Southern blot, Long PCR, MLPA), quantification of mtDNA deletions by Quantitative PCR. If genetic confirmation and quantification of mtDNA deletion is not available, it will performed at screening • Newcastle Pediatric Mitochondrial Disease Scale score of =15 and = 60 on sections 1-3 • Evidence of disease progression within 12 months preceeding the screening either by NPMDS score or documented evidence of neurologic deterioration • Availability of pre-enrollment brain MRI that confirms the characteristic basal ganglia damage or leukoencephalopathy of PS/KSS syndromes performed within 6 months prior to screening (if brain MRI/MRS is not available, it will performed at screening) • Male or female age 1 to 25 years • Patient or patient’s guardian able to consent and comply with protocol requirements |
a. Diagnosi, geneticamente confermata, delle sindromi PS/KSS. La diagnosi sarà confermata dalla presenza di delezione del mtDNA su campioni di DNA mitocondriale estratto da linfociti del sangue periferico, cellule di sfaldamento del tratto urinario nelle urine, cellule muscolari/fibroblasti da biopsia muscolo-cutanea attraverso tecniche di Southern blot, Long PCR, MLPA e dalla determinazione quantitativa tramite PCR delle delezioni del mtDNA. Se la conferma genetica e la determinazione quantitativa delle delezioni a carico del mtDNA non saranno gia’ disponibili, verranno eseguite alla visita di screening b. Punteggio del questionario NPMDS/NAMDS compreso tra 15 e 60 (inclusi) per le sezioni 1-3 c. Evidenza di progressione delle malattia entro 12 mesi precedenti lo screening, attraverso il punteggio del questionario NPMDS/NAMDS o documentata evidenza di deterioramento neurologico. d. Disponibilità di una risonanza magnetica cerebrale pre-arruolamento che confermi le caratteristiche di danno ai gangli della base o la leucoencefalopatia caratteristica delle sindromi PS/KSS eseguita nei 6 mesi precedenti lo screening (se la risonanza magnetica al cervello non è disponibile, sarà eseguita alla visita di screening) e. Maschio o Femmina di età compresa tra 1 e 25 anni f. Paziente o Genitori del paziente in grado di fornire il proprio consenso scritto e rispettare le procedure previste dal protocollo |
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E.4 | Principal exclusion criteria |
• Allergy to folinic acid • Clinical history of bleeding or abnormal baseline PT, PTT (or aPTT) or INR • Pernicious Anemia, • Hereditary fructose intolerance, glucose / galactose malabsorption syndrome or sucrase-isomaltase deficiency, • Not-mitochondrial Diabetes • Concomitant use of methotrexate • Clinically significant disease, such as, but not limited to, hepatitis C virus (HCV) / human Immunodeficiency virus (HIV) / hepatitis B virus (HBV) / Cancer, that precludes study participation • Diagnosis of any other concurrent inborn error of metabolism • Previous tracheostomy • Ventilator dependent or use of noninvasive ventilatory support within one month of enrollment • Hepatic insufficiency with ALT, AST, Alkaline phosphatase, Total bilirubin grater than two times upper limit of normal • Renal insufficiency requiring dialysis • End stage cardiac failure • Use of anticoagulant medications • Severe end-organ hypo-perfusion syndrome secondary to cardiac failure resulting in lactic acidosis • Pregnancy and breastfeeding women. |
a. Allergia all’acido folinico; b. Storia clinica di sanguinamento o valori basali di PT, PTT (o aPTT) o INR anormali; c. Anemia perniciosa; d. Intolleranza ereditaria al fruttosio, sindrome da malassorbimento del glucosio/galattosio o deficit dell’enzima sucrasi-isomaltasi; e. Diabete non mitocondirale; f. Uso concomitante di Metotrexato; g. Disturbi clinicamente significativi, come, ad esempio (e non limitati a) infezione da virus dell’Epatite C (HCV), virus dell’immunodeficienza umana (HIV) o virus dell’ Epatite B (HBV) o Cancro, che precludano la partecipazione allo studio; diagnosi di qualsiasi altro errore congenito del metabolismo; h. Precedente tracheostomia; i. Sviluppo di dipendenza da ventilazione meccanica o utilizzo di supporti ventilatori non invasivi entro un mese dall’arruolamento; j. Insufficienza epatica con valori dei valori di AST, ALT, Fosfatasi Alcalina e Bilirubina Totale maggiori di due volte il limite superiore di normalità k. Insufficienza renale che richieda dialisi; l. Insufficienza cardiaca allo stadio terminale; m. Uso di farmaci anticoagulanti; n. Grave sindrome da ipo-perfusione multiorgano secondaria a insufficienza cardiaca con acidosi lattica; o. Gravidanza e allattamento. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Newcastle Pediatric Mitochondrial Disease Scale Sections 1-3 |
Sezioni 1-3 del questionario Newcastle Pediatric Mitochondrial Disease Scale/Newcastle Adult Mitochondrial Disease Scale |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
• Weight • Neuromuscular Functional scales (6-minute walk test; 30 seconds sit to stand test; Caregiver burden scale; Grip strength; New muscle endurance test: International Paediatric/Adult Mitochondrial Disease Scale; Timed test) • Newcastle Pediatric/Adult Mitochondrial Disease Scale Section 4 • Glutathione cycle components • Metabolomics analysis in blood and urine • Brain and spinal MRI/MRS • Electrophysiological test (VEP/ERG) • Total hospitalizations and total hospital days • Total number of medical encounters • Mortality • Physical examination with vital signs • Neurological assessment • Routine assessments of AEs and SAEs • Routine serum chemistries with liver function tests, electrolytes, lactate, lipids and blood gas analysis • Routine hematology tests with coagulation tests • Adrenal gland hormone studie • 12-lead ECG, Holter ECG, Ecocardiography |
- Peso - Scala della funzione neuromuscolare (test del cammino di 6 minuti; sit to stand test di 30 secondi; questionario sul grado di impegno del caregiver; forza nella presa; Nuovo test di resistenza muscolare; questionario International Paediatric Mitochondrial Disease Scale; Test a tempo) - Sezione 4 del Newcastle Pediatric/Adult Mitochondrial Disease Scale - Metaboliti del ciclo del glutatione - Analisi metabolomica nel sangue e nelle urine - MRI/MRS cerebrale e spinale - Test elettrofisiologici (VEP/ERG) - Numero totale di ospedalizzazioni e numero di giorni in ospedale - Numero totale di visite mediche - Mortalità - Esame fisico e segni vitali - Valutazione neurologica - Valutazione routinaria di Eventi Avversi seri e non - Chimica clinica nel siero con LFTs, elettroliti, lattato, lipidi e emogas - Studio ormoni delle ghiandole surrenali - Valutazione cardiologica, ECG a 12 derivazioni, Holter ECG, Ecocardiogramma |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | No |
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) | 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) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
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 | Information not present in EudraCT |
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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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 | 36 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 36 |
E.8.9.2 | In all countries concerned by the trial days | 0 |