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    Summary
    EudraCT Number:2021-003094-61
    Sponsor's Protocol Code Number:GWEP20238
    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:2022-05-12
    Trial 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
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2021-003094-61
    A.3Full title of the trial
    A randomized, double-blind, placebo-controlled, multisite, Phase 3 study to investigate the efficacy and safety of cannabidiol oral solution (GWP42003-P) in children and adolescents with epilepsy with myoclonic-atonic seizures
    Studio di Fase 3, randomizzato, in doppio cieco, controllato con placebo, multicentrico, volto a valutare l’efficacia e la sicurezza della soluzione orale di cannabidiolo (GWP42003-P) in bambini e adolescenti affetti da epilessia con crisi mioclonicheatoniche
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A safety and efficacy study of cannabidiol oral solution (GWP42003-P) in children and adolescents with epilepsy between 1 and 18 years of age,
    inclusive
    Studio sulla sicurezza e sull’efficacia della soluzione orale di cannabidiolo (GWP42003-P) in bambini e adolescenti affetti da epilessia di età compresa tra 1 e 18 anni compiuti.
    A.3.2Name or abbreviated title of the trial where available
    Safety and efficacy study of cannabidiol oral solution in children and adolescents with Epilepsy
    Studio sulla sicurezza e sull’efficacia della soluzione orale di cannabidiolo in bambini e adolescen
    A.4.1Sponsor's protocol code numberGWEP20238
    A.5.4Other Identifiers
    Name:IND numberNumber: 120055
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorGW RESEARCH LTD.
    B.1.3.4CountryUnited Kingdom
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportGW Research Ltd
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationGW Research Ltd
    B.5.2Functional name of contact pointGW Research Ltd Switchboard
    B.5.3 Address:
    B.5.3.1Street AddressSovereign House, Vision Park, Chivers Way
    B.5.3.2Town/ cityHiston, Cambridge
    B.5.3.3Post codeCB24 9BZ
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number00441223266800
    B.5.5Fax number00441223235667
    B.5.6E-mailinfo@gwpharm.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Soluzione orale di CBD, conosciuta e approvata in EU come Epidyolex 100mg/ml soluzione orale
    D.2.1.1.2Name of the Marketing Authorisation holderGW Pharma (International) B.V.
    D.2.1.2Country which granted the Marketing AuthorisationEuropean Union
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEMA/OD/0000075999
    D.3 Description of the IMP
    D.3.1Product nameCannabidiol (CBD)
    D.3.2Product code [GWP42003-P]
    D.3.4Pharmaceutical form Oral solution
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNCannabidiolo
    D.3.9.1CAS number 13956-29-1
    D.3.9.2Current sponsor codeGWP42003-P
    D.3.9.4EV Substance CodeSUB26600
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product Yes
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product Yes
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboOral solution
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Epilepsy with myoclonic-atonic seizures
    epilessia con crisi miocloniche-atoniche
    E.1.1.1Medical condition in easily understood language
    Epilepsy with seizures
    epilessia con convulsioni
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10081179
    E.1.2Term Epilepsy with myoclonic-atonic seizures
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    PART A:To evaluate the efficacy of GWP42003-P compared with placebo in reducing the frequency of EMAS-associated seizures

    PARTB: To evaluate the long-term safety and tolerability of GWP42003-P in participants with EMAS
    Parte A: Valutare l’efficacia di GWP42003-P rispetto al placebo nel ridurre la frequenza delle crisi associate all’EMAS.

    Parte B: Valutare la sicurezza e la tollerabilità a lungo termine di GWP42003-P nei partecipanti con EMAS
    E.2.2Secondary objectives of the trial
    PART-A
    1.To evaluate the rate of treatment response to GWP42003-P compared with placebo in reducing the frequency of EMAS-associated seizures
    2.To evaluate the effect of GWP42003-P in reducing the frequency of all seizure types compared with placebo
    3.To evaluate the effect of GWP42003-P compared with placebo on caregiver impression of change
    4.To evaluate the effect of GWP42003-P compared with placebo on physician impression of change
    5.To evaluate the effect of GWP42003-P compared with placebo on additional antiepileptic measures from daily seizure diaries
    6.To evaluate the safety and tolerability of GWP42003-P compared with placebo

    Part B
    1.To evaluate long-term effect of GWP42003-P on EMAS-associated seizure frequency
    2.To evaluate long-term effect of GWP42003-P on additional measures
    Parte A:
    1. Valutare il tasso di risposta al trattamento con GWP42003-P rispetto al placebo nel ridurre la frequenza delle crisi associate all’EMAS
    2. Valutare l’effetto di GWP42003-P nel ridurre la frequenza di tutti i tipi di crisi rispetto al placebo
    3.Valutare l’effetto di GWP42003-P rispetto al placebo mediante l’impressione del cambiamento da parte del caregiver
    4. Valutare l’effetto di GWP42003-P rispetto al placebo mediante l’impressione del cambiamento daparte del medico
    5. Valutare l’effetto di GWP42003-P rispetto al placebo su ulteriori misure antiepilettiche dai diari delle crisi giornaliere
    6.Valutare la sicurezza e la tollerabilità di GWP42003-P rispetto al placebo

    Parte B:
    1. Valutare l’effetto a lungo termine di GWP42003-P sulla frequenza delle crisi associate all’EMAS
    2. Valutare l’effetto a lungo termine di GWP42003-P su misure aggiuntive
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Participants are eligible to be included in the study only if ALL of the following criteria apply:
    Age and Sex
    1. Participant must be male or female between 1 and 18 years of age, inclusive, at the time of initial informed consent/assent.
    Type of Participant
    2. Participant has a current diagnosis of EMAS, also known as Doose syndrome, myoclonic-astatic epilepsy, or myoclonic-atonic epilepsy, consistent with the ILAE guidelines. Presence of myoclonic-atonic seizures is mandatory to support a diagnosis of EMAS as determined by medical history and independent approval by TESC.
    3. Participant experiences a minimum average frequency of = 2 TESC-approved, countable, EMAS-associated seizures (myoclonic-atonic, atonic, tonic, clonic, or tonic-clonic) per week (at least 8 seizures per month), as reported in the baseline seizure eDiary from baseline (Part A Visit 2) until the evening prior to randomization (Part A Visit 3). At least 1 myoclonic-atonic seizure is mandatory and must be
    observed during the baseline period.
    4. Participant’s initial seizure onset occurred from = 6 months to < 6 years of age, with normal or mildly impaired/delayed neurodevelopment reported prior to onset of seizures. During the first year of seizure onset, the majority of seizures experienced by the participant were myoclonic-atonic seizures or generalized tonic-clonic seizures as determined by medical history.
    5. Participant is currently treated with 1 or more AEDs on a stable regimen (= 28 days prior to starting the baseline period [Part A Visit 2]) or on a stable ketogenic diet(= 3 months prior to starting the baseline period [Part A Visit 2]) and no changes to treatment are planned for the duration of the study.
    6. Participant is refractory to anticonvulsant medication and failed at least 1 AED(e.g., valproic acid, clobazam, clonazepam, and levetiracetam) at therapeutic doses.
    7. Participant is able to provide a historical EEG report, which was performed within 12 months of screening (Part A Visit 1), or is willing to complete an EEG at screening(Part A Visit 1), that confirms a 3 to 6 Hz generalized spike-and-slow-wave or polyspike-and-slow-wave pattern.
    Sex and Contraceptive/Barrier Requirements
    8. Contraceptive use by male and female participants should be consistent with Clinical Trial Facilitation Group guidelines and any applicable local regulations regarding the methods of contraception for those participating in clinical studies.
    Male participants:
    o Fertile male participants with partners of CBP must be willing to use a male barrier method of contraception in addition to a second method of acceptable contraception used by their female of CBP partners, from the time of screening (Part A Visit 1) until 3 months after the follow-up visit, as detailed in Section 10.5 (Appendix 5).
    Female participants of CBP:
    o Will not be pregnant or lactating and have a confirmed negative highly sensitive
    serum pregnancy test at screening (Part A Visit 1).
    o Must also have a confirmed negative urine pregnancy test prior to receiving their first dose of blinded IMP at Part A Visit 3.
    o Who are continuing to Part B must have a confirmed negative urine pregnancy test prior to receiving their first dose of open-label GWP42003-P at Part B Visit 1.
    o Must be willing to use a highly effective method of contraception from the time of signing the ICF until 3 months after the follow-up visit, as detailed in Section 10.5 (Appendix 5).
    Informed Consent/Assent
    9. Participant or participant’s caregiver(s) (according to local laws) is/are willing and able to give signed informed consent/assent for participation in the study including compliance with the requirements and restrictions listed in the ICF and in
    Section 10.2.3.
    10. Participant’s caregiver(s) are willing to allow the responsible authorities to be notified of participation in the study, if mandated by local law.
    ............................
    I partecipanti sono idonei a essere inclusi nello studio solo se risultano soddisfatti
    TUTTI i seguenti criteri:
    Età e sesso
    1. Il/La partecipante deve essere di sesso maschile o femminile e avere un’età compresa tra 1 e 18 anni al momento del consenso/dell’assenso informato iniziale.
    Tipo di partecipante
    2. Il/La partecipante presenta una diagnosi corrente di EMAS, nota anche come sindrome di Doose, epilessia mioclono-astatica o epilessia mioclono-atonica, in conformità alle
    linee guida della Lega internazionale contro l’epilessia (International League Against Epilepsy, ILAE). La presenza di crisi convulsive mioclono-atoniche è obbligatoria per
    supportare una diagnosi di EMAS in base all’anamnesi medica e all’approvazione indipendente da parte del Consorzio di studio sull'epilessia (The Epilepsy Study
    Consortium, TESC).
    3. Il/La partecipante presenta una frequenza media minima di >= 2 crisi convulsive numerabili associate a EMAS e approvate dal TESC (mioclono-atoniche, atoniche, toniche,
    cloniche o tonico-cloniche) alla settimana (almeno 8 convulsioni al mese), come riportato nel diario elettronico delle crisi convulsive al basale, dal basale (Parte A
    Visita 2) fino alla sera precedente la randomizzazione (Parte A Visita 3). Almeno 1 crisi convulsiva mioclono-atonica è obbligatoria e deve essere osservata durante il
    periodo basale.
    4. L’insorgenza iniziale delle crisi convulsive del/la partecipante si è verificata da >=6 mesi a <6 anni di età, con neurosviluppo normale o lievemente compromesso/ritardato
    riferito prima dell’insorgenza delle crisi convulsive. Durante il primo anno di insorgenza delle crisi convulsive, la maggior parte delle crisi convulsive manifestate dal/la
    partecipante sono state crisi convulsive mioclono-atoniche o crisi convulsive tonicocloniche generalizzate, come determinato dall’anamnesi medica.
    5. Il/La partecipante viene attualmente trattato/a con 1 o più farmaci antiepilettici (AED) a regime stabile (>=28 giorni prima dell’inizio del periodo basale [Parte A Visita
    2]) o segue una dieta chetogenica stabile (>=3 mesi prima di iniziare il periodo basale [Parte A Visita 2]) e non sono previste modifiche al trattamento per la durata dello studio.
    6. Il/La partecipante è refrattario/a ai medicinali anticonvulsivanti e ha risposto negativamente ad almeno 1 AED (ad es. acido valproico, clobazam, clonazepam e
    levetiracetam) a dosi terapeutiche.
    7. Il/La partecipante è in grado di fornire un referto di elettroencefalogramma (EEG) storico, eseguito nei 12 mesi prima dello screening (Parte A Visita 1), oppure è
    disposto/a a sottoporsi a un EEG allo screening (Parte A Visita 1), che conferma un pattern generalizzato punta-onda lenta o polipuntaonda lenta da 3 a 6 Hz.
    Requisiti relativi ai rapporti sessuali e alla contraccezione
    8. L’uso di contraccettivi da parte dei partecipanti di sesso maschile e femminile deve essere in linea con le linee guida del Gruppo di facilitazione delle sperimentazioni
    cliniche e con qualsiasi normativa locale applicabile riguardante i metodi contraccettivi per i partecipanti agli studi clinici.
    Partecipanti di sesso maschile:
    o I partecipanti di sesso maschile fertili con partner di sesso femminile in età fertile devono essere disposti a usare un metodo barriera di contraccezione maschile in aggiunta
    a un secondo metodo di contraccezione accettabile utilizzato dalle loro partner di sesso femminile in età fertile, dallo screening (Parte A Visita 1) fino a 3 mesi dopo la
    visita di follow-up, come descritto in dettaglio nella Sezione 10.5 (Appendice 5).
    Partecipanti di sesso femminile in età fertile:
    o Non devono essere incinta né allattare al seno e devono avere un test di gravidanza sul siero altamente sensibile negativo confermato allo screening (Parte A Visita 1).
    ..................................................
    E.4Principal exclusion criteria
    Participants are excluded from the study if ANY of the following criteria apply:
    Medical Conditions
    1. Has a history of psychogenic non-epileptic seizures that confounds the assessment of the primary efficacy measure.
    2. Has clinically significant unstable medical condition(s), other than EMAS.
    3. Has a clinically significant illness in the 28 days prior to screening (Part A Visit 1) or randomization (Part A Visit 3), other than epilepsy, which in the opinion of the investigator could affect seizure frequency.
    4. Has presence of focal seizures or persistent focal epileptiform discharges on EEG.
    5. Has a history of infantile spasms.
    6. Has moderate to severe neurocognitive and/or developmental delay prior to seizure onset.
    7. Has a progressive neurological condition.
    8. Has known or suspected hypersensitivity to cannabinoids or any of the excipients of GWP42003-P such as sesame oil.
    9. Is unwilling or unable to remain stable on concurrent AEDs throughout the study.
    10. Has, in the opinion of the investigator, clinically significant abnormalities in the ECG measured at screening (Part A Visit 1), or any concurrent cardiovascular conditions, which will interfere with the ability to read their ECGs.
    11. Has significantly impaired hepatic function at the screening visit (Part A Visit 1) or prior to dosing, defined as any of the following:
    o ALT or AST > 5 × ULN
    o TBL (serum total bilirubin) = 2 × ULN or INR > 1.5 (TBL = 2 × ULN exclusion will not apply for participants diagnosed with Gilbert’s disease).
    o Serum ALT or AST = 3 × ULN with the presence of fatigue, nausea, vomiting, right upper quadrant pain or tenderness, fever, rash, and/or eosinophilia (> 5%).
    o Elevated ALT or AST at screening (Part A Visit 1), should be discussed with the medical monitor prior to randomization (Part A Visit 3); the medical monitor may allow for a confirmatory re-draw prior to randomization.
    This criterion can only be confirmed once the laboratory results are available.
    12. Has clinically significant impaired renal function at screening (Part A Visit 1), as evidenced by an estimated creatinine clearance < 60 mL/min.
    13. Is a female participant of CBP, who is pregnant (positive pregnancy test), lactating or planning pregnancy during the course of the study and for 3 months thereafter.
    14. Participant has any known or suspected history of alcohol or substance abuse.
    15. Any clinically significant abnormalities identified following a physical examination or laboratory assessments of the participant that, in the opinion of the investigator, would jeopardize the safety of the participant if they take part in the study.
    16. Participant has any other clinically significant disease or disorder which, in the opinion of the investigator, may either put the participant, other participants, or site staff at risk because of participation in the study, may influence the result of the study, or may affect the participant’s ability to take part in the study.
    Prior Therapy
    17. Has previously been treated with Epidiolex/Epidyolex® or experienced a lack of efficacy and/or poor tolerability to an adequate treatment study with GWP42003-P based on medical history and per the clinical judgment of the investigator.
    18. Has a change in anticonvulsant therapies within 28 days of starting the baseline period (Part A Visit 2), including AEDs or settings on vagal nerve stimulator.
    19. Has any planned clinical interventions or intends to change any or all medications that may impact seizures during the study.
    20. Has been treated with a general anesthetic in the 28 days prior to screening (Part A Visit 1) or randomization (Part A Visit 3).
    ...........................
    I partecipanti vengono esclusi dallo studio se risulta soddisfatto UNO QUALSIASI dei seguenti criteri:
    Condizioni mediche
    1. Anamnesi di crisi psicogene non epilettiche, che confonde la valutazione della misura di efficacia primaria.
    2. Presenza di una o più condizioni mediche instabili clinicamente significative diverse dall’EMAS.
    3. Presenza di una malattia clinicamente significativa nei 28 giorni precedenti lo screening (Parte A Visita 1) o la randomizzazione (Parte A Visita 3) diversa
    dall’epilessia, che a giudizio dello sperimentatore potrebbe compromettere la frequenza delle crisi convulsive.
    4. Presenza di crisi convulsive focali o di scariche epilettiformi focali persistenti all’EEG.
    5. Anamnesi di spasmi infantili.
    6. Ritardo neurocognitivo e/o dello sviluppo da moderato a grave prima dell’insorgenza delle crisi convulsive.
    7. Condizione neurologica progressiva.
    8. Ipersensibilità nota o sospetta ai cannabinoidi o a uno qualsiasi degli eccipienti di GWP42003-P, come l’olio di sesamo.
    9. Il soggetto non è disposto a o non è in grado di utilizzare stabilmente AED concomitanti per tutta la durata dello studio.
    10. Secondo il giudizio dello sperimentatore, il soggetto presenta anomalie clinicamente significative nell’elettrocardiogramma (ECG) misurate allo screening (Parte A Visita 1)
    o eventuali condizioni cardiovascolari concomitanti che potrebbero interferire con la capacità di leggere gli ECG.
    11. Funzionalità epatica significativamente compromessa alla visita di screening (Parte A Visita 1) o prima della somministrazione, definita come una qualsiasi delle seguenti condizioni:
    o Alanina transaminasi (ALT) o aspartato transaminasi (AST) >5 volte il limite superiore della norma (ULN)
    o TBL (concentrazione sierica di bilirubina totale) >= 2 volte l’ULN o rapporto normalizzato internazionale (INR) >1,5 (il criterio di esclusione relativo a TBL >=2
    volte l’ULN non si applica a partecipanti con diagnosi di malattia di Gilbert).
    o ALT o AST nel siero >= 3 volte l’ULN con presenza di affaticamento, nausea, vomito, dolore o indolenzimento nel quadrante superiore destro, febbre, eruzione cutanea e/o eosinofilia (>5%).
    o I livelli elevati di ALT o AST allo screening (Parte A Visita 1) devono essere discussi con il responsabile del monitoraggio medico prima della randomizzazione (Parte A Visita 3); il responsabile del monitoraggio medico può consentire un nuovo prelievo di conferma prima della randomizzazione.
    Questo criterio può essere confermato solo quando i risultati di laboratorio saranno disponibili.
    12. Insufficienza renale clinicamente significativa allo screening (Parte A Visita 1), come evidenziato da una clearance della creatinina stimata <60 ml/min.
    13. Soggetto di sesso femminile in età fertile incinta (test di gravidanza positivo), che allatta al seno o che sta pianificando una gravidanza nel corso dello studio e per i successivi 3 mesi.
    14. Il/La partecipante presenta un’anamnesi nota o sospetta di abuso di alcol o sostanze.
    15. Qualsiasi anomalia clinicamente significativa identificata a seguito di un esame obiettivo o di valutazioni di laboratorio del/la partecipante che, a giudizio dello
    sperimentatore, potrebbe compromettere la sicurezza del soggetto in caso di partecipazione allo studio.
    16. Il/La partecipante presenta qualsiasi altra malattia o disturbo clinicamente significativi che, a giudizio dello sperimentatore, potrebbe mettere a rischio il/la
    partecipante, altri partecipanti o il personale del centro a causa della partecipazione allo studio, potrebbe influenzare il risultato dello studio o influire sulla capacità
    del/la partecipante di partecipare allo studio.
    Terapia precedente
    17. Il soggetto è stato precedentemente trattato con Epidiolex/Epidyolex® o ha presentato una mancanza di efficacia e/o scarsa tollerabilità a uno studio di trattamento adeguato con GWP42003-P in base all’anamnesi medica e al giudizio clinico dello sperimentatore.
    .....................................
    E.5 End points
    E.5.1Primary end point(s)
    Part-A
    EMAS-associated seizure frequency (myoclonic-atonic, atonic, tonic, clonic, or tonic-clonic) over the 14-week treatment period

    Part-B
    • Frequency of TEAEs over the 48-week treatment period
    • Laboratory tests
    • Vital signs
    • Physical examination procedures
    • ECG
    • Tanner Staging
    • Change in:
    o C-SSRS ideation score
    o Number of suicide attempts in the
    C-SSRS
    Parte A:
    Frequenza delle crisi associate all’EMAS (miocloniche-atoniche, atoniche, toniche, cloniche o tonico-cloniche) durante il periodo di trattamento di 14 settimane.

    Parte B:
    • Frequenza dei TEAE durante il periodo di trattamento di 48 settimane
    • Esami di laboratorio
    • Parametri vitali
    • Procedure dell’esame obiettivo
    • ECG
    • Stadiazione di Tanner
    • Variazione nel:
    o punteggio di ideazione C-SSRS
    o numero di tentativi di suicidio nella C-SSRS
    E.5.1.1Timepoint(s) of evaluation of this end point
    Throughout the study, see the Schedule of Activities in the study protocol.
    Durante lo studio, si prega di consultare la Pianificazione delle Attività nel protocollo di studio.
    E.5.2Secondary end point(s)
    Part-A

    Key secondary:
    • Proportion of participants who achieve = 50% reduction from baseline in EMAS-associated seizures over the 14-week treatment-period
    • Total seizure frequency over the 14-week treatment period
    • CGIC score at Week 14

    Secondary:
    • PGIC score at Week 14
    •Proportion of participants who achieve = 25%, = 50%, = 75%, and 100% reduction from baseline in total seizures over the 14-week treatment period
    • Change from baseline in number of EMAS-associated seizure-free days over the 14-week treatment period
    • Proportion of participants with at least 25% and 50% reductions in the number of days per week with myoclonic seizures during the treatment period
    • Time to baseline seizure frequency.
    • Frequency of TEAEs over the 14-week treatment period
    • Laboratory tests
    • Vital signs
    • Physical examination procedures
    • ECG
    • Tanner Staging
    • Change in:
    o C-SSRS ideation score
    o Number of suicide attempts in the C-SSRS

    Part-B
    Key secondary:
    • EMAS-associated seizure frequency (myoclonic-atonic, atonic, tonic, clonic, or tonic-clonic)
    • Proportion of participants achieving = 50% reduction in EMAS-associated seizures
    • Total seizure frequency

    Secondary:
    • CGIC score
    • PGIC score
    • Proportion of participants who achieve = 25%, = 50%, = 75%, and 100% reduction in total seizures from baseline
    • Change from baseline in number of EMAS-associated seizure-free days
    • Proportion of patients with at least 25% and 50% reduction in the number of days per week with myoclonic seizures
    Parte A:
    secondari principali:
    • Percentuale di partecipanti che raggiungono una riduzione >=50% dal basale delle crisi associate all’EMAS durante il periodo di trattamento di 14 settimane
    • Frequenza delle crisi totali durante il periodo di trattamento di 14 settimane
    • Punteggio CGIC alla Settimana 14
    Secondari:
    • Punteggio PGIC alla Settimana 14
    • Percentuale di partecipanti che raggiunge una riduzione >= 25%, >= 50%, >= 75% e = 100% dal basale delle crisi totali durante il periodo di trattamento di 14 settimane
    • Variazione dal basale nel numero di giorni liberi da crisi associate all’EMAS durante il periodo di trattamento di 14 settimane
    • Percentuale di partecipanti con almeno il 25% e il 50% di riduzione nel numero di giorni per settimana con crisi miocloniche durante il periodo di trattamento
    • Tempo alla frequenza delle crisi al basale
    • Frequenza TEAE durante il periodo di trattamento di 14 settimane
    • Esami di laboratorio
    • Parametri vitali
    • Procedure dell’esame obiettivo
    • Elettrocardiogramma (ECG) a 12 derivazioni
    • Stadiazione di Tanner
    • Variazione nel:
    o punteggio dell’ideazione CSSRS
    o numero di tentativi di suicidio nella C-SSRS
    Parte B:
    Secondi principali:
    • Frequenza delle crisi associate all’EMAS (miocloniche-atoniche, atoniche, toniche, cloniche o tonico-cloniche)
    • Percentuale di partecipanti che ottengono una riduzione >=50% delle crisi associate all’EMAS
    • Frequenza delle crisi totali
    Secondari:
    • Punteggio CGIC
    • Punteggio PGIC
    • Percentuale di partecipanti che raggiungono una riduzione >= 25%, >= 50%, >= 75% e del 100% delle crisi totali rispetto al basale
    • Variazione rispetto al basale del numero di giorni senza crisi associate all’EMAS
    • Percentuale di pazienti con una riduzione di almeno il 25% e il 50% nel numero di giorni della settimana con crisi miocloniche
    E.5.2.1Timepoint(s) of evaluation of this end point
    Throughout the study, see the Schedule of Activities in the study protocol.
    Durante lo studio, si prega di consultare la Pianificazione delle Attività nel protocollo di studio.
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others Yes
    E.6.13.1Other scope of the trial description
    Genetics Assessment
    In Part A, samples for epilepsy gene panel analysis will be collected at the time point indicated in the SoA (Section 1.3), if the participant/caregiver/legal representative provides consent/assent.
    Participation is optional. Participants who do not wish to participate in the genetic research may still participate in the study.
    Valutazione genetica Nella Parte A, i campioni per l'analisi del pannello genico dell'epilessia saranno raccolti nel momento indicato nella SoA (Sezione 1.3), se il partecipante/caregiver/rappresentante legale fornisce il consenso/assenso. La partecipazione è facoltativa. I partecipanti che non desiderano partecipare alla ricerca genetica possono comunque partecipare allo studio.
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA8
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Australia
    United States
    Italy
    United Kingdom
    E.8.7Trial 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
    The end of the study is defined as the date of the last participant’s final completed scheduled visit or last completed study assessment, whichever occurs last.
    La fine dello studio è definita come la data dell'ultima visita programmata completata dell'ultimo partecipante o dell'ultima valutazione dello studio completata, a seconda di quale evento si verifica per ultimo.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years3
    E.8.9.1In the Member State concerned months8
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years3
    E.8.9.2In all countries concerned by the trial months8
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 Yes
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) Yes
    F.1.1.5.1Number of subjects for this age range: 90
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 120
    F.1.2Adults (18-64 years) No
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally Yes
    F.3.3.6.1Details of subjects incapable of giving consent
    caregivers can give consent
    i caregivers possono dare il consenso
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state15
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 24
    F.4.2.2In the whole clinical trial 240
    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)
    none
    nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2022-09-26
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-07-05
    P. End of Trial
    P.End of Trial StatusPrematurely Ended
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