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    Summary
    EudraCT Number:2021-005387-22
    Sponsor's Protocol Code Number:ACP-103-069
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2022-02-03
    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 ConcernedSpain - AEMPS
    A.2EudraCT number2021-005387-22
    A.3Full title of the trial
    A Phase 2, Randomized, Double-blind, Placebo-controlled Study to Evaluate the Efficacy and Safety of Pimavanserin for the Treatment of Irritability Associated With Autism Spectrum Disorder
    Estudio de fase II, aleatorizado, doble ciego y controlado con placebo para evaluar la eficacia y la seguridad de la pimavanserina para el tratamiento de la irritabilidad asociada al trastorno del espectro autista.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to evaluate the efficacy and safety of Pimavanserin for the treatment of irritability associated with Autism Spectrum Disorder
    Un estudio para evaluar la eficacia y la seguridad de Pimavanserina para el tratamiento de la irritabilidad asociada al trastorno del espectro autista.
    A.4.1Sponsor's protocol code numberACP-103-069
    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 SponsorAcadia Pharmaceuticals Inc.
    B.1.3.4CountryUnited States
    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 supportAcadia Pharmaceuticals Inc
    B.4.2CountryUnited States
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAcadia Pharmaceuticals Inc.
    B.5.2Functional name of contact pointReg Affairs (Chelsea Gavilanes)
    B.5.3 Address:
    B.5.3.1Street Address12830 El Camino Real, Suite 400
    B.5.3.2Town/ citySan Diego, CA
    B.5.3.3Post code92130
    B.5.3.4CountryUnited States
    B.5.4Telephone number0018582612765
    B.5.6E-mailcgavilanes@acadia-pharm.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 No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePimavanserin
    D.3.2Product code ACP-103
    D.3.4Pharmaceutical form Capsule
    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 INNPimavanserin
    D.3.9.1CAS number 706782-28-7
    D.3.9.2Current sponsor codepimavanserin ACP-103
    D.3.9.3Other descriptive namePIMAVANSERIN TARTRATE
    D.3.9.4EV Substance CodeSUB128275
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    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 No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    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 No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePimavanserin
    D.3.2Product code ACP-103
    D.3.4Pharmaceutical form Capsule
    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 INNPimavanserin
    D.3.9.1CAS number 706782-28-7
    D.3.9.2Current sponsor codepimavanserin ACP-103
    D.3.9.3Other descriptive namePIMAVANSERIN TARTRATE
    D.3.9.4EV Substance CodeSUB128275
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    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 No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    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 No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namePimavanserin
    D.3.2Product code ACP-103
    D.3.4Pharmaceutical form Capsule
    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 INNPimavanserin
    D.3.9.1CAS number 706782-28-7
    D.3.9.2Current sponsor codepimavanserin ACP-103
    D.3.9.3Other descriptive namePIMAVANSERIN TARTRATE
    D.3.9.4EV Substance CodeSUB128275
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number34
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    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 No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    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 placeboCapsule
    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
    Treatment of irritability associated with autistic disorder in children and adolescents with ASD
    Tratamiento de la irritabilidad asociada al trastorno autista en niños y adolescentes con TEA.
    E.1.1.1Medical condition in easily understood language
    Treatment of irritability associated with autistic disorder in children and adolescents with ASD
    Tratamiento de la irritabilidad asociada al trastorno autista en niños y adolescentes con TEA.
    E.1.1.2Therapeutic area Psychiatry and Psychology [F] - Mental Disorders [F03]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 21.1
    E.1.2Level PT
    E.1.2Classification code 10063844
    E.1.2Term Autism spectrum disorder
    E.1.2System Organ Class 10037175 - Psychiatric disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Primary efficacy objective
    • To evaluate the efficacy of pimavanserin compared with placebo in the treatment of irritability associated with ASD in children and adolescents
    Safety objective
    • To evaluate the safety and tolerability of pimavanserin compared with placebo in the treatment of irritability associated with ASD in children and adolescents
    Pharmacokinetic objective
    • To characterize the pharmacokinetics (PK) of pimavanserin in children and adolescents with ASD
    Pharmacokinetic/pharmacodynamic objective
    • To characterize the pharmacokinetic/ pharmacodynamic (PK/PD) relationship of pimavanserin for the treatment of irritability associated with ASD in children and adolescents
    Objetivo principal de eficacia
    • Evaluar la eficacia de la pimavanserina en comparación con el placebo para el tratamiento de la irritabilidad asociada al TEA en niños y adolescentes.
    Objetivo de seguridad
    • Evaluar la seguridad y la tolerabilidad de la pimavanserina en comparación con el placebo para el tratamiento de la irritabilidad asociada al TEA en niños y adolescentes.
    Objetivo de farmacocinética
    • Caracterizar la farmacocinética (FC) de la pimavanserina en niños y adolescentes con TEA.
    Objetivo de farmacocinética/farmacodinámica
    • Caracterizar la relación farmacocinética/farmacodinámica (FC/FD) de la pimavanserina para el tratamiento de la irritabilidad asociada al TEA en niños y adolescentes.
    E.2.2Secondary objectives of the trial
    Secondary objectives
    • To evaluate the efficacy of pimavanserin compared with placebo, in both the treatment of non irritability symptoms, magnitude of improvement in irritability and the response rate in children and adolescents with ASD.
    Objetivos secundarios
    • Evaluar la eficacia de la pimavanserina en comparación con el placebo, en el tratamiento de los síntomas diferentes de la irritabilidad, en la magnitud de la mejora de la irritabilidad y en el índice de respuesta, en niños y adolescentes con TEA.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    Study Population
    1. Is a male or female 5 through 17 years of age at Screening and Baseline visits
    2. Is within the 5th to 95th percentile for gender specific weight for-age and height-for-age growth charts from the National Center for Health Statistics
    3. Informed consent prior to the conduct of any study procedures is required as follows:
    a. The subject should provide written or oral assent if deemed able by the Investigator. The process of obtaining informed consent will be conducted in accordance with institutional review board (IRB) or ethics committee (EC) policy and applicable local law.
    b. The subject’s parent/legally acceptable representative (LAR) (who serves as a caregiver) must provide written consent. The subject’s parent/LAR must be considered reliable by the Investigator, able to complete assessments regarding the subject’s development and behavior throughout the study, and able to help ensure compliance with study treatment, study visits, and protocol procedures
    4. In the Investigator’s opinion, the subject to the best of his/her ability and parent/LAR are able to understand the nature of the study, follow protocol requirements, and be willing to comply with study drug administration requirements
    5. Is able to swallow the test placebo capsule without difficulty during the Screening visit
    6. Has a mental age of ≥2 years as determined by Investigator based upon school evaluation social history or medical records documented at any time before or at Screening
    Psychiatric Diagnosis and Concomitant Medications
    7. Meets Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for a primary diagnosis of ASD (APA 2013) and the diagnosis is confirmed by the Autism Diagnostic Interview–Revised (ADI-R)
    8. Has a score ≥18 on the Irritability subscale of the Aberrant Behavior Checklist (ABC) at Screening and Baseline. If the ABC-Irritability score at Baseline exceeds ≥20% improvement from Screening, the patient will not be randomized and will be withdrawn from the study.
    9. Has a score ≥4 (moderate or greater severity) on the Clinical Global Impression–Severity (CGI-S) of irritability score at Screening and Baseline
    10. Has no current comorbid psychiatric disorder other than attention-deficit hyperactivity disorder (ADHD), or anxiety disorder
    11. Is drug-naïve to antipsychotic treatment (including prior antipsychotic treatment, approved or off-label, of less than 2 weeks for any reason), or had prior lack of tolerability to adequate dose of any duration of antipsychotic confirmed by caregiver and medical records review when available
    12. Has been discontinued from previous treatments for irritability associated with ASD and washed out for at least 5 drug half-lives prior to Baseline
    13. Is able to discontinue all prohibited concomitant medications to meet protocol requirements prior to and during the study period (for further information see Appendix A and Appendix B). Investigators should not withdraw a subject’s medication solely for the purpose of enrolling them into the study unless discontinuation of the medication is deemed to be clinically appropriate (e.g., symptoms are not well controlled or the subject cannot tolerate the current medication)
    14. If subject is undergoing concurrent behavioral therapy for autism related symptoms or behaviors, this non pharmacological treatment regimen has been stable for at least 4 weeks prior to Screening, and will be consistent throughout the study
    15. Is judged by the Investigator to be clinically stable (i.e., no psychiatric hospitalization, unless it took place exclusively for social reasons, within 12 weeks prior to Screening) and not at imminent risk of suicide or injury to self, others, or property
    Contraceptives
    16. Female subjects who participate in this study must either be unable to become pregnant (e.g., premenarchal, surgically sterile, etc.) - OR- agree to use a highly effective non-hormonal method of contraception (e.g., intrauterine device, condom or diaphragm with spermicides, or contraceptive sponge) from 28 days before Baseline to 45 days after last dose (if subject does not roll over into the open-label extension study). Females of childbearing potential must have a negative serum human chorionic gonadotropin (hCG) pregnancy test at Screening and a negative urine hCG pregnancy test at Baseline.
    Población del estudio
    1. Varón o una mujer de 5 a 17 años en las visitas de preselección e inicial
    2.Entre el percentil 5 y el 95 de las tablas de aumento de peso para la edad y de estatura para la edad según el Centro Nacional de Estadísticas Sanitarias
    3.Consentimiento informado antes de realizar cualquier procedimiento del estudio, como se indica a continuación:
    a.El paciente debe dar su consentimiento por escrito o verbal si el Investigador lo considera capaz. Se llevará a cabo de acuerdo con la política del Consejo de Revisión Institucional(CRI) o del Comité de Ética(CE) y la legislación local aplicable
    b.El progenitor/representante legal(RL) del paciente debe prestar su consentimiento por escrito. El Investigador debe considerar que el progenitor/RL del paciente es fiable, capaz de realizar evaluaciones sobre la evolución y la conducta del paciente a lo largo del estudio, y capaz de ayudar a garantizar el cumplimiento del tratamiento, las visitas del estudio y los procedimientos del protocolo
    4.En opinión del Investigador, el paciente, en la medida de lo posible y el progenitor/RL son capaces de entender la naturaleza del estudio, seguir los requisitos del protocolo y estar dispuestos a cumplir los requisitos de administración del medicamento del estudio.
    5.Es capaz de tragar la cápsula de placebo de prueba sin dificultad durante la visita de preselección
    6.Tiene una edad mental de ≥2 años según lo determinado por el Investigador basándose a la evaluación escolar, los antecedentes sociales o la historia clínica, documentados en cualquier momento antes o durante la preselección.
    Diagnóstico psiquiátrico y medicamentos concurrentes
    7.Cumple los criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales, Quinta Edición (DSM-5) para un diagnóstico primario de TEA (APA 2013) y el diagnóstico se confirma mediante la entrevista para el diagnóstico del autismo-revisada (EDA-R).
    8.Tiene una puntuación ≥18 en la subescala de irritabilidad de la escala de conductas anómalas (ECA) en la preselección y en la situación inicial. Si la puntuación de irritabilidad de la ECA en la situación inicial supera ≥20 % de mejoría con respecto a la preselección, no se aleatorizará al paciente y será considerado fallo de preselección
    9.Tiene una puntuación ≥4 (intensidad moderada o mayor) en la puntuación de la impresión clínica global-intensidad (ICG-I) de la irritabilidad en la preselección y en la situación inicial
    10.No tiene ningún trastorno psiquiátrico concurrente que no sea el trastorno por déficitde atención con hiperactividad (TDAH) o un trastorno de ansiedad
    11.No ha recibido ningún tratamiento antipsicótico previo (NI ha recibido un tratamiento antipsicótico de menos de 2 semanas por cualquier motivo), NI ha presentado falta de tolerancia anterior a una dosis adecuada de un antipsicótico de cualquier duración, confirmada por el cuidador y la revisión de la historia clínica, cuando esté disponible
    12.Se le han suspendido tratamientos anteriores para la irritabilidad asociada al TEA y se ha sometido a reposo farmacológico durante al menos 5 semividas del fármaco antes del inicio
    13.Es capaz de suspender todos los medicamentos concurrentes prohibidos para cumplir los requisitos del protocolo antes y durante el período del estudio (para más información, véase el apéndice A y el apéndice B). Los investigadores no deben retirar la medicación de un paciente con el único objeto de incluirle en el estudio, a menos que la interrupción de la medicación se considere clínicamente adecuada (por ejemplo, los síntomas no están bien controlados o el paciente no tolera la medicación actual)
    14.Si el paciente está recibiendo psicoterapia conductual simultánea para los síntomas o conductas relacionados con el autismo, este tratamiento no farmacológico ha sido estable durante al menos 4 semanas antes de la preselección y será constante a lo largo del estudio
    15.El Investigador considera que está clínicamente estable (es decir, que no ha sido hospitalizado por motivos psiquiátricos, a menos que lo haya sido exclusivamente por razones sociales, en las 12 semanas anteriores a la preselección) y que no corre un riesgo inminente de suicidio o de autolesionarse, lesionar a otros o causar daños a la propiedad.
    Anticoncepción
    16. Las mujeres que participen en este estudio deben ser incapaces de quedarse embarazadas (por ejemplo, premenárquicas, quirúrgicamente estériles, etc.) o aceptar utilizar un método anticonceptivo no hormonal altamente eficaz (por ejemplo, dispositivo intrauterino, preservativo o diafragma con espermicidas o esponja anticonceptiva) desde 28 días antes del inicio hasta 45 días después de la última dosis (si la paciente no pasa al estudio de extensión abierto).
    Las mujeres en edad fértil deben tener una prueba de embarazo de gonadotropina coriónica humana (GCH) negativa en suero en el momento de la preselección y una prueba de embarazo de GCH negativa en orina al inicio
    E.4Principal exclusion criteria
    Central Nervous System, Psychiatric, and Illicit Drug Use Criteria
    1. Requires treatment with a medication prohibited by the protocol, including concomitant psychotropic drugs targeting irritability, including those used off-label (clonidine, guanfacine, and propranolol; lithium, valproate; stimulants, and non-stimulant medications), medications that prolong the QT interval, and strong cytochrome P450 (CYP) 3A4 enzyme (CYP3A4) inhibitors and inducers
    2. Subjects who have had changes in medications or medication doses (for medical and allowed comorbid psychiatric conditions) within 4 weeks of Baseline
    3. Known history or presence of clinically significant intolerance to any antipsychotic medications including but not limited to angioedema, serotonin or neuroleptic malignant syndromes, severe dystonia, or moderate to severe tardive dyskinesia
    4. Is at a significant risk of suicide, or is a danger to self or others, in the opinion of the Investigator based upon all available sources of information including C-SSRS (positive answer to suicidal ideation questions 4 or 5 [current or over last 6 months]) at Screening or Baseline and including more than one life-threatening suicide attempt (positive answer to suicidal behavior questions [over last 6 months])
    5. Is at risk of significant violent behavior to the extent that participation would pose an undue risk to other patients, caregivers, or others in the opinion of the Investigator
    6. Has a positive urine drug test at Screening or Baseline or positive urine drug dipstick test result at Baseline (Day 1). For study eligibility, the urine toxicology (drug) screen (UDS) must be negative for any substance of which the subject does not have a valid prescription.
    7. Has met DSM-5 criteria for substance use disorders within the last 6 months prior to Baseline
    8. Has treatment-refractory irritability, defined as failure to demonstrate clinically meaningful improvement of irritability in at least three previous clinically adequate drug trials (one trial must include aripiprazole or risperidone), as confirmed by caregiver reports and medical records review when available
    9. Has a current comorbid diagnosis of bipolar disorder, schizophrenia, major depressive disorder, substance use disorder, Rett syndrome, or fragile-X syndrome, as confirmed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) at Screening. ADHD and anxiety disorders are exclusionary if they are the primary disorder, or are not stable or adequately treated.
    Medical Criteria
    10. Has a confirmed genetic disorder other than ASD associated with cognitive and/or behavioral disturbance or profound intellectual disability (IQ<50) documented at any time before or at Screening (measured and documented standardized, individualized, test of intelligence)
    11. Has a history of seizures, unless seizure-free and off epileptic drugs for at least 6 months prior to Screening
    12. Has any condition that, in the opinion of the Investigator, would interfere with the ability to comply with study instructions, or that might confound the interpretation of the study results or put the subject at undue risk
    13. Has current evidence, or history within the previous 12 weeks prior to Screening, of a serious and/or unstable psychiatric, neurologic, cardiovascular, respiratory, gastrointestinal, renal, hepatic, hematologic, or other medical disorder, including cancer or malignancies that in the judgment of the Investigator would jeopardize the safe participation of the subject in the study
    14. Clinically significant finding(s) on physical examination determined by the Investigator to pose a health concern to the subject while on study
    15. Weight <15 kg
    16. Resting position (sitting or supine) systolic blood pressure (BP) >139 mmHg or <90 mmHg or diastolic BP >89 mmHg or <60 mmHg, at Screening or at Baseline
    17. Has a clinically significant abnormal ECG at Screening or at Baseline
    Criterios del SNC, psiquiátricos y de consumo de drogas
    1.Requiere tratamiento con un medicamento prohibido por el protocolo, incluidos los fármacos psicotrópicos que actúan contra la irritabilidad, como los utilizados los extraoficial (clonidina, guanfacina y propranolol; litio, valproato; estimulantes y medicamentos no estimulantes), medicamentos que prolongan el intervalo QT e inhibidores e inductores fuertes de la enzima 3A4 del citocromo P450(CYP3A4)
    2.Pacientes que han tenido cambios en la medicación o en la dosis (para afecciones médicas y psiquiátricas permitidas) en las 4 semanas anteriores al inicio
    3.Antecedentes o presencia de intolerancia clínicamente significativa a cualquier medicamento antipsicótico, incluyendo, entre otros, angioedema, síndromes malignos neuroléptico o serotoninérgico, distonía grave o discinesia tardía moderada o grave
    4.Tiene un riesgo significativo de suicidio o es un peligro para sí mismo o para los demás, en opinión del Investigador, basándose en todas las fuentes de información disponibles, incluyendo la C-SSRS (respuesta positiva a las preguntas de ideación suicida 4 o 5 [actual o en los últimos 6 meses]) en la preselección o en la inicial e incluyendo más de un intento de suicidio con riesgo de muerte (respuesta + a las preguntas sobre conducta suicida [últimos 6 meses])
    5.Tiene un riesgo significativo de conducta violenta hasta el punto que la participación supondría un riesgo indebido para otros pacientes, cuidadores u otras personas, según Investigador
    6.Test de orina por drogas + en la preselección o inicio o un resultado + en la prueba de drogas en orina mediante tira reactiva en el momento inicial (día 1). Para poder participar, el análisis toxicológico en orina (ADO) debe ser neg. para cualquier sustancia para la que el paciente no tenga una prescripción válida.
    7.Cumple criterios del DSM-5 para trastornos por uso de sustancias ilícitas en los 6 meses previos al inicio
    8.Irritabilidad refractaria al tratamiento, definida como fallo de demostrar una mejoría clínicamente significativa de la irritabilidad en al menos 3 pruebas anteriores de fármacos clínicamente adecuados (una debe incluir aripiprazol o risperidona), según confirme los informes del cuidadore y la revisión de la hªclínica cuando disponible
    9.Diagnóstico concurrente actual de trastorno bipolar, esquizofrenia, trastorno depresivo mayor, trastorno por sustancias ilícitas, síndrome de Rett o síndrome del cromosoma X frágil, confirmado por la minientrevista neuropsiquiátrica inter. para niños y adolescentes (MINI-KID) en la preselección. El TDAH y los trastornos de ansiedad son excluyentes si son trastorno primario, no están estables o adecuadamente tratados.
    Criterios médicos
    10.Trastorno genético confirmado distinto a TEA asociado a alteración cognitiva/conductual o por discapacidad intelectual profunda(CI <50) documentada antes o en preselección (prueba de inteligencia normalizada e individualizada, medida y documentada).
    11.Antecedentes de convulsiones, a menos que esté libre de convulsiones y sin medicamentos antiepilépticos durante al menos 6 meses antes de la preselección.
    12.Alguna afección que, según el Investigador, podría interferir en la capacidad de cumplir las instrucciones del estudio, o que podría confundir la interpretación de los resultados del estudio o suponer un riesgo indebido para el paciente.
    13.Pruebas actuales o antecedentes en las 12 semanas previas a la preselección, de trastorno psiquiátrico, neurológico, cardiovascular, respiratorio, gastrointestinal, renal, hepático, hematológico u otro trastorno médico, incluyendo cáncer o tumores malignos que, según el Investigador, podrían poner en peligro la participación segura del paciente
    14.Hallazgo(s) clínicamente significativo(s) en la exploración física que el Investigador determine que plantean un problema de salud para el paciente durante el estudio
    15.Peso <15 kg.
    16.Tensión arterial(TA) sistólica en reposo (sentado o en decúbito supino)>139 mmHg o <90 mmHg o TA diastólica>89 mmHg o <60 mmHg, en la preselección o al inicio
    17.ECG anómalo clínicamente significativo en la preselección o al inicio.
    E.5 End points
    E.5.1Primary end point(s)
    • Change from Baseline at Week 6 in the caregiver-rated Aberrant Behavior Checklist (ABC) Irritability subscale score
    • Variación en la semana 6 con respecto al valor inicial en la puntuación de la subescala de irritabilidad de la escala de conductas anómalas (ECA) calificada por el cuidador.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Weekly for 6 weeks
    Semanalmente durante 6 semanas
    E.5.2Secondary end point(s)
    Secondary endpoints
    • Change from Baseline at Week 6 in the caregiver-rated ABC subscale scores
    o Stereotypic behavior
    o Lethargy
    o Hyperactivity
    o Inappropriate speech
    • Change from Baseline at Week 6 in the Clinical Global Impression–Severity (CGI-S) of irritability score
    • Clinical Global Impression–Improvement (CGI-I) of irritability score at Week 6
    • Change from Baseline at Week 6 in the Repetitive Behavior Scale–Revised (RBS-R) scores
    • Change from Baseline at Week 6 in the Vineland Adaptive Behavior Scales (VABS)–Socialization subscale score
    • Change from Baseline at Week 6 in the Caregiver Strain Questionnaire (CGSQ) scores
    • Proportion of subjects who have at least 25% reduction from Baseline in the ABC–Irritability subscale score at Week 6
    • Proportion of subjects who have CGI-I of irritability score of 1 (very much improved) or 2 (much improved) at Week 6
    • Proportion of subjects who have at least 25% reduction from Baseline in the ABC–Irritability subscale score AND a CGI-I of irritability score of 1 (very much improved) or 2 (much improved) at Week 6
    Safety endpoints
    Safety will be evaluated by analyses of the following:
    • Treatment-emergent adverse events
    • Vital signs
    • Weight and body mass index (BMI)
    • 12-lead electrocardiograms (ECGs)
    • Physical examination results
    • Clinical laboratory tests (including urinalysis) and hormonal assessments
    • Columbia–Suicide Severity Rating Scale (C-SSRS)
    • Extrapyramidal Symptom Rating Scale–Abbreviated (ESRS-A)
    Pharmacokinetic endpoints
    • Plasma concentrations of pimavanserin, and AC-279
    • Pimavanserin PK parameters such as, but not limited to, Cmax and AUC, using a population PK approach
    Pharmacokinetic/pharmacodynamic endpoint
    • PK/PD using appropriate PK/PD analysis methods (e.g., evaluate the relationship between exposure and efficacy/safety endpoints)
    Criterios secundarios de valoración
    • Variación en la semana 6 con respecto al valor inicial en las puntuaciones de las subescalas de la ECA calificadas por el cuidador.
    o Conducta estereotipada
    o Letargo
    o Hiperactividad
    o Discurso inadecuado
    • Variación en la semana 6 con respecto al valor inicial en la puntuación de la impresión clínica global-intensidad (ICG-I) de la irritabilidad.
    • Puntuación de la impresión clínica global-mejoría (ICG-M) de la irritabilidad en la semana 6.
    • Variación en la semana 6 con respecto al valor inicial en las puntuaciones de la escala de conducta repetitiva-revisada (ECR-R).
    • Variación en la semana 6 con respecto al valor inicial en la puntuación de la subescala de socialización de las escalas de conducta adaptativa de Vineland (ECAV).
    • Variación en la semana 6 con respecto al valor inicial en las puntuaciones del cuestionario de tensión del cuidador (CGSQ, por sus siglas en inglés).
    • Proporción de pacientes que tienen al menos una reducción del 25 % desde el inicio en la puntuación de la subescala de irritabilidad de la ECA en la semana 6.
    • Proporción de pacientes que tienen una puntuación de la ICG-M de la irritabilidad de 1 (muchísimo mejor) o 2 (mucho mejor) en la semana 6.
    • Proporción de pacientes que tienen al menos una reducción del 25 % desde el inicio en la puntuación de la subescala de irritabilidad de la ECA Y una puntuación de la ICG-M de la irritabilidad de 1 (muchísimo mejor) o 2 (mucho mejor) en la semana 6

    Criterios de valoración de la seguridad
    La seguridad se evaluará mediante análisis de lo siguiente:
    • Acontecimientos adversos surgidos durante el tratamiento
    • Constantes vitales
    • Peso e índice de masa corporal (IMC)
    • Electrocardiogramas (ECG) de 12 derivaciones
    • Resultados de la exploración física
    • Pruebas analíticas clínicas (incluido análisis de orina) y evaluaciones hormonales
    • Escala de Columbia para evaluar el riesgo de suicidio (C-SSRS, por sus siglas en inglés).
    • Escala de puntuación de síntomas extrapiramidales-abreviada (ESRS-A)
    Criterios de valoración de la farmacocinética
    • Concentraciones plasmáticas de pimavanserina y AC-279.
    • Parámetros FC de la pimavanserina, como, por ejemplo, la Cmáx y el ABC, utilizando un enfoque de FC poblacional.

    Criterio de valoración de la farmacocinética/farmacodinámica
    • FC/FD utilizando métodos de análisis de la FC/FD adecuados (por ejemplo, evaluar la relación entre la exposición y los criterios de valoración de la eficacia/seguridad).
    E.5.2.1Timepoint(s) of evaluation of this end point
    Weekly for 6 weeks
    Semanalmente durante 6 semanas
    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 No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    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 trial3
    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 concerned8
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA33
    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 No
    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
    France
    Hungary
    Italy
    Poland
    Spain
    United Kingdom
    United States
    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
    LVLS
    UPUV
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months0
    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.1.1Number of subjects for this age range: 228
    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: 114
    F.1.1.6Adolescents (12-17 years) Yes
    F.1.1.6.1Number of subjects for this age range: 114
    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 No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state25
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 125
    F.4.2.2In the whole clinical trial 228
    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)
    If the study is terminated for any reason, subjects remaining in the study will return to standard of care.
    Si el estudio termina por alguna razón, los sujectos aún en estudio volverán al tratamiento habitual.
    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 Decision2022-06-27
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2022-04-04
    P. End of Trial
    P.End of Trial StatusOngoing
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