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Trial to Demonstrate the Efficacy and Safety of Conversion to Lacosamide Monotherapy for Partial-onset Seizures

A Historical-controlled, Multicenter, Double-blind, Randomized Trial to Assess the Efficacy and Safety of Conversion to Lacosamide 400 mg/Day Monotherapy in Subjects With Partial-onset Seizures

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00520741
Acronym
ALEX-MT
Enrollment
426
Registered
2007-08-27
Start date
2007-08-31
Completion date
2012-12-31
Last updated
2018-07-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Epilepsy

Keywords

Epilepsy, Partial Onset Seizures, Lacosamide, Monotherapy, Vimpat

Brief summary

The objective of this historical-controlled trial is to demonstrate the efficacy and safety of conversion to Lacosamide monotherapy in subjects with Partial-onset Seizures who are withdrawn from 1 to 2 marketed antiepileptic drugs.

Detailed description

Sudden unexplained death in epilepsy have been reported in epilepsy patients. A causal relationship with the administration of antiepileptic drugs has not been established. The most important known risk factor for sudden unexplained death in epilepsy (SUDEP) is the occurrence and frequency of generalized tonic-clonic seizures (GTCS). Twenty-seven patients with only GTCS were enrolled in the conversion to monotherapy study. In this study, two patients with only GTCS had SUDEP. Due to the potential increased risk of SUDEP in patients with only GTCS in a trial setting, the 1 remaining patient with only GTCS was withdrawn from this study.

Interventions

DRUGLacosamide

50 mg and 100 mg tablets provided for 200 mg twice daily dosing for up to 20 weeks.

Sponsors

UCB BIOSCIENCES, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)

Eligibility

Sex/Gender
ALL
Age
16 Years to 70 Years
Healthy volunteers
No

Inclusion criteria

* Subject has a diagnosis of Epilepsy with Simple Partial Seizures (motor component) and or Complex Partial Seizures (with or without secondary generalization) * Must be experiencing 2 to 40 seizures per 28-day period * Stable dose of 1 or 2 marketed antiepileptic drugs * Second Antiepileptic Drug (AED) must be less than or equal to 50 % of the minimum recommended maintenance dose per USA product label at screening

Exclusion criteria

* Subject has a history of primary generalized or unclassified seizures * Seizure disorder primarily characterized by isolated auras * History of status epilepticus * Seizures that are uncountable due to clustering * Has greater than 5 seizures/day * Subjects taking Benzodiazepines, Phenobarbital or Primidone * Subject has Vagus Nerve Stimulation (VNS) * Significant medical or psychiatric condition * History of alcohol or drug abuse * History of Ethosuximide use, Felbamate use after 1994 or Vigabatrin use after 1997

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Subjects (Using Kaplan-Meier) Who Are Identified As Meeting At Least 1 Pre-defined Exit Criteria By Day 112 Relative To The Start of Withdrawal of Background Antiepileptic Drug(s)16 Weeks Maintenance Period (approximately 112 days)Pre-defined exit criteria: 1. A 2-fold or greater increase in average monthly (28-day) partial seizure frequency (motor and non-motor) compared to average monthly partial seizure frequency (motor and non-motor) during the Baseline Phase 2. A 2-fold or greater increase in consecutive 2-day partial seizure frequency (motor and non-motor) versus the highest consecutive 2-day partial seizure frequency (motor and non-motor) that occurred during the Baseline Phase. Note: if the highest consecutive 2-day partial seizure frequency during the Baseline Phase is 1, a 2-day partial seizure frequency of ≥3 is required to meet this exit criterion 3. Occurrence of a single generalized tonic-clonic seizure if none had occurred in the 6 months prior to randomization 4. A prolongation or worsening of overall seizure duration, frequency, type or pattern considered by the investigator as serious enough to warrant trial discontinuation 5. Status epilepticus, or new onset of serial/cluster seizures

Secondary

MeasureTime frameDescription
Time to First Occurrence of Any Exit Event During The Maintenance Period16 Weeks Maintenance Period (approximately 112 days)The time to first occurrence (days) of any exit event was estimated using Kaplan-Meier methods and was based on the time from the start of the Maintenance Phase to the earliest date a subject met an exit criterion. Subjects who discontinued during the Maintenance Phase due to non-exit criteria reasons or who completed the Maintenance Phase before 112 days and did not meet an exit criterion were censored as of the last Maintenance Phase dose date. Subjects completing 112 days in the Maintenance Phase were censored as of Day 112.
Percentage of Subjects (Using Kaplan-Meier) Who Are Identified as Meeting at Least 1 Pre-defined Exit Criteria by Day 112, Withdrew Due to Adverse Event (AE) or Withdrew Due to Lack of Efficacy During The Maintenance Period16 Weeks Maintenance Period (approximately 112 days)Subjects were classified as having an exit event if they experienced at least 1 of the following events during the Maintenance Phase as of Day 112: 1. Met at least 1 exit criterion based on the calculations applied for the Primary Efficacy Analysis 2. Withdrawal due to AE with onset during the Maintenance Phase 3. Withdrew prematurely due to lack of efficacy during the Maintenance Phase The date the subject experienced the event was set to the earliest date the subject met an exit criterion or the date of the last Maintenance Phase dose for subjects not meeting an exit criterion but withdrawing due to an AE or lack of efficacy. The secondary analysis is only conducted on the Lacosamide 400 mg/day group.
Duration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12)Visit 9 - Visit 12 (approximately 10 weeks)Days on Monotherapy Treatment were defined as the number of days during the Monotherapy Phase when the subject took Lacosamide (LCM) only (ie, the total number of days exposed to LCM during the Monotherapy Phase minus any days where a concomitant or rescue Anti-epileptic Drug (AED) was taken by the subject). The days on Monotherapy Treatment did not need to be consecutive.
Clinical Global Impression of Change (CGIC) From Baseline To Last VisitBaseline; Last Visit (approximately 27 weeks)For the assessment of the Clinical Global Impression of Change (CGIC), the investigator should provide his/her assessment of the subject's clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status. He was asked the following:Please check the number that best describes the subject's condition over the past 4 weeks compared to Baseline: 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse
Patient's Global Impression of Change (PGIC) From Baseline To Last VisitBaseline; Last Visit (approximately 27 weeks)For the assessment of the Patient's Global Impression of Change, the subject should provide his/her assessment of his/her own clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status.The subject was asked to answer the following: Over the past 4 weeks, how have you felt compared to before you entered this clinical trial? (Please check the number that best describes your condition.) 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse

Countries

Australia, Austria, Canada, Denmark, France, Germany, Ireland, Italy, Poland, Puerto Rico, Spain, United Kingdom, United States

Participant flow

Recruitment details

The study was conducted at 160 sites in the United States of America (USA), Canada, Europe, and Australia.The maximum duration of a subject's trial participation is 30 weeks. The Participant Flow refers to the Safety Set (SS) population which consists of all patients who received at least one dose of study medication.

Pre-assignment details

Subjects were randomized 3:1 to one of two therapeutic doses of Lacosamide, 400 mg/day or 300 mg/day, to ensure a study design comparable to the historical control.

Participants by arm

ArmCount
Lacosamide 300 mg/Day
Lacosamide 300 mg/day Lacosamide : 50 mg and 100 mg tablets provided for 150 mg twice daily dosing for up to 20 weeks. Subjects were randomized 3:1 to one of two therapeutic doses of Lacosamide, 400 mg/day or 300 mg/day, to ensure a study design comparable to the historical control.
106
Lacosamide 400 mg/Day
Lacosamide 400 mg/day Lacosamide : 50 mg and 100 mg tablets provided for 200 mg twice daily dosing for up to 20 weeks. Subjects were randomized 3:1 to one of two therapeutic doses of Lacosamide, 400 mg/day or 300 mg/day, to ensure a study design comparable to the historical control.
319
Total425

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event1656
Overall StudyLack of Efficacy1130
Overall StudyLost to Follow-up44
Overall StudyOther reasons for premature termination06
Overall StudyProtocol Violation215
Overall StudyUnsatisfactory compliance of subject43
Overall StudyWithdrawal by Subject011

Baseline characteristics

CharacteristicLacosamide 300 mg/DayLacosamide 400 mg/DayTotal
Age, Categorical
<=18 years
3 Participants7 Participants10 Participants
Age, Categorical
>=65 years
4 Participants9 Participants13 Participants
Age, Categorical
Between 18 and 65 years
99 Participants303 Participants402 Participants
Age, Continuous41.4 years
STANDARD_DEVIATION 14.3
40.4 years
STANDARD_DEVIATION 12.5
40.6 years
STANDARD_DEVIATION 13
Average Baseline Seizure Frequency per 28 days10.10 seizures/28 days
STANDARD_DEVIATION 8.82
10.22 seizures/28 days
STANDARD_DEVIATION 8.88
10.19 seizures/28 days
STANDARD_DEVIATION 8.86
Body Mass Index (BMI)28.22 kg/m^2
STANDARD_DEVIATION 5.74
28.67 kg/m^2
STANDARD_DEVIATION 6.64
28.56 kg/m^2
STANDARD_DEVIATION 6.42
Height169.72 centimeter
STANDARD_DEVIATION 10.69
169.01 centimeter
STANDARD_DEVIATION 10.87
169.19 centimeter
STANDARD_DEVIATION 10.82
Race/Ethnicity, Customized
Asian
0 participants1 participants1 participants
Race/Ethnicity, Customized
Black
9 participants53 participants62 participants
Race/Ethnicity, Customized
Other
6 participants19 participants25 participants
Race/Ethnicity, Customized
White
91 participants246 participants337 participants
Sex: Female, Male
Female
50 Participants169 Participants219 Participants
Sex: Female, Male
Male
56 Participants150 Participants206 Participants
Weight81.62 kilogram
STANDARD_DEVIATION 19.53
82.13 kilogram
STANDARD_DEVIATION 21.3
82.00 kilogram
STANDARD_DEVIATION 20.85

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
74 / 106215 / 319
serious
Total, serious adverse events
4 / 10621 / 319

Outcome results

Primary

Percentage of Subjects (Using Kaplan-Meier) Who Are Identified As Meeting At Least 1 Pre-defined Exit Criteria By Day 112 Relative To The Start of Withdrawal of Background Antiepileptic Drug(s)

Pre-defined exit criteria: 1. A 2-fold or greater increase in average monthly (28-day) partial seizure frequency (motor and non-motor) compared to average monthly partial seizure frequency (motor and non-motor) during the Baseline Phase 2. A 2-fold or greater increase in consecutive 2-day partial seizure frequency (motor and non-motor) versus the highest consecutive 2-day partial seizure frequency (motor and non-motor) that occurred during the Baseline Phase. Note: if the highest consecutive 2-day partial seizure frequency during the Baseline Phase is 1, a 2-day partial seizure frequency of ≥3 is required to meet this exit criterion 3. Occurrence of a single generalized tonic-clonic seizure if none had occurred in the 6 months prior to randomization 4. A prolongation or worsening of overall seizure duration, frequency, type or pattern considered by the investigator as serious enough to warrant trial discontinuation 5. Status epilepticus, or new onset of serial/cluster seizures

Time frame: 16 Weeks Maintenance Period (approximately 112 days)

Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (ie, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).~The primary analysis is only conducted on the Lacosamide 400 mg/day group.

ArmMeasureValue (NUMBER)
Lacosamide 400 mg/DayPercentage of Subjects (Using Kaplan-Meier) Who Are Identified As Meeting At Least 1 Pre-defined Exit Criteria By Day 112 Relative To The Start of Withdrawal of Background Antiepileptic Drug(s)30.0 percentage of subjects
Comparison: The upper limit of the Confidence Interval for the estimate of the Lacosamide (LCM) 400 mg/day exit rate was compared with the lower bound of the 95 % prediction interval for the historical-control of 0.653; hereafter referred to as the historical-control exit rate. The LCM 400 mg/day dose group would be declared an effective conversion to monotherapy treatment if the upper 95 % confidence limit for the estimate of the exit rate was less than 0.653.95% CI: [0.246, 0.355]Kaplan-Meier
Secondary

Clinical Global Impression of Change (CGIC) From Baseline To Last Visit

For the assessment of the Clinical Global Impression of Change (CGIC), the investigator should provide his/her assessment of the subject's clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status. He was asked the following:Please check the number that best describes the subject's condition over the past 4 weeks compared to Baseline: 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse

Time frame: Baseline; Last Visit (approximately 27 weeks)

Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (eg, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).

ArmMeasureGroupValue (NUMBER)
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMinimally worse6 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMinimally improved18 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMuch worse8 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitVery much improved21 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitVery much worse1 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitNo change8 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitNot done4 participants
Lacosamide 300 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMuch improved33 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitNot done12 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitVery much improved56 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMinimally improved42 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitNo change18 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMinimally worse16 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMuch worse23 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitVery much worse1 participants
Lacosamide 400 mg/DayClinical Global Impression of Change (CGIC) From Baseline To Last VisitMuch improved116 participants
Secondary

Duration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12)

Days on Monotherapy Treatment were defined as the number of days during the Monotherapy Phase when the subject took Lacosamide (LCM) only (ie, the total number of days exposed to LCM during the Monotherapy Phase minus any days where a concomitant or rescue Anti-epileptic Drug (AED) was taken by the subject). The days on Monotherapy Treatment did not need to be consecutive.

Time frame: Visit 9 - Visit 12 (approximately 10 weeks)

Population: The Analysis Population refers to a subset of the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs).This subset of the FAS included subjects who entered the Maintenance Phase but who never achieved Lacosamide (LCM) monotherapy.

ArmMeasureValue (MEDIAN)Dispersion
Lacosamide 300 mg/DayDuration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12)71 daysFull Range 22
Lacosamide 400 mg/DayDuration of Monotherapy Treatment During the Monotherapy Phase of The Maintenance Period (Visit 9 - Visit 12)71 daysFull Range 20.3
Secondary

Patient's Global Impression of Change (PGIC) From Baseline To Last Visit

For the assessment of the Patient's Global Impression of Change, the subject should provide his/her assessment of his/her own clinical status, compared to Baseline, including an evaluation of seizure frequency and intensity, the occurrence of AEs, and subject's functional status.The subject was asked to answer the following: Over the past 4 weeks, how have you felt compared to before you entered this clinical trial? (Please check the number that best describes your condition.) 1. Very much improved 2. Much improved 3. Minimally improved 4. No change 5. Minimally worse 6. Much worse 7. Very much worse

Time frame: Baseline; Last Visit (approximately 27 weeks)

Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (eg, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).

ArmMeasureGroupValue (NUMBER)
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitVery much improved24 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMinimally worse3 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMinimally improved15 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMuch worse7 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMuch improved33 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitVery much worse3 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitNo change10 participants
Lacosamide 300 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitNot done4 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitNo change15 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitVery much improved81 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMuch improved93 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMinimally improved37 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitNot done14 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMinimally worse19 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitMuch worse22 participants
Lacosamide 400 mg/DayPatient's Global Impression of Change (PGIC) From Baseline To Last VisitVery much worse3 participants
Secondary

Percentage of Subjects (Using Kaplan-Meier) Who Are Identified as Meeting at Least 1 Pre-defined Exit Criteria by Day 112, Withdrew Due to Adverse Event (AE) or Withdrew Due to Lack of Efficacy During The Maintenance Period

Subjects were classified as having an exit event if they experienced at least 1 of the following events during the Maintenance Phase as of Day 112: 1. Met at least 1 exit criterion based on the calculations applied for the Primary Efficacy Analysis 2. Withdrawal due to AE with onset during the Maintenance Phase 3. Withdrew prematurely due to lack of efficacy during the Maintenance Phase The date the subject experienced the event was set to the earliest date the subject met an exit criterion or the date of the last Maintenance Phase dose for subjects not meeting an exit criterion but withdrawing due to an AE or lack of efficacy. The secondary analysis is only conducted on the Lacosamide 400 mg/day group.

Time frame: 16 Weeks Maintenance Period (approximately 112 days)

Population: The Analysis Population refers to the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs) (eg, entered the Maintenance Phase and took at least 1 dose of Maintenance medication).

ArmMeasureValue (NUMBER)
Lacosamide 400 mg/DayPercentage of Subjects (Using Kaplan-Meier) Who Are Identified as Meeting at Least 1 Pre-defined Exit Criteria by Day 112, Withdrew Due to Adverse Event (AE) or Withdrew Due to Lack of Efficacy During The Maintenance Period32.3 percentage of subjects
Comparison: The upper limit of the Confidence Interval for the estimate of the Lacosamide (LCM) 400 mg/day exit rate was compared with the historical-control exit rate. The LCM 400 mg/day dose group would be declared an effective conversion to monotherapy treatment if the upper 95 % confidence limit for the estimate of the exit rate was less than 0.653.95% CI: [0.268, 0.378]Kaplan-Meier
Secondary

Time to First Occurrence of Any Exit Event During The Maintenance Period

The time to first occurrence (days) of any exit event was estimated using Kaplan-Meier methods and was based on the time from the start of the Maintenance Phase to the earliest date a subject met an exit criterion. Subjects who discontinued during the Maintenance Phase due to non-exit criteria reasons or who completed the Maintenance Phase before 112 days and did not meet an exit criterion were censored as of the last Maintenance Phase dose date. Subjects completing 112 days in the Maintenance Phase were censored as of Day 112.

Time frame: 16 Weeks Maintenance Period (approximately 112 days)

Population: The Analysis Population refers to a subset of the Full Analysis Set (FAS). The FAS included subjects who completed the Titration Phase and started withdrawing background Anti-epileptic Drugs (AEDs). In addition to being a member of FAS, subjects also met at least one of the exit criterion noted under the Primary Outcome Measure.

ArmMeasureValue (MEDIAN)Dispersion
Lacosamide 300 mg/DayTime to First Occurrence of Any Exit Event During The Maintenance Period39 daysFull Range 21.2
Lacosamide 400 mg/DayTime to First Occurrence of Any Exit Event During The Maintenance Period45.0 daysFull Range 24.3

Source: ClinicalTrials.gov · Data processed: Mar 20, 2026