Cushing's Syndrome
Conditions
Keywords
Cushing's Disease, Cushing's Syndrome, Cushings, Pituitary, ACTH, Adrenocorticotropic hormone, Ectopic, Adrenal adenoma, Adrenal carcinoma, Adrenal autonomy, Cortisol, Hypercortisolemia, Cushingoid, Moon facies, Dorsocervical fat, Plethora, Hirsutism, Violaceous striae, Hormone, Contraceptive, Endocrine, Cushing Syndrome, Ectopic ACTH Secretion
Brief summary
Patients will receive Corlux (mifepristone) daily for up to 24 weeks. Assessments of the signs and symptoms of Cushing's syndrome will be obtained.
Detailed description
Cushing's syndrome is a relatively rare disorder caused by prolonged exposure to high levels of the glucocorticoid hormone cortisol. Cushing's syndrome may result from elevated endogenous or exogenous sources of cortisol. Endogenous Cushing's syndrome resulting from cortisol overproduction by the adrenal glands is the subject of this protocol. Patients with exogenous Cushing's syndrome, which develops as a side effect of chronic administration of high doses of glucocorticoids, are not eligible for enrollment in this study. This will evaluate the safety and efficacy of mifepristone for treatment of the signs and symptoms of hypercortisolemia in patients with endogenous Cushing's syndrome from ACTH-dependent or adrenal disorders. The study will enroll subjects for whom the investigator has determined that medical treatment of endogenous hypercortisolemia is needed. Medical treatment may be intended to treat the effects of persistent or recurrent hypercortisolemia after surgery and/or radiation for Cushing's syndrome, to bridge the period of time for radiation to become effective, or when surgery is not feasible.
Interventions
DRUGmifepristone
Patients take mifepristone by mouth once a day. The dose is increased during scheduled timepoints during the study or until symptoms improve or the highest dosage allowed is reached. Dose escalation will be based upon weight. During clinic visits, blood pressure, glucose tolerance and blood chemistries are measured and EKG and urinalysis will be performed.
Sponsors
Corcept Therapeutics
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Individuals eligible for enrollment into this study are adult male and non-pregnant female adult patients who: * Are at least 18 years of age * Have a confirmed diagnosis of endogenous hypercortisolemia caused by ACTH dependent or ACTH independent etiologies, including 1. Cushing's Disease (that has recurred after primary pituitary surgery, or has failed pituitary surgery, or has been treated with radiation therapy to the pituitary, or is not treatable with surgery, or exists in patients who are not candidates for surgery, and is confirmed by documentation of ACTH immuno-reactivity on a pathological evaluation of pituitary tissue from a previous surgical specimen or IPSS with a central-to-peripheral gradient (ratio) of \>2 before or \>3 after CRH administration). 2. Ectopic ACTH 3. Ectopic CRF secretion 4. Adrenal adenoma 5. Adrenal carcinoma 6. Adrenal autonomy * Require medical treatment of hypercortisolemia * Have diabetes mellitus type 2 or glucose intolerance AND/OR have hypertension \*Note: To be eligible for inclusion subjects must have documented evidence of persistent endogenous hypercortisolemia
Exclusion criteria
Individuals not eligible to be enrolled into the study are those who: * Have de novo Cushing's disease and are surgical candidates for pituitary surgery. * Have an acute or unstable medical problem, which could be aggravated by mifepristone treatment. * Taking medications within 14 days of the baseline visit (Day 1) that a) have a large first pass metabolism largely mediated by CYP3A4 and a narrow therapeutic margin and/or b) are strong CYP3A4 inhibitors. * Female patients of reproductive potential, who are pregnant or who are unable or unwilling to use medically acceptable, non-hormonal methods of contraception during the study. * Have received investigational treatment (drug, biological agent or device) within 30 days of Screening * Have a history of an allergic reaction or intolerance to CORLUX (mifepristone) * Have a non-endogenous source of hypercortisolemia such as factious hypercortisolemia (exogenous source of glucocorticoid, iatrogenic Cushing's syndrome), factious or therapeutic use of ACTH * Have Pseudo-Cushing's syndrome. * Receive PPARgamma agonist drugs (e.g. pioglitazone, rosiglitazone) within 4 months of Baseline (Day 1). * Postmenopausal women with an intact uterus who have experienced unexplained vaginal bleeding within 12 months of Screening are excluded. * Have renal failure as defined by a serum creatinine of ≥2.2 mg/dL.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improvement in Diabetes and/or Glucose Intolerance. | Baseline to Week 24 | Responder is defined as subject with a decrease greater than or equal to 25% in area under the curve for glucose on 2-hour oral glucose test from baseline to week 24 or last visit, for Cushing's patients with type-2 diabetes mellitus/impaired glucose tolerance. |
| Decrease in Diastolic Blood Pressure. | Baseline to Week 24 | Responder is defined as subject with a decrease greater than or equal to 5mm Hg in diastolic blood pressure from baseline to week 24 or last visit. |
Countries
United States
Participant flow
Recruitment details
24 week multicenter, open-label trial after failed multimodality therapy at 14 U.S. academic medical centers and three private research centers.
Pre-assignment details
Adults with endogenous Cushing's Syndrome associated with either type 2 diabetes mellitus/impaired glucose tolerance or a diagnosis of hypertension.
Participants by arm
| Arm | Count |
|---|---|
| Mifepristone Mifepristone was administered at doses of 300-1200 mg daily. | 50 |
| Total | 50 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 7 |
| Overall Study | Death | 2 |
| Overall Study | Subject was non-compliant. | 1 |
| Overall Study | Subject was too ill to travel. | 1 |
| Overall Study | Withdrawal by Subject | 5 |
Baseline characteristics
| Characteristic | Mifepristone |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 4 Participants |
| Age, Categorical Between 18 and 65 years | 46 Participants |
| Age Continuous | 45.4 years STANDARD_DEVIATION 11.85 |
| Region of Enrollment United States | 50 participants |
| Sex: Female, Male Female | 35 Participants |
| Sex: Female, Male Male | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 49 / 50 |
| serious Total, serious adverse events | 16 / 50 |
Outcome results
Primary
Decrease in Diastolic Blood Pressure.
Responder is defined as subject with a decrease greater than or equal to 5mm Hg in diastolic blood pressure from baseline to week 24 or last visit.
Time frame: Baseline to Week 24
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mifepristone | Decrease in Diastolic Blood Pressure. | 8 participants |
Primary
Improvement in Diabetes and/or Glucose Intolerance.
Responder is defined as subject with a decrease greater than or equal to 25% in area under the curve for glucose on 2-hour oral glucose test from baseline to week 24 or last visit, for Cushing's patients with type-2 diabetes mellitus/impaired glucose tolerance.
Time frame: Baseline to Week 24
Population: Patients with at least 30 days of dosing.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Mifepristone | Improvement in Diabetes and/or Glucose Intolerance. | 15 participants |