Autism Spectrum Disorders, Fragile X Syndrome
Conditions
Keywords
Fragile X Syndrome, Acamprosate
Brief summary
Fragile X syndrome (FXS) is the most common inherited form of developmental disability. FXS is inherited from the carrier parent, most often the mothers. FXS is associated with severe interfering behavioral symptoms which include anxiety related symptoms, attention deficit hyperactivity, and aggressive behaviors. Approximately 25-33% of individuals with FXS also meet criteria for autistic disorder. The hypothesis of this study is that treatment with acamprosate will reduce inattention/hyperactivity, language impairment, irritability, social deficits, and cognitive delay in youth with FXS. The purpose of this study is to investigate the effectiveness and tolerability of acamprosate in youth with Fragile X Syndrome and to assess the potential psychophysiological differences between FXS and autism spectrum disorders.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Male and female outpatients between the ages of 5 and 17 years. * Confirmed diagnosis of Fragile X Syndrome based upon genetic testing. * Stable dosing of all psychotropic medications for at least 2 weeks prior to baseline. * Subjects with a stable seizure disorder or history of only childhood febrile seizures will be included. * Clinical Global Impression-Severity Score of 4 (Moderately Ill) or greater. * Must be in good physical health. * Subjects of child bearing age of both genders will be required to utilize birth control as applicable.
Exclusion criteria
* Diagnosis of schizophrenia, another psychotic disorder, bipolar disorder or alcohol or other substance abuse based on Diagnostic and Statistical Manual Fourth Edition-Text Revised (DSM-IV-TR). * A significant medical condition such as heart, liver, renal or pulmonary disease or unstable seizure disorder. * Females with a positive urine pregnancy test * Creatinine clearance of less than 30. * Concomitant use of another glutamatergic agent (memantine,riluzole, d-cycloserine, amantadine topiramate, gabapentin, among others. * Evidence of hypersensitivity to acamprosate or potentially serious adverse effect. * Subjects who, in the opinion of the investigator, are unsuitable in any other way to participate in this study including being unable to comply with the requirements of the study for any reason.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Global Impression- Severity Scale (CGI-S) | Week 10 | The Clinical Global Impression - Severity scale (CGI-S) is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis. Considering total clinical experience, a patient is assessed on severity of mental illness at the time of rating 1, normal, not at all ill; 2, borderline mentally ill; 3, mildly ill; 4, moderately ill; 5, markedly ill; 6, severely ill; or 7, extremely ill. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Social Responsiveness Scale | Week 10 | The 65-item SRS is a standardized measure of the core symptoms of autism. Each item is scored on a 4-point Likert scale. The score of each individual item is summed to create a total raw score. A total scores results are as follows: 0-62: Within normal limits 63-79: Mild range of impairment 80-108: Moderate range of impairment 109-149: Severe range of impairment |
| Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD | Week 10 | The Children's Yale-Brown Obsessive Compulsive Scales-Modified (CY-BOCS) is a 5-item, semi-structured clinician rating scale modified designed to rate the current severity of repetitive behavior in children and adolescents with PDD. Once the current repetitive behaviors are identified, they are separately rated on 5 items: Time Spent, Interference, Distress, Resistance, and Control. Each of these items is scored on a 5-point scale form 0 (least symptomatic) to 4 (most symptomatic). The CY-BOCS yields a Total Score from 0 to 20 and is sensitive to change. |
| ADHD Rating Scale 4th Edition | Week 10 | The ADHD Rating Scale is an 18-item scale directly derived from DSM-IV criteria for Attention Deficit Hyperactivity Disorder. The ADHD Rating Scale-IV is completed by the parent and scored by a clinician. The scale consists of 2 subscales: inattention (9 items) and hyperactivity-impulsivity (9 items). If 3 or more items are skipped, the clinician should use extreme caution in interpreting the scale. The total score can range from 0 to 54, with a higher score indicating greater severity. |
| The Aberrant Behavior Checklist (ABC) | Week 10 | The Aberrant Behavior Checklist (ABC) is a 58-item rating scale used to assess maladaptive behaviors across five original subscales: Irritability (15 items from 0-45), Social Withdrawal (16 items from 0-48), Stereotypy (7 items from 0-21), Hyperactivity (16 items from 0-48), Inappropriate Speech (4 items from 0-12). Additionally, Social Avoidance, a newly developed four-item subscale (from 0-12) of the ABC that captures core social avoidance aspects of Fragile X Syndrome is reported. All items on the ABC are rated from 0 (not at all a problem) to 3 (the problem is severe in degree). Higher scores indicate greater maladaptive behaviors. Differences between Baseline and Week 10 are used as an indicator of change. |
| Peabody Picture Vocabulary | Week 10 | The Peabody Picture Vocabulary Test is one of the most commonly used assessment tests that measure verbal ability in standard American English vocabulary. This test has been nationally standardized using examinees from various age groups, from children to adults. Thus, the raw scores are equated to mental age, using the norms obtained from standardization. The total standard scores range from 40 (worse receptive vocabulary) to 160 (better receptive vocabulary). The scores can also be converted to percentile rank. |
| Brain-derived Neurotrophic Factor (BDNF) | Screen and Week 10 | BDNF is a protein that supports the survival of existing neurons and growth and differentiation of new neurons and synapses. |
| Vineland Adaptive Behavior Scales-II (VABS-II) Communication Domain | Week 10 | The VABS-II is a semi-structured interview designed to assess adaptive functioning in communication, daily living, socialization and motor skills. Recognizing that language is a major area of impairment in the study population, the Communication Domain (99 Items from 0-198), in particular the Expressive Subdomain (54 Items from 0-108) are of interest in this study. Items arranged in a developmental sequence are rated on a 3-point scale. Each item is scored from 0 (never performs the behavior) to 3 (usually performs the behavior independently). Higher scores indicate higher adaptive functioning. Differences between Baseline and Week 10 are used as an indicator of change. |
Countries
United States
Participant flow
Pre-assignment details
The psychophysiological measures proved non-feasible as subjects could not tolerate the procedures. The paradigms were tried on two subjects in the Autism Spectrum Disorder arm; however, the data that was collected was not usable. Subsequently, neurobiological characterization was halted.
Participants by arm
| Arm | Count |
|---|---|
| Acamprosate Treatment Group Twelve subjects received open-label acamprosate, mean final of 1,054 mg/day (range: 666-1,998 mg/day) | 12 |
| Total | 12 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Physician Decision | 0 | 2 |
Baseline characteristics
| Characteristic | Acamprosate Treatment Group |
|---|---|
| Aberrant Behavior Checklist ABC Hyperactivity | 16.8 units on a scale STANDARD_DEVIATION 9.1 |
| Aberrant Behavior Checklist ABC Inappropriate Speech | 5.2 units on a scale STANDARD_DEVIATION 3.5 |
| Aberrant Behavior Checklist ABC Irritability | 9.9 units on a scale STANDARD_DEVIATION 7.8 |
| Aberrant Behavior Checklist ABC Social Avoidance | 3.3 units on a scale STANDARD_DEVIATION 2.6 |
| Aberrant Behavior Checklist ABC Social Withdrawal | 8.8 units on a scale STANDARD_DEVIATION 5.8 |
| Aberrant Behavior Checklist ABC Stereotypy | 6.8 units on a scale STANDARD_DEVIATION 6.8 |
| ADHD Rating Scale 4th Edition | 23.6 units on a scale STANDARD_DEVIATION 10.6 |
| Age, Categorical <=18 years | 12 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants |
| Age, Continuous | 11.9 years |
| Brain-derived neurotropic factor | 790.4 pg/mL STANDARD_DEVIATION 1.305 |
| Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD | 11.1 units on a scale STANDARD_DEVIATION 2.6 |
| Clinical Global Impression -Severity | 4.25 units on a scale STANDARD_DEVIATION 0.45 |
| Peabody Picture Vocabulary Test | 85.2 units on a scale STANDARD_DEVIATION 32 |
| Region of Enrollment United States | 12 participants |
| Sex: Female, Male Female | 2 Participants |
| Sex: Female, Male Male | 10 Participants |
| Social Responsiveness Scale | 91.3 units on a scale STANDARD_DEVIATION 27.4 |
| Vineland Adaptive Behavior Scales-II (VABS-II) Communication Domain Communication Domain | 63.4 units on a scale STANDARD_DEVIATION 10 |
| Vineland Adaptive Behavior Scales-II (VABS-II) Communication Domain Expressive Communication Domain | 69.8 units on a scale STANDARD_DEVIATION 23 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 9 / 12 |
| serious Total, serious adverse events | 0 / 12 |
Outcome results
Clinical Global Impression- Severity Scale (CGI-S)
The Clinical Global Impression - Severity scale (CGI-S) is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis. Considering total clinical experience, a patient is assessed on severity of mental illness at the time of rating 1, normal, not at all ill; 2, borderline mentally ill; 3, mildly ill; 4, moderately ill; 5, markedly ill; 6, severely ill; or 7, extremely ill.
Time frame: Week 10
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Acamprosate Treatment Group | Clinical Global Impression- Severity Scale (CGI-S) | 7.0 units on a scale | Standard Deviation 8.9 |
ADHD Rating Scale 4th Edition
The ADHD Rating Scale is an 18-item scale directly derived from DSM-IV criteria for Attention Deficit Hyperactivity Disorder. The ADHD Rating Scale-IV is completed by the parent and scored by a clinician. The scale consists of 2 subscales: inattention (9 items) and hyperactivity-impulsivity (9 items). If 3 or more items are skipped, the clinician should use extreme caution in interpreting the scale. The total score can range from 0 to 54, with a higher score indicating greater severity.
Time frame: Week 10
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Acamprosate Treatment Group | ADHD Rating Scale 4th Edition | 16.7 units on a scale | Standard Deviation 8 |
Brain-derived Neurotrophic Factor (BDNF)
BDNF is a protein that supports the survival of existing neurons and growth and differentiation of new neurons and synapses.
Time frame: Screen and Week 10
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Acamprosate Treatment Group | Brain-derived Neurotrophic Factor (BDNF) | 1,007.6 pg/mL |
Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD
The Children's Yale-Brown Obsessive Compulsive Scales-Modified (CY-BOCS) is a 5-item, semi-structured clinician rating scale modified designed to rate the current severity of repetitive behavior in children and adolescents with PDD. Once the current repetitive behaviors are identified, they are separately rated on 5 items: Time Spent, Interference, Distress, Resistance, and Control. Each of these items is scored on a 5-point scale form 0 (least symptomatic) to 4 (most symptomatic). The CY-BOCS yields a Total Score from 0 to 20 and is sensitive to change.
Time frame: Week 10
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Acamprosate Treatment Group | Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD | 9.8 units on a scale | Standard Deviation 4.1 |
Peabody Picture Vocabulary
The Peabody Picture Vocabulary Test is one of the most commonly used assessment tests that measure verbal ability in standard American English vocabulary. This test has been nationally standardized using examinees from various age groups, from children to adults. Thus, the raw scores are equated to mental age, using the norms obtained from standardization. The total standard scores range from 40 (worse receptive vocabulary) to 160 (better receptive vocabulary). The scores can also be converted to percentile rank.
Time frame: Week 10
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Acamprosate Treatment Group | Peabody Picture Vocabulary | 83.3 units on a scale | Standard Deviation 32 |
Social Responsiveness Scale
The 65-item SRS is a standardized measure of the core symptoms of autism. Each item is scored on a 4-point Likert scale. The score of each individual item is summed to create a total raw score. A total scores results are as follows: 0-62: Within normal limits 63-79: Mild range of impairment 80-108: Moderate range of impairment 109-149: Severe range of impairment
Time frame: Week 10
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Acamprosate Treatment Group | Social Responsiveness Scale | 76.4 units on a scale | Standard Deviation 26.8 |
The Aberrant Behavior Checklist (ABC)
The Aberrant Behavior Checklist (ABC) is a 58-item rating scale used to assess maladaptive behaviors across five original subscales: Irritability (15 items from 0-45), Social Withdrawal (16 items from 0-48), Stereotypy (7 items from 0-21), Hyperactivity (16 items from 0-48), Inappropriate Speech (4 items from 0-12). Additionally, Social Avoidance, a newly developed four-item subscale (from 0-12) of the ABC that captures core social avoidance aspects of Fragile X Syndrome is reported. All items on the ABC are rated from 0 (not at all a problem) to 3 (the problem is severe in degree). Higher scores indicate greater maladaptive behaviors. Differences between Baseline and Week 10 are used as an indicator of change.
Time frame: Week 10
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Acamprosate Treatment Group | The Aberrant Behavior Checklist (ABC) | ABC Irritability | 7.0 units on a scale | Standard Deviation 8.9 |
| Acamprosate Treatment Group | The Aberrant Behavior Checklist (ABC) | ABC Social Withdrawal | 4.1 units on a scale | Standard Deviation 6.5 |
| Acamprosate Treatment Group | The Aberrant Behavior Checklist (ABC) | ABC Stereotypy | 6.0 units on a scale | Standard Deviation 6.3 |
| Acamprosate Treatment Group | The Aberrant Behavior Checklist (ABC) | ABC Hyperactivity | 11.0 units on a scale | Standard Deviation 8.6 |
| Acamprosate Treatment Group | The Aberrant Behavior Checklist (ABC) | ABC Inappropriate Speech | 4.8 units on a scale | Standard Deviation 3.4 |
| Acamprosate Treatment Group | The Aberrant Behavior Checklist (ABC) | ABC Social Avoidance | 1.6 units on a scale | Standard Deviation 2.7 |
Vineland Adaptive Behavior Scales-II (VABS-II) Communication Domain
The VABS-II is a semi-structured interview designed to assess adaptive functioning in communication, daily living, socialization and motor skills. Recognizing that language is a major area of impairment in the study population, the Communication Domain (99 Items from 0-198), in particular the Expressive Subdomain (54 Items from 0-108) are of interest in this study. Items arranged in a developmental sequence are rated on a 3-point scale. Each item is scored from 0 (never performs the behavior) to 3 (usually performs the behavior independently). Higher scores indicate higher adaptive functioning. Differences between Baseline and Week 10 are used as an indicator of change.
Time frame: Week 10
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Acamprosate Treatment Group | Vineland Adaptive Behavior Scales-II (VABS-II) Communication Domain | Communication Domain | 66.6 units on a scale | Standard Deviation 11.2 |
| Acamprosate Treatment Group | Vineland Adaptive Behavior Scales-II (VABS-II) Communication Domain | Expressive Communication | 78.9 units on a scale | Standard Deviation 21.2 |