Chronic Inflammatory Demyelinating Polyneuropathy, Peripheral Neuropathy, Charcot-Marie-Tooth Disease, Charcot-Marie-Tooth Disease Type 1A, Charcot-Marie-Tooth Disease, Type 1B, Anti-MAG Neuropathy
Conditions
Keywords
Neuropathy, Demyelinating polyradiculoneuropathy
Brief summary
The single-center, open-label Phase II study has the objective of assess the effect of MD1003 on motor and sensory conduction in patients suffering from demyelinating polyneuropathies in 15 subjects.
Interventions
DRUGMD1003
Sponsors
MedDay Pharmaceuticals SA
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Male and female aged between 20 and 85 years. * Patients fulfilling one of the following diagnosis: * Five patients with chronic inflammatory demyelinating polyneuropathy on both clinical and neurophysiological grounds. * Five patients with proven genetic diagnosis of CMT1a or CMT1b * Five patients with anti-MAG polyneuropathy. * Electrophysiological parameters worsening for the past 3 years * Available EMG record, performed during the past 6 months to assess variability of NCV parameters * Signed and dated written informed consent to participate in the study in accordance with local regulations * Likely to be able to participate in all scheduled evaluation and complete all required study procedures, * In the opinion of the investigator, the patient will be compliant and have a high probability of completing the study. * Both male and female subjects who are not either surgically sterile (tubal ligation/obstruction or removal of ovaries or uterus) or post-menopausal (no spontaneous menstrual periods for at least one year confirmed by a negative hormone panel) must commit to using TWO highly effective method of birth control for the duration of the study and for two months after the treatment termination.
Exclusion criteria
* Any general chronic handicapping disease other than peripheral neuropathy * Impossibility to perform the 10 meters walking test * Impossibility to assess electrophysiological parameters * Patients with uncontrolled hepatic disorder, renal or cardiovascular disease, or cancer, * Patients with hypersensitivity to MD1003 excipients (lactose) * Laboratory tests out of normal range according to the reference laboratory values. Deviations may be accepted if considered by the investigator as not clinically significant with regards to the study continuation, * Patients with history or presence of alcohol abuse or drug addiction, * Patients likely to be non-compliant to the study procedures or for whom a long-term follow-up seems to be difficult to achieve. * Any new medication for neuropathy initiated less than 3 months prior to inclusion. For CIDP patients, relapse in the past 3 months before inclusion. * Not easily contactable by the investigator in case of emergency or not capable to call the investigator * Subjects without effective contraception
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Motor Nerve Conduction Velocity (m/Sec) | 48 weeks | Absolute change from baseline at Week 48. |
| Distal Latency (Msec) | 48 weeks | Absolute change from baseline at Week 48. |
| F Wave Latency (Msec) | 48 weeks | Absolute change from baseline at Week 48. |
| Length of Motor Nerve Potential | 48 weeks | Absolute change from baseline at W48. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 6-minute Walk Test | 48 weeks | The 6MWT is a practical simple test that requires a 30 m (100-ft) hallway. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes. Absolute change from baseline at week 48. |
| Posturography Score | 48 weeks | Computerized dynamic posturography (CDP) is a non-invasive specialized clinical assessment technique used to quantify the central nervous system adaptive mechanisms (sensory, motor and central) involved in the control of posture and balance, both in normal and abnormal conditions. Absolute change of speed in spontaneous speed condition from baseline at week 48. |
| Excitability Testing: Supernormality (%) | 48 weeks | Nerve excitability testing is a non-invasive approach in investigating the pathophysiology of peripheral nerve disorders, which determines the electrical properties of the nerve membrane at the site of stimulation. Absolute change from baseline at week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). During the 10-30 ms following the end of the refractory period, the axon increases its excitability and the nerve fiber is more easily excited (the supernormal period). Depolarization of the node of Ranvier excites the adjacent internodes, which then charge with electric current as capacitors. Supernormality depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only. |
| Strength-duration Time Constant (ms) | 48 weeks | This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. Strength-duration Time Constant (ms) is a measurement of excitability, defined as the duration of the stimulus that has twice the strength of the rheobase current (see below). The lower the rheobase is, the higher is the Strenght duration time constant. Accordingly, higer values of SDTC are associated with better outcome. |
| ONLS (Overall Neuropathy Limitations Scale) | 48 weeks | The ONLS focuses on upper and lower limb functions, and consists of a checklist for interviewing patients. It is scored from 0 to 5 on the upper limb section and from 0 to 7 on the lower limb section. A score of 0 indicates no limitations (the ceiling of the scale) and a score of 5 or 7 indicates no purposeful movement. Absolute change from baseline at week 48. |
| Refractoriness (%) | 48 weeks | This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline to week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). Refractoriness depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only. |
| Minimum Absolute Refractory Period (ms). | 48 weeks | This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). Refractoriness depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only. |
| Maximum Absolute Refractory Period (ms). | Week 48 | This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). Refractoriness depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only. |
| Rheobase (mA) | 48 weeks | This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. Rheobase is the minimal strength of an electrical stimulus of infinitely long duration that is able to cause excitation. Low values are associated with better outcome (the nerve becomes more excitable). |
| Change From Baseline at Week 48 for Timed 10-meter Walk Test | 48 weeks | Absolute change from baseline at week 48. The patient is instructed to walk at normal pace for 10 meters. Start and stop of performance time coincides with the toes of the leading foot crossing the 2-m mark and the 8-m mark, respectively. From these data, the speed may be calculated by dividing the middle 6 m by the time (in seconds). |
| Absolute Change From Baseline at Week 48 for Medical Research Council (MRC) Subscore (Total Muscle) and Total Score | 48 weeks | MRC score assessed in 19 muscles. The muscle scale grades muscle power on a scale of 0 to 5 in relation to the maximum expected for that muscle. The patient's effort is graded on a scale of 0-5: Grade 5: Muscle contracts normally against full resistance. Grade 4: Muscle strength is reduced but muscle contraction can still move joint against resistance. Grade 3: Muscle strength is further reduced such that the joint can be moved only against gravity with the examiner's resistance completely removed. As an example, the elbow can be moved from full extension to full flexion starting with the arm hanging down at the side. Grade 2: Muscle can move only if the resistance of gravity is removed. As an example, the elbow can be fully flexed only if the arm is maintained in a horizontal plane. Grade 1: Only a trace or flicker of movement is seen or felt in the muscle or fasciculations are observed in the muscle. Grade 0: No movement is observed. |
| INCAT Sensory Sum Score (ISS) | 48 weeks | This sensory scale comprises pin prick and vibration sense plus a two point discrimination value in the arms and legs, and ranges from 0 (normal sensation) to 20 (most severe sensory deficit). Absolute change from baseline at week 48. |
Countries
France
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| MD1003 MD1003 100mg capsules, 1 capsule tid for 48 weeks | 15 |
| Total | 15 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
Baseline characteristics
| Characteristic | MD1003 | — |
|---|---|---|
| Age, Continuous | 61.36 years STANDARD_DEVIATION 14.07 | — |
| Disease type anti-MAG polyneuropathy | 5 participants | — |
| Disease type CIDP patients | 5 participants | — |
| Disease type CMT1a or CMT1b patients | 5 participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment France | 15 participants | — |
| Sex: Female, Male Female | 8 Participants | — |
| Sex: Female, Male Male | 7 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 15 |
| other Total, other adverse events | 14 / 15 |
| serious Total, serious adverse events | 2 / 15 |
Outcome results
Primary
Distal Latency (Msec)
Absolute change from baseline at Week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Distal Latency (Msec) | 0.20 ms | Standard Deviation 8.89 |
p-value: 0.5995Wilcoxon (Mann-Whitney)
Primary
F Wave Latency (Msec)
Absolute change from baseline at Week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | F Wave Latency (Msec) | 4.8 ms | Standard Deviation 8.4 |
p-value: 0.1641Wilcoxon (Mann-Whitney)
Primary
Length of Motor Nerve Potential
Absolute change from baseline at W48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Length of Motor Nerve Potential | 8.5 ms | Standard Deviation 16.5 |
p-value: 0.0353Wilcoxon (Mann-Whitney)
Primary
Motor Nerve Conduction Velocity (m/Sec)
Absolute change from baseline at Week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Motor Nerve Conduction Velocity (m/Sec) | 1.67 m/s | Standard Deviation 11.45 |
p-value: 0.7615Wilcoxon (Mann-Whitney)
Secondary
6-minute Walk Test
The 6MWT is a practical simple test that requires a 30 m (100-ft) hallway. This test measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6 minutes. Absolute change from baseline at week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | 6-minute Walk Test | 61.1 m | Standard Deviation 48.9 |
Secondary
Absolute Change From Baseline at Week 48 for Medical Research Council (MRC) Subscore (Total Muscle) and Total Score
MRC score assessed in 19 muscles. The muscle scale grades muscle power on a scale of 0 to 5 in relation to the maximum expected for that muscle. The patient's effort is graded on a scale of 0-5: Grade 5: Muscle contracts normally against full resistance. Grade 4: Muscle strength is reduced but muscle contraction can still move joint against resistance. Grade 3: Muscle strength is further reduced such that the joint can be moved only against gravity with the examiner's resistance completely removed. As an example, the elbow can be moved from full extension to full flexion starting with the arm hanging down at the side. Grade 2: Muscle can move only if the resistance of gravity is removed. As an example, the elbow can be fully flexed only if the arm is maintained in a horizontal plane. Grade 1: Only a trace or flicker of movement is seen or felt in the muscle or fasciculations are observed in the muscle. Grade 0: No movement is observed.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Absolute Change From Baseline at Week 48 for Medical Research Council (MRC) Subscore (Total Muscle) and Total Score | 4.5 score on a scale | Standard Deviation 8.2 |
p-value: 0.0371Wilcoxon (Mann-Whitney)
Secondary
Change From Baseline at Week 48 for Timed 10-meter Walk Test
Absolute change from baseline at week 48. The patient is instructed to walk at normal pace for 10 meters. Start and stop of performance time coincides with the toes of the leading foot crossing the 2-m mark and the 8-m mark, respectively. From these data, the speed may be calculated by dividing the middle 6 m by the time (in seconds).
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Change From Baseline at Week 48 for Timed 10-meter Walk Test | -0.6 second | Standard Deviation 1.2 |
p-value: 0.1777Wilcoxon (Mann-Whitney)
Secondary
Excitability Testing: Supernormality (%)
Nerve excitability testing is a non-invasive approach in investigating the pathophysiology of peripheral nerve disorders, which determines the electrical properties of the nerve membrane at the site of stimulation. Absolute change from baseline at week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). During the 10-30 ms following the end of the refractory period, the axon increases its excitability and the nerve fiber is more easily excited (the supernormal period). Depolarization of the node of Ranvier excites the adjacent internodes, which then charge with electric current as capacitors. Supernormality depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Excitability Testing: Supernormality (%) | 9.84 percentage of supernormality | Standard Deviation 28.16 |
p-value: 0.213Wilcoxon (Mann-Whitney)
Secondary
INCAT Sensory Sum Score (ISS)
This sensory scale comprises pin prick and vibration sense plus a two point discrimination value in the arms and legs, and ranges from 0 (normal sensation) to 20 (most severe sensory deficit). Absolute change from baseline at week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | INCAT Sensory Sum Score (ISS) | -2.2 score on a scale | Standard Deviation 2.9 |
p-value: 0.0142Wilcoxon (Mann-Whitney)
Secondary
Maximum Absolute Refractory Period (ms).
This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). Refractoriness depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only.
Time frame: Week 48
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Maximum Absolute Refractory Period (ms). | -0.277 ms | Standard Deviation 0.871 |
Secondary
Minimum Absolute Refractory Period (ms).
This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). Refractoriness depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Minimum Absolute Refractory Period (ms). | 0.000 ms | Standard Deviation 0.092 |
p-value: 0.9229Wilcoxon (Mann-Whitney)
Secondary
ONLS (Overall Neuropathy Limitations Scale)
The ONLS focuses on upper and lower limb functions, and consists of a checklist for interviewing patients. It is scored from 0 to 5 on the upper limb section and from 0 to 7 on the lower limb section. A score of 0 indicates no limitations (the ceiling of the scale) and a score of 5 or 7 indicates no purposeful movement. Absolute change from baseline at week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | ONLS (Overall Neuropathy Limitations Scale) | -0.5 score on a scale | Standard Deviation 1.4 |
p-value: 0.2642Wilcoxon (Mann-Whitney)
Secondary
Posturography Score
Computerized dynamic posturography (CDP) is a non-invasive specialized clinical assessment technique used to quantify the central nervous system adaptive mechanisms (sensory, motor and central) involved in the control of posture and balance, both in normal and abnormal conditions. Absolute change of speed in spontaneous speed condition from baseline at week 48.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Posturography Score | 0.111 m/s | Standard Deviation 0.201 |
p-value: 0.1055Wilcoxon (Mann-Whitney)
Secondary
Refractoriness (%)
This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline to week 48. After a nerve fiber is depolarized, a sequence of excitability changes, called the 'recovery cycle', occurs before the membrane potential returns to its resting stage. This cycle includes phases in which the nerve excitability is decreased ('refractory period' or increased ('supernormal period'). Refractoriness depends on many factors and its interpretation is therefore not univoqual. Data were provided for information only.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Refractoriness (%) | -4.28 percentage of refractoriness | Standard Deviation 32.21 |
p-value: 0.3303Wilcoxon (Mann-Whitney)
Secondary
Rheobase (mA)
This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. Rheobase is the minimal strength of an electrical stimulus of infinitely long duration that is able to cause excitation. Low values are associated with better outcome (the nerve becomes more excitable).
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Rheobase (mA) | -5.905 mA | Standard Deviation 6.283 |
p-value: 0.0004Wilcoxon (Mann-Whitney)
Secondary
Strength-duration Time Constant (ms)
This secondary outcome measure is an electrophysiological testing endpoint. Absolute change from baseline at week 48. Strength-duration Time Constant (ms) is a measurement of excitability, defined as the duration of the stimulus that has twice the strength of the rheobase current (see below). The lower the rheobase is, the higher is the Strenght duration time constant. Accordingly, higer values of SDTC are associated with better outcome.
Time frame: 48 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| MD1003 | Strength-duration Time Constant (ms) | 0.068 ms | Standard Deviation 0.112 |
p-value: 0.0393Wilcoxon (Mann-Whitney)