An Open-label Study to Define the Safety, Tolerability and Clinical Activity of Deutetrabenazine (AUstedo) in Adult Study Subjects With DYsTonia

The AUDYT Trial: An Open-label Study to Define the Safety, Tolerability and Clinical Activity of Deutetrabenazine (AUstedo) in Adult Study Subjects With DYsTonia

Status

Completed

Phases

Phase 1Phase 2

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT04173260

Acronym

AUDYT

Enrollment

Registered

2019-11-21

Start date

2021-04-29

Completion date

2024-08-31

Last updated

2024-09-20

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

Conditions

Dystonia, Primary

Brief summary

This is a single-center, open-label study of AUSTEDO in study subjects with dystonia. The study will provide preliminary experience of the safety, tolerability, and clinical activity of AUSTEDO in study subjects with dystonia. Study duration will be up to 13 weeks from screening (Visit 1) to the post treatment evaluation (Visit 5). Treatment period from drug initiation to final on-treatment Visit will be 12 weeks, or less, as follows: during the ramp-up period, study drug will start at 12 mg/day (6 mg twice daily) and will be titrated weekly by 6 mg/day increments until either 1) the maximal allowable dose (48 mg/day) is reached, or 2) dose-limiting side-effects occur. In study subjects receiving a strong CYP2D6 inhibitor, the maximum allowed dose of AUSTEDO will be 36 mg/day, reducing study duration (due to a reduction in the ramp-up period) to 11 weeks. Study subjects who experience dose-limiting side effects will be maintained on their maximum tolerated dose. Once the maximal dose is established for each participant, they will complete 6 continuous weeks on this dose (maintenance period), followed by a 1-week washout. For study subjects unable to titrate up to 48 mg/day due to side effects, the 6 weeks of maintenance will start once they reduce the study drug back to the maximum well-tolerated dose. Adverse events will be monitored throughout the study and will be reported after drug initiation. Dose reductions, suspensions, and withdrawals due to adverse events will be recorded. ECG readings will be measured at screening, during week 2, during the first week of the maintenance period (whenever this is established to be, typically week 7 for subjects able to titrate up to 48 mg/day), immediately before washout (week 12 for those study subjects who are able to titrate up to 48 mg/day) and during week 13. Assessment of Columbia Suicide Severity Rating Scale and Epworth Sleepiness Scale scores will occur at screening and all clinic Visits. The Mini Mental (MMSE) Scale will be performed at screening and at the final on-treatment Visit (week 12). A video examination of the study subjects will be made at screening (right before initiation of the study drug), and after 6 weeks on AUSTEDO at a steady dose (right before drug cessation). Part III of the MDS-UPDRS will be performed at both of these Visits as well to screen for the appearance of drug-induced parkinsonism. Videos will be sent to raters blinded to treatment, Visit number and recording date.

Interventions

DRUGDeutetrabenazine 6 MG

Increasing doses of Deutetrabenazine

Study design

Allocation

Intervention model

SINGLE_GROUP

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

1. Study subjects with definite dystonia, as established by a movement disorder specialist. 2. Study subjects of any race and either gender, age 18 or more on the date the informed consent form (ICF) is signed and with the capacity to provide voluntary informed consent. 3. Study subjects able to read and understand English and the ICF and are willing to comply with all study procedures, treatment and follow-up. 4. Study subjects who are taking any central nervous system acting medications (e.g., benzodiazepines, antidepressants, hypnotics), including medications for the treatment of dystonia, will be on a stable regimen for at least 30 days prior to the screening Visit, and will willing to remain on the same dose for the duration of the study. 5. Female of child-bearing potential will not be pregnant and will be using an acceptable method of contraception. 6. Study subjects with an MMSE \>24.

Exclusion criteria

1. Exposure to dopamine blockers prior to the onset of dystonia that could, in the investigator's opinion, have caused dystonia. 2. Study subjects with genetically-confirmed dopa-responsive dystonia. 3. Study subjects with a diagnosis of Parkinson's or an atypical parkinsonian syndrome. 4. Study subjects with a history of bipolar disorder or major depression, or the presence of active depression. 5. Study subjects with a history of a suicide attempt or suicidal ideations, as well as the presence of active suicidal ideation as detailed on the C-SSRS administered during Visit 1. 6. Study subjects with a history of schizophrenia or schizophrenia spectrum disorders. 7. Treatment with tetrabenazine, reserpine, valbenazine, a monoamino oxidase inhibitor, a-methyl-p-tyrosine, strong anticholinergic medications, metoclopramide, antipsychotics, dopamine agonists, levodopa, and/or stimulants within 30 days of screening. 8. Treatment with botulinum toxin less than 11 weeks prior to screening (Visit 1); subjects receiving injections sooner than every 12 weeks will be excluded if their next injection is scheduled farther than 6 days from screening. 9. Presence of a neurologic condition that could confound dystonia assessments. 10. Study subjects with a history of clinically relevant hepatic disease. 11. Study subjects with a history of renal insufficiency. 12. Any unstable medical illness. 13. A corrected QT (Bazett) interval of 450 (458) milliseconds in men or 460 (472) milliseconds in women on 12-lead ECG at screening, or a history of cardiac arrhythmias. 14. Study subjects participating in any drug or device clinical investigation concurrently or within 30 days prior to screening for this study. 15. Study subjects with a known hypersensitivity or contraindication to the study drug or its components.

Design outcomes

Primary

Measure	Time frame	Description
Proportion of Study Subjects Able to Titrate up to the Maximum Tolerated Dose	3 months	Proportion of study subjects able to titrate up to 48 mg/d (or up to 36 mg/d if receiving a strong CYP2D6 inhibitor) and able to complete the study at this dosage

Secondary

Measure	Time frame	Description
Change in Median Daytime Somnolence Score Among Subjects	Baseline and 3 months	Documentation of change in the Stanford Sleepiness Scale. Scale was assessed at the initial and last study visit; difference was calculated between both scores, and reported herein as a median among all participants' scores and full range. Items on this scale are numeric (1-7). Lower numeric values indicate a better outcome.
Change in Median MMSE Score Among Subjects	Baseline and 3 months	Documentation of change in the Mini Mental Scale. Scale was assessed at the initial and last study visit; difference was calculated between both scores, and reported herein as a median among all participants' scores and full range. The higher the total score on this scale, the better the outcome. Values range from 0 to a maximum of 30.
Number of Participants With Change in Suicidality	Baseline and 3 months	Documentation of change in the Columbia Suicide Severity Rating Scale. Items on this scale are both binary (Yes/No) and numeric (0-5). No answers and lower numeric values indicate a better outcome.
Change in Median PGI-I Score	Baseline and 3 months	Documentation of change in the Patient Global Impression of Improvement Scale (PGI-I). This is a Likert scale, with values from 1-7. A value of 1 indicates the best outcome. A value of 4 indicates no perceived change.
Change in Dystonia Severity, as Determined by the Change in Median GDS Score	Baseline and 3 months	Documentation of change in the Global Dystonia Rating Scale. Scale was assessed blindly from videos captured at the initial and last study visit; difference was calculated between both scores, and reported herein as a median among all participants' scores and full range. The lower the total score on this scale, the better the outcome. Values range from 0 to a maximum of 140.
Development of Parkinsonism, as Determined by Change in Median MDS-UPDRS III Score Among Subjects	Baseline and 3 months	Documentation of change in the MDS-Unified Parkinson's Disease Rating Scale, Part III. Scale was assessed at the initial and last study visit; difference was calculated between both scores, and reported herein as a median among all participants' scores and full range. The lower the total score on this scale, the better the outcome. Values range from 0 to a maximum of 128.

Countries

United States

Participant flow

Recruitment details

Fifteen subjects were recruited between April 2021 and December 2023.

Pre-assignment details

All subjects received IP; there was no placebo arm.

Participants by arm

Arm	Count
Intervention Arm - Oral Deutetrabenazine This is the only arm for this trial. All subjects will receive oral Deutetrabanazine. Deutetrabenazine 6 MG: Increasing doses of Deutetrabenazine	15
Total	15

Withdrawals & dropouts

Period	Reason	FG000
Overall Study	Early termination	4

Baseline characteristics

Characteristic	Intervention Arm - Oral Deutetrabenazine
Age, Categorical <=18 years	0 Participants
Age, Categorical >=65 years	7 Participants
Age, Categorical Between 18 and 65 years	8 Participants
Age, Continuous	63 years
Race (NIH/OMB) American Indian or Alaska Native	0 Participants
Race (NIH/OMB) Asian	1 Participants
Race (NIH/OMB) Black or African American	2 Participants
Race (NIH/OMB) More than one race	0 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants
Race (NIH/OMB) White	12 Participants
Region of Enrollment United States	15 participants
Sex: Female, Male Female	11 Participants
Sex: Female, Male Male	4 Participants

Adverse events

Event type	EG000 affected / at risk
deaths Total, all-cause mortality	0 / 15
other Total, other adverse events	15 / 15
serious Total, serious adverse events	0 / 15

Outcome results

Primary

Proportion of Study Subjects Able to Titrate up to the Maximum Tolerated Dose

Proportion of study subjects able to titrate up to 48 mg/d (or up to 36 mg/d if receiving a strong CYP2D6 inhibitor) and able to complete the study at this dosage

Time frame: 3 months

Arm	Measure	Value (COUNT_OF_PARTICIPANTS)
Intervention Arm - Oral Deutetrabenazine	Proportion of Study Subjects Able to Titrate up to the Maximum Tolerated Dose	6 Participants

Secondary

Change in Dystonia Severity, as Determined by the Change in Median GDS Score

Documentation of change in the Global Dystonia Rating Scale. Scale was assessed blindly from videos captured at the initial and last study visit; difference was calculated between both scores, and reported herein as a median among all participants' scores and full range. The lower the total score on this scale, the better the outcome. Values range from 0 to a maximum of 140.