Idiopathic Hypersomnia
Conditions
Keywords
Disorders of Excessive Somnolence, Sleep Disorders, Intrinsic Dyssomnias, Sleep Wake Disorders, Nervous System Diseases, Mental Disorders
Brief summary
This is a study of the safety, efficacy and pharmacokinetics (PK) of Serdexmethylphenidate (SDX) compared to placebo in subjects with Idiopathic Hypersomnia (IH).
Detailed description
SDX is a prodrug of dexmethylphenidate (d-MPH). SDX behaves as a prototypical prodrug that is devoid of pharmacological effects until metabolized to active d-MPH. Central nervous system (CNS) stimulants, including d-MPH products, are being used off-label by patients with IH. The potential advantage of SDX-derived d-MPH is its unique PK profile with rising d-MPH plasma concentrations at approximately 3 hours postdose followed by a broad peak from approximately 8 to 12 hours postdose (without sharp exposure spikes), and a gradual decline after the peak. The optimal dose of SDX will be determined for each participant by titration based on individual tolerability and response during the 5-week SDX-only Open-Label Titration period (OLTP), after which 2/3 of the participants will continue to receive SDX and 1/3 of the participants will receive placebo (withdrawal design) in the 2-week Double-Blind Withdrawal Period (DBWP). The study will evaluate safety (primary endpoint), efficacy and PK in patients with IH after daily oral administration of SDX either once per day in the evening (qd pm) or twice per day (morning and evening: bid). The study is expected to inform about the optimal SDX dose range and the best dose regimen (nighttime dosing or twice-per-day) for further studies in patients with IH and narcolepsy. The evening dosing regimen (just before bedtime) is of interest since there is little or no exposure to d-MPH for the first several hours post-dose and the mean peak d-MPH concentration occurs at 10-12 hours post-dose (ie, in the morning after a nighttime dose).
Interventions
DRUGSerdexmethylphenidate
Participants randomized to active drug will receive their optimized dose according to a dosing regimen set by randomization at the start of the OLTP. The 4 possible oral SDX doses are 80, 160, 240, or 320 mg/day. The optimal SDX dose will be determined during the 5-week OLTP preceding the 2-week DBWP.
OTHERPlacebo
Participants randomized to placebo will receive matching placebo capsules to the optimized dose established at the end of the OLTP, according to a dosing regimen set by randomization at the start of the OLTP.
Sponsors
Zevra Therapeutics
Rho, Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Masking description
Open-Label Titration Period with a Double-Blind Withdrawal Period
Intervention model description
Phase 2, placebo-controlled, double-blind, randomized withdrawal study to determine the safety and efficacy of oral SDX in patients with Idiopathic Hypersomnia (IH).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. At least 18 years of age at the time of consent 2. Body Mass Index (BMI) ≤35 kg/m2 3. Documented primary diagnosis of IH according to the International Classification of Sleep Disorders (ICSD-3) criteria 4. At the Screening Visit and Baseline Visit (start of OLTP), Epworth Sleepiness Scale (ESS) scores ≥11 5. Average nightly Total Sleep Time (TST) of ≥7 hours, per subject history and confirmed during screening. 6. Subject must be in general good health defined as the absence of any clinically relevant abnormalities as determined by the Investigator based on physical and neurological examinations, vital signs, ECGs, medical history, and clinical laboratory values (hematology, chemistry, and urinalysis) at Screening. 7. If currently treated with nicotine replacement therapy, must have been taking the same regimen and dose for at least 2 months prior to screening and must agree to take the same dose during the study. 8. Have used a medically acceptable method of contraception for at least 2 months prior to the first dose of study drug and consent to use a medically acceptable method of contraception from the first dose of study drug, throughout the entire study period, and for 90 days after the last dose of study drug.
Exclusion criteria
1. Hypersomnia due to another medical, behavioral, or psychiatric disorder condition (eg, narcolepsy, depression disorders, multiple sclerosis, Parkinson's disease, stroke). 2. Clinically significant sleep-related breathing disorders, including sleep apnea, treatment with Continuous Positive Airway Pressure (CPAP) therapy, Obstructive Apnea Hypopnea Index (AHI) \>15 episodes per hour, or hypoventilation. 3. Clinically significant parasomnias (eg, sleep walking, rapid eye movement \[REM\] sleep behavior disorder, etc). 4. Periodic Limb Movement Disorder (PLMD) Arousal Index (PLMA-I) \>15 during Screening PSG, a historical diagnosis of PLMD (last 10 years), or a PLMD diagnosis older than 10 years with current (last 60 days) treatment or symptoms of rhythmic movements involving one or both legs during sleep. 5. Occupation requiring nighttime shift work or variable shift work with early work start times (before 6 AM), if this occurs more than once per week. 6. Planned travel during the study that includes more than 3 time zones, or planned travel that includes 3 time zones on more than 2 occasions during the study. 7. Going to sleep for the night later than 1 AM at a frequency of more than once per week. 8. Current or past (within 1 year) major depressive episode according to DSM-5 criteria. 9. Any history of attempted suicide (lifetime) or clinically significant suicidal ideation, in the opinion of the Investigator, based on the C-SSRS assessment at Screening. 10. Any clinically significant unstable medical abnormality, chronic disease (eg, asthma or diabetes), or a history of a clinically significant abnormality of the cardiovascular, central nervous system, 11. Any of the following out-of-range vital signs at Screening: systolic blood pressure outside 90-145 mmHg; diastolic blood pressure outside 50-90 mmHg; resting heart rate outside 40-100 beats per minute. 12. History or presence of abnormal ECGs, which in the Investigator's opinion is clinically significant, including the following: 1. ECG findings of ischemia or infarct 2. Complete bundle branch blocks 3. Symptomatic arrhythmias as ventricular arrhythmias (non- sustained ventricular tachycardia (VT), multifocal or frequent premature ventricular contractions), bundle branch block, axis deviation, or abnormal or any predominantly non-sinus- conducted rhythm. 4. QTcF \>450 msec for males or \>470 msec for females, on Screening ECG. 5. PR interval outside the range of 120 to 220 msec on Screening ECG 13. Estimated glomerular filtration rate (GFR) at Screening \<60 mL/min/1.73 m2. 14. Malignant neoplastic disease requiring therapy within 2 years prior to Screening or during the study, or clinically relevant as judged by the Investigator. 15. Uncontrolled thyroid disorder as evidenced by thyroid stimulating hormone (TSH) ≤0.8 x the lower limit of normal (LLN) or ≥1.25 x the upper limit of normal (ULN) for the reference laboratory at Screening. 16. Laboratory value for aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \>3 x upper limits of normal (ULN). 17. Excessive caffeine use during the 10 days prior to first dose of study drug or anticipated excessive use defined as \>600 mg/day of caffeine during the treatment periods of the study. 18. Treatment or planned treatment with prohibited medications (including medications that may affect daytime sleepiness and nighttime sleep) or unwilling to refrain from any prohibited medications. Treatment must have been discontinued 14 days or 5 half-lives, whichever is longer, prior to the first dose of study medication (and at least 30 days for sedating antidepressants; at least 14 days for CNS stimulants). 19. Current or past (within 12 months prior to Screening) substance use disorder (including alcohol and psychoactive cannabinoids) according to DSM-5 criteria; current or past history of substance abuse treatment (including alcohol), or unwilling to refrain from substance use (including alcohol) during the study. 20. Nicotine dependence that has an effect on sleep (eg, a subject who routinely awakens at night to smoke). 21. Evidence of substance or alcohol use or has a positive urine or breath alcohol or positive urine drug screen at Screening.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Epworth Sleepiness Scale (ESS) Score | Start to end of DBWP (2 weeks) | Scores level of daytime sleepiness ranging from 0 to 24, with a higher score indicating worsened sleepiness |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Epworth Sleepiness Scale (ESS) Score | Changes from Titration Baseline to Week 5 (5 weeks) | Scores level of daytime sleepiness ranging from 0 to 24, with a higher score indicating worsened sleepiness |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORChristopher Drake, PhD
Investigator
Participant flow
Recruitment details
66 subjects enrolled into the study by entering the Open-Label Titration Period (OLTP). After subjects titrated to their highest tolerated dose over the 5-week period, 50 were randomized into the Double-Blind Withdrawal Period (DBWP).
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous Double-Blind Withdrawal Period | 35.1 years STANDARD_DEVIATION 8.92 |
| Age, Continuous Open-Label Titration Period | 35.4 years STANDARD_DEVIATION 11.85 |
| Race (NIH/OMB) Double-Blind Withdrawal Period American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Double-Blind Withdrawal Period Asian | 1 Participants |
| Race (NIH/OMB) Double-Blind Withdrawal Period Black or African American | 5 Participants |
| Race (NIH/OMB) Double-Blind Withdrawal Period More than one race | 0 Participants |
| Race (NIH/OMB) Double-Blind Withdrawal Period Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Double-Blind Withdrawal Period Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Double-Blind Withdrawal Period White | 36 Participants |
| Race (NIH/OMB) Open-Label Titration Period American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Open-Label Titration Period Asian | 2 Participants |
| Race (NIH/OMB) Open-Label Titration Period Black or African American | 6 Participants |
| Race (NIH/OMB) Open-Label Titration Period More than one race | 0 Participants |
| Race (NIH/OMB) Open-Label Titration Period Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Open-Label Titration Period Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Open-Label Titration Period White | 24 Participants |
| Sex: Female, Male Double-Blind Withdrawal Period Female | 0 Participants |
| Sex: Female, Male Double-Blind Withdrawal Period Male | 14 Participants |
| Sex: Female, Male Open-Label Titration Period Female | 47 Participants |
| Sex: Female, Male Open-Label Titration Period Male | 9 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 32 | 0 / 34 | 0 / 7 | 0 / 16 | 0 / 8 | 0 / 19 |
| other Total, other adverse events | 22 / 32 | 17 / 34 | 0 / 7 | 3 / 16 | 3 / 8 | 3 / 19 |
| serious Total, serious adverse events | 1 / 32 | 0 / 34 | 0 / 7 | 0 / 16 | 0 / 8 | 0 / 19 |
Outcome results
None listed