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Myotonic DystrophyPhase 3NCT04624750

Open Label Study in Adolescents and Children With Myotonic Disorders

A Phase 3 study testing Mexiletine in people with Myotonic Dystrophy, run by Lupin Ltd. at 1 site in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is an open-label, multi-centre, single arm, interventional study to describe the steady-state PK, safety, and efficacy of mexiletine in paediatric patients (6 to <18 years of age) with myotonic disorders. Read more about this study

Who is it for?
Ages 6 to 18 years
Conditions the study is for
Myotonic Dystrophy
What is being tested?
Mexiletine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
12 participants
Where
1 siteFrance
Study dates
3 Sep 2021to 8 Aug 2024
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 6 to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Male or female patients aged ≥ 6 and < 18 years who are able to comply with the study requirements
  • A genetically confirmed diagnosis of NDM or DM (DM1or DM2)
  • Presence of clinical symptoms of myotonia (hand grip myotonia, myotonia in the leg muscles, any other myotonia symptoms)
  • No significant cardiac abnormalities as determined by a cardiologist's assessment of the ECG and echocardiogram performed within 3 months prior to enrolment in the study. (If not done within 3 months before trial, electrocardiogram (ECG) and echocardiogram assessments will be performed at screening)
  • No history of any significant liver disorder
  • Patients receiving mexiletine treatment agree to stop treatment at least 7 days prior to initiation of treatment with Namuscla
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  • Patients receiving other antimyotonic treatment agree to stop treatment for at least 7 times the half-life of respective drug
  • Laboratory investigations for haematology, biochemistry, and urinalysis at screening are within the normal range, or showing no clinically relevant abnormal values, as judged by the Investigator.
  • Female patients of childbearing potential must be using an acceptable form of birth control as determined by the Investigator (e.g., oral contraception, implantable, injectable/transdermal hormonal contraception, intrauterine device (IUD), barrier methods), tubal ligation or are practicing abstinence.
  • Patients able to provide assent to study participation and a parent or legal guardian to sign the written informed consent prior to study entry.

Who cannot join

  • Any contra-indication to mexiletine as listed in the Namuscla Summary of Product Characteristics (SmPC):
  • Hypersensitivity to the active substance, or to any of the excipients
  • Hypersensitivity to any local anaesthetic
  • Ventricular tachyarrhythmia
  • Complete heart block (i.e., third-degree atrioventricular block) or any heart block susceptible to evolve to complete heart block (first-degree atrioventricular block with markedly prolonged PR interval (≥ 200 ms) and/or wide QRS complex (≥ 120 ms), second-degree atrioventricular block, bundle branch block, bifascicular and trifascicular block),
  • QT interval > 450ms
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  • Myocardial infarction (acute or past), or abnormal Q-waves
  • Symptomatic coronary artery disease
  • Heart failure with ejection fraction <50%
  • Atrial tachyarrhythmia, fibrillation or flutter
  • Sinus node dysfunction (including sinus rate < 50 bpm)
  • Co-administration with medicinal products inducing torsades de pointes (class Ia, Ic, III antiarrhythmics): Co-administration of mexiletine and antiarrhythmics inducing torsades de pointesclass Ia: quinidine, procainamide, disopyramide, ajmaline; class Ic: encainide, flecainide, propafenone, moricizine; class III: amiodarone, sotalol, ibutilide, dofetilide, dronedarone, vernakalant) increases the risk of potentially lethal torsades de pointes.
  • Co-administration with medicinal products with narrow therapeutic index
  • Any other neurological or psychiatric condition that might affect the study assessments
  • Any clinically significant illness, laboratory findings, ECG, or other clinical symptoms, which in the opinion of the Investigator could affect the patient's optimal participation in the study
  • Strong inducer or inhibitor of CYP2D6 or CYP1A2 within 7 days prior to study drug administration
  • Any concurrent illness, or medications which could affect the muscle function
  • Seizure disorder, diabetes mellitus requiring treatment by insulin
  • Pregnant or breastfeeding
  • Concurrent participation in any other clinical trial.

Trial locations and contacts

1 site in 1 country.

France1 site
  • Hôpital Necker-Enfants-Malades

    Paris

Other trials in France

About this study

Official title: An Open-label, Non-Comparative Study to Evaluate the Steady-State Pharmacokinetics, Safety, and Efficacy of Mexiletine in Adolescents and Children With Myotonic Disorders

This is an open-label, multi-centre, single arm, interventional study to describe the steady-state PK, safety, and efficacy of mexiletine in paediatric patients (6 to <18 years of age) with myotonic disorders.

Read the detailed description

This is an open-label, multi-centre, single arm, interventional study to describe the steady-state PK, safety, and efficacy of mexiletine in paediatric patients (6 to <18 years of age) with myotonic disorders.

Patients who meet the eligibility criteria will be enrolled stepwise, sequentially in 2 cohorts by age groups.

Cohort 1 - Adolescents aged 12 to <18 years, will be enrolled first. If no safety concerns are observed (based on data evaluation by the Data Safety Monitoring Board [DSMB]), and the dose for the age group 6 to <12 years is confirmed by PK model, enrolment for Cohort 2 will begin.

Cohort 2 - Children aged 6 to <12 years, will be enrolled. The overall treatment duration for each cohort will be approximately 56 days (8 weeks): a dose titration phase of 4 weeks and the maintenance phase of 4 weeks. The overall study duration would be approximately 22 months.

Dose titration phase: In this phase, patients will receive mexiletine starting at an age appropriate dose (as evaluated by the investigator and based on body weight) at a frequency of once a day. Dose will be up-titrated every 14 days based on tolerability of mexiletine up to a maximum of three-times a day as assessed by investigator.

Maintenance phase: During the maintenance phase, patients will continue to receive mexiletine at the best-tolerated dose from the titration phase for further 4 weeks. Following completion, all participants will be offered follow-up in PIP Study 7 (MEX-NM-303) (EudraCT: 2019-003758-97).

Being tested
Mexiletine
Medical subject headings
Myotonic Dystrophy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MexiletineDrug

    Also called Namuscla ™

    Patients will be enrolled sequentially into 2 cohorts. Cohort 1 - (patients aged 12 to < 18 years): approximately 8 weeks - 4 weeks of dose titration period + 4 weeks of maintenance period.

    Cohort 2 - (patients aged 6 to < 12 years,): approximately 8 weeks - 4 weeks of dose titration period + 4 weeks of maintenance period.

    Enrolment for Cohort 2 will begin after initial safety assessment of patients in Cohort 1 by the DSMB and no safety concerns are observed. The dose level for cohort 2 will be confirmed by PK modelling study.

Study groups in NCT04624750
Study groupRoleWhat they receive
Cohort 1 and 2Other7 patients aged 12 to < 18 years , inclusive in cohort-1 7 patients aged 6 to < 12 years, inclusive in cohort-2
Receives: Drug: Mexiletine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number and frequency of adverse events (AEs)/serious adverse events (SAEs)

    Number and frequency of adverse events (AEs)/serious adverse events (SAEs), throughout the study while on treatment with Namuscla

    Measured: Baseline to Day 56

  2. Incidence of adverse events of special interest (AESI)

    Incidence of adverse events of special interest (AESI)

    Measured: Baseline to Day 56

  3. Changes in ECG assessments from baseline

    On resting ECG any alteration will be noted:

    • Mild ECG abnormalities: PR interval ≥200 ms and QRS duration ≥100 ms
    • Severe ECG abnormalities: PR interval ≥240 ms, QRS duration ≥120 ms, second or third degree AV block and a rhythm other than sinus

    Measured: Baseline to Day 56

  4. Efficacy of Namuscla treatment on the clinical outcomes based on the following functional evaluation mean change in Visual Analogue Scale (VAS) for muscle stiffness.

    Mean change in Visual Analogue Scale (VAS) for muscle stiffness. The VAS is constructed as an absolute measure, with a 10 cm straight horizontal line having the endpoints "no stiffness at all" and "stiffness as worst possible". The patient's responses will be scored on the line to the nearest millimetre (a 100-point scale). (myotonia severity).

    Measured: Baseline to Day 56

  5. Efficacy of Namuscla treatment on the clinical outcomes(change from baseline to Days 14, 28, 42 and 56, respectively) based on the following functional evaluation

    The score of handgrip myotonia as quantitatively measured using a commercially available grip dynamometer and computerised capture system. In standardised conditions (i.e. in a room at controlled temperature, after a definite period of rest), maximum voluntary contractions following forced right hand grip will be recorded and the time to relax from 90% to 5% of maximal force will be determined using automated analysis software

    Measured: Baseline to Day 56

Secondary outcomes (15)
  1. Mean change in VAS score for muscle pain, weakness and fatigue

    The VAS is constructed as an absolute measure, with a 10 cm straight horizontal line having the endpoints "no stiffness at all" and "stiffness as worst possible". The patient's responses will be scored on the line to the nearest millimetre (a 100-point scale). The score of stiffness severity as self-reported by the patient on a 10-point VAS will be used for adolescents and children older than 8 years and will be summarised descriptively by visit

    Measured: Baseline - Day 56

  2. Clinical myotonia assessment for mean change in time to open the eyes

    Mean change in time to open the eyes after forced eye closure as measured on a stopwatch (when eyelid myotonia present). Subjects will be asked to squeeze their eyes closed for 5 seconds then rapidly open them for 5 seconds then rapidly open. Five trials of each manoeuvre will be performed in sequence at each visit and the time measured on a stopwatch

    Measured: Baseline - Day 56

  3. Clinical myotonia assessment of clinical change in flexor myotonia

    Clinical change in flexor myotonia (right hand flexor muscles). Subjects will be asked to make a tight fist for 5 seconds then rapidly open. Five trials of each manoeuvre will be performed in sequence at each visit and the time measured on a stopwatch

    Measured: Baseline - Day 56

  4. Clinical myotonia assessment of mean change in time to perform Timed-up and go (TUG) test

    Mean change in time to perform Timed-up and go (TUG) test. Measures, in seconds, the time taken by an individual to stand up from a standard arm chair (approximate seat height of 46 cm, arm height 65 cm), walk a distance of 3 meters (approximately 10 feet), turn, walk back to the chair, and sit down.

    Measured: Baseline - Day 56

  5. Mean change in health-related quality-of-life as measured by the Paediatric Quality of Life (PedsQL) score

    Mean change from baseline to Day 56, respectively in health-related quality-of-life as measured by the Paediatric Quality of Life (PedsQL) score. These multidimensional scales assess the frequency of health problems using generic and disease-specific approaches, respectively. Subjects and/or parent or proxies report a score of 0 to 4 (never to almost always) and questionnaires are tailored to age groups.

    Measured: Baseline - Day 56

  6. Clinical Global Impression (CGI) scores (efficacy and tolerability) evaluated by the patient

    Clinical Global Impression (CGI) scores (efficacy and tolerability) evaluated by the patient, a parent or proxy and by the investigator at baseline and Day 56. Evaluated on a 4-point scale as very efficient, good, fair or poor.

    Measured: Baseline - Day 56

  7. Mean change in Myotonia Behaviour Scale (MBS) scores

    Mean change from baseline to Day 56 in Myotonia Behaviour Scale (MBS) scores The Myotonia Behaviour Scale (MBS) (Hammaren et al., 2005) 0 No stiffness

    1. Some stiffness exists, which can be ignored
    2. Some stiffness exists, which can be ignored at times, but doesn't impair daily activities
    3. Stiffness exists, which demands a higher level of mental awareness when performing some duties and activities
    4. Severe stiffness exists, which impairs every duty and activity
    5. Incapacitating stiffness exists, which demands constant moving not to be totally locked up, with regard to movement

    Measured: Baseline - Day 56

  8. Changes in clinical laboratory values for laboratory safety assessments - Potassium

    Changes in Potassium values from baseline to Day 56.

    Measured: Baseline - Day 56

  9. Acceptability of the capsule formulation with respect to the swallowability.

    Acceptability of the capsule formulation with respect to the swallowability. It will be assessed by interviewing patients and their caregivers at Day 56.

    Measured: Baseline - Day 56

  10. Palatability of alternative administration

    Palatability of alternative administration (capsule content with milk/juice or sprinkled on food) by 5-point facial hedonic scale correlated with 100-point Visual Analogue Scale (VAS) at each clinic visit

    Measured: Baseline - Day 56

  11. Changes in clinical laboratory values from baseline to Day 56 for laboratory safety assessments - Changes in Magnesium values

    Changes in Magnesium values from baseline to Day 56.

    Measured: Baseline - Day 56

  12. Changes in clinical laboratory values from baseline to Day 56 for laboratory safety assessments - Changes in Sodium values

    Changes in Sodium values from baseline to Day 56.

    Measured: Baseline - Day 56

  13. Changes in clinical laboratory values from baseline to Day 56 for laboratory safety assessments - Changes in Calcium values

    Changes in Calcium values from baseline to Day 56.

    Measured: Baseline - Day 56

  14. Changes in clinical laboratory values from baseline to Day 56 for laboratory safety assessments - Changes in Chloride values

    Changes in Chloride values from baseline to Day 56.

    Measured: Baseline - Day 56

  15. Mean change in Faces scale for muscle pain, weakness and fatigue

    A Faces (or other symbol) scale for children aged 6 to 8 years will be used to measure the score of muscle stiffness (myotonia severity). Faces scale will be used to assess pain, weakness and tiredness in study participants with a 10 cm straight horizontal line having the endpoints "no [symptom] at all" and "[symptom] as worst possible"

    Measured: Baseline - Day 56

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Nov 2020
  2. Study start3 Sep 2021
  3. Primary completion14 Jun 2024
  4. Study completion8 Aug 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
This is an open-label, multi-centre, single arm, interventional, study to evaluate the safety, steady-state PK, and efficacy of mexiletine for the treatment of myotonia in paediatric population aged 6 to \< 18 years. The study comprises a screening period of 30 days, a dose-titration period of 4 weeks, and a maintenance period of 4 weeks. After last visit, all patients will be offered follow-up in clinical study MEX-NM-303 (PIP Study 7).
Masking
None (open label)
Enrolment
12 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04624750
Sponsor's protocol ID
MEX-NM-301
Status last verified
Nov 2024
First submitted
20 Oct 2020
Last updated
25 Nov 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Mexiletine in people with Myotonic Dystrophy, run by Lupin Ltd. at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number and frequency of adverse events (AEs)/serious adverse events (SAEs) (time frame: Baseline to Day 56). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Nov 2024.

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