Clobazam in Patients With Lennox-Gastaut Syndrome

Overview

The purpose of this study is to evaluate the safety and efficacy of clobazam as adjunctive therapy in the treatment of seizures which lead to drop attacks (drop seizures) in patients 2 to 60 years of age with Lennox-Gastaut Syndrome (LGS). Patients will be enrolled at approximately 65 sites in the U.S. and ex-US for up to 23 weeks. Patients will be randomly assigned to either a low, medium or high dose, or placebo. The study will include a baseline period, a titration period and a maintenance period. After the maintenance period, patients will either continue into an open-label extension study or enter the taper period with a final visit 1 week after the last dose.

Full Title of Study: “Double-Blind, Placebo-Controlled, Efficacy and Safety Study of Clobazam in Patients With Lennox-Gastaut Syndrome”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Triple (Participant, Care Provider, Investigator)
  • Study Primary Completion Date: December 2009

Detailed Description

LGS poses a significant treatment challenge. No single antiepileptic drug (AED) provides satisfactory relief for all or most patients with LGS and a combination of treatments is often required. Even with combination therapy, many LGS patients show resistance to treatment. Adjunctive therapy with newer anticonvulsant medications has demonstrated efficacy for some patients, although polytherapy and high medication doses are often associated with unfavorable adverse event profiles. More effective and better-tolerated treatment options are needed for this population of medically intractable epilepsy patients. Clobazam may provide an improved safety profile compared to other AEDs currently approved for the treatment of LGS and may have less hypotonia and drooling effects than other benzodiazepines.

Interventions

  • Drug: Clobazam Low Dose
    • 0.25 mg/kg/day; tablets; orally; for 15-18 weeks
  • Drug: Clobazam Medium Dose
    • 0.5 mg/kg/day; tablets; orally; for 15-18 weeks
  • Drug: Clobazam High Dose
    • 1.0 mg/kg/day; tablets; orally; for 15-18 weeks
  • Drug: Placebo
    • tablets; orally; daily for 15-18 weeks

Arms, Groups and Cohorts

  • Experimental: Clobazam Low Dose
  • Experimental: Clobazam Medium Dose
  • Experimental: Clobazam High Dose
  • Placebo Comparator: Placebo

Clinical Trial Outcome Measures

Primary Measures

  • Percent Reduction in Number of Drop Seizures (12-week Maintenance Period).
    • Time Frame: 4-week baseline period and 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.

Secondary Measures

  • Percent Reduction in Number of Drop Seizures (First 4 Weeks of the 12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the first 4 weeks of the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Percent Reduction in Number of Drop Seizures (Middle 4 Weeks of the 12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the middle 4 weeks of the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Percent Reduction in Number of Drop Seizures (Last 4 Weeks of the 12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the last 4 weeks of the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Percent of Patients Considered Treatment Responders Defined as Those With a >=25%, >=50%, >=75%, 100% Reduction in Drop Seizures (12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Percent of Patients Considered Treatment Responders Defined as Those With a >=25%, >=50%, >=75%, 100% Reduction in Drop Seizures (First 4 Weeks of the 12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the first 4 weeks of the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Percent of Patients Considered Treatment Responders Defined as Those With a >=25%, >=50%, >=75%, 100% Reduction in Drop Seizures (Middle 4 Weeks of the 12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the middle 4 weeks of the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Percent of Patients Considered Treatment Responders Defined as Those With a >=25%, >=50%, >=75%, 100% Reduction in Drop Seizures (Last 4 Weeks of the 12-week Maintenance Period).
    • Time Frame: 4-week baseline period and the last 4 weeks of the 12-week maintenance period
    • Number of drop seizures (average per week) was obtained from seizure diaries. The average drop in seizures per week for patients who did not complete the maintenance period was calculated based on the time from the beginning of the maintenance period to date of withdrawal.
  • Tolerance
    • Time Frame: 4-week baseline period and first 4/first 8 weeks of the maintenance period
    • Study responders who have ≥50% reduction in their drop seizure rate during the first 4 or first 8 weeks of maintenance compared to the 4 week baseline period.
  • Investigator Global Evaluations of the Patient’s Overall Change in Symptoms.
    • Time Frame: Week 15
    • The physician was asked to rate the patient’s overall change in symptoms and overall change in seizure activity and Quality of Life since the beginning of clobazam treatment by checking “very much improved”, “much improved”, “minimally improved”, “no change”, “minimally worse”, “much worse”, or “very much worse”.
  • Parent/Caregiver Global Evaluations of the Patient’s Overall Change in Symptoms.
    • Time Frame: Week 15
    • The parent/caregiver was asked to rate the patient’s overall change in symptoms and overall change in seizure activity and Quality of Life since the beginning of clobazam treatment by checking “very much improved”, “much improved”, “minimally improved”, “no change”, “minimally worse”, “much worse”, or “very much worse”.

Participating in This Clinical Trial

Inclusion Criteria

  • Patient must have been <11 years of age at the onset of LGS. – Patient must have LGS. – Patient must be on at least 1 AED. – Parent or caregiver must be able to keep an accurate seizure diary. Exclusion Criteria:

  • Etiology of patient's seizures is a progressive neurologic disease. Patients with tuberous sclerosis will not be excluded from study participation, unless there is a progressive tumor. – Patient has had an episode of status epilepticus within 12 weeks of baseline. – Patient has had an anoxic episode requiring resuscitation within 6 months of screening. – Patient has a clinically significant history of an allergic reaction or significant sensitivity to benzodiazepines. – Patient is taking more than 3 concurrent AEDs. – Patient has been on the ketogenic diet for less than 30 days prior to screening or suffers from frequent stooling. – If the patient has a Vagal Nerve Stimulator (VNS), the settings have not been stable for at least 30 days prior to screening. – Patient has taken corticotropins in the 6 months prior to screening. – Patient is currently taking long-term systemic steroids (excluding inhaled mediation for asthma treatment) or any other daily medication known to exacerbate epilepsy. An exception will be made of prophylactic medication, for example, for idiopathic nephrotic syndrome or asthma. – If the patient is taking felbamate, has been taking it for less than 1 year prior to screening. Other protocol-defined inclusion and exclusion criteria may apply.

Gender Eligibility: All

Minimum Age: 2 Years

Maximum Age: 60 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Lundbeck LLC
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Email contact via H. Lundbeck A/S, Study Director, LundbeckClinicalTrials@lundbeck.com

Citations Reporting on Results

Ng YT, Conry JA, Drummond R, Stolle J, Weinberg MA; OV-1012 Study Investigators. Randomized, phase III study results of clobazam in Lennox-Gastaut syndrome. Neurology. 2011 Oct 11;77(15):1473-81. doi: 10.1212/WNL.0b013e318232de76. Epub 2011 Sep 28.

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