Cannabidiol Expanded Access Study in Medically Refractory Sturge-Weber Syndrome

Overview

The purpose of this study is to determine the tolerability and optimal dose of cannabidiol (CBD) as an simultaneous treatment in children and young adults with Sturge-Weber syndrome (SWS) and drug resistant epilepsy.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: April 2019

Detailed Description

We hope to gain an understanding of the utility of pure CBD used for the treatment of medically refractory epilepsy in SWS in this open-label, safety dose-finding, study. Recent evidence suggests that CBD has multiple, beneficial, effects in patients (such as those with SWS that undergo neurological deterioration) suffering from medically refractory seizures. We hypothesize that CBD will reduce seizure frequency in children and young adults with SWS and will therefore help stabilize and improve their neurologic status.This trial is part of an expanded access program, available through a partnership with GW Pharmaceutical, which has been sanctioned by the FDA to study the safety and efficacy of Epidiolex (cannabidiol/CBD) in participants with SWS and medically refractory seizures.

Interventions

  • Drug: Cannabidiol
    • Initiation of treatment will begin with 2mg/kg/day. The dose will be increased by 3 mg/kg/day after seven days and then by 5 mg/kg/day every seven days up to a maximum dose of 25 mg/kg/day given. The dose of concomitant antiepileptic drugs will remain unchanged during the first 12 weeks of CBD treatment (or until 8 weeks after steady state at final dose), unless symptoms of toxicity and/or significant changes in blood levels are observed.

Arms, Groups and Cohorts

  • Experimental: Cannabidiol
    • All subjects will receive the experimental Epidiolex (cannabidiol) oral solution to be taken at home twice a day, and will be treated on an outpatient basis. The drug will be taken for 48 weeks unless the subject chooses to participate in the extension phase of the study, in which case the subject will continue to receive the drug for one additional year or until the drug is approved for clinical use for the treatment of epilepsy in patients with Sturge-Weber syndrome.

Clinical Trial Outcome Measures

Primary Measures

  • Change in seizure frequency
    • Time Frame: 1 year
    • Seizure Frequency between visits and per week will be calculated

Secondary Measures

  • Change in average seizure duration by seizure type
    • Time Frame: 1 year
    • Average seizure duration in seconds and minutes for each seizure type experienced by subject.
  • Change in the number of episodes of status epilepticus, defined as convulsive seizure lasting longer than 10 minutes
    • Time Frame: 1 year
    • Any episodes of status epilepticus are noted and changes in the number experienced by subject over the 1 year time frame are calculated.
  • Change in the number of uses of rescue medication
    • Time Frame: 1 year
    • Each time a rescue medication is used for a seizure between visits the data is noted and changes in frequency used over the 1 year time period will be calculated.
  • Change in the number of ER visits/ hospitalizations
    • Time Frame: 1 year
    • Number of ER visits or hospitalizations will be recorded and changes in frequency will be calculated.

Participating in This Clinical Trial

Inclusion Criteria

Participants with Sturge-Weber syndrome brain involvement as defined on neuroimaging (n=10 subjects, male and female, ages 1 month to 45 years of age) and the following:

  • Documentation of a diagnosis of drug resistant epilepsy as evidenced by failure to control seizures despite appropriate trial of two or more AEDs at therapeutic doses. Drug resistant epilepsy for this study is defined as: At least 1 reported quantifiable (no cluster or innumerable) defined seizure with motor signs per month for at least 3 months prior to initial visit and during the period between Visit 1 (Screening Visit) and Visit 2 (Baseline Visit), as per data captured in daily seizure diaries. These can be focal seizures, focal seizures with impaired consciousness, myoclonic seizures, generalized, and secondarily generalized seizures. – Between 1-5 baseline anti-epileptic drugs at stable doses for a minimum of 4 weeks prior to enrollment. Vagus nerve stimulator (VNS), ketogenic diet and modified Atkins diet do not count toward this limit. – VNS must be on stable settings for a minimum of 3 months prior to enrollment. – If on ketogenic or Atkins diet, must be on stable ratio for a minimum of 3 months prior to enrollment. – Previous subjects who failed at any point to meet continuation criteria and withdrew early may be considered for re-enrollment under a new subject ID as long as the above inclusion criteria are met. The determination of whether to re-enroll will be made by the PI and sponsor on a case-by-case basis. Re-enrollment can occur no earlier than 4 weeks after the final, post-weaning follow-up visit under the old subject ID. Written informed consent obtained from the patient or the patient's legal representative must be obtained prior to beginning treatment. Exclusion Criteria:
  • Patients with seizures secondary to metabolic, toxic, infectious or psychogenic disorder or drug abuse or current seizures related to an acute medical illness. – Presence of only non-motor partial seizures (without limb or facial movements, eye deviation or head turning) – Patients who require rescue medication during the Baseline phase for more than 6 days. – Patients with any severe and/or uncontrolled medical conditions at randomization such as: 1. liver disease such as cirrhosis, decompensated liver disease, and chronic hepatitis [i.e. quantifiable hepatitis B virus (HBV)-DNA and/or positive HbsAg, quantifiable hepatitis C virus (HCV)-RNA] 2. Uncontrolled diabetes as defined by fasting serum glucose > 1.5 3. Active (acute or chronic) or uncontrolled severe infections. 4. Patients with an active, bleeding diathesis. – Patients who have had a major surgery or significant traumatic injury within 4 weeks of study entry. Patients who have not recovered from the side effects of any major surgery (defined as requiring general anesthesia), or patients that may require major surgery during the course of the study. – Patients who change the dose of the AEDs during 4 weeks before screening or during the baseline period. – Prior treatment with any investigational drug within the preceding 4 weeks prior to study entry. – Patients with a history of non-compliance to medical regimens or who are considered potentially unreliable or will not be able to complete the entire study. Those in foster care, unable to keep follow-up appointments, maintain close contact with Principal Investigator, or complete all necessary studies to maintain safety. – Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test.
  • Gender Eligibility: All

    Minimum Age: 1 Month

    Maximum Age: 45 Years

    Are Healthy Volunteers Accepted: No

    Investigator Details

    • Lead Sponsor
      • Anne Comi, MD
    • Collaborator
      • GW Pharmaceuticals Ltd.
    • Provider of Information About this Clinical Study
      • Sponsor-Investigator: Anne Comi, MD, Principal Investigator, Director Sturge-Weber Center, Kennedy Krieger Institute, Professor Johns Hopkins University School of Medicine – Hugo W. Moser Research Institute at Kennedy Krieger, Inc.
    • Overall Official(s)
      • Anne M Comi, MD, Principal Investigator, Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

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