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Episodic Ataxia Type 2Phase 24AP in EA2NCT01543750

4-Aminopyridine in Episodic Ataxia Type 2

A Phase 2 study testing 4-Aminopyridine in people with Episodic Ataxia Type 2, run by University of California, Los Angeles at 3 sites in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

Episodic ataxia type 2 (EA2) is a rare familial neurological condition characterized by debilitating episodes of vertigo and imbalance. Since the serendipitous discovery of dramatic response of EA2 to acetazolamide, acetazolamide has been the first-line treatment for EA2. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Episodic Ataxia Type 2
What is being tested?
4-Aminopyridine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
0 participants
Where
3 sitesUnited States
Study dates
Start not givento not given
Phase
Phase 2
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients will be included if they:
  • Have EA2 genetically confirmed to harbor mutations in CACNA1A
  • Are ≥ 18 years of age
  • Are not taking acetazolamide (because of intolerance, poor response, or allergy)
  • Are able to maintain a daily log of ataxia episode(s) and report daily by using an Interactive Voice Recording System (IVR) throughout the study
  • Experience ≥ 3 ataxia episodes per month during the two-month screening period to qualify for randomization

Who cannot join

  • Patients will be excluded if they:
  • Have seizures or a history of seizures
  • Have first-degree relatives with EA2 and seizures
  • Have renal disease with impaired function (Creatinine clearance CrCl≤50ml/min)
  • Are pregnant or breast feeding (women of childbearing age will be tested for pregnancy and must be using birth control)
  • Are unable to comply with the study requirement

Trial locations and contacts

3 sites in 1 country.

United States3 sites
  • University of California, Los Angeles (UCLA)

    Los Angeles, California, 90095

  • University of Rochester School of Medicine

    Rochester, New York, 14642

  • University of South Florida

    Tampa, Florida, 33612

Other trials in United States

About this study

Official title: Phase 2 Study of 4-Aminopyridine for the Treatment of Episodic Ataxia Type 2

Episodic ataxia type 2 (EA2) is a rare familial neurological condition characterized by debilitating episodes of vertigo and imbalance. Since the serendipitous discovery of dramatic response of EA2 to acetazolamide, acetazolamide has been the first-line treatment for EA2. Yet, for those patients who do not respond to or cannot tolerate acetazolamide, there is no alternative treatment. The purpose of this randomized trial is to test whether 4-aminopyridine may reduce the ataxia episodes in EA2 as an alternative to acetazolamide. Funding Source - FDA OOPD

Read the detailed description

This study aims to determine whether 4-aminopyridine (4AP) can reduce attacks of ataxia in patients with episodic ataxia type 2 (EA2), a rare but often debilitating condition. Episodic ataxia (EA) is a group of inherited disorders characterized by recurrent, discrete episodes of vertigo and ataxia variably associated with progressive ataxia. EA2, the most common and the best characterized of all the EA syndromes, is caused by heterozygous mutations in CACNA1A, which encodes the main subunit of a neuronal voltage-gated calcium channel, Cav2.1.

Although observational data suggest symptomatic resolution with acetazolamide in many EA2 patients, the investigators found in our patient databases that at least a third of the EA2 patients continue to suffer debilitating ataxia attacks, either because of incomplete control while on acetazolamide or because of intolerability or hypersensitivity to acetazolamide. For these patients there is no alternative intervention. 4-Aminopyridine (4AP) has been found to be helpful in a handful of patients with EA2. Recently, dalfampridine, an extended release formulation of 4AP (AMPYRA) by Acorda Therapeutics, received FDA approval to improve gait in multiple sclerosis.

The investigators plan to recruit 20 subjects with genetically defined EA2 who suffer frequent ataxia episodes (at least 3 episodes a month) to conduct a randomized trial of 4AP to examine its efficacy and tolerability in EA2. Study subjects will be recruited at UCLA and the University of Rochester to participate in a randomized, double-blind, double-crossover trial of 4AP.Each treatment period is 2-months with a 1-week wash-out period in between each treatment period. Participating subjects will undergo standardized history and physical examination at the time of enrollment. Participants will log their ataxia attacks daily by interactive voice response (IVR) system and will be interviewed monthly for events and side effects/toxicity. Study visits will occur at the beginning and the end of the study.

Being tested
4-Aminopyridine, Placebo
Keywords
episodic ataxia, CACNA1A mutations
Medical subject headings
Episodic Ataxia, Type 2, Episodic Ataxia

What participants receive

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

  • 4-AminopyridineDrug

  • PlaceboDrug

    Placebo

Study groups in NCT01543750
Study groupRoleWhat they receive
Study MedicationExperimental4-aminopyridine 10mg twice daily for 8 weeks
Receives: Drug: 4-Aminopyridine
PlaceboExperimentalplacebo twice daily for 8 weeks
Receives: Drug: Placebo

What is being measured

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

  1. the frequency of ataxia episodes

    Trial participants have frequent episodes of ataxia at baseline. The participants will document daily whether ataxia events occurred during the 2-month screening period and the 9-month study period by calling a toll-free number and participating in an Interactive Voice Response (IVR) system.

    Measured: 11 months

Secondary outcomes (6)
  1. impact on daily activities

    Participants will use IVR to log the impact (on a scale of 0-3) of ataxia events, if any, on their daily activities:

    • (0) No impact
    • (1) Mild
    • (2) Moderate
    • (3) Severe

    Measured: 11 months

  2. duration of ataxia episodes

    Study Participants will use IVR daily to log the duration of ataxia events, if any, in hours.

    Measured: 11 months

  3. severity of ataxia episodes

    Study Participants will use IVR daily to log the severity of ataxia events, if any, on a scale of 1-9:

    (1) mild (9) very severe

    Measured: 11 months

  4. treatment satisfaction

    The study participant will respond by phone interview to the 11-item Treatment Satisfaction Questionnaire for Medication (TSQM Version 2) at the end of each of the four treatment periods.

    Measured: 9 months

  5. Toxicity

    The study participant will be interviewed by phone regarding toxicity using the [Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0] at two different time points (4 weeks, 8 weeks) of each 8-week Treatment Period. Spectrum and severity of toxicity and the prevalence among study participants will be documented.

    Measured: 9 months

  6. Side Effects

    The study participant will log side effects as they occur (reporting the seizures or other severe side effects immediately to Investigators) and will be interviewed by phone regarding side effects at two different time points (4 weeks, 8 weeks) of each 8-week Treatment Period. Spectrum of side effects and the prevalence among those treated will be documented.

    Measured: 9 months

Timeline

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

  1. First posted5 Mar 2012 (estimated)

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01543750
Sponsor's protocol ID
CINCH-EA2
Other IDs
R01FD003923
Acronym
4AP in EA2
Status last verified
Nov 2020
First submitted
27 May 2011
Last updated
16 Nov 2020
Results posted
No
Data monitoring committee
Yes

Publications

  • Atkinson MJ, Sinha A, Hass SL, Colman SS, Kumar RN, Brod M, Rowland CR. Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease. Health Qual Life Outcomes. 2004 Feb 26;2:12. doi: 10.1186/1477-7525-2-12.

    PubMed 14987333
  • Bever CT Jr, Young D, Anderson PA, Krumholz A, Conway K, Leslie J, Eddington N, Plaisance KI, Panitch HS, Dhib-Jalbut S, et al. The effects of 4-aminopyridine in multiple sclerosis patients: results of a randomized, placebo-controlled, double-blind, concentration-controlled, crossover trial. Neurology. 1994 Jun;44(6):1054-9. doi: 10.1212/wnl.44.6.1054.

    PubMed 8208399
  • DuMouchel W, Groer PG. A Bayesian methodology for scaling radiation studies from animals to man. Health Phys. 1989;57 Suppl 1:411-8. doi: 10.1097/00004032-198907001-00058.

    PubMed 2606701
  • Glasauer S, Strupp M, Kalla R, Buttner U, Brandt T. Effect of 4-aminopyridine on upbeat and downbeat nystagmus elucidates the mechanism of downbeat nystagmus. Ann N Y Acad Sci. 2005 Apr;1039:528-31. doi: 10.1196/annals.1325.060.

    PubMed 15827015
  • Griggs RC, Moxley RT 3rd, Lafrance RA, McQuillen J. Hereditary paroxysmal ataxia: response to acetazolamide. Neurology. 1978 Dec;28(12):1259-64. doi: 10.1212/wnl.28.12.1259.

    PubMed 366453
  • Imbrici P, Jaffe SL, Eunson LH, Davies NP, Herd C, Robertson R, Kullmann DM, Hanna MG. Dysfunction of the brain calcium channel CaV2.1 in absence epilepsy and episodic ataxia. Brain. 2004 Dec;127(Pt 12):2682-92. doi: 10.1093/brain/awh301. Epub 2004 Oct 13.

    PubMed 15483044
  • Harno H, Heikkinen S, Kaunisto MA, Kallela M, Hakkinen AM, Wessman M, Farkkila M, Lundbom N. Decreased cerebellar total creatine in episodic ataxia type 2: a 1H MRS study. Neurology. 2005 Feb 8;64(3):542-4. doi: 10.1212/01.WNL.0000150589.26350.3D.

    PubMed 15699392
  • Hoebeek FE, Stahl JS, van Alphen AM, Schonewille M, Luo C, Rutteman M, van den Maagdenberg AM, Molenaar PC, Goossens HH, Frens MA, De Zeeuw CI. Increased noise level of purkinje cell activities minimizes impact of their modulation during sensorimotor control. Neuron. 2005 Mar 24;45(6):953-65. doi: 10.1016/j.neuron.2005.02.012.

    PubMed 15797555
  • Jen J, Kim GW, Baloh RW. Clinical spectrum of episodic ataxia type 2. Neurology. 2004 Jan 13;62(1):17-22. doi: 10.1212/01.wnl.0000101675.61074.50.

    PubMed 14718690
  • Jen JC, Graves TD, Hess EJ, Hanna MG, Griggs RC, Baloh RW; CINCH investigators. Primary episodic ataxias: diagnosis, pathogenesis and treatment. Brain. 2007 Oct;130(Pt 10):2484-93. doi: 10.1093/brain/awm126. Epub 2007 Jun 15.

    PubMed 17575281
  • Jouvenceau A, Eunson LH, Spauschus A, Ramesh V, Zuberi SM, Kullmann DM, Hanna MG. Human epilepsy associated with dysfunction of the brain P/Q-type calcium channel. Lancet. 2001 Sep 8;358(9284):801-7. doi: 10.1016/S0140-6736(01)05971-2.

    PubMed 11564488
  • Lohle M, Schrempf W, Wolz M, Reichmann H, Storch A. Potassium channel blocker 4-aminopyridine is effective in interictal cerebellar symptoms in episodic ataxia type 2--a video case report. Mov Disord. 2008 Jul 15;23(9):1314-6. doi: 10.1002/mds.22071.

    PubMed 18442126
  • March B, Cardi T. Assessment of the cardiac safety of fampridine-SR sustained-release tablets in a thorough QT/QTc evaluation at therapeutic and supratherapeutic doses in healthy individuals. Expert Opin Investig Drugs. 2009 Dec;18(12):1807-15. doi: 10.1517/13543780903443096.

    PubMed 19938897
  • McEvoy KM, Windebank AJ, Daube JR, Low PA. 3,4-Diaminopyridine in the treatment of Lambert-Eaton myasthenic syndrome. N Engl J Med. 1989 Dec 7;321(23):1567-71. doi: 10.1056/NEJM198912073212303.

    PubMed 2555713
  • Ophoff RA, Terwindt GM, Vergouwe MN, van Eijk R, Oefner PJ, Hoffman SM, Lamerdin JE, Mohrenweiser HW, Bulman DE, Ferrari M, Haan J, Lindhout D, van Ommen GJ, Hofker MH, Ferrari MD, Frants RR. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell. 1996 Nov 1;87(3):543-52. doi: 10.1016/s0092-8674(00)81373-2.

    PubMed 8898206

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing 4-Aminopyridine in people with Episodic Ataxia Type 2, run by University of California, Los Angeles at 3 sites in United States.

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 6 inclusion and 6 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: withdrawn, as of the sponsor's last update on 16 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in United States. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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 was withdrawn before enrolling participants, so there are no results.

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?

the frequency of ataxia episodes (time frame: 11 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01543750, which also lists 31 linked publications.

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 16 Nov 2020.

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