Clinical trial NCT03479476: A Trial of Metformin in Individuals With Fragile X Syndrome
Official title: A Double-Blind, Placebo-Controlled Trial of Metformin in Individuals With Fragile X Syndrome
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
PHASE3
Conditions: Fragile X Syndrome
Fragile X Mental Retardation Syndrome
Mental Retardation, X Linked
Genetic Diseases, X-Linked
Trinucleotide Repeat Expansion
Fra(X) Syndrome
Intellectual Disability
FXS
Neurobehavioral Manifestations
Sex Chromosome Disorders
Keywords: Congenital Abnormalities
Metformin
Nervous System Diseases
Chromosome Disorders
Lead sponsor: University of California, Davis
Sponsor class: OTHER
Collaborators: name: University of Alberta
name: St. Justine's Hospital
First posted: 2018-03-27
Enrollment: 120
Sex: ALL
Minimum age (years): 6
Maximum age (years): 25
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study is a controlled trial of metformin in individuals with fragile X syndrome between the ages of 6 and 25 years. Participants will be randomized in a double-blind design to either drug or placebo and will attend three visits to the study site in a 4-month period for a series of tests. The primary objectives are to assess safety, tolerability, and efficacy of metformin in the treatment of language deficits, behavior problems, and obesity/excessive appetite in individuals with fragile X syndrome.

Detailed description: This is a multi-site study for fragile X syndrome (FXS) patients aged 6 to 25 years inclusive. It is a randomized, double-blind, placebo-controlled trial of metformin (also known as Glumetza, Glucophage, Fortamet), a type 2 diabetes medication that can also improve obesity and excessive appetite.

Metformin has emerged as a candidate drug for the targeted treatment of FXS based on animal studies showing rescue of multiple phenotypes in the FXS model. Metformin may contribute to normalizing signaling pathways in FXS in the central nervous system, which may include activities of mTOR and PI3K, both of which have shown to be pathogenically overactive in FXS. In addition, metformin inhibits phosphodiesterase, which would lead to correction of cAMP levels, and MMP9 production, which is also elevated in FXS. Looking at the potential signaling pathways, metformin appears to be a good candidate for targeting several of the intracellular functions in neurons disrupted in FXS and, therefore, has potential to rescue several types of symptoms in individuals with FXS. The researchers have utilized metformin in the clinical treatment of over 20 individuals with FXS between the ages of 4 and 58 years and have found the medication to be well tolerated and to provide benefits not only in lowering weight gain and normalizing appetite but also in language and behavior. In this controlled trial, the researchers hope to further assess metformin's safety and benefits in the areas of language and cognition, eating and weight loss, and overall behavior.

Each participant will be involved in this trial for a period of 4 months. This will include 3 visits to the UC Davis MIND Institute and 5 phone calls. At each visit, the researchers will assess behavioral, cognitive, and language development. The researchers will also assess the side effects of the study medication throughout the trial.

Study record updated 9/26/2018 to reflect the following IRB-approved protocol modifications: Erroneous references to "digital" books for primary outcome measure were removed, as this measure is administered using print (non-digital) materials. Eligibility criteria were updated to include subjects with IQ of up to and including 79 on the Leiter-III at screening. The Hyperphagia Questionnaire (HQ-CT) was replaced by the Anxiety Depression and Mood Screen (ADAMS) as a secondary outcome measure.

Eligibility criteria: Inclusion Criteria:

* Molecular genetic confirmation of the full FMR1 mutation or mosaicism.
* Males and non-pregnant, non-lactating females age 6 to 25 years, inclusive.
* Ability of subject and/or caregiver to understand, read, write, and speak English fluently to complete study-related materials.
* IQ ≤ 79 as measured by the Leiter-III at screening.
* Participant is able to speak at least occasional 3-word phrases.
* Participant and parent/caregiver are willing to participate in the protocol and able to attend the clinic regularly and reliably.
* Stable concomitant medication dose and dosing regimen for at least 4 weeks prior to the screening/baseline visit, and the intention to maintain a stable regimen of allowed concomitant medications for the full duration of the study.
* Stable behavioral/educational treatments for at least 4 weeks prior to the screening/baseline visit.
* Sexually active women of childbearing potential must be using a medically acceptable method of birth control for the duration of the study and have a negative urine pregnancy test collected at the initial screening/baseline visit.
* For participants who are not their own legal guardian, the parent/legal authorized representative is able to understand and sign an informed consent to participate in the study.

Exclusion Criteria:

* Non-cooperation or inability to follow through with the study protocol.
* Life-threatening medical problem or other major systemic illness that compromises health or safety and/or would interfere with the study.
* History of intolerable adverse events with metformin.
* Current or recent metformin treatment (within the past year).
* Body mass index (BMI) less than 2 standard deviations for age.
* Serum creatinine \> 1.4 mg/dl (female) or \> 1.5 mg/dl (male) at screening.
* History of metabolic acidosis or a condition with lactic acidosis.
* Severe B12 deficiency.
* Pregnancy at screening or unwillingness to use acceptable method of birth control, if applicable.

Primary outcomes:
measure: Change from baseline in the Expressive Language Sampling (ELS) mean Number of Different Words (NDW) score
timeFrame: Baseline, End of Treatment/Week 16
Secondary outcomes:
measure: Change from baseline in the FXS-normed Aberrant Behavior Checklist - Community Edition (ABC-C)
timeFrame: Baseline, Week 8, End of Treatment/Week 16
measure: Improvement of symptoms in FXS using the Clinical Impression - Improvement (CGI-I) scale
timeFrame: Baseline, Week 8, End of Treatment/Week 16
measure: Change from baseline in the Visual Analog Scale (VAS)
timeFrame: Baseline, Week 8, End of Treatment/Week 16
measure: Change from baseline in the Vineland Adaptive Behavior Scales-Third Edition (VABS-III) Adaptive Behavior Composite Score
timeFrame: Baseline, End of Treatment/Week 16
measure: Change from baseline in the Anxiety Depression and Mood Screen (ADAMS) overall score
timeFrame: Baseline, Week 8, End of Treatment/Week 16
measure: Change from baseline in the Child Sleep Habits Questionnaire (CSHQ) overall score
timeFrame: Baseline, Week 8, End of Treatment/Week 16
measure: Change from baseline in the Swanson, Nolan and Pelham Questionnaire (SNAP-IV) overall score
timeFrame: Baseline, Week 8, End of Treatment/Week 16
measure: Change from baseline in the Pediatric Quality of Life Questionnaire (PedsQL) Parent Proxy overall score
timeFrame: Baseline, Week 8, End of Treatment/Week 16
Other outcomes:
Locations:
city: Sacramento
country: United States
facility: UC Davis MIND Institute
state: California
city: Edmonton
country: Canada
facility: University of Alberta
state: Alberta
city: Montréal
country: Canada
facility: St Justine Hospital
state: Quebec
Study officials:
affiliation: University of California, Davis
name: Randi J Hagerman, MD
role: PRINCIPAL_INVESTIGATOR
References: