Clinical trial NCT04925960: Oral Epalrestat Therapy in Pediatric Subjects With PMM2-CDG
Official title: A Prospective, Randomized, Double-Blind, Placebo-Controlled, Single-Center Study of Oral Epalrestat Therapy in Pediatric Subjects With Phosphomannomutase 2-congenital Disorder of Glycosylation (PMM2-CDG)
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE3
Conditions: Pmm2-CDG
Phosphomannomutase 2 Deficiency
Phosphomannomutase 2 Congenital Disorder of Glycosylation
Phosphomannomutase II Congenital Disorder of Glycosylation
Phosphomannomutase II Deficiency
Lead sponsor: Maggie's Pearl, LLC
Sponsor class: INDUSTRY
First posted: 2021-06-14
Enrollment: 40
Sex: ALL
Minimum age (years): 2
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Subjects will be randomized to treatment or placebo. Patients and study staff will be blinded to the study arm.
Primary purpose: TREATMENT

Brief summary: This is a prospective, single-center, randomized, double-blind, placebo-controlled study designed to assess the safety, tolerability, and clinical and metabolic improvement of pediatric subjects with PMM2-CDG on oral epalrestat therapy vs. placebo.

Detailed description: This is a prospective, single-center, randomized, double-blind, placebo-controlled study designed to assess the safety, tolerability, and clinical and metabolic improvement of pediatric subjects with PMM2-CDG on oral epalrestat therapy vs. placebo. The primary study objective is to evaluate the safety and probable benefit of oral epalrestat therapy in pediatric subjects with PMM2-CDG. Study outcomes include evaluating the metabolic improvement of pediatric subjects treated with oral epalrestat therapy compared to placebo, evaluating safety, clinical improvement, and pharmocokinetics (PK) of oral epalrestat therapy in pediatric subjects compared to placebo, and evaluating urine polyols, adverse events, laboratory data, other safety measures, PK, and Quality of Life surveys to measure clinical improvement.

Eligibility criteria: Inclusion Criteria:

1. Age ≥ 2 and \< 18 years
2. Diagnosis of PMM2-CDG, based on molecularly confirmed biallelic PMM2 pathogenic variants (can be historical diagnosis with lab report on file)
3. Informed consent (and assent, as applicable) document personally signed by the legally authorized representative of the patient, indicating that the patient's parent/guardian has been informed and agreed to all aspects of the study
4. Be willing and able to adhere to the study assessments and schedule described in the protocol and consent/assent documents
5. Negative urine pregnancy test (only for female subjects of child-bearing potential)
6. For subjects of child-bearing potential-only, subject has been counseled on and agrees to the requirement either for double barrier contraceptive methods and/or for total abstinence from prior to randomization through 3-months after the cessation of treatment.

Exclusion Criteria:

1. Known or suspected other known CDG
2. Known allergy to aldose reductase inhibitors
3. Hypersensitivity to epalrestat
4. Hepatic impairment defined as any one of the following:

   1. AST/ALT \>5x ULN in the 6 months prior to screening
   2. Bilirubin \>2X ULN in the last 6 months prior to screening
   3. Synthetic liver dysfunction (albumin deficiency \< 2.8 mmol/L) at screening, or
   4. Diagnosis of liver fibrosis (Fibroscan \> 7 kPa) confirmed by liver elastogram at screening
5. Renal impairment defined as serum creatinine: \> 0.5 mg/dL (≤ 6 years); \> 0.7 mg/dL (7-10 years); \> 1.24 mg/dL (≥ 11 years)
6. Low platelet count (\< 125x109 /L)
7. Any other clinically significant lab abnormality which, in the opinion of the investigator, should be exclusionary
8. Anemia (Hgb \< 10 g/dL)
9. Use of an investigational drug, including acetazolamide, in the past 28 days; use of an investigational biologic in the past 12 months
10. Concurrent or planned participation in interventional protocol or use of any other unapproved therapeutics, and,
11. Any other medical condition, which, in the opinion of the investigator, will interfere with the patient's ability to comply with the protocol, compromises patient safety, or interferes with the interpretation of the study results.

Primary outcomes:
measure: Change in sorbitol (mmol/mol creatinine)
timeFrame: 9 months
measure: Change in ICARS
timeFrame: 9 months
measure: Change in Antithrombin III (ATIII)
timeFrame: 9 months
Secondary outcomes:
measure: Change of Body Max Index (BMI) percentile
timeFrame: 9 months
measure: Change of factor XI activity percentage
timeFrame: 9 months
measure: Change of liver transaminases (U/L)
timeFrame: 9 months
measure: Change of transferrin glycosylation (ratio)
timeFrame: 9 months
measure: Change in Nijmegen Pediatric CDG Rating Scale (NPCRS) score
timeFrame: 9 months
measure: Change of normalized mannitol (mmol/mol creatinine)
timeFrame: 9 months
Other outcomes:
Locations:
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
Study officials:
affiliation: Mayo Clinic
name: Eva Morava-Kozicz, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: