Clinical trial NCT04041713: A Pilot Study of an Antioxidant Cocktail vs. Placebo in the Treatment of Children and Adolescents With Rett Syndrome
Official title: A Pilot Study of an Antioxidant Cocktail vs. Placebo in the Treatment of Children and Adolescents With Rett Syndrome
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE2
Conditions: Rett Syndrome
Keywords: Rett Syndrome
Rett
RTT
Lead sponsor: Anagnostou, Evdokia, M.D.
Sponsor class: INDIV
Collaborators: name: Ontario Brain Institute
name: Unity Health Toronto
name: Holland Bloorview Kids Rehabilitation Hospital
First posted: 2019-08-01
Enrollment: 35
Sex: FEMALE
Minimum age (years): 2
Maximum age (years): 21
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: This is an 18-week pilot, single site, randomized,double blind, placebo-controlled cross-over trial of Rett-T vs. placebo. Periods I and II of the randomized study are 8 weeks long with a 2 week washout period.
Primary purpose: TREATMENT

Brief summary: This study will examine the potential efficacy and safety of Rett-T for core motor deficits of Rett syndrome, and will explore biological markers of safety and treatment response.

Detailed description: There are currently no available medicines shown to be effective for Rett syndrome. Numerous studies implicate mitochondrial dysfunction and oxidative stresses in the pathophysiology of Rett syndrome. Mitochondrial dysfunction has been reported in Rett patients, Rett mouse models and MECP2-deficient cells.

Collaborators have tested a combination of specific antioxidants known to enhance mitochondrial function in a cell and mouse model of Rett syndrome. The formulation normalized mitochondrial membrane potential in MECP2 neurons, and MECP2-deficient mice displayed improved exploratory, locomotor and social behavior compared to MECP2-deficient mice. These results support testing anti-oxidative strategies for benefit in individuals with Rett syndrome.In this study, the formulation has been adjusted and optimized based on current guidelines for human use, with the goal of translating a potential new treatment from the animal model to use in humans. Results of this study could lead to the first approved medication treatment for the disorder.

Eligibility criteria: Inclusion Criteria:

1. Female outpatients 2-21 years of age inclusive.
2. Diagnosis of Rett syndrome.
3. At least partially ambulatory (may need assistive device to take a step).
4. If already receiving stable interventions must meet the following criteria:

   * If already receiving stable concomitant medications or nutraceuticals affecting behaviour, must be on a stable dose during the preceding 1 month prior to Screening (with the exception of fluoxetine, where a period of 6 weeks is needed), and will not electively initiate new or modify ongoing medications for study duration.
5. Have normal laboratory test results at Screening/Baseline. If abnormal, the finding(s) must be deemed clinically insignificant by the Investigator.
6. Ability to complete assessments, fluency in English (parent/legal guardian; participant, if verbal).
7. Ability to obtain assent (if developmentally appropriate), as well as written informed consent from their parent(s)/legal guardian(s).

Exclusion Criteria:

1. Pregnant females; sexually active females on inadequate birth control (extremely unlikely in this population).
2. Have another serious medical condition that, based on Investigator judgment, might interfere with the conduct of the study, confound interpretation of the study results, or endanger their own well-being. Have evidence or history of malignancy or any significant hematological, endocrine, cardiovascular (including any rhythm disorder), respiratory, renal, hepatic, or gastrointestinal disease, not including mild common pediatric diseases in these areas that are stable (e.g. mild asthma, constipation, etc.).
3. Have hypersensitivity to any components of Rett-T.
4. Have one or more of the following: HIV, HBV, HCV, hemophilia (bleeding problems, recent nose and brain injuries), drug abuse, immunity disorder, major depressive episode or psychosis.
5. Unable to tolerate venipuncture procedures for blood sampling.
6. Receiving concomitant medications/nutraceuticals that include any of the components of Rett-T.
7. Actively enrolled in another intervention study.

Primary outcomes:
measure: Rett Syndrome Natural History Motor Behavior Assessment (MBA)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
Secondary outcomes:
measure: Rett Syndrome Gross Motor Scale (RSGMS)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
measure: Safety Monitoring Uniform Report Form (SMURF)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
measure: Clinical Global Impressions - Improvement Scale - Global (CGI-I)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
measure: The Top 3 Causes for Concern
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
measure: The Rett Syndrome Behaviour Questionnaire (RSBQ)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
measure: Anxiety, Depression, and Mood Scale (ADAMS)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
measure: Children's Sleep Habits Questionnaire (CSHQ)
timeFrame: 18 weeks total: 8 weeks on Rett-T, 8 weeks on placebo, 2 week washout in interim
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: Holland Bloorview Kids Rehabilitation Hospital
state: Ontario
Study officials:
affiliation: Holland Bloorview Kids Rehabilitation Hospital
name: Evdokia Anagnostou, MD
role: PRINCIPAL_INVESTIGATOR
References: