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| Name | Class |
|---|---|
| Simons Foundation | OTHER |
| Clinical Research Associates, LLC | OTHER |
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This is a single-site, randomized, acute dose-response study to determine whether STX209 produces a dose-dependent significant change in MEG target parameters compared to baseline as well as compared to placebo treatment.
Recent evidence from magnetoencephalographic (MEG) studies in ASD have pointed to abnormalities (specifically, delays) in auditory evoked neuromagnetic responses (e.g. M100 - see Roberts et al., 2010, and mismatch field, MMF - see Roberts et al., 2011) as well as abnormalities in the oscillatory behavior of auditory cortex, especially in the gamma band (30-50Hz), at rest and in response to simple auditory stimuli (see Gandal et al., 2010 and Cornew et al., 2012; Edgar et al., 2013). The local circuitry underlying such evoked activity and oscillations, and synaptic transmission in general, requires an appropriate balance of excitation and inhibition, mediated by glutamate and GABA, respectively. One model of the neural oscillatory deficits in ASD suggests that impaired regulatory control by inhibitory interneurons onto pyramidal cells underlies abnormal auditory latency and oscillatory electrophysiological measures. As such, electrophysiological deficits are interpreted in terms of local circuitry abnormalities, with inferences at the molecular level of imbalances in the activity of glutamate and GABA.
A candidate therapeutic for ASD has been developed - STX209, a GABA-B agonist. Since this pharmaceutical targets synaptic activity that has clear electrophysiological correlates, one goal of this proposal is to assess the responsiveness (sensitivity to change) of MEG measures to acute administration of STX209 at various doses in adolescents on the autism spectrum. The study also aims to establish the nature of the putative relationship between such electrophysiologic markers and GABA and glutamate levels using MEGAPRESS spectrally-edited magnetic resonance spectroscopy (MRS).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| A. Placebo then 15mg then 30mg | Experimental | Subjects will receive a single dose of placebo on week 1, 15 mg of STX209 on week 2 and 30 mg of STX209 on week 3. Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. |
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| B. 15mg then placebo then 30mg | Experimental | Subjects will receive a single dose of 15 mg of STX209 on week 1, placebo on week 2 and 30 mg of STX209 on week 3. Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. |
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| C. 15mg then 30mg then placebo | Experimental | Subjects will receive a single dose of 15 mg of STX209 on week 1, 30 mg of STX209 on week 2 and placebo on week 3. Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| STX209 (15mg) | Drug | A randomized acute dose-response design will be employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. Each participant will receive a single dose of placebo in random order and a single dose of STX209 from smallest to largest (15mg, and 30mg). MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. The STX209 (15mg) intervention is the "low dose" |
| Measure | Description | Time Frame |
|---|---|---|
| M50 Latency (Left Hemisphere) | The latency of the M50 auditory evoked response component arising from the left cerebral hemisphere | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
| M50 Latency (Right Hemisphere) | The latency of the M50 auditory evoked response component arising from the right cerebral hemisphere | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
| Steady State Inter Trial Coherence (Left Hemisphere) | The inter trial coherence (ITC) of auditory steady state response arising from the left cerebral hemisphere | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
| Steady State Inter Trial Coherence (Right Hemisphere) | The inter trial coherence (ITC) of auditory steady state response arising from the right cerebral hemisphere | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
| GABA (Left Hemisphere) | GABA/Cr ratio arising from a voxel in the left superior temporal gyrus | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Timothy Roberts, PhD | Children's Hospital of Philadelphia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Children's Hospital of Phladelphia | Philadelphia | Pennsylvania | 19104 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | A. Placebo Then 15mg Then 30mg | Subjects will receive a single dose of placebo, then (a week later) 15mg STX209 then (a week later) 30mg STX209. Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. A randomized acute dose-response design will be employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. Over the course of the three weeks, each participant will receive a single dose of placebo and a single dose of STX209 from smallest to largest (15mg, and 30mg). On each occasion, separated by 1 week, participants will receive either placebo or 15mg STX209 or 30mg STX209. MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. |
| FG001 | B. 15mg Then Placebo Then 30mg | Subjects will receive a single dose of 15mg STX209, then (a week later) placebo then (a week later) 30mg STX209. Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. A randomized acute dose-response design will be employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. Over the course of the three weeks, each participant will receive a single dose of placebo and a single dose of STX209 from smallest to largest (15mg, and 30mg). On each occasion, separated by 1 week, participants will receive either placebo or 15mg STX209 or 30mg STX209. MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. |
| FG002 | C. 15mg Then 30mg Then Placebo | Subjects will receive a single dose of 15mg STX209, then (a week later) 30mg STX209 then (a week later) placebo . Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. A randomized acute dose-response design will be employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. Over the course of the three weeks, each participant will receive a single dose of placebo and a single dose of STX209 from smallest to largest (15mg, and 30mg). On each occasion, separated by 1 week, participants will receive either placebo or 15mg STX209 or 30mg STX209. MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
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| Neuropsych Screening |
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| First Intervention (1 Day) |
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| Washout (1 Week) |
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| Second Intervention (1 Day) |
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| Second Washout (1 Week) |
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| Third Intervention (1 Day) |
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| Third Washout (1 Week) |
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| ID | Title | Description |
|---|---|---|
| BG000 | All Participants | Subjects receive a single dose of STX209 or placebo starting at 15 mg, increasing to 30 mg on each of three separate occasions (different dose on each occasion, according to their randomization scheme Arm. Outcome measures are reported by dose administered (or placebo) and not by randomization schedule, since the same outcome measures are acquired after each dose administration. Subjects will receive STX209 via oral disintegrating tablets, administered in individual 15mg tablets. A randomized acute dose-response design is employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. |
| Units | Counts |
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| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | M50 Latency (Left Hemisphere) | The latency of the M50 auditory evoked response component arising from the left cerebral hemisphere | For placebo and 15mg dose, 1 case each was unavailable due to artifact. At 30mg dose, 2 cases were unevaluable due to artifact | Posted | Mean | Standard Deviation | ms | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
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3 weeks
Although 25 participants are in the participant flow, two participants did not proceed past teh neuropsychological evaluation and onto any of the interventions and therefore did not receive any drug dose or placebo (having withdrawn or been excluded after screening). Therefore, we consider only 23 participants to have been placed at risk by the study.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Placebo | Subjects will receive a single dose of placebo via oral disintegrating tablets, administered as two individual tablets. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| cold symptoms / upper respiratory | Respiratory, thoracic and mediastinal disorders | Systematic Assessment | stuffy nose, sore throat, coughing, sneezing |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Timothy Roberts, Professor | Children's Hospital of Philadelphia | 267 426 0307 | robertstim@email.chop.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Nov 8, 2018 | Jun 13, 2019 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D001321 | Autistic Disorder |
| ID | Term |
|---|---|
| D000067877 | Autism Spectrum Disorder |
| D002659 | Child Development Disorders, Pervasive |
| D065886 | Neurodevelopmental Disorders |
| D001523 | Mental Disorders |
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All subjects receive placebo and two separate doses of STX209 (15mg, 30mg). The order of administration of these (at weekly intervals) is randomized into groups: (A) placebo, 15, 30 ; (B) 15, placebo, 30 and (C) 15, 30, placebo.
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Each participant receives dose of drug or placebo. Both participant and investigator are masked to dose level/placebo. It is not open label.
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| placebo | Drug | A randomized acute dose-response design will be employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. Each participant will receive a single dose of placebo in random order and a single dose of STX209 from smallest to largest (15mg, and 30mg). MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. The placebo intervention is the non-active placebo control dose |
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| STX209 (30mg) | Drug | A randomized acute dose-response design will be employed with a total study duration of 3 weeks. At each visit, baseline MEG will be obtained followed by acute single-dose drug/placebo administration, followed 60 minutes later by repeat MEG. Each participant will receive a single dose of placebo in random order and a single dose of STX209 from smallest to largest (15mg, and 30mg). MRI and MRS will be performed immediately following MEG to provide an anatomic basis for source localization as well as to assess acute effects of STX209 administration on MRS estimates of GABA and glutamate. The STX209 (30mg) intervention is the "high dose" |
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| years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| M50 Latency (Left Hemisphere) | Latency of M50 evoked response component arising from left cerebral hemisphere | in 2 cases pre-placebo and in 1 case each pre-15mg and pre-30mg, evoked response data was unevaluable due to artifact | Mean | Standard Deviation | ms |
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| M50 Latency (Right Hemisphere) | Latency of M50 evoked response component arising from right cerebral hemisphere | in 2 cases pre-placebo,1 case pre-15mg and and 2 cases pre-30mg, evoked response data was unevaluable due to artifact | Mean | Standard Deviation | ms |
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| Steady State Inter-Trial Coherence (Left Hemisphere) | inter-trial coherence (ITC) of left hemisphere responses to steady state auditory stimuli | in 1 participant prior to 15mg and in 4 participants prior to 30mg dose, data was unevaluable. | Mean | Standard Deviation | unitless |
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| Steady State Inter-Trial Coherence (Right Hemisphere) | Inter-trial coherence (ITC) to auditory steady state stimuli arising from right cerebral hemisphere | in 1 participant prior to 15mg and in 4 participants prior to 30mg dose, data was unevaluable. | Mean | Standard Deviation | unitless |
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| GABA (Left Hemisphere) | GABA/Cr ratio for voxel in left superior temporal gyrus | In 7 cases pre-placebo and in 5 cases each pre-15mg or 30mg, spectroscopy data was unevaluable | Mean | Standard Deviation | ratio |
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| Primary | M50 Latency (Right Hemisphere) | The latency of the M50 auditory evoked response component arising from the right cerebral hemisphere | For placebo and 15mg dose, 1 case each was unavailable due to artifact. At 30mg dose, 4 cases were unevaluable due to artifact | Posted | Mean | Standard Deviation | ms | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
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| Primary | Steady State Inter Trial Coherence (Left Hemisphere) | The inter trial coherence (ITC) of auditory steady state response arising from the left cerebral hemisphere | For placebo, 3 cases and for 15mg and 30mg doses, 1 case each was unevaluable due to artifact. | Posted | Mean | Standard Deviation | unitless | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
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| Primary | Steady State Inter Trial Coherence (Right Hemisphere) | The inter trial coherence (ITC) of auditory steady state response arising from the right cerebral hemisphere | For placebo, 3 cases and for 15mg dose and 30mg doses, 1 case each was unevaluable due to artifact. | Posted | Mean | Standard Deviation | unitless | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
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| Primary | GABA (Left Hemisphere) | GABA/Cr ratio arising from a voxel in the left superior temporal gyrus | For placebo, 5 cases were unevaluable. For 15mg, 7 cases were unevaluable. For 30mg, 4 cases were unevaluable | Posted | Mean | Standard Deviation | ratio | 1 hour per intervention followed by a 1 week washout for a total of three weeks |
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| 0 |
| 23 |
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| 23 |
| 7 |
| 23 |
| EG001 | STX209 (15mg) | Subjects will receive a single dose of 15mg STX209 via oral disintegrating tablets, administered as two individual tablets (one being 15mg drug, one being placebo) | 0 | 23 | 0 | 23 | 11 | 23 |
| EG002 | STX209 (30mg) | Subjects will receive a single dose of 15mg STX209 via oral disintegrating tablets, administered as two individual tablets (each being 15mg drug) | 0 | 23 | 0 | 23 | 4 | 23 |
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| fatigue | General disorders | Systematic Assessment |
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| increased appetite | General disorders | Systematic Assessment | hungry / thirsty |
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| overly energetic | General disorders | Systematic Assessment |
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| vomiting | Gastrointestinal disorders | Systematic Assessment |
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| Post-30mg dose |
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| Post-30mg dose |
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| Post-30mg dose |
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| Post-30mg dose |
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