Efficacy and Safety of Rapamycin Versus Vigabatrin in the Prevention of Tuberous Sclerosis Complex Symptoms in Infants

Randomized, Placebo-controlled, Double-blind and Double-dummy Clinical Trial Comparing the Safety, Tolerability, and Efficacy of Vigabatrin and Rapamycin in a Preventive Treatment of Infants With Tuberous Sclerosis Complex

The purpose of the study is to evaluate the efficacy, tolerability, and safety of vigabatrin versus rapamycin as a preventive treatment in infants with Tuberous Sclerosis Complex (TSC).

This is a two-arm, randomized, double-blind and double-dummy, placebo controlled study to evaluate the efficacy, tolerability, and safety of vigabatrin versus rapamycin as a preventive treatment in infants with TSC. The study consists of 3 phases for each patient: screening, core blinded phase, and open-label follow-up phase. Patients who meet the eligibility criteria will be randomized to receive vigabatrin or rapamycin. The randomization ratio is 1:1. Randomization will be stratified by the sex and the presence of epileptiform activity on baseline videoEEG (video electroencephalography) recording (yes versus no). Approximately 60 infants are planned to be enrolled in the study.

Inclusion Criteria:

• Male or female aged from 4 up to 16 weeks (44-56 weeks of gestational age) at the day of randomization
• Parents/caregivers are willing to and able to give informed consent form for the participation in the study
• Parents/caregivers are willing to and able to comply with all study requirements
• Definite diagnosis of TSC according to the Consensus criteria (Northrup,2013)
• At least 1 focus of cortical dysplasia disclosed on brain MRI

Exclusion Criteria:

• history of seizures prior to randomization,
• history of antiepileptic treatment,
• history of treatment with mTOR (mammalian Target of Rapamycin) inhibitor,
• gestational age below 44 weeks at the day of randomization,
• body weight lower than 3 kg at the day of randomization,
• SEGA (Subependymal Giant Cell Astrocytoma) or other TSC-associated lesion requiring urgent surgical intervention
• recent surgery within 1 month prior to the randomization
• intercurrent infection at the date of randomization
• known history of HIV seropositivity
• live vaccination within 1 month prior to randomization*
• lack of first TBC and hepatitis B vaccinations
• Any significant clinical, laboratory , ECG or other abnormalities, comorbidity or concomitant treatment which, in the opinion of the investigator, may either put a patient at significant risk associated with the participation in the study or may influence the results of the study.
• Use of an investigational drug within 1 month prior to randomization.