This is a randomized, double-blind, placebo-controlled study comparing the safety and efficacy of 2 dosage regimens of palovarotene versus placebo in preventing disease progression in pediatric subjects with multiple osteochondromas (MO).
Multiple osteochondromas is a rare condition where children develop multiple benign cartilage-capped bony tumors called osteochondromas on bones throughout the body, resulting in pain, deformity, limb length discrepancy, disability, and eventually arthritis and possible malignancy. The primary objective is to compare the efficacy of two dosage regimens of palovarotene with placebo to prevent the formation of new osteochondromas in pediatric MO subjects with exostosin 1 or exostosin 2 gene mutations. Osteochondroma formation was assessed by whole body magnetic resonance imaging (MRI). Secondary efficacy objectives were to compare the effects of palovarotene with placebo on the volume of osteochondromas as assessed by MRI; the proportion of subjects with no new osteochondromas as assessed by whole-body MRI; the annualized rate of new or worsening deformities; the annualized rate of MO-related surgeries; and palatability. The overall safety and pharmacokinetics of palovarotene and the effects of palovarotene on linear growth, bone growth plates, bone mineral density, quality of life, and pain due to osteochondromas was also studied.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
193
Subjects received a weight-adjusted dose equivalent of 2.5 mg palovarotene, once daily, for up to 24 months.
Subjects received a weight-adjusted dose equivalent of 5.0 mg palovarotene, once daily, for up to 24 months.
Subjects received placebo, once daily, for up to 24 months.
Annualized Rate of New Osteochondromas (OCs)
The annualized rate of new OCs was assessed by whole-body magnetic resonance imaging (MRI) (that is, the total number of new OCs divided by the time in years between the baseline and latest post-baseline MRI).
Time frame: Month 12
Mean Change From Baseline in the Total Volume of New OCs at Month 12
The change from baseline in the total volume of OCs was assessed by whole-body MRI. Baseline was defined as the last available value prior to first administration of study drug.
Time frame: Baseline (Day 1) and Month 12
Percentage of Participants With No New OCs
The percentage of participants with no new OCs as assessed by whole-body MRI. Participants with new OCs not identified by MRI due to surgical resection during the treatment period were categorized as having new OCs for this analysis.
Time frame: Month 12
Annualized Rate of New or Worsening Deformities
The annualized rate of new or worsening deformities as assessed by radiographic imaging of both upper and lower limbs.
Time frame: Month 12
Annualized Rate of MO-Related Surgeries
The MO-related surgeries included any procedure indicated for the treatment of MO, such as an excision of a symptomatic OC or correction of a limb deformity.
Time frame: Month 12
Maximum Observed Plasma Drug Concentrations at Steady State (Cmax,ss) of Palovarotene
The Cmax,ss of palovarotene was evaluated. The pharmacokinetic (PK) sampling was performed at Month 1. If samples could not be obtained at Month 1, then one additional attempt was made at a subsequent visit.
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Children's Orthopaedic Center
Los Angeles, California, United States
Shriners Hospital for Children - Sacramento
Sacramento, California, United States
University of California-San Francisco
San Francisco, California, United States
Children's National Medical Center
Washington D.C., District of Columbia, United States
The Paley Institute
West Palm Beach, Florida, United States
Shriners Hospital for Children - Chicago
Chicago, Illinois, United States
Johns Hopkins University
Baltimore, Maryland, United States
Boston Children's Hospital
Boston, Massachusetts, United States
Mayo Clinic - PPDS
Rochester, Minnesota, United States
Shriners Hospitals for Children - Portland
Portland, Oregon, United States
...and 21 more locations
Time frame: Month 1: pre-dose and 3, 6, 10 and 24 hours post-dose
Minimum Observed Plasma Drug Concentrations at Steady State (Cmin,ss) of Palovarotene
The Cmin,ss of palovarotene was evaluated. The PK sampling was performed at Month 1. If samples could not be obtained at Month 1, then one additional attempt was made at a subsequent visit.
Time frame: Month 1: pre-dose and 3, 6, 10 and 24 hours post-dose
Time to Maximum Observed Drug Concentration at Steady State (Tmax,ss) of Palovarotene
The Tmax,ss of palovarotene was evaluated. The PK sampling was performed at Month 1. If samples could not be obtained at Month 1, then one additional attempt was made at a subsequent visit.
Time frame: Month 1: pre-dose and 3, 6, 10 and 24 hours post-dose
Area Under the Plasma Concentration-Time Curve at Steady State From Time 0 to 24 Hours After Dosing (AUC0-24,ss) of Palovarotene
The AUC0-24,ss of palovarotene was evaluated. The PK sampling was performed at Month 1. If samples could not be obtained at Month 1, then one additional attempt was made at a subsequent visit.
Time frame: Month 1: pre-dose and 3, 6, 10 and 24 hours post-dose
Number of Participants With Palatability of Sprinkled Palovarotene and Placebo
Palatability of palovarotene and placebo when sprinkled on specific foods as assessed with a 5-point hedonic face scale at the first dose (Day 1) and at Month 1 in all participants (including \<4 years old) who sprinkled the palovarotene or placebo onto a spoonful of specific foods. The hedonic face scale ranges from 1 to 5 where, 1= dislike very much, 2= dislike slightly, 3= neither like nor dislike, 4= like slightly, 5= like very much. Higher scores indicate positive outcome.
Time frame: Day 1 and Month 1