AIMS-2-CT-01 is a randomized, double-blind, placebo controlled, study to explore the efficacy, safety and tolerability of Arbaclofen administered to children and adolescents (ages 5-17) for the treatment of social adaptive function in participants with ASD. The effects of Arbaclofen on social function in children and adolescents with ASD will be evaluated in a randomized, placebo controlled, parallel-group study of 16 weeks duration. Subjects who meet protocol criteria will be randomly allocated to receive either Arbaclofen or placebo in a 1:1 ratio in the Treatment Period. There will be 7 recruiting sites and randomization will be stratified by site. A sample of 130 patients will be recruited. Blinding will be maintained by utilizing identical tablets containing either Arbaclofen or placebo.
Autism Spectrum Disorder (ASD) is a clinically and etiologically heterogeneous neurodevelopmental condition affecting approximately 1% of the population. The core symptoms of ASD are deficits in social communication and the presence of repetitive and restricted behaviours and interests, including sensory anomalies. Currently, there are no effective medical treatments for the core symptoms of ASD, and families frequently use costly non evidence based interventions. Developing drugs for ASD has been challenging because of a limited understanding of its underlying pathophysiology(ies), and difficulties modelling it in vitro and in vivo. A recent study from EU-AIMS reported, for the first time in ASD, that differences in E-I balance can be 'shifted' using a GABA acting drug (riluzole), and that abnormalities in functional connectivity can be 'normalised' by targeting E-I, even in adults. This offers promise that drugs targeting specific parts of the GABA pathway may improve symptoms. The aim of the investigator's project is to conduct a double-blind Randomized Control Trial (RCT) focused on GABA/glutamate equilibrium, to assess the efficacy of a drug that targets core and/or comorbid symptoms in ASD. Arbaclofen is a selective GABA-B receptor agonist and augments GABA-ergic activity, inhibits presynaptic release of glutamate, inhibits postsynaptic transmission, and modulates intracellular signalling. Through elevation of GABA-ergic inhibitory activity, Arbaclofen may act to alleviate ASD symptoms with social anxiety and emotional hyperarousal. Hypothesis: Arbaclofen will be superior to placebo in improving social function as measured by the Vineland-3 social domain.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
124
Arbaclofen tablet.
Placebo tablet.
Robert Debré Hospital
Paris, France
Hospital Clínic de Barcelona
Barcelona, Spain
Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón, SERMAS
Madrid, Spain
University of Salamanca & Complejo asistencial de Zamora
Salamanca, Spain
University of Glasgow
Glasgow, United Kingdom
King's College London
London, United Kingdom
University of Newcastle upon Tyne
Newcastle, United Kingdom
Effect of Arbaclofen vs. placebo on social function
Vineland-3 (socialization domain): The Vineland Adaptive Behavior Scales, Third Edition is designed to assess the personal and social functioning of handicapped and non-handicapped persons. It is a gold standard for the assessment of adaptive functioning. The Socialization domain is one of the 4 adaptive domains assessed by the comprehensive interview form. The other 3 adaptive domains are communication, daily living skills and motor skills. The Socialization domain has 3 subdomains: interpersonal relations, play and leisure and coping skills.
Time frame: Week 0 + Week 16
Effect of Arbaclofen vs. placebo on measures of global function
CGI-I: Clinical Global Impression - Improvement Scale is used to determine the patient's improvement in response to treatment.
Time frame: Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Effect of Arbaclofen vs. placebo on measures of global function
CGI-S: The Clinical Global Impression - Severity Scale is used to assess the impairment of neurobehavioral function in study subjects.
Time frame: Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Effect of Arbaclofen vs. placebo on other adaptive domains
Vineland-3 (other adaptive domains): The Vineland Adaptive Behavior Scales, Third Edition, other adaptive domains: communication, daily living skills and motor skills.
Time frame: Week 0 + Week 16
Effect of Arbaclofen on measures of social abilities and responsiveness
ADOS-2: The Autism Diagnostic Observation Schedule, Version 2, will be used to assess autistic symptomatology.The ADOS-2 is a standardized protocol for the observation of social and communicative behaviour in children, adolescents, and adults who are suspected of having an ASD.
Time frame: Week -3
Effect of Arbaclofen on measures of social abilities and responsiveness through BOSCC
BOSCC: The Brief Observation of Social Communication Change will be used to to sensitively measure change of core autistic symptoms by observation of a semi-structured social interaction between a child and an examiner.
Time frame: Week 0 + Week 16
Effect of Arbaclofen on measures of social abilities and responsiveness through SRS-2-P
SRS-2-P: The Social Responsiveness Scale (parent version) measures the severity of social impairment in ASD.
Time frame: Week 0 + Week 16
Effect of Arbaclofen on measures of social abilities and responsiveness through SRS-2-T
SRS-2-T: The Social Responsiveness Scale (teacher version) measures the severity of social impairment in ASD.
Time frame: Week 0 + Week 16
Effect of Arbaclofen on measures of problem behaviours
ABC-C: This is the community version of the original residential version of the Aberrant Behaviour Checklist. It is designed to objectively identify five behaviour subscales through observation by the primary caregiver: irritability, lethargy, stereotypy, hyperactivity, and inappropriate speech.
Time frame: Week 0 + Week 4 + Week 8 + Week 12 + Week 16
Effect of Arbaclofen on measures of problem behaviours
CBCL: Child Behaviour Checklist is a caregiver report form identifying problem behaviour in children.
Time frame: Week 0 + Week 16
Effect of Arbaclofen on other measures of core symptoms
AIM: The Autism Impact Measure is designed to measure change in the core symptoms of autism.
Time frame: Week 0 + Week 4 + Week 8 + Week 12 + Week 16
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with the SMURF
SMURF: Safety Monitoring Uniform Research Form.
Time frame: Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with the ESS-CHAD
ESS-CHAD: The Epworth Sleepiness Scale for Children and Adolescents will be employed to evaluate sedation.
Time frame: Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with the C-SSRS
C-SSRS: The Columbia Suicide Severity Rating Scale is used to measure suicidality.
Time frame: Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with a pulse rate measurement
Vital signs: pulse
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with a body temperature measurement
Vital signs: body temperature
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with a blood pressure measurement
Vital signs: blood pressure
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed by measuring weight
Weight: Weight (in kg) will be assessed with all outer wear and shoes removed.
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed by measuring height
Height: Height (in cm) will be assessed with all outer wear and shoes removed.
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with the Tanner scale
Tanner stage
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16 + Week 18
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with blood tests
Blood tests: CBC, serum chemistry, liver enzymes and renal function.
Time frame: Week -3 + Week 16
Safety and tolerability of Arbaclofen in children and adolescents with ASD as assessed with blood tests
Urine tests: basic urinalysis, toxics (amphetamines, benzodiazepines, barbiturates, marijuana/cannabis, cocaine, opioids (narcotics)) and pregnancy.
Time frame: Drug testing: Week -3 + Week 16, Pregnancy testing: Week -3 + Week 0 + Week 4 + Week 8 + Week 12 + Week 16
To explore the use and feasibility of digital biomarkers
To explore the use and feasibility of digital biomarkers as treatment-responsive measures of core and associated symptoms of ASD
Time frame: Week -3 + Week 0 + Week 2 + Week 4 + Week 6 + Week 8 + Week 12 + Week 16
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