This is a phase 1 / 2, randomized, double-blinded, single cross-over study, with a washout period between treatment regimens, to test the efficacy and safety of tamoxifen therapy to improve motor and respiratory function in males with XLMTM.
Pre-clinical studies in Mtm1 knockout mice (a model of XLMTM) demonstrated prolonged survival, increased motor function (including muscle strength), and improved muscle histopathology with tamoxifen treatment. Based on these data, and the known safety profile of the drug in humans, we hypothesize that tamoxifen treatment will be safe and will improve motor and respiratory function in XLMTM patients. This is a randomized, double-blinded, single crossover clinical trial to test this hypothesis and determine the safety and efficacy of tamoxifen in improving motor and respiratory function in MTM patients. Each subject will serve as his own control during the placebo phase of the study. As treatments for XLMTM are current not available, this study addresses a critical unmet need by testing a therapy that, if effective, may serve as a primary treatment, or in the future as an adjunct to other therapies in development.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
6
All participants will receive tamoxifen (ApoTamox) for approximately 6 months (6 months + 1 week). Participants and study staff will be blinded as to whether the participants are starting with the placebo or the drug. Depending on randomization, drug or placebo will be dispensed at the end of the t=0 study visit (Phase 1). Dosing will commence the day after the t=0 study visit. At the end of Phase 1, participants will enter a 'washout' period, when they will cease treatment. After approximately 3 months of washout, participants will cross-over to the other treatment regimen and receive the other interventional product (IP) for the final 6 months of their study participation (Phase 2).
placebo comparator
Ann and Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
National Institutes of Health
Rockville, Maryland, United States
Hospital for Sick Children
Toronto, Ontario, Canada
Great Ormond Street Hospital for Children
London, United Kingdom
Motor Function Measure 32 (MFM32)
Mean change from baseline of Motor Function Measure 32 for subjects aged 4 and older
Time frame: Baseline to 15 Months
Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders for subjects aged 2-4 years (CHOP INTEND)
Mean change from baseline of Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders for subjects aged 2-4 years
Time frame: Baseline to 15 months
10 meter walk test
Mean change from baseline in velocity in 10 meter walk test for ambulant participants
Time frame: Baseline to 15 months
Change in pulmonary function testing scores 1) Forced Expiratory Volume in the first second
Mean change from baseline in participants without invasive respiratory support
Time frame: Baseline to 15 months
Change in pulmonary function testing scores 2) Forced Vital Capacity
Mean change from baseline in participants without invasive respiratory support
Time frame: Baseline to 15 months
Change in pulmonary function testing scores 3) Peak Cough Flow
Mean change from baseline in participants without invasive respiratory support
Time frame: Baseline to 15 months
Change in pulmonary function testing scores 4) Maximum Expiratory Pressure
Mean change from baseline in participants without invasive respiratory support
Time frame: Baseline to 15 months
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Change in pulmonary function testing scores 5) Maximum Inspiratory Pressure or Sniff Inspiratory Pressure
Mean change from baseline in participants without invasive respiratory support
Time frame: Baseline to 15 months
invasive ventilation - time off ventilation
Mean change in time off ventilator for participants dependent on invasive respiratory support
Time frame: Baseline to 15 months
Incidence and severity of Adverse Events related to the treatment [ Time Frame: 15 Months ]
Incidence of serious adverse events and adverse events throughout the study, as assessed by CTCAE v4.0
Time frame: Baseline to 15 months
micro RNA 133a (miR133a)
Assess miR133a as a biomarker of XLMTM
Time frame: Baseline to 15 months