This study is a double-blind, double-dummy, two-way cross-over, randomised, Phase II study to be conducted at approximately 6 investigational sites in 2 countries. The study will compare the efficacy, safety and tolerability of twice daily Chronocort, a modified-release hydrocortisone, with once daily Plenadren, a modified-release hydrocortisone, over a treatment period of up to 2 months in participants aged 18 years and over, diagnosed with primary Adrenal Insufficiency (AI).
The 4-month study period will comprise a Screening Period of up to 4 weeks (during which participants will receive usual standard of care \[SoC\] treatment), two 4-week cross-over periods (Treatment Periods 1 and 2), and a 4-week Follow-up Period. Participants will be randomly assigned on a 1:1 basis to either Chronocort in Treatment Period 1 and Plenadren in Treatment Period 2 (Treatment Sequence I), or Plenadren in Treatment Period 1 and Chronocort in Treatment Period 2 (Treatment Sequence II). The total daily dose of Chronocort or Plenadren will be 25 mg according to international guidelines and the Plenadren Summary of Product Characteristics (SmPC). Plenadren 25 mg will be taken once daily in the morning on waking (typically between 06:00 and 08:00 hours). Chronocort 10 mg will be taken in the morning on waking (typically between 06:00 and 08:00 hours) and Chronocort 15 mg will be taken at night just prior to going to bed (typically between 22:00 hours and midnight). Placebo capsules and tablets will be provided to each participant to mask the treatment being received and maintain the study blinding. The first dose of study drug will be taken in the evening of Day 1 and the morning dose on Day 29 will be the last study drug dose in Treatment Period 1. The first dose of study drug in Treatment Period 2 will be taken in the evening of Day 29 and the morning dose on Day 57 will be the last study drug dose in Treatment Period 2 and the end of the dosing periods. The dose will not be changed during the study, but participants will receive stress dosing rules and an emergency treatment pack. Use of stress doses and reasons for use will be collected in an electronic participant diary. If a stress dose is taken within 48 hours before any clinic visit, then the visit should be delayed until the participant has had a 48-hour period without use of any stress doses.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
58
Hydrocortisone modified-release hard gelatin capsules for oral administration - 5mg and 10mg
Hydrocortisone modified-release tablets for oral administration - 5mg and 20mg
Diurnal Investigational Site in Hamburg
Hamburg, Germany
Diurnal Investigational Site in Munich
Munich, Germany
Diurnal Investigational Site in Munich
Munich, Germany
Diurnal Investigational Site in Würzburg
Würzburg, Germany
To measure the change in morning serum cortisol levels from baseline, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
The primary efficacy outcome variable is the 07:00 hour serum cortisol level after 4 weeks of treatment. The treatment effect (Chronocort minus Plenadren, after logarithmic transformation) will be estimated in the efficacy evaluable analysis set (EEAS) (defined as participants with morning serum cortisol assessed at baseline and after each treatment period, with no major protocol violations) using a linear mixed model.
Time frame: Baseline and end of each 4 week treatment period.
To measure change in morning fatigue from baseline, using the Multidimensional Assessment of Fatigue (MAF) questionnaire within 1 hr of waking, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
MAF morning fatigue score after 4 weeks of treatment. MAF is a 16 item scale that measures fatigue according to 4 dimensions; degree and severity, distress that it causes, timing of fatigue, and it's impact of various activities of daily living to give a Global Fatigue Score of up to 50, where a higher value equates to more fatigue.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline, in terms of achieving physiological morning cortisol levels after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
Whether or not a participant has achieved a physiological morning cortisol level (defined as the 07:00 hour serum cortisol before the morning dose of \>140 nmol/L after 4 weeks of treatment) will be summarised and compared between treatment periods. Note: a morning cortisol level below 140 nmol/L is considered to reflect relative AI in international guidelines \[Bornstein, 2016\].
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline in terms of closeness of overall salivary cortisone levels during the day to a normal physiological profile, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
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Diurnal Investigational Site in Birmingham
Birmingham, United Kingdom
Diurnal Investigational Site in Cardiff
Cardiff, United Kingdom
Diurnal Investigational Site in Newcastle
Newcastle, United Kingdom
Diurnal Investigational Site in Sheffield
Sheffield, United Kingdom
A salivary cortisone profile score will be derived at the end of 4 weeks of treatment. The profile score is calculated by comparing the on-study salivary cortisol profile with a profile obtained from healthy volunteers. Five timepoints are compared, where a more similar profile to the normal healthy volunteer profile is preferred.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline in ACTH control in the morning, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
The 07:00 hour plasma ACTH level after 4 weeks of treatment will be summarised and compared between treatment periods.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline to the bone marker of osteocalcin, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
Osteocalcin levels after 4 weeks of treatment will be summarised and compared between treatment periods.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline in morning fatigue using the PROMIS® 7b questionnaire within 1 hour of waking, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
Morning fatigue, using the Patient-Reported Outcomes Measurement Information System (PROMIS® 7b) questionnaire, within 1 hour of waking after 4 weeks of treatment will be summarized and compared between treatment periods. PROMIS 7b is a 7-item scale that measures self-reported fatigue that may impact daily activities and normal functioning. A higher PROMIS 7b score indicates greater fatigue and therefore a less favorable outcome.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline in QoL using the EuroQol 5-level Standardized Health Questionnaire (EQ-5D-5L™), after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
QoL, using the EQ-5D-5L after 4 weeks of treatment, will be summarized and compared between treatment periods. The scale measures on a 5-component scale including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Where the minimum score is 0 and maximum score is 100, a high score indicates a more favorable outcome.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline in QoL using the Health-related Quality of Life in Addison's disease (AddiQoL) questionnaire, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
QoL, using the AddiQoL questionnaire after 4 weeks of treatment, will be summarized and compared between treatment periods. AddiQoL is a 30 item scale measuring health-related quality of life in Addison's disease. A higher score indicates a higher quality of life and therefore a more favorable outcome.
Time frame: Baseline and end of each 4 week treatment period.
To measure the change from baseline in terms of QoL using the 36-Item Short Form Health Survey (SF-36®) questionnaire, after 4 weeks treatment with Chronocort compared with 4 weeks treatment with Plenadren (crossover study).
QoL, using SF-36 questionnaire after 4 weeks of treatment, will be summarized and compared between treatment periods. Analyses of SF-36 at other timepoints are exploratory analyses. The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). All components contribute in different proportions to the overall measures. Where the minimum score is 0 and maximum score is 100 and a high score is a more favorable score.
Time frame: Baseline and end of each 4 week treatment period.