A randomized, double-blind, placebo-controlled, crossover study to assess the safety, tolerability, and pharmacokinetics of single doses of AUT00201 at 100 mg or matching placebo in patients with myoclonus epilepsy and ataxia due to potassium channel mutation (MEAK).
6 to 10 patients aged 18 years and older, diagnosed with MEAK will be enrolled in the study. Patients will be administered a single dose of AUT00201 and matching placebo in a crossover design. The study is comprised of an outpatient screening and procedure orientation followed by approximately 5 days of an inpatient stay at a clinical research unit. After screening/orientation (Visit 1), and baseline assessments (Visit 2), patients will be administered a single dose of 100 mg of AUT00201 or matching placebo the morning of Visit 3. PK assessments will be done at Visits 3, 4, 5, and 6 from predose and up to 27 hours postdose. Visit 4 will be a washout day for patients. At Visit 5 patients will be administered the crossover treatment. At Visit 6 patients will be discharged from the unit. Safety and tolerability assessments will be conducted throughout. PD parameters will also be assessed. Patients will be followed up by telephone 14 days after discharge.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
TRIPLE
Enrollment
6
University of Pennsylvania, Penn Epilepsy Center
Philadelphia, Pennsylvania, United States
Number of Participants With Treatment-Related Adverse Events After Single Dose Treatment of AUT00201 Compared to Placebo
Time frame: 19 Days
Change From Baseline in Cortical Inhibition; as Measured by Paired-pulse Transcranial Magnetic Stimulation (ppTMS) at Short Interval Cortical Inhibition (SICI) Inter-stimulus-intervals (ISI): the Outcome is the Average %-Inhibition at SICI 2.5 and 3ms ISI
ppTMS allows measurement of cortical inhibitory circuit functions. In ppTMS protocols 2 consecutive pulses are delivered to the hand motor region at a fixed interstimulus interval such that the motor-evoked potential, captured by surface EMG sensors, resultant from the second (test) stimulus is modulated by an conditioning stimulus. First resting motor threshold is recorded, which is defined as the lowest stimulus intensity (expressed as a percentage of maximal stimulator output, %MSO) required to induce motor evoked potentials of 50μV. SICI will be elicited with a conditioning stimulus of 70% of resting motor threshold at 2.5ms ISI and 3ms ISI. SICI at each ISI will be reported in %-inhibition and the average calculated for this outcome measure. An increase (positive change from baseline) would indicate a normalisation in this population. Post-dose collected 2-4h post dose on Day1 and Day3 (active vs placebo randomised crossover).
Time frame: 2 - 4 hours post dose
Pharmacokinetics: Maximum Plasma Concentrations (Cmax) of AUT00201
Time frame: 27 hours
Pharmacokinetics: Area Under the Plasma Concentration-time Curve (AUC) of AUT00201 to the Last Observed Quantifiable Concentration
AUCt
Time frame: 27 hours
Change From Baseline in Measures of Dysarthria as Assessed by Speaking Rate Metric From Automated Standardized Speech Test.
Baseline data were collected on Study Day -1 (V2); post-dose data were collected 1 hour post dose on Day 1 (V3) and Day 3 (V5) (active vs placebo randomised crossover). An increase (positive change from baseline) in syllables/sec would indicate an improvement in this population.
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Time frame: 1 hour post dose
Change From Baseline in Myoclonus Index (MI; a Measure of Positive Myoclonus) Evaluated With EMG and Accelerometer
Average MI from 0 to 4 hours postdose, calculated during hourly finger-to-nose tasks and Unified Myoclonus Rating Scale Section 4 and 5 tasks, averaged across arms. The Myoclonus Index (MI) is a novel methodology for objectively measuring severity of positive myoclonus. The MI is calculated from positive myoclonus detected using surface electromyography (EMG) and accelerometry data, as described in the publication by Rissanen et al (Clin Neurophysiol. 2021). People who do not experience myoclonus would be expected to have a score of '0' on the Myoclonus Index; there is no maximum score, although higher scores indicate more severe myoclonus. A reduction of MI (negative change from baseline) would indicate an improvement in this population. Baseline data are collected on Study Day -1 (V2); post-dose data are collected hourly from dosing to 4 hours post dose, then averaged, on Day 1 (V3) and Day 3 (V5) (active vs placebo randomised crossover).
Time frame: 0-4 hours post dose
Change From Baseline in Measures of Dysarthria as Assessed by Buttercup Count From Automated Standardized Speech Test.
Number of times the word "Buttercup" was correctly repeated within 30 seconds. An increase (positive change from baseline) in number of 'buttercups' would indicate an improvement in this population. Baseline data collected were collected on Study Day -1 (V2); post-dose data were collected 1-hour post-dose on Day 1 (V3) and Day 3 (V5) (active vs placebo randomised crossover).
Time frame: 1 hour post-dose