Evaluation of the efficacy and safety of stiripentol in patients 6 years and older with primary hyperoxaluria type 1, 2 or 3.
A multicenter randomized, double-blind, placebo-controlled phase 3 study The study is designed to compare the efficacy of stiripentol to a placebo in patients 6 years and older with primary hyperoxaluria type 1, 2 or 3. The study will be conducted in 2 periods: a 6-month, placebo-controlled, double-blind treatment period (period 1) followed by a 6-month open-label treatment period with blind maintained on results (period 2). Patients who benefit from the treatment after the first 12 months of study treatment will be proposed to enter the open-label extension (OLE) part of the study to continue to assess the long-term efficacy and safety of stiripentol.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
42
The target dose of stiripentol will be 50 mg/kg/day with a maximum dose of 3,000 mg/day. Patients allocated to the Stiripentol group will receive this treatment during the first 6 months, and in continuation up to 12 months.
Placebo capsules will be administered for the first 6 months. Then patients will switch to stiripentol over the 6- to 12-month period.
Collections of urine over 24 hours and the first urine in the morning (spot urines) will be carried out. Urine collections will be performed either during hospitalizations, or at home if appropriate conditions are met.
% change in 24-hour urinary oxalate excretion corrected for body surface area (BSA) determined from 24-hour urine sample collections
% change in 24-hour urinary oxalate excretion in mg/kg corrected for body surface area (BSA) between baseline and Month 6 and determined from 24-hour urine sample collections
Time frame: % change in 24-hour urinary oxalate excretion between baseline value and value at month 6
% change in 24-hour urinary oxalate excretion corrected for body surface area (BSA) determined from 24-hour urine sample collections
% change in 24-hour urinary oxalate excretion in mg/kg corrected for body surface area (BSA) from baseline to Month 3 and determined from 24-hour urine sample collections
Time frame: % change in 24-hour urinary oxalate excretion between baseline value and value at month 3
Absolute change in 24-hour urinary oxalate excretion in mg/kg corrected for body surface area (BSA) from baseline to Month 3 and Month 6
Absolute change in 24-hour urinary oxalate excretion in mg/kg corrected for BSA from baseline to Month 3 and Month 6
Time frame: Absolute change in 24-hour urinary oxalate excretion between baseline value to Month 3 and Month 6 values.
Change in 24-hour urine oxalate/creatinine ratio from baseline to Month 3 and Month 6
Concentration of 24-hour urine oxalate and 24-hour urine creatinine will be combined to report urine oxalate/creatinine ratio from baseline to Month 3 and Month 6. The concentrations will be determined using a validated assay
Time frame: Change in 24-hour urine oxalate/creatinine ratio between baseline value to month 3 and month 6 values
% of patients with urinary oxalate lower than 1.5 x upper limit of normal (ULN)) at Month 3 and Month 6
%of patients with near normalisation of 24-hour urinary oxalate level corrected for BSA (defined as urinary oxalate lower than 1.5 x upper limit of normal (ULN)) at Month 3 and Month 6)
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Series of blood samples will be taken (serum pregnancy test, Primary Hyperoxaluria genetic characterization, clinical laboratory assessments, vitamin B6 dosage, plasma oxalate dosage, stiripentol pharmacokinetics)
Kidney imaging will be obtained. Renal ultrasounds will be compulsory for all patients.
Kidney Disease Quality of Life Questionnaire : KDQOL-36 for patients ≥18 years of age at screening, and the Pediatric Quality of Life Inventory (PedsQL) including the generic and KF modules (parent and/or self-report versions) for patients \<18 years of age at screening. EQ-5D: a standardized instrument consisting of a questionnaire and a visual analog scale pertaining to 5 dimensions. Scoring of the questionnaire is based on degrees of disability. Scoring of the visual analog scale is based on a visual scale ranging from 0 (worst imaginable health state) to 100 (best imaginable health state). Higher scores indicate better health status. The EQ-5D-5L questionnaire (will be utilized in patients ≥18 years of age at screening, and the EQ-5D-Y questionnaire will be utilized in patients \<18 years of age at screening, where available.
Time frame: At 3 and 6 months of treatment.
% of patients with normalisation of 24-hour urinary oxalate level corrected for bode surface area at Month 3 and Month 6
% of patients with near normalisation of 24-hour urinary oxalate level corrected for BSA (defined as urinary oxalate lower than 1.5 x upper limit of normal (ULN)) at Month 3 and Month 6)
Time frame: At 3 and 6 months of treatment.
Blood samples for assessment of change in estimated glomerular filtration rate (eGFR in mL/min/1.73m2) from baseline to Month 6
Blood samples for assessment of change in estimated glomerular filtration rate (eGFR). EGFR (mL/min/1.73m2) will be calculated from baseline to Month 6
Time frame: Change in estimated glomerular filtration rate (eGFR) between baseline value and month 6 value
Occurrence of and frequency of kidney stone events during the follow-up of the patient
Number of and frequency of kidney stone events reported during the follow-up of the patient
Time frame: From start of participation of the patient to end of the study (Month 60)
Change in urine oxalate/creatinine ratios as assessed in spot urine collections between baseline and Month 6
Urine oxalate/creatinine ratios will be calculated from the oxalate and creatinine levels measured in spot urine collected during patients' hospitalizations or at home. The concentrations will be determined using a validated assay.
Time frame: From start of participation of the patient to end of the study (Month 60)
Change in biological parameters : oxalate concentration measured in urinary spots collections between baseline and Month 6
Change in oxalate concentration, related to kidney stone formation, measured in urinary spots collections between baseline and Month 6
Time frame: From baseline to 6 months of treatment.
Change in biological parameters : creatinine concentration measured in urinary spots collections between baseline and Month 6
Change in creatinine concentration, related to kidney stone formation, measured in urinary spots collections between baseline and Month 6
Time frame: From baseline to 6 months of treatment.
Absolute change in quality of life measured by the Pediatric Quality of Life Inventory (PedsQL) questionnaire
Absolute change in the Pediatric Quality of Life Inventory (PedsQL \[the generic and kidney failure (KF) modules\]) for patients \< 18 years of age (at screening) which is a 23 items 5-point Likert scale from: 0 (Never) to 4 (Almost always). Scores are transformed on a scale from 0 to 100 so higher score means better health.
Time frame: At baseline and every 6 months until the end of the study (Month 60)
Absolute change in quality of life measured by the Kidney Disease Quality of Life Questionnaire (KDQOL)
Absolute changes in the Kidney Disease Quality of Life Questionnaire (KDQOL) for patients ≥ 18 years of age (at screening) which is a 36 items survey with five subscales. Scores are transformed on a scale from 0 to 100 so higher score means better health.
Time frame: At baseline and every 6 months until the end of the study (Month 60)
Change in quality of life measured by the Euro Quality of Life Health State Profile Questionnaire (EQ-5D)
Change in Euro Quality of Life Health State Profile Questionnaire (EQ-5D) is a standardized instrument consisting of a questionnaire. Scoring of the questionnaire is based on degrees of disability. Higher scores indicate better health status.
Time frame: At baseline and every 6 months until the end of the study (Month 60)
Change in quality of life measured by the Euro Quality of Life Health State Profile Visual Analog Scale (VAS) : EQ-5D
Change in EQ-5D Visual Analog Scale EQ-5D is a standardized instrument consisting of a visual analog scale pertaining to 5 dimensions. Scoring of the visual analog scale is based on a visual scale ranging from 0 (worst imaginable health state) to 100 (best imaginable health state). Higher scores indicate better health status.
Time frame: At baseline and every 6 months until the end of the study (Month 60)