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Pharmacological Treatment of Rett Syndrome With Glatiramer Acetate (Copaxone)

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ClinicalTrials.gov Identifier: NCT02153723
Recruitment Status : Completed
First Posted : June 3, 2014
Results First Posted : November 5, 2018
Last Update Posted : November 5, 2018
Sponsor:
Collaborator:
Rett Syndrome Research Trust
Information provided by (Responsible Party):
Aleksandra Djukic, Montefiore Medical Center

Study Description
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Brief Summary:
A phase 2 open label trial to test a potential drug treatment for Rett syndrome, the leading known genetic cause of severe neurological impairment in girls. The drug, Copaxone (generic name - Glatiramer acetate) is medication FDA approved for the treatment of multiple sclerosis. Copaxone's high safety profile has been documented in large cohorts of patients for more than 12 years.

Condition or disease Intervention/treatment Phase
Rett Syndrome Drug: Glatiramer Acetate Phase 2

Detailed Description:

Background/rationale for the study:

In Rett syndrome brain cells aren't actually lost, instead poor maturation of connections between brain cells (synapses) prevents effective neurological functioning, and is the main morphological feature of the disease. The MeCP2 gene plays a major role in transcriptional regulation of other genes, one of which is the gene encoding brain-derived neurotrophic factor (BDNF).

The disease progression and severity of symptoms is directly affected by the level of BDNF expression. An increase of BDNF levels (by genetic manipulations or pharmacological agents) leads to delayed onset of Rett syndrome-like symptoms in experimental models; rescued gait/mobility, improved quality of life and increased survival rates.

Copaxone treatment by subcutaneous injection caused elevation of BDNF levels. Quantitative immunofluorescence assays showed about a twofold increase in neuronal expression of BDNF following Copaxone treatment.

We expect that an increase in BDNF levels with Copaxone administration will stimulate communication between brain cells (synaptic maturation), which will lead to amelioration of symptoms (motor functions/gait, cognitive functions, breathing, encephalopathy and improve quality of life) for girls with Rett syndrome.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 10 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pharmacological Treatment of Rett Syndrome With Glatiramer Acetate (Copaxone)
Study Start Date : August 2013
Actual Primary Completion Date : August 2014
Actual Study Completion Date : January 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Rett Syndrome

Arms and Interventions
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Arm Intervention/treatment
Experimental: Copaxone

Dose escalation:

Study drug will be administered once a week for 4 weeks, twice a week for 4 weeks and daily for 24 weeks. Drug is administered as a subcutaneous injection.

 Drug: Glatiramer Acetate
Other Name: Copaxone


Outcome Measures
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Primary Outcome Measures :
  1. Gait Velocity as Measured by GAITRite System [ Time Frame: Baseline and Final week of treatment (week 32) ]
    To perform quantitative gait assessments a computerized walkway (457 × 90.2 × 0.64cm) with embedded pressure sensors (GAIT Rite system) was used. Subjects walked on the walkway for two trials, while wearing comfortable footwear.


Secondary Outcome Measures :
  1. Breath Hold Index (Number of Breath Holds Per Hour; Assessed in the Sleep Monitoring Lab) [ Time Frame: Baseline and during final week of treatment (week 32) ]
    Breath hold index is defined as number of breath holds/hour. Respirations were monitored with sleep monitoring equipment during the daytime at the polysomnography laboratory with additional oronasal airflow, electromyography (EMG), EEG and video monitoring to confirm wakefulness during the period of study.

  2. Breath Hold Time (Assessed in the Sleep Monitoring Lab) [ Time Frame: Baseline and Final week of treatment (week 32) ]
    Breath Hold Time is defined as percentage of time spent holding the breath in a specific time unit. It is measured by a standard medical technique where belts are placed on the chest and abdomen to record movement and sensors are used to record nasal flow. Wake respiration was monitored with sleep monitoring equipment during the daytime at the polysomnography laboratory with additional oronasal airflow, EMG, EEG and video monitoring to confirm wakefulness during the period of study.

  3. Visual Memory Novelty Score as Assessed by TX300 Tobii Computer. [ Time Frame: Baseline and Final week of treatment (week 32) ]
    Eye-tracking is considered an indication of visual memory. Eye-tracking data was recorded at 300 Hz sampling rate using a Tobii T300 computer (Tobii Technology, Danderyd, Sweden). The actual data given by the computer represents the percentage of time spent looking at a novel visual target - this is called the novelty score. Visual memory, as indexed by the novelty score, is the percentage of time spent looking at a novel target during the test ("visual paired comparison paradigm"). Duration of testing was 2 minutes.

  4. Visual Attention (Number of Fixations) Assessed by Eye-tracking TX300 Tobii Computer. [ Time Frame: Baseline and Final week of treatment (week 32) ]

    Visual attention is indexed by duration and number of fixations on novel target on testing. The standard method of assessing visual attention in neuropsychology is by measuring:

    A)number of fixations (how many times the subject looks at each of the 2 visual targets). The higher number of fixations, the more attentive the subject to that visual target.

    B) duration of fixations in seconds (the longer the fixation the more attentive). Duration of fixations correlates with intelligence: the smarter the person is the shorter his fixations are.

    Eye-tracking data was recorded at 300 Hz sampling rate using a Tobii T300 (Tobii Technology AB, Danderyd, Sweden). The measured index is called the Novelty Score which indicates the percentage of time spent looking at novel visual target. Duration of testing session was 2 minutes.


  5. Visual Attention (Fixation Length) Assessed by Eye-tracking TX300 Tobii Computer. [ Time Frame: Baseline and Final week of treatment (week 32) ]

    The standard method of assessing visual attention in neuropsychology is by measuring:

    A)number of fixations (how many times the subject looks at each of the 2 visual targets). The higher number of fixations, the more attentive the subject to that visual target.

    B) duration of fixations in seconds (the longer the fixation the more attentive). Duration of fixations correlates with intelligence: the smarter the person is the shorter his fixations are.

    Eye-tracking data was recorded at 300 Hz sampling rate using a Tobii T300 (Tobii Technology AB, Danderyd, Sweden). The measured index is called the Novelty Score which indicates the percentage of time spent looking at novel visual target. Visual attention is indexed by number of fixations on novel target on test.

    Duration of testing session was 2 minutes.



Eligibility Criteria
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Ages Eligible for Study:   10 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Female patients with genetically confirmed Rett Syndrome (RTT)
  • Age: 10 or more years old. Selection of the age is based on the available evidence of the safety of Glatiramer Acetate (GA) in this group, and the relative homogeneity/stability of the phenotype, which is not expected to spontaneously change within a 6 month period at this age
  • Ambulatory (with our without support)

Exclusion Criteria:

  • Prolonged Qtc (obtained within 30 days prior to enrollment)
  • Presence of co morbid non-Rett related disease
  • Presence of immunodeficiency requiring intravenous immunoglobulin 3 (IVIG 3) months prior to enrollment
  • Allergy/sensitivity to GA or mannitol
  • Inability or unwillingness of legal guardians to give written informed consent
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02153723


Locations
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United States, New York
Montefiore Medical center
Bronx, New York, United States, 10467
Sponsors and Collaborators
Montefiore Medical Center
Rett Syndrome Research Trust
More Information
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Publications of Results:

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Responsible Party: Aleksandra Djukic, Associate Professor of Clinical Neurology and Clinical Pediatrics, Director, Tri State Rett Syndrome Center, Montefiore Medical Center
ClinicalTrials.gov Identifier: NCT02153723    
Other Study ID Numbers: 13-05-117
First Posted: June 3, 2014    Key Record Dates
Results First Posted: November 5, 2018
Last Update Posted: November 5, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Keywords provided by Aleksandra Djukic, Montefiore Medical Center:
Treatment trial, Rett syndrome, Glatiramer acetate
Additional relevant MeSH terms:
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Rett Syndrome
Syndrome
Disease
Pathologic Processes
Mental Retardation, X-Linked
Intellectual Disability
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Genetic Diseases, X-Linked
 Genetic Diseases, Inborn
Heredodegenerative Disorders, Nervous System
Glatiramer Acetate
(T,G)-A-L
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Immunosuppressive Agents
Antirheumatic Agents