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Efficacy Study of Epoetin Alfa in Friedreich Ataxia

Information source: Federico II University
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Friedreich Ataxia

Intervention: Epoetin alfa (Drug); Placebo (Drug)

Phase: Phase 2

Status: Completed

Sponsored by: Federico II University

Official(s) and/or principal investigator(s):
Francesco Saccà, MD, Study Director, Affiliation: University Federico II, Naples Italy

Summary

Friedreich's ataxia (FRDA) is a rare genetic disorder characterised by severe neurological disability and cardiomyopathy. Friedreich's ataxia is the consequence of frataxin deficiency. Although several drugs have been proposed, there is no available treatment. Four trials recently demonstrated that erythropoietin can increase the intracellular levels of frataxin. The present project is aimed at testing a long term therapeutic approach using erythropoietin, which is an already available and commercialised drug. The study will test the effect of erythropoietin on exercise capacity, which is reduced in patients with FRDA. Additional objectives of the study will be the drug's safety and tolerability, and its effect on frataxin, blood vessel reactivity, heart functional indexes, and disease progression.

Clinical Details

Official title: A Double-blind, Randomized, Placebo-controlled, Clinical Trial to Test the Efficacy of Epoetin Alfa on Physical Performance of Friedreich Ataxia Patients.

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome: Peak oxygen uptake (VO2 max) at the cardiopulmonary exercise test (CPET)

Secondary outcome:

Secondary outcome variables at the CPET (anaerobic threshold, ventilatory efficiency, exercise duration, and power output).

Frataxin levels in peripheral blood mononuclear cells (PBMCs).

Echocardiography

Vascular reactivity

Neurological progression

Quality of life

Safety and tolerability

Detailed description: Friedreich's ataxia (FA) is an autosomal recessive ataxia caused by a trinucleotide GAA expansion in the first intron of the FXN gene. The gene encodes for a 210aa mitochondrial protein called frataxin, whose mRNA and protein levels are severely reduced in FA. It has been suggested that frataxin is involved in iron-sulphur cluster and heme biogenesis, iron binding/storage, and chaperone activity. Clinically, the age of onset is generally around puberty and, as the disease progresses, there is increasing ataxia of the limbs, and eventually most patients are wheelchair bound by the twenties. Cardiomyopathy with myocardial hypertrophy occurs very often and is the predominant cause of death. Type II diabetes, scoliosis, foot deformities, optic atrophy, and deafness are other relatively frequent symptoms. Erythropoietin (EPO) is a glycoprotein that acts as a main regulator for erythropoiesis. Evidence suggests that both EPO and its receptor are expressed in the nervous tissue, and neuroprotective effects have been shown in animal models of cerebral ischemic damage. EPO increases frataxin levels in cultured human lymphocytes from FRDA patients. However, frataxin protein increase is not preceded by mRNA increase, suggesting that a post-transcriptional mechanism is involved. To date, four phase II clinical trials have been published regarding the use of EPO in FRDA patients.

Eligibility

Minimum age: 12 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Molecular diagnosis of Friedreich Ataxia

- Age ≥12 years

- Body weight ≥30, ≤90 Kg

- SARA score ≤30

- Patient able to read and sign the informed consent

- Patients able to perform a cardiopulmonary test

Exclusion Criteria:

- Treatment with Erythropoietin in the previous 12 months

- Treatment with Idebenone

- Contraindications to CPET: cardiac valve disease, ischemic cardiomyopathy, atrial

fibrillation, asthma, chronic obstructive pulmonary disease, other arrhythmias judged as not compatible with exercise.

- Any Cardiac and/or Hepatic and/or Renal disease judged as clinically relevant by the

investigator

- Any clinically relevant ECG abnormalities that may interfere with the study

- Any abnormal and clinically relevant laboratory exams at screening visit that may

interfere with the trial

- Anemia with Hemoglobin <10 g/dL

- Positive history for venous and/or arterial thrombosis

- Drug-resistant arterial hypertension

- Positive history for drug-resistant epilepsy

- Patients in treatment with not allowed study drugs (starting from 3 months prior to

screening)

- Any acute/chronic disease that might interfere with the clinical trial, as judged by

the investigator

- Hypersensitivity to Epoetin alfa or any other component of the study drug

- Patients not able to comply to the study

- For female patients (Sexually not active, hysterectomized, sterilized, menopause

patients are excluded from the following criteria): pregnancy and/or breastfeeding and/or inadequate contraception.

Locations and Contacts

Dipartimento di Scienze Neurologiche, Napoli 80131, Italy

Università di Bari, Bari, BA 70124, Italy

Università la Sapienza, Neurologia C, Rome, RM 00186, Italy

Additional Information

Clinical trials site

University Federico II, Naples Italy

Friedreich Ataxia Research Alliance

Associazione Italiana per la lotta alle Sindromi Atassiche

Related publications:

Saccà F, Piro R, De Michele G, Acquaviva F, Antenora A, Carlomagno G, Cocozza S, Denaro A, Guacci A, Marsili A, Perrotta G, Puorro G, Cittadini A, Filla A. Epoetin alfa increases frataxin production in Friedreich's ataxia without affecting hematocrit. Mov Disord. 2011 Mar;26(4):739-42. doi: 10.1002/mds.23435. Epub 2010 Nov 10.

Acquaviva F, Castaldo I, Filla A, Giacchetti M, Marmolino D, Monticelli A, Pinelli M, Saccà F, Cocozza S. Recombinant human erythropoietin increases frataxin protein expression without increasing mRNA expression. Cerebellum. 2008;7(3):360-5. doi: 10.1007/s12311-008-0036-x.

Boesch S, Sturm B, Hering S, Scheiber-Mojdehkar B, Steinkellner H, Goldenberg H, Poewe W. Neurological effects of recombinant human erythropoietin in Friedreich's ataxia: a clinical pilot trial. Mov Disord. 2008 Oct 15;23(13):1940-4. doi: 10.1002/mds.22294.

Boesch S, Sturm B, Hering S, Goldenberg H, Poewe W, Scheiber-Mojdehkar B. Friedreich's ataxia: clinical pilot trial with recombinant human erythropoietin. Ann Neurol. 2007 Nov;62(5):521-4.

Sturm B, Stupphann D, Kaun C, Boesch S, Schranzhofer M, Wojta J, Goldenberg H, Scheiber-Mojdehkar B. Recombinant human erythropoietin: effects on frataxin expression in vitro. Eur J Clin Invest. 2005 Nov;35(11):711-7.

Starting date: January 2013
Last updated: August 10, 2015

Page last updated: August 23, 2015

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