EPX-100 for Dravet Syndrome

(ARGUS Trial)

Recruiting at 27 trial locations

Age: Any Age

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Epygenix

Must be taking: Aeds

Must not be taking: Carbamazepine, Oxcarbazepine, Phenytoin, Fenfluramine

Disqualifiers: Suicidal thoughts, Cardiac disease, others

Stay on Your Current Meds

Prior Safety Data

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

The purpose of this study is to evaluate the safety and efficacy of EPX-100 as adjunctive therapy in participants with Dravet syndrome.

Will I have to stop taking my current medications?

The trial requires that participants are on a stable regimen of anti-epileptic drugs (AEDs) for at least 30 days before starting. However, you cannot take certain medications like carbamazepine, oxcarbazepine, phenytoin, or fenfluramine, and you must avoid grapefruit products.

What data supports the effectiveness of the drug EPX-100 for Dravet Syndrome?

EPX-100 is mentioned as a potential drug in the initial stages of clinical evaluation for Dravet Syndrome, with experimental data and initial clinical studies highlighting its potential effectiveness. ^{1 2 3 4 5}

Is EPX-100 safe for humans?

There is limited safety information available for EPX-100, but initial clinical studies suggest it is being evaluated for safety in treating Dravet Syndrome. However, specific safety data for humans is not detailed in the available research. ^{1 2 6 7 8}

How does the drug EPX-100 differ from other drugs for Dravet Syndrome?

EPX-100 is a novel drug being evaluated for Dravet Syndrome, which is a severe form of epilepsy. Unlike traditional treatments like valproate and benzodiazepines, EPX-100 is part of a new wave of drugs with different mechanisms of action, potentially offering new hope for patients who do not respond to existing therapies. ^{1 2 9 10 11}

Research Team

George Nomikos, MD, PhD

Principal Investigator

Harmony Biosciences Management, Inc.

Eligibility Criteria

This trial is for children and adults aged 2 years and older with Dravet Syndrome who experience frequent convulsive seizures. Participants must be able to maintain a seizure diary, use birth control if applicable, and have not been exposed to the study drug or similar drugs before. They should not have any significant medical conditions that could interfere with the trial.

Inclusion Criteria

I am using birth control and my pregnancy tests are negative.

I am at least 2 years old.

I have been diagnosed with Dravet Syndrome and meet the specific seizure criteria.

Exclusion Criteria

My seizures are caused by a specific condition.

I have used lorcaserin before or am currently using it.

I am taking fenfluramine without an echocardiogram report.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Observational

Participants are observed for baseline seizure activity

4 weeks

Treatment

Participants receive either EPX-100 or placebo in a double-blind manner

16 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Open-label extension

Participants may opt into continuation of treatment long-term

3 years

Treatment Details

Interventions

• Clemizole Hydrochloride (Antihistamine)

Trial Overview The study tests EPX-100 (Clemizole HCl) as an additional treatment alongside standard anti-epileptic drugs in patients with Dravet Syndrome. It aims to see if it's safe and effective at controlling seizures compared to a placebo (a substance with no active drug).

Participant Groups

Group I: EPX-100 (clemizole HCl) Experimental Treatment 1 Intervention

Group II: Placebo arm Placebo Group 1 Intervention

Color- and taste-matched placebo oral solution dosed to match the active arm.

Who Is Running the Clinical Trial?

Epygenix

Lead Sponsor

Trials

3

Recruited

150+

Liberyx Therapeutics

Collaborator

Trials

1

Recruited

100+

Forest Hills Lab

Industry Sponsor

Trials

3

Recruited

170+

Harmony Biosciences Management, Inc.

Industry Sponsor

Trials

9

Recruited

2,000+

Harmony Biosciences, LLC

Industry Sponsor

Trials

9

Recruited

2,000+

Findings from Research

Bromide was found to be the most effective antiepileptic drug for patients with Dravet syndrome, particularly in those without SCN1A mutations, showing high responder rates of 94.44%.

Carbamazepine should be avoided in patients with SCN1A mutations, as it either had no effect or worsened seizures in all SCN1A-positive patients, highlighting the importance of genotype in treatment decisions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of antiepileptic drugs for the treatment of Dravet syndrome with different genotypes. Shi, XY., Tomonoh, Y., Wang, WZ., et al.[2016]

Dravet syndrome, a severe form of epilepsy that begins in infancy, is often linked to mutations in the SCN1A gene, affecting about 85% of patients, and leads to various stages of seizure activity and developmental challenges.

Several potential treatments are being explored, including fenfluramine and STK-001, which target different mechanisms of action, showing promise in early clinical evaluations and animal models for managing the symptoms of Dravet syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advances in the design and discovery of novel small molecule drugs for the treatment of Dravet Syndrome. Miziak, B., Czuczwar, S.[2021]

Cenobamate (CNB) has shown significant efficacy as an add-on therapy for adult patients with Dravet syndrome (DS), resulting in over 80% seizure reduction in four patients over a follow-up period of up to 542 days.

No severe adverse events were reported, suggesting that CNB may be a safe option for managing seizures in DS, although further research is needed to determine its effectiveness across all patients with this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful treatment of adult Dravet syndrome patients with cenobamate. Makridis, KL., Friedo, AL., Kellinghaus, C., et al.[2023]

A study of 93 caregivers in Germany revealed that patients with Dravet syndrome commonly use a variety of antiepileptic drugs (AEDs), with sodium valproate being the most frequently prescribed, but no clear relationship was found between medication type and seizure frequency.

Despite following clinical guidelines for AED combinations, the treatment did not significantly impact seizure control, highlighting the complexity of managing Dravet syndrome and suggesting a need for further research into effective treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Seizure management and prescription patterns of anticonvulsants in Dravet syndrome: A multicenter cohort study from Germany and review of literature. Schubert-Bast, S., Wolff, M., Wiemer-Kruel, A., et al.[2020]

In a study of 15 children with benign childhood epilepsy with centrotemporal spikes (BECCT) and electrical status epilepticus during sleep (ESES), the combination of levetiracetam (LEV) and short-term clonazepam (CZP) led to significant improvements in EEG results and seizure control after two months of treatment.

The combination therapy was effective for 14 out of 15 children, with most showing either significantly reduced EEG discharges or no discharges at follow-up, indicating a promising treatment option with minimal side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Efficacy of levetiracetam combined with short-term clonazepam in treatment of electrical status epilepticus during sleep in children with benign childhood epilepsy with centrotemporal spikes]. Su, TF., Xu, SQ., Chen, L.[2018]

Recent advancements in the management of Dravet Syndrome have led to the approval of new antiseizure medications that show promise in both efficacy and safety, particularly in young children under 5 years old.

Despite these advancements, there is a critical need for more data on the broader needs of patients and families, as evaluating the effectiveness and safety of treatments beyond seizure control remains challenging due to cognitive and behavioral issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety considerations selecting antiseizure medications for the treatment of individuals with Dravet syndrome. Nabbout, R., Chemaly, N., Chiron, C., et al.[2021]

In a comprehensive analysis of safety data from 1957 patients, adjunctive brivaracetam (BRV) showed a treatment-emergent adverse event (TEAE) incidence of 66.9%, slightly higher than the 62.8% observed with placebo, indicating a generally acceptable safety profile.

The most common TEAEs with BRV included somnolence, headache, dizziness, and fatigue, with psychiatric-related TEAEs occurring in 11.3% of patients, suggesting that while BRV is effective for focal seizures, monitoring for these side effects is important.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and tolerability of adjunctive brivaracetam in epilepsy: In-depth pooled analysis. Brandt, C., Klein, P., Badalamenti, V., et al.[2020]

In clinical trials involving 1021 adults and 202 children, eslicarbazepine acetate (ESL) was associated with a low incidence of cutaneous allergic reactions, primarily mild to moderate rashes and pruritus, with serious skin reactions being rare.

While the incidence of rash increased with higher ESL doses, most rash-related adverse events were not deemed related to the treatment, highlighting the overall safety profile of ESL in managing focal seizures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analysis of cutaneous allergic reactions in clinical trials of eslicarbazepine acetate. Rogin, J., Resnick, T., Strom, L., et al.[2020]

Stiripentol is the only new drug shown to be effective for treating Dravet syndrome when used alongside valproate and clobazam, based on two independent double-blind controlled trials involving children with the condition.

Stiripentol enhances GABAergic neurotransmission and should be prescribed with reduced doses of valproate and clobazam to minimize side effects, such as loss of appetite and weight, making it a valuable adjunctive therapy for over 500 Dravet patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Current therapeutic procedures in Dravet syndrome. Chiron, C.[2012]

Perampanel (PER) and brivaracetam (BRV) are new antiseizure drugs that have shown comparable efficacy in treating various epilepsy syndromes, with PER acting on AMPA receptors and BRV targeting SV2A with a faster brain entry.

Both drugs are well tolerated and have the potential to become important options in epilepsy treatment, especially in acute situations like status epilepticus, due to BRV's rapid action and PER's unique mechanism.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Recent advances in the pharmacotherapy of epilepsy: brivaracetam and perampanel as broad-spectrum antiseizure drugs for the treatment of epilepsies and status epilepticus. Willems, LM., Bauer, S., Rosenow, F., et al.[2021]

Stiripentol is the only medication proven effective for Dravet syndrome in two independent randomized placebo-controlled trials, especially when used alongside valproate and clobazam, and has been safely administered to over 500 children since its approval in 2007.

Due to its mechanism of action as a GABAergic agent, stiripentol can help manage seizures in Dravet syndrome, and it is recommended to start treatment as soon as the diagnosis is confirmed to prevent cognitive decline.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The pharmacologic treatment of Dravet syndrome. Chiron, C., Dulac, O.[2018]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Efficacy of antiepileptic drugs for the treatment of Dravet syndrome with different genotypes. [2016]

2. England pubmed.ncbi.nlm.nih.gov

Advances in the design and discovery of novel small molecule drugs for the treatment of Dravet Syndrome. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Successful treatment of adult Dravet syndrome patients with cenobamate. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Seizure management and prescription patterns of anticonvulsants in Dravet syndrome: A multicenter cohort study from Germany and review of literature. [2020]

5. China pubmed.ncbi.nlm.nih.gov

[Efficacy of levetiracetam combined with short-term clonazepam in treatment of electrical status epilepticus during sleep in children with benign childhood epilepsy with centrotemporal spikes]. [2018]

6. England pubmed.ncbi.nlm.nih.gov

Safety considerations selecting antiseizure medications for the treatment of individuals with Dravet syndrome. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Safety and tolerability of adjunctive brivaracetam in epilepsy: In-depth pooled analysis. [2020]

8. Denmark pubmed.ncbi.nlm.nih.gov

Analysis of cutaneous allergic reactions in clinical trials of eslicarbazepine acetate. [2020]

9. England pubmed.ncbi.nlm.nih.gov

Current therapeutic procedures in Dravet syndrome. [2012]

10. England pubmed.ncbi.nlm.nih.gov

Recent advances in the pharmacotherapy of epilepsy: brivaracetam and perampanel as broad-spectrum antiseizure drugs for the treatment of epilepsies and status epilepticus. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

The pharmacologic treatment of Dravet syndrome. [2018]