Pediatric Pharmacokinetic and Pharmacodynamic Study of Oral Baclofen for the Treatment of Spasticity Associated With Cerebral Palsy
Overview
- Phase
- Phase 1
- Intervention
- baclofen
- Conditions
- Spasticity
- Sponsor
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- Enrollment
- 61
- Locations
- 11
- Primary Endpoint
- Determine pharmacokinetic parameters of oral baclofen in children with spasticity associated with cerebral palsy (CP).
- Status
- Completed
- Last Updated
- 14 years ago
Overview
Brief Summary
Oral baclofen is used commonly to treat spasticity in children with cerebral palsy. Although for adults there is dosing,safety and efficacy information in the package insert, this is not the case for children. The purpose of this study is to determine how fast the drug is cleared from the body, the correct dose, and long-term safety and efficacy for children with spasticity.
Detailed Description
Although oral baclofen has been used for several decades for the treatment of spasticity in adults and in children, there is very little data regarding the pharmacokinetic (PK) or pharmacodynamic (PD) properties of baclofen in children. Therefore, pediatric guidelines, including dose ranges, dosing schedules, dose escalation strategies and anticipated side effects are extrapolated from adult data and require an assumption that safety and efficacy in children is comparable to that in adults. Furthermore, there is wide variability in dosing strategies among practitioners who treat children with cerebral palsy (CP) with respect to starting doses, maximum doses and rates of dose escalation.Establishment of safe and effective dosing strategies for children with CP requires an understanding of the PK and PD properties of baclofen in children and recognition of individual differences that may contribute to divergent clinical responses to baclofen among children with CP.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Males and females aged 2-16 years, inclusive.
- •Triceps skinfold thickness between the 5th and 95th percentiles for age (Refer to Appendix 3).
- •Gross Motor Function Classification Scale (GMFCS) Level II - V (GMFCS classifies children by functional mobility with Level I indicating minimal motor disability and V indicating total body involvement and dependence on others for mobility (Palisano et al, 1997).
- •Ashworth score of 2 or higher in at least one arm and one leg (knee + elbow flexors and/or extensors).
- •Cerebral Palsy: Motor disability due to a static, non-progressive brain injury/ malformation occurring prenatally or any time prior to the age of 2 years.
- •No history of baclofen use within the past 4 months.
- •Female subject, is premenarchal, or is incapable of pregnancy because of a hysterectomy or tubal ligation; or female subject who is sexually active and capable of pregnancy, has been using an acceptable method of contraception (hormonal contraceptives, intrauterine device, spermicide and barrier) for at least one month prior to study entry and agrees to continue to use one of these for the duration of the study; or female subject who is sexually abstinent and capable of pregnancy, agrees to continued abstinence or to use an acceptable method of birth control (either intrauterine device or spermicide and barrier) should sexual activity commence.
- •Subject ≥10 years of age has negative urine tests at screening and baseline for alcohol, non-medically prescribed drugs of abuse, and no history of tobacco use.
Exclusion Criteria
- •Hypersensitivity to baclofen.
- •Selective dorsal rhizotomy.
- •Active intrathecal baclofen pump within the past 6 months.
- •Use of botulinum toxin in past 4 months or use any time during the study.
- •Use of tone altering medications (e.g. baclofen, benzodiazepines, levodopa, trihexyphenidyl) for \>3 consecutive days duration within the past 4 months.
- •Start of any drug or product known to be a significant cytochrome P450 enzyme inducer or inhibitor within the past 30 days.
- •Orthopaedic surgery within the past year or any time during the study.
- •Abdominal surgery within the past six months or any time during the study.
- •Uncontrolled seizures (baseline seizure frequency \>1 per month or history of more than 2 prolonged seizures lasting longer than 5 minutes duration within the past year.
- •Severe behavior difficulties or psychiatric disturbance
Arms & Interventions
1
starting dose of baclofen 2.5 mg PO TID with dose escalation as tolerated
Intervention: baclofen
Outcomes
Primary Outcomes
Determine pharmacokinetic parameters of oral baclofen in children with spasticity associated with cerebral palsy (CP).
Time Frame: 1 year
Describe the relationship between plasma concentrations of oral baclofen and clinical measures of spasticity.
Time Frame: 1 year
Determine optimal dosing range and interval for administration of oral baclofen for use in a randomized clinical trial of safety and efficacy.
Time Frame: 1 year
Secondary Outcomes
- Describe the relationship between plasma concentrations of oral baclofen and measures of strength, function, ease of care, pain/comfort and health related quality of life.(1 year)
- Describe the safety and tolerability of oral baclofen in children with spasticity associated with CP.(1 year)
- Investigate preliminarily whether oral baclofen improves dystonia(1 year)