Study to Evaluate the Efficacy and Safety of Perampanel as Monotherapy or First Adjunctive Therapy in Subjects With Partial Onset Seizures With or Without Secondarily Generalized Seizures or With Primary Generalized Tonic-Clonic Seizures

Phase 4

Completed

Conditions: Primary Generalized Tonic-Clonic Seizures
Partial Onset Seizures
Secondarily Generalized Seizures

Interventions: Drug: Perampanel

Registration Number: NCT03288129

Lead Sponsor: Eisai Inc.

Brief Summary: This study will assess the retention rate of perampanel when given as monotherapy or first adjunctive therapy in participants with partial-onset seizures or primary generalized tonic clonic seizures. The study consists of 4 periods: a Screening Period (to start no earlier than 6 weeks before the first dose of study drug), a Titration Period (up to 13 weeks), a Maintenance Period (39 weeks), and a Follow-Up Period (4 weeks).

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 54

Inclusion Criteria

Participants will be male or female and no younger than 4 years of age and be able to swallow perampanel tablets.
Participants must have a diagnosis of epilepsy with POS with or without SGS or with PGTCS. Either of the following must have occurred to support an epilepsy diagnosis:
1. At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart
2. One unprovoked (or reflex) seizure with Electroencephalography (EEG) evidence of seizures
Participants who receive perampanel as a first adjunctive therapy must currently have been treated with stable doses of monotherapy with an anti-epileptic drug (AED) for 8 weeks prior to Visit 2 (Week 0), have not previously received adjunctive AED treatment, and must, in the investigator's judgement, be in need of initial adjunctive therapy after failure to control seizures with AED monotherapy, at the optimal dose and duration.
Participants who receive perampanel as monotherapy, who were newly diagnosed (treatment naïve), following the defined diagnosis of epilepsy.
Participants who are currently receiving monotherapy treatment may receive perampanel as monotherapy if, in the investigator's judgment, the participant may benefit from a change in monotherapy treatment. Participants must not have previously received adjunctive AED treatment.
If antidepressants or antianxiety drugs are used, participants must be on a stable dose regimen of these drugs during the 8 weeks before Visit 2 (Week 0).

Exclusion Criteria

Participants should not have previously received or currently be receiving perampanel.
Females who are breastfeeding or pregnant at Screening or Baseline (as documented by a positive beta human chorionic gonadotropin [β-hCG] or hCG test with a minimum sensitivity of 25 International Units per liter [IU/L] or equivalent units of β-hCG or hCG); a separate baseline assessment is required if a negative screening pregnancy test was obtained more than 72 hours before the first dose of study drug.
Females of childbearing potential who:
- Within 28 days before study entry, did not use a highly effective method of contraception, which includes any of the following:
  - Total abstinence (if it is their preferred and usual lifestyle)
  - An intrauterine device or intrauterine hormone-releasing system
  - An oral contraceptive (with additional barrier method if using contraceptive containing levonorgestrel); participant must be on a stable dose of the same oral contraceptive product for at least 28 days before dosing and throughout the study and for 28 days after study drug discontinuation
  - Have a vasectomized partner with confirmed azoospermia
- Do not agree to use a highly effective method of contraception (as described above) throughout the entire study period and for 28 days after study drug discontinuation For sites outside of the European Union, it is permissible that if a highly effective method of contraception is not appropriate or acceptable to the participant, then the participant must agree to use a medically acceptable method of contraception, i.e, double barrier methods of contraception such as condom plus diaphragm or cervical/vault cap with spermicide.

NOTE: All females will be considered to be of childbearing potential unless they are postmenopausal (amenorrheic for at least 12 consecutive months, in the appropriate age group, and without other known or suspected cause) or have been sterilized surgically (i.e, bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, all with surgery at least 1 month before dosing).

Presence of or previous history of Lennox-Gastaut syndrome
Presence of non-motor simple partial seizures only
A history of status epilepticus within 1 year before Screening Visit (Visit 1)
Participants on antipsychotics or who have psychotic disorder(s) or unstable recurrent affective disorder(s) with a history of attempted suicide within 1 year before Screening Visit (Visit 1)
Presence of a progressive central nervous system (CNS) disease, including degenerative CNS diseases and progressive tumors
Concomitant use of barbiturates (except for seizure control indication and premedication for electroencephalogram) and benzodiazepines (except for seizure control indication) within 8 weeks prior to Visit 2 (Week 0)
Use of intermittent rescue benzodiazepines (i.e, 1 to 2 doses over a 24-hour period is considered a one time rescue) 2 or more times in the 8-week period prior to Visit 2 (Week 0)
Severe renal insufficiency (defined by estimated glomerular filtration rate of < 30 milliliters per minute [mL/min]) or participants who receive hemodialysis
Evidence of clinically significant disease (eg, cardiac, respiratory, gastrointestinal, renal disease, hepatic disease) that in the opinion of the investigator(s) could affect the participant's safety or study conduct NOTE: Stable elevation of liver enzymes, alanine aminotransferase and aspartate aminotransferase due to concomitant medication(s) will be allowed if they are less than 3 times the upper limits of normal.
Hypersensitivity to perampanel or any excipients
Participants with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
Participants who are participating in other interventional clinical trial
Participant who are judged to have inadequate cognitive ability for participation in the study (intelligence quotient < 80 or investigator judgment)
Any suicidal ideation with intent with or without a plan, at the time of or within 6 months of screening, as indicated by answering "Yes" to questions 4 and 5 on the Suicidal Ideation section of the Columbia Suicide Severity Rating Scale (C-SSRS)
Any lifetime suicidal behavior based on the C-SSRS
Concomitant use of any form of cannabidiol (CBD)
Planned brain surgery during study participation

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Perampanel	Perampanel	Perampanel will be administered orally once daily (QD) at bedtime. At the beginning of the Titration Period, oral perampanel will start at a dose of 2 milligrams (mg) QD. Doses of perampanel will then be up titrated in increments of 2 mg at no less than 2-week intervals according to the investigator's judgment. At the 4 mg dose, the investigator will confirm whether further dose escalation is needed based on participant response and tolerability. The investigator may adjust dosing further or leave the participant at 4 mg. The maximum dose is 12 mg. During the 39-week Maintenance Period, participants will continue to receive the perampanel dose level that was administered at the end of the Titration Period.

Primary Outcome Measures

Name	Time	Method
Percentage of Participants Remaining on Perampanel Treatment at 9 Months After the Initiation of Treatment	Month 9	The retention rate was defined as the percentage of participants remaining on perampanel treatment at 9 months after the initiation of treatment.
Percentage of Participants Remaining on Perampanel Treatment at 3 Months After the Initiation of Treatment	Month 3	The retention rate was defined as the percentage of participants remaining on perampanel treatment at 3 months after the initiation of treatment.
Percentage of Participants Remaining on Perampanel Treatment at 12 Months After the Initiation of Treatment	Month 12	The retention rate was defined as the percentage of participants remaining on perampanel treatment at 12 months after the initiation of treatment.
Percentage of Participants Remaining on Perampanel Treatment at 6 Months After the Initiation of Treatment	Month 6	The retention rate was defined as the percentage of participants remaining on perampanel treatment at 6 months after the initiation of treatment.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants Who Achieved 6-month Seizure-free Status During the Maintenance Period	Up to 6 months of Maintenance Period	Seizure-free status was defined as no incidence of seizure at 6 months during Maintenance Period. Partial seizures: when abnormal electrical activity begins in only one part of brain include (1) simple partial seizures: participant does not lose consciousness may experience muscle jerking or stiffening, (2) complex partial seizures: participant loses awareness. SGS: disturbances that spread to both sides of brain after partial seizure has already begun and happen when burst of electrical activity in limited area (the partial seizure) spreads throughout brain. PGTCS: disturbances in functioning of both sides of brain that caused by electrical signals spreading through brain inappropriately.
Percentage of Participants Who Received Perampanel as a First Adjunctive Therapy and Converted to Perampanel Monotherapy	Up to 52 weeks	Percentage of participants who received perampanel as a first adjunctive therapy and converted to perampanel monotherapy were reported.
Percentage of Participants Who Achieved 3-month Seizure-free Status During the Maintenance Period	Up to 3 months of Maintenance Period	Seizure-free status was defined as no incidence of seizure at 3 months during the Maintenance Period. Partial seizures: when abnormal electrical activity begins in only one part of brain include (1) simple partial seizures: participant does not lose consciousness may experience muscle jerking or stiffening, (2) complex partial seizures: participant loses awareness. SGS: disturbances that spread to both sides of brain after partial seizure has already begun and happen when burst of electrical activity in limited area (the partial seizure) spreads throughout brain. PGTCS: disturbances in functioning of both sides of brain that caused by electrical signals spreading through brain inappropriately.
Number of Participants With Treatment-emergent Serious Adverse Events (SAE)	From date of first administration of study drug up to 28 days after last dose of study drug (up to 56 weeks)	A SAE was defined as any untoward medical occurrence that at any dose: resulted in death; was life-threatening; required inpatient hospitalization or prolongation of existing hospitalization; resulted in persistent or significant disability/incapacity; was a congenital anomaly/birth defect. A TEAE was defined as an event that emerges during treatment having been absent pre-treatment, or worsens relative to the pre-treatment state.
Number of Participants With Treatment-emergent Adverse Events (TEAE)	From date of first administration of study drug up to 28 days after last dose of study drug (up to 56 weeks)	A TEAE was defined as an adverse event (AE) that emerged during treatment, having been absent at pretreatment (Baseline) or reemerged during treatment, having been present at pretreatment (Baseline) but stopped before treatment, or worsened in severity during treatment relative to the pretreatment state, when the AE was continuous.
Percentage of Participants Who Achieved Seizure-free Status During the Maintenance Period	Up to 39 weeks of Maintenance Period	Seizure-free status was defined as no incidence of seizure during the entire maintenance period. Partial seizures: when abnormal electrical activity begins in only one part of brain include (1) simple partial seizures: participants does not lose consciousness may experience muscle jerking or stiffening, (2) complex partial seizures: participant loses awareness. SGS: disturbances that spread to both sides of brain after partial seizure has already begun and happen when burst of electrical activity in limited area (the partial seizure) spreads throughout brain. PGTCS: disturbances in functioning of both sides of brain that caused by electrical signals spreading through brain inappropriately.

Trial Locations

Locations (24): Mount Sinai Medical Center
🇺🇸
New York, New York, United States
UCSD Epilepsy Center
🇺🇸
La Jolla, California, United States
Michigan State University
🇺🇸
East Lansing, Michigan, United States
Johns Hopkins Medicine
🇺🇸
Baltimore, Maryland, United States
UT Southwestern Medical Center
🇺🇸
Dallas, Texas, United States
Stanford Medical Center
🇺🇸
Palo Alto, California, United States
Minneapolis Clinic of Neurology
🇺🇸
Golden Valley, Minnesota, United States
UC Davis Medical Center
🇺🇸
Sacramento, California, United States
UNM Health Providers
🇺🇸
Albuquerque, New Mexico, United States
Baptist Health, Nemours Children's Specialty Care
🇺🇸
Jacksonville, Florida, United States
The Regents of The University of Michigan
🇺🇸
Ann Arbor, Michigan, United States
The Board of Trustees of the University of Alabama for the University of Alabama at Birmingham
🇺🇸
Birmingham, Alabama, United States
RUSH University Medical Center
🇺🇸
Chicago, Illinois, United States
Mid-Atlantic Epilepsy and Sleep Center
🇺🇸
Bethesda, Maryland, United States
Duke Neurology
🇺🇸
Durham, North Carolina, United States
Tufts Medical Center
🇺🇸
Boston, Massachusetts, United States
University Hospitals Cleveland Medical Center
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic
🇺🇸
Cleveland, Ohio, United States
Children's Hospital of San Antonio
🇺🇸
San Antonio, Texas, United States
Northeast Regional Epilepsy Group
🇺🇸
Hackensack, New Jersey, United States
Barrow Neurological Institute
🇺🇸
Phoenix, Arizona, United States
Arkansas Epilepsy Program
🇺🇸
Little Rock, Arkansas, United States
University of Kentucky
🇺🇸
Lexington, Kentucky, United States
JFK Medical Center
🇺🇸
Edison, New Jersey, United States