A Study to Assess the Safety and Efficacy of Levoketoconazole in the Treatment of Endogenous Cushing’s Syndrome
- Conditions
- Endogenous Cushing´s syndrome (CS)MedDRA version: 20.0Level: LLTClassification code 10011657Term: Cushings syndromeSystem Organ Class: 100000004860Therapeutic area: Body processes [G] - Metabolic Phenomena [G03]
- Registration Number
- EUCTR2017-001219-35-NL
- Lead Sponsor
- Cortendo AB
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- ot Recruiting
- Sex
- All
- Target Recruitment
- 84
The following categories of potential subjects, categorized by prior use of levoketoconazole, may be eligible if the following 11 inclusion criteria are all met:
- Naïve to levoketoconazole;
- Completers of SONICS visit M12 who are not currently on levoketoconazole (i.e. not actively receiving open label treatment after SONICS as part of EAP or OLE study);
1. Male or female and at least 18 years of age.
2. Able and willing to provide written informed consent
3. Confirmed newly diagnosed, persistent or recurrent endogenous Cushing’s syndrome of any etiology, except secondary to malignancy (including pituitary or adrenal carcinoma). Persistence will not be considered confirmed until 6 weeks or more post-surgery
4. Elevated mean 24 hour UFC levels at least 1.5X ULN of the normative range of the study’s central laboratory assay and from a minimum of three measurements from adequately collected urine; the study’s central laboratory must be used for all qualifying measurements.
NOTE: This criterion does not apply to subjects currently on levoketoconazole.
5. Presence of abnormal values from at least one of these two diagnostic tests (discrepancies between test findings will not be investigated nor considered exclusionary):
• Abnormal Dexamethasone Suppression Test (DST): Elevated 8 AM blood cortisol at least 1.8 µg/dL (50 nmol/L) after 1 mg dexamethasone orally at 11 PM the evening prior with concurrent dexamethasone blood concentration greater than 5.6 nmol/liter (220 ng/dL) (results from within the 2 months prior to start of Screening or newly tested with results available by the Baseline Visit [TM0]) OR
• Elevated LNSC concentrations (at least two measurements) each greater than the ULN of the study’s central laboratory normative range; the study’s test kit and lab must be used for all qualifying measurements.
NOTE: Abnormal LNSC is required among eligible subjects with estimated glomerular filtration rate (eGFR as determined by Modified Diet in Renal Disease MDRD equation) above 40 and below 60 mL/min/1.73 m2 .
NOTE: This criterion does not apply to subjects currently on levoketoconazole.
6. Non-candidates for CS-specific surgery, refuse surgery or surgery will be delayed until after study completion and agree to complete this study prior to surgery.
7. If post-surgical for CS-specific surgery, then no significant post operative sequelae remain and the risk of such sequelae is considered negligible.
8. Agree to the following minimum washout periods prior to the Baseline Visit (TM0) (as applicable):
• Ketoconazole or metyrapone: 2 weeks;
• Dopamine agonists: bromocriptine (2 weeks), cabergoline (8 weeks);
• Octreotide acetate LAR, lanreotide Autogel®, pasireotide LAR: 12 weeks;
• Lanreotide SR: 8 weeks;
• Octreotide acetate (immediate release) or short-acting pasireotide: 1 week;
• Mifepristone (RU 486, KORLYM®): 4 weeks;
• Megestrol acetate or medroxyprogesterone acetate (and selected other synthetic progestins): 6 weeks.
9. Females who are either of non-child bearing potential (i.e. incapable of becoming pregnant):
• Post-menopausal, defined as age 50 or older with amenorrhea for more than 1 year or any age with serum follicle stimulating hormone (FSH) at least 23 mIU/mL and estradiol no more than 40 pg/mL (140 pmol/L) OR
• Surgically sterile—documented hysterectomy and/or bilateral oophorectomy or tubal ligation.
OR
• Females of child-bearing potential who agree to use highly effective methods of birth
Subjects will be excluded from the study if ANY of the following criteria are met:
1.Enrolled or early terminated from SONICS or currently on levoketoconazole
2.Pseudo-Cushing's syndrome based on Investigator assessment
3.Cyclic Cushing's syndrome with multi-week periods of apparent spontaneous CS remission
4.Non-endogenous source of hypercortisolism, including pharmacological corticosteroids or ACTH
5.Radiotherapy of any modality directed against the source of hypercortisolism within the last 5 years
6.Treatment with mitotane within 6 months of enrolment
7.History of malignancy, including adrenal or pituitary carcinomas (other than low risk, well-differentiated carcinomas of thyroid, breast or prostate that are very unlikely to require further treatment in the opinion of the treating physician, or squamous cell or basal cell carcinoma of the skin)
8.Clinical or radiological signs of compression of optic chiasm
9.Major surgery within 1 month of Screening (or within 6 weeks for pituitary surgery)
10.Clinically significant abnormality in 12-lead ECG during the Screening Phase requiring medical intervention
11.QTc interval above 470 msec during the Screening Phase via central reader interpretation
12.History of Torsades des Pointes, ventricular tachycardia, ventricular fibrillation, history of prolonged QT syndrome
13.Use of medications associated with possible, probable, or definite QT/QTc prolongation
14.Pre-existing hepatic disease
15.Hepatitis B surface antigen (HbsAg) or hepatitis C-positive
16.Human immunodeficiency virus (HIV)-positive.
17.History of symptomatic cholelithiasis with intact gallbladder
18.History of pancreatitis
19.Liver safety tests during the Screening Phase as follows:
-ALT and/or AST above 3X ULN
-Alkaline phosphatase or total bilirubin above 2X ULN Subjects with isolated indirect bilirubin up to 3X ULN are presumed to have Gilbert's syndrome & may be enrolled if all other liver tests are within normal levels
20.History of documented or suspected drug-induced liver injury to ketoconazole or any other azole drug
21.Serum potassium below 4.0 mEq/L
22.Abnormal FT4, unless subsequently corrected and stable for at least 4 weeks. Subjects with TSH less than the LLN and normal FT4 are potentially eligible without intervention
23.History of persistent uncontrolled hypertension
24.Hypercholesterolemia currently treated with atorvastatin, lovastatin or simvastatin and unwilling or unable to change to alternative therapy with: pravastatin, fluvastatin, pitavastatin or rosuvastatin (must switch statin at least 2 weeks prior to dosing) or another allowed therapy. For subjects for whom lipid reduction therapy is considered, all lipid lowering drugs should be added and stabilized for at least 4 weeks prior to TM0 for the levoketoconazole-naïve cohort, as improvements in lipids are being assessed as an endpoint for levoketoconazole treatment
25.More than one hospitalization for hyperglycemia or complication of diabetes during the last 12 months
26.Decreased renal function as defined by eGFR below 40 mL/min/1.73m2, using MDRD equation for eGFR
27.Pregnant or lactating
28.Body habitus preventing repeated venipuncture as required by protocol
29.Any other clinically significant medical condition, as determined by the Investigator that precludes enrollment and participation in the study through completion, including conditions that would preclude the subject from being able to follow instructions or pe
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method