A Study of the Efficacy and Safety of JZP-258 in Subjects With Narcolepsy With Cataplexy

Phase 3

Completed

Conditions: Narcolepsy With Cataplexy

Interventions: Other: Placebo
Drug: JZP-258

Registration Number: NCT03030599

Lead Sponsor: Jazz Pharmaceuticals

Brief Summary: This is a double-blind, placebo-controlled, randomized-withdrawal, multicenter study of the efficacy and safety of JZP-258.

Detailed Description: Subjects will be transitioned to JZP-258 based on their treatment status at study entry. All subjects will begin JZP-258 treatment at the beginning of this period and continue through Week 12. They will be treated with JZP-258 alone for the final two weeks of this 12-week period. Once the JZP-258 dose has been optimized per the Investigator's judgment, these subjects may enter the 2-week Stable-Dose Period with that dose. Subjects are eligible to enter the Double-Blind Randomized-Withdrawal Period if the dose of JZP-258 remains unchanged during the Stable-Dose Period and, in the judgment of the Investigator, no clinically significant worsening in narcolepsy symptoms or clinically significant adverse events due to JZP-258 treatment have occurred. Subjects will return for a Safety Follow-up visit 2 weeks after the Double-Blind Randomized-Withdrawal Period. Subjects who complete the double-blind treatment period during the Main Study are eligible to enter a 24-week Open-Label Extension. During this period subjects will receive open label JZP-258. Subjects will return for a Safety Follow-up visit 2 weeks after the Open-Label Extension Period.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 201

Inclusion Criteria

Male or female subjects between 18 and 70 years of age, inclusive.
Have a primary diagnosis of narcolepsy with cataplexy that meets ICSD-3 criteria or DSM-5 criteria, and currently untreated or treated with or without anticataplectics.
If applicable, treated with a stimulant or alerting agent at unchanged doses for at least 2 months prior to dosing or not treated with a stimulant or alerting agent.
Willing and able to comply with the study design schedule and other requirements.
Willing and able to provide written informed consent.

Exclusion Criteria

Narcolepsy secondary to another medical condition (e.g., CNS injury or lesion)
History or presence of any unstable or clinically significant medical condition, behavioral or psychiatric disorder (including active suicidal ideation), or history or presence of another neurological disorder or surgical history that might affect the subject's safety and/or interfere with the conduct of the study in the opinion of the Investigator.
Treatment with any central nervous system sedating agents, including but not limited to benzodiazepines, nonbenzodiazepine anxiolytics/ hypnotics/sedatives, neuroleptics, opioids, barbiturates, phenytoin, ethosuximide, or MCT inhibitors, e.g. diclofenac, valproate, ibuprofen, within 2 weeks prior to enrollment (discontinuation for the purpose of study enrollment is permitted only if considered safe by the Investigator and approved by the Medical Monitor).
Treatment with an antidepressant for cataplexy, if the withdrawal of the antidepressant during cross-titration with JZP-258 might be unsafe due to prior history of depression.
Unsafe for the subject to receive placebo treatment for 2 weeks, in the opinion of the Investigator.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Placebo
JZP-258	JZP-258	JZP-258

Primary Outcome Measures

Name	Time	Method
Change in Weekly Number of Cataplexy Attacks	Change from baseline (2 weeks of the Stable Dose Period) to the 2 weeks of the Double Blind Randomized Withdrawal Period (DB RWP)	Participants completed a daily Cataplexy Frequency Diary each night prior to bedtime. Participants were to record the number of cataplexy attacks that they had each day.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Worsening Patient Global Impression of Change (PGIc) for Narcolepsy Overall	At the end of the Double Blind Randomized Withdrawal Period	At the end of the Double Blind Randomized Withdrawal Period (DB RWP), participants rated the change in their condition on a 7-point scale ranging from 1 = "very much improved" to 7 = "very much worse" since the last visit. This endpoint measures the percentage of participants with worsening PGIc scores for narcolepsy overall (defined as scores of Much Worse or Very Much Worse).
Change in the Epworth Sleepiness Scale (ESS) Score	From the end of the Stable Dose Period to the end of the Double Blind Randomized Withdrawal Period	This is the key secondary endpoint. The Epworth Sleepiness Scale (ESS) was a self-administered questionnaire with 8 questions. Participants were asked to rate, on a 4-point scale (0-3), their usual chances of dozing off or falling asleep while engaged in eight different activities. Most participants engaged in those activities at least occasionally, although not necessarily every day. The ESS score (the sum of 8 item scores, 0-3) can range from 0 to 24. The higher the ESS score, the higher that participants average sleep propensity in daily life (ASP), or their 'daytime sleepiness'.
Change in 36-Item Short Form Health Survey Version 2 (SF-36v2) Scores	At the End of the Stable Dose Period to the End of the Double Blind Randomized Withdrawal Period	The SF-36v2 is a multi-purpose, short-form health survey with 36 questions/ items. It yields an 8-scale profile of functional health and well-being scores as well as a psychometrically-based physical and mental overall component summary measures. Two summary scores were derived using the SF-36v2. Physical Component Summary measures dimensions of functional health that are meaningful to respondents, including the impact of health and health-related changes on physical function, pain, and the ability to carry out daily roles. The Mental Component Summary component scale measures the impact of health and health-related changes on well-being, including vitality, social function, and emotional well-being. Participants self-report on items in a summary that have between 2-6 choices per item (e.g. none of the time, some of the time, etc.). Summations of item scores were transformed into a range from 0 to 100; zero= worst HRQL, 100=best HRQL. Higher scores indicate better health status.
Number of Participants With Worsening Clinical Global Impression of Change (CGIc) for Narcolepsy Overall	At the end of the Double Blind Randomized Withdrawal Period	At the end of the Double Blind Randomized Withdrawal Period, Investigators rated their impression of any change in the severity of the participant's narcolepsy overall condition since the start of the Double Blind Randomized Withdrawal Period on a 7-point scale ranging from 1 = "very much improved" to 7 = "very much worse". This endpoint measures the percentage of participants with worsening CGIc scores for narcolepsy overall, defined as scores of Much Worse or Very Much Worse.
Change in 5-level EQ-5D (EQ-5D-5L) Crosswalk Index Score and Visual Analog Scale	At the End of the Stable Dose Period to the End of the Double Blind Randomized Withdrawal Period	The EQ-5D-5L is a measure of health outcome that includes a descriptive system consisting of 5 dimensions (mobility, self-care, usual activities, pain/ discomfort, and anxiety/ depression). The EQ-5D-5L includes 5 levels of severity for each of the 5 dimensions of the descriptive system (1= no problems, 2= slight problems, 3= moderate problems, 4= severe problems, and 5= extreme problems) that reflect increasing levels of difficulty. The 5 digit health states for each dimension are converted into a single value per country (0= equivalent to death, 1= equivalent to best imaginable health and values below 0= health states rated worse than death capped at -1), using the EQ-5D-5L crosswalk index value calculator as recommended by EuroQol group. A visual analogue scale (VAS) used within this scale recorded the participants self-rated health on a VAS and the endpoints resulted in a numeric value set ranging from 0 (= worst imaginable health state) up to 100 (= best imaginable health state).

Trial Locations

Locations (25): SDS Clinical Trials, Inc.
🇺🇸
Orange, California, United States
Stanford Health Services
🇺🇸
Stanford, California, United States
Fort Wayne Neurological Center
🇺🇸
Fort Wayne, Indiana, United States
Pulmonary Disease Specialists
🇺🇸
Kissimmee, Florida, United States
Center for Sleep & Wake Disorders
🇺🇸
Chevy Chase, Maryland, United States
Kentucky Research Group
🇺🇸
Louisville, Kentucky, United States
Montefiore/ Sleep-Wake Disorders Center
🇺🇸
Bronx, New York, United States
Gastonia Medical Specialty Clinic
🇺🇸
Gastonia, North Carolina, United States
UZ Antwerpen
🇧🇪
Edegem, Belgium
Intrepid Research
🇺🇸
Cincinnati, Ohio, United States
Cleveland Clinic, Sleep Disorder Center
🇺🇸
Cleveland, Ohio, United States
Universitair Ziekenhuis Gent
🇧🇪
Gent, Belgium
UZ Leuven
🇧🇪
Leuven, Belgium
Vseobecna fakultni nemocnice v Praze
🇨🇿
Praha 2, Czechia
Helsingin Uniklinikka, Vitalmed Oy
🇫🇮
Helsinki, Finland
Fakultni nemocnice Ostrava
🇨🇿
Ostrava-Poruba, Czechia
Hôpital Gui de Chauliac
🇫🇷
Montpellier, Herault, France
Hopital Roger Salengro - CHU Lille
🇫🇷
Lille, France
Hospital Universitari Vall d'Hebron
🇪🇸
Barcelona, Spain
Hospital Clinic i Provincial de Barcelona
🇪🇸
Barcelona, Spain
Instituto de Investigaciones del Sueño
🇪🇸
Madrid, Spain
Hospital General de Castellón
🇪🇸
Castelló, Spain
Hospital Vithas Nuestra Señora de America
🇪🇸
Madrid, Spain
Colorado Sleep Institute
🇺🇸
Boulder, Colorado, United States
Research Carolina
🇺🇸
Huntersville, North Carolina, United States