In a significant development for pediatric endocrinology, a phase 3, multinational, randomized trial has shown that crinecerfont, a novel oral treatment, offers a promising approach to managing congenital adrenal hyperplasia (CAH) in children. CAH, a condition caused by 21-hydroxylase deficiency, necessitates treatment with glucocorticoids, often at supraphysiologic doses, to address cortisol insufficiency and control excess adrenal androgens. However, this treatment can lead to complications related to glucocorticoid use.
The trial involved 103 pediatric participants with CAH, who were assigned in a 2:1 ratio to receive either crinecerfont or placebo over a 28-week period. The study aimed to assess the change in androstenedione levels from baseline to week 4 as the primary efficacy endpoint, with a key secondary endpoint being the percent change in glucocorticoid dose from baseline to week 28, provided that androstenedione levels were controlled.
Results from the trial were encouraging. At week 4, participants receiving crinecerfont experienced a significant reduction in androstenedione levels compared to those on placebo. By week 28, the mean glucocorticoid dose had decreased by 18.0% in the crinecerfont group, while it increased by 5.6% in the placebo group, all while maintaining control over androstenedione levels. The most common adverse events reported were headache, pyrexia, and vomiting.
This study, funded by Neurocrine Biosciences, highlights crinecerfont's potential to not only reduce elevated androstenedione levels but also to decrease the reliance on supraphysiologic doses of glucocorticoids, thereby mitigating the risk of glucocorticoid-related complications in children with CAH. The findings represent a significant step forward in the treatment of this challenging condition, offering hope for improved management strategies and quality of life for affected children.
