Methylprednisolone Treatment of Friedreich Ataxia

Condition(s) targeted: Friedreich Ataxia

Intervention: Methylprednisolone (Drug)

Phase: Phase 0

Status: Not yet recruiting

Sponsored by: Children's Hospital of Philadelphia

Official(s) and/or principal investigator(s):
David R Lynch, MD PhD, Principal Investigator, Affiliation: Children's Hospital of Philadelphia

Overall contact:
Charles J Isaacs, Phone: 267-426-1386, Email: isaacsc@email.chop.edu

This study will explore whether methylprednisolone treatment is safe, well-tolerated, and beneficial in patients that are diagnosed with Friedreich Ataxia (FRDA). The study will also explore if methylprednisolone has any effects on biomarkers associated with FRDA. All subjects in the study will receive the same steroid treatment.

Official title: Open-label Pilot Study of Methylprednisolone for the Treatment of Patients With Friedreich Ataxia (FRDA)

Study design: Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Change in the Timed 25 Foot Walk (T25FW) Score

Secondary outcome:

Change in the Friedreich Ataxia Rating Scale (FARS) Score

Change in The 1-Minute Walk Distance

Change in the Change in the 9-Hole Peg Test (9HPT) Time

Detailed description: Context: Friedreich ataxia (FRDA) is a progressive neurodegenerative disease of children and adults for which there is presently no therapy. One of the hallmarks of FRDA is a deficiency of frataxin protein, causing dysregulation of iron metabolism, lack of detoxification, and increased iron bioavailability. The accumulation of iron in mitochondria leads to increased sensitivity to oxidative stress. A secondary inflammatory response has also been proposed to be present in FRDA, as revealed in autopsy studies and in the alteration of immune pathways in microarray analysis. Inflammation in FRDA raises the possibility of a therapeutic benefit from anti-inflammatory steroid treatment, as inflammation may directly underlie multiple complications of FRDA including cardiomyopathy. In support of this theory are clinical observations and patient self-reports of improvement of ataxia symptoms following the prescription of steroids for indications other than the primary FRDA diagnosis. Objectives: Primary: To assess the effect of oral administration of methylprednisolone on the functional performance scores of patients with FRDA using the Timed 25-Foot Walk (T25FW). Secondary: To assess the effect of methylprednisolone on neurological performance measures (Friedreich Ataxia Rating Scale, 9-Hole Peg Test, 1-minute walk, home-based measures of gait, hand function and speech assessed through smartphone application) and to assess the safety and tolerability of methylprednisolone in the FRDA population. Study Design: This study is an open-label clinical trial of methylprednisolone in patients with FRDA. Setting/Participants: This study will take place at the Children's Hospital of Philadelphia as an outpatient trial in 5 children who are at least 5 years and less than 10 years of age, and in 5 adults ages 45 years and older, with genetically confirmed FRDA. See below for description of study intervention and measures.

Minimum age: 5 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Subjects with FRDA confirmed by genetic testing who are able to walk 25 feet

(assistive devices allowed).

- Children between ages 5 and less than 10 years or adults ages 45 years and older at

screening.

- Stable doses of all medications, vitamins and supplements for 30 days prior to study

entry and for the duration of the study. Throughout the study, all possible efforts will be made to maintain stable doses of concomitant medications.

- Females who are not pregnant or breast feeding, and who do not intend to become

pregnant. Females of child-bearing potential must use a reliable method of contraception and must provide a negative urine pregnancy test at screening.

- Informed consent for adult participants, parent/guardian permission (informed

consent) and child assent for pediatric participants. Exclusion Criteria:

- Patients unable to walk 25 feet.

- Treatment with methylprednisolone or cyclic methylprednisolone during the 3 previous

months before inclusion.

- Treatment with gamma interferon, immunoglobulin G or other immunomodulating treatment

the 3 previous month before inclusion

- Immunosuppressive treatment within 6 month of inclusion

- Prior history of a disease associated with immune dysfunction

- Poorly controlled Diabetes Mellitus (HbA1C > 9. 0)

- History of untreated or uncontrolled hypertension

- Presence of infectious disease or other active infections which the treating

physician finds relevant

- Active or previous history of liver or renal failure

- Known history of renal insufficiency or creatinine > 2 x upper limint of normal (ULN)

- Active infection at time of screening

- History of known osteoporosis

Charles J Isaacs, Phone: 267-426-1386, Email: isaacsc@email.chop.edu

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States; Not yet recruiting
Charles J Isaacs, Phone: 267-426-1386, Email: isaacsc@email.chop.edu
Julianna E Shinnick, Phone: 267-426-3567, Email: shinnickj@email.chop.edu
David R Lynch, MD PhD, Principal Investigator

Starting date: June 2015
Last updated: April 20, 2015