Treatment for Endogenous Cushing's Syndrome

NCT ID: NCT01838551

Last Updated: 2021-04-19

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

94 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-08-31

Study Completion Date

2018-11-30

Brief Summary

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The primary objectives of this study are to evaluate the clinical responder rate, defined as the proportion of subjects with normal UFC after 6 months of treatment with COR-003 in the Maintenance Phase without dose increase, and to evaluate the range of effective doses in subjects with various levels of hypercortisolism.

Detailed Description

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This is an open label, single arm study with a Screening Phase, a Dose Titration Phase, a 6-month Maintenance Phase, and a 6-month Extended Evaluation Phase designed to assess efficacy, safety, tolerability, and PK of COR-003 in subjects with endogenous CS.

Following an initial screening and washout period, as applicable, this study will be conducted in three treatment phases as follows:

* Dose Titration Phase: approximately 2 to 21 weeks to achieve an effective and tolerable maximum dose (the Therapeutic Dose). Dose titration will occur in increments of 150 mg with a starting dose of 150 mg twice daily (BID) over a period of approximately 2 to 21 weeks to achieve an effective and tolerable maximum dose (the Therapeutic Dose).
* Maintenance Phase: 6 months of treatment at the Therapeutic Dose following the Dose Titration Phase. Once the Therapeutic Dose has been reached and confirmed from the mean of a total of four adequately collected 24 hour urine collections for UFC measurements, subjects will enter into the Maintenance Phase of the study and will be asked to return to the clinic monthly for 6 months for assessment of efficacy and safety. During the Maintenance Phase, doses may not be increased to maintain UFC levels at or below ULN of the assay unless it is confirmed that a dose increase is deemed medically necessary at the discretion of the Investigator after discussion with the Medical Monitor. Prior to the End of Maintenance Phase Visit, four complete 24 hour urine collections will be obtained and subjects may enter the Extended Evaluation Phase.
* Extended Evaluation Phase: 6 months of continued treatment after the Maintenance Phase. In the 6-month Extended Evaluation Phase, subjects will return to the clinical site every 90 days (±14 days) for safety and efficacy evaluations.

Efficacy will be assessed primarily by measuring mean UFC concentrations at specified times as described in the clinical protocol. Safety will be assessed primarily by physical examinations with vital sign measurements, adverse events, clinical laboratory measures, electrocardiography, and pituitary MRI.

An independent Data Safety Monitoring Board (DSMB) will review the safety of the drug throughout the study. Membership of the DSMB is described in a Charter.

Conditions

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Endogenous Cushing's Syndrome

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

Dose titration
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

A data integrity plan prevented the Sponsor from accessing summary efficacy data prior to locking the clinical database.

Study Groups

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Levoketoconazole DL0

Levoketoconazole Tablets Dose Level 0 Once Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL1

Levoketoconazole Tablets Dose Level 1 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL2

Levoketoconazole Tablets Dose Level 1 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL3

Levoketoconazole Tablets Dose Level 3 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL4

Levoketoconazole Tablets Dose Level 4 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL5

Levoketoconazole Tablets Dose Level 5 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL6

Levoketoconazole Tablets Dose Level 6 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Levoketoconazole DL7

Levoketoconazole Tablets Dose Level 7 Twice Daily

Group Type EXPERIMENTAL

Levoketoconazole

Intervention Type DRUG

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Interventions

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Levoketoconazole

Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole

Intervention Type DRUG

Other Intervention Names

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COR-003

Eligibility Criteria

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Inclusion Criteria

1. Male or female ≥18 years of age
2. Able to provide written informed consent prior to any study procedures being performed; eligible subjects must be able to understand the informed consent form prior to inclusion into the study.
3. Confirmed diagnosis of newly diagnosed, persistent or recurrent Cushing's disease (CD) or endogenous CS of other etiology if subjects are not candidates for surgery or radiotherapy within the 18 months after enrollment.

Previous medical records will be collected and used to support the diagnosis of CD or endogenous CS of other etiology, including the following etiologies:
* Ectopic adrenocorticotropic hormone (ACTH) secretion, i.e. ACTH not of pituitary origin
* Ectopic corticotropin-releasing hormone (CRH) secretion
* Adrenal-dependent CS (i.e. adrenal adenoma (NOT carcinoma), adrenal hyperplasia, etc.)
* Etiology unknown.
4. Must have elevated mean 24 hour UFC levels ≥1.5X ULN based on the normative range of the central lab assay and on a minimum of four measurements from adequately collected urine.
5. In addition to elevated mean UFC, presence of abnormal values from one of the following tests:

* Abnormal DST: Elevated 8 AM serum cortisol ≥1.8 micrograms/dL (50 nmol/L) after 1 mg dexamethasone orally at 11 PM the evening prior (if not conducted already in the diagnostic workup of the subject within the previous 2 months before start of Screening Phase; in that case previous test results and details of conduct will need to be available by the Baseline Visit)
* Elevated late night salivary cortisol concentrations (at least two measurements) \>ULN
6. Previously irradiated subjects with CD or endogenous CS of other etiology will be allowed as long as the radiation treatment occurred \> 4 years ago and subjects have not exhibited evidence for improvement in their underlying CD for 6 months prior to the Screening visit. The total number of previously irradiated subjects enrolled in this study will not exceed 10.
7. Subjects with CD or CS of other etiology who are not candidates for surgery, refuse surgery, or in whom surgery will be delayed for at least 18 months following enrollment. Subjects may be allowed to participate in the trial while awaiting surgery, but must agree to complete this study prior to surgery.
8. Subjects on treatment for CD or endogenous CS of other etiology for whom treatment has been inadequate or not well tolerated must agree to minimum washout periods prior to the Baseline Visit as specified.

Exclusion Criteria

1. Subjects with Pseudo-Cushing's syndrome based on assessment of the Investigator.
2. Subjects with cyclic CS based on assessment of the Investigator
3. Subjects with a non-endogenous source of hypercortisolism such as exogenous source of glucocorticoids or therapeutic use of ACTH.
4. Known inherited syndrome as the cause of hypercortisolism, including but not limited to multiple endocrine neoplasia Type 1, McCune Albright Syndrome and Carney Complex
5. Subjects with adrenal carcinoma
6. History of malignancy, other than thyroid, early stage prostate, squamous cell and basal cell carcinoma, within 3 years prior to the Screening Phase.
7. Subjects with QTc interval of \>470 msec during the Screening Phase.
8. Pre-existing hepatic disease; subjects with mild to moderate hepatic steatosis consistent with fatty infiltration (non-alcoholic fatty liver disease \[NAFLD\] are allowed).
9. History of documented or suspected drug-induced liver injury requiring drug discontinuation of ketoconazole or any azole antifungals.
10. Subjects who receive any prohibited concomitant medication and cannot discontinue it safely prior to the Baseline Visit.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Cortendo AB

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Fredric J Cohen, MD

Role: STUDY_DIRECTOR

Cortendo AB

Locations

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UCLA School of Medicine

Los Angeles, California, United States

Site Status

Johns Hopkins University

Baltimore, Maryland, United States

Site Status

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status

University of Michigan Medical Center

Ann Arbor, Michigan, United States

Site Status

University of New Mexico HSC

Albuquerque, New Mexico, United States

Site Status

Memorial Sloan Kettering Cancer Center

New York, New York, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Oregon Health & Science University

Portland, Oregon, United States

Site Status

Allegheny Neuroendocrinology Center

Pittsburgh, Pennsylvania, United States

Site Status

University Hospitals Leuven Department of Endocrinology

Leuven, , Belgium

Site Status

University Specialized Hospital for Active Treatment in Endocrinology (USHATE)

Sofia, , Bulgaria

Site Status

St. Pauls Hospital/Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status

Vseobecna fakultni nemocnice v Praze - III. Interni klinika VFN a 1. LF UK

Prague, , Czechia

Site Status

Aarhus University Hospital

Aarhus, , Denmark

Site Status

Rigshospitalet,Copenhagen University Hospital

Copenhagen, , Denmark

Site Status

Hôpital de la CONCEPTION, Service d'Endocrinologie, Diabète et Maladies Métaboliques

Marseille, , France

Site Status

Med Clinic I - University of Lueback

Lübeck, , Germany

Site Status

Bnail Zion Medical Center Institute of Endocrinology & Metabolism

Haifa, , Israel

Site Status

Institute of Endocrinology & Metabolism, Rabin Medical Center

Petah Tikva, , Israel

Site Status

Sourasky Medical Center, Endocrinology & Metabolism

Tel Aviv, , Israel

Site Status

Azienda Ospedaliera-Universitaria Ancona

Ancona, , Italy

Site Status

UOC di Endocrinologia, Dipartimento di Medicina Clinica e Sperimentale

Messina, , Italy

Site Status

Istituto Auxologico Italiano

Milan, , Italy

Site Status

University of Naples Federico II

Naples, , Italy

Site Status

SCDU Medicina Interna I Università di Torino Dipartimento di Scienze Cliniche e Biologiche

Orbassano, , Italy

Site Status

University of Padua

Padua, , Italy

Site Status

Institute of Medical Pathology

Roma, , Italy

Site Status

Azienda Ospedaliero - Universitaria Città della Salute e della Scienza di Torino

Torino, , Italy

Site Status

Policlinico GB Rossi

Verona, , Italy

Site Status

Leiden University, Leiden University Medical Center, Dept. of Endocrinology

Leiden, , Netherlands

Site Status

Erasmus MC, Dpt. Of Internal Medicine, Division of Endocrinology

Rotterdam, , Netherlands

Site Status

Instytut Centrum Zdrowia Matki Polki

Lodz, , Poland

Site Status

Terpa Sp.z.o.o

Lublin, , Poland

Site Status

Szpital Kliniczny im. Heliodora Swiecickiego

Poznan, , Poland

Site Status

Outpatient Clinic: Reuma Centrum

Warsaw, , Poland

Site Status

Samodzielny Publiczny Szpital Kliniczny Nr 1

Wroclaw, , Poland

Site Status

Clinical Center of Serbia

Belgrade, , Serbia

Site Status

Hospital Universidad De La Ribera

Alzira, Valencia, Spain

Site Status

Endocrinologia, Hospital Sant Pau,Universitat Autònoma de Barcelona

Barcelona, , Spain

Site Status

Hospital Universitario Reina Sofía

Córdoba, , Spain

Site Status

Bezmi Alem Vakıf Üniversitesi Endokrinoloji Bölümü Adnan

Istanbul, , Turkey (Türkiye)

Site Status

Istanbul University Medical Faculty

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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United States Belgium Bulgaria Canada Czechia Denmark France Germany Israel Italy Netherlands Poland Serbia Spain Turkey (Türkiye)

References

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Fleseriu M, Pivonello R, Elenkova A, Salvatori R, Auchus RJ, Feelders RA, Geer EB, Greenman Y, Witek P, Cohen F, Biller BMK. Efficacy and safety of levoketoconazole in the treatment of endogenous Cushing's syndrome (SONICS): a phase 3, multicentre, open-label, single-arm trial. Lancet Diabetes Endocrinol. 2019 Nov;7(11):855-865. doi: 10.1016/S2213-8587(19)30313-4. Epub 2019 Sep 18.

Reference Type RESULT
PMID: 31542384 (View on PubMed)

Geer EB, Salvatori R, Elenkova A, Fleseriu M, Pivonello R, Witek P, Feelders RA, Bex M, Borresen SW, Puglisi S, Biller BMK, Cohen F, Pecori Giraldi F. Levoketoconazole improves clinical signs and symptoms and patient-reported outcomes in patients with Cushing's syndrome. Pituitary. 2021 Feb;24(1):104-115. doi: 10.1007/s11102-020-01103-6. Epub 2020 Nov 20.

Reference Type RESULT
PMID: 33216275 (View on PubMed)

Pivonello R, Elenkova A, Fleseriu M, Feelders RA, Witek P, Greenman Y, Geer EB, Perotti P, Saiegh L, Cohen F, Arnaldi G. Levoketoconazole in the Treatment of Patients With Cushing's Syndrome and Diabetes Mellitus: Results From the SONICS Phase 3 Study. Front Endocrinol (Lausanne). 2021 Apr 7;12:595894. doi: 10.3389/fendo.2021.595894. eCollection 2021.

Reference Type DERIVED
PMID: 33897615 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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COR-2012-01

Identifier Type: -

Identifier Source: org_study_id

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