Study Results
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View full resultsBasic Information
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COMPLETED
PHASE3
94 participants
INTERVENTIONAL
2014-08-31
2018-11-30
Brief Summary
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Detailed Description
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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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Study Design
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NON_RANDOMIZED
SEQUENTIAL
TREATMENT
NONE
Study Groups
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Levoketoconazole DL0
Levoketoconazole Tablets Dose Level 0 Once Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL1
Levoketoconazole Tablets Dose Level 1 Twice Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL2
Levoketoconazole Tablets Dose Level 1 Twice Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL3
Levoketoconazole Tablets Dose Level 3 Twice Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL4
Levoketoconazole Tablets Dose Level 4 Twice Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL5
Levoketoconazole Tablets Dose Level 5 Twice Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL6
Levoketoconazole Tablets Dose Level 6 Twice Daily
Levoketoconazole
Levoketoconazole is the 2S,4R- enantiomer derived from racemic ketoconazole
Levoketoconazole DL7
Levoketoconazole Tablets Dose Level 7 Twice Daily
Levoketoconazole
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
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
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
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.
18 Years
ALL
No
Sponsors
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Cortendo AB
INDUSTRY
Responsible Party
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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
Johns Hopkins University
Baltimore, Maryland, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
University of Michigan Medical Center
Ann Arbor, Michigan, United States
University of New Mexico HSC
Albuquerque, New Mexico, United States
Memorial Sloan Kettering Cancer Center
New York, New York, United States
Cleveland Clinic
Cleveland, Ohio, United States
Oregon Health & Science University
Portland, Oregon, United States
Allegheny Neuroendocrinology Center
Pittsburgh, Pennsylvania, United States
University Hospitals Leuven Department of Endocrinology
Leuven, , Belgium
University Specialized Hospital for Active Treatment in Endocrinology (USHATE)
Sofia, , Bulgaria
St. Pauls Hospital/Vancouver General Hospital
Vancouver, British Columbia, Canada
Vseobecna fakultni nemocnice v Praze - III. Interni klinika VFN a 1. LF UK
Prague, , Czechia
Aarhus University Hospital
Aarhus, , Denmark
Rigshospitalet,Copenhagen University Hospital
Copenhagen, , Denmark
Hôpital de la CONCEPTION, Service d'Endocrinologie, Diabète et Maladies Métaboliques
Marseille, , France
Med Clinic I - University of Lueback
Lübeck, , Germany
Bnail Zion Medical Center Institute of Endocrinology & Metabolism
Haifa, , Israel
Institute of Endocrinology & Metabolism, Rabin Medical Center
Petah Tikva, , Israel
Sourasky Medical Center, Endocrinology & Metabolism
Tel Aviv, , Israel
Azienda Ospedaliera-Universitaria Ancona
Ancona, , Italy
UOC di Endocrinologia, Dipartimento di Medicina Clinica e Sperimentale
Messina, , Italy
Istituto Auxologico Italiano
Milan, , Italy
University of Naples Federico II
Naples, , Italy
SCDU Medicina Interna I Università di Torino Dipartimento di Scienze Cliniche e Biologiche
Orbassano, , Italy
University of Padua
Padua, , Italy
Institute of Medical Pathology
Roma, , Italy
Azienda Ospedaliero - Universitaria Città della Salute e della Scienza di Torino
Torino, , Italy
Policlinico GB Rossi
Verona, , Italy
Leiden University, Leiden University Medical Center, Dept. of Endocrinology
Leiden, , Netherlands
Erasmus MC, Dpt. Of Internal Medicine, Division of Endocrinology
Rotterdam, , Netherlands
Instytut Centrum Zdrowia Matki Polki
Lodz, , Poland
Terpa Sp.z.o.o
Lublin, , Poland
Szpital Kliniczny im. Heliodora Swiecickiego
Poznan, , Poland
Outpatient Clinic: Reuma Centrum
Warsaw, , Poland
Samodzielny Publiczny Szpital Kliniczny Nr 1
Wroclaw, , Poland
Clinical Center of Serbia
Belgrade, , Serbia
Hospital Universidad De La Ribera
Alzira, Valencia, Spain
Endocrinologia, Hospital Sant Pau,Universitat Autònoma de Barcelona
Barcelona, , Spain
Hospital Universitario Reina Sofía
Córdoba, , Spain
Bezmi Alem Vakıf Üniversitesi Endokrinoloji Bölümü Adnan
Istanbul, , Turkey (Türkiye)
Istanbul University Medical Faculty
Istanbul, , Turkey (Türkiye)
Countries
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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.
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.
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.
Provided Documents
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Document Type: Study Protocol
Document Type: Statistical Analysis Plan
Other Identifiers
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COR-2012-01
Identifier Type: -
Identifier Source: org_study_id
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