Trial Outcomes & Findings for Low-Dose Ketamine in Children With ADNP Syndrome (NCT NCT04388774)

NCT ID: NCT04388774

Last Updated: 2023-07-07

Results Overview

Number of Participants with an adverse event as defined by the Systematic Longitudinal Assessment of Adverse Events (SLAES) which is a comprehensive form that assesses medical and behavioral conditions that were present at screening and/or baseline. Conditions are considered treatment emergent if their severity increased significantly after the participant had taken at least one dose of the study treatment. Treatment emergent adverse events will be tracked considered in the adverse event safety analysis. Severity of adverse events are categorized as mild, moderate, severe, life-threatening, or resulting in death and the treating physician indicates if the adverse event was related or unrelated to study drug.

Recruitment status

COMPLETED

Study phase

PHASE1/PHASE2

Target enrollment

10 participants

Primary outcome timeframe

Week 4

Results posted on

2023-07-07

Participant Flow

Ten participants were screened, and all met criteria for inclusion and were enrolled between August 2020 and May 2021.

Participant milestones

Participant milestones
Measure
Ketamine
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Overall Study
STARTED
10
Overall Study
COMPLETED
10
Overall Study
NOT COMPLETED
0

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Low-Dose Ketamine in Children With ADNP Syndrome

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Age, Continuous
9.50 years
STANDARD_DEVIATION 2.30 • n=99 Participants
Sex: Female, Male
Female
3 Participants
n=99 Participants
Sex: Female, Male
Male
7 Participants
n=99 Participants
Race/Ethnicity, Customized
Hispanic/Latino
2 Participants
n=99 Participants
Race/Ethnicity, Customized
White
8 Participants
n=99 Participants
Developmental quotient
VDQ - verbal developmental quotient
26.71 quotient
STANDARD_DEVIATION 15.33 • n=99 Participants
Developmental quotient
NVDQ - nonverbal developmental quotient
31.28 quotient
STANDARD_DEVIATION 16.13 • n=99 Participants
Developmental quotient
FSDQ - full scale developmental quotient
28.81 quotient
STANDARD_DEVIATION 15.42 • n=99 Participants
Number of Participants with ASD
4 Participants
n=99 Participants
Number of Participants with ADHD
7 Participants
n=99 Participants
Genetic mutation
Frameshift
6 Participants
n=99 Participants
Genetic mutation
Nonsense
4 Participants
n=99 Participants

PRIMARY outcome

Timeframe: Week 4

Number of Participants with an adverse event as defined by the Systematic Longitudinal Assessment of Adverse Events (SLAES) which is a comprehensive form that assesses medical and behavioral conditions that were present at screening and/or baseline. Conditions are considered treatment emergent if their severity increased significantly after the participant had taken at least one dose of the study treatment. Treatment emergent adverse events will be tracked considered in the adverse event safety analysis. Severity of adverse events are categorized as mild, moderate, severe, life-threatening, or resulting in death and the treating physician indicates if the adverse event was related or unrelated to study drug.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Number of Participants With an Adverse Event
9 Participants

SECONDARY outcome

Timeframe: Baseline, Week 1

Population: Each participant had one caregiver provide rated assessments.

Changes in scale at week 1 compared to baseline. Aberrant Behavior Checklist is a behavior rating scale for the assessment of treatment effects. Each item is scored as 0 (never a problem), 1 (slight problem), 2 (moderately serious problem), or 3 (severe problem). Subscales from 0-45 for Irritability; 0-48 for Social Withdrawal and Hyperactivity; from 0-21 for Stereotypy; and 0-12 for In Speech , with total scale from 0 to 48, with higher score indicating worse health outcomes.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
n=10 Participants
Caregiver rated assessments at 1 week
Aberrant Behavior Checklist
Irritability
20.5 score on a scale
Standard Deviation 13.33
10.9 score on a scale
Standard Deviation 10.6
Aberrant Behavior Checklist
Social withdrawal
9.9 score on a scale
Standard Deviation 8.96
4.2 score on a scale
Standard Deviation 4.96
Aberrant Behavior Checklist
Motor stereotypies
7.8 score on a scale
Standard Deviation 5.31
4.5 score on a scale
Standard Deviation 3.66
Aberrant Behavior Checklist
Hyperactivity
24.5 score on a scale
Standard Deviation 14.66
16.2 score on a scale
Standard Deviation 13.35
Aberrant Behavior Checklist
Inappropriate speech
3.6 score on a scale
Standard Deviation 2.88
3.3 score on a scale
Standard Deviation 2.21

SECONDARY outcome

Timeframe: Baseline and Week 1

The ADAMS is a parent/caregiver-completed measure and consists of 28 items, grouped into five subscales (Manic/Hyperactive Behavior, Depressed Mood, Social Avoidance, General Anxiety, Obsessive Behavior), and scored on a four-point Likert scale that combines frequency and severity ratings from 0-3. Subscales range - Hyperactivity 0-15; Depressed 0-21; Social Avoidance 0-21; General anxiety 0-21; OCD 0-9. Scores are not summed. Higher score indicates poorer health outcomes.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
n=10 Participants
Caregiver rated assessments at 1 week
Anxiety, Depression and Mood Scales (ADAMS)
Hyperactivity
10.1 score on a scale
Standard Deviation 4.23
6.7 score on a scale
Standard Deviation 3.5
Anxiety, Depression and Mood Scales (ADAMS)
Depressed
2.6 score on a scale
Standard Deviation 3.31
2.1 score on a scale
Standard Deviation 2.69
Anxiety, Depression and Mood Scales (ADAMS)
Social avoidance
6.1 score on a scale
Standard Deviation 4.23
3.5 score on a scale
Standard Deviation 3.47
Anxiety, Depression and Mood Scales (ADAMS)
General anxiety
6.3 score on a scale
Standard Deviation 5.96
4.3 score on a scale
Standard Deviation 4.74
Anxiety, Depression and Mood Scales (ADAMS)
Obsessive/compulsive
2.5 score on a scale
Standard Deviation 2.01
1.6 score on a scale
Standard Deviation 1.51

SECONDARY outcome

Timeframe: Baseline, Week 1

Change in repetitive behaviors at weeks 1 compared to baseline. RBS-R subscales - Stereo 0-18; Self injury 0-24; Compulsive 0-24; Ritualistic 0-18; Sameness 0-33; Restricted 0-12. Total scale range from 0 to 126 with higher score indicating worse health outcomes.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
n=10 Participants
Caregiver rated assessments at 1 week
Repetitive Behavior Scale-Revised (RBS-R)
Stereotyped
6.6 score on a scale
Standard Deviation 3.31
5.1 score on a scale
Standard Deviation 4.93
Repetitive Behavior Scale-Revised (RBS-R)
Self-injury
5.9 score on a scale
Standard Deviation 4.79
4.2 score on a scale
Standard Deviation 3.49
Repetitive Behavior Scale-Revised (RBS-R)
Compulsive
3.7 score on a scale
Standard Deviation 2.75
2.2 score on a scale
Standard Deviation 1.87
Repetitive Behavior Scale-Revised (RBS-R)
Ritualistic
2.9 score on a scale
Standard Deviation 3.63
2.9 score on a scale
Standard Deviation 2.38
Repetitive Behavior Scale-Revised (RBS-R)
Sameness
5.6 score on a scale
Standard Deviation 6.33
4.3 score on a scale
Standard Deviation 5.46
Repetitive Behavior Scale-Revised (RBS-R)
Restricted
3.9 score on a scale
Standard Deviation 3.14
3.6 score on a scale
Standard Deviation 2.37
Repetitive Behavior Scale-Revised (RBS-R)
Overall
28.6 score on a scale
Standard Deviation 17.56
22.3 score on a scale
Standard Deviation 14.28

SECONDARY outcome

Timeframe: Baseline, Week 2, and Week 4

Changes in scale at weeks 2, and 4 compared to baseline. Clinical Global impressions - Improvement Scale is anchored to symptoms of ADNP syndrome for the assessment of treatment effects. CGI-I total score from 1 to 7 point scale, with higher score indicating worse health outcomes.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Clinical Global Impressions - Improvement Scale (CGI-I)
Baseline
0 score on a scale
Standard Deviation 0
Clinical Global Impressions - Improvement Scale (CGI-I)
Week 2
1.5 score on a scale
Standard Deviation 0.53
Clinical Global Impressions - Improvement Scale (CGI-I)
Week 4
1.0 score on a scale
Standard Deviation 0.52

SECONDARY outcome

Timeframe: Baseline, Week 1

Change in sleep habits at week 1 compared to baseline. Full scale from 0 to 110, with higher score indicating worse health outcomes.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
n=10 Participants
Caregiver rated assessments at 1 week
Childrens Sleep Habits Questionnaire
2.83 units on a scale
Standard Deviation 0.75
2.93 units on a scale
Standard Deviation 0.82

SECONDARY outcome

Timeframe: Baseline, Week 1, Week 2, and Week 4

Expressive and receptive language assessed by Peabody Picture Vocabulary Test and Expressive Vocabulary Test at Day 1, Weeks 1, 2, and 4. Full scale from 40 to 160, with higher score indicating better health outcomes.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Peabody Picture Vocabulary Test and Expressive Vocabulary Test
Baseline, Day 1
50.9 score on a scale
Standard Deviation 13.40
Peabody Picture Vocabulary Test and Expressive Vocabulary Test
Week 1
52.8 score on a scale
Standard Deviation 17.38
Peabody Picture Vocabulary Test and Expressive Vocabulary Test
Week 2
51.5 score on a scale
Standard Deviation 13.87
Peabody Picture Vocabulary Test and Expressive Vocabulary Test
Week 4
50.9 score on a scale
Standard Deviation 15.29

SECONDARY outcome

Timeframe: Baseline, Day 1, Week 1

Population: Not every trial was valid. Eye tracking data were successfully collected from nine participants for the Joint Attention task, but only four participants had \>25% valid trials at all three time points and were included in analysis.

Change at Day 1 and Week 1 as compared to baseline using computerized eye tracking to record where the subject is looking during an activity in which the subject will see a video of a person with two objects, turning her head towards one of the objects, the target. Mean proportion of trials in which participants made saccades to the target before the distractor.

Outcome measures

Outcome measures
Measure
Ketamine
n=48 Trials
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Proportion of Target-First Trials Saccades
Baseline
0.53 proportion of target-first saccades
Standard Deviation 0.14
Proportion of Target-First Trials Saccades
Day 1
0.75 proportion of target-first saccades
Standard Deviation 0.17
Proportion of Target-First Trials Saccades
Week 1
0.70 proportion of target-first saccades
Standard Deviation 0.14

SECONDARY outcome

Timeframe: Baseline, Day 1, Week 1

Population: Eye tracking data were successfully collected from nine participants for the Joint Attention task, but only four participants had \>25% valid trials at all three time points and were included in analysis.

Change at week 1, week 2, and week 4 as compared to baseline using computerized eye tracking to record where the subject is looking during an activity in which the subject will see different social and non-social stimuli. Latency to first saccade to the target

Outcome measures

Outcome measures
Measure
Ketamine
n=4 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Latency to First Saccade
Baseline
2319.38 ms
Standard Deviation 1202.34
Latency to First Saccade
Day 1
2089.96 ms
Standard Deviation 754.70
Latency to First Saccade
Week 1
1674.18 ms
Standard Deviation 301.93

SECONDARY outcome

Timeframe: Baseline, Day 1, Week 1

Population: Eye tracking data were successfully collected from nine participants for the Joint Attention task, but only four participants had \>25% valid trials at all three time points and were included in analysis.

Change at Day 1 and Week 1 as compared to baseline using computerized eye tracking to record where the subject is looking during an activity in which the subject will see different social and non-social stimuli. Proportion of time participants spent dwelling on the target versus distractor.

Outcome measures

Outcome measures
Measure
Ketamine
n=4 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Proportion of Target-Dwelling
Week 1
0.66 proportion of time
Standard Deviation 0.11
Proportion of Target-Dwelling
Baseline
0.51 proportion of time
Standard Deviation 0.19
Proportion of Target-Dwelling
Day 1
0.59 proportion of time
Standard Deviation 0.13

SECONDARY outcome

Timeframe: Baseline, Week 1, Week 2, and Week 4

Population: participants with fewer than five wavelets at any time point were excluded

Electroencephalographic recordings to measure Auditory Event Related Potentials at baseline, week 1, week 2, and week 4. In separate blocks, participants heard a 500-ms click at either a stimulation rate of 40 or 20 Hz. Click trains were presented 150 times each, with an intertrial interval of 50 ms, at approximately 60 db. Higher number indicates higher amplitude neural response to auditory stimuli.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
Caregiver rated assessments at 1 week
Electrophysiology Recording
40-Hz Baseline
0.19 ms
Standard Deviation 0.03
Electrophysiology Recording
40-Hz Week1
0.26 ms
Standard Deviation 0.09
Electrophysiology Recording
20-Hz Baseline
0.18 ms
Standard Deviation 0.06
Electrophysiology Recording
20-Hz Week 1
0.15 ms
Standard Deviation 0.05
Electrophysiology Recording
20-Hz Week 2
0.18 ms
Standard Deviation 0.06
Electrophysiology Recording
20-Hz Week 4
0.19 ms
Standard Deviation 0.11
Electrophysiology Recording
40-Hz Week 2
0.18 ms
Standard Deviation 0.06
Electrophysiology Recording
40-Hz Week 4
0.20 ms
Standard Deviation 0.06

SECONDARY outcome

Timeframe: Baseline and Week 4

Changes in scale at week 4 compared to baseline. Vineland Adaptive Behavior Scales measures adaptive functioning. Higher score indicating better health outcomes. Domain scores are standard scores - population mean 100 standard deviation 15. an overall composite score, it consists of three subscales: (a) communication (receptive, expressive, written), (b) socialization (interpersonal relationships, play and leisure, coping skills), and (c) daily living (person, domestic, community).

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
n=10 Participants
Caregiver rated assessments at 1 week
Vineland Adaptive Behavior Scales
Abc
42.7 score on a scale
Standard Deviation 13.9
44.0 score on a scale
Standard Deviation 15.19
Vineland Adaptive Behavior Scales
Comm
32.6 score on a scale
Standard Deviation 14.73
33.4 score on a scale
Standard Deviation 15.53
Vineland Adaptive Behavior Scales
Daily Living
48.5 score on a scale
Standard Deviation 14.45
49.2 score on a scale
Standard Deviation 16.14
Vineland Adaptive Behavior Scales
Social
44.5 score on a scale
Standard Deviation 15.62
46.8 score on a scale
Standard Deviation 16.90
Vineland Adaptive Behavior Scales
Motor
51.5 score on a scale
Standard Deviation 8.73
49.83 score on a scale
Standard Deviation 4.58

SECONDARY outcome

Timeframe: Baseline and Week 1

Caregiver Strain Questionnaire (CGSQ) is a 13 question tool, with a 5-point Likert scale ranging from Not at all (0) to Very much (4). Domains (Objective strain, Subjective externalized strain, Subjective internalized strain) are averaged scores, range from 0-4. Total score (Global score) is a sum of the three subdomains. Full scale range 0-12, higher score indicates more severe strain.

Outcome measures

Outcome measures
Measure
Ketamine
n=10 Participants
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Caregiver Rated Assessment at 1 Week
n=10 Participants
Caregiver rated assessments at 1 week
Caregiver Strain Questionnaire (CGSQ)
Global score
8.27 score on a scale
Standard Deviation 3.08
6.77 score on a scale
Standard Deviation 2.32
Caregiver Strain Questionnaire (CGSQ)
Objective strain
2.79 score on a scale
Standard Deviation 1.11
2.45 score on a scale
Standard Deviation 0.99
Caregiver Strain Questionnaire (CGSQ)
Subjective externalized strain
2.18 score on a scale
Standard Deviation 1.11
1.62 score on a scale
Standard Deviation 0.69
Caregiver Strain Questionnaire (CGSQ)
Subjective internalized strain
3.3 score on a scale
Standard Deviation 1.15
2.7 score on a scale
Standard Deviation 0.97

Adverse Events

Ketamine

Serious events: 0 serious events
Other events: 9 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Ketamine
n=10 participants at risk
Single-dose (0.5 mg/kg) infused intravenously over 40 minutes
Psychiatric disorders
Elated/silly
50.0%
5/10 • 4 Weeks
Psychiatric disorders
Aggression
40.0%
4/10 • 4 Weeks
Nervous system disorders
Fatigue
40.0%
4/10 • 4 Weeks
General disorders
Decreased appetite
30.0%
3/10 • 4 Weeks
Psychiatric disorders
Anxiety
30.0%
3/10 • 4 Weeks
General disorders
Increased appetite
20.0%
2/10 • 4 Weeks
Psychiatric disorders
Restless
20.0%
2/10 • 4 Weeks
General disorders
Increased fluid intake
20.0%
2/10 • 4 Weeks
Gastrointestinal disorders
Nausea/vomiting
20.0%
2/10 • 4 Weeks
Psychiatric disorders
Moody/irritable
20.0%
2/10 • 4 Weeks
General disorders
Dry mouth
20.0%
2/10 • 4 Weeks
Gastrointestinal disorders
Gagging/reflux
10.0%
1/10 • 4 Weeks
Psychiatric disorders
Self-injury
10.0%
1/10 • 4 Weeks
Gastrointestinal disorders
Loose stool
10.0%
1/10 • 4 Weeks
Nervous system disorders
Difficulty falling asleep
10.0%
1/10 • 4 Weeks
Nervous system disorders
Early morning wakening
10.0%
1/10 • 4 Weeks
Musculoskeletal and connective tissue disorders
Limping with possible pain
10.0%
1/10 • 4 Weeks
General disorders
Decreased fluid intake
10.0%
1/10 • 4 Weeks
Psychiatric disorders
Distractibility
10.0%
1/10 • 4 Weeks
Gastrointestinal disorders
Constipation
10.0%
1/10 • 4 Weeks
Psychiatric disorders
Increased frustration
10.0%
1/10 • 4 Weeks
Psychiatric disorders
Oppositional
10.0%
1/10 • 4 Weeks
Infections and infestations
Upper respiratory tract infection
10.0%
1/10 • 4 Weeks
Psychiatric disorders
Agitation
10.0%
1/10 • 4 Weeks

Additional Information

Dr. Alexander Kolevzon

Icahn School of Medicine at Mount Sinai

Phone: (212) 659-8762

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place