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Trial · Interventional

CompletedPhase 3Results postedRegistry data

Treatment for Endogenous Cushing's Syndrome

Short name SONICS

This trial does not test a peptide that PepBank tracks.

  • Measures ACTH (corticotropin), does not give it. It appears in the eligibility rules.

Overview

Status
Completed
Phase
Phase 3
Enrollment
94 participants (actual)
Sponsor
Cortendo AB · Industry
Design
Not randomized · Open label (no masking)
Countries
15 countries

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

Start
Aug 2014
Primary completion
Apr 2018
Completion
Nov 2018
First posted
24 Apr 2013 (estimated)
Last update posted
19 Apr 2021
Conditions
Endogenous Cushing's Syndrome

Timeline

1 trial · 1 completed · 1 with posted results

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
201420152016201720182019
  1. Ph 3

    SONICS

    NCT01838551

    Aug 2014 to Nov 2018

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

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.

Interventions

  • LevoketoconazoleDrug

Arms8

  • Experimental

    Levoketoconazole DL0

    Levoketoconazole Tablets Dose Level 0 Once Daily

  • Experimental

    Levoketoconazole DL1

    Levoketoconazole Tablets Dose Level 1 Twice Daily

  • Experimental

    Levoketoconazole DL2

    Levoketoconazole Tablets Dose Level 1 Twice Daily

  • Experimental

    Levoketoconazole DL3

    Levoketoconazole Tablets Dose Level 3 Twice Daily

  • Experimental

    Levoketoconazole DL4

    Levoketoconazole Tablets Dose Level 4 Twice Daily

  • Experimental

    Levoketoconazole DL5

    Levoketoconazole Tablets Dose Level 5 Twice Daily

  • Experimental

    Levoketoconazole DL6

    Levoketoconazole Tablets Dose Level 6 Twice Daily

  • Experimental

    Levoketoconazole DL7

    Levoketoconazole Tablets Dose Level 7 Twice Daily

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Normalization in Urinary Free Cortisol in Patients With Endogenous Cushing's Syndrome.

    Time frame · 6 months of maintenance phase therapy without a prior dose increase during that phase

    Registry description

    The response to COR-003 is defined as mean UFC concentration ≤ULN following 6 months of maintenance phase therapy without a prior dose increase during that phase. The proportion of responders at the End of Maintenance Phase visit, following 6 months of treatment in the Maintenance Phase, for all dose groups combined was estimated using a generalized linear model with repeated measurements based on a binomial distribution with a logit link function and with region (US vs. non-US), concurrent CS medical conditions (diabetes \[Yes/No\], hypertension \[Yes/No\]), age (rounded median split based on the ITT population), sex, disease duration (years), prior CS medication (Yes/No), prior radiation therapy (Yes/No) as Baseline covariates and visit as an independent factor. The least squares mean (LSMEAN) estimate of the UFC response after 6 months of treatment in the Maintenance Phase alongside its 95% Wald CI is presented.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

Primary outcome results

Primary outcomeLeast squares mean· 6 months of maintenance phase therapy without a prior dose increase during that phase

Normalization in Urinary Free Cortisol in Patients With Endogenous Cushing's Syndrome.

GroupValue (proportion of subjects meeting endpoint)
Levoketoconazole All Doses.30

Adverse events, as posted

Adverse events as posted: participants affected out of participants at risk, by group
GroupDeathsSerious eventsOther events
Levoketoconazole All DosesAll doses used in the study combined1 / 9416 / 9492 / 94

Each cell reads participants affected / participants at risk, as the registry posted them.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies0

Studies that cite this trial.

No study cites this trial.

Other registry references

References listed at the registry that are not in PepBank. They link to PubMed.

  • ResultFleseriu 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. PMID 31542384
  • ResultGeer 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. PMID 33216275
  • DerivedPivonello 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. PMID 33897615

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Key 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. Key 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.

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