A phase 1/2, open-label assessment of the safety, tolerability, and efficacy of transdermal cannabidiol (ZYN002) for the treatment of pediatric fragile X syndrome.
Heussler et al.·Journal of Neurodevelopmental Disorders
Clear benefitGRADELow104 citations
Samplen = 20 Pat.
Duration12 weeks
EndpointADAMS
Blindingoffen
DesignPhase 1/2 Open-Label-Studie
Cannabinoidcbd
Max. dose250.0 mg
Routetopisch
”Key finding
ZYN002 significantly reduced anxiety and behavioral symptoms and was well tolerated, without serious adverse events.
Summary
Phase 1/2 safety study (n=20 pediatric patients) with transdermal CBD gel (ZYN002) over 12 weeks: 85% of participants reported treatment-emergent AEs, of which 70% were mild — no serious adverse reactions. Diarrhea, fatigue and somnolence documented as common adverse effects. CBD well tolerated at doses of 50–250 mg/day.
P
PopulationChildren and adolescents (6–17 years) with fragile X syndrome (FMR1 full mutation molecularly confirmed), n=20
I
InterventionTransdermal CBD gel (ZYN002), 2× daily, titration from 50 mg to max. 250 mg/day
O
OutcomeStatistically significant reduction in ADAMS total score from screening to week 12; significant improvements on nearly all secondary endpoints (ABC-CFXS, PARS-R, PedsQL, VAS, CGI)
Confidence in the evidence
Very lowLowModerateHigh
Low
The second of four GRADE levels, the effect estimate is of limited reliability.
Downgraded for
Risk of biasImprecision
Quality profile
Sample size★★★★★
BlindingOpen-label
Effect sizeClear benefit
Citations / year★★★★★
Authors
Heussler H, Cohen J, Silove N, Tich N, Bonn-Miller MO, Du W, O'Neill C, Sebree T.
<h4>Background</h4>Fragile X syndrome (FXS) is characterized by a range of developmental, neuropsychiatric, and behavioral symptoms that cause significant impairment in those with the disorder. Cannabidiol (CBD) holds promise as a potential treatment for FXS symptoms due to its safety profile and positive effects on a number of emotional and behavioral symptoms associated with FXS. The aim of the current study was to evaluate the safety, tolerability, and initial efficacy of ZYN002, a transdermal CBD gel, in a pediatric population with FXS.<h4>Methods</h4>Twenty children and adolescents (aged 6-17 years) with a diagnosis of FXS (confirmed through molecular documentation of FMR1 full mutation) were enrolled in an open-label, multi-site, trial of ZYN002. Transdermal CBD gel was administered twice daily for 12 weeks, titrated from 50 mg to a maximum daily dose of 250 mg. The primary efficacy endpoint was change from screening to week 12 on the Anxiety, Depression, and Mood Scale (ADAMS). Secondary endpoint measures included the Aberrant Behavior Checklist-Community for FXS (ABC-C<sub>FXS</sub>), Pediatric Anxiety Rating Scale (PARS-R), Pediatric Quality of Life Inventory (PedsQL™), three Visual Analogue Scales (VAS), and the Clinical Global Impression Scale-Severity (CGI-S) and Improvement (CGI-I).<h4>Results</h4>The majority of treatment-emergent AEs (reported by 85% of participants) were mild in severity (70%), and no serious adverse events were reported. There was a statistically significant reduction in ADAMS total score from screening to week 12 and significant reductions on nearly all other secondary endpoints, including all ADAMS subscales (except depressed mood), all ABC-C<sub>FXS</sub> subscale scores (e.g., social avoidance, irritability), PARS-R total severity score, and PedsQL total score.<h4>Conclusions</h4>ZYN002 was well tolerated and produced clinically meaningful reductions in anxiety and behavioral symptoms in children and adolescents with FXS. These findings support further study of ZYN002 in a randomized, well-controlled trial for the treatment of behavioral symptoms of FXS.<h4>Trial registration</h4>ANZCTR, ACTRN12617000150347 Registered 27 January 2017.