Title

Study of Leuprolide Acetate Injectable Suspension in the Treatment of Central Precocious Puberty
An Open-label, Single Arm, Multicenter Study on the Efficacy, Safety, and Pharmacokinetics of Leuprolide Acetate 45 mg for Injectable Suspension Controlled Release in Subjects With Central (Gonadotropin-Dependent) Precocious Puberty
  • Phase

    Phase 3
  • Study Type

    Interventional
  • Intervention/Treatment

    leuprolide ...
  • Study Participants

    64
This study determines the effectiveness of leuprolide acetate 45 mg for injectable suspension for treatment of children with Central Precocious Puberty.
Leuprolide acetate is a GnRH agonist that inhibits pituitary gonadotropin secretion by binding to the GnRH receptors and blocking downstream hormone synthesis. The steady decrease in hormone synthesis (LH and FSH) leads to a suppression of testicular and ovarian steroidogenesis. In children with CPP, this steady decrease in hormone synthesis disrupts the progression of puberty.
Study Started
Aug 31
2015
Primary Completion
Sep 05
2018
Study Completion
Sep 05
2018
Results Posted
May 20
2020
Last Update
Jun 02
2020

Drug Leuprolide Acetate 45 mg

Subcutaneous injection

Assigned Intervention Experimental

Leuprolide acetate 45 mg will be administered as a subcutaneous injection at 6-month intervals for the 12 month study period.

Criteria

Inclusion Criteria:

Females age 2 to 8 years (inclusive) or males age 2 to 9 years (inclusive)
Confirmed diagnosis of CPP within 12 months of Baseline Visit (Day 0) but have not received prior GnRH agonist treatment for CPP
Pubertal-type LH response following an abbreviated GnRHa stimulation test before treatment initiation
Clinical evidence of puberty, defined as Tanner stage ≥ 2 for breast development in females or testicular volume ≥ 4 mL in males
Difference between bone age (Greulich and Pyle method) and chronological age ≥ 1 year

Exclusion Criteria:

Gonadotropin-independent (peripheral) precocious puberty
Prior or current GnRH treatment for CPP
Prior or current therapy with medroxyprogesterone acetate, growth hormone or insulin-like growth factor-1 (IGF-1)
Diagnosis of short stature (ie, 2.25 standard deviations (SD) below the mean height for age)
Known history of seizures, epilepsy, and/or central nervous system disorders that may be associated with seizures or convulsions
Any other medical condition or serious intercurrent illness that, in the opinion of the Investigator, may make it undesirable for the subject to participate in the study

Summary

Assigned Intervention

All Events

Event Type Organ System Event Term Assigned Intervention

Percentage of Participants With Suppression of Peak-Stimulated Luteinizing Hormone at 6 Months.

Luteinizing Hormone (LH) suppression is defined as peak-stimulated LH <4 IU/L. Peak stimulated LH refers to the maximum LH concentration measured 30 minutes after a gonadotropin-releasing hormone agonst (GnRHa) stimulation test.

Assigned Intervention

Bone Age Ratio to Chronological Age at Time of Measurement

Bone Age Ratio to Chronological Age at Time of Measurement is bone age/age at bone age assessment.

Assigned Intervention

Baseline

1.39
Ratio (Mean)
Standard Deviation: 0.160

End of Treatment, Week 48

1.32
Ratio (Mean)
Standard Deviation: 0.143

Maximum Post-baseline Value

1.36
Ratio (Mean)
Standard Deviation: 0.138

Minimum Post-baseline Value

1.3
Ratio (Mean)
Standard Deviation: 0.138

Visit 5, Week 24

1.34
Ratio (Mean)
Standard Deviation: 0.138

Percentage of Subjects With Suppression of Luteinizing Hormone Measured by Blood Levels.

Percentage of subjects with suppressed serum LH concentrations(<4 IU/L) 30 minutes post GnRHa stimulation test at all assessed timepoints.

Assigned Intervention

End of Treatment, Week 48

Visit 3, Week 12

Visit 5, Week 24

Visit 6, Week 36

Percent Change From Baseline in Height

The percent change from baseline in height at each available post-baseline measurement. Percent change is defined as (((change from Baseline)/(Baseline)) x 100).

Assigned Intervention

End of Treatment, Week 48

4.3
Percent change (Mean)
Standard Deviation: 1.34

Visit 2, Week 4

0.5
Percent change (Mean)
Standard Deviation: 0.78

Visit 3, Week 12

1.4
Percent change (Mean)
Standard Deviation: 0.82

Visit 4, Week 20

1.9
Percent change (Mean)
Standard Deviation: 0.89

Visit 5, Week 24

2.3
Percent change (Mean)
Standard Deviation: 1.06

Visit 6, Week 36

3.3
Percent change (Mean)
Standard Deviation: 1.17

Visit 7, Week 44

3.9
Percent change (Mean)
Standard Deviation: 1.26

Changes in Height Velocity (Growth Rate)

Changes in height velocity (growth rate) at all study timepoints after Screening to end of study. Growth velocity is defined for each visit as change from baseline / [(number of weeks since baseline)/52]. Week 48: Change from Week 24 growth velocity is defined as change from week 24 to week 48 / [(number of weeks since week 24)/52].

Assigned Intervention

End of Treatment, Week 48

6.37
cm/year (Mean)
Standard Deviation: 1.893

End of Treatment, Week 48: Change from Week 24

5.79
cm/year (Mean)
Standard Deviation: 2.213

Visit 2, Week 4

8.89
cm/year (Mean)
Standard Deviation: 13.128

Visit 3, Week 12

8.3
cm/year (Mean)
Standard Deviation: 4.782

Visit 4, Week 20

6.66
cm/year (Mean)
Standard Deviation: 3.155

Visit 5, Week 24

6.9
cm/year (Mean)
Standard Deviation: 3.074

Visit 6, Week 36

6.48
cm/year (Mean)
Standard Deviation: 2.272

Visit 7, Week 44

6.23
cm/year (Mean)
Standard Deviation: 1.953

Tanner Scores: Boys - Development of External Genitalia (Change From Baseline)

Sexual development (physical signs) in puberty were assessed by Tanner staging, a system developed by Marshall and Tanner to categorize pubertal maturation. Tanner stages are commonly used to categorize pubertal maturation in terms of sequence, timing and tempo. Tanner Stages: the minimum is Stage 1 = pre-pubertal physical characteristics and the maximum is Stage 5 = fully matured (adult) physical characteristics.

Assigned Intervention

End of Treatment, Week 48

-1.0
Score on a scale (Mean)
Standard Deviation: 0.00

Visit 3, Week 12

-0.5
Score on a scale (Mean)
Standard Deviation: 0.71

Visit 5, Week 24

-0.5
Score on a scale (Mean)
Standard Deviation: 0.71

Visit 6, Week 36

-0.5
Score on a scale (Mean)
Standard Deviation: 0.71

Tanner Scores: Boys and Girls - Pubic Hair

Sexual development (physical signs) in puberty were assessed by Tanner staging, a system developed by Marshall and Tanner to categorize pubertal maturation. Tanner stages are commonly used to categorize pubertal maturation in terms of sequence, timing and tempo. Tanner Stages: the minimum is Stage 1 = pre-pubertal physical characteristics and the maximum is Stage 5 = fully matured (adult) physical characteristics.

Assigned Intervention

Baseline

2.3
Score on a scale (Mean)
Standard Deviation: 0.81

End of Treatment, Week 48

2.4
Score on a scale (Mean)
Standard Deviation: 0.95

Visit 3, Week 12

2.4
Score on a scale (Mean)
Standard Deviation: 0.89

Visit 5, Week 24

2.5
Score on a scale (Mean)
Standard Deviation: 0.92

Visit 6, Week 36

2.3
Score on a scale (Mean)
Standard Deviation: 0.94

Tanner Scores: Boys and Girls - Pubic Hair (Change From Baseline)

Sexual development (physical signs) in puberty were assessed by Tanner staging, a system developed by Marshall and Tanner to categorize pubertal maturation. Tanner stages are commonly used to categorize pubertal maturation in terms of sequence, timing and tempo. Tanner Stages: the minimum is Stage 1 = pre-pubertal physical characteristics and the maximum is Stage 5 = fully matured (adult) physical characteristics.

Assigned Intervention

End of Treatment, Week 48

0.1
Score on a scale (Mean)
Standard Deviation: 0.58

Visit 3, Week 12

0.1
Score on a scale (Mean)
Standard Deviation: 0.56

Visit 5, Week 24

0.1
Score on a scale (Mean)
Standard Deviation: 0.59

Visit 6, Week 36

0.1
Score on a scale (Mean)
Standard Deviation: 0.60

Tanner Scores: Girls - Breast Development

Sexual development (physical signs) in puberty were assessed by Tanner staging, a system developed by Marshall and Tanner to categorize pubertal maturation. Tanner stages are commonly used to categorize pubertal maturation in terms of sequence, timing and tempo. Tanner Stages: the minimum is Stage 1 = pre-pubertal physical characteristics and the maximum is Stage 5 = fully matured (adult) physical characteristics.

Assigned Intervention

Baseline

3.2
Score on a scale (Mean)
Standard Deviation: 0.61

End of Treatment, Week 48

2.4
Score on a scale (Mean)
Standard Deviation: 0.93

Visit 3, Week 12

2.7
Score on a scale (Mean)
Standard Deviation: 0.90

Visit 5, Week 24

2.6
Score on a scale (Mean)
Standard Deviation: 1.0

Visit 6, Week 36

2.5
Score on a scale (Mean)
Standard Deviation: 0.89

Tanner Scores: Girls - Breast Development (Change From Baseline)

Sexual development (physical signs) in puberty were assessed by Tanner staging, a system developed by Marshall and Tanner to categorize pubertal maturation. Tanner stages are commonly used to categorize pubertal maturation in terms of sequence, timing and tempo. Tanner Stages: the minimum is Stage 1 = pre-pubertal physical characteristics and the maximum is Stage 5 = fully matured (adult) physical characteristics.

Assigned Intervention

End of Treatment, Week 48

-0.7
Score on a scale (Mean)
Standard Deviation: 0.89

Visit 3, Week 12

-0.5
Score on a scale (Mean)
Standard Deviation: 0.90

Visit 5, Week 24

-0.6
Score on a scale (Mean)
Standard Deviation: 0.87

Visit 6, Week 36

-0.6
Score on a scale (Mean)
Standard Deviation: 0.86

Tanner Scores: Boys - Development of External Genitalia

Sexual development (physical signs) in puberty were assessed by Tanner staging, a system developed by Marshall and Tanner to categorize pubertal maturation. Tanner stages are commonly used to categorize pubertal maturation in terms of sequence, timing and tempo. Tanner Stages: the minimum is Stage 1 = pre-pubertal physical characteristics and the maximum is Stage 5 = fully matured (adult) physical characteristics.

Assigned Intervention

Baseline

3.0
Score on a scale (Mean)
Standard Deviation: 0.00

End of Treatment, Week 48

2.0
Score on a scale (Mean)
Standard Deviation: 0.00

Visit 3, Week 12

2.5
Score on a scale (Mean)
Standard Deviation: 0.71

Visit 5, Week 24

2.5
Score on a scale (Mean)
Standard Deviation: 0.71

Visit 6, Week 36

2.5
Score on a scale (Mean)
Standard Deviation: 0.71

Height

Height at each available measurement point. Baseline is defined as the last non-missing height measurement collected prior to or on the date of first injection.

Assigned Intervention

Baseline

136.61
cm (Mean)
Standard Deviation: 8.071

End of Treatment, Week 48

142.37
cm (Mean)
Standard Deviation: 8.207

Screening

136.17
cm (Mean)
Standard Deviation: 8.292

Visit 2, Week 4

137.32
cm (Mean)
Standard Deviation: 8.201

Visit 3, Week 12

138.52
cm (Mean)
Standard Deviation: 8.284

Visit 4, Week 20

138.87
cm (Mean)
Standard Deviation: 8.070

Visit 5, Week 24

139.78
cm (Mean)
Standard Deviation: 8.206

Visit 6, Week 36

140.99
cm (Mean)
Standard Deviation: 8.374

Visit 7, Week 44

141.81
cm (Mean)
Standard Deviation: 8.268

Bone Age

Bone Age at each available measurement point.

Assigned Intervention

Baseline

11.01
years (Mean)
Standard Deviation: 1.307

End of Treatment, Week 48

11.65
years (Mean)
Standard Deviation: 1.124

Visit 5, Week 24

11.3
years (Mean)
Standard Deviation: 1.238

Bone Age Progression

Bone age progression at each available post-baseline measurement point. Bone age progression is defined as (((change from baseline)/(baseline)) x 100), which is percent change from baseline.

Assigned Intervention

End of Treatment, Week 48

6.81
percent change (Mean)
Standard Deviation: 5.741

Maximum Post-Baseline Value

6.63
percent change (Mean)
Standard Deviation: 5.736

Minimum Post-Baseline Value

2.91
percent change (Mean)
Standard Deviation: 4.607

Visit 5, Week 24

2.91
percent change (Mean)
Standard Deviation: 4.607

Bone Age Ratio to Chronological Age at Time of Measurement (Percent Change From Baseline)

Bone Age Ratio to Chronological Age at Time of Measurement is bone age/age at bone age assessment.

Assigned Intervention

End of Treatment, Week 48

-4.9
percent change (Mean)
Standard Deviation: 4.689

Maximum Post-baseline Value

-1.89
percent change (Mean)
Standard Deviation: 4.155

Minimum Post-baseline Value

-6.15
percent change (Mean)
Standard Deviation: 3.934

Visit 5, Week 24

-3.25
percent change (Mean)
Standard Deviation: 4.382

Bone Age Ratio to Chronological Age at Start of Study (Percent Change From Baseline)

Bone age advancement was evaluated relative to chronological age at each given measurement point. Percent change from baseline is: 100 x (the change from baseline value at the post-baseline visit / baseline value).

Assigned Intervention

End of Treatment, Week 48

6.81
percent change (Mean)
Standard Deviation: 5.741

Maximum Post-baseline Value

6.63
percent change (Mean)
Standard Deviation: 5.736

Minimum Post-baseline Value

2.91
percent change (Mean)
Standard Deviation: 4.607

Visit 5, Week 24

2.91
percent change (Mean)
Standard Deviation: 4.607

Bone Age Ratio to Chronological Age at Start of Study

Bone age advancement was evaluated relative to chronological age at each given measurement point. Bone Age Ratio to Chronological Age at Start of Study is bone age/age at first injection.

Assigned Intervention

Baseline

1.38
Ratio (Mean)
Standard Deviation: 0.158

End of Treatment, Week 48

1.47
Ratio (Mean)
Standard Deviation: 0.178

Maximum Post-baseline Value

1.47
Ratio (Mean)
Standard Deviation: 0.176

Minimum Post-baseline Value

1.42
Ratio (Mean)
Standard Deviation: 0.153

Visit 5, Week 24

1.42
Ratio (Mean)
Standard Deviation: 0.153

GnRH Antagonist Evaluation

GnRH Antagonist Evaluation occurred for the two week period following each treatment and at each visit to assess flare symptoms. The percent of subjects who affirm (or whose parent/guardian affirms) each symptom domain in the global interview.

Assigned Intervention

End of Treatment, Week 48

Telephone Contact #1, Week 2

Telephone Contact #2, Week 26

Visit 2, Week 4

Visit 3, Week 12

Visit 4, Week 20

Visit 5, Week 24

Visit 6, Week 36

Visit 7, Week 44

Percentage of Subjects With Suppression of FSH, Estradiol, Oestradiol (HS), and Testosterone Measured by Blood Levels.

The percentage of subjects with FSH, estradiol and testosterone suppression to prepubertal levels (FSH < 2.5 mIU/mL, estradiol < 20 pg/mL and testosterone < 28.4 ng/dL) at each available time point.

Assigned Intervention

End of Treatment, Week 48 : Estradiol

End of Treatment, Week 48 : FSH

End of Treatment, Week 48 : Oestradiol (HS)

End of Treatment, Week 48 : Testosterone

Visit 3, Week 12 : Estradiol

Visit 3, Week 12 : FSH

Visit 3, Week 12 : Oestradiol (HS)

Visit 3, Week 12 : Testosterone

Visit 5, Week 24 : Estradiol

Visit 5, Week 24 : FSH

Visit 5, Week 24 : Oestradiol (HS)

Visit 5, Week 24 : Testosterone

Visit 6, Week 36 : Estradiol

Visit 6, Week 36 : FSH

Visit 6, Week 36 : Oestradiol (HS)

Visit 6, Week 36 : Testosterone

Changes in the Ratio of LH/FSH

Changes in ratio of LH/FSH at each time point from Screening to End of Study

Assigned Intervention

Baseline

0.604
Ratio (Mean)
Standard Deviation: 0.9851

Baseline: 1 hr Post Inj

2.424
Ratio (Mean)
Standard Deviation: 2.1534

Baseline: 1 hr Post Inj: Change from Baseline

1.856
Ratio (Mean)
Standard Deviation: 1.7277

Baseline: 4 hr Post Inj

2.11
Ratio (Mean)
Standard Deviation: 2.3939

Baseline: 4 hr Post Inj: Change from Baseline

1.542
Ratio (Mean)
Standard Deviation: 2.0932

Baseline: 6 hr Post Inj

1.691
Ratio (Mean)
Standard Deviation: 1.7330

Baseline: 6 hr Post Inj: Change from Baseline

1.123
Ratio (Mean)
Standard Deviation: 1.4378

Screening: Post GnRHa Stimulation Test

2.187
Ratio (Mean)
Standard Deviation: 1.6713

Screening: Pre GnRHa Stimulation Test

0.387
Ratio (Mean)
Standard Deviation: 0.4675

Week 12: Post GnRHa Stim Test

1.342
Ratio (Mean)
Standard Deviation: 1.7934

Week12: Post GnRHa Stim Test: Change from Baseline

0.721
Ratio (Mean)
Standard Deviation: 1.7237

Week 12: Pre GnRHa Stim Test

0.565
Ratio (Mean)
Standard Deviation: 0.9100

Week 12: Pre GnRHa Stim Test: Change from Baseline

-0.05
Ratio (Mean)
Standard Deviation: 1.0423

Week 20

0.654
Ratio (Mean)
Standard Deviation: 0.9806

Week 20: Change from Baseline

0.068
Ratio (Mean)
Standard Deviation: 1.1859

Week 24: Post GnRHa Stim Test

1.32
Ratio (Mean)
Standard Deviation: 1.2843

Week24: Post GnRHa Stim Test: Change from Baseline

0.716
Ratio (Mean)
Standard Deviation: 1.4450

Week 24: Pre GnRHa Stim Test

0.611
Ratio (Mean)
Standard Deviation: 0.9571

Week 24: Pre GnRHa Stim Test: Change from Baseline

0.007
Ratio (Mean)
Standard Deviation: 1.1818

Week 36: Post GnRHa Stim Test

1.051
Ratio (Mean)
Standard Deviation: 1.4130

Week36: Post GnRHa Stim Test: Change from Baseline

0.461
Ratio (Mean)
Standard Deviation: 15374

Week 36: Pre GnRHa Stim Test

0.474
Ratio (Mean)
Standard Deviation: 0.5249

Week 36: Pre GnRHa Stim Test: Change from Baseline

-0.125
Ratio (Mean)
Standard Deviation: 1.0038

Week 4

0.843
Ratio (Mean)
Standard Deviation: 1.0004

Week 44

0.517
Ratio (Mean)
Standard Deviation: 0.7846

Week 44: Change from Baseline

-0.073
Ratio (Mean)
Standard Deviation: 1.0575

Week 48: Post GnRHa Stim Test

1.092
Ratio (Mean)
Standard Deviation: 1.5655

Week48: Post GnRHa Stim Test: Change from Baselin

0.509
Ratio (Mean)
Standard Deviation: 1.5780

Week 48: Pre GnRHa Stim Test

0.557
Ratio (Mean)
Standard Deviation: 1.0957

Week 48: Pre GnRHa Stim Test: Change from Baseline

-0.033
Ratio (Mean)
Standard Deviation: 1.2191

Week 4: Change from Baseline

0.233
Ratio (Mean)
Standard Deviation: 1.1425

Age, Continuous

7.5
years (Mean)
Standard Deviation: 0.89

Luteinizing Hormone

23.46
IU/L (Mean)
Standard Deviation: 24.282

Race/Ethnicity, Customized

Region of Enrollment

Sex: Female, Male

Overall Study

Assigned Intervention