Study of Diazepam Buccal Film Administered in the Interictal and in the Ictal-Periictal States to Adults With Epilepsy
Study of Diazepam Buccal Film Administered in the Interictal and in the Ictal-Periictal States to Adults With Epilepsy
This Phase 2 open-label, two-way study was conducted in adult subjects with epilepsy who were
 on stable regimens of anti-epileptic drugs (AEDs) and who were admitted to an Epilepsy
 Monitoring Unit (EMU), General Clinical Research Center (GCRC), or similar facility for
 evaluation of their seizures. All subjects received a single DBF 12.5 mg dose during the
 Interictal State and a single DBF 12.5 mg dose during the Ictal/peri-ictal state with at
 least 14 days washout between the 2 doses.
This was a Phase 2 multicenter, open-label, two-way study conducted in adult subjects to
 assess the bioavailability, pharmacokinetics, and safety of DBF during the Interictal Period
 and during the Ictal/peri-ictal Period, with a minimum of 14 days of washout between periods.
 Subjects had a clinical diagnosis of epilepsy (with generalized tonic-clonic seizures or
 focal seizures with impaired awareness) who were on stable regimens of anti-epileptic drugs
 and were scheduled for admission to an EMU, GCRC, or similar facility for evaluation.

 All subjects were to receive a single 12.5-mg dose of study drug, without regard to meals,
 during both Interictal Period and Ictal/peri-ictal Period. The treatment was identical for
 both periods. Treatment sequence was not randomized. The interictal period and
 ictal/peri-ictal could occur in either order as determined by seizure occurrence.

 Interictal Period: Subjects were considered to be in an interictal state if an interval of at
 least 3 hours had elapsed since any clinically observable postictal signs or symptoms (from
 the last observed seizure) and the subject had been seizure-free over this period. Subjects
 on electroencephalogram (EEG) video monitoring were to be considered to be in an interictal
 state if an interval of at least 3 hours had elapsed since there were any postictal
 electrical findings on EEG.

 Ictal/peri-ictal Period: For the purposes of this study, the ictal state was defined as an
 ongoing clinically observable seizure or seizure activity as verified via EEG. The periictal
 state was defined clinically as the subject's immediate postictal state following a
 generalized tonic-clonic (GTC) seizure or focal seizure with impaired awareness, and within 5
 minutes following the last clonic jerk. For subjects on EEG video monitoring, the periictal
 state was to be defined as less than 5 minutes after cessation of seizure activity as
 verified via EEG.
Inclusion Criteria:

 Potential subjects meeting all of the following criteria may be included in the study:

 1. Subjects scheduled for admission to the institution's EMU, GCRC (General Clinical
 Research Center) or similar facility for evaluation within 28 days.

 2. Male and female subjects between 18 to 65 years of age, inclusive.

 3. Subjects having a body weight of ≥ 40 kg to 111 kg.

 4. Subjects have a clinical diagnosis of epilepsy and are scheduled to be admitted to an
 Epilepsy Monitoring Unit (EMU) for extracranial video-Electroencephalogram (EEG)
 recording of a seizure event for evaluation of their epilepsy.

 5. Subjects have an average frequency of > 1 seizure every 3 days or > 10 seizures /
 month as documented by seizure diaries dispensed at the Screening Visit and verified
 prior to initiation of Period A or Period B.

 6. Female subjects have a negative serum pregnancy test at Screening. Female subjects of
 childbearing potential (i.e., not surgically sterile or 2 years postmenopausal) must
 have a negative pregnancy test at screening and a partner who is sterile, agree to
 abstinence, be practicing double barrier contraception or using an FDA approved
 contraceptive (e.g., licensed hormonal or barrier methods) for greater than 2 months
 prior to screening visit and commit to an acceptable form of birth control for the
 duration of the study and for 30 days after participation in the study.

 7. Subjects are currently receiving at least one antiepileptic medication.

 8. Subjects or subject's legally authorized representative (LAR) must be willing and able
 to complete informed consent/assent and HIPAA authorization.

 9. Subjects must agree and must be willing to comply with all required study procedures
 while in the EMU or GCRC.

 10. Ability to comprehend and be informed of the nature of the study, as assessed by the
 PI or Sub-Investigator.

 11. Ability to consume standard meals.

 12. Availability to volunteer for the entire study duration and willing to adhere to all
 protocol requirements.

 Exclusion Criteria:

 Potential subjects meeting any of the following criteria will be excluded:

 1. Subjects having a progressive neurological disorder such as brain tumor, demyelinating
 disease, or degenerative central nervous system (CNS) disease that is likely to
 progress in the next 12 months.

 2. Subjects having respiratory failure (or is at risk for respiratory failure) or other
 severe cardiorespiratory disease with New York Heart Association Class III or IV
 functional status, or requires supplemental oxygen.

 3. Female subjects who are lactating or positive serum pregnancy test (ß-hCG) at
 screening for female subjects ≥12 years of age.

 4. Subjects with severe psychiatric disease that in the Investigator's judgment would
 prevent the patient's successful completion of the study.

 5. Subjects who have an episode of status epilepticus, as determined by the Principal
 Investigator/Sub-Investigator, at any time during Period B (EMU, GCRC or similar
 facility Visit

 6. Subjects with known history or presence of any clinically significant hepatic (e.g.
 hepatic impairment), renal/genitourinary (renal impairment, kidney stones),
 psychiatric, dermatological or hematological disease or condition unless determined as
 not clinically significant by the Principal Investigator/Sub-Investigator and
 confirmed by Sponsor via written communication prior to subject enrollment.

 7. Subjects with any clinically significant illness other than epilepsy within 30 days
 prior to first dosing, as determined by the Principal Investigator/Sub-Investigator.

 8. Subjects with any significant physical or organ abnormality as determined by the
 Principal Investigator/Sub-Investigator.

 9. Subjects with any significant lesion of the oral cavity or having oral prophylactic
 procedures within 30 days prior to first dosing.

 10. Subjects with a QTc interval QTcF>450 msec for males and QTcF>470 msec for females on
 screening ECG, unless determined as not clinically significant by the Investigator.

 11. Subjects with a positive test result for any of the following: drugs of abuse
 (amphetamines, cocaine, opiates, or phencyclidine), a positive breath alcohol test.

 12. Subjects with a known history or presence of: a. Alcohol abuse or dependence within
 one year prior to first drug administration; b. Drug abuse or dependence; c.
 Hypersensitivity or idiosyncratic reaction to diazepam, its excipients, sodium
 phosphates; and/or related substances, e.g. benzodiazepines; d. Glaucoma (open or
 acute narrow angle); e. Severe allergic reactions (e.g. anaphylactic reactions,
 angioedema

 13. Subjects who have participated in another clinical trial or who received an
 investigational drug within 30 days prior to first drug administration or 5 half-lives
 of the investigational drug-whichever is the longer period.

 14. Blood or plasma donation within 30 days prior to Screening

 15. Subjects not willing or unable to tolerate blood draws.

 16. Subjects who have received any other dosage form of diazepam or benzodiazepines within
 2 weeks prior to entering Period A or Period B.

 17. Consumption of alcohol within 48 hours before dosing and food or beverages containing
 grapefruit, star fruit, Seville oranges, and/or pomelo or their derived products
 (e.g., fruit juice) within 10 days prior to first drug administration.

 18. Use of any enzyme-modifying drugs, including strong inhibitors of cytochrome P450
 (CYP) enzymes (e.g. cimetidine, fluoxetine, quinidine, erythromycin, ciprofloxacin,
 fluconazole, ketoconazole, diltiazem, or HIV antivirals) and strong inducers of CYP
 enzymes (e.g. glucocorticoids, St. John´s Wort, or rifampicin) in the previous 30 days
 before first drug administration [barbiturates, carbamazepine, and phenytoin are
 allowed since these are common AEDs (Anti-epileptic drugs)].

 19. Use of any monoamine oxidase (MAO) inhibitors (e.g. phenelzine, tranylcypromine),
 phenothiazines (chlorpromazine) within 30 days prior to first drug administration.

 20. Employee or immediate relative of an employee of the investigator, MonoSol Rx LLC, any
 of its affiliates or partners, or inVentiv Health.