A Randomized, Double-blind, Placebo-controlled, Multicenter Study to Evaluate the Efficacy and Safety of Cenobamate Adjunctive Therapy in Subjects with Primary Generalized Tonic-Clonic Seizures

Prior treatment

• Subject has a history of intermittent use of rescue benzodiazepines 4 or more times within the 30 days prior to Visit 1 (Screening/Baseline).
• Subject has received an investigational drug or device within 30 days prior to Visit 1 (Screening/Baseline).
• Subject has a history of drug or alcohol dependency or abuse within 2 years prior to Visit 1 (Screening/Baseline).
• Subject tests positive, via urine drug screen at Visit 1 (Screening/Baseline), for illicit drugs not legalized in your state or for a drug that has not been prescribed.
• Subject has a history of status epilepticus that required hospitalization within 12 months prior to Visit 1 (Screening/Baseline).
• Previous exposure to cenobamate or sensitivity/allergy to components of the oral suspension.
• Subject has a concomitant diagnosis of partial onset seizure (POS).
• Subject is currently taking (within the 30 days prior to Visit 1 [Screening/Baseline]) any of the following medications: diazepam (for any reason other than as intermittent benzodiazepine rescue medication), phenytoin, mephenytoin, fosphenytoin, phenobarbital, primidone, ethotoin, clopidogrel, fluvoxamine, amitriptyline, clomipramine, bupropion, methadone, ifosfamide, cyclophosphamide, or efavirenz.
• Subject has participated in previous cenobamate clinical studies.
• Subject has a history of vigabatrin use within 5 months prior to Visit 1 (Screening/Baseline), or the subject plans to begin treatment with vigabatrin during the study. a) A subject with a history of vigabatrin use that ended more than 5 months prior to Visit 1 may be enrolled after documented evidence of no vigabatrin-associated clinically significant abnormality in an automated visual perimetry test.

Other illness

• Subject has a history of any serious drug-induced hypersensitivity reaction (including, but not limited to, Stevens Johnson syndrome, toxic epidermal necrolysis, or DRESS syndrome) or any drug-related rash requiring hospitalization.
• History of AED-associated rash that involved conjunctiva or mucosae.
• History of more than one non-serious drug-related hypersensitivity reaction that required discontinuation of the medication.
• Subject has evidence of clinically significant abnormalities or disease that, in the opinion of the Principal Investigator, could affect the subject's safety or conduct of the study.
• Subject has any significant active central nervous system (CNS) infection, demyelinating disease, degenerative neurologic disease or any CNS disease deemed to be progressive during the course of the study that may confound the interpretation of the study results.
• Subject has a history of positive antibody/antigen test for hepatitis A, hepatitis B, hepatitis C, or HIV.
• Subject has PGTC seizure clusters where individual seizures cannot be counted or classified.
• Subject has a history of non-epileptic psychogenic seizures.
• Subject has a clinical diagnosis of Lennox-Gastaut syndrome.

Lab values

• Presence of congenital short QT syndrome or relevant replicated change in QT/QTc interval less than 340 msec on ECG.
• Subject has a creatinine clearance less than 50 mL/min, as calculated by Cockcroft-Gault equation.
• Subject has an absolute neutrophil count less than 1500/μL.
• Subject has platelet count lower than 80,000/μL in subjects treated with valproate.

Other

• Female subjects who are pregnant (or planning to become pregnant during the study), lactating, or breast-feeding.
• Subject has any suicidal ideation (with intent with or without a plan) at Visit 1 (Screening/Baseline) or Visit 4 (Randomization).
• Subject has more than 1 lifetime suicide attempt.
• Subject is a staff member or immediate family member of study staff.

• Subject is male or female and aged ≥12 years.
• Subject taking a ketogenic diet will be allowed as long as the diet has been stable for at least 3 months prior to Visit 1 (Screening/Baseline) and will remain stable for the duration of the study.
• Written informed consent signed by the subject, legal guardian, or legally authorized representative (LAR) prior to entering the study, in accordance with the International for Conference on Harmonisation (ICH) Good Clinical Practice (GCP) guidelines. Age-appropriate assent will be obtained for adolescents. If the written informed consent is provided by the legal guardian because the subject is unable to do so, a written or verbal assent from the subject must also be obtained. As required by country-specific regulations, only the subject may sign the ICF in accordance with ICH guidelines.
• Female subjects of childbearing potential are willing to use an acceptable form of birth control.
• Subject has a clinical diagnosis of PGTC seizures (with or without other subtypes of generalized seizures) in the setting of idiopathic generalized epilepsy.
• Subject experiences at least 5 PGTC seizures in 12 weeks during the Pre-Randomization Period.
• Subject has had a routine electroencephalogram (EEG) within 5 years prior to Visit 1 (Screening/Baseline) or during the Pre-Randomization Period with electroencephalographic features consistent with idiopathic generalized epilepsy; other concomitant anomalies must be explained by adequate past medical history.
• Subject has undergone computed tomography (CT) or magnetic resonance imaging (MRI) within 10 years prior to Visit 1 (Screening/Baseline) or during the Pre-Randomization Period that ruled out a progressive cause of epilepsy.
• Subject is currently receiving 1 to a maximum of 3 concomitant antiepileptic drugs (AEDs) with fixed dosing regimens for a minimum of 30 days prior to Visit 1 (Screening/Baseline). a) Benzodiazepines (except diazepam, see Exclusion Criterion No. 7) taken at least once per week during the 30 days prior to Visit 1 (Screening/Baseline) for epilepsy, anxiety, or sleep disorder will be counted as 1 AED and the dosage must be continued unchanged throughout the study. Therefore, only a maximum of 2 additional approved AEDs will be allowed. (See Exclusion Criterion No. 10 for intermittent benzodiazepine rescue parameters.) b) Subjects receiving felbamate as a concomitant AED must meet the following criteria: i. Have a 2-year history of felbamate use and a history of a fixed dosing regimen for a minimum of 60 days prior to Visit 1 (Screening/Baseline). ii. No prior or known history of hepatotoxicity or hematologic disorder due to felbamate.
• Subject with an implanted vagal nerve or deep brain stimulator will be allowed if the stimulator was implanted at least 5 months prior to Visit 1 (Screening/Baseline) and the stimulator parameters are not changed for 30 days prior to Visit 1 and for the duration of the study.