Study of the Efficacy and Safety of Nicotinamide in Patients With Friedreich Ataxia

Prior treatment

• Clinically significant psychiatric illness (e.g., uncontrolled major depression, schizophrenia, bipolar affective disorder) within 6 months prior to screening.
• Patients with a significant history of substance abuse (e.g. alcohol or drug abuse) within the previous six months before enrolment.
• The subject received an investigational drug within 30 days prior to inclusion into this study.
• Use of vitamin B1 (thiamine), withdrawal should be at least 3 months prior screening or 5 half-lives, whichever is longer.
• Use of vitamin B3 (nicotinamide), withdrawal should be at least 3 months prior screening.
• Patients participating at start or have been within 30 days before start of study in another pharmacological and non-pharmacological clinical trial, excluding natural history / observational studies.

Other illness

• Patients with any medical condition or illness that, in the opinion of the investigator would interfere with study compliance and/or impair the patient´s ability to participate or complete the study.
• Any uncontrolled medical or neurological/neurodegenerative condition (other than Friedreich ataxia).
• Hypersensitivity to nicotinamide.
• Patients known to be positive for human immunodeficiency virus (HIV).
• Patients with a history of severe allergies to medications.
• History of malignancy or carcinoma. The following exceptions may be made after discussion with the Sponsor:
  • Subjects with cancers in remission more than 5 years prior to screening.
  • Subjects with a history of excised or treated basal cell or squamous carcinoma.
  • Subjects with prostate cancer in situ.
• History or evidence of an autoimmune disorder considered clinically significant by the Investigator or requiring chronic use of systemic corticosteroids or other immunosuppressants.
• The subject has a history of any other illness, which, in the opinion of the Investigator, might pose an unacceptable risk by administering study medication.
• For subjects who will undergo an MRI: Any contraindications to MRI such as, but not limited to cardiac pacemaker, implanted cardiac defibrillator, aneurysm clips, carotid artery vascular clamp, neurostimulator, implanted drug infusion devices, metal fragments or foreign objects in the eyes, skin or body, bone growth/fusion stimulator, cochlear, otologic implant, severe claustrophobia or any condition that would counterindicate an MRI scan.

Lab values

• Indication of impaired liver function as shown by an abnormal liver function profile at screening (e.g., repeated values of aspartate aminotransferase [AST], alanine aminotransferase [ALT] and bilirubin ≥3 × the upper limit of normal).
• History of clinically significant cardiac disease (ejection fraction < 40% [normal range 50-70%], cardiac insufficiency defined as New York Heart Association [NYHA] Class >2; clinically significant congenital or acquired valvular disease; symptomatic coronary disease such as prior myocardial infarction or angina, B-type natriuretic peptide (BNP) level increase more than 2 x of the normal age- and gender dependent range; history of unstable arrhythmias, history of atrial fibrillation).
• Patients taking sodium valproate, tranylcypromine or any other known histone deacetylase inhibitor.
• Pregnant females as determined by positive [serum or urine] hCG test at Screening or prior to dosing. Participants of child-bearing age should use adequate contraception as defined in the study protocol.

Other

• Patients with significant clinical dysphagia.
• If patients are taking idebenone or coenzyme Q10 (CoQ), this should be stable over the last three months and not changed during the study.
• The subject is unwilling or unable to provide written informed consent and to follow the procedures outlined in the protocol.
• The subject is mentally or legally incapacitated.
• Lactating females.

• Patients must have a molecular genetic diagnosis of Friedreich ataxia with a GAA- repeat expansion on both alleles of the FXN gene and a SARA Score >7 and <28 and age <50 years.
• Patients must be ≥18 years old and have a weight of at least 50kg.
• Written informed consent prior to study participation
• A female subject is eligible to participate if she is of: Non-childbearing potential defined as pre-menopausal females with a documented tubal ligation or hysterectomy; or postmenopausal defined as 12 months of spontaneous amenorrhea or of childbearing potential and agrees to