New ZTALMY recommended titration schedule — click here to access the latest prescribing information

The pivotal trial included 101 children and young
adults with CDD1,2

Patients in the randomized, placebo-controlled pivotal trial ranged in age from 2 to 19 years. Approximately 79% of these patients were female, 92% were white, and the mean age was 7.3 years.1,3 The minimum and maximum weight of patients enrolled in this study were 8.7 kg and 46.5 kg, respectively.3 The trial included 10 patients aged 15 years or older.3

Baseline characteristics

Patients had tried and discontinued a median
of 7 ASMs (range, 1 to 16)3

Patients were taking a median of
2 concomitant ASMs3*

Patients had a median of 50 major motor
seizures per 28 days3

ASMs=antiseizure medications.

*96% of patients were taking at least 1 ASM. The most frequently used (≥20% of patients) concomitant ASMs were valproate, levetiracetam, clobazam, and vigabatrin.1

Patients taking ZTALMY experienced a significant reduction in seizure frequency1

ZTALMY reduced the frequency of monthly major motor seizures by a median of 31%, compared with 7% for placebo, over 17 weeks (P=0.0036).1

Reduction in monthly major motor seizure frequency over 17 weeks (primary endpoint)1

Chart showing seizure reduction of ZTALMY versus placebo Chart showing seizure reduction of ZTALMY versus placebo

ZTALMY provided

4x

the reduction in seizure

frequency vs placebo1

*Change from baseline. Median baseline frequency of major motor seizures per 28 days was 54 for the ZTALMY group (n=49) and 49 for the placebo group (n=51).1

Multiple major motor seizure types associated with CDD were measured1

  • Bilateral tonic
  • Generalized tonic-clonic
  • Atonic
  • Bilateral clonic
  • Focal to bilateral tonic-clonic

Seizure frequency was reduced by at least half for some patients1,2

More patients in the ZTALMY group (24.5%) experienced a ≥50% reduction from baseline in monthly major motor seizure frequency over 17 weeks compared with placebo (9.8%).3

Responder analysis over 17 weeks3

ZTALMY (n=49) Placebo (n=51)
Proportion of patients seeing a reduction in 28-day major motor seizure frequency ZTALMY versus placebo Proportion of patients seeing a reduction in 28-day major motor seizure frequency ZTALMY versus placebo

21 patients taking ZTALMY had a <25% response, compared with 39 placebo-treated patients.3

*A key secondary endpoint; not statistically significant.3

Pivotal trial design: The Marigold study1-4

The efficacy and safety of ZTALMY to treat seizures associated with CDD in patients 2 years and older were established in a single, double-blind, randomized, placebo-controlled study.1

Patients enrolled in the study were required to have1:

  • Molecular confirmation of a pathogenic or likely pathogenic cyclin-dependent kinase-like 5 (CDKL5) variant
  • Seizures inadequately controlled by at least 2 previous ASM regimens
  • A minimum of 16 major motor seizures per 28 days during the
    2 months prior to screening
Study design for the Marigold study

The 17-week double-blind phase of the Marigold study was followed by a long-term open-label phase in which all patients received ZTALMY. The secondary objectives of the OLE study were to assess the long-term efficacy, safety, and tolerability of ZTALMY.2,4

*Total daily dosage divided three times a day.

Results from an open-label extension study of patients taking ZTALMY

Following the pivotal trial, 88 out of 101 patients entered an open-label extension (OLE) study to evaluate the ongoing efficacy, safety, and tolerability of ZTALMY.3

The secondary objectives of the OLE study included the collection of additional safety and tolerability data. Safety findings were consistent with the double-blind phase; no new safety findings had emerged at the time of analysis.3,4 The most common treatment-related, treatment-emergent adverse events were somnolence (17%; n=15), seizure (11.4%; n=10), and decreased appetite (5.7%; n=5).5

Secondary objectives of the OLE study also included additional efficacy assessments. Open-label design and small sample size preclude conclusions about efficacy.

Percent reduction in median major motor seizure frequency through 2 years of the OLE study3*

Median percent reduction in 28-day major motor seizure frequency, open-label ZTALMY versus placebo
Median percent reduction in 28-day major motor seizure frequency, open-label ZTALMY versus placebo

Patients who remained in this study at 2 years experienced sustained reduction in MMSF3

Reasons for discontinuation: 37 (42.0%) patients discontinued from the OLE due to lack of efficacy (n=13), withdrawal by caregiver (n=12), adverse events (n=10), physician decision (n=1), and death (n=1).3†

MMSF=major motor seizure frequency.

*Date of analysis: June 30, 2022.

†Death occurred due to sepsis that was deemed unrelated to the study drug.

Questions? Sign up to stay informed or speak with a ZTALMY representative

SIGN UP

Learn about the
safety data for ZTALMY

SAFETY

IMPORTANT SAFETY INFORMATION AND INDICATION

WARNINGS AND PRECAUTIONS

  • •

    Somnolence and Sedation: ZTALMY can cause somnolence and sedation. In a clinical study somnolence and sedation appeared early during treatment and were generally dose related. Other CNS depressants, including opioids, antidepressants, and alcohol, could potentiate these effects. Monitor patients for these effects and advise them not to drive or operate machinery until they have gained sufficient experience on ZTALMY to gauge whether it adversely affects their ability to drive or operate machinery.

IMPORTANT SAFETY INFORMATION AND INDICATION

INDICATION AND USAGE

ZTALMY is indicated for the treatment of seizures associated with cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) in patients 2 years and older.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

ADVERSE REACTIONS

The most common adverse reactions (incidence of at least 5% and at least twice the rate of placebo) were somnolence (38%), pyrexia (18%), salivary hypersecretion (6%), and seasonal allergy (6%).

DRUG INTERACTIONS

Cytochrome P450 inducers will decrease ganaxolone exposure. Avoid concomitant use with strong or moderate CYP3A4 inducers; if unavoidable, consider a dosage increase of ZTALMY, but do not exceed the maximum recommended dosage.

UGT inhibitors may increase ganaxolone exposure. Consider a reduction of ZTALMY maintenance dose when initiating UGT inhibitors.

USE IN SPECIFIC POPULATIONS

DRUG ABUSE AND DEPENDENCE

ZTALMY contains ganaxolone, a Schedule V controlled substance (CV). Advise patients of the potential for abuse and dependence. It is recommended that ZTALMY be tapered according to the dosage recommendations unless symptoms warrant immediate discontinuation.

Please see full Prescribing Information.

References:

  1. Ztalmy. Package insert. Immedica Pharma US Inc.
  2. Knight EMP, Amin S, Bahi-Buisson N, et al. Lancet Neurol. 2022;21(5):417-427.
  3. Data on file. Immedica Pharma AB.
  4. Specchio N, Amin S, Hulihan J, et al. Extended duration safety and efficacy of ganaxolone for the treatment of CDKL5 deficiency disorder: preliminary open-label extension analysis (Marigold Study). American Epilepsy Society. Dec 4-8, 2020. Virtual conference.
  5. Olson HE, Amin S, Bahi-Buisson N, et al. Epilepsia. 2024;65(1):37-45.