Pre-Symptomatic Study of Intravenous Onasemnogene Abeparvovec-xioi in Spinal Muscular Atrophy (SMA) for Patients With Multiple Copies of SMN2 (SPR1NT)
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| ClinicalTrials.gov Identifier: NCT03505099 |
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Recruitment Status :
Completed
First Posted : April 23, 2018
Results First Posted : January 11, 2022
Last Update Posted : September 7, 2022
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| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Spinal Muscular Atrophy | Biological: onasemnogene abeparvovec-xioi | Phase 3 |
Phase 3, open-label, single-arm study of a single, one-time dose of onasemnogene abeparvovec-xioi (gene replacement therapy) in patients with spinal muscular atrophy who meet enrollment criteria and are genetically defined by bi-allelic deletion of survival motor neuron 1 gene (SMN1) with 2 or 3 copies of survival motor neuron 2 gene (SMN2). Patients with SMN1 point mutations or the SMN2 gene modifier mutation (c.859G>C) may enroll but will not be included in the efficacy analysis sets.
The study includes a screening period, a gene replacement therapy period, and a follow-up period. During the screening period (Days -30 to -2), patients whose parent(s)/legal guardian(s) provide informed consent will undergo screening procedures to determine eligibility for study enrollment. Patients who meet the entry criteria will enter the in-patient gene replacement therapy period (Day -1 to Day 2). On Day -1, patients will be admitted to the hospital for pre-treatment baseline procedures. On Day 1, patients will receive a single, one-time intravenous (IV) infusion of onasemnogene abeparvovec-xioi, and will undergo in-patient safety monitoring for a minimum of 24 hours post infusion. Patients may be discharged 24 hours (48 hours in Japan) after the infusion, based on Investigator judgment. During the outpatient follow-up period (Days 3 to End of Study at 18 or 24 of age, dependent upon respective SMN2 copy number), patients will return at regularly scheduled intervals for efficacy and safety assessments until the End of Study when the patient reaches 18 months of age (SMN2 = 2) or 24 months of age (SMN2 = 3). After the End of Study visit, eligible patients will be invited to rollover into a long-term follow up study.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 30 participants |
| Allocation: | N/A |
| Intervention Model: | Single Group Assignment |
| Intervention Model Description: | Open-label, single arm |
| Masking: | None (Open Label) |
| Primary Purpose: | Treatment |
| Official Title: | A Global Study of a Single, One-Time Dose of AVXS-101 Delivered to Infants With Genetically Diagnosed and Pre-symptomatic Spinal Muscular Atrophy With Multiple Copies of SMN2 |
| Actual Study Start Date : | April 2, 2018 |
| Actual Primary Completion Date : | June 15, 2021 |
| Actual Study Completion Date : | June 15, 2021 |
| Arm | Intervention/treatment |
|---|---|
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Experimental: onasemnogene abeparvovec-xioi
One-time intravenous infusion of onasemnogene abeparvovec-xioi at 1.1 X 10^14 vg/kg
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Biological: onasemnogene abeparvovec-xioi
A non-replicating recombinant AAV9 containing the complimentary deoxyribonucleic acid (cDNA) of the human SMN gene under the control of the cytomegalovirus (CMV) enhancer/chicken-β-actin-hybrid promoter (CB). The AAV inverted terminal repeat (ITR) has been modified to promote intramolecular annealing of the transgene, thus forming a double-stranded transgene ready for transcription.
Other Name: Zolgensma |
- Cohort 1: Number of Participants Who Achieved Sitting Alone for at Least 30 Seconds [ Time Frame: From Day 1 up to 18 months of age visit ]Defined by the Bayley Scales of Infant and Toddler Development (BSID) Gross Motor (GM) subtest performance criteria number 26, confirmed by video recording, as a participant who sits for at least 30 seconds without assistance from another person or object. The participant was allowed to use their upper extremities.
- Cohort 2: Number of Participants Who Achieved Standing Alone for at Least 3 Seconds [ Time Frame: From Day 1 up to 24 months of age visit ]Defined by the BSID GM subtest performance criteria number 40, confirmed by video recording, as a participant who stands alone for at least 3 seconds unsupported.
- Cohort 1: Event-free Survival at 14 Months of Age [ Time Frame: From Day 1 up to 14 months of age ]Event-free survival at 14 months of age was defined as the number of participants who did not die, did not require permanent ventilation and did not withdraw from the study by 14 months of age.
- Cohort 1: Number of Participants Who Achieved the Ability to Maintain Weight at or Above the Third Percentile Without the Need for Non-Oral or Mechanical Feeding Support [ Time Frame: From Day 1 up to 18 months of age ]
The ability to maintain weight at or above the third percentile without the need for non-oral or mechanical feeding support was defined by meeting the following criteria at each visit up to 18 months of age:
- Did not receive nutrition through mechanical support (i.e., feeding tube)
- Maintained weight (≥ third percentile for age and sex as defined by World Health Organization [WHO] guidelines) consistent with the participant's age at the assessment.
- Cohort 2: Number of Participants Who Achieved the Ability to Walk Alone [ Time Frame: From Day 1 up to 24 months of age visit ]Defined by the BSID GM subtest performance criteria number 43, confirmed by video recording, as a participant who takes 5 coordinated independent steps.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
| Ages Eligible for Study: | up to 42 Days (Child) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age ≤6 weeks (≤42 days) at time of dose
- Ability to tolerate thin liquids as demonstrated through a formal bedside swallowing test
- Compound muscle action potential (CMAP) ≥2mV at Baseline; centralized review of CMAP data will be conducted
- Gestational age of 35 to 42 weeks
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Parent(s)/legal guardian(s) willing and able to complete the informed consent process and comply with study procedures and visit schedule
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Patients with pre-symptomatic SMA Type 1 as determined by the following features:
a. 2 copies of SMN2 (n ≥14)
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Patients with pre-symptomatic SMA Type 2 as determined by the following features:
- 3 copies of SMN2 (n ≥12)
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Exclusion Criteria:
- Weight at screening visit <2 kg
- Hypoxemia (oxygen saturation <96% awake or asleep without any supplemental oxygen or respiratory support) at the screening visit or for altitudes >1000 m, oxygen saturation <92% awake or asleep without any supplemental oxygen or respiratory support at the screening visit
- Any clinical signs or symptoms at screening or immediately prior to dosing that are, in the opinion of the Investigator, strongly suggestive of SMA
- Tracheostomy or current prophylactic use or requirement of noninvasive ventilatory support at any time and for any duration prior to screening or during the screening period
- Patients with signs of aspiration/inability to tolerate nonthickened liquids based on a formal swallowing test performed as part of screening or patients receiving any non-oral feeding method
- Clinically significant abnormal laboratory values (gamma-glutamyl transferase [GGT], Alanine transaminase [ALT], and aspartate aminotransferase [AST], or total bilirubin > 2 × the upper limit of normal [ULN], creatinine ≥ 1.0 mg/dL, hemoglobin [Hgb] < 8 or > 18 g/dL; white blood cell [WBC] > 20,000 per cmm) prior to gene replacement therapy. Patients with an elevated bilirubin level that is unequivocally the result of neonatal jaundice shall not be excluded
- Treatment with an investigational or commercial product, including nusinersen, given for the treatment of SMA. This includes any history of gene therapy, prior antisense oligonucleotide treatment, or cell transplantation.
- Patients whose weight-for-age is below the third percentile based on World Health Organization (WHO) Child Growth Standards
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Biological mother with active viral infection as determined by screening laboratory samples (includes human immunodeficiency virus [HIV] or positive serology for hepatitis B or C)
• Biological mothers with clinical suspicion of Zika virus that meet Centers for Disease Control and Prevention (CDC) Zika virus epidemiological criteria including history of residence in or travel to a geographic region with active Zika transmission at the time of travel will be tested for Zika virus RNA. Positive results warrant confirmed negative Zika virus RNA testing in the patient prior to enrollment.
- Serious nonrespiratory tract illness requiring systemic treatment and/or hospitalization within 2 Weeks prior to screening
- Upper or lower respiratory infection requiring medical attention, medical intervention, or increase in supportive care of any manner within 4 Weeks prior to dosing
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Severe nonpulmonary/respiratory tract infection within 4 Weeks before administration of gene replacement therapy or concomitant illness that, in the opinion of the Investigator or Sponsor medical monitor, creates unnecessary risks for gene replacement therapy such as:
- Major renal or hepatic impairment
- Known seizure disorder
- Diabetes mellitus
- Idiopathic hypocalciuria
- Symptomatic cardiomyopathy
- Known allergy or hypersensitivity to prednisolone or other glucocorticosteroids or their excipients
- Previous, planned or expected major surgical procedure including scoliosis repair surgery/procedure during the study assessment period
- Concomitant use of any of the following: drugs for treatment of myopathy or neuropathy, agents used to treat diabetes mellitus, or ongoing immunosuppressive therapy, plasmapheresis, immunomodulators such as adalimumab, immunosuppressive therapy within 4 Weeks prior to gene replacement therapy
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AntiAAV9 antibody titer >1:50 as determined by Enzyme-linked Immunosorbent Assay (ELISA) binding immunoassay
• Should a potential patient demonstrate AntiAAV9 antibody titer >1:50, he or she may receive retesting inside the 30-Day screening period and will be eligible to participate if the AntiAAV9 antibody titer upon retesting is ≤1:50, provided the <6 Week age requirement at the time of dosing is still met
- Biological mother involved with the care of the child refuses anti-AAV9 antibody testing prior to dosing
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03505099
| United States, California | |
| David Geffen School of Medicine at UCLA | |
| Los Angeles, California, United States, 90095 | |
| United States, Colorado | |
| Children's Hospital Colorado | |
| Aurora, Colorado, United States, 80045 | |
| United States, Florida | |
| Nemours Children's Hospital | |
| Orlando, Florida, United States, 32827 | |
| United States, Massachusetts | |
| Massachusetts General Hospital | |
| Boston, Massachusetts, United States, 02114 | |
| United States, Michigan | |
| Helen DeVos Children's Hospital | |
| Grand Rapids, Michigan, United States, 49503 | |
| United States, Missouri | |
| St. Louis Children's Hospital | |
| Saint Louis, Missouri, United States, 63110 | |
| United States, New York | |
| Columbia University Medical Center | |
| New York, New York, United States, 10032 | |
| United States, Ohio | |
| Nationwide Children's Hospital | |
| Columbus, Ohio, United States, 43205 | |
| United States, Pennsylvania | |
| Clinic for Special Children | |
| Strasburg, Pennsylvania, United States, 17579 | |
| United States, Texas | |
| Children's Medical Center Dallas | |
| Dallas, Texas, United States, 75235 | |
| United States, Wisconsin | |
| University Hospital and UW Health Clinics | |
| Madison, Wisconsin, United States, 53792 | |
| Australia, New South Wales | |
| Sydney Children's Hospital | |
| Randwick, New South Wales, Australia, 2145 | |
| Belgium | |
| Centre Hospitalier Régional Hôpital La Citadelle | |
| Liège, Belgium, 4000 | |
| Canada, Ontario | |
| Canada Childrens Hospital of Eastern Ontario | |
| Ottawa, Ontario, Canada, K1H8L1 | |
| Japan | |
| Tokyo Women's Medical | |
| Tokyo, Japan | |
| United Kingdom | |
| Great Ormond Street Hospital for Children NHS Foundation Trust | |
| London, United Kingdom, WC1N 3JH | |
| Study Director: | Novartis Pharmaceuticals | Novartis Pharmaceuticals |
Documents provided by Novartis ( Novartis Gene Therapies ):
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Novartis Gene Therapies |
| ClinicalTrials.gov Identifier: | NCT03505099 |
| Other Study ID Numbers: |
AVXS-101-CL-304 2017-004087-35 ( EudraCT Number ) JapicCTI-184203 ( Registry Identifier: JapicCTI ) COAV101A12303 ( Other Identifier: Novartis Pharmaceuticals ) |
| First Posted: | April 23, 2018 Key Record Dates |
| Results First Posted: | January 11, 2022 |
| Last Update Posted: | September 7, 2022 |
| Last Verified: | August 2022 |
| Individual Participant Data (IPD) Sharing Statement: | |
| Plan to Share IPD: | Yes |
| Plan Description: | Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on https://www.clinicalstudydatarequest.com/. |
| URL: | https://www.clinicalstudydatarequest.com/ |
| Studies a U.S. FDA-regulated Drug Product: | Yes |
| Studies a U.S. FDA-regulated Device Product: | No |
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gene therapy |
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Muscular Atrophy Muscular Atrophy, Spinal Atrophy Pathological Conditions, Anatomical Neuromuscular Manifestations Neurologic Manifestations |
Nervous System Diseases Spinal Cord Diseases Central Nervous System Diseases Motor Neuron Disease Neurodegenerative Diseases Neuromuscular Diseases |