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Evaluation of Safety, Tolerability, and Changes in Biomarker and Clinical Outcome Assessments of Losmapimod for FSHD1 (FSHD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT04004000
Recruitment Status : Active, not recruiting
First Posted : July 1, 2019
Last Update Posted : January 22, 2021
Information provided by (Responsible Party):
Fulcrum Therapeutics

Brief Summary:
This clinical trial is a study to evaluate the safety, tolerability, and changes in biomarker and clinical outcome assessments of Losmapimod for patients with Facioscapulohumeral Muscular Dystrophy 1 (FSHD1).

Condition or disease Intervention/treatment Phase
Facioscapulohumeral Muscular Dystrophy 1 Drug: Losmapimod Phase 2

Detailed Description:

This study is a Phase 2, single-centre, open-label pilot study that will investigate the safety, tolerability, pharmacokinetics (PK), and target engagement during long-term dosing with losmapimod tablets in adult subjects with Facioscapulohumeral Muscular Dystrophy 1 (FSHD1). Patients will participate in this for approximately 68 weeks. The total treatment duration will be approximately 52 weeks. Subjects will be evaluated during an 8-week pre-treatment period (Visits 1 through 3) to establish pre-treatment baseline assessments. Subjects will then be treated with losmapimod for approximately 52 weeks (Visits 4 through 9) and assessed at relatively regular intervals for change from pre-treatment in various assessments. Patients must have a confirmed diagnosis of FSHD1 and genetic confirmation must be obtained prior to the screening MRI and baseline muscle biopsy. Patients will receive 15 mg of losmapimod twice daily given as two 7.5 mg tablets per dose by mouth; for a total of 4 pills or 30 mg daily for 52 weeks. All patients will be asked to visit the study clinic for each scheduled visit.

The primary endpoint of the study is to evaluate the safety and tolerability of long-term dosing of losmapimod tablets in subjects with FSHD1. Secondary endpoints include assessment of target engagement of losmapimod in blood and skeletal muscle and repeated dose pharmacokinetics in subjects with FSHD1 over long-term dosing.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 14 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: This is a single-centre, open-label pilot study.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Open-Label Pilot Study of Losmapimod to Evaluate the Safety, Tolerability, and Changes in Biomarker and Clinical Outcome Assessments in Subjects With Facioscapulohumeral Muscular Dystrophy 1 (FSHD1)
Actual Study Start Date : August 23, 2019
Estimated Primary Completion Date : April 2021
Estimated Study Completion Date : April 2021

Arm Intervention/treatment
Experimental: Treatment
FSHD1 patients with genetic confirmation with receive 15 mg of losmapimod twice daily given as two 7.5 mg tablets per dose by mouth; for a total of 4 pills or 30 mg daily for for up to approximately 52 weeks.
Drug: Losmapimod
This study includes up to a 52 week treatment period. Patients will receive 15 mg of losmapimod twice daily given as two 7.5 mg tablets per dose by mouth; for a total of 4 pills or 30 mg daily. The study drug should be taken with food and the date and time of each dose taken recorded in the subject diary.

Primary Outcome Measures :
  1. Treatment-Emergent Adverse Events [ Time Frame: Week 56 ]
    Incidence of treatment-emergent adverse events assessed by clinically significant laboratory test results, ECGs, and vital signs.

Secondary Outcome Measures :
  1. Target Engagement in Blood [ Time Frame: Week 52 ]
    Change from baseline in phospho-HSP27 and ratio of pHSP27/total HSP27 will be measured in peripheral whole blood.

  2. Target Engagement in Skeletal Muscle [ Time Frame: Week 40 ]
    Change from baseline in phospho-HSP27 and ratio of pHSP27/total HSP27 will be measured in muscle.

  3. Plasma Concentration of Losmapimod [ Time Frame: Week 52 ]
    Blood samples will be collected to measure the plasma concentration of losmapimod at specified timepoints.

Other Outcome Measures:
  1. Muscle Disease Transcripts [ Time Frame: Week 40 ]
    To evaluate the change from baseline in inflammatory, immune, apoptotic, and muscle disease transcripts in muscle biopsy and circulating proteins in plasma and serum.

  2. DUX4 Activity [ Time Frame: Week 40 ]
    Change from baseline in DUX4 activity will be measured by quantitative polymerase chain reaction (qPCR) of skeletal muscle using a subset of DUX4-regulated gene transcripts.

  3. Muscle Lean Tissue Volume [ Time Frame: Week 52 ]
    Change from baseline in skeletal muscle lean tissue volume as measured by whole body magnetic resonance imaging (MRI).

  4. Muscle Tissue Replacement by Fat [ Time Frame: Week 52 ]
    Change from baseline in skeletal muscle tissue replacement by fat as measured by whole body magnetic resonance imaging (MRI).

  5. Muscle Ultrasound [ Time Frame: Week 52 ]
    Ultrasound will be used to evaluate the echogenicity of specified muscles.

  6. Reachable Work Space (RWS) [ Time Frame: Week 52 ]
    Subjects are seated in front of a 3D camera and asked to perform a standardized upper extremity movement protocol under the supervision of a study clinical evaluator with and without weights.

  7. Timed Up and Go (TUG) [ Time Frame: Week 52 ]
    Subjects are timed as they start from a seated or laying position, rise to a standing position, walk a total of 6 meters and then return to either a seated or laying position.

  8. Motor Function Measure (MFM) Domain 1 [ Time Frame: Week 52 ]
    The MFM domain 1 is a validated evaluator administered functional measure for neuromuscular disorders, with 13 items related to standing and transfers.

  9. Muscle Strength [ Time Frame: Week 52 ]
    Muscle strength will be assessed by Hand-Held Quantitative Dynamometry.

  10. FSHD Rasch-built Overall Disability Scale (RODS) [ Time Frame: Week 52 ]
    The FSHD-RODS is a patient-reported, linearly weighted scale that precisely measures activities of daily living (ADLs) and participation in subjects with FSHD using 50 items based on the Rasch model.

  11. FSHD Health Index (FSHD-HI) [ Time Frame: Week 52 ]
    The HI is a 15 domain questionnaire designed and based on patient interviews to measure total FSHD health-related quality-of-life, including both motor impairment and the social and emotional impact of FSHD. 116 questions are combined into a total score, the score is transformed onto a percentage scale, with 100 representing maximal disability, and lower scores representing decreasing disability.

  12. Patients' Global Impression of Change (PGIC) [ Time Frame: Week 52 ]
    The PGIC is a single question that assesses on a scale of 1-7 if there has been an improvement, decline or no change in clinical status.

  13. Real World Mobility Assessments [ Time Frame: Week 52 ]
    Each subject's activity will be monitored in the outpatient setting intermittently from the signing of the informed consent form (ICF) to the end of the study. Wearable activity monitoring devices will be provided to each subject at the start of the study. One device is placed on 1 arm, and 1 device goes on 1 leg.

  14. Respiratory Function [ Time Frame: Week 52 ]
    Forced vital capacity and forced expiratory volume in 1 second using bedside spirometry.

  15. Quantitative Dynamometry [ Time Frame: Week 52 ]
    Force will be measured on digital myometer, in KG-force.

Information from the National Library of Medicine

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.

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • FSHD1 subjects age 18-65 years.
  • Subject will sign and date an informed consent form (ICF).
  • Confirmed diagnosis of FSHD1 with 1 to 9 repeats via assessment of the size of the D4Z4 array on chromosome 4. Genetic confirmation must be obtained prior to the screening MRI and baseline muscle biopsy; genetic confirmation can come from previous testing if verified with appropriate documentation.
  • Must be willing and able to comply with scheduled visits, treatment plan, study restrictions, laboratory tests, contraceptive guidelines, scheduled needle muscle biopsies, and other study procedures.
  • Both male and female subjects must be willing to practice an approved method of birth control.
  • Clinical Severity Score between 2 and 4 on Ricci's Scale (scale range is from 0 to 5).
  • Commitment to complete the 2 visits for skeletal muscle needle biopsy and all visits for whole-body MRI.
  • Able to complete the RWS, TUG, and FSHD PROs (FSHD-RODS and FSHD-HI) at the screening visit.
  • Must have an MRI-eligible muscle for biopsy

Exclusion Criteria:

  • Subject has a history of any illness or any clinical condition that, in the opinion of the investigator, might confound the results of the study or pose an additional risk in administering study drug to the subject. This may include, but is not limited to, history of relevant drug or food allergies; history of cardiovascular or central nervous system disease; history or presence of clinically significant pathology; clinically significant history of mental disease; and history of cancer, except for squamous cell skin cancer, basal cell skin cancer, and Stage 0 cervical carcinoma in situ (all 3 with no recurrence for the last 5 years).
  • Subject has a known or clinically suspected infection with human immunodeficiency virus or hepatitis B or C viruses.
  • Subject has current clinically significant liver or kidney dysfunction.
  • Subject screens positive for hepatitis B surface antigen, hepatitis C virus (HCV) antibody, or antibodies against human immunodeficiency viruses 1 and 2 (HIV 1/HIV 2 antibodies).
  • Subject has any condition possibly affecting drug absorption (eg, gastrectomy, cholecystectomy, or other gastrointestinal tract surgery, except appendectomy).
  • Male subject has a female partner who is planning to become pregnant during the study or within 90 days after the last study drug dose.
  • Subject has participated in a clinical trial in which they have received an investigational product within the following time period prior to enrolment in the current study: 30 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever was longer).
  • For subjects that are on drug(s) or supplements that may affect muscle function as determined by the treating physician or included in the list of drugs presented in Section 15: subjects must be on a stable dose of that drug(s) or supplement for at least 3 months prior to enrollment in the study and remain on that stable dose for the duration of the study (list of drugs presented in Section 15). Changes to the dose or treatment discontinuation during the study can only be done for strict medical reasons by the treating physician with clear documentation and notification to the sponsor.
  • Subject has a history of sensitivity to any of the study medications or components thereof, or a history of drug or other allergy that, in the opinion of the investigator or Medical Monitor, contraindicated their participation.
  • Subject is unwilling or unable to follow the procedures outlined in the protocol.
  • Subject has any contraindication for MRI (including severe claustrophobia and any shrapnel or metal implants in the body that are not MRI compatible).
  • Subject was mentally or legally incapacitated up to 2 years prior to enrollment.

Information from the National Library of Medicine

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 identifier (NCT number): NCT04004000

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Radboud University Medical Center
Nijmegen, Netherlands, 9101
Sponsors and Collaborators
Fulcrum Therapeutics
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Study Director: Michelle Mellion, MD Fulcrum Therapeutics
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Responsible Party: Fulcrum Therapeutics Identifier: NCT04004000    
Other Study ID Numbers: FIS-001-2019
First Posted: July 1, 2019    Key Record Dates
Last Update Posted: January 22, 2021
Last Verified: January 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Fulcrum Therapeutics:
Muscular Dystrophies
Facioscapulohumeral Muscular Disorders
Atrophic Muscular Diseases
Musculoskeletal Diseases
Neuromuscular Diseases
Additional relevant MeSH terms:
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Muscular Dystrophies
Muscular Dystrophy, Facioscapulohumeral
Muscular Disorders, Atrophic
Muscular Diseases
Musculoskeletal Diseases
Neuromuscular Diseases
Nervous System Diseases
Genetic Diseases, Inborn