A Study to Investigate the Safety and Efficacy of RO7204239 in Combination With Risdiplam (RO7034067) in Participants With Spinal Muscular Atrophy (MANATEE)

• ClinicalTrials.gov Identifier: NCT05115110
• Recruitment Status: Recruiting
• First Posted: November 10, 2021
• Last Update Posted: March 17, 2023
• Sponsor: Hoffmann-La Roche
• Information provided by (Responsible Party): Hoffmann-La Roche

Study Description

Brief Summary:

Risdiplam works by helping the body produce more survival motor neuron (SMN) protein throughout the body. This means fewer motor neurons - nerve cells that pass impulses from nerves to muscles to cause movement - are lost, which may improve how well muscles work in people with SMA. RO7204239 is an investigational anti-myostatin antibody that is designed to target myostatin. Myostatin plays an important role in the regulation of skeletal muscle size by controlling growth. Inhibiting myostatin may help muscles grow in size and strength. RO7204239 in combination with risdiplam, which is designed to increase the amount of SMN protein throughout the body, has the potential to further improve motor function and clinical outcomes for people living with SMA.

This trial will study: 1) The safety and efficacy of RO7204239 in combination with risdiplam in patients aged 2-10 years with spinal muscular atrophy (SMA) that are either ambulant or non-ambulant, and 2) the efficacy and safety of RO7204239 in combination with risdiplam in patients aged 2-25 years with SMA that are ambulant.

Condition or disease	Intervention/treatment	Phase
Spinal Muscular Atrophy (SMA)	Drug: RO7204239; Drug: Placebo; Drug: Risdiplam	Phase 2; Phase 3

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 259 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Double (Participant, Investigator)
• Primary Purpose: Treatment
• Official Title: A Two-Part, Seamless, Multi-Center, Randomized, Placebo-Controlled, Double-Blind Study to Investigate the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics and Efficacy of RO7204239 in Combination With Risdiplam (RO7034067) in Patients With Spinal Muscular Atrophy
• Actual Study Start Date: June 2, 2022
• Estimated Primary Completion Date: June 27, 2026
• Estimated Study Completion Date: June 27, 2026

Arms and Interventions

Arm	Intervention/treatment
Experimental: RO7204239 + Risdiplam; Participants who have not previously been treated with risdiplam will receive risdiplam for at least 8 weeks prior to randomization into a treatment group (Part 1 only). Participants that have been treated with risdiplam for at least 8 continuous weeks immediately prior to joining the study may be immediately randomized to combination therapy, or join the study run-in period (the period between screening and randomization to a treatment group) where they will continue to receive risdiplam monotherapy until randomization. Participants enrolled in Part 1 will receive RO7204239 (low or high dose) + risdiplam for 24 weeks, followed by RO7204239 + risdiplam for 72 weeks. Participants enrolled in Part 2 will receive risdiplam for 8 weeks and then treatment with RO7204239 + risdiplam for 72 weeks. Once the treatment period has completed (Part 1 or Part 2), participants will have the option of treatment with RO7204239 + risdiplam for 2 additional years.	Drug: RO7204239; RO7204239 will administered every 4 weeks (Q4W) by subcutaneous (SC) injection into the abdomen. RO7204239 will be investigated at low- and high-dose in Part 1.; Drug: Risdiplam; Risdiplam will be administered orally once daily (QD) for the duration of the study.; Other Names: RO7034067; Evrysdi
Active Comparator: Placebo + Risdiplam; Participants who have not previously been treated with risdiplam will receive risdiplam for at least 8 weeks prior to randomization into a treatment group (Part 1 only). Participants that have been treated with risdiplam for at least 8 continuous weeks immediately prior to joining the study may be immediately randomized to combination therapy, or join the study run-in period (the period between screening and randomization to a treatment group) where they will continue to receive risdiplam monotherapy until randomization. Participants enrolled in Part 1 will receive placebo (low or high dose-matched) + risdiplam for 24 weeks, followed by RO7204239 + risdiplam for 72 weeks. Participants enrolled in Part 2 will receive risdiplam for 8 weeks and then treatment with placebo + risdiplam for 72 weeks. Once the treatment period has completed (Part 1 or Part 2), participants will have the option of treatment with RO7204239 + risdiplam for 2 additional years.	Drug: Placebo; Placebo will be administered Q4W by SC injection into the abdomen.; Drug: Risdiplam; Risdiplam will be administered orally once daily (QD) for the duration of the study.; Other Names: RO7034067; Evrysdi

Outcome Measures

Primary Outcome Measures :

1. Part 1 - Percentage of participants with adverse events (AEs) [ Time Frame: Up to 4.5 years ]
2. Part 1 - Incidence of relevant echocardiographic parameter z scores > 2 [ Time Frame: Up to 4.5 years ]
3. Part 1 - Serum concentration of RO7204239 [ Time Frame: Through Week 96 ]
4. Part 1 - Time to maximum serum concentration (Cmax) of RO7204239 [ Time Frame: Through Week 96 ]
5. Part 1 - Area under the curve (AUC) of RO7204239 [ Time Frame: Through Week 96 ]
6. Part 1 - Trough concentration (Ctrough) of RO7204239 [ Time Frame: Through Week 96 ]
7. Part 1 - Plasma concentration of risdiplam [ Time Frame: Week 21 ]
8. Part 1 - Plasma concentration of risdiplam metabolite (M1) [ Time Frame: Week 21 ]
9. Part 1 - Cmax of risdiplam [ Time Frame: Week 21 ]
10. Part 1 - AUC of risdiplam [ Time Frame: Week 21 ]
11. Part 1 - Ctrough of risdiplam [ Time Frame: Week 21 ]
12. Part 1 - Incidence of anti-drug antibodies (ADAs) [ Time Frame: Through Week 96 ]
13. Part 1 - Change from baseline in serum concentration of total myostatin [ Time Frame: Through Week 85 ]
14. Part 1 - Change from baseline in serum concentration of free latent myostatin [ Time Frame: Through Week 85 ]
15. Part 1 - Change from baseline in serum concentration of mature myostatin [ Time Frame: Through Week 85 ]
16. Part 1 - Percent change from baseline in the contractile area of skeletal muscle in the dominant thigh muscles as assessed by magnetic resonance imaging (MRI) in participants aged at least 5 years [ Time Frame: Week 24 of combination treatment ]
17. Part 1 - Percent change from baseline in the contractile area of skeletal muscle in the dominant calf muscles as assessed by MRI in participants aged at least 5 years [ Time Frame: Week 24 of combination treatment ]
18. Part 2 - Change from baseline in Revised Hammersmith Scale (RHS) total score [ Time Frame: Week 72 of combination treatment (study Week 80) ]

Secondary Outcome Measures :

1. Part 2 - Change from baseline in Motor Function Measure (MFM) Domain 1 + Domain 2 (D1 + D2) score [ Time Frame: Week 72 of combination treatment (study Week 80) ]
2. Part 2 - Change from baseline in MFM-32 total score [ Time Frame: Week 72 of combination treatment (study Week 80) ]
3. Part 2 - Change from baseline in time taken to rise from the floor as measured by RHS Item 25 [ Time Frame: Week 72 of combination treatment (study Week 80) ]
4. Part 2 - Change from baseline in time taken to walk/run 10 meters as measured by RHS Item 19 [ Time Frame: Week 72 of combination treatment (study Week 80) ]
5. Part 2 - Percent change from baseline in lean mass as assessed by full body dual energy X-ray absorptiometry (DXA) scan in participants aged at least 5 years [ Time Frame: Week 72 of combination treatment (study Week 80) ]
6. Part 2 - Percentage of participants with adverse events (AEs) [ Time Frame: Up to 4.5 years ]
7. Part 2 - Serum concentration of RO7204239 [ Time Frame: Through Week 80 ]
8. Part 2 - Cmax of RO7204239 [ Time Frame: Through Week 80 ]
9. Part 2 - AUC of RO7204239 [ Time Frame: Through Week 80 ]
10. Part 2 - Ctrough of RO7204239 [ Time Frame: Through Week 80 ]
11. Part 2 - Plasma concentration of risdiplam [ Time Frame: Week 32 ]
12. Part 2 - Plasma concentration of risdiplam metabolite (M1) [ Time Frame: Week 32 ]
13. Part 2 - Cmax of risdiplam [ Time Frame: Week 32 ]
14. Part 2 - AUC of risdiplam [ Time Frame: Week 32 ]
15. Part 2 - Ctrough of risdiplam [ Time Frame: Week 32 ]
16. Part 2 - Incidence of ADAs [ Time Frame: Through Week 80 ]

Eligibility Criteria

• Ages Eligible for Study: 2 Years to 25 Years (Child, Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Age at screening: Part 1- Cohorts A, B, and D: 5-10 years, inclusive; Part 1 Cohort C: 2-4 years, inclusive; Part 2: 2-25 years, inclusive
• Participants who have a confirmed genetic diagnosis of 5q-autosomal recessive SMA
• Symptomatic SMA disease, as per investigator's clinical judgement
• Participants who have received previous SMA disease-modifying therapies may be included provided that: Onasemnogene abeparvovec was received at least 90 days prior to screening. Participants should be tapered off steroids prior to receiving risdiplam. In addition, participants should have normal levels of liver function tests, coagulatory parameters, platelets, and troponin-I at 90 days after administration of onasemnogene abeparvovec or at least 1 month after tapering off corticosteroids, whichever comes later; Nusinersen last dose was received at least 90 days prior to screening; Risdiplam is switched to the investigational medicinal product (IMP) provided by the site

Inclusion Criteria for Part 1 Cohorts A, B, and C and Part 2 only:

• Participants who are ambulant, where ambulant is defined as able to walk/run unassisted (i.e., without the use of assistive devices such as canes, walking sticks, crutches, walkers, person/hand-held assistance, braces, orthoses, over the malleoli insoles or any other type of support) 10 meters in ≤ 30 seconds as measures by the Timed 10-Meter Walk/Run Test [10MWRT] at screening

Inclusion Criteria for Part 1 Cohort D only:

• Participants who are able to sit, defined by: A score of 3 on Item 9 of the MFM32 (sitting without upper limb support while maintaining contact between the two hands for 5 seconds); A score of at least 2 on Item 10 of the MFM32 (while seated, leaning forward to touch a tennis ball and sitting back again, either with or without upper limb support)
• Participants who are able to raise a standardized plastic cup with a 200g weight in it to the mouth, using both hands if necessary, defined by a score of 3 on the entry item of the Revised Upper Limb Module (RULM)

Exclusion Criteria:

• Concomitant or previous participation in any investigational drug or device study within 90 days prior to screening or 5 half-lives of the drug whichever is longer, with the exception of those who have completed a risdiplam study, or participated in a nusinersen or onasemnogene abeparvovec study
• Receiving or have received previous administration of anti-myostatin therapies
• Any history of cell therapy
• Hospitalization for a pulmonary event within the last 2 months or planned hospitalization at the time of screening
• Past surgery for scoliosis or hip fixation in the 6 months preceding screening or planned within the next 9 months (Part 1) or 21 months (Part 2)
• Unstable gastrointestinal, renal, hepatic, endocrine, or cardiovascular system diseases considered to be clinically significant
• Clinically significant ECG abnormalities at screening from average of triplicate measurement, abnormal findings at echocardiography, or cardiovascular disease indicating a safety risk for participants at the time of screening
• Any major illness within 1 month before screening
• Received any multidrug and toxin extrusion (MATE1/2K) substrates within 2 weeks before screening
• Hereditary fructose intolerance
• Used any of the following medications within 90 days prior to screening: riluzole, valproic acid, hydroxyurea, sodium phenylbutyrate, butyrate derivatives, creatine, carnitine, growth hormone, anabolic steroids, probenecid, acetyl cholinesterase inhibitors, agents that could potentially increase or decrease muscle strength, and agents with known or presumed histone deacetylase (HDAC) inhibitory effect
• Clinically significant abnormalities in laboratory test results at the time of screening
• Ascertained or presumptive hypersensitivity to RO7204239 or risdiplam, or to the constituents of its formulations
• Clinically relevant history of anaphylactic reaction requiring inotropic support
• Any abnormal skin conditions, pigmentation or lesions in the area intended for SC injection (abdomen) and that would prevent visualization of potential injection site reactions to RO7204239
• Immobilization, surgical procedures, fracture, or trauma to the upper or lower limbs within 90 days prior to screening

Exclusion Criteria for Part 1 Cohorts A and B only:

• Participants with contraindications for MRI scan (including, but not restricted to, claustrophobia, pacemaker, artificial heart valves, cochlear implants, presence of foreign metal objects in heart or body, including spinal rods, intracranial vascular clips, insulin pumps, etc.), difficulties maintaining a prolonged supine position, or any other clinical history or examination finding that would pose a potential hazard in combination with MRI

Exclusion Criteria for Part 1 Cohort D only:

• Participants who are unable to adopt the correct position to endure adequate quality of DXA scan acquisition, as determined by the DXA scan technologist
• Participants who have contractures at screening that would interfere with DXA scan acquisition or functional assessments, as confirmed by the DXA scan technologist and clinical evaluator
• For participants able to take steps only: Able to walk unassisted (i.e., without the use of assistive devices such as canes, walking sticks, crutches, walkers, person/hand held assistance, braces, orthoses, over the malleoli insoles or any other type of support) 10 meters in ≤ 30 seconds as measured by the timed 10MWRT at screening
• Participants who have severe scoliosis (curvature > 40°) at screening based on the participant's most recent X-ray as performed per standard of care or scoliosis that would interfere with functional assessments, as confirmed by the clinical evaluator. An X-ray is not required if it is not clinically indicated (e.g., in participants with mild scoliosis)
• Participants who require invasive ventilation, tracheostomy, or the use of noninvasive ventilation (e.g., bilevel positive airway pressure) during the daytime

Contacts and Locations

Contacts

Contact: Reference Study ID Number: BN42644 https://forpatients.roche.com/; 888-662-6728; global-roche-genentech-trials@gene.com

Locations

United States, Massachusetts

Boston Childrens Hospital; Recruiting

Boston, Massachusetts, United States, 02115

Belgium

UZ Gent; Recruiting

Gent, Belgium, 9000

Chr de La Citadelle; Recruiting

Liège, Belgium, 4000

Italy

Policlinico Agostino Gemelli; Dipartimento di Neuropsichiatria Infantile; Recruiting

Roma, Lazio, Italy, 00168

Fondazione IRCCS Istituto Neurologico ?Carlo Besta?; UO di Neurologia dello Sviluppo; Recruiting

Milano, Lombardia, Italy, 20133

Netherlands

Universitair Medisch Centrum Utrecht; Recruiting

Utrecht, Netherlands, 3584 CX

Poland

Uniwersyteckie Centrum Kliniczne; Klinika Neurologii Rozwojowej; Recruiting

Gdańsk, Poland, 80-952

Uniwersytecki Szpital Kliniczny w Poznaniu; Od. Kliniczny Neurologii Dzieci i M?odziezy; Recruiting

Poznań, Poland, 60-355

Klinika Neurologii I Wydzialu Lekarskiego WUM w Warszawie; Recruiting

Warszawa, Poland, 02-097

United Kingdom

Great Ormond Street Hospital For Children; Neurology; Recruiting

London, United Kingdom, WC1N 3JH

John Radcliffe Hospital; Recruiting

Oxford, United Kingdom, OX3 9DU

Sponsors and Collaborators

Hoffmann-La Roche

Investigators

• Study Director: Clinical Trials; Hoffmann-La Roche

More Information

• Responsible Party: Hoffmann-La Roche
• ClinicalTrials.gov Identifier: NCT05115110
• Other Study ID Numbers: BN42644
• First Posted: November 10, 2021
• Last Update Posted: March 17, 2023
• Last Verified: March 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: Qualified researchers may request access to individual patient level data through the clinical study data request platform (www.vivli.org). Further details on Roche's criteria for eligible studies are available here (https://vivli.org/ourmember/roche/). For further details on Roche's Global Policy on the Sharing of Clinical Information and how to request access to related clinical study documents, see here (https://www.roche.com/research_and_development/who_we_are_how_we_work/clinical_trials/our_commitment_to_data_sharing.htm).

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

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; Risdiplam; Neuromuscular Agents; Peripheral Nervous System Agents; Physiological Effects of Drugs