Dose-Ranging Study of AVI-4658 to Induce Dystrophin Expression in Selected Duchenne Muscular Dystrophy (DMD) Patients

Duchenne Muscular Dystrophy Clinical Trial

Official title:

Clinical Study to Assess the Safety fo AVI-4658 in Subjects With Duchenne Muscular Dystrophy Due to a Frame-shift Mutation Amenable to Correction by Skipping Exon 51.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00844597
• Other study ID #: AVI-4658-28
• Status: Completed
• Phase: Phase 1/Phase 2
• First received: December 24, 2008
• Last updated: September 3, 2015
• Start date: January 2009
• Est. completion date: December 2010

Study information

• Verified date: September 2015
• Source: Sarepta Therapeutics
• Contact: n/a
• Is FDA regulated: No
• Health authority: United Kingdom: Medicines and Healthcare Products Regulatory Agency
• Study type: Interventional

Clinical Trial Summary

The specific aim of this Phase I/II study is to assess the safety of intravenous administered Morpholino oligomer directed against exon 51 (AVI-4658 PMO).

Description:

Primary outcome is safety, tolerability and dose selection for future studies.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 19
• Est. completion date: December 2010
• Est. primary completion date: June 2010
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 5 Years to 15 Years

Eligibility

Inclusion Criteria:

1. Has provided written informed assent (as required by EC) and parents/guardians have provided written informed consent.

2. Has an out-of-frame deletion(s) that could be corrected by skipping exon 51 based on DNA sequencing data from the candidate.

3. Is male and between the ages of = 5 years and = 15 years.

4. Has a muscle biopsy analysis showing < 5% revertant fibres present at baseline.

5. DNA sequencing of the candidate's dystrophin exon 51 confirms that no DNA polymorphisms are present that could compromise PMO duplex formation or there is confirmation of in vitro dystrophin production after AVI-4658 exposure to fibroblast or myoblast in vitro cultures.

6. Intact right and left bicep muscles or alternative arm muscle group.

7. Is able to walk independently at least 25 meters.

8. Has a forced vital capacity (FVC) = 50% of predicted and does not require ventilatory support or supplemental oxygen.

9. Receives the standard of care for DMD as recommended by the DMD care recommendations from the North Star UK and TREAT-NMD.

10. The parent(s) or legal guardian and Subject have undergone counselling about the expectations of this protocol and agree to participate.

11. The parent(s) or legal guardian and Subject intend to comply with all study evaluations and return for all study activities.

Exclusion Criteria:

1. A DNA polymorphism within exon 51 that may compromise PMO duplex formation.

2. Known antibodies to dystrophin.

3. Lacks intact right and left bicep muscles or alternative arm muscle group.

4. A calculated creatinine clearance less than 70% of predicted normal for age based on the Cockcroft and Gault Formula.

5. A left ventricular ejection fraction (EF) of < 35% and/or fractional shortening of <25% based on echocardiography (ECHO)during screening.

6. A history of respiratory insufficiency as defined by need for intermittent or continuous supplemental oxygen.

7. A severe cognitive dysfunction rendering the potential subject unable to understand and comply with the study protocol.

8. Any known immune deficiency or autoimmune disease.

9. A known bleeding disorder or has received chronic anticoagulant treatment within three months of study entry.

10. Receipt of pharmacologic treatment, apart from corticosteroids, that might affect muscle strength or function within 8 weeks of study entry (viz., growth hormone, anabolic steroids).

11. Surgery within 3 months of study entry or planned for anytime during the duration of the study.

12. Another clinically significant illness at time of study entry.

13. Subject or parent has active psychiatric disorder, has adverse psychosocial circumstances,recent significant emotional loss, and/or history of depressive or anxiety disorder that might interfere with protocol compliance.

14. Use of any experimental treatments, has participated in any DMD interventional clinical trial within 4 weeks of study entry or participated in the AVI-4658-33 intramuscular (i.m.) trial.

Study Design

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Duchenne Muscular Dystrophy
• Muscular Dystrophies
• Muscular Dystrophy, Duchenne

Intervention

Drug:
• AVI-4658 for Injection
AVI-4658 for Injection, is packaged as 100 mg/mL in phosphate buffered saline with 1 mL per vial. Study dosages will be infused over a 1 hour period with Normal saline in 6 dose cohorts.

Locations

Country	Name	City	State
United Kingdom	Great Ormond Street Hospital	London	England
United Kingdom	Royal Victoria Infirmary	Newcastle Upon Tyne	England

Sponsors (2)

Lead Sponsor	Collaborator
Sarepta Therapeutics	British Medical Research Council

Country where clinical trial is conducted

United Kingdom, 

References & Publications (1)

Cirak S, Arechavala-Gomeza V, Guglieri M, Feng L, Torelli S, Anthony K, Abbs S, Garralda ME, Bourke J, Wells DJ, Dickson G, Wood MJ, Wilton SD, Straub V, Kole R, Shrewsbury SB, Sewry C, Morgan JE, Bushby K, Muntoni F. Exon skipping and dystrophin restorat — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety and Tolerability	Number of subjects with 1 or more Treatment Emergent Adverse Event that are possibly related to the investigational drug	Baseline to 6 months	Yes
Primary	Treatment Emergent Adverse Events	Number of Patients with Treatment Emergent Adverse Events	from Baseline to Follow up (27 weeks)	Yes
Secondary	Pharmacokinetics - Mean Peak Plasma Concentration of AVI-4658 After Administration	Standard Pharmacokinetic parameters estimated using non-compartmental modeling of plasma concentration data.	Samples were taken: 30 minutes pre dose; and at 5 (±1), 15 (±2), 30 (±5), 60 (±5), and 90 (±5) minutes; and 2, 4, 6, 8, 12, and 24 hours (all ± 15 minutes) post dose at Weeks 1, 6, and 12	Yes
Secondary	Efficacy of Eteplirsen Over 12 Weeks of Dosing	Efficacy was defined as an estimated change in the percentage of dystrophin positive fibers (assessed by IHC) at Week 14 from Baseline after 12 weekly doses of eterplirsen. This outcome measure represents the number of patients to show an increase in the percentage of dystrophin-positive fibers.	Biopsies were taken at Baseline and Week 14	No

External Links

•   Exon skipping and dystrophin restoration in patients with Duchenne muscular dystrophy after systemic phosphorodiamidate morpholino oligomer treatment an open-label, phase 2, dose-escalation study