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Clinical Trial Details — Status: Enrolling by invitation

Administrative data

NCT number NCT04729907
Other study ID # 232SM302
Secondary ID 2023-505637-27
Status Enrolling by invitation
Phase Phase 3
First received
Last updated
Start date April 19, 2021
Est. completion date July 31, 2026

Study information

Verified date March 2024
Source Biogen
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The primary objective of this study is to evaluate the long-term safety and tolerability of nusinersen administered intrathecally at higher doses to participants with spinal muscular atrophy (SMA) who previously participated in study 232SM203 (NCT04089566). The secondary objective of this study is to evaluate the long-term efficacy of nusinersen administered intrathecally at higher doses to participants with SMA who previously participated in study 232SM203 (NCT04089566).


Recruitment information / eligibility

Status Enrolling by invitation
Enrollment 145
Est. completion date July 31, 2026
Est. primary completion date July 31, 2026
Accepts healthy volunteers No
Gender All
Age group N/A and older
Eligibility Key Inclusion Criteria: - Completed the Day 302 visit in study 232SM203 (NCT04089566) in accordance with the study protocol Key Exclusion Criteria: - Treatment with another investigational therapy or enrollment in another interventional clinical study - Treatment with an approved therapy for SMA after the Day 302 Visit of Study 232SM203 (NCT04089566) NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
Nusinersen
Administered as specified in the treatment arm

Locations

Country Name City State
Brazil Hospital de Clínicas de Porto Alegre Porto Alegre
Brazil Hospital das Clinicas - FMUSP São Paulo
Canada London Health Sciences Centre (LHSC) - Children's Hospital London Ontario
Chile Clinica Las Condes Santiago
Chile Clinica MEDS La Dehesa Santiago
Chile Hospital Luis Calvo Mackenna Santiago
China Guangzhou Woman and Children's Medical Center Guangzhou Guangdong
China The Children's Hospital of Zhejiang University School of Medicine Hangzhou Zhejiang
Colombia Hospital Universitario San Ignacio Bogota
Estonia Tallinn Children's Hospital Tallinn
Germany Universitaetsklinikum Freiburg Freiburg Baden Wuerttemberg
Germany Universitaetsklinikum Giessen und Marburg GmbH Giessen Hessen
Italy Fondazione Serena Onlus - Centro Clinico Nemo Milano
Italy Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma
Japan Kurume University Hospital Kurume-shi Fukuoka-Ken
Japan Hyogo Medical University Hospital Nishinomiya-shi Hyogo-Ken
Japan Tokyo Women's Medical University Hospital Shinjuku-ku Tokyo-To
Lebanon Saint George University Hospital Medical Center Beirut
Mexico Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde Guadalajara
Mexico Hospital Infantil de Mexico Federico Gomez Mexico Distrito Federal
Mexico Instituto Nacional de Pediatria Mexico Distrito Federal
Poland Instytut 'Pomnik - Centrum Zdrowia Dziecka' Warszawa
Russian Federation Regional Pediatric Clinical Hospital #1 Ekaterinburg
Russian Federation Russian Children Neuromuscular Center of Veltischev Moskva
Saudi Arabia King Fahad Specialist Hospital Dammam
Saudi Arabia National Guard Health Affairs: King Abdulaziz Medical City Jeddah
Saudi Arabia King Faisal Specialist Hospital & Research Center Riyadh
Spain Hospital Universitario La Paz Madrid
Spain Hospital Universitari i Politecnic La Fe Valencia
Taiwan Kaohsiung Medical University Chung-Ho Memorial Hospital Kaohsiung
Taiwan National Taiwan University Hospital Taipei
United States Children's Hospital Colorado Aurora Colorado
United States The Johns Hopkins Hospital Baltimore Maryland
United States Boston Children's Hospital Boston Massachusetts
United States Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
United States St. Jude Children's Research Hospital Memphis Tennessee
United States Children's Medical Center Plano Texas
United States Stanford University Medical Center Sacramento California

Sponsors (1)

Lead Sponsor Collaborator
Biogen

Countries where clinical trial is conducted

United States,  Brazil,  Canada,  Chile,  China,  Colombia,  Estonia,  Germany,  Italy,  Japan,  Lebanon,  Mexico,  Poland,  Russian Federation,  Saudi Arabia,  Spain,  Taiwan, 

Outcome

Type Measure Description Time frame Safety issue
Primary Number of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs) An AE is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. An SAE is any untoward medical occurrence that at any dose results in death, in the view of the investigator, places the participant at immediate risk of death, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a birth defect, or is a medically important event. Up to Day 1921
Primary Change from Baseline in Growth Parameters Growth parameters will be assessed by measuring body length or height (if feasible and appropriate), ulnar length (all participants), and head circumference, chest circumference, and arm circumference (all participants 3 years of age and younger) in centimeters. Up to Day 1921
Primary Number of Participants With Shifts from Baseline in Clinical Laboratory Parameters Up to Day 1921
Primary Number of Participants With Shifts from Baseline in Electrocardiogram (ECG) Up to Day 1921
Primary Number of Participants With Shifts from Baseline in Vital Signs Up to Day 1921
Primary Change from Baseline in Activated Partial Thromboplastin Time (aPTT) Up to Day 1921
Primary Change from Baseline in Prothrombin Time (PT) Up to Day 1921
Primary Change from Baseline in International Normalized Ratio (INR) Up to Day 1921
Primary Change from Baseline in Urine Total Protein Up to Day 1921
Primary Change from Baseline in Neurological Examination Outcomes for Participants =2 Years of Age For participants 2 years of age and younger, the Hammersmith Infant Neurological Exam (HINE) Sections 1 and 3 will be conducted. This standard examination (developed by [Dubowitz and Dubowitz 1981]) is a quantitative scorable method for assessing the neurological development of infants between 2 and 24 months of age. The examination includes assessment of cranial nerve functions, posture, movements, tone, and reflexes. The HINE Section 1 form utilized in ONWARD contains 26 items and the Section 3 form utilized contains 3 items. For HINE Section 1 items, each item is scored 0-3. For HINE Section 3 items, scoring is variable (1-4, 1-5, or 1-6). Higher scores indicate better neurological function. Up to Day 1921
Primary Number of Participants with Change from Baseline in Neurological Examination Outcomes for Participants >2 Years of Age For all participants >2 years of age, standard neurological examinations, which include assessments of mental status, level of consciousness, sensory function, motor function, cranial nerve function, and reflexes, will be conducted. Up to Day 1921
Primary Percentage of Participants With a Postbaseline Platelet Count Below the Lower Limit of Normal on at least 2 Consecutive Measurements Up to Day 1921
Primary Percentage of Participants With a Postbaseline Corrected QT Interval Using Fridericia's Formula (QTcF) of >500 millisecond (msec) and an Increase from Baseline to Any Postbaseline Timepoint in QTcF of >60 msec Up toDay 1921
Secondary Total Number of New World Health Organization (WHO) Motor Milestones Up to Day 1921
Secondary Number of Participants Who Used Respiratory Support, by Type Up to Day 1921
Secondary Number of Hours Per Day of Respiratory Support Up to Day 1921
Secondary Number of Days That Respiratory Support Is Used Up to Day 1921
Secondary Time to Death (Overall Survival) Up to Day 1921
Secondary Change from Baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) Total Score The CHOP INTEND test is designed to evaluate the motor skills of infants with significant motor weakness. It includes 16 items (capturing neck, trunk, and proximal and distal limb strength) structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0-4. The total score ranges from 0-64, with higher scores depicting better response. This outcome measure will be assessed for participants who were evaluated with this measure in study 232SM203 (NCT04089566). Up to Day 1921
Secondary Change from Baseline in Hammersmith Infant Neurological Examination (HINE) Section 2 Motor Milestones Section 2 of the HINE is used to assess motor milestones of the participants. It is composed of 8 motor milestone categories: voluntary grasp (0 to 3), ability to kick in supine position (0 to 4), head control (0 to 2), rolling (0 to 3), sitting (0 to 4), crawling (0 to 4), standing (0 to 3), and walking (0 to 3). Total HINE score is the sum of points from each item and can range from 0 to 26, with higher scores depicting better level of ability. This outcome measure will be assessed for participants who were evaluated with this measure in study 232SM203 (NCT04089566). Up to Day 1921
Secondary Percentage of HINE Section 2 Motor Milestone Responders Section 2 of HINE is used to assess motor milestones of participants. It is composed of 8 motor milestone categories: voluntary grasp (0 to 3), ability to kick in supine position (0 to 4), head control (0 to 2), rolling (0 to 3), sitting (0 to 4), crawling (0 to 4), standing (0 to 3), and walking (0 to 3). Total HINE score is sum of points from each item and can range from 0 to 26, with higher scores depicting better level of ability. HINE section 2 motor milestone responder is participant who demonstrates at least 2-point increase in category of ability to kick or increase to maximal score on that category or 1-point increase in motor milestones category of head control, rolling, sitting, crawling, standing, or walking, and among 7 motor milestone categories (excluding voluntary grasp), participant demonstrates improvement in more categories than worsening. This outcome measure will be assessed for participants who were evaluated with this measure in study 232SM203 (NCT04089566). Up to Day 1921
Secondary Percentage of Time Spent on Ventilation This outcome measure will be assessed for participants who were evaluated with this measure in study 232SM203 (NCT04089566). Up to Day 1921
Secondary Time to Death or Permanent Ventilation Permanent ventilation is defined as tracheostomy or =16 hours of ventilation/day continuously for >21 days in the absence of an acute reversible event. This outcome measure will be assessed for participants who were evaluated with this measure in study 232SM203 (NCT04089566). Up to Day 1921
Secondary Change from Baseline in Hammersmith Functional Motor Scale - Expanded (HFMSE) Score The HFMSE is a tool used to assess motor function in children with SMA. The original 20 item Hammersmith Functional Motor Scale (HFMS) was expanded to include 13 additional items to improve sensitivity for the higher functioning ambulant population. Participants will be asked to complete a specific movement and are then graded on the quality and execution of that movement. Higher scores indicate higher levels of motor ability. The overall score is the sum of the scores for all activities, with a maximum score of 66 with higher scores depicting better ability to perform activities. Participants = 2 years of age (at the time of the study visit) will be evaluated with HFMSE. Up to Day 1921
Secondary Change from Baseline in Revised Upper Limb Module (RULM) Score The RULM is developed to assess upper limb functional abilities participants with SMA. This test consists of upper limb performance items that are reflective of activities of daily living. The RULM is scored from 0 to 37 points, with higher scores indicating better function. Participants = 2 years of age (at the time of the study visit) will be evaluated with RULM. Up to Day 1921
Secondary Change From Baseline in Plasma Levels of Neurofilament (NF) Up to Day 1921
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