A Study to Assess the Efficacy and Safety of Vamorolone in Boys With Duchenne Muscular Dystrophy (DMD)

March 7, 2023 updated by: ReveraGen BioPharma, Inc.

A Phase IIb Randomized, Double-blind, Parallel Group, Placebo- and Active-controlled Study With Double-Blind Extension to Assess the Efficacy and Safety of Vamorolone in Ambulant Boys With Duchenne Muscular Dystrophy (DMD)

Brief Summary: This Phase IIb study is a randomized, double-blind, parallel group, placebo and active-controlled study to evaluate the efficacy, safety, PD, and population PK of vamorolone administered orally at daily doses of 2.0 mg/kg and 6.0 mg/kg versus prednisone 0.75 mg/kg/day and placebo over a Treatment Period of 24 weeks, and to evaluate persistence of effect over a Treatment Period of 48 weeks in ambulant boys ages 4 to <7 years with DMD.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This Phase IIb study is a randomized, double-blind, parallel group, placebo and active-controlled study to evaluate the efficacy, safety, PD, and population PK of vamorolone administered orally at daily doses of 2.0 mg/kg and 6.0 mg/kg versus prednisone 0.75 mg/kg/day and placebo over a Treatment Period of 24 weeks, and to evaluate persistence of effect over a Treatment Period of 48 weeks in ambulant boys ages 4 to <7 years with DMD.

The study is comprised of a 5-week Pretreatment Screening Period, a 1-day Pretreatment Baseline Period, a 24-week Treatment Period #1 (Weeks 1-24), a 4-week Transition Period (Weeks 25-28), a 20-week Treatment Period #2 (Weeks 28 + 1 day to 48), and a 4-week Dose-tapering Period (Weeks 49-52).

Subjects will be randomized to one of six treatment groups in a 2:2:1:1:1:1 ratio, where the two prednisone groups in Treatment Period #1 (Groups 3 and 4) will be combined and the two placebo groups in Treatment Period #1 (Groups 5 and 6) will be combined, effectively resulting in a 1:1:1:1 randomization (vamorolone 2.0 mg/kg/day : vamorolone 6.0 mg/kg/day : prednisone 0.75 mg/kg/day : placebo) for Treatment Period #1.

Subjects will be stratified based on age at study entry (<6 vs. ≥ 6 years). During the 4-week Transition Period between Treatment Period #1 and Treatment Period #2, all subjects will continue on the same oral suspension (vamorolone 2.0 mg/kg or 6.0 mg/kg, or matching placebo) they received during Treatment Period #1 and all subjects will have their tablet dose tapered to zero. Thus, subjects randomized to receive vamorolone during Treatment Period #1 (Groups 1 and 2) will continue to receive vamorolone at the same dose, while subjects randomized to receive prednisone will have their dose tapered to zero, and subjects randomized to placebo will continue to receive placebo.

The prednisone group will be used as an active control comparison for safety and efficacy endpoints as requested by the European Medicines Agency (EMA). The placebo group will be used as comparator for efficacy endpoints (superiority model) as requested by the EMA and Food and Drug Administration (FDA) protocol advisory board. Although glucocorticoids are part of the care recommendations for DMD, their adverse effect profile has limited their use. The age at which glucocorticoids should be started in DMD boys is uncertain, ranging from 4 to 7 years, based on a balance between benefits and side effects. In view of the age inclusion criteria and duration of the placebo-controlled study period (6 months), the use of a placebo group has been considered acceptable as in clinical practice it will not cause a real delay in prescription of an accepted treatment for this condition. Any exposure of placebo longer than 6 months was considered unethical.

At the end of the Treatment Period #2, subjects may be given access to vamorolone through an additional study or general access program, or given the option to transition to standard of care treatment for DMD (may include glucocorticoids). Subjects completing VBP15-004 and enrolling directly into an additional vamorolone study or general access program to receive vamorolone will not need to taper their vamorolone dose prior to enrollment. All other subjects will begin a 4-week double-blind Dose-tapering Period during which the dose of study medication will be progressively reduced and discontinued.

Study Type

Interventional

Enrollment (Actual)

121

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Australia
      • Melbourne, Australia
        • Royal Children's Hospital
      • Westmead, Australia
        • Sydney Children's Hospital
  • Belgium
      • Ghent, Belgium
        • Ghent University Hospital
      • Leuven, Belgium
        • University Hospitals Leuven
  • Canada
    • Alberta
      • Calgary, Alberta, Canada, AB T3B 6A8
        • Alberta'S Children Hospital
    • British Columbia
      • Vancouver, British Columbia, Canada, V6H 3N1
        • British Columbia Children's Hospital
    • Ontario
      • Ottawa, Ontario, Canada, K1H 8L1
        • Children's Hospital of Eastern Ontario
    • Quebec
      • Montréal, Quebec, Canada, H4A 3J1
        • Montreal Children's Hospital
  • Czechia
      • Brno, Czechia
        • University Hospital Brno
      • Prague, Czechia
        • Charles University
  • Greece
      • Athens, Greece
        • Agia Sofia Children's Hospital
  • Israel
      • Petah Tikvah, Israel, 49202
        • Schneider Children's Medical Center
  • Netherlands
      • Leiden, Netherlands
        • Leiden University Medical Center
      • Nijmegen, Netherlands
        • Radboud University
  • Spain
      • Barcelona, Spain
        • Sant Joan de Deu Hospital - Barcelona, Spain
      • Valencia, Spain
        • Hospital Universitario y Politécnico La FE
  • Sweden
      • Gothenburg, Sweden, 41685
        • Queen Silvia Children's Hospital
  • United Kingdom
      • Birmingham, United Kingdom
        • Birmingham Heartlands Hospital
      • Glasgow, United Kingdom, G51 4TF
        • Royal Hospital for Children
      • Leeds, United Kingdom
        • Leeds Teaching Hospital Trust
      • Liverpool, United Kingdom, L12 2AP
        • Alder Hey Children's NHS Foundation Trust
      • London, United Kingdom
        • Great Ormond Street Hospital
      • Newcastle upon Tyne, United Kingdom, NE7 7DN
        • Newcastle upon Tyne Hospitals NHS Foundation Trust
  • United States
    • California
      • Davis, California, United States, 95616
        • University of California Davis
      • Los Angeles, California, United States, 90095
        • University of California Los Angeles
    • Colorado
      • Aurora, Colorado, United States, 80045
        • Children's Hospital Colorado
    • Florida
      • Orlando, Florida, United States, 32827
        • Nemours Children's Hospital
    • Illinois
      • Chicago, Illinois, United States, 60611
        • Ann & Robert H. Lurie Children's Hospital
    • Minnesota
      • Saint Paul, Minnesota, United States, 55101
        • Gillette Children's Speciality Health Care
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke Children's Hospital
    • Texas
      • Dallas, Texas, United States, 75207
        • University of Texas Southwestern Medical Center
    • Virginia
      • Richmond, Virginia, United States, 23219
        • Children's Hospital of Virginia of Virginia Commonwealth University
    • Washington
      • Seattle, Washington, United States, 98105
        • Seattle Children's Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

4 years to 7 years (Child)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Male

Description

Inclusion Criteria:

  1. Subject's parent(s) or legal guardian(s) has (have) provided written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization, where applicable, prior to any study-related procedures; participants will be asked to give written or verbal assent according to local requirements

  2. Subject has a centrally confirmed (by TRiNDS central genetic counselor[s]) diagnosis of DMD as defined as:

    • Dystrophin immunofluorescence and/or immunoblot showing complete dystrophin deficiency, and clinical picture consistent with typical DMD, OR
    • Identifiable mutation within the DMD gene (deletion/duplication of one or more exons), where reading frame can be predicted as 'out-of-frame,' and clinical picture consistent with typical DMD, OR
    • Complete dystrophin gene sequencing showing an alteration (point mutation, duplication, other) that is expected to preclude production of the dystrophin protein (i.e., nonsense mutation, deletion/duplication leading to a downstream stop codon), with a clinical picture consistent with typical DMD;
  3. Subject is ≥ 4 years and <7 years of age at time of enrollment in the study;
  4. Subject weighs >13.0 kg and ≤ 39.9 kg at the Screening Visit;
  5. Subject is able to walk independently without assistive devices;
  6. Subject is able to complete the Time to Stand Test (TTSTAND) without assistance in <10 seconds, as assessed at the Screening Visit;
  7. Clinical laboratory test results are within the normal range at the Screening Visit, or if abnormal, are not clinically significant, in the opinion of the Investigator. [Notes: Serum gamma glutamyl transferase (GGT), creatinine, and total bilirubin all must be ≤ upper limit of the normal range at the Screening Visit. An abnormal vitamin D level that is considered clinically significant will not exclude a subject from randomization];

  8. Subject has evidence of chicken pox immunity as determined by:

    • Presence of IgG antibodies to varicella, as documented by a positive test result from the local laboratory from blood collected during the Screening Period, OR
    • Documentation, provided at the Screening Visit, that the subject has had 2 doses of varicella vaccine, with or without serologic evidence of immunity; the second of the 2 immunizations must have been given at least 14 days prior to randomization.
  9. Subject is able to swallow tablets, as confirmed by successful test swallowing of placebo tablets during the Screening Period; and
  10. Subject and parent(s)/guardian(s) are willing and able to comply with scheduled visits, study drug administration plan, and study procedures.

Exclusion Criteria:

  1. Subject has current or history of major renal or hepatic impairment, diabetes mellitus or immunosuppression;
  2. Subject has current or history of chronic systemic fungal or viral infections;
  3. Subject has had an acute illness within 4 weeks prior to the first dose of study medication;
  4. Subject has used mineralocorticoid receptor agents, such as spironolactone, eplerenone, canrenone (canrenoate potassium), prorenone (prorenoate potassium), mexrenone (mexrenoate potassium) within 4 weeks prior to the first dose of study medication;
  5. Subject has a history of primary hyperaldosteronism;
  6. Subject has evidence of symptomatic cardiomyopathy [Note: Asymptomatic cardiac abnormality on investigation would not be exclusionary];
  7. Subject is currently being treated or has received previous treatment with oral glucocorticoids or other immunosuppressive agents [Notes: Past transient use of oral glucocorticoids or other oral immunosuppressive agents for no longer than 1 month cumulative, with last use at least 3 months prior to first dose of study medication, will be considered for eligibility on a case-by-case basis, unless discontinued for intolerance. Inhaled and/or topical glucocorticoids are permitted if last use is at least 4 weeks prior to first dose of study medication or if administered at stable dose beginning at least 4 weeks prior to first dose of study medication and anticipated to be used at the stable dose regimen for the duration of the study];
  8. Subject has an allergy or hypersensitivity to the study medication or to any of its constituents;
  9. Subject has used idebenone within 4 weeks prior to the first dose of study medication;
  10. Subject has severe behavioral or cognitive problems that preclude participation in the study, in the opinion of the Investigator;
  11. Subject has previous or ongoing medical condition, medical history, physical findings or laboratory abnormalities that could affect safety, make it unlikely that treatment and follow-up will be correctly completed or impair the assessment of study results, in the opinion of the Investigator;
  12. Subject is taking (or has taken within 4 weeks prior to the first dose of study medication) herbal remedies and supplements which can impact muscle strength and function (e.g., Co-enzyme Q10, creatine, etc);
  13. Subject is taking (or has taken within 3 months prior to the first dose of study medication) any medication indicated for DMD, including Exondys51 and Translarna;
  14. Subject has been administered a live attenuated vaccine within 14 days prior to the first dose of study medication;
  15. Subject is currently taking any other investigational drug or has taken any other investigational drug within 3 months prior to the first dose of study medication;
  16. Subject has a sibling who is currently enrolled in any vamorolone study or Expanded Access Program, or who intends to enroll in any vamorolone study or Expanded Access Program during the subject's participation in the VBP15-004 study; or
  17. Subject has previously been enrolled in the study. Note: Any parameter/test may be repeated at the Investigator's discretion during Screening to determine reproducibility. In addition, subjects may be rescreened if ineligible due to a transient condition which would prevent the subject from participating, such as an upper respiratory tract infection or injury, or if ineligible due to negative anti-varicella IgG antibody test result.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Treatment Group 1
Patients enrolled in Treatment Group 1 (experimental group) will receive vamorolone 2.0 mg/kg/day for the duration of the study.
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Experimental: Treatment Group 2
Patients enrolled in Treatment Group 2 (experimental group) will receive vamorolone at 6.0 mg/kg/day for the duration of the study.
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Active Comparator: Treatment Group 3
Patients enrolled in Treatment Group 3 (active comparator group) will receive prednisone 0.75 mg/kg/day for 24 weeks followed by 20 weeks of treatment with 2.0 mg/kg/day vamorolone.
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Prednisone
Oral administration of 0.75 mg/kg/day for 24 weeks.
Active Comparator: Treatment Group 4
Patients enrolled in Treatment Group 4 (active comparator group) will receive prednisone 0.75 mg/kg/day for 24 weeks followed by 20 weeks treatment with 6.0 mg/kg/day vamorolone.
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Prednisone
Oral administration of 0.75 mg/kg/day for 24 weeks.
Placebo Comparator: Treatment Group 5
Patients enrolled in Treatment Group 5 (placebo comparator group) will receive placebo daily for 24 weeks followed by 20 weeks treatment with 2.0 mg/kg/day vamorolone.
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Other: Placebo
Oral administration of placebo daily for 24 weeks.
Placebo Comparator: Treatment Group 6
Patients enrolled in Treatment Group 6 (placebo comparator group) will receive placebo daily for 24 weeks followed by 20 weeks treatment with 6.0 mg/kg/day vamorolone.
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for the duration of the study.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 2.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Drug: Vamorolone
Oral administration of 6.0 mg/kg/day for 20 weeks.
Other Names:
  • VBP15
Other: Placebo
Oral administration of placebo daily for 24 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Efficacy Measured by Time to Stand Test (TTSTAND) Velocity in Rises/Second Change From Baseline
Time Frame: 24 weeks
Vamorolone at 6.0mg/kg/day vs. placebo group in change from baseline to the Week 24 assessment
24 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

ReveraGen BioPharma, Inc.

Collaborators

University of Pittsburgh
Newcastle University
European Union
Cooperative International Neuromuscular Research Group

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 29, 2018

Primary Completion (Actual)

February 23, 2021

Study Completion (Actual)

August 19, 2021

Study Registration Dates

First Submitted

January 9, 2018

First Submitted That Met QC Criteria

February 13, 2018

First Posted (Actual)

February 20, 2018

Study Record Updates

Last Update Posted (Estimate)

March 9, 2023

Last Update Submitted That Met QC Criteria

March 7, 2023

Last Verified

March 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • VBP15-004

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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