First-in-Human Study of NI006 in Patients With Amyloid Transthyretin Cardiomyopathy

A Phase 1, First-in-Human, Double-Blind, Placebo-Controlled, Multicenter, Single and Multiple Ascending Dose Study of NI006 in Patients With Amyloid Transthyretin Cardiomyopathy Followed by an Open-Label Extension

A phase 1, randomized, placebo-controlled, double-blind, dose escalation trial combining single-ascending dose and multiple-ascending dose phases of NI006 or placebo, followed by an open-label extension phase in subjects with Amyloid Transthyretin Cardiomyopathy (ATTR-CM).

Study Overview

• Status: Completed
• Conditions: Amyloid Transthyretin Cardiomyopathy
• Intervention / Treatment: Drug: NI006; Drug: Placebo

Detailed Description

This phase 1, randomized, placebo-controlled, double-blind trial in subjects with Amyloid Transthyretin Cardiomyopathy (ATTR-CM) consists of single-ascending dose (SAD) and multiple-ascending dose (MAD) phases, followed by an open-label extension (OLE) phase.

In the SAD phase subjects are randomized in a 4:2 ratio to receive a single infusion of NI006 or placebo.

Subjects completing the SAD phase will be enrolled in the MAD phase upon evaluation of all available safety data and receive a maximum of 3 additional infusions of NI006 or placebo every 28 days.

Subjects completing the MAD phase will have the possibility to continue in an OLE phase with treatment up-titrations and switch from placebo to NI006 and receive up to 8 infusions of NI006 every 28 days.

Subjects of cohort 1 to 5 who received at least one dose of NI006 during the OLE phase will have the possibility for a second OLE phase (OLE2) after completing the OLE phase and receive up to 10 additional infusions of NI006 every 28 days.

In total, about 42 subjects are planned to be enrolled in 7 cohorts of 6 subjects each, at 6 ascending dose levels.

• Study Type: Interventional
• Enrollment (Actual): 46
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Christiane Schindeldecker; Phone Number: +41 44 755 4612; Email: christiane.schindeldecker@neurimmune.com
• Study Contact Backup: Name: Peter C. Kahr, MD; Phone Number: +41 44 755 46 14; Email: peter.kahr@neurimmune.com

Study Locations

• France
  • Créteil, France, 94000
    • Hôpital Henri Mondor
  • Rennes, France, 35033
    • CHU de Rennes - Hôpital Pontchaillou
  • Toulouse, France, 31059
    • CHU Toulouse - Hôpital Rangueil
• Germany
  • Heidelberg, Germany, 69120
    • Universitätsklinikum Heidelberg
• Netherlands
  • Groningen, Netherlands, 9713
    • University Medical Center Groningen
• Spain
  • Majadahonda, Spain, 28222
    • Hospital Universitario Puerta de Hierro Majadahonda

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Written informed consent obtained from the subject prior to any trial-related procedure indicating that he/she understands the purpose of, and procedures required for the trial and is willing to participate in it
2. Male or female subjects aged ≥18 years (and < 85 years only for cohort 7) at the time of obtaining informed consent and with confirmed availability for the scheduled trial visits

3. Confirmed ATTR-Cardiomyopathy diagnosis established by:

   • Polarizing light microscopy of green birefringent material in Congo red-stained tissue specimens and confirmed diagnosis of ATTR amyloidosis by IHC or mass spectrometry OR
   • positive bone scintigraphy using either DPD, HMDP or PYP, with cardiac signal intensity indicative of ATTR-Cardiomyopathy (early phase imaging: cardiac mediastinum ratio > 1.21; late phase imaging: Perugini Grade 2 or 3) and absence of gammopathy (negative serum and urine immunofixation electrophoresis plus normal free light chain serum ratio). If a gammopathy is detected, diagnosis must be established based on tissue biopsy as indicated above

4. Known genotype as follows:

   1. Known pathogenic TTR mutation for subjects with hereditary ATTR- Cardiomyopathy
   2. Known negative genetic testing for a TTR mutation for subjects with sporadic, WT- ATTR-Cardiomyopathy

5. Chronic Heart Failure with all of the following characteristics:

   1. LVEF ≥40%
   2. LVWT ≥14 mm, measured by echocardiography
   3. NT-proBNP level ≥600 pg/mL
   4. Able to walk ≥150 meter in the 6-MWT
   5. NYHA class III (applicable only for cohort 7)
   6. No hospitalizations for cardiac disease for at least 30 calendar days prior to screening
6. General health status acceptable for a participation in a clinical trial with a Karnofsky Performance Status ≥60%
7. Stable pharmacological treatment of any other chronic condition for at least 30 calendar days prior to screening, with the exclusion of immunomodulatory and immunosuppressive treatments
8. ANC ≥1000 cells/mm³, platelet count ≥100,000 cells/mm³, and hemoglobin ≥10 g/dL
9. Women of childbearing potential must have a negative serum pregnancy test at screening and must agree to use highly effective physician-approved contraception from screening to 5 months after ending trial participation
10. Males must be surgically sterile or must agree to use highly effective physician-approved contraception throughout of the trial participation, and for 5 months after ending trial participation

Exclusion Criteria:

1. Amyloid light-chain amyloidosis or any other non ATTR amyloidosis
2. Heart failure corresponding to NYHA class IV
3. Uncontrolled hypertension with systolic pressure ≥180 mmHg or diastolic pressure ≥110 mmHg confirmed by 3 measurements in supine position recorded with 5 minutes break in between the measurements
4. Hypotension with systolic pressure ≤ 90 mmHg or diastolic pressure ≤ 60 mmHg confirmed by 3 measurements in supine position recorded with 5 minutes break in between the measurements
5. NT-proBNP ≥6'000 pg/mL (NT-proBNP ≥8'500 pg/mL applicable only for cohort 7)
6. Heart failure not predominantly caused by ATTR-Cardiomyopathy
7. Any severe uncorrected valve disease

8. Chronic liver disease with liver function test abnormalities:

   1. ALT and AST > 2.5 × ULN
   2. Total bilirubin > 2 × ULN
9. Respiratory insufficiency requiring oxygen therapy
10. Renal insufficiency with eGFR < 30 mL/min/1.73 m2 using the CKD-EPI equation

11. Active malignancy with exception of the following:

    1. Adequately treated basal cell carcinoma
    2. Squamous cell carcinoma of the skin
    3. In situ cervical cancer
    4. Low risk prostate cancer with Gleason score < 7 and prostate specific antigen < 10 mg/mL
    5. Any other cancer from which the subject has been disease-free for ≥ 2 years
12. Uncontrolled infection as per Investigator's judgement
13. Known HIV infection, seropositivity for HIV, hepatitis B and C as well as active hepatitis A
14. Autoimmune disease requiring immunosuppressive/modulating treatment in the last 2 years
15. History of organ transplantation or ventricular assist device
16. Polyneuropathy disability score > IIIA
17. Suspected or known intolerance/allergy to proteins or any components of the investigational medicinal product
18. Concomitant immunosuppressant therapy e.g., corticosteroids, prednisone, dexamethasone except as indicated in low dose (i.e., up to 10 mg prednisone or equivalent daily is allowed) for other medical conditions such as inhaled steroid for asthma
19. Use of the following drugs acting on TTR or ATTR: tolcapone, diflunisal, patisiran, inotersen, and long-term doxycycline, in the 30 calendar days prior to signing informed consent form. Tafamidis is permitted if it is given as standard of care in a stable dose for at least 30 calendar days prior to signing the informed consent form
20. Participation in another investigational clinical trial or intake of investigational drug within 30 calendar days before signing the informed consent form
21. Suspected or known drug or alcohol abuse
22. Serious psychiatric or any other medical condition (including laboratory abnormalities), which, in the opinion of the Investigator, makes the subject unsuitable for inclusion and puts the subject at an unacceptable risk
23. Subject is nursing or is considering becoming pregnant during the trial or in the 5 months after ending trial participation
24. Unwillingness or inability to adhere to the trial requirements
25. If subject is in any way dependent on Neurimmune AG or the principal Investigator or if the subject is accommodated in an establishment on judicial or administrative order
26. Employee or immediate family (spouse, parent, child or sibling, whether biological or legally adopted) of an employee of Neurimmune AG, the contract research organization or the trial site

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: NI006; Dose escalation in up to 6 dose cohorts. Subjects will be administered a single dose of NI006 in the SAD, multiple doses of NI006 in the MAD and OLE phases.	Drug: NI006; NI006 will be administered intravenously
Placebo Comparator: Placebo; Subjects will be administered a single dose of placebo in the SAD phase and multiple doses of placebo in the MAD phase. In the OLE phase, all subjects will be administered multiple doses of NI006.	Drug: Placebo; Formulation buffer of NI006, matching volume of NI006 doses will be administered intravenously

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram	Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters (hematology, clinical chemistry, immunology, urinalysis), vital signs, electrocardiogram and echocardiogram	4 months
Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram	Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters (hematology, clinical chemistry, immunology, urinalysis), vital signs, electrocardiogram and echocardiogram	12 months
Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram	Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters (hematology, clinical chemistry, immunology, urinalysis), vital signs, electrocardiogram and echocardiogram	additional up to 10 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NI006 pharmacokinetic profile and parameters - Cmax	Maximum observed serum concentration (Cmax) of NI006	4 months
NI006 pharmacokinetic profile and parameters - Tmax	Time to maximum observed serum concentration (Tmax) of NI006	4 months
NI006 pharmacokinetic profile and parameters - AUCinf	Area under the serum concentration-time curve from zero to infinity (AUCinf) of NI006	1 month
NI006 pharmacokinetic profile and parameters - CL	Serum clearance (CL) of NI006	4 months
NI006 pharmacokinetic profile and parameters - Vz	NI006 apparent volume of distribution during terminal phase (Vz)	4 months
NI006 pharmacokinetic profile and parameters - Vss	NI006 apparent volume of distribution at steady state (Vss)	4 months
NI006 pharmacokinetic profile and parameters - t½	Terminal elimination half-life (t½) of NI006 in serum	4 months
NI006 pharmacokinetic profile and parameters - AUCtau	Area under the serum concentration-time curve from time zero to the end of the dosing interval after the first dose (AUCtau) of NI006	4 months
NI006 pharmacokinetic profile and parameters - RaccCmax	Accumulation ratio for maximum concentration (RaccCmax) of NI006 in serum	4 months
NI006 pharmacokinetic profile and parameters - RaccAUC	Accumulation ratio calculated from AUC (RaccAUC) of NI006 in serum	4 months
NI006 pharmacokinetic profile and parameters - Ctrough	Minimum observed concentration (Ctrough) of NI006 in serum	12 months
NI006 OLE2 pharmacokinetic profile and parameters - Ctrough	Minimum observed concentration (Ctrough) of NI006 in serum	up to 10 months
NI006 pharmacokinetic profile and parameters - dose-normalized Ctrough	Dose-normalized minimum observed concentration (Ctrough) of NI006 in serum	12 months
NI006 OLE2 pharmacokinetic profile and parameters - dose-normalized Ctrough	Dose-normalized minimum observed concentration (Ctrough) of NI006 in serum	up to 10 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Exploratory - Efficacy of multiple doses of NI006 on 6-Minute Walk Test (6-MWT)	Changes in 6-MWT	4 and 12 months
Exploratory - Efficacy of multiple doses of NI006 on patient questionnaire outcome	Changes in patient questionnaire outcome	4 and 12 months
Exploratory - Efficacy of multiple doses of NI006 on amyloid load	Changes in amyloid load assessed by cardiac imaging	4 and 12 months
Exploratory - Efficacy of multiple doses of NI006 on cardiac biomarkers - NT-proBNP	Changes in NT-proBNP concentration	4 and 12 months
Exploratory - Efficacy of multiple doses of NI006 on cardiac biomarkers - Troponin-T	Changes in Troponin-T concentration	4 and 12 months
Exploratory - Immunogenicity of NI006	Determination of anti-drug antibody response	4 and 12 months

Collaborators and Investigators

• Sponsor: Neurimmune AG

Study record dates

Study Major Dates

• Study Start (Actual): February 10, 2020
• Primary Completion (Actual): July 26, 2023
• Study Completion (Actual): July 26, 2023

Study Registration Dates

• First Submitted: March 11, 2020
• First Submitted That Met QC Criteria: April 21, 2020
• First Posted (Actual): April 24, 2020

Study Record Updates

• Last Update Posted (Actual): November 3, 2023
• Last Update Submitted That Met QC Criteria: November 2, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: Amyloidosis; Cardiomyopathy; ATTR; Transthyretin; ATTR-CM
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Metabolic Diseases; Proteostasis Deficiencies; Amyloidosis; Cardiomyopathies
• Other Study ID Numbers: NI006-101; 2019-001932-80 (EudraCT Number)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No