A Study of CAP-1002 in Ambulatory and Non-Ambulatory Patients With Duchenne Muscular Dystrophy (HOPE-3)

March 29, 2024 updated by: Capricor Inc.

A Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Efficacy and Safety of Human Allogeneic Cardiosphere-Derived Cells for the Treatment of Duchenne Muscular Dystrophy

HOPE-3 is a two cohort, Phase 3, multi-center, randomized, double-blind, placebo-controlled clinical trial evaluating the efficacy and safety of a cell therapy called CAP-1002 in study participants with Duchenne muscular dystrophy (DMD) and impaired skeletal muscle function. Non-ambulatory and ambulatory boys and young men who meet eligibility criteria will be randomly assigned to receive either CAP-1002 or placebo every 3 months for a total of 4 doses during the first 12-months of the study. All participants will be eligible to receive 4 doses of CAP-1002 for an additional 12 months as part of an open-label extended assessment period.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Up to 102 eligible study subjects will participate in this two cohort study. Cohort A will enroll approximately 58 subjects randomized in a 1:1 ratio (active:placebo). Subjects randomized to the active treatment group in Cohort A will receive CAP-1002A (manufactured at Capricor's manufacturing facility in Los Angeles, CA). Once Cohort A enrollment is completed, Cohort B enrollment will begin. Cohort B will enroll approximately 44 participants randomized in a 1:1 ratio (active:placebo). Subjects randomized to the active treatment group in Cohort B will receive CAP-1002B (manufactured at Capricor's manufacturing facility in San Diego, CA). Both cohorts will include visits at Screening, Baseline/Day 1, Month 1, and Months 3, 6, 9, and 12. Subjects will receive IV infusions of CAP-1002 or placebo on Day 1 and Months 3, 6, and 9. All subjects will then be eligible to receive additional IV infusions of CAP-1002 at Month 12, 15, 18, and 21 as part of the open-label phase of the study.

A primary analysis of efficacy and safety will be performed for each individual cohort at Month 12 following 4 administrations of CAP-1002 or placebo.

The primary efficacy endpoint is the mean change from baseline in upper limb function as assessed by Performance of the Upper Limb test, version 2.0 [PUL 2.0] Total Score at the 12-month time point. Secondary endpoints evaluated at the 12-month time point include assessment of changes in cardiac muscle function and structure by cardiac magnetic resonance imaging [cMRI], changes in hand-to-mouth function [eat 10-bites assessed by the Duchenne Video Assessment (DVA)], quality of life assessments, and biomarker analysis for creatine kinase MB isoenzyme (CK-MB).

Safety evaluations will include adverse events, concomitant medications, physical exam, vital signs, and clinical laboratory testing.

Following the initial 4 infusions in Cohort A or Cohort B, all subjects will be eligible to participate in a 12-month open label extended assessment period and receive up to 4 additional IV infusions of CAP-1002 once every 3 months. An analysis of extended safety and efficacy will be conducted after all subjects have completed the Month 24 visit.

Study Type

Interventional

Enrollment (Estimated)

102

Phase

  • Phase 3

Contacts and Locations

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

Study Contact

Study Locations

  • United States
    • Arizona
      • Phoenix, Arizona, United States, 85016
        • Recruiting
        • Phoenix Children's Hospital
        • Principal Investigator:
          • Saunder Bernes, MD
        • Contact:
    • Arkansas
      • Little Rock, Arkansas, United States, 72202
        • Recruiting
        • Arkansas Children's Hospital
        • Principal Investigator:
          • Aravindhan Veerapandiyan, MD
        • Contact:
    • California
      • La Jolla, California, United States, 92037
        • Recruiting
        • UCSD Altman Clinical and Translational Research Institute
        • Contact:
        • Principal Investigator:
          • Chamindra Laverty, MD
      • Los Angeles, California, United States, 90027
        • Recruiting
        • Children's Hospital of Los Angeles, Division of Neurology
        • Principal Investigator:
          • Leigh M Ramos-Platt, MD
        • Contact:
      • Sacramento, California, United States, 95817
        • Recruiting
        • University of California, Davis
        • Principal Investigator:
          • Craig McDonald, MD
        • Contact:
    • Colorado
      • Aurora, Colorado, United States, 80045
    • Georgia
      • Atlanta, Georgia, United States, 30329
    • Illinois
      • Chicago, Illinois, United States, 60611
        • Recruiting
        • Ann & Robert H. Lurie Children's Hospital of Chicago
        • Principal Investigator:
          • Katheryn Gambetta, MD
        • Contact:
        • Contact:
    • Iowa
      • Iowa City, Iowa, United States, 52242
        • Recruiting
        • University of Iowa Hospitals and Clinics
        • Contact:
        • Principal Investigator:
          • Katherine Mathews, MD
    • Massachusetts
      • Boston, Massachusetts, United States, 02115
    • Missouri
      • Columbia, Missouri, United States, 65212
        • Recruiting
        • University of Missouri Health Care
        • Contact:
        • Principal Investigator:
          • Jane A Emerson, MD
      • Saint Louis, Missouri, United States, 63110
        • Recruiting
        • Saint Louis Children's Hospital
        • Contact:
        • Principal Investigator:
          • Arun Varadhachary, MD
    • New York
      • East Setauket, New York, United States, 11733
        • Recruiting
        • Stony Brook Clinical Research Center
        • Principal Investigator:
          • Simona Treidler, MD
        • Contact:
    • North Carolina
      • Hillsborough, North Carolina, United States, 27278
    • Ohio
      • Akron, Ohio, United States, 44308
        • Recruiting
        • Akron Children's Hospital
        • Principal Investigator:
          • Kathryn Mosher, MD
        • Contact:
      • Cincinnati, Ohio, United States, 45229
        • Recruiting
        • Cincinnati Children's Hospital Medical Center
        • Principal Investigator:
          • Cuixia Tian, MD
        • Contact:
    • Texas
      • Dallas, Texas, United States, 75207
        • Recruiting
        • Children's Health Specialty Care Pavilion
        • Principal Investigator:
          • Susan Iannaccone, MD
        • Contact:
    • Utah
      • Salt Lake City, Utah, United States, 84112
        • Recruiting
        • University of Utah Hospital
        • Contact:
        • Principal Investigator:
          • Russell Butterfield, MD
    • Virginia
      • Charlottesville, Virginia, United States, 22903
        • Recruiting
        • University of Virginia Children's Hospital
        • Contact:
        • Principal Investigator:
          • Rebecca J Scharf, MD
    • Washington
      • Seattle, Washington, United States, 98105
    • Wisconsin
      • Milwaukee, Wisconsin, United States, 53226
        • Recruiting
        • Children's Wisconsin
        • Principal Investigator:
          • Matthew Harmelink, MD
        • Contact:

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

10 years and older (Child, Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Male subjects at least 10 years of age at time of consent who are willing and able to provide informed consent to participate in the trial if ≥ 18 years of age or assent with parental or guardian informed consent if < 18 years of age. If a third-party caregiver is involved, they must provide informed consent.
  2. Diagnosis of DMD based on clinical and phenotypic manifestations consistent with DMD (e.g., family history of DMD, elevated creatine kinase, dystrophin muscle biopsy, calf pseudohypertrophy, history of Gowers' sign, and gait impairment before 7 years of age) as confirmed by the Investigator.
  3. Confirmatory genetic testing performed to have reached a diagnosis of DMD at any time in the past or currently performed at a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory or equivalent.
  4. Performance of the Upper Limb test (PUL) entry item scores 2-6 and total PUL score less than or equal to 40. For Cohort A only: enrollment of patients with PUL entry score 6, Exon 44 skipping amenable, and/or Exon 3 through 7 deletions will be capped at no more than 10% of the total study population (approximately 6 patients with these characteristics).
  5. Reduced ability to walk/run (if ambulatory): subjects must take more than 10 seconds for the 10-meter walk/run (i.e., velocity < 1 meter/second).
  6. If non-ambulatory, loss of independent ambulation between 10th and 18th year birthday (standing unassisted or ability to take, at most, several steps independently is not considered ambulation). Subjects who are considered non-ambulatory between the ages of 9 and10 may be enrolled with prior approval from the sponsor.
  7. Receiving standard of care therapy at an experienced, multidisciplinary DMD center as evidenced by regular cardiac and pulmonary monitoring, systemic glucocorticoid treatment, and at-home range of motion exercises.
  8. Treatment with systemic glucocorticoids for at least 12 months and at a stable dose at least 6 months prior to study participation, except for either weight-based dose adjustment or a decrease in steroid dose of ≤ 10% for toxicity. For patients on chronic deflazacort, treatment with an equivalent dose of prednisone or prednisolone for a period of ≤ 30 days to bridge lack of availability of deflazacort during the 6 months prior to randomization is acceptable.
  9. Current and up-to-date immunizations according to children and adolescent Centers for Disease Control and Prevention immunization schedule at the discretion of the Investigator.
  10. Adequate venous access for parenteral IP infusions and routine blood collection.
  11. Assessed by the Investigator as willing and able to comply with the requirements of the trial.
  12. Sexually active subjects and their partners who are fertile must agree to use effective method(s) of contraception.

Exclusion Criteria:

  1. Left ventricular ejection fraction (LVEF) less than or equal to 35% prior to randomization.
  2. Elbow-flexion contractures > 30° in both extremities.
  3. Body mass index (BMI) > 45.
  4. Percent predicted forced vital capacity (FVC%) < 35% within 6 months prior to randomization.
  5. Inability to perform consistent PUL 2.0 measurement within ± 2 points without shoulder domain or within ± 3 points with shoulder domain during paired testing at screening.
  6. Risk of near-term respiratory decompensation in the judgment of the Investigator, or the need for initiation of day and night non-invasive ventilator support as defined by serum bicarbonate ≥ 29 mmol/L at screening.
  7. History of non DMD-related chronic respiratory disease requiring ongoing or intermittent treatment, including, but not limited to, asthma, bronchitis, and tuberculosis.
  8. Acute respiratory illness within 30 days prior to screening and during screening.
  9. Initiation of nocturnal non-invasive ventilation within 30 days prior to screening.
  10. Planned or anticipated thoracic or spinal surgery within the 6 months following randomization.
  11. Planned or anticipated lower extremity surgery within the 6 months following randomization, if ambulatory.
  12. Known hypersensitivity to dimethyl sulfoxide (DMSO) or bovine products.
  13. Initiation of treatment with metformin or insulin within 3 months prior to randomization.
  14. Initiation of treatment with an FDA-approved exon skipping therapy for the treatment of DMD and/or non-weight based adjustments within 12 months prior to randomization.
  15. Treatment with human growth hormone within 3 months prior to randomization, unless on a stable dose allowing for weight-based dose adjustments (as determined by the site Investigator) for at least 24 months prior to randomization.
  16. Treatment with a cell therapy product within 12 months prior to randomization; any prior exposure to CAP-1002 will be excluded.
  17. Treatment with an investigational product within 6 months prior to randomization.
  18. History, or current use, of drugs or alcohol that could impair the ability to comply with participation in the trial.
  19. Inability to comply with the investigational plan and follow-up visit schedule for any reason, in the judgment of the investigator.
  20. Inability to undergo a cardiac MRI. For Cohort B Only - Subjects with a known hypersensitivity to gadolinium may forgo the LGE assessment but must complete a cardiac MRI without contrast. For Cohort B Only - Subjects who are unable to tolerate gadolinium due to renal insufficiency as measured by an estimated Glomerular Filtration Rate (eGFR) less than 60 mL/min/1.73 m2 may forgo the LGE assessment but must complete a cardiac MRI without contrast.
  21. For Cohort B: Subjects with PUL entry score 6, Exon 44 skipping amenable, or Exon 3 through 7 deletions are excluded from participation.

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: CAP-1002

Cohort A: Approximatetly 29 subjects will receive CAP-1002A active treatment consisting of 150 million cardiosphere-derived cells (CDCs) via intravenous infusion every 3 months

Cohort B: Approximately 22 participants will receive CAP-1002B active treatment consisting of 150 million cardiosphere-derived cells (CDCs) via intravenous infusion every 3 months
Biological: CAP-1002
Cohort A: CAP-1002A manufactured in Los Angeles, CA; Cohort B: CAP-1002B manufactured in San Diego, CA
Other Names:
  • Cardiosphere-Derived Cells (CDCs)
Placebo Comparator: Placebo

Cohort A: Approximately 29 subjects will receive a Placebo solution via intravenous infusion every 3 months

Cohort B: Approximately 22 participants will receive a Placebo solution via intravenous infusion every 3 months
Biological: Placebo
Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in the upper limb function
Time Frame: At Month 12
Mean change from baseline in Performance of the Upper Limb test, version 2 (PUL 2.0) Total Score. Items are scored on a three-point scale: 0=unable to perform the item, 1=impaired or performs with compensation, 2=performs task without compensation
At Month 12

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in cardiac muscle function and structure by assessment of left ventricular ejection fraction
Time Frame: At Month 12
Mean change from baseline in left ventricular ejection fraction as assessed by Cardiac Magnetic Resonance (cMRI)
At Month 12
Change in cardiac muscle function and structure by assessment of left ventricular end-systolic volume
Time Frame: At Month 12
Mean change from baseline in left ventricular end-systolic volume as assessed by Cardiac Magnetic Resonance (cMRI)
At Month 12
Change in cardiac muscle function and structure by assessment of left ventricular end-diastolic volume
Time Frame: At Month 12
Mean change from baseline in left ventricular end-diastolic volume as assessed by Cardiac Magnetic Resonance (cMRI)
At Month 12
Change in elbow and distal level upper limb function
Time Frame: At Month 12
Mean change from baseline in mid [elbow] plus distal level upper limb function in Performance of the Upper Limb test, version 2 (PUL 2.0); items are scored on a three-point scale: 0=unable to perform the item, 1=impaired or performs with compensation, 2=performs task without compensation
At Month 12
Change in hand-to-mouth function in the context of functional eating
Time Frame: At Month 12
Mean change from baseline in the functional ability of eating 10 bites evaluated by Duchenne Video Assessment (DVA) using a video record of patient performing the task at home. Physical therapists score the patient's quality of movement in the video using scorecards with pre-specified compensatory movement criteria.
At Month 12
Change in hand-to-mouth function
Time Frame: At Month 12
Mean change from baseline in item 7 [hand-to-mouth] in Performance of the Upper Limb test, version 2 (PUL 2.0); items are scored on a three-point scale: 0=unable to perform the item, 1=impaired or performs with compensation, 2=performs task without compensation
At Month 12
Number of patients with total loss of hand-to-mouth function
Time Frame: At Month 12
Proportion of patients with total loss of hand-to-mouth function as assessed by item 7 [hand-to-mouth] in Performance of the Upper Limb test, version 2 (PUL 2.0)
At Month 12
Changes in patient-reported upper limb function
Time Frame: At Month 12
Mean change from baseline in Duchenne Muscular Dystrophy Upper Limb Patient-Reported Outcome Measures (DMD UL PROM) questionnaire. Patient or caretaker evaluates the perceived difficulty in performing activities of daily living on a 3-level scale: 0=impossible without help, 1=can do task with difficulty, 2= can do task easily.
At Month 12
Changes in cardiac inflammation biomarker, creatine kinase MB isoenzyme [CK-MB]
Time Frame: At months 1, 3, 6, 9, 12
Mean change from baseline in CK-MB blood levels - MB fraction (% of total CK).
At months 1, 3, 6, 9, 12
Evaluation of disease modifying effects of CAP-1002
Time Frame: At Month 24
Mean change from baseline between patients initially randomized to either CAP-1002 or placebo in full Performance of the Upper Limb test, version 2 (PUL 2.0) at Month 24 in the open label phase of the trial. items in PUL 2.0 are scored on a three-point scale: 0=unable to perform the item, 1=impaired or performs with compensation, 2=performs task without compensation
At Month 24

Collaborators and Investigators

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

Sponsor

Capricor Inc.

Investigators

  • Study Director: Mark Awadalla, Capricor Inc.
  • Principal Investigator: Craig McDonald, MD, University of California, Davis

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 22, 2022

Primary Completion (Estimated)

December 1, 2024

Study Completion (Estimated)

December 1, 2026

Study Registration Dates

First Submitted

November 4, 2021

First Submitted That Met QC Criteria

November 16, 2021

First Posted (Actual)

November 19, 2021

Study Record Updates

Last Update Posted (Actual)

April 1, 2024

Last Update Submitted That Met QC Criteria

March 29, 2024

Last Verified

March 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CAP-1002-DMD-04

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

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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