Sikkerhed, PK/PD og eksplorativ effektivitetsundersøgelse af AMT-191 i klassisk Fabrys sygdom
En fase 1/2, enkeltdosis, dosiseskaleringsundersøgelse af intravenøs AAV5-GLA (AMT-191) hos voksne mænd med klassisk Fabrys sygdom
The main goals of this clinical study are to characterize safety and PK/PD of AMT-191 i.e. if drug doses used in the study are safe and tolerable and to understand how it acts in the body of people with Fabry disease.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
In Fabry disease, the enzyme α-galactosidase A is deficient. AMT-191 is an investigational gene therapy that encodes a recombinant serotype 5 based adeno-associated viral vector (rAAV5). AMT-191 is designed to target the liver for production of the enzyme α-galactosidase A (αGAL). AMT-191 is delivered via a single (one-time) intravenous (IV) infusion.
In this first-in-human study of AMT-191, three dose levels will be tested. All eligible participants will receive AMT-191 at one of the dose levels; there is no placebo in this study. The starting dose level is decided based on accepted rules for dose translation from preclinical (animal) studies to humans. Subsequent dose cohort levels are decided based on the review of safety, tolerability, and PK/PD results by an Independent Data Monitoring Committee and in agreement with the Sponsor.
Participants will be monitored through study site visits, blood tests, imaging questionnaires, and other assessments as per the study protocols.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
- Fase 1
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: uniQure
- Telefonnummer: 1-866-520-1257
- E-mail: medinfo@uniqure.com
Undersøgelse Kontakt Backup
- Navn: Christy Quintana, Director, Clinical Operations
- Telefonnummer: 734-680-7773
- E-mail: medinfo@uniqure.com
Studiesteder
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Alabama
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Birmingham, Alabama, Forenede Stater, 35233
- Rekruttering
- The Kirklin Clinic Of University of Alabama Birmingham Hospital
-
Kontakt:
- Christina Desruisseau, BSN
- Telefonnummer: 205-975-2935
- E-mail: csingleton@uabmc.edu
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Ledende efterforsker:
- Eric Wallace, MD
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California
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Los Angeles, California, Forenede Stater, 90095
- Rekruttering
- University of California Los Angeles (UCLA)
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Ledende efterforsker:
- Nicola Longo, MD
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Kontakt:
- Kimberly L. Schweigman
- E-mail: KSchweigman@mednet.ucla.edu
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Georgia
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Atlanta, Georgia, Forenede Stater, 30322
- Rekruttering
- Emory University School of Medicine
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Ledende efterforsker:
- William Wilcox, MD
-
Kontakt:
- Dawn Laney
- Telefonnummer: 404-778-8518
- E-mail: dawn.laney@emory.edu
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Illinois
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Chicago, Illinois, Forenede Stater, 60611
- Rekruttering
- Ann & Robert H. Lurie Children's Hospital of Chicago
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Ledende efterforsker:
- Carlos E Prada, MD
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Kontakt:
- Carolyn Rasmussen, MS Genetic Counseling
- Telefonnummer: 312.227.6763
- E-mail: crasmussen@luriechildrens.org
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Kontakt:
- Esperanza Mendoza
- E-mail: eemendoza@luriechildrens.org
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-
Minnesota
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Minneapolis, Minnesota, Forenede Stater, 55455
- Rekruttering
- MHealth Fairview University of Minnesota Medical Center East Bank
-
Kontakt:
- Melissa Fetterley, BSN
- Telefonnummer: 612-672-5151
- E-mail: Melissa.Fetterley@fairview.org
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Kontakt:
- Brenda Diethelm-Okita, Masters
- E-mail: dieth001@umn.edu
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Ledende efterforsker:
- Chester B Whitley, MD
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New York
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New York, New York, Forenede Stater, 10029
- Rekruttering
- NYC Health + Hospitals/Metropolitan
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Ledende efterforsker:
- Maryam Banikazemi
-
Kontakt:
- Alla Pinkhasova
- Telefonnummer: (917) 796-8272
- E-mail: pinkhasa4@nychhc.org
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Ohio
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Cincinnati, Ohio, Forenede Stater, 45229
- Rekruttering
- Children's Hospital Medical Center
-
Ledende efterforsker:
- Robert J. Hopkin, MD
-
Kontakt:
- Laurie Bailey
- E-mail: Laurie.Bailey@cchmc.org
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Pennsylvania
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Pittsburgh, Pennsylvania, Forenede Stater, 15224
- Rekruttering
- UPMC Children's Hospital of Pittsburgh
-
Kontakt:
- Jennifer Baker
- Telefonnummer: 412-692-6378
- E-mail: Jennifer.Baker@chp.edu
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Ledende efterforsker:
- Damara Ortiz, MD
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Utah
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Salt Lake City, Utah, Forenede Stater, 84108
- Rekruttering
- University of Utah, Clinical and Translational Sciences Institute
-
Kontakt:
- Carrie Bailey, Bachelor of Science
- Telefonnummer: 801-587-3605
- E-mail: carrie.bailey@hsc.utah.edu
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Kontakt:
- Jenny Billy
- E-mail: jenny.billy@hsc.utah.edu
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Ledende efterforsker:
- Brian Shayota, MD, MPH
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Virginia
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Fairfax, Virginia, Forenede Stater, 22030
- Rekruttering
- Lysosomal & Rare Disorders Research and Treatment Center, Inc
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Ledende efterforsker:
- Ozlem Goker-Alpan
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Kontakt:
- Lauren Noll
- Telefonnummer: (571) 732-4655
- E-mail: LNoll@ldrtc.org
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Kontakt:
- BreAnna Davis
- E-mail: BDavis@ldrtc.org
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Key Inclusion Criteria:
-
Male of age ≥ 18 years and ≤65 years
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Confirmed clinical diagnosis of classic Fabry disease (FD) defined as:
- Absent or minimal αGAL A enzyme activity < 1% of mean normal measured in plasma regardless of variant status; OR
- α-galactosidase A (GLA) pathogenic or likely pathogenic variant associated with classic FD phenotype identified on molecular genetic testing with plasma αGLA A enzyme activity below lower bound of the reference range (as measured at trough enzyme replacement therapy [ERT] levels).
-
eGFR ≥ 40 mL/min/1.73 m2
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Participant agrees to use a condom during sexual intercourse with any female partner who could become pregnant
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Suboptimal response after at least 12 months of enzyme replacement therapy (ERT) treatment. Suboptimal response is defined as plasma lyso-Gb3 ≥ 2.3 nanograms per milliliter (ng/mL) at Screening and one or both of the following:
- Persistent moderate or severe neuropathic pain (intermittent or continuous) over a period of at least 3 months prior to consent
- Presence of gastrointestinal symptoms (abdominal cramping, constipation, or diarrhea), reported by the Participant as moderate or severe and that are either persistent or occurring two or more times over the 12 weeks prior to consent
-
Weight ≤ 120 kilograms (kg) and ≥ 45 kg
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Able and willing to provide informed consent
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Agrees to have no vaccinations within 6 weeks prior to and 6 weeks after dosing with AMT-191 unless allowed by stud protocol
Key Exclusion Criteria:
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Any allergic hypersensitivity reaction to ERT or infusion reaction in the 12 months prior to consent that was of severity grade 3 or above based on Common Terminology Criteria for Adverse Events (CTCAE v5.0) and required emergency intervention for hypertension/hypotension to stabilize blood pressure or hypoxia OR any other life-threatening complication.
-
Proteinuria, with random urine protein/creatinine ratio (rUPCR) ≥1 mg/mg at Screening
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Any previous treatment with investigational drug within 3 months prior to first Screening assessment
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Any previous treatment with gene therapy
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Any anticipated participation in interventional studies for the treatment of FD
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Current use of chaperone therapy such as migalastat (Galafold®)
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Malignancy within 5 years of Screening, except for basal or squamous cell carcinoma of the skin
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Presence of chronic, active, or latent infection with hepatitis B or C, human immunodeficiency virus (HIV), or tuberculosis (TB) as assessed at the screening visit.
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Active or ongoing infection or any other significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, cardiovascular, hematological, GI, endocrine (such as diabetes mellitus with poor glycemic control), pulmonary, neurological, cerebral, or psychiatric disease, alcoholism, drug dependency, or any other psychological disorder that could, in the opinion of the Investigator, risk the safety of the Participant, or interfere with adherence to the protocol procedures or interpretation of results
-
Evidence of any liver disease, including hepatitis, fibrosis, cirrhosis of the liver, neoplastic lesion, or any known medical condition that could impact the intended transduction of the vector and/or expression and activity of the protein
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History of kidney transplantation or currently on hemodialysis or peritoneal dialysis
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Moderately severe to severe cardiovascular disease, history of stroke or transient ischemic attacks within 12 months prior to Screening, history of ventricular tachycardia, history of or detection of other significant arrhythmia during Screening; significant thromboembolic disease history; or history of thrombotic risk resulting in current use of anticoagulant/antiplatelet agents.
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Uncontrolled hypertension, defined as systolic blood pressure >140 millimeters of mercury (mmHg) (inclusive) and/or diastolic blood pressure outside the range of 60 to 85 mmHg (inclusive) at Screening, confirmed on at least 2 repeated measurements
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Patients taking blood pressure medication to control blood pressure or proteinuria (eg, angiotensin-converting enzyme [ACE] inhibitors and angiotensin II receptor blockers [ARBs]) and have been titrated to a stable dose for at least 3 months prior to Screening are allowed in the study.
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Glycated hemoglobin (HbA1c) at Screening ≥7%
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Contraindication to systemic corticosteroid therapy or immunosuppressive therapy
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Chronic steroid use, defined as ≥ 3 months of oral corticosteroid use within 12 months prior to Screening
-
Screening laboratory values for renal and liver function that meet or exceed any of the following:
- Alanine transaminase (ALT) > 1.5 x upper limit of normal for the testing laboratory (ULN)
- Aspartate aminotransferase (AST) > 1.5 x ULN
- Total Bilirubin > ULN (except if this is caused by Gilbert disease)
- Alkaline phosphatase (ALP) > ULN
- Creatinine > 2 x ULN
- Direct bilirubin > ULN
- Albumin < 30 g/L
- Gamma-glutamyl transferase (GGT) > ULN
- Alpha-fetoprotein > 20 ng/mL unless cause is known and does not meet any other exclusion criteria
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Screening laboratory values for hematologic and coagulation function that meet any of the following:
- Hemoglobin < lower limit of normal (LLN) (as per reference laboratory ranges)
- Platelet count < 150 x1000/μl
- International normalized ratio (INR) >1.1
- Soluble terminal complement complex (sC5b-9)>ULN
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Significant anatomical abnormalities on renal ultrasound such as the presence of only 1 kidney, significant differences in kidney sizes between the right and left kidneys >1.5 centimeters (about 0.59 inch), or presence of kidney cysts
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Pre-existing ocular disease and/or intraocular pressure >21 mmHg at Screening unless referred for formal ophthalmology review and cleared b ophthalmologist to commence prednisone
-
To be (re)-assessed on Day 0 prior to planned infusion:
- Active systemic bacterial, viral, or fungal infection
- ALT or AST ≥ 1.5 x ULN
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomiseret
- Interventionel model: Sekventiel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Dosisvarierende kohorte 1
|
A recombinant serotype 5 based adeno-associated viral vector (AMT-191) for one-time intravenous (IV) administration will be investigated in this study. This recombinant AAV5-based vector contains a coding deoxyribonucleic acid (DNA) sequence for human α-galactosidase A. Delivery of AMT-191 to the systemic circulation is expected to result in a therapeutic effect by promoting the liver expression of the lysosomal enzyme GLA in plasma levels in patients with Fabry disease. |
|
Eksperimentel: Dosisvarierende kohorte 2
|
A recombinant serotype 5 based adeno-associated viral vector (AMT-191) for one-time intravenous (IV) administration will be investigated in this study. This recombinant AAV5-based vector contains a coding deoxyribonucleic acid (DNA) sequence for human α-galactosidase A. Delivery of AMT-191 to the systemic circulation is expected to result in a therapeutic effect by promoting the liver expression of the lysosomal enzyme GLA in plasma levels in patients with Fabry disease. |
|
Eksperimentel: Dosisvarierende kohorte 3
|
A recombinant serotype 5 based adeno-associated viral vector (AMT-191) for one-time intravenous (IV) administration will be investigated in this study. This recombinant AAV5-based vector contains a coding deoxyribonucleic acid (DNA) sequence for human α-galactosidase A. Delivery of AMT-191 to the systemic circulation is expected to result in a therapeutic effect by promoting the liver expression of the lysosomal enzyme GLA in plasma levels in patients with Fabry disease. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Evaluer sikkerheden og tolerabiliteten af forskellige dosisniveauer af intravenøst administreret AMT-191 hos deltagere med FD
Tidsramme: 60 måneder
|
60 måneder
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Characterize the vector shedding of intravenously-administered AMT-191
Tidsramme: 60 Months
|
Duration of vector deoxyribonucleic acid (DNA) shedding present in blood, saliva, feces, semen, and urine. |
60 Months
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Studieleder: Arian Pano, MD, MPH, Clinical Development and Program Lead, uniQure biopharma, B.V.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Cerebrovaskulære lidelser
- Hjernesygdomme
- Sygdomme i centralnervesystemet
- Sygdomme i nervesystemet
- Karsygdomme
- Hjerte-kar-sygdomme
- Metabolisme, medfødte fejl
- Genetiske sygdomme, medfødte
- Metaboliske sygdomme
- Lipidmetabolismeforstyrrelser
- Genetiske sygdomme, X-forbundet
- Lysosomale opbevaringssygdomme
- Hjernesygdomme, metaboliske, medfødte
- Hjernesygdomme, metaboliske
- Lipidmetabolisme, medfødte fejl
- Lysosomale opbevaringssygdomme, nervesystemet
- Cerebrale småkarsygdomme
- Sphingolipidoser
- Lipidoser
- Medfødte, arvelige og neonatale sygdomme og abnormiteter
- Ernæringsmæssige og metaboliske sygdomme
- Fabrys sygdom
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- CT-AMT-191-01
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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