- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT02255435
RTA 408 kapsler hos pasienter med Friedreichs ataksi - MOXIe
En fase 2-studie av sikkerheten, effekten og farmakodynamikken til RTA 408 i behandling av Friedreichs ataksi (MOXIe)
Friedreichs ataksi er en autosomal recessiv cerebellar ataksi forårsaket av triplet-gjentatte ekspansjoner. Den forårsakende mutasjonen er en gjentatt trinukleotid (GAA) ekspansjon i det første intronet til frataxingenet, noe som fører til svekket transkripsjon av frataxin. De patologiske konsekvensene av frataxinmangel inkluderer en alvorlig forstyrrelse av jern-svovelklyngebiosyntesen, mitokondriell jernoverbelastning koblet til cellulær jerndysregulering og en økt følsomhet for oksidativt stress.
Et kjennetegn på Friedreichs ataksi er svekkelse av antioksidative forsvarsmekanismer, som spiller en stor rolle i sykdomsprogresjonen. Studier har vist at nukleær faktor erytroid-avledet 2-relatert faktor 2 (Nrf2) signalering er sterkt svekket hos pasienter med Friedreichs ataksi. Derfor antas det at evnen til omaveloxolone (RTA 408) til å aktivere Nrf2 og indusere antioksidantmålgener er terapeutisk hos pasienter med Friedreichs ataksi.
Denne 2-delte studien vil evaluere effekten, sikkerheten og farmakodynamikken til omaveloxolone (RTA 408) i behandlingen av pasienter med Friedreichs ataksi.
Del 1: Den første delen av denne studien vil være en randomisert, placebokontrollert, dobbeltblind, doseeskaleringsstudie for å evaluere sikkerheten til omaveloxolone (RTA 408) ved ulike doser hos pasienter med Friedreichs ataksi.
Del 2: Den andre delen av denne studien er en randomisert, placebokontrollert, dobbeltblind, parallellgruppestudie for å evaluere sikkerheten og effekten av omaveloxolone (RTA 408) 150 mg hos pasienter med Friedreichs ataksi. Pasienter som er registrert i del 2 vil bli randomisert 1:1 for å få omaveloxolone (RTA 408) 150 mg eller placebo.
Forlengelse: Utvidelsen vil vurdere langsiktig sikkerhet og tolerabilitet av omaveloxolone (RTA 408) hos kvalifiserte pasienter med Friedreichs ataksi etter fullføring av del 1 eller del 2. Pasienter vil ikke bli avblindet for å studere behandling i del 1 eller del 2 når de går inn i utvidelsesstudie. Pasienter vil få åpent omaveloxolone (RTA 408) med 150 mg én gang daglig.
Studieoversikt
Status
Forhold
Intervensjon / Behandling
- Legemiddel: Placebo
- Legemiddel: Omaveloxolone kapsler, 2,5 mg
- Legemiddel: Omaveloxolone kapsler, 5 mg
- Legemiddel: Omaveloxolone kapsler, 10 mg
- Legemiddel: Omaveloxolone kapsler, 20 mg
- Legemiddel: Omaveloxolone kapsler, 40 mg
- Legemiddel: Omaveloxolone kapsler, 80 mg
- Legemiddel: Omaveloxolone kapsler, 160 mg
- Legemiddel: Omaveloxolone kapsler, 300 mg
- Legemiddel: Omaveloxolone kapsler, 150 mg
Detaljert beskrivelse
Studietype
Registrering (Faktiske)
Fase
- Fase 2
Kontakter og plasseringer
Studiesteder
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Victoria
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Parkville, Victoria, Australia, 3052
- Murdoch Childrens Research Institute
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California
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Los Angeles, California, Forente stater, 90095
- UCLA
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Florida
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Gainesville, Florida, Forente stater, 32610
- University of Florida - Neurology
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Tampa, Florida, Forente stater, 33612
- USF Ataxia Research Center
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Georgia
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Atlanta, Georgia, Forente stater, 30329
- Emory University Hospital - Neurology
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Iowa
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Iowa City, Iowa, Forente stater, 52242
- University of Iowa Stead Family Children's Hospital
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Ohio
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Columbus, Ohio, Forente stater, 43221
- Ohio State University - Neurology
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Pennsylvania
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Philadelphia, Pennsylvania, Forente stater, 19104
- Children's Hospital of Philadelphia
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Milan, Italia, 20133
- Neurological Institute Carlo Besta
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London, Storbritannia, WC1E 6BT
- University College of London
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Innsbruck, Østerrike, 6020
- Medical University Innsbruck
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Beskrivelse
Inklusjonskriterier:
- Har genetisk bekreftet Friedreichs ataksi
- Ha en modifisert FARS-score ≥20 og ≤80
- Vær mann eller kvinne og ≥16 år og ≤40 år
- Har ingen endringer i treningsregimet innen 30 dager før studiedag 1 og vær villig til å forbli på samme treningsregime i løpet av den 16 uker lange studieperioden
- Har evnen til å fullføre maksimal treningstesting
- Kunne svelge kapsler
Ekskluderingskriterier:
- Har ukontrollert diabetes (HbA1c >11,0 %)
- Har B-type natriuretisk peptidverdi >200 pg/ml
- Har en historie med klinisk signifikant venstresidig hjertesykdom og/eller klinisk signifikant hjertesykdom
- Har kjent aktiv sopp-, bakterie- og/eller virusinfeksjon, inkludert humant immunsviktvirus eller hepatittvirus (B eller C)
- Har kjent eller mistenkt aktivt narkotika- eller alkoholmisbruk
- Har klinisk signifikante abnormiteter i klinisk hematologi eller biokjemi, inkludert men ikke begrenset til forhøyninger større enn 1,5 ganger øvre normalgrense for aspartataminotransferase eller alaninaminotransferase
- Har en unormal laboratorietestverdi eller alvorlig eksisterende medisinsk tilstand som, etter etterforskerens oppfatning, vil sette pasienten i fare ved studieregistrering
Har tatt noen av følgende legemidler innen 7 dager før studiedag 1 eller planlegger å ta noen av disse legemidlene i løpet av studiedeltakelsestiden:
- Sensitive substrater for cytokrom P450 2C8 eller 3A4 (f.eks. repaglinid, midazolam, sildenafil)
- Moderate eller sterke hemmere eller induktorer av cytokrom P450 3A4 (f.eks. karbamazepin, fenytoin, ciprofloksacin, grapefruktjuice)
- Substrater for p-glykoproteintransportør (f.eks. ambrisentan, digoksin)
- Har deltatt i andre intervensjonelle kliniske studier innen 30 dager før studiedag 1
- Har en kognitiv svikt som kan utelukke evnen til å følge studieprosedyrer
- Tidligere deltagelse i en utprøving med omaveloxolone (RTA 408)
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Dobbelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Eksperimentell: Part 1: Omaveloxolone 2.5 and 5 mg
Participants received omaveloxolone 2.5 mg, oral capsule, QD for 2 weeks, followed by 5 mg Omaveloxolone, oral capsule, QD for 10 weeks.
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Andre navn:
Andre navn:
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Eksperimentell: Part 1: Omaveloxolone 10 mg
Participants received omaveloxolone 10 mg, oral capsule, QD for 12 weeks.
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Andre navn:
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Eksperimentell: Part 1: Omaveloxolone 20 mg
Participants received omaveloxolone 20 mg, oral capsule, QD for 12 weeks.
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Andre navn:
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Eksperimentell: Part 1: Omaveloxolone 40 mg
Participants received omaveloxolone 40 mg, oral capsule, QD for 12 weeks.
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Andre navn:
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Eksperimentell: Part 1: Omaveloxolone 80 mg
Participants received omaveloxolone 80 mg, oral capsule, QD for 12 weeks.
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Andre navn:
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Eksperimentell: Part 1: Omaveloxolone 160 mg
Participants received omaveloxolone 160 mg, oral capsule, QD for 12 weeks.
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Eksperimentell: Part 1: Omaveloxolone 300 mg
Participants received omaveloxolone 300 mg, oral capsule, QD for 12 weeks.
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Andre navn:
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Placebo komparator: Part 1: Placebo
Participants received placebo, oral capsule, QD for 12 weeks.
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Eksperimentell: Part 2: Omaveloxolone 150 mg
Participants received omaveloxolone 150 mg, oral capsule, QD for 48 weeks.
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Andre navn:
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Placebo komparator: Part 2: Placebo
Participants received placebo, oral capsule, QD for 48 weeks.
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Eksperimentell: OLE: Placebo/ Omaveloxolone
All eligible participants who had received either omaveloxone or placebo in Part 1 and eligible participants who received placebo in Part 2 received omaveloxone, 150 mg, oral capsule, QD, until the drug was available through commercial channels or alternate post-trial access mechanisms, or until participant withdrawal, whichever was sooner (up to approximately 370 weeks).
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Andre navn:
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Eksperimentell: OLE: Omaveloxolone/ Omaveloxolone
All eligible participants who had received omaveloxone in Part 2 continued to receive omaveloxolone, 150 mg, oral capsule, QD until the drug was available through commercial channels or alternate post-trial access mechanisms, or until participant withdrawal, whichever was sooner (up to approximately 370 weeks).
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Andre navn:
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Part 1: Change From Baseline in Peak Work During Maximal Exercise Testing at Week 12
Tidsramme: Baseline, Week 12
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Cycle ergometry using a recumbent stationary bicycle was used to conduct maximal exercise testing and workload was increased incrementally.
Peak work is defined as the workload at which participants reach maximal volition (defined as an inability to continue to exercise due to exhaustion).
A positive change from baseline suggests an improvement.
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Baseline, Week 12
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Part 1: Number of Participants With Treatment Emergent Adverse Events (TEAEs) and Treatment Emergent Serious Adverse Events (TESAEs)
Tidsramme: From first dose of study drug up to end of Part 1 of the study (up to Week 16)
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An adverse event (AE) was any unfavorable and unintended sign (including any clinically significant abnormal laboratory test result), symptom, or disease temporally associated with the use of the study drug whether or not it is considered to be study drug related.
An SAE was any untoward medical occurrence that at any dose resulted in death, in the view of the Investigator, placed the participant at immediate risk of death, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, resulted in a birth defect.
TEAEs were defined as any AEs, regardless of relationship to study drug, that had an onset or worsened in severity on or after the first dose of study drug.
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From first dose of study drug up to end of Part 1 of the study (up to Week 16)
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Part 2: Change From Baseline in the Modified Friedreich's Ataxia Rating Scale (mFARS) at Week 48
Tidsramme: Baseline, Week 48
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The Friedreich Ataxia Rating Scale (FARS) is a neurological-exam-based rating scale with five sections: Bulbar (section A), Upper Limb Coordination (section B), Lower Limb Coordination (section C), Peripheral Nervous System (section D), and Upright Stability (section E). mFARS is the sum of sections A (score 0 to 11), B (score 0 to 36), C (score 0 to 16), and E (score 0 to 36).
The minimum score is 0 and the maximum score is 99.
A lower score indicates better neurological function.
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Baseline, Week 48
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Part 2: Number of Participants With TEAEs and TESAEs
Tidsramme: From first dose of study drug up to end of Part 2 of the study (up to Week 52)
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An AE was any unfavorable and unintended sign (including any clinically significant abnormal laboratory test result), symptom, or disease temporally associated with the use of the study drug whether or not it is considered to be study drug related.
An SAE was any untoward medical occurrence that at any dose resulted in death, in the view of the Investigator, placed the participant at immediate risk of death, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, resulted in a birth defect.
TEAEs were defined as any AEs, regardless of relationship to study drug, that had an onset or worsened in severity on or after the first dose of study drug.
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From first dose of study drug up to end of Part 2 of the study (up to Week 52)
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Part 1: Change From Baseline in the mFARS at Week 12
Tidsramme: Baseline, Week 12
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The FARS is a neurological-exam-based rating scale with five sections: Bulbar (section A), Upper Limb Coordination (section B), Lower Limb Coordination (section C), Peripheral Nervous System (section D), and Upright Stability (section E). mFARS is the sum of sections A (score 0 to 11), B (score 0 to 36), C (score 0 to 16), and E (score 0 to 36).
The minimum score is 0 and the maximum score is 99.
A lower score indicates better neurological function.
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Baseline, Week 12
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Part 2: Number of Participants With Patient Global Impression of Change (PGI-C)
Tidsramme: Week 48
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The PGI-C is a 7-point scale that requires participants to assess how much their illness has improved or worsened relative to their baseline state at the beginning of the trial.
Participants self-rated their perceived change by completing the following statement: "Since I began trial treatment, my overall status is:" 1=Very much improved, 2=Much improved, 3=Minimally improved, 4=No change, 5=Minimally worse, 6=Much worse and 7=Very much worse.
Lower score indicates better improvement.
The categories with at least one participant having a PGI-C score are reported.
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Week 48
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Part 2: Number of Participants With Clinical Global Impression of Change (CGI-C)
Tidsramme: Week 48
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The CGIC scale is a 7 point scale that requires the clinician to assess how much the participant's illness has improved or worsened relative to a baseline state at the beginning of an intervention.
The CGIC was assessed by completing the following statement "Compared to the participant's condition at the start of the trial, this participant's overall status is", where 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, 7=very much worse.
Lower score indicates better improvement.
The categories with at least one participant having a CGIC score are reported.
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Week 48
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Part 2: Change From Baseline in Performance on a 9-Hole Peg Test (9-HPT) at Week 48
Tidsramme: Baseline, Week 48
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The 9-HPT is a brief, standardized, quantitative test of upper extremity (arm and hand) function.
Both the dominant and nondominant hands were tested twice (2 consecutive trials of the dominant hand, followed immediately by 2 consecutive trials of the nondominant hand).
The participant picks up pegs 1 at a time (9 in total), using 1 hand only, and places them into holes on the board as quickly as possible, in any order until all holes are filled.
Then, without pausing, the participant removes the pegs 1 at a time and returns them as quickly as possible.
The times recorded for the two trials for each hand are averaged, and the reciprocal average value for each hand was used in analyses.
Longer test times reflect more impairment on the participant's upper extremity function, thus a negative change from baseline suggests an improvement.
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Baseline, Week 48
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Part 2: Change From Baseline in Performance on a 25-Foot Timed Walk Test (T25-FWT) at Week 48
Tidsramme: Baseline, Week 48
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The T25-FWT is a quantitative mobility and leg function performance test based on time (in seconds) to complete a 25-foot walk.
Participants were instructed to attempt two T25-FWT trials at each visit.
Both walk times were averaged, and the reciprocal average value was used in analyses.
Longer test times reflect more impairment on the participant's ability to walk, thus a negative change from baseline suggests an improvement.
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Baseline, Week 48
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Part 2: Total Number of Falls
Tidsramme: Up to Week 48
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A fall was defined as "the participant unintentionally coming to rest on the ground or at a lower level."
The total number of falls before and after study drug administration has been reported.
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Up to Week 48
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Part 2: Change From Baseline in Peak Work During Maximal Exercise Testing at Week 48
Tidsramme: Baseline, Week 48
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Cycle ergometry using a recumbent stationary bicycle was used to conduct maximal exercise testing and workload was increased incrementally.
Peak work is defined as the workload at which participants reach maximal volition (defined as an inability to continue to exercise due to exhaustion).
A positive change from baseline suggests an improvement.
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Baseline, Week 48
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Part 2: Change From Baseline in the Activities of Daily Living (ADL) Score at Week 48
Tidsramme: Baseline, Week 48
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The ADL scale examines the ability of participants to complete everyday tasks (e.g., holding a fork, dressing).
The ADL is a 9-question assessment, with the total score being the sum of 9 questions.
The ADL survey assesses 9 concepts: (1) speech; (2) swallowing; (3) cutting food and handling utensils; (4) dressing; (5) personal hygiene; (6) falling; (7) walking; (8) quality of sitting position; and (9) bladder function.
Each of these is rated on a 5-point scale where 0= normal and 4= severe disability/inability to carry out activity independently, for a total possible score of 0 to 36, with higher scores representing greater disability/dependency.
A negative change from baseline indicates improvement.
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Baseline, Week 48
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Samarbeidspartnere og etterforskere
Sponsor
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Lynch DR, Chin MP, Delatycki MB, Subramony SH, Corti M, Hoyle JC, Boesch S, Nachbauer W, Mariotti C, Mathews KD, Giunti P, Wilmot G, Zesiewicz T, Perlman S, Goldsberry A, O'Grady M, Meyer CJ. Safety and Efficacy of Omaveloxolone in Friedreich Ataxia (MOXIe Study). Ann Neurol. 2021 Feb;89(2):212-225. doi: 10.1002/ana.25934. Epub 2020 Nov 5.
- Lynch DR, Farmer J, Hauser L, Blair IA, Wang QQ, Mesaros C, Snyder N, Boesch S, Chin M, Delatycki MB, Giunti P, Goldsberry A, Hoyle C, McBride MG, Nachbauer W, O'Grady M, Perlman S, Subramony SH, Wilmot GR, Zesiewicz T, Meyer C. Safety, pharmacodynamics, and potential benefit of omaveloxolone in Friedreich ataxia. Ann Clin Transl Neurol. 2018 Nov 10;6(1):15-26. doi: 10.1002/acn3.660. eCollection 2019 Jan.
- Perlman S, Zhang S, Setyawan J, Yang H, Jiang A, Hua Q, Boudreau J, Khan S, Bajaj A, Lynch DR, Lawson R. The clinical burden of Friedreich ataxia in the United States: A retrospective claims database analysis. J Neurol Sci. 2025 Aug 15;475:123594. doi: 10.1016/j.jns.2025.123594. Epub 2025 Jun 25.
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Primær fullføring (Faktiske)
Studiet fullført (Faktiske)
Datoer for studieregistrering
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Antatt)
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Hjernesykdommer
- Sykdommer i sentralnervesystemet
- Sykdommer i nervesystemet
- Genetiske sykdommer, medfødte
- Metabolske sykdommer
- Nevrodegenerative sykdommer
- Heredodegenerative lidelser, nervesystemet
- Ryggmargssykdommer
- Cerebellare sykdommer
- Spinocerebellare degenerasjoner
- Medfødte, arvelige og neonatale sykdommer og abnormiteter
- Ernæringsmessige og metabolske sykdommer
- Mitokondrielle sykdommer
- Friedreich Ataxia
- Substandard medisiner
- Farmasøytiske preparater
- omaveloxolone
- ORF 50 Transactivator
Andre studie-ID-numre
- RTA 408-C-1402
- 2024-517436-22 (Annen identifikator: EU CTIS Number)
Plan for individuelle deltakerdata (IPD)
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IPD-planbeskrivelse
Legemiddel- og utstyrsinformasjon, studiedokumenter
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