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A Study to Evaluate Subcutaneously Administered rAvPAL-PEG in Patients With Phenylketonuria for 24 Weeks

Primary Purpose

Phenylketonuria

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
BMN 165 (rAvPAL-PEG)
Sponsored by
BioMarin Pharmaceutical
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Phenylketonuria focused on measuring PKU, Injections, PEG-PAL, PAL

Eligibility Criteria

16 Years - 70 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. A diagnosis of PKU, with the following:

    • Current blood Phe concentration of ≥ 600 µmol/L at Screening.
    • Average blood Phe concentration of ≥ 600 µmol/L over the past 6 months, using available data.
    • Naïve to prior treatment with rAvPAL-PEG.
  2. Evidence that the patient is a non responder to Kuvan® treatment (ie, 4 weeks of treatment with 20 mg/kg/day of Kuvan, insufficient response per investigator determination, unsuitable for Kuvan® per Investigator determination, and treatment end date ≥ 2 days prior to Day 1 [ie, first dose]). Patients who have had a previous response to Kuvan® treatment but are not currently taking Kuvan® because of noncompliance and have been off treatment for ≥ 4 months prior to Screening are eligible for participation.
  3. Willing and able to provide written, signed informed consent after the nature of the study has been explained and prior to any research-related procedures. In the case of participants under the age of 18 or participants who have been deemed mentally unable to provide informed consent, a parent or legal guardian may provide written informed consent (and, if required, the patient will provide written assent).
  4. Willing and able to comply with all study procedures.
  5. Between the ages of 16 and 70 years, inclusive.
  6. Females of childbearing potential must have a negative pregnancy test at Screening and be willing to have additional pregnancy tests during the study. Females considered not of childbearing potential include those who have been in menopause at least 2 years, or had tubal ligation at least 1 year prior to Screening, or who have had total hysterectomy.
  7. Sexually active patients must be willing to use an acceptable method of contraception while participating in the study.
  8. Maintained a stable diet with no significant modifications during the 4 weeks preceding the administration of study drug and willing to continue with the diet while on study so as to avoid potential variability of response due to variations in dietary intake.
  9. In generally good health as evidenced by physical examination, clinical laboratory evaluations (hematology, chemistry, and urinalysis), and electrocardiogram (ECG) at Screening.

Exclusion Criteria:

  1. Use of any investigational product or investigational medical device within 30 days prior to Screening, or requirement for any investigational agent prior to completion of all scheduled study assessments.
  2. Use of any medication that is intended to treat PKU, including use of large amino acids, within 2 days prior to the administration of study drug.
  3. Use or planned use of any injectable drugs containing PEG (other than rAvPAL-PEG), including Depo-Provera, within 3 months prior to Screening and during study participation.
  4. A prior reaction that included systemic symptoms (eg, respiratory or gastrointestinal problems, hypotension, angioedema, anaphylaxis) to a PEG containing product. Patients with a prior systemic reaction of generalized rash may be eligible for participation per the discretion of the Principal Investigator in consultation with the Sponsor's Medical Officer.
  5. Pregnant or breastfeeding at Screening or planning to become pregnant (self or partner) or to breastfeed at any time during the study.
  6. Concurrent disease or condition that would interfere with study participation or safety (eg, history or presence of clinically significant cardiovascular, pulmonary, hepatic, renal, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurological, oncologic, or psychiatric disease).
  7. Any condition that, in the view of the PI, places the patient at high risk of poor treatment compliance or of not completing the study.
  8. Alanine aminotransferase (ALT) concentration > 2 times the upper limit of normal.
  9. Creatinine > 1.5 times the upper limit of normal.
  10. A positive test for human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen and hepatitis C antibody.

Sites / Locations

  • The Children's Hospital
  • University of Florida, Gainesville
  • Children's Hospital Boston
  • Nebraska Medical Center
  • Albany Medical Center
  • University of Utah Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Group 1

Arm Description

4-8 week induction of rAvPAL-PEG at 2.5 mg, followed by titration to maintenance dose

Outcomes

Primary Outcome Measures

Blood Phenylalanine Concentration
All patients will have their plasma Phenylalanine (Phe) assessed. Please note that "Pharmacokinetics Sub-study" was not performed, and thus no results are available.

Secondary Outcome Measures

Number of Participants With Study Drug Related Adverse Events
Percentage of Participants With Positive Anti-PAL Immunoglobulin G [IgG]
Antibody Positivity
Trough Concentration of BMN 165
PK assessment from pre-dose blood draw.
Percentage of Participants With Positive Anti-PEG IgG
Antibody Positivity
Percentage of Participants With Positive PAL-IgM
Antibody Positivity
Percentage of Participants With Positive Anti-PEG-IgM
Antibody positivity
Percentage of Participants With Positive Neutralizing Antibodies [Nab]
Antibody positivity
Percentage of Participants With Positive Anti-PAL-IgE Antibodies
Antibody positivity
Percentage of Participants With Positive Anti-PAL-PEG IgE Antibodies
Antibody positivity

Full Information

First Posted
March 5, 2012
Last Updated
July 23, 2019
Sponsor
BioMarin Pharmaceutical
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1. Study Identification

Unique Protocol Identification Number
NCT01560286
Brief Title
A Study to Evaluate Subcutaneously Administered rAvPAL-PEG in Patients With Phenylketonuria for 24 Weeks
Official Title
A Phase II, Multi-center, Open-label, Dose-finding Study to Evaluate Safety, Efficacy and Tolerability of Subcutaneously (SC) Administered rAvPAL-PEG in Patients With PKU for 24 Weeks
Study Type
Interventional

2. Study Status

Record Verification Date
July 2019
Overall Recruitment Status
Completed
Study Start Date
May 2012 (undefined)
Primary Completion Date
September 2013 (Actual)
Study Completion Date
July 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
BioMarin Pharmaceutical

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The primary objective of the study is to evaluate the effect of dosing regimens of multiple subcutaneous (SC) doses of rAvPAL-PEG to induce an early and sustained Phe reduction while decreasing the frequency and severity of hypersensitivity reactions in patients with PKU.
Detailed Description
The primary rationale for this study is to define an optimal rAvPAL-PEG dose regimen by establishing the therapeutic effect within the shortest time possible time for induction, titration and maintenance phases while reducing the severity and frequency of hypersensitivity reactions that may lead to dose interruptions. It is hypothesized that these goals can be achieved by keeping rAvPAL-PEG doses low when anti-PEG IgM response is predicted to be high and titrating to an efficacious dose once the IgG response to PAL has developed. Further investigation is needed to determine how early and quickly patients can titrate safely to lower blood Phe; therefore, this protocol proposes to assess two Groups using an induction/titration and maintenance schedule with an aim towards establishing the therapeutic effect safety within an optimal period of time.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Phenylketonuria
Keywords
PKU, Injections, PEG-PAL, PAL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
4-8 week induction of rAvPAL-PEG at 2.5 mg, followed by titration to maintenance dose
Intervention Type
Biological
Intervention Name(s)
BMN 165 (rAvPAL-PEG)
Other Intervention Name(s)
Recombinant Anabaena variabilis phenylalanine ammonia lyase
Intervention Description
Subcutaneous injection of rAvPAL-PEG administered from 1 time up to 5 times per week between 2.5mg up to a maximum of 375mg for 24 weeks.
Primary Outcome Measure Information:
Title
Blood Phenylalanine Concentration
Description
All patients will have their plasma Phenylalanine (Phe) assessed. Please note that "Pharmacokinetics Sub-study" was not performed, and thus no results are available.
Time Frame
Baseline, Week 24
Secondary Outcome Measure Information:
Title
Number of Participants With Study Drug Related Adverse Events
Time Frame
Minimum Weekly Assessment of Injection Sites, Vital Signs and Adverse Events. Other Safety Assessments will be performed at other intervals (below):
Title
Percentage of Participants With Positive Anti-PAL Immunoglobulin G [IgG]
Description
Antibody Positivity
Time Frame
Baseline, Week 24
Title
Trough Concentration of BMN 165
Description
PK assessment from pre-dose blood draw.
Time Frame
Week 1, Week 24
Title
Percentage of Participants With Positive Anti-PEG IgG
Description
Antibody Positivity
Time Frame
Baseline, Week 24
Title
Percentage of Participants With Positive PAL-IgM
Description
Antibody Positivity
Time Frame
Baseline, Week 24
Title
Percentage of Participants With Positive Anti-PEG-IgM
Description
Antibody positivity
Time Frame
Baseline, Week 24
Title
Percentage of Participants With Positive Neutralizing Antibodies [Nab]
Description
Antibody positivity
Time Frame
Baseline, Week 24
Title
Percentage of Participants With Positive Anti-PAL-IgE Antibodies
Description
Antibody positivity
Time Frame
Baseline, Week 24
Title
Percentage of Participants With Positive Anti-PAL-PEG IgE Antibodies
Description
Antibody positivity
Time Frame
Baseline, Week 24

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A diagnosis of PKU, with the following: Current blood Phe concentration of ≥ 600 µmol/L at Screening. Average blood Phe concentration of ≥ 600 µmol/L over the past 6 months, using available data. Naïve to prior treatment with rAvPAL-PEG. Evidence that the patient is a non responder to Kuvan® treatment (ie, 4 weeks of treatment with 20 mg/kg/day of Kuvan, insufficient response per investigator determination, unsuitable for Kuvan® per Investigator determination, and treatment end date ≥ 2 days prior to Day 1 [ie, first dose]). Patients who have had a previous response to Kuvan® treatment but are not currently taking Kuvan® because of noncompliance and have been off treatment for ≥ 4 months prior to Screening are eligible for participation. Willing and able to provide written, signed informed consent after the nature of the study has been explained and prior to any research-related procedures. In the case of participants under the age of 18 or participants who have been deemed mentally unable to provide informed consent, a parent or legal guardian may provide written informed consent (and, if required, the patient will provide written assent). Willing and able to comply with all study procedures. Between the ages of 16 and 70 years, inclusive. Females of childbearing potential must have a negative pregnancy test at Screening and be willing to have additional pregnancy tests during the study. Females considered not of childbearing potential include those who have been in menopause at least 2 years, or had tubal ligation at least 1 year prior to Screening, or who have had total hysterectomy. Sexually active patients must be willing to use an acceptable method of contraception while participating in the study. Maintained a stable diet with no significant modifications during the 4 weeks preceding the administration of study drug and willing to continue with the diet while on study so as to avoid potential variability of response due to variations in dietary intake. In generally good health as evidenced by physical examination, clinical laboratory evaluations (hematology, chemistry, and urinalysis), and electrocardiogram (ECG) at Screening. Exclusion Criteria: Use of any investigational product or investigational medical device within 30 days prior to Screening, or requirement for any investigational agent prior to completion of all scheduled study assessments. Use of any medication that is intended to treat PKU, including use of large amino acids, within 2 days prior to the administration of study drug. Use or planned use of any injectable drugs containing PEG (other than rAvPAL-PEG), including Depo-Provera, within 3 months prior to Screening and during study participation. A prior reaction that included systemic symptoms (eg, respiratory or gastrointestinal problems, hypotension, angioedema, anaphylaxis) to a PEG containing product. Patients with a prior systemic reaction of generalized rash may be eligible for participation per the discretion of the Principal Investigator in consultation with the Sponsor's Medical Officer. Pregnant or breastfeeding at Screening or planning to become pregnant (self or partner) or to breastfeed at any time during the study. Concurrent disease or condition that would interfere with study participation or safety (eg, history or presence of clinically significant cardiovascular, pulmonary, hepatic, renal, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurological, oncologic, or psychiatric disease). Any condition that, in the view of the PI, places the patient at high risk of poor treatment compliance or of not completing the study. Alanine aminotransferase (ALT) concentration > 2 times the upper limit of normal. Creatinine > 1.5 times the upper limit of normal. A positive test for human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen and hepatitis C antibody.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Debra Lounsbury
Organizational Affiliation
BioMarin Pharmaceutical
Official's Role
Study Director
Facility Information:
Facility Name
The Children's Hospital
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80048
Country
United States
Facility Name
University of Florida, Gainesville
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
Children's Hospital Boston
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Nebraska Medical Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198
Country
United States
Facility Name
Albany Medical Center
City
Albany
State/Province
New York
ZIP/Postal Code
12208
Country
United States
Facility Name
University of Utah Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States

12. IPD Sharing Statement

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A Study to Evaluate Subcutaneously Administered rAvPAL-PEG in Patients With Phenylketonuria for 24 Weeks

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