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An Open Label Study of LMI070 (Branaplam) in Type 1 Spinal Muscular Atrophy (SMA)

Primary Purpose

Spinal Muscular Atrophy

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
branaplam
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Muscular Atrophy focused on measuring Type 1 Spinal Muscular Atrophy

Eligibility Criteria

28 Days - 182 Days (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Common for both Parts 1 and 2:

  • Type 1 SMA, diagnosed clinically, with symptom onset <6 months of age and genetic confirmation of mutations in both alleles of the SMN1 gene, and with SMN2 copy number of 2.
  • Best supportive care in place and stable for at least 14 days before screening.
  • Must be able to demonstrate antigravity strength in both biceps. At birth gestational age >32 weeks and body weight at birth >2 kg.
  • Must live within 2 hours drive of study center. Clearance should be obtained from the site investigator and sponsor if the patient resides more than 2 hours ground travel from the study center

Specific for Part 1

  • Age at screening between 1 and 7 months
  • Must have or agree to have placement of feeding tube for enteral access via nasogastric (NG), nasojejunal (NJ), percutaneous gastrostomy (PEG), or percutaneous jejunostomy (PEJ) tube for administration of branaplam (for patients in whom branaplam cannot be administered orally ; NG tube may be removed between doses).

Specific for Part 2

  • Age at screening between 30 and 180 days of age
  • Must have or agree to have placement of feeding tube for enteral access via nasogastric (NG), nasojejunal (NJ), percutaneous gastrostomy (PEG), or percutaneous jejunostomy (PEJ) tube for administration of branaplam (for the first administration only and for patients in whom branaplam cannot be administered orally; NG tube may be removed between doses).
  • Minimum CHOP INTEND score of 15 at baseline
  • Must be able to feed orally for all nutritional needs and be greater than the 2nd percentile for weight on the standard growth curves for the country of origin

Exclusion Criteria:

Common for both Parts 1 and 2:

  • Neurologic, or neuromuscular conditions other than SMA.
  • Anemia, leukopenia, neutropenia or thrombocytopenia
  • Hepatic dysfunction
  • Age adjusted renal dysfunction
  • Presence of an untreated or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy at any time during the screening period.
  • Presence of an untreated or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy at any time during the screening period.
  • Excluding SMA, any medically unstable condition including cardiomyopathy, hepatic dysfunction, kidney disorder, endocrine disorder, GI disorders, prematurity of <32 weeks gestation, metabolic disorders, severe respiratory compromise and significant brain abnormalities or injuries including hypoxic-ischemic encephalopathy.
  • Current diagnosis of cardiac and/or vascular abnormalities or ECG abnormalities
  • Acute or ongoing medical condition that, according to the Site Investigator and discussed with sponsor, would interfere with the conduct and assessments of the study. Examples are medical disability other than SMA that would interfere with the assessment of safety or would compromise the ability of the subject to undergo study procedures including be assessed by CHOP INTEND motor scale, changes in hematologic parameters or gastrointestinal dysfunction that would compromise the ability of adequate assessment of safety

Specific for Part 1

  • Use of other investigational drugs within 14 days.
  • Intractable seizure disorder (other than inactive febrile seizures).
  • Persistent (in the opinion of the Investigator) hypoxemia (O2 saturation awake <92% or O2 saturation asleep <91%, without ventilation support) or requiring oral suctioning >2 per day, or presence of a tracheostomy.

Specific for Part 2

  • Use of nusinersen or gene transfer at any time or other investigational drugs within 14 days.
  • Intractable epilepsy
  • Persistent (in the opinion of the Investigator) hypoxemia (O2 saturation awake <92% or O2 saturation asleep <91%, without ventilation support), or presence of a tracheostomy.

Sites / Locations

  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site
  • Novartis Investigative Site

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

branaplam

Arm Description

branaplam Treatment

Outcomes

Primary Outcome Measures

Number of participants with adverse events (AEs), serious adverse events (SAEs)
Participants are monitored for safety throughout the study
Number of participants with adverse events (AEs), serious adverse events (SAEs)
Participants are monitored for safety throughout the study

Secondary Outcome Measures

Change from baseline in length
To evaluate the effect of branaplam on length in cm
Change from baseline in pulse oximetry
To evaluate the effect of branaplam on respiratory function by measurement of Pulse oximetry in percentage (%) of oxygen saturation
Change from baseline in Hammersmith Infant Neurology Examination (HINE) section 2
To evaluate the effect of branaplam on infant motor development using HINE section 2
Pharmacokinetic: AUC
To evaluate branaplam pharmacokinetics in plasma after single and repeated doses of branaplam by determination of AUC.
In addition to the above for Part 2 - Change from baseline in feeding status
To evaluate the efficacy of branaplam on preservation of oral feeding
In addition to the above for Part 2 - Changes in Ulnar Nerve Compound Motor Action Potential (CMAP) from baseline
To evaluate the efficacy of branaplam on Ulnar and Peroneal Nerve Compound Motor Action Potentials (CMAPs) in terms of % increase from baseline
In addition to the above for Part 2 - Changes from baseline on the ability to site without support
To evaluate the efficacy of branaplam on the ability to sit without support
Change from baseline in weight
To evaluate the effect of branaplam on weight in kilograms
Change from baseline in head circumference
To evaluate the effect of branaplam on head circumference in cm
Change from baseline in chest circumference
To evaluate the effect of branaplam on chest circumference
Change from baseline in Children's Hospital of Philadelphia Infant Neuromuscular Disorders (CHOP INTEND)
To evaluate the effect of branaplam on infant motor development using CHOP INTEND
Change from baseline in respiratory rate
To evaluate the effect of branaplam on respiratory function by measurement of the respiratory rate
Change from baseline in chest circumference during quiet breathing
To evaluate the effect of branaplam on respiratory function by measurement of the chest circumference in cm during expiration and during inspiration
Change from baseline in paradoxical breathing
To evaluate the effect of branaplam on respiratory function by evaluation of the presence of absence of paradoxical breathing
Pharmacokinetic: Cmax
To evaluate branaplam pharmacokinetics in plasma after single and repeated doses of branaplam by determination of Cmax.

Full Information

First Posted
October 1, 2014
Last Updated
April 21, 2023
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT02268552
Brief Title
An Open Label Study of LMI070 (Branaplam) in Type 1 Spinal Muscular Atrophy (SMA)
Official Title
An Open Label Multi-part First-in-human Study of Oral LMI070 in Infants With Type 1 Spinal Muscular Atrophy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Completed
Study Start Date
April 2, 2015 (Actual)
Primary Completion Date
December 29, 2022 (Actual)
Study Completion Date
December 29, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

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

5. Study Description

Brief Summary
An open-label, multi-part, first-in-human study of oral branaplam in infants with Type 1 spinal muscular atrophy. The purpose of this study is to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD) and efficacy after 13 weeks; and to estimate the Maximum Tolerated Dose (MTD) of orally administered branaplam; and to identify the dose that is safe for long term use as well as that can provide durable efficacy optimal dosing regimen in patients with Type 1 SMA.
Detailed Description
This is an open-label, multi-part, first-in-human, proof of concept study in infants with Type 1 spinal muscular atrophy who have exactly 2 copies of SMN2, to evaluate safety, tolerability, PK, PD and efficacy of oral branaplam after 13 weeks treatment. Parts 1 and 2 are intended to be non-confirmatory. In Part 1 of the study, patients will be dosed once weekly with branaplam. The branaplam dose will be escalated in subsequent cohorts until MTD is determined or when sufficient PK results confirm that the MTD cannot be reached due to a potential pharmacokinetic plateau at higher doses. A decision to dose escalate the next cohort will be made after safety data have been collected for 14 days following the first dose (14-day DLT window). PK will be used to confirm that there is no accumulation of the compound. Part 2 of the study will enroll new patients into one of up to 3 dose cohorts with once weekly dosing for 52 weeks. The branaplam dose will be escalated in subsequent cohorts after 6 patients have been enrolled and at least 3 patients from the previous cohort will have completed 13 weeks of treatment. After 52 weeks, patients may continue treatment if Novartis, the investigator and the independent DMC agree that this is in the best interest of the patient. In all cases continuation of the treatment will be done at a dose selected as optimum, considering existing safety as well as efficacy data

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Muscular Atrophy
Keywords
Type 1 Spinal Muscular Atrophy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
branaplam
Arm Type
Experimental
Arm Description
branaplam Treatment
Intervention Type
Drug
Intervention Name(s)
branaplam
Primary Outcome Measure Information:
Title
Number of participants with adverse events (AEs), serious adverse events (SAEs)
Description
Participants are monitored for safety throughout the study
Time Frame
13 weeks
Title
Number of participants with adverse events (AEs), serious adverse events (SAEs)
Description
Participants are monitored for safety throughout the study
Time Frame
52 weeks
Secondary Outcome Measure Information:
Title
Change from baseline in length
Description
To evaluate the effect of branaplam on length in cm
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Change from baseline in pulse oximetry
Description
To evaluate the effect of branaplam on respiratory function by measurement of Pulse oximetry in percentage (%) of oxygen saturation
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Change from baseline in Hammersmith Infant Neurology Examination (HINE) section 2
Description
To evaluate the effect of branaplam on infant motor development using HINE section 2
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Pharmacokinetic: AUC
Description
To evaluate branaplam pharmacokinetics in plasma after single and repeated doses of branaplam by determination of AUC.
Time Frame
Parts 1 and 2: Day 1 (Pre-dose + 1, 2, 4, 8 & 24 hours post-dose), Days 2, 3, 5, 8, 29. Part 1: Day 43. Part 2: Day 57, 57, 92 (Pre-dose + 4 & 24 hours post-dose), 94, 99, 274 (Pre-dose + 4 & 24 hours post-dose), 276, 281
Title
In addition to the above for Part 2 - Change from baseline in feeding status
Description
To evaluate the efficacy of branaplam on preservation of oral feeding
Time Frame
Baseline, Day 15, Day 36, Day 57, Day 88 + End of Study
Title
In addition to the above for Part 2 - Changes in Ulnar Nerve Compound Motor Action Potential (CMAP) from baseline
Description
To evaluate the efficacy of branaplam on Ulnar and Peroneal Nerve Compound Motor Action Potentials (CMAPs) in terms of % increase from baseline
Time Frame
Baseline, Day 88 + End of Study
Title
In addition to the above for Part 2 - Changes from baseline on the ability to site without support
Description
To evaluate the efficacy of branaplam on the ability to sit without support
Time Frame
52 weeks
Title
Change from baseline in weight
Description
To evaluate the effect of branaplam on weight in kilograms
Time Frame
Screening, Day 1, Day 8 to Day 85. Extended treatment periods: every 4 weeks and at the End of Study
Title
Change from baseline in head circumference
Description
To evaluate the effect of branaplam on head circumference in cm
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Change from baseline in chest circumference
Description
To evaluate the effect of branaplam on chest circumference
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Change from baseline in Children's Hospital of Philadelphia Infant Neuromuscular Disorders (CHOP INTEND)
Description
To evaluate the effect of branaplam on infant motor development using CHOP INTEND
Time Frame
Part 1: Baseline, Day 36, Day 85, and every 6 to 7 weeks in the extended treatment periods, and at the End of Study. Part 2: Baseline, Day 36, Day 85, Day 127, Day 176, Day 218, Day 267, Day 309, Day 358 and End of Study
Title
Change from baseline in respiratory rate
Description
To evaluate the effect of branaplam on respiratory function by measurement of the respiratory rate
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Change from baseline in chest circumference during quiet breathing
Description
To evaluate the effect of branaplam on respiratory function by measurement of the chest circumference in cm during expiration and during inspiration
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Change from baseline in paradoxical breathing
Description
To evaluate the effect of branaplam on respiratory function by evaluation of the presence of absence of paradoxical breathing
Time Frame
Part 1 Screening, Days 1, 8 to 85. Extended treatment periods: every 4 weeks and at the end of study. Part 2: Screening, days 1 through 358 and end of study.
Title
Pharmacokinetic: Cmax
Description
To evaluate branaplam pharmacokinetics in plasma after single and repeated doses of branaplam by determination of Cmax.
Time Frame
Parts 1 and 2: Day 1 (Pre-dose + 1, 2, 4, 8 & 24 hours post-dose), Days 2, 3, 5, 8, 29. Part 1: Day 43. Part 2: Day 57, 57, 92 (Pre-dose + 4 & 24 hours post-dose), 94, 99, 274 (Pre-dose + 4 & 24 hours post-dose), 276, 281

10. Eligibility

Sex
All
Minimum Age & Unit of Time
28 Days
Maximum Age & Unit of Time
182 Days
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Common for both Parts 1 and 2: Type 1 SMA, diagnosed clinically, with symptom onset <6 months of age and genetic confirmation of mutations in both alleles of the SMN1 gene, and with SMN2 copy number of 2. Best supportive care in place and stable for at least 14 days before screening. Must be able to demonstrate antigravity strength in both biceps. At birth gestational age >32 weeks and body weight at birth >2 kg. Must live within 2 hours drive of study center. Clearance should be obtained from the site investigator and sponsor if the patient resides more than 2 hours ground travel from the study center Specific for Part 1 Age at screening between 1 and 7 months Must have or agree to have placement of feeding tube for enteral access via nasogastric (NG), nasojejunal (NJ), percutaneous gastrostomy (PEG), or percutaneous jejunostomy (PEJ) tube for administration of branaplam (for patients in whom branaplam cannot be administered orally ; NG tube may be removed between doses). Specific for Part 2 Age at screening between 30 and 180 days of age Must have or agree to have placement of feeding tube for enteral access via nasogastric (NG), nasojejunal (NJ), percutaneous gastrostomy (PEG), or percutaneous jejunostomy (PEJ) tube for administration of branaplam (for the first administration only and for patients in whom branaplam cannot be administered orally; NG tube may be removed between doses). Minimum CHOP INTEND score of 15 at baseline Must be able to feed orally for all nutritional needs and be greater than the 2nd percentile for weight on the standard growth curves for the country of origin Exclusion Criteria: Common for both Parts 1 and 2: Neurologic, or neuromuscular conditions other than SMA. Anemia, leukopenia, neutropenia or thrombocytopenia Hepatic dysfunction Age adjusted renal dysfunction Presence of an untreated or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy at any time during the screening period. Presence of an untreated or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy at any time during the screening period. Excluding SMA, any medically unstable condition including cardiomyopathy, hepatic dysfunction, kidney disorder, endocrine disorder, GI disorders, prematurity of <32 weeks gestation, metabolic disorders, severe respiratory compromise and significant brain abnormalities or injuries including hypoxic-ischemic encephalopathy. Current diagnosis of cardiac and/or vascular abnormalities or ECG abnormalities Acute or ongoing medical condition that, according to the Site Investigator and discussed with sponsor, would interfere with the conduct and assessments of the study. Examples are medical disability other than SMA that would interfere with the assessment of safety or would compromise the ability of the subject to undergo study procedures including be assessed by CHOP INTEND motor scale, changes in hematologic parameters or gastrointestinal dysfunction that would compromise the ability of adequate assessment of safety Specific for Part 1 Use of other investigational drugs within 14 days. Intractable seizure disorder (other than inactive febrile seizures). Persistent (in the opinion of the Investigator) hypoxemia (O2 saturation awake <92% or O2 saturation asleep <91%, without ventilation support) or requiring oral suctioning >2 per day, or presence of a tracheostomy. Specific for Part 2 Use of nusinersen or gene transfer at any time or other investigational drugs within 14 days. Intractable epilepsy Persistent (in the opinion of the Investigator) hypoxemia (O2 saturation awake <92% or O2 saturation asleep <91%, without ventilation support), or presence of a tracheostomy.
Facility Information:
Facility Name
Novartis Investigative Site
City
Gent
ZIP/Postal Code
9000
Country
Belgium
Facility Name
Novartis Investigative Site
City
Leuven
ZIP/Postal Code
3000
Country
Belgium
Facility Name
Novartis Investigative Site
City
Sofia
ZIP/Postal Code
1606
Country
Bulgaria
Facility Name
Novartis Investigative Site
City
Copenhagen
ZIP/Postal Code
2100 O
Country
Denmark
Facility Name
Novartis Investigative Site
City
Essen
ZIP/Postal Code
45147
Country
Germany
Facility Name
Novartis Investigative Site
City
Milano
State/Province
MI
ZIP/Postal Code
20133
Country
Italy
Facility Name
Novartis Investigative Site
City
Roma
State/Province
RM
ZIP/Postal Code
00165
Country
Italy
Facility Name
Novartis Investigative Site
City
Warsaw
ZIP/Postal Code
04 730
Country
Poland
Facility Name
Novartis Investigative Site
City
Wroclaw
ZIP/Postal Code
50 420
Country
Poland
Facility Name
Novartis Investigative Site
City
Ekaterinburg
ZIP/Postal Code
620134
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Moscow
ZIP/Postal Code
119049
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Moscow
ZIP/Postal Code
127412
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Saint Petersburg
ZIP/Postal Code
197341
Country
Russian Federation
Facility Name
Novartis Investigative Site
City
Volgograd
ZIP/Postal Code
400120
Country
Russian Federation

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com
Citations:
PubMed Identifier
35241644
Citation
Keller CG, Shin Y, Monteys AM, Renaud N, Beibel M, Teider N, Peters T, Faller T, St-Cyr S, Knehr J, Roma G, Reyes A, Hild M, Lukashev D, Theil D, Dales N, Cha JH, Borowsky B, Dolmetsch R, Davidson BL, Sivasankaran R. An orally available, brain penetrant, small molecule lowers huntingtin levels by enhancing pseudoexon inclusion. Nat Commun. 2022 Mar 3;13(1):1150. doi: 10.1038/s41467-022-28653-6.
Results Reference
derived

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An Open Label Study of LMI070 (Branaplam) in Type 1 Spinal Muscular Atrophy (SMA)

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