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Gene Transfer Clinical Study in X-Linked Myotubular Myopathy (ASPIRO)

Primary Purpose

X-Linked Myotubular Myopathy

Status
Active
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
AT132
Sponsored by
Astellas Gene Therapies
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for X-Linked Myotubular Myopathy focused on measuring AAV8-Delivered Gene Therapy, XLMTM, Adeno Associated Virus

Eligibility Criteria

undefined - 5 Years (Child)MaleDoes not accept healthy volunteers

Key Inclusion Criteria:

  • Subject has a diagnosis of XLMTM resulting from a genetically confirmed mutation in the MTM1 gene as assessed by a Sponsor-approved testing facility.
  • Subject is male.
  • Subject is aged less than 5 years old at dosing
  • Subject requires mechanical ventilatory support:

Part 1: Subject requires some mechanical ventilatory support (e.g., ranging from 24 hours per day full time mechanical ventilation, to noninvasive support such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) during sleeping hours).

Part 2: Subject requires invasive mechanical ventilatory support ranging from 20 - 24 hours per day at screening (confirmed by daytime polysomnographic study).

  • Subject requiring invasive mechanical ventilator support is fitted with or willing to be fitted with a cuffed tracheostomy tube for some respiratory assessments.
  • Subject has ventilator maximum positive end-expiratory pressure (PEEP) <8 cm H2O at screening.

Key Exclusion Criteria:

  • Subject is participating in an interventional study designed to treat XLMTM.
  • Subject born <35 weeks gestation who is still not term as per corrected age.
  • Subject tests positive for AAV8 neutralizing antibody with titers above protocol specified threshold.
  • Subject had recent surgery (<3 months before Day 1) or has planned surgery that may confound data collection during the first 48 weeks of the study.
  • Subject has a clinically important condition other than XLMTM in the opinion of the investigator.
  • Subject has a clinically significant underlying liver disease.
  • Subject is currently experiencing a clinically important respiratory infection or other active infection.
  • Subject has received pyridostigmine or any medication to treat XLMTM within 3 months before Day 1.
  • Other than as required per protocol, subject has received immune-modulating agents within 3 months before Day 1 (use of inhaled corticosteroids to manage chronic respiratory conditions is allowed); use of other concomitant medications to manage chronic conditions must have been stable for at least 4 weeks before dosing.
  • Subject has a contraindication to prednisolone.
  • Subject has a contraindication to study drug or ingredients.
  • Subject has contractures, scoliosis, or other medical condition that would limit the potential to achieve unassisted sitting, in the opinion of the investigator (Part 2 including any subjects enrolled under protocol V8 and beyond).
  • Subject is able to sit without assistance for at least 30 seconds at screening, in the opinion of the investigator (Part 2 including any subjects enrolled under protocol V8 and beyond).

Sites / Locations

  • UCLA Medical Center
  • Ann & Robert H Lurie Children's Hospital of Chicago
  • National Institute of Neurological Disorders and Stroke/NIH Porter
  • Hospital for Sick Children
  • Hopital Armad Trousseau
  • Kinderklinik und Kinderpoliklinik im Dr. Von Haunerschen Kinderspital Klinikum der Universitat Munchen

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

No Intervention

Arm Label

Lower Dose

Higher Dose

Delayed-Treatment Control

Arm Description

1.0 x 10^14 vg/kg of AT132 defined with the use of 1st generation vg titer assay delivered intravenously one time. 1.3 x10^14 vg/kg of AT132 defined with the use of 2nd generation vg titer assay delivered intravenously one time.

3.0 x 10^14 vg/kg of AT132 defined with the use of 1st generation vg titer assay delivered intravenously one time. 3.5 x 10^14 vg/kg of AT132 defined with the use of 2nd generation vg titer assay delivered intravenously one time

Delayed-Treatment Control subjects will generally have the same assessments as treated subjects. After the follow up period, eligible delayed-treatment control subjects will be dosed with AT132 and initiate the same post-dose procedures as subjects who received AT132.

Outcomes

Primary Outcome Measures

Treatment-emergent adverse events (safety and tolerability)
Adverse events, serious adverse events, and laboratory abnormalities (including immunological parameters)
Change from baseline in hours of ventilation support at Week 24
Change in hours of ventilation

Secondary Outcome Measures

Percentage of subjects achieving functionally independent sitting for at least 30 seconds by Week 24
Achieve functionally independent sitting for at least 30 seconds
Time to reduction in required ventilator support to ≤ 16 hours a day (only in subjects who require invasive ventilation) at Week 24
Reduction in required ventilator support
Change from baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) at Week 24
Change in CHOP-INTEND
Change from baseline in maximal inspiratory pressure (MIP) at Week 24
Change in respiratory endurance
Change from baseline in quantitative analysis of myotubularin expression in the muscle biopsy at Week 24
Change in myotubularin expression
Change from baseline in quality of life Assessment of Caregiver Experience with Neuromuscular Disease (ACEND) at Week 24
The ACEND questionnaire will be completed by the caregiver for subjects in the study. Scoring from 1 (needs full time assistance) to 6 (needs no assistance).
Change from baseline in Pediatric Quality of Life Inventory (PedsQL) assessment at Week 24
PedsQL Inventory Scale comprises of 15 items in 4 domains: physical functioning, emotional functioning, social functioning and school functioning. A Likert scale from 0 (Never/Not at all) to 4 (Almost always/A lot) will be used to record response. Higher scores indicate better quality of life. Scale is based on the participant's age and will be assessed by participant or caregiver.
Percentage of age-appropriate clinically relevant gross motor function milestones attained through Week 24
Percentage of participants attaining gross motor function milestones will be reported.
Percentage of subjects achieving full ventilator independence in the absence of acute illness and perioperatively at Week 24
Percentage of participants achieving full ventilator independence will be reported.
Survival
Survival will be assessed at each visit.

Full Information

First Posted
June 21, 2017
Last Updated
July 28, 2023
Sponsor
Astellas Gene Therapies
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1. Study Identification

Unique Protocol Identification Number
NCT03199469
Brief Title
Gene Transfer Clinical Study in X-Linked Myotubular Myopathy
Acronym
ASPIRO
Official Title
ASPIRO: A Phase 1/2/3, Randomized, Open-Label, Ascending-Dose, Delayed-Treatment Concurrent Control Clinical Study to Evaluate the Safety and Efficacy of AT132, an AAV8-Delivered Gene Therapy in X-Linked Myotubular Myopathy (XLMTM) Patients
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 2, 2017 (Actual)
Primary Completion Date
March 31, 2024 (Anticipated)
Study Completion Date
October 31, 2030 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Astellas Gene Therapies

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
This is a multinational, open-label, ascending-dose, delayed-treatment concurrent control clinical study to evaluate the safety and efficacy of AT132 in subjects with X-Linked Myotubular Myopathy aged less than 5 years old. Subjects will receive a single dose of AT132 and will be followed for safety and efficacy for 10 years
Detailed Description
This study will evaluate safety and efficacy of gene transfer in X-Linked Myotubular Myopathy. Subjects will receive a single dose of AT132 delivered intravenously. ASPIRO is being conducted in two parts. Part 1 is a dose escalation phase that is evaluating the preliminary safety and efficacy of AT132 at doses of 1x10^14 vg/kg and 3x10^14 vg/kg. Part 2 of ASPIRO is a pivotal expansion cohort designed to confirm the safety and efficacy of AT132 at a dose of 3x10^14 vg/kg. The pivotal expansion cohort will enroll eight subjects, consisting of four age-matched pairs (within +/- 6 months of age). One subject from each pair will be randomized to receive a single dose of AT132 at 3x10^14 vg/kg, and the other will serve as a delayed treatment control. Eligible delayed treatment control subjects will be administered AT132 after that individual subject has completed the Week 24 visit as a delayed treatment control. The primary efficacy endpoint measures will be assessed at Week 24. Subjects will be followed for a total of 10 years after administration of AT132. This study utilizes an independent Data Monitoring Committee (DMC) that monitors subject safety and provides recommendations to Astellas regarding dose escalation, dose expansion, and safety matters.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
X-Linked Myotubular Myopathy
Keywords
AAV8-Delivered Gene Therapy, XLMTM, Adeno Associated Virus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
ASPIRO is being conducted in two parts. Part 1 is a dose escalation phase that is evaluating the preliminary safety and efficacy of AT132 at doses of 1x10^14 vg/kg and 3x10^14 vg/kg. Part 2 of ASPIRO is a pivotal expansion cohort designed to confirm the safety and efficacy of AT132 at a dose of 3x10^14 vg/kg. The pivotal expansion cohort will enroll eight subjects, consisting of four age-matched pairs (within +/- 6 months of age). One subject from each pair will be randomized to receive a single dose of AT132 at 3x10^14 vg/kg, and the other will serve as a delayed treatment control. Eligible delayed treatment control subjects will be administered AT132 after that individual subject has completed the Week 24 visit as a delayed treatment control.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
26 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Lower Dose
Arm Type
Experimental
Arm Description
1.0 x 10^14 vg/kg of AT132 defined with the use of 1st generation vg titer assay delivered intravenously one time. 1.3 x10^14 vg/kg of AT132 defined with the use of 2nd generation vg titer assay delivered intravenously one time.
Arm Title
Higher Dose
Arm Type
Experimental
Arm Description
3.0 x 10^14 vg/kg of AT132 defined with the use of 1st generation vg titer assay delivered intravenously one time. 3.5 x 10^14 vg/kg of AT132 defined with the use of 2nd generation vg titer assay delivered intravenously one time
Arm Title
Delayed-Treatment Control
Arm Type
No Intervention
Arm Description
Delayed-Treatment Control subjects will generally have the same assessments as treated subjects. After the follow up period, eligible delayed-treatment control subjects will be dosed with AT132 and initiate the same post-dose procedures as subjects who received AT132.
Intervention Type
Genetic
Intervention Name(s)
AT132
Intervention Description
AT132 is an AAV8 vector containing a functional copy of the human MTM1 (hMTM1) gene.
Primary Outcome Measure Information:
Title
Treatment-emergent adverse events (safety and tolerability)
Description
Adverse events, serious adverse events, and laboratory abnormalities (including immunological parameters)
Time Frame
Up to Month 120
Title
Change from baseline in hours of ventilation support at Week 24
Description
Change in hours of ventilation
Time Frame
Baseline to Week 24
Secondary Outcome Measure Information:
Title
Percentage of subjects achieving functionally independent sitting for at least 30 seconds by Week 24
Description
Achieve functionally independent sitting for at least 30 seconds
Time Frame
Up to Week 24
Title
Time to reduction in required ventilator support to ≤ 16 hours a day (only in subjects who require invasive ventilation) at Week 24
Description
Reduction in required ventilator support
Time Frame
Baseline to Week 24
Title
Change from baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) at Week 24
Description
Change in CHOP-INTEND
Time Frame
Baseline to Week 24
Title
Change from baseline in maximal inspiratory pressure (MIP) at Week 24
Description
Change in respiratory endurance
Time Frame
Baseline to Week 24
Title
Change from baseline in quantitative analysis of myotubularin expression in the muscle biopsy at Week 24
Description
Change in myotubularin expression
Time Frame
Baseline to Week 24
Title
Change from baseline in quality of life Assessment of Caregiver Experience with Neuromuscular Disease (ACEND) at Week 24
Description
The ACEND questionnaire will be completed by the caregiver for subjects in the study. Scoring from 1 (needs full time assistance) to 6 (needs no assistance).
Time Frame
Baseline to Week 24
Title
Change from baseline in Pediatric Quality of Life Inventory (PedsQL) assessment at Week 24
Description
PedsQL Inventory Scale comprises of 15 items in 4 domains: physical functioning, emotional functioning, social functioning and school functioning. A Likert scale from 0 (Never/Not at all) to 4 (Almost always/A lot) will be used to record response. Higher scores indicate better quality of life. Scale is based on the participant's age and will be assessed by participant or caregiver.
Time Frame
Baseline to Week 24
Title
Percentage of age-appropriate clinically relevant gross motor function milestones attained through Week 24
Description
Percentage of participants attaining gross motor function milestones will be reported.
Time Frame
Up to Week 24
Title
Percentage of subjects achieving full ventilator independence in the absence of acute illness and perioperatively at Week 24
Description
Percentage of participants achieving full ventilator independence will be reported.
Time Frame
Week 24
Title
Survival
Description
Survival will be assessed at each visit.
Time Frame
Up to Week 24

10. Eligibility

Sex
Male
Maximum Age & Unit of Time
5 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subject has a diagnosis of XLMTM resulting from a genetically confirmed mutation in the MTM1 gene as assessed by a Sponsor-approved testing facility. Subject is male. Subject is aged less than 5 years old at dosing Subject requires mechanical ventilatory support: Part 1: Subject requires some mechanical ventilatory support (e.g., ranging from 24 hours per day full time mechanical ventilation, to noninvasive support such as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) during sleeping hours). Part 2: Subject requires invasive mechanical ventilatory support ranging from 20 - 24 hours per day at screening (confirmed by daytime polysomnographic study). Subject requiring invasive mechanical ventilator support is fitted with or willing to be fitted with a cuffed tracheostomy tube for some respiratory assessments. Subject has ventilator maximum positive end-expiratory pressure (PEEP) <8 cm H2O at screening. UNIQUE to France: Subject's weight is ≥ 4.8 kg. Exclusion Criteria: Subject is participating in an interventional study designed to treat XLMTM. Subject born <35 weeks gestation who is still not term as per corrected age. Subject tests positive for AAV8 neutralizing antibody with titers above protocol specified threshold. Subject had recent surgery (<3 months before Day 1) or has planned surgery that may confound data collection during the first 48 weeks of the study. Subject has a clinically important condition other than XLMTM in the opinion of the investigator. Subject has a clinically significant underlying liver disease. Subject is currently experiencing a clinically important respiratory infection or other active infection. Subject has received pyridostigmine or any medication to treat XLMTM within 3 months before Day 1. Other than as required per protocol, subject has received immune-modulating agents within 3 months before Day 1 (use of inhaled corticosteroids to manage chronic respiratory conditions is allowed); use of other concomitant medications to manage chronic conditions must have been stable for at least 4 weeks before dosing. Subject has a contraindication to prednisolone. Subject has a contraindication to study drug or ingredients. Subject has previous scoliosis repair surgery/procedure, or planned/expected scoliosis repair surgery/procedure in the 12 months following Day 1 (Part 2 including any subjects enrolled under protocol v8 and beyond). Subject has contractures, scoliosis, or other medical condition that would limit the potential to achieve unassisted sitting, in the opinion of the investigator (Part 2 including any subjects enrolled under protocol V8 and beyond). Subject is able to sit without assistance for at least 30 seconds at screening, in the opinion of the investigator (Part 2 including any subjects enrolled under protocol V8 and beyond). Subject has a clinically important condition, including CTCAE v4.03 Grade ≥ 2 anemia (< 10 g/dL hemoglobin). Subject has a contraindication to ursodiol (ursodeoxycholic acid). UNIQUE to France: Subject has a prior diagnosis or history of cardiac arrhythmias, myocarditis, or any other cardiac disease. UNIQUE to France: Subject has a contraindication to general anesthesia and to muscle biopsy procedures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director
Organizational Affiliation
Astellas Pharma Global Development, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
UCLA Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90095
Country
United States
Facility Name
Ann & Robert H Lurie Children's Hospital of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
National Institute of Neurological Disorders and Stroke/NIH Porter
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
208892
Country
United States
Facility Name
Hospital for Sick Children
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G0A4
Country
Canada
Facility Name
Hopital Armad Trousseau
City
Paris
ZIP/Postal Code
75012
Country
France
Facility Name
Kinderklinik und Kinderpoliklinik im Dr. Von Haunerschen Kinderspital Klinikum der Universitat Munchen
City
München
ZIP/Postal Code
80337
Country
Germany

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Access to anonymized individual participant level data will not be provided for this trial as it meets one or more of the exceptions described on www.clinicalstudydatarequest.com under "Sponsor Specific Details for Astellas."

Learn more about this trial

Gene Transfer Clinical Study in X-Linked Myotubular Myopathy

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