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Study of Nusinersen (BIIB058) in Participants With Spinal Muscular Atrophy (DEVOTE)

Primary Purpose

Muscular Atrophy, Spinal

Status
Active
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Nusinersen
Sponsored by
Biogen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Muscular Atrophy, Spinal

Eligibility Criteria

7 Days - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Key Inclusion Criteria:

Part A, B and C:

- Genetic documentation of 5q SMA (homozygous gene deletion, mutation, or compound heterozygote)

Part A:

  • Onset of clinical signs and symptoms consistent with SMA at > 6 months (> 180 days) of age (i.e., later-onset SMA)
  • Age 2 to ≤ 15 years, inclusive, at the time of informed consent

Part B:

  • Participants with SMA symptom onset ≤ 6 months (≤ 180 days) of age (infantile onset) should have age > 1 week to ≤ 7 months (≤ 210 days) at the time of informed consent
  • Participants with SMA symptom onset > 6 months (> 180 days) of age (later onset):

    • Age 2 to < 10 years at the time of informed consent
    • Can sit independently but has never had the ability to walk independently
    • HFMSE score ≥ 10 and ≤ 54 at Screening

Part C:

- Currently on nusinersen treatment at the time of Screening, with the first dose being at least 1 year prior to Screening

Part C Cohort 1:

- Participants of any age (individuals ≥18 years of age at Screening must be ambulatory)

Part C Cohort 2:

  • Participants ≥18 years of age at Screening (can be ambulatory or nonambulatory)
  • HFMSE total score ≥4 points at Screening
  • RULM entry item A score ≥3 points at Screening

Key Exclusion Criteria:

Part A, B and C:

  • 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 implanted shunt for the drainage of cerebrospinal fluid (CSF) or of an implanted central nervous system (CNS) catheter
  • Hospitalization for surgery, pulmonary event, or nutritional support within 2 months prior to Screening or planned within 12 months after the participant's first dose

Part A:

  • Respiratory insufficiency, defined by the medical necessity for invasive or noninvasive ventilation for > 6 hours during a 24-hour period, at Screening
  • Medical necessity for a gastric feeding tube
  • Treatment with an investigational drug given for the treatment of SMA, biological agent, or device within 30 days or 5 half-lives of the agent, whichever is longer, prior to Screening or anytime during the study; any prior or current treatment with any survival motor neuron-2 gene (SMN2)-splicing modifier or gene therapy; or prior antisense oligonucleotide treatment, or cell transplantation

Part B:

  • Treatment with an investigational drug including but not limited to the treatment of SMA, biological agent, or device within 30 days or 5 half-lives of the agent, whichever is longer, prior to Screening or anytime during the study; any prior or current treatment with any SMN2-splicing modifier or gene therapy; or prior antisense oligonucleotide treatment, or cell transplantation
  • Participants with SMA symptom onset > 6 months (> 180 days) of age (later onset):

    • Respiratory insufficiency, defined by the medical necessity for invasive or noninvasive ventilation for > 6 hours during a 24-hour period, at Screening
    • Medical necessity for a gastric feeding tube
  • Participants with SMA symptom onset ≤ 6 months (≤ 180 days) of age (infantile onset): Signs or symptoms of SMA present at birth or within the first week after birth

Part C:

  • Concurrent or previous participation and/or administration of nusinersen in another clinical study
  • Concomitant or previous administration of any SMN2-splicing modifier (excluding nusinersen) or gene therapy, either in a clinical study or as part of medical care.
  • Concurrent or previous participation in any interventional investigational study for any other drug or device within 30 days or 5 half-lives of the agent, whichever is longer, prior to Screening

NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

Sites / Locations

  • Stanford Hospital and Clinics
  • Children's Hospital Colorado
  • Ann & Robert H. Lurie Children's Hospital of Chicago
  • The Johns Hopkins Hospital
  • Boston Children's Hospital
  • St. Jude Children's Research Hospital
  • The University of Texas Southwestern Medical Center
  • Royal Children's Hospital
  • HC-UFMG - Hospital das Clinicas da Universidade Federal de Minas Gerais
  • Hospital de Clínicas de Porto Alegre
  • Hospital das Clínicas da Faculdade de Medicina da USP
  • BC Children's Hospital
  • London Health Sciences Centre (LHSC) - Children's Hospital
  • McGill University Health Centre/Glen Site/Montreal Children's Hospital
  • Hospital Luis Calvo Mackenna
  • Clinica Las Condes
  • Clinica MEDS La Dehesa
  • Peking University First Hospital
  • Beijing Children's Hospital
  • Children's Hospital Chongqing University of Medical Science
  • Guangzhou Woman and Children's Medical Center
  • Xiangya Hospital, Central South University
  • Qilu Hospital of Shandong University
  • The Second Hospital affiliated to West China Medical University
  • Hospital Universitario San Ignacio
  • Fundacion Hospitalaria San Vicente de Paul
  • Tallinn Children's Hospital
  • Hopital Purpan
  • Hôpital Raymond Poincaré
  • Universitaetsklinikum Freiburg
  • Universitaetsklinikum Giessen und Marburg GmbH
  • University General Hospital "Attikon"
  • General Hospital of Thessaloniki "Hippokration"
  • Semmelweis Egyetem
  • Magyarorszagi Reformatus Egyhaz Bethesda Gyermekkorhaz
  • The Children's University Hospital
  • Schneider Children's Medical Center
  • Tel Aviv Sourasky Medical Center
  • Fondazione Serena Onlus - Centro Clinico Nemo
  • Fondazione Policlinico Universitario Agostino Gemelli IRCCS
  • Kurume University Hospital
  • Hyogo College of Medicine Hospital
  • Tokyo Women's Medical University Hospital
  • Kyungpook National University Chilgok Hospital
  • Seoul National University Hospital
  • Children's Clinical University Hospital
  • Saint George University Hospital Medical Center
  • Instituto Nacional de Pediatria
  • Hospital Infantil de Mexico Federico Gomez
  • Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde
  • UMC Utrecht
  • Uniwersyteckie Centrum Kliniczne
  • Instytut Pomnik - Centrum Zdrowia Dziecka
  • Regional Pediatric Clinical Hospital #1
  • Russian Children Neuromuscular Center of Veltischev
  • King Fahad Specialist Hospital
  • National Guard Health Affairs: King Abdulaziz Medical City
  • King Faisal Specialist Hospital & Research Center
  • Hospital Sant Joan de Deu
  • Hospital Universitari Vall d'Hebron
  • Hospital Universitario La Paz
  • Hospital Universitari i Politecnic La Fe
  • Kaohsiung Medical University Chung-Ho Memorial Hospital
  • National Taiwan University Hospital
  • Akdeniz Univesity Medical Faculty
  • Great Ormond Street Hospital for Children

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Active Comparator

Experimental

Experimental

Arm Label

28/28 Milligram (mg) Safety Group

12/12 mg Randomized Control Group

50/28 mg Randomized Treatment Group

12/50/28 mg Titration Group

Arm Description

Part A: Participants with later-onset SMA will receive loading doses of 28 mg of nusinersen intrathecally on Days 1, 15 and 29 followed by maintenance doses of 28 mg on Days 149 and 269.

Part B: Participants with infantile- or later-onset SMA will receive loading doses of 12 mg of nusinersen intrathecally on Days 1, 15, 29, and 64 followed by maintenance doses of 12 mg on Days 183 and 279. Sham procedure will be administered on Day 135.

Part B: Participants with infantile- or later-onset SMA will receive loading doses of 50 mg of nusinersen intrathecally on Days 1 and 15 followed by maintenance doses of 28 mg on Days 135 and 279. Sham procedure will be administered on Days 29, 64 and 183.

Part C: Participants who have been receiving the approved dose of 12 mg for at least 1 year prior to entry, will receive a single bolus dose of 50 mg of nusinersen intrathecally on Day 1 (4 months after their most recent maintenance dose of 12 mg) followed by maintenance doses of 28 mg on Days 121 and 241.

Outcomes

Primary Outcome Measures

Part B Infantile-onset SMA: Change from Baseline in CHOP-INTEND Total Score
The CHOP-INTEND test is designed to evaluate the motor skills of infants with significant motor weakness. It includes 16 items (capturing neck, trunk, and proximal and distal limb strength) structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0-4.
Part A and C: Number of Participants with Adverse Events (AEs) and Serious Adverse Events (SAEs)
An AE is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal assessment such as an abnormal laboratory value), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. An SAE is any untoward medical occurrence that at any dose results in death, in the view of the Investigator, places the participant at immediate risk of death, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a birth defect.
Part A and C: Number of Participants with Clinically Significant Shifts from Baseline in Clinical Laboratory Parameters
Part A and C: Number of Participants with Clinically Significant Shifts from Baseline in Electrocardiograms (ECGs)
Part A and C: Number of Participants with Clinically Significant Shifts from Baseline in Vital Signs
Part A and C: Change from Baseline in Body Length/Height
Part C Infantile-onset SMA: Change from Baseline in Head Circumference
Part C Infantile-onset SMA: Change from Baseline in Chest Circumference
Part C Infantile-onset SMA: Change from Baseline in Arm Circumference
Part A and C Later-onset SMA: Change from Baseline in Ulnar Length
Part A and C: Ratio of Weight for Age
Part A and C: Ratio of Weight for Length
Part C: Ratio of Head-to-chest Circumference
Part A and C: Change from Baseline in Activated Partial Thromboplastin Time (aPTT)
Part A and C: Change from Baseline in Prothrombin Time (PT)
Part A and C: Change from Baseline in International Normalized Ratio (INR)
Part A and C: Change in Urine Total Protein
Part A and C: Change from Baseline in Neurological Examination Outcomes
Part A and C: Percentage of Participants with a Postbaseline Platelet Count Below the Lower Limit of Normal on at least 2 Consecutive Measurements
Part A and C: Percentage of Participants with a Postbaseline Corrected QT Interval Using Fridericia's Formula (QTcF) of > 500 millisecond (msec) and an Increase from Baseline to Any Postbaseline Timepoint in QTcF of > 60 msec

Secondary Outcome Measures

Part B Infantile-onset SMA: Percentage of Hammersmith Infant Neurological Examination (HINE) Section 2 Motor Milestone Responders
Section 2 of the HINE is used to assess motor milestones of the participants It is composed of 8 motor milestone categories: voluntary grasp, ability to kick in supine position, head control, rolling, sitting, crawling, standing, and walking.
Part B Infantile-onset SMA: Change from Baseline in HINE Section 2 Motor Milestones Total Score
Section 2 of the HINE is used to assess motor milestones of the participants. It is composed of 8 motor milestone categories: voluntary grasp, ability to kick in supine position, head control, rolling, sitting, crawling, standing, and walking.
Part B Infantile-onset SMA: Time to Death or Permanent Ventilation
Permanent ventilation is defined as tracheostomy or ≥ 16 hours of ventilation/day continuously for > 21 days in the absence of an acute reversible event.
Part B Infantile-onset SMA: Time to Death (Overall Survival)
Part A and B Later-onset SMA: Change from Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) Score
HFMSE scale is a tool to assess motor function in children with SMA. The original 20 item Hammersmith Functional Motor Scale was expanded to include 13 additional adapted items from the Gross Motor Function Measure to improve sensitivity for the higher functioning ambulant population.
Part A and B Later-onset SMA: Change from Baseline in Revised Upper Limb Module (RULM) Score
The RULM is developed to assess upper limb functional abilities participants with SMA. This test consists of upper limb performance items that are reflective of activities of daily living.
Part A and B Later-onset SMA: Total Number of New WHO Motor Milestones
Part A and B Later-onset SMA: Change from Baseline in Assessment of Caregiver Experience with Neuromuscular Disease (ACEND)
ACEND is designed to quantify the caregiver impact experienced by parents/caregivers of children affected with severe neuromuscular diseases. It includes domains assessing physical impact (including feeding/grooming/dressing, sitting/play, transfers, and mobility) and general caregiver impact (including time, emotion, and finance).
Part A and B Later-onset SMA: Change from Baseline in Pediatric Quality of Life Inventory™ (PedsQL)
PedsQL is used to measure health related quality of life (HRQOL) in children and adolescents. The PedsQL Measurement 4.0 Generic Core Scales include assessment of physical functioning, emotional functioning, social functioning, and school functioning and the PedsQL 3.0 Neuromuscular Module measures HRQOL.
Part B: Number of Participants with AEs and SAEs
An AE is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal assessment such as an abnormal laboratory value), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. An SAE is any untoward medical occurrence that at any dose results in death, in the view of the Investigator, places the participant at immediate risk of death, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a birth defect.
Part B: Number of Participants with Clinically Significant Shifts from Baseline in Clinical Laboratory Parameters
Part B: Number of Participants with Clinically Significant Shifts from Baseline in ECGs
Part B: Number of Participants with Clinically Significant Shifts from Baseline in Vital Signs
Part B: Change from Baseline in Body Length/Height
Part B Infantile-onset SMA: Change from Baseline in Head Circumference
Part B Infantile-onset SMA: Change from Baseline in Chest Circumference
Part B Infantile-onset SMA: Change from Baseline in Arm Circumference
Part B Later-onset SMA: Change from Baseline in Ulnar Length
Part B: Ratio of Weight for Age
Part B: Ratio of Weight for Length
Part B: Ratio of Head-to-chest Circumference
Part B: Change from Baseline in aPTT
Part B: Change from Baseline in PT
Part B: Change from Baseline in INR
Part B: Change in Urine Total Protein
Part B: Change from Baseline in Neurological Examination Outcomes
Part B: Percentage of Participants with a Postbaseline Platelet Count Below the Lower Limit of Normal on at least 2 Consecutive Measurements
Part B: Percentage of Participants with a Postbaseline QTcF of > 500 msec and an Increase from Baseline to Any Postbaseline Timepoint in QTcF of > 60 msec
Part A, B and C: Number of Hospitalizations
Part A, B and C: Duration of Hospitalizations
Part A, B and C: Clinical Global Impression of Change (CGIC)
The CGIC scale is a 7 point scale that requires the clinician to assess how much the participant's illness has changed relative to a baseline state at the beginning of the intervention, where 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, 7=very much worse. Higher rating will indicate worsening of the condition.
Part A, B and C: Number of Participants with Serious Respiratory Events
Part B Infantile-onset SMA: Percentage of Time on Ventilation
Parts A, B and C: Ventilator Use
Parts A and B: Change from Baseline in the Parent Assessment of Swallowing Ability (PASA) Scale
PASA questionnaire is developed to assess the signs and symptoms of dysphagia. It includes 33 items across 4 domains. General feeding, drinking liquids and eating solid foods will be assessed with 5 levels of response (Never, Rarely, Sometimes, Often, and Always), and 2 items will be assessed with 'Yes'/'No'. The assessment of swallowing concerns has 4 levels of response: Strongly Agree, Agree, Disagree, and Strongly Disagree. For Part A, it will be assessed in participants with later-onset SMA and in Part B, it will be assessed in participants with infantile- and later-onset SMA.
Part C: Change from Baseline in HFMSE Score
HFMSE scale is a tool to assess motor function in children with SMA. The original 20 item Hammersmith Functional Motor Scale was expanded to include 13 additional adapted items from the Gross Motor Function Measure to improve sensitivity for the higher functioning ambulant population.
Part C: Change from Baseline in RULM Score
The RULM is developed to assess upper limb functional abilities participants with SMA. This test consists of upper limb performance items that are reflective of activities of daily living.
Part C: Total Number of New WHO Motor Milestones
Part C: Change from Baseline in ACEND
ACEND is designed to quantify the caregiver impact experienced by parents/caregivers of children affected with severe neuromuscular diseases. It includes domains assessing physical impact (including feeding/grooming/dressing, sitting/play, transfers, and mobility) and general caregiver impact (including time, emotion, and finance).
Part C: Change from Baseline in PedsQL™
PedsQL is used to measure healthrelated quality of life (HRQOL) in children and adolescents. The PedsQL Measurement 4.0 Generic Core Scales include assessment of physical functioning, emotional functioning, social functioning, and school functioning and the PedsQL 3.0 Neuromuscular Module measures HRQOL.
Part C: Change from Baseline in CHOP-INTEND Total Score
The CHOP-INTEND test is designed to evaluate the motor skills of infants with significant motor weakness. It includes 16 items (capturing neck, trunk, and proximal and distal limb strength) structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0-4.
Part C: Change from Baseline in HINE Section 2 Motor Milestones Total Score
Section 2 of the HINE is used to assess motor milestones of the participants. It is composed of 8 motor milestone categories: voluntary grasp, ability to kick in supine position, head control, rolling, sitting, crawling, standing, and walking.

Full Information

First Posted
September 11, 2019
Last Updated
September 21, 2023
Sponsor
Biogen
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1. Study Identification

Unique Protocol Identification Number
NCT04089566
Brief Title
Study of Nusinersen (BIIB058) in Participants With Spinal Muscular Atrophy
Acronym
DEVOTE
Official Title
Escalating Dose and Randomized, Controlled Study of Nusinersen (BIIB058) in Participants With Spinal Muscular Atrophy
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 26, 2020 (Actual)
Primary Completion Date
April 3, 2024 (Anticipated)
Study Completion Date
June 4, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Biogen

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 objectives of this study are to examine the clinical efficacy of nusinersen administered intrathecally at higher doses to participants with spinal muscular atrophy (SMA), as measured by change in Children's Hospital of Philadelphia-Infant Test of Neuromuscular Disorders (CHOP-INTEND) total score (Part B); to examine the safety and tolerability of nusinersen administered intrathecally at higher doses to participants with SMA (Parts A and C). The secondary objectives of this study are to examine the clinical efficacy of nusinersen administered intrathecally at higher doses to participants with SMA (Parts A, B and C); to examine the effect of nusinersen administered intrathecally at higher doses to participants with SMA (Parts A and C); to examine the safety and tolerability of nusinersen administered intrathecally at higher doses to participants with SMA, to examine the effect of nusinersen administered intrathecally at higher doses compared to the currently approved dose in participants with SMA (Part B).

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Sequential Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
145 (Actual)

8. Arms, Groups, and Interventions

Arm Title
28/28 Milligram (mg) Safety Group
Arm Type
Experimental
Arm Description
Part A: Participants with later-onset SMA will receive loading doses of 28 mg of nusinersen intrathecally on Days 1, 15 and 29 followed by maintenance doses of 28 mg on Days 149 and 269.
Arm Title
12/12 mg Randomized Control Group
Arm Type
Active Comparator
Arm Description
Part B: Participants with infantile- or later-onset SMA will receive loading doses of 12 mg of nusinersen intrathecally on Days 1, 15, 29, and 64 followed by maintenance doses of 12 mg on Days 183 and 279. Sham procedure will be administered on Day 135.
Arm Title
50/28 mg Randomized Treatment Group
Arm Type
Experimental
Arm Description
Part B: Participants with infantile- or later-onset SMA will receive loading doses of 50 mg of nusinersen intrathecally on Days 1 and 15 followed by maintenance doses of 28 mg on Days 135 and 279. Sham procedure will be administered on Days 29, 64 and 183.
Arm Title
12/50/28 mg Titration Group
Arm Type
Experimental
Arm Description
Part C: Participants who have been receiving the approved dose of 12 mg for at least 1 year prior to entry, will receive a single bolus dose of 50 mg of nusinersen intrathecally on Day 1 (4 months after their most recent maintenance dose of 12 mg) followed by maintenance doses of 28 mg on Days 121 and 241.
Intervention Type
Drug
Intervention Name(s)
Nusinersen
Other Intervention Name(s)
BIIB058
Intervention Description
Administered as specified in the treatment arm
Primary Outcome Measure Information:
Title
Part B Infantile-onset SMA: Change from Baseline in CHOP-INTEND Total Score
Description
The CHOP-INTEND test is designed to evaluate the motor skills of infants with significant motor weakness. It includes 16 items (capturing neck, trunk, and proximal and distal limb strength) structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0-4.
Time Frame
Baseline up to Day 183
Title
Part A and C: Number of Participants with Adverse Events (AEs) and Serious Adverse Events (SAEs)
Description
An AE is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal assessment such as an abnormal laboratory value), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. An SAE is any untoward medical occurrence that at any dose results in death, in the view of the Investigator, places the participant at immediate risk of death, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a birth defect.
Time Frame
Screening up to Day 389
Title
Part A and C: Number of Participants with Clinically Significant Shifts from Baseline in Clinical Laboratory Parameters
Time Frame
Screening up to Day 302
Title
Part A and C: Number of Participants with Clinically Significant Shifts from Baseline in Electrocardiograms (ECGs)
Time Frame
Screening up to Day 302
Title
Part A and C: Number of Participants with Clinically Significant Shifts from Baseline in Vital Signs
Time Frame
Screening up to Day 302
Title
Part A and C: Change from Baseline in Body Length/Height
Time Frame
Baseline up to Day 302
Title
Part C Infantile-onset SMA: Change from Baseline in Head Circumference
Time Frame
Baseline up to Day 302
Title
Part C Infantile-onset SMA: Change from Baseline in Chest Circumference
Time Frame
Baseline up to Day 302
Title
Part C Infantile-onset SMA: Change from Baseline in Arm Circumference
Time Frame
Baseline up to Day 302
Title
Part A and C Later-onset SMA: Change from Baseline in Ulnar Length
Time Frame
Baseline up to Day 302
Title
Part A and C: Ratio of Weight for Age
Time Frame
Baseline up to Day 302
Title
Part A and C: Ratio of Weight for Length
Time Frame
Baseline up to Day 302
Title
Part C: Ratio of Head-to-chest Circumference
Time Frame
Baseline up to Day 302
Title
Part A and C: Change from Baseline in Activated Partial Thromboplastin Time (aPTT)
Time Frame
Baseline up to Day 269
Title
Part A and C: Change from Baseline in Prothrombin Time (PT)
Time Frame
Baseline up to Day 269
Title
Part A and C: Change from Baseline in International Normalized Ratio (INR)
Time Frame
Baseline up to Day 269
Title
Part A and C: Change in Urine Total Protein
Time Frame
Baseline up to Day 302
Title
Part A and C: Change from Baseline in Neurological Examination Outcomes
Time Frame
Baseline up to Day 302
Title
Part A and C: Percentage of Participants with a Postbaseline Platelet Count Below the Lower Limit of Normal on at least 2 Consecutive Measurements
Time Frame
Baseline up to Day 302
Title
Part A and C: Percentage of Participants with a Postbaseline Corrected QT Interval Using Fridericia's Formula (QTcF) of > 500 millisecond (msec) and an Increase from Baseline to Any Postbaseline Timepoint in QTcF of > 60 msec
Time Frame
Baseline up to Day 302
Secondary Outcome Measure Information:
Title
Part B Infantile-onset SMA: Percentage of Hammersmith Infant Neurological Examination (HINE) Section 2 Motor Milestone Responders
Description
Section 2 of the HINE is used to assess motor milestones of the participants It is composed of 8 motor milestone categories: voluntary grasp, ability to kick in supine position, head control, rolling, sitting, crawling, standing, and walking.
Time Frame
Day 302
Title
Part B Infantile-onset SMA: Change from Baseline in HINE Section 2 Motor Milestones Total Score
Description
Section 2 of the HINE is used to assess motor milestones of the participants. It is composed of 8 motor milestone categories: voluntary grasp, ability to kick in supine position, head control, rolling, sitting, crawling, standing, and walking.
Time Frame
Baseline up to Day 302
Title
Part B Infantile-onset SMA: Time to Death or Permanent Ventilation
Description
Permanent ventilation is defined as tracheostomy or ≥ 16 hours of ventilation/day continuously for > 21 days in the absence of an acute reversible event.
Time Frame
Screening up to Day 302
Title
Part B Infantile-onset SMA: Time to Death (Overall Survival)
Time Frame
Screening up to Day 399
Title
Part A and B Later-onset SMA: Change from Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) Score
Description
HFMSE scale is a tool to assess motor function in children with SMA. The original 20 item Hammersmith Functional Motor Scale was expanded to include 13 additional adapted items from the Gross Motor Function Measure to improve sensitivity for the higher functioning ambulant population.
Time Frame
Baseline up to Day 302
Title
Part A and B Later-onset SMA: Change from Baseline in Revised Upper Limb Module (RULM) Score
Description
The RULM is developed to assess upper limb functional abilities participants with SMA. This test consists of upper limb performance items that are reflective of activities of daily living.
Time Frame
Baseline up to Day 302
Title
Part A and B Later-onset SMA: Total Number of New WHO Motor Milestones
Time Frame
Baseline up to Day 302
Title
Part A and B Later-onset SMA: Change from Baseline in Assessment of Caregiver Experience with Neuromuscular Disease (ACEND)
Description
ACEND is designed to quantify the caregiver impact experienced by parents/caregivers of children affected with severe neuromuscular diseases. It includes domains assessing physical impact (including feeding/grooming/dressing, sitting/play, transfers, and mobility) and general caregiver impact (including time, emotion, and finance).
Time Frame
Baseline up to Day 302
Title
Part A and B Later-onset SMA: Change from Baseline in Pediatric Quality of Life Inventory™ (PedsQL)
Description
PedsQL is used to measure health related quality of life (HRQOL) in children and adolescents. The PedsQL Measurement 4.0 Generic Core Scales include assessment of physical functioning, emotional functioning, social functioning, and school functioning and the PedsQL 3.0 Neuromuscular Module measures HRQOL.
Time Frame
Baseline up to Day 302
Title
Part B: Number of Participants with AEs and SAEs
Description
An AE is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal assessment such as an abnormal laboratory value), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not related to the medicinal (investigational) product. An SAE is any untoward medical occurrence that at any dose results in death, in the view of the Investigator, places the participant at immediate risk of death, requires inpatient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, results in a birth defect.
Time Frame
Screening up to Day 399
Title
Part B: Number of Participants with Clinically Significant Shifts from Baseline in Clinical Laboratory Parameters
Time Frame
Screening up to Day 302
Title
Part B: Number of Participants with Clinically Significant Shifts from Baseline in ECGs
Time Frame
Day 1 up to Day 302
Title
Part B: Number of Participants with Clinically Significant Shifts from Baseline in Vital Signs
Time Frame
Screening up to Day 302
Title
Part B: Change from Baseline in Body Length/Height
Time Frame
Baseline up to Day 302
Title
Part B Infantile-onset SMA: Change from Baseline in Head Circumference
Time Frame
Baseline up to Day 302
Title
Part B Infantile-onset SMA: Change from Baseline in Chest Circumference
Time Frame
Baseline up to Day 302
Title
Part B Infantile-onset SMA: Change from Baseline in Arm Circumference
Time Frame
Baseline up to Day 302
Title
Part B Later-onset SMA: Change from Baseline in Ulnar Length
Time Frame
Baseline up to Day 302
Title
Part B: Ratio of Weight for Age
Time Frame
Baseline up to Day 302
Title
Part B: Ratio of Weight for Length
Time Frame
Baseline up to Day 302
Title
Part B: Ratio of Head-to-chest Circumference
Time Frame
Baseline up to Day 302
Title
Part B: Change from Baseline in aPTT
Time Frame
Baseline up to Day 279
Title
Part B: Change from Baseline in PT
Time Frame
Baseline up to Day 279
Title
Part B: Change from Baseline in INR
Time Frame
Baseline up to Day 279
Title
Part B: Change in Urine Total Protein
Time Frame
Baseline up to Day 302
Title
Part B: Change from Baseline in Neurological Examination Outcomes
Time Frame
Baseline up to Day 302
Title
Part B: Percentage of Participants with a Postbaseline Platelet Count Below the Lower Limit of Normal on at least 2 Consecutive Measurements
Time Frame
Baseline up to Day 302
Title
Part B: Percentage of Participants with a Postbaseline QTcF of > 500 msec and an Increase from Baseline to Any Postbaseline Timepoint in QTcF of > 60 msec
Time Frame
Baseline up to Day 302
Title
Part A, B and C: Number of Hospitalizations
Time Frame
Day 1 to Day 302
Title
Part A, B and C: Duration of Hospitalizations
Time Frame
Day 1 to Day 302
Title
Part A, B and C: Clinical Global Impression of Change (CGIC)
Description
The CGIC scale is a 7 point scale that requires the clinician to assess how much the participant's illness has changed relative to a baseline state at the beginning of the intervention, where 1=very much improved, 2=much improved, 3=minimally improved, 4=no change, 5=minimally worse, 6=much worse, 7=very much worse. Higher rating will indicate worsening of the condition.
Time Frame
Day 302
Title
Part A, B and C: Number of Participants with Serious Respiratory Events
Time Frame
Screening up to Day 399
Title
Part B Infantile-onset SMA: Percentage of Time on Ventilation
Time Frame
Screening up to Day 302
Title
Parts A, B and C: Ventilator Use
Time Frame
Screening up to Day 302
Title
Parts A and B: Change from Baseline in the Parent Assessment of Swallowing Ability (PASA) Scale
Description
PASA questionnaire is developed to assess the signs and symptoms of dysphagia. It includes 33 items across 4 domains. General feeding, drinking liquids and eating solid foods will be assessed with 5 levels of response (Never, Rarely, Sometimes, Often, and Always), and 2 items will be assessed with 'Yes'/'No'. The assessment of swallowing concerns has 4 levels of response: Strongly Agree, Agree, Disagree, and Strongly Disagree. For Part A, it will be assessed in participants with later-onset SMA and in Part B, it will be assessed in participants with infantile- and later-onset SMA.
Time Frame
Baseline up to Day 302
Title
Part C: Change from Baseline in HFMSE Score
Description
HFMSE scale is a tool to assess motor function in children with SMA. The original 20 item Hammersmith Functional Motor Scale was expanded to include 13 additional adapted items from the Gross Motor Function Measure to improve sensitivity for the higher functioning ambulant population.
Time Frame
Baseline up to Day 302
Title
Part C: Change from Baseline in RULM Score
Description
The RULM is developed to assess upper limb functional abilities participants with SMA. This test consists of upper limb performance items that are reflective of activities of daily living.
Time Frame
Baseline up to Day 302
Title
Part C: Total Number of New WHO Motor Milestones
Time Frame
Baseline up to Day 302
Title
Part C: Change from Baseline in ACEND
Description
ACEND is designed to quantify the caregiver impact experienced by parents/caregivers of children affected with severe neuromuscular diseases. It includes domains assessing physical impact (including feeding/grooming/dressing, sitting/play, transfers, and mobility) and general caregiver impact (including time, emotion, and finance).
Time Frame
Baseline up to Day 302
Title
Part C: Change from Baseline in PedsQL™
Description
PedsQL is used to measure healthrelated quality of life (HRQOL) in children and adolescents. The PedsQL Measurement 4.0 Generic Core Scales include assessment of physical functioning, emotional functioning, social functioning, and school functioning and the PedsQL 3.0 Neuromuscular Module measures HRQOL.
Time Frame
Baseline up to Day 302
Title
Part C: Change from Baseline in CHOP-INTEND Total Score
Description
The CHOP-INTEND test is designed to evaluate the motor skills of infants with significant motor weakness. It includes 16 items (capturing neck, trunk, and proximal and distal limb strength) structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0-4.
Time Frame
Baseline to up Day 302
Title
Part C: Change from Baseline in HINE Section 2 Motor Milestones Total Score
Description
Section 2 of the HINE is used to assess motor milestones of the participants. It is composed of 8 motor milestone categories: voluntary grasp, ability to kick in supine position, head control, rolling, sitting, crawling, standing, and walking.
Time Frame
Baseline up to Day 302

10. Eligibility

Sex
All
Minimum Age & Unit of Time
7 Days
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: Part A, B and C: - Genetic documentation of 5q SMA (homozygous gene deletion, mutation, or compound heterozygote) Part A: Onset of clinical signs and symptoms consistent with SMA at > 6 months (> 180 days) of age (i.e., later-onset SMA) Age 2 to ≤ 15 years, inclusive, at the time of informed consent Part B: Participants with SMA symptom onset ≤ 6 months (≤ 180 days) of age (infantile onset) should have age > 1 week to ≤ 7 months (≤ 210 days) at the time of informed consent Participants with SMA symptom onset > 6 months (> 180 days) of age (later onset): Age 2 to < 10 years at the time of informed consent Can sit independently but has never had the ability to walk independently HFMSE score ≥ 10 and ≤ 54 at Screening Part C: - Currently on nusinersen treatment at the time of Screening, with the first dose being at least 1 year prior to Screening Part C Cohort 1: - Participants of any age (individuals ≥18 years of age at Screening must be ambulatory) Part C Cohort 2: Participants ≥18 years of age at Screening (can be ambulatory or nonambulatory) HFMSE total score ≥4 points at Screening RULM entry item A score ≥3 points at Screening Key Exclusion Criteria: Part A, B and C: 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 implanted shunt for the drainage of cerebrospinal fluid (CSF) or of an implanted central nervous system (CNS) catheter Hospitalization for surgery, pulmonary event, or nutritional support within 2 months prior to Screening or planned within 12 months after the participant's first dose Part A: Respiratory insufficiency, defined by the medical necessity for invasive or noninvasive ventilation for > 6 hours during a 24-hour period, at Screening Medical necessity for a gastric feeding tube Treatment with an investigational drug given for the treatment of SMA, biological agent, or device within 30 days or 5 half-lives of the agent, whichever is longer, prior to Screening or anytime during the study; any prior or current treatment with any survival motor neuron-2 gene (SMN2)-splicing modifier or gene therapy; or prior antisense oligonucleotide treatment, or cell transplantation Part B: Treatment with an investigational drug including but not limited to the treatment of SMA, biological agent, or device within 30 days or 5 half-lives of the agent, whichever is longer, prior to Screening or anytime during the study; any prior or current treatment with any SMN2-splicing modifier or gene therapy; or prior antisense oligonucleotide treatment, or cell transplantation Participants with SMA symptom onset > 6 months (> 180 days) of age (later onset): Respiratory insufficiency, defined by the medical necessity for invasive or noninvasive ventilation for > 6 hours during a 24-hour period, at Screening Medical necessity for a gastric feeding tube Participants with SMA symptom onset ≤ 6 months (≤ 180 days) of age (infantile onset): Signs or symptoms of SMA present at birth or within the first week after birth Part C: Concurrent or previous participation and/or administration of nusinersen in another clinical study Concomitant or previous administration of any SMN2-splicing modifier (excluding nusinersen) or gene therapy, either in a clinical study or as part of medical care. Concurrent or previous participation in any interventional investigational study for any other drug or device within 30 days or 5 half-lives of the agent, whichever is longer, prior to Screening NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Medical Director
Organizational Affiliation
Biogen
Official's Role
Study Director
Facility Information:
Facility Name
Stanford Hospital and Clinics
City
Palo Alto
State/Province
California
ZIP/Postal Code
94304
Country
United States
Facility Name
Children's Hospital Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
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
The Johns Hopkins Hospital
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Boston Children's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
St. Jude Children's Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
Facility Name
The University of Texas Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Royal Children's Hospital
City
Parkville
State/Province
Victoria
ZIP/Postal Code
3052
Country
Australia
Facility Name
HC-UFMG - Hospital das Clinicas da Universidade Federal de Minas Gerais
City
Belo Horizonte
State/Province
Minas Gerais
ZIP/Postal Code
30130-100
Country
Brazil
Facility Name
Hospital de Clínicas de Porto Alegre
City
Porto Alegre
State/Province
Rio Grande Do Sul
ZIP/Postal Code
90035-903
Country
Brazil
Facility Name
Hospital das Clínicas da Faculdade de Medicina da USP
City
São Paulo
State/Province
Sao Paulo
ZIP/Postal Code
05403-000
Country
Brazil
Facility Name
BC Children's Hospital
City
Vancouver
State/Province
British Columbia
ZIP/Postal Code
V6H 3V4
Country
Canada
Facility Name
London Health Sciences Centre (LHSC) - Children's Hospital
City
London
State/Province
Ontario
ZIP/Postal Code
N6A 5W9
Country
Canada
Facility Name
McGill University Health Centre/Glen Site/Montreal Children's Hospital
City
Montreal
State/Province
Quebec
ZIP/Postal Code
H4A 3J1
Country
Canada
Facility Name
Hospital Luis Calvo Mackenna
City
Santiago
ZIP/Postal Code
7500539
Country
Chile
Facility Name
Clinica Las Condes
City
Santiago
ZIP/Postal Code
7591046
Country
Chile
Facility Name
Clinica MEDS La Dehesa
City
Santiago
ZIP/Postal Code
7691236
Country
Chile
Facility Name
Peking University First Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100034
Country
China
Facility Name
Beijing Children's Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100045
Country
China
Facility Name
Children's Hospital Chongqing University of Medical Science
City
Chongqing
State/Province
Chongqing
ZIP/Postal Code
400014
Country
China
Facility Name
Guangzhou Woman and Children's Medical Center
City
Guangzhou
State/Province
Guangzhou
ZIP/Postal Code
510623
Country
China
Facility Name
Xiangya Hospital, Central South University
City
Changsha
State/Province
Hunan
ZIP/Postal Code
410008
Country
China
Facility Name
Qilu Hospital of Shandong University
City
Jinan
State/Province
Shandong
ZIP/Postal Code
250012
Country
China
Facility Name
The Second Hospital affiliated to West China Medical University
City
Chendu
State/Province
Sichuan
ZIP/Postal Code
610041
Country
China
Facility Name
Hospital Universitario San Ignacio
City
Bogota
ZIP/Postal Code
110231
Country
Colombia
Facility Name
Fundacion Hospitalaria San Vicente de Paul
City
Medellin
ZIP/Postal Code
050010
Country
Colombia
Facility Name
Tallinn Children's Hospital
City
Tallinn
ZIP/Postal Code
13419
Country
Estonia
Facility Name
Hopital Purpan
City
Toulouse cedex 9
State/Province
Haute Garonne
ZIP/Postal Code
31059
Country
France
Facility Name
Hôpital Raymond Poincaré
City
Garches
State/Province
Hauts De Seine
ZIP/Postal Code
92380
Country
France
Facility Name
Universitaetsklinikum Freiburg
City
Freiburg
State/Province
Baden Wuerttemberg
ZIP/Postal Code
79106
Country
Germany
Facility Name
Universitaetsklinikum Giessen und Marburg GmbH
City
Giessen
State/Province
Hessen
ZIP/Postal Code
35392
Country
Germany
Facility Name
University General Hospital "Attikon"
City
Athens
ZIP/Postal Code
12462
Country
Greece
Facility Name
General Hospital of Thessaloniki "Hippokration"
City
Thessaloniki
ZIP/Postal Code
54642
Country
Greece
Facility Name
Semmelweis Egyetem
City
Budapest
ZIP/Postal Code
1094
Country
Hungary
Facility Name
Magyarorszagi Reformatus Egyhaz Bethesda Gyermekkorhaz
City
Budapest
ZIP/Postal Code
1146
Country
Hungary
Facility Name
The Children's University Hospital
City
Dublin
ZIP/Postal Code
D01 XD99
Country
Ireland
Facility Name
Schneider Children's Medical Center
City
Petach-Tikva
ZIP/Postal Code
4920235
Country
Israel
Facility Name
Tel Aviv Sourasky Medical Center
City
Tel Aviv
ZIP/Postal Code
6423906
Country
Israel
Facility Name
Fondazione Serena Onlus - Centro Clinico Nemo
City
Milano
ZIP/Postal Code
20162
Country
Italy
Facility Name
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
City
Roma
ZIP/Postal Code
00168
Country
Italy
Facility Name
Kurume University Hospital
City
Kurume-shi
State/Province
Fukuoka-Ken
ZIP/Postal Code
830-0011
Country
Japan
Facility Name
Hyogo College of Medicine Hospital
City
Nishinomiya-shi
State/Province
Hyogo-Ken
ZIP/Postal Code
663-8501
Country
Japan
Facility Name
Tokyo Women's Medical University Hospital
City
Shinjuku-ku
State/Province
Tokyo-To
ZIP/Postal Code
162-8666
Country
Japan
Facility Name
Kyungpook National University Chilgok Hospital
City
Daegu
State/Province
Gyeongsangbuk-do
ZIP/Postal Code
41404
Country
Korea, Republic of
Facility Name
Seoul National University Hospital
City
Seoul
ZIP/Postal Code
03080
Country
Korea, Republic of
Facility Name
Children's Clinical University Hospital
City
Riga
ZIP/Postal Code
LV- 1004
Country
Latvia
Facility Name
Saint George University Hospital Medical Center
City
Beirut
ZIP/Postal Code
11 00 2807
Country
Lebanon
Facility Name
Instituto Nacional de Pediatria
City
Mexico City
State/Province
Distrito Federal
ZIP/Postal Code
04530
Country
Mexico
Facility Name
Hospital Infantil de Mexico Federico Gomez
City
Mexico
State/Province
Distrito Federal
ZIP/Postal Code
06720
Country
Mexico
Facility Name
Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde
City
Guadalajara
State/Province
Jalisco
ZIP/Postal Code
44280
Country
Mexico
Facility Name
UMC Utrecht
City
Utrecht
ZIP/Postal Code
3584 CX
Country
Netherlands
Facility Name
Uniwersyteckie Centrum Kliniczne
City
Gdansk
ZIP/Postal Code
80-214
Country
Poland
Facility Name
Instytut Pomnik - Centrum Zdrowia Dziecka
City
Warszawa
ZIP/Postal Code
04-730
Country
Poland
Facility Name
Regional Pediatric Clinical Hospital #1
City
Ekaterinburg
ZIP/Postal Code
620149
Country
Russian Federation
Facility Name
Russian Children Neuromuscular Center of Veltischev
City
Moskva
ZIP/Postal Code
125412
Country
Russian Federation
Facility Name
King Fahad Specialist Hospital
City
Dammam
ZIP/Postal Code
31444
Country
Saudi Arabia
Facility Name
National Guard Health Affairs: King Abdulaziz Medical City
City
Jeddah
ZIP/Postal Code
21423
Country
Saudi Arabia
Facility Name
King Faisal Specialist Hospital & Research Center
City
Riyadh
ZIP/Postal Code
11211
Country
Saudi Arabia
Facility Name
Hospital Sant Joan de Deu
City
Esplugues Del Llobregat
State/Province
Barcelona
ZIP/Postal Code
08950
Country
Spain
Facility Name
Hospital Universitari Vall d'Hebron
City
Barcelona
ZIP/Postal Code
08035
Country
Spain
Facility Name
Hospital Universitario La Paz
City
Madrid
ZIP/Postal Code
28046
Country
Spain
Facility Name
Hospital Universitari i Politecnic La Fe
City
Valencia
ZIP/Postal Code
46026
Country
Spain
Facility Name
Kaohsiung Medical University Chung-Ho Memorial Hospital
City
Kaohsiung
ZIP/Postal Code
80756
Country
Taiwan
Facility Name
National Taiwan University Hospital
City
Taipei
ZIP/Postal Code
10002
Country
Taiwan
Facility Name
Akdeniz Univesity Medical Faculty
City
Antalya
ZIP/Postal Code
07070
Country
Turkey
Facility Name
Great Ormond Street Hospital for Children
City
London
State/Province
Greater London
ZIP/Postal Code
WC1N 3JH
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
In accordance with Biogen's Clinical Trial Transparency and Data Sharing Policy on https://www.biogentrialtransparency.com/
IPD Sharing URL
https://vivli.org/
Citations:
PubMed Identifier
35567345
Citation
Finkel RS, Ryan MM, Pascual Pascual SI, Day JW, Mercuri E, De Vivo DC, Foster R, Montes J, Gurgel-Giannetti J, MacCannell D, Berger Z. Scientific rationale for a higher dose of nusinersen. Ann Clin Transl Neurol. 2022 Jun;9(6):819-829. doi: 10.1002/acn3.51562. Epub 2022 May 13.
Results Reference
derived
Links:
URL
http://www.sma-europe.eu/
Description
SMA Europe
URL
http://www.curesma.org/
Description
CureSMA
URL
http://www.mda.org/disease/spinal-muscular-atrophy
Description
Muscular Dystrophy Association
URL
https://www.biogentriallink.com/en-us/home.html
Description
Study website - US patients only

Learn more about this trial

Study of Nusinersen (BIIB058) in Participants With Spinal Muscular Atrophy

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