Study of Nusinersen (BIIB058) in Participants With Spinal Muscular Atrophy (DEVOTE)
Muscular Atrophy, Spinal
About this trial
This is an interventional treatment trial for Muscular Atrophy, Spinal
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.
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
Experimental
Active Comparator
Experimental
Experimental
28/28 Milligram (mg) Safety Group
12/12 mg Randomized Control Group
50/28 mg Randomized Treatment Group
12/50/28 mg Titration Group
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.