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Study of Safety, Tolerability and Efficacy of PBKR03 in Pediatric Subjects With Early Infantile Krabbe Disease (GALax-C)

Primary Purpose

Leukodystrophy, Globoid Cell

Status
Active
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
PBKR03
Sponsored by
Passage Bio, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leukodystrophy, Globoid Cell focused on measuring infantile, early infantile, Krabbe Disease, Rare disease, Leukodystrophy, GALC, Lysosomal storage disease

Eligibility Criteria

1 Month - 9 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. > 1 month and < 9 months of age at enrollment, either presymptomatic or symptomatic with first symptoms of Krabbe Disease at < 6 months of age
  2. Leukocyte GALC activity below lower limit of normal (LLN)
  3. Whole blood psychosine > 10 nM
  4. Biallelic pathogenic GALC gene variants previously associated with early infantile Krabbe Disease or variants classified as likely pathogenic
  5. Parents or the subject's legally authorized representative provide written informed consent prior to any study-related procedures, including screening evaluations
  6. Symptomatic subjects must exhibit a minimum level of neurological and developmental function that indicates that they have the potential to benefit from treatment, at least with slowing or stabilization of their disease. In particular, the subject must demonstrate the following clinical features (when age-appropriate):

    • Thrusting of legs in play
    • Lifting of head
    • Eyes follow moving person
    • Smiles in response to speaker's attention

Exclusion Criteria:

  1. Any clinically significant neurocognitive deficit not attributable to Krabbe disease.
  2. An acute illness requiring hospitalization within 30 days of enrollment.
  3. History of chronic ventilation assisted respiratory support (defined as more than 12 hours/day of bilevel positive airway pressure, continuous positive airway pressure (CPAP) or ventilator) or a need for tracheostomy as a result of their disease. Note: This does not exclude patients who use respiratory vests.
  4. Intractable seizure or uncontrolled epilepsy defined as having had an episode of status epilepticus, or seizures requiring hospitalization.
  5. Family history of seizures or epilepsy of infantile or childhood onset, other than febrile seizures. This does not exclude subjects with a family history of Krabbe disease.
  6. Any contraindication to the ICM administration procedure, including contraindications to fluoroscopic imaging, intrathecal contrast and anesthesia or any condition that would increase the risk of adverse outcomes from the ICM procedure including, but not limited to, the presence of a space occupying lesion, aberrant vascular anatomy or congenital anatomical abnormalities such as a Chiari malformation.
  7. Any contraindication to MRI or lumbar puncture (LP).
  8. Prior gene therapy.
  9. Enrollment in any other clinical study with an investigational product within 4 weeks prior to Screening or within 5 half-lives of the investigational product used in that clinical study, whichever is longer.
  10. Prior Hematopoietic Stem Cell Transplantation (HSCT)
  11. Receipt of a vaccine within 14 days prior to or after dosing.
  12. Estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73 m2 based on creatinine
  13. Hematological abnormalities

    • Coagulopathy (INR > 1.5) or activated partial thromboplastin time [aPTT] > 40 seconds
    • WBC < 5.5 x 103 cells/ μL
    • Hemoglobin <10 g/dL
    • Thromobcytopenia (platelet count < 100,000 per μL.)
  14. AST or ALT > 3 times the upper limit of normal (ULN) or total bilirubin > 1.5x ULN
  15. Abnormal respiratory function

    1. Required suctioning in the absence of upper respiratory tract infection
    2. Hypoxemia (oxygen [O2] saturation awake less than 96% or O2 saturation asleep less than 96%, without ventilation support) as assessed during screening. Ventilatory support is defined as dependence on supplemental O2 or use of a ventilator or bilevel positive airway pressure (BiPap) or continuous positive airway pressure (Cpap) machine.
  16. Poor peripheral perfusion or temperature instability in the absence of intercurrent illness
  17. Medical conditions or laboratory or vital sign abnormalities that would increase risk of complications from intra-cisterna magna injection, anesthesia, fluoroscopy, LP, and/or MRI
  18. Any condition (e.g., history of any disease, evidence of any current disease, any finding upon physical examination, or any laboratory abnormality) that, in the opinion of the investigator, would put the subject at undue risk during the administration procedure or would interfere with evaluation of PBKR01 or interpretation of subject safety or study results.

Sites / Locations

  • Ann & Robert Lurie
  • New York-Presbyterian
  • The Children's Hospital of Philadelphia
  • University of Utah School of Medicine
  • Hospital De Clinicas De Porto Alegre
  • Montreal Children's Hospital
  • Shaare Zadek Medical Center
  • Amsterdam UMC
  • Manchester University

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Part 1: Dose Escalation Cohorts designed to identify the optimal dose of PBKR03

Part 2: Expansion Cohort designed to confirm the safety and efficacy of PBKR03

Arm Description

Cohort 1: Subjects aged >4 to <9 months Drug: PBKR03 1.5 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna Cohort 2: Subjects aged >4 to <9 months Drug: PBKR03 5.0 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna Cohort 3: Subjects aged >1 to <4 months Drug: PBKR03 1.5 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna Cohort 4: Subjects aged >1 to <4 months Drug: PBKR03 5.0 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna *GC/g: genome copiesy per gram of estimated brain weight

Cohort 5: Subjects aged >1 to <9 months Drug: PBKR03 Single dose of PBKR03, via intra cisterna magna Dose to be used for the confirmatory cohorts in Part 2 will be defined after a review of data from Part 1. *GC/g: genome copiesy per gram of estimated brain weight

Outcomes

Primary Outcome Measures

Number of participants with treatment-related adverse events (AEs) and serious adverse events (SAEs) at Grade 3 or higher within 24 months of dosing
Assess the number of adverse events and serious adverse events at Grade 3 or higher as assessed by CTCAEv5.0
Change from baseline in nerve conduction and velocity in motor nerve conduction studies
NCS will measure velocity and amplitude in distal segments of the median, peroneal and tibial motor nerves to evaluate effects on peripheral nerve integrity.
Change from baseline in nerve conduction and velocity in sensory nerve conduction studies
NCS will measure velocity and amplitude in distal segments of the sural, radial and median sensory nerves to evaluate effects on peripheral nerve integrity
Number of Participants with Clinically Significant Laboratory Abnormalities as Measured Using Hematology, Chemistry and Coagulation Tests
Assess the number of participants with clinically significant laboratory changes including hematology, serum chemistry, and coagulation tests
Assess Humoral Response Against the Vector and Transgene in Serum
Assess serum antibody titers against AAVhu68 and against GALC following ICM administration of PBKR03
Assess Humoral Response Against the Vector and Transgene in CSF
Assess antibody titers in the cerebrospinal fluid against AAVhu68 and against GALC following ICM administration of PBKR03

Secondary Outcome Measures

Change from Baseline in Developmental Milestones as Assessed by the Bayley Scale of Infant and Toddler Development, Third Edition
Assess changes in the developmental age and the total number of developmental milestones using the Bayley Scale of Infant and Toddler Development, Third Edition instrument
Change from Baseline in Developmental Milestones as Assessed by the Vineland Adaptive Behavior Scale-II
Assess changes in the developmental age and the total number of developmental milestones using the Vineland Adaptive Behavior Scale-II instrument
Change in Biomarkers of GALC Activity in Blood
Assess change in biomarkers of GALC activity in blood when compared with baseline
Change in Biomarkers of GALC Activity in CSF
Assess change in biomarkers of GALC activity when compared with baseline
Change in Biomarkers of GALC Substrates in Blood
Assess change in concentration of GALC substrates in blood
Change in Biomarkers of GALC Substrates in CSF
Assess change in concentration of GALC in CSF when compared with baseline
Change in Concentration of Biomarker of Disease Progression in Plasma
Assess change in neurofilament light chain (NfL) concentration as a marker for neurodegeneration and disease progression in plasma
Change in Concentration of Biomarker of Disease Progression in CSF
Assess change in neurofilament light chain concentration (NfL) as a marker for neurodegeneration and disease progression in CSF
Change in Brain Anatomy as Assessed by MRI
Assess change in disease severity, volumetric MRI measures, brain diffusivity, and white matter lesions by MRI imaging
Change in Quality of Life Using Pediatric Quality of Life Scale
Assess change in quality of life as measured by Pediatric Quality of Life Scale (Peds QL)
Change in Quality of Life Using Pediatric Quality of Life Scales
Assess change in quality of life as measured by the Pediatric Quality of Life - Infant Scale (PedsQL-IS)
Change in Ventilator-Free Survival Compared with Natural History Data
Assess change compared with natural history data in ventilator-free survival and chronic ventilatory support.
Incidence of Feeding Tube Placement at or Before Month 24
Though speech and swallowing assessment, study participants will be evaluated to determine whether a feeding tube is warranted

Full Information

First Posted
February 23, 2021
Last Updated
January 4, 2023
Sponsor
Passage Bio, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04771416
Brief Title
Study of Safety, Tolerability and Efficacy of PBKR03 in Pediatric Subjects With Early Infantile Krabbe Disease
Acronym
GALax-C
Official Title
A Phase 1/2 Open-Label, Multicenter Dose-Ranging and Confirmatory Study to Assess the Safety, Tolerability and Efficacy of PBKR03 Administered to Pediatric Subjects With Early Infantile Krabbe Disease (Globoid Cell Leukodystrophy)
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
February 24, 2022 (Actual)
Primary Completion Date
January 2027 (Anticipated)
Study Completion Date
January 2030 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Passage Bio, Inc.

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
PBKR03 is a gene therapy for Krabbe Disease (Globoid cell leukodystrophy) intended to deliver a functional copy of the GALC gene to the brain and peripheral tissues. This study will evaluate the safety, tolerability and efficacy of this treatment by first evaluating two different doses in two different age groups, then confirming the optimal dose to be used for confirmation of safety and efficacy.
Detailed Description
PBKR03 is an adeno-associated viral vector serotype Hu68 carrying the gene encoding for human galactosylceramidase, GALC, formulated as a solution for injection into the cisterna magna. This is a global interventional, multicenter, single-arm, dose escalation, study of PBKR03 delivered as a one-time dose administered into the cisterna magna of subjects with early infantile Krabbe Disease. The dose-ranging portion of the study will enroll independent dose escalation cohorts in two age groups of subjects with early infantile Krabbe disease: Cohort 1: 3 subjects aged ≥4 to <9 months will receive the low dose (Dose I) Cohort 2: 3 subjects aged ≥4 to <9 months will receive the high dose (Dose II) Cohort 3: 3 subjects aged ≥1 to <4 months will receive the low dose (Dose I) Cohort 4: 3 subjects aged ≥1 to <4 months will receive the high dose (Dose II) Part 1 of the study will enroll a total of four cohorts, enrolled sequentially with separate age-based dose-escalation cohorts. Enrollment will initiate in Cohort 1. Following completion of Cohort 1, simultaneous enrollment in Cohort 2 and Cohort 3 will occur. Cohort 4 will follow completion of cohort 3. The confirmatory cohort, Part 2, will enroll subjects with early infantile Krabbe Disease, aged >1 to <9 months. These subjects will receive a dose chosen based on the data obtained in part 1 of the study This will be a 2-year study with a 3-year safety extension.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leukodystrophy, Globoid Cell
Keywords
infantile, early infantile, Krabbe Disease, Rare disease, Leukodystrophy, GALC, Lysosomal storage disease

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Open-label, multi-center, dose escalation
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
24 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Part 1: Dose Escalation Cohorts designed to identify the optimal dose of PBKR03
Arm Type
Experimental
Arm Description
Cohort 1: Subjects aged >4 to <9 months Drug: PBKR03 1.5 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna Cohort 2: Subjects aged >4 to <9 months Drug: PBKR03 5.0 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna Cohort 3: Subjects aged >1 to <4 months Drug: PBKR03 1.5 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna Cohort 4: Subjects aged >1 to <4 months Drug: PBKR03 5.0 x 10^11 GC/g* Single dose of PBKR03, via intra cisterna magna *GC/g: genome copiesy per gram of estimated brain weight
Arm Title
Part 2: Expansion Cohort designed to confirm the safety and efficacy of PBKR03
Arm Type
Experimental
Arm Description
Cohort 5: Subjects aged >1 to <9 months Drug: PBKR03 Single dose of PBKR03, via intra cisterna magna Dose to be used for the confirmatory cohorts in Part 2 will be defined after a review of data from Part 1. *GC/g: genome copiesy per gram of estimated brain weight
Intervention Type
Biological
Intervention Name(s)
PBKR03
Intervention Description
Single dose of PBKR03, via intra cisterna magna
Primary Outcome Measure Information:
Title
Number of participants with treatment-related adverse events (AEs) and serious adverse events (SAEs) at Grade 3 or higher within 24 months of dosing
Description
Assess the number of adverse events and serious adverse events at Grade 3 or higher as assessed by CTCAEv5.0
Time Frame
Up to 5 years (multiple visits)
Title
Change from baseline in nerve conduction and velocity in motor nerve conduction studies
Description
NCS will measure velocity and amplitude in distal segments of the median, peroneal and tibial motor nerves to evaluate effects on peripheral nerve integrity.
Time Frame
From baseline to 5 years (multiple visits)
Title
Change from baseline in nerve conduction and velocity in sensory nerve conduction studies
Description
NCS will measure velocity and amplitude in distal segments of the sural, radial and median sensory nerves to evaluate effects on peripheral nerve integrity
Time Frame
From baseline to 5 years (multiple visits)
Title
Number of Participants with Clinically Significant Laboratory Abnormalities as Measured Using Hematology, Chemistry and Coagulation Tests
Description
Assess the number of participants with clinically significant laboratory changes including hematology, serum chemistry, and coagulation tests
Time Frame
Up to 5 years (multiple visits)
Title
Assess Humoral Response Against the Vector and Transgene in Serum
Description
Assess serum antibody titers against AAVhu68 and against GALC following ICM administration of PBKR03
Time Frame
Up to 5 years (multiple visits)
Title
Assess Humoral Response Against the Vector and Transgene in CSF
Description
Assess antibody titers in the cerebrospinal fluid against AAVhu68 and against GALC following ICM administration of PBKR03
Time Frame
Up to 5 years (multiple visits)
Secondary Outcome Measure Information:
Title
Change from Baseline in Developmental Milestones as Assessed by the Bayley Scale of Infant and Toddler Development, Third Edition
Description
Assess changes in the developmental age and the total number of developmental milestones using the Bayley Scale of Infant and Toddler Development, Third Edition instrument
Time Frame
From baseline to 2 years (multiple visits)
Title
Change from Baseline in Developmental Milestones as Assessed by the Vineland Adaptive Behavior Scale-II
Description
Assess changes in the developmental age and the total number of developmental milestones using the Vineland Adaptive Behavior Scale-II instrument
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Biomarkers of GALC Activity in Blood
Description
Assess change in biomarkers of GALC activity in blood when compared with baseline
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Biomarkers of GALC Activity in CSF
Description
Assess change in biomarkers of GALC activity when compared with baseline
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Biomarkers of GALC Substrates in Blood
Description
Assess change in concentration of GALC substrates in blood
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Biomarkers of GALC Substrates in CSF
Description
Assess change in concentration of GALC in CSF when compared with baseline
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Concentration of Biomarker of Disease Progression in Plasma
Description
Assess change in neurofilament light chain (NfL) concentration as a marker for neurodegeneration and disease progression in plasma
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Concentration of Biomarker of Disease Progression in CSF
Description
Assess change in neurofilament light chain concentration (NfL) as a marker for neurodegeneration and disease progression in CSF
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Brain Anatomy as Assessed by MRI
Description
Assess change in disease severity, volumetric MRI measures, brain diffusivity, and white matter lesions by MRI imaging
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Quality of Life Using Pediatric Quality of Life Scale
Description
Assess change in quality of life as measured by Pediatric Quality of Life Scale (Peds QL)
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Quality of Life Using Pediatric Quality of Life Scales
Description
Assess change in quality of life as measured by the Pediatric Quality of Life - Infant Scale (PedsQL-IS)
Time Frame
From baseline to 2 years (multiple visits)
Title
Change in Ventilator-Free Survival Compared with Natural History Data
Description
Assess change compared with natural history data in ventilator-free survival and chronic ventilatory support.
Time Frame
From baseline to 2 years (multiple visits)
Title
Incidence of Feeding Tube Placement at or Before Month 24
Description
Though speech and swallowing assessment, study participants will be evaluated to determine whether a feeding tube is warranted
Time Frame
24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Month
Maximum Age & Unit of Time
9 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: > 1 month and < 9 months of age at enrollment, either presymptomatic or symptomatic with first symptoms of Krabbe Disease at < 6 months of age Leukocyte GALC activity below lower limit of normal (LLN) Whole blood psychosine > 10 nM Biallelic pathogenic GALC gene variants previously associated with early infantile Krabbe Disease or variants classified as likely pathogenic Parents or the subject's legally authorized representative provide written informed consent prior to any study-related procedures, including screening evaluations Symptomatic subjects must exhibit a minimum level of neurological and developmental function that indicates that they have the potential to benefit from treatment, at least with slowing or stabilization of their disease. In particular, the subject must demonstrate the following clinical features (when age-appropriate): Thrusting of legs in play Lifting of head Eyes follow moving person Smiles in response to speaker's attention Exclusion Criteria: Any clinically significant neurocognitive deficit not attributable to Krabbe disease. An acute illness requiring hospitalization within 30 days of enrollment. History of chronic ventilation assisted respiratory support (defined as more than 12 hours/day of bilevel positive airway pressure, continuous positive airway pressure (CPAP) or ventilator) or a need for tracheostomy as a result of their disease. Note: This does not exclude patients who use respiratory vests. Intractable seizure or uncontrolled epilepsy defined as having had an episode of status epilepticus, or seizures requiring hospitalization. Family history of seizures or epilepsy of infantile or childhood onset, other than febrile seizures. This does not exclude subjects with a family history of Krabbe disease. Any contraindication to the ICM administration procedure, including contraindications to fluoroscopic imaging, intrathecal contrast and anesthesia or any condition that would increase the risk of adverse outcomes from the ICM procedure including, but not limited to, the presence of a space occupying lesion, aberrant vascular anatomy or congenital anatomical abnormalities such as a Chiari malformation. Any contraindication to MRI or lumbar puncture (LP). Prior gene therapy. Enrollment in any other clinical study with an investigational product within 4 weeks prior to Screening or within 5 half-lives of the investigational product used in that clinical study, whichever is longer. Prior Hematopoietic Stem Cell Transplantation (HSCT) Receipt of a vaccine within 14 days prior to or after dosing. Estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73 m2 based on creatinine Hematological abnormalities Coagulopathy (INR > 1.5) or activated partial thromboplastin time [aPTT] > 40 seconds WBC < 5.5 x 103 cells/ μL Hemoglobin <10 g/dL Thromobcytopenia (platelet count < 100,000 per μL.) AST or ALT > 3 times the upper limit of normal (ULN) or total bilirubin > 1.5x ULN Abnormal respiratory function Required suctioning in the absence of upper respiratory tract infection Hypoxemia (oxygen [O2] saturation awake less than 96% or O2 saturation asleep less than 96%, without ventilation support) as assessed during screening. Ventilatory support is defined as dependence on supplemental O2 or use of a ventilator or bilevel positive airway pressure (BiPap) or continuous positive airway pressure (Cpap) machine. Poor peripheral perfusion or temperature instability in the absence of intercurrent illness Medical conditions or laboratory or vital sign abnormalities that would increase risk of complications from intra-cisterna magna injection, anesthesia, fluoroscopy, LP, and/or MRI Any condition (e.g., history of any disease, evidence of any current disease, any finding upon physical examination, or any laboratory abnormality) that, in the opinion of the investigator, would put the subject at undue risk during the administration procedure or would interfere with evaluation of PBKR01 or interpretation of subject safety or study results.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Samiah Al-Zaidy, MD
Organizational Affiliation
Passage Bio, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Ann & Robert Lurie
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
New York-Presbyterian
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
The Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
University of Utah School of Medicine
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Hospital De Clinicas De Porto Alegre
City
Porto Alegre
Country
Brazil
Facility Name
Montreal Children's Hospital
City
Montréal
Country
Canada
Facility Name
Shaare Zadek Medical Center
City
Jerusalem
Country
Israel
Facility Name
Amsterdam UMC
City
Amsterdam
Country
Netherlands
Facility Name
Manchester University
City
Manchester
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35333110
Citation
Hordeaux J, Jeffrey BA, Jian J, Choudhury GR, Michalson K, Mitchell TW, Buza EL, Chichester J, Dyer C, Bagel J, Vite CH, Bradbury AM, Wilson JM. Efficacy and Safety of a Krabbe Disease Gene Therapy. Hum Gene Ther. 2022 May;33(9-10):499-517. doi: 10.1089/hum.2021.245. Epub 2022 Mar 22.
Results Reference
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Study of Safety, Tolerability and Efficacy of PBKR03 in Pediatric Subjects With Early Infantile Krabbe Disease

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