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Trial to Evaluate the Efficacy and Safety of KM-819 Treatment to Slow the Progression of Multiple System Atrophy (MSA)

Primary Purpose

Multiple System Atrophy

Status
Recruiting
Phase
Phase 2
Locations
Korea, Republic of
Study Type
Interventional
Intervention
KM-819
Placebo
Sponsored by
Kainos Medicine Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple System Atrophy focused on measuring neurodegenerative disorder, Fas-associated factor 1 (FAF1), autonomic dysfunction, KM-819

Eligibility Criteria

30 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Must be diagnosed as probable or possible MSA, according to the second consensus criteria for diagnosis of MSA Patients who are able to visit the clinic during the study period to be in the study. ≥ 30 years and ≤ 80 years of age at the time of signing the Informed Consent Antiparkinsonian medications should be stable for, at least, one month before enrollment. Body Mass Index (BMI) range of 18.5 to 30 kg/m^2 inclusive at Screening Patient agrees to use acceptable contraceptive methods during the study For women, menopause, sterilization confirmed. For childbearing women, older than 40, and agreed with more than 2 methods of contraception below and agreed with no desire to be pregnant during and after the study, and, agreed with maintaining medically acceptable methods of contraception during for 90 days after the study. Cognitive ability for possible to make self-decision, understand and follow the instruction, to make written signature on consent form. If no ability to walk, patients must be accompanied by caregiver by wheelchair on schedule. Exclusion Criteria: A diagnosis of drug induced parkinsonism by typical neuroleptic treatment or haloperidol medication. Women who are pregnant or lactating History of suicide attempt. Any recent suicidal ideation (a level of 4 or 5) within the last 3 months prior to Day 1, or has a positive response ('Yes') to either question 4 or 5 of the Columbia Suicide Severity Rating Scale (C-SSRS) at check-in (Day 1), or who is at significant risk to commit suicide, as judged by the Investigator using the C-SSRS at Screening. Febrile illness or symptomatic viral, bacterial (including upper respiratory infection) or fungal (non-cutaneous) infection. Any clinically significant abnormality following the Investigator's review of the physical examination and protocol-defined clinical laboratory tests at Screening or site check-in. Patient has a mean pulse rate < 40 Patient has a mean corrected QT interval using Fridericia's formula (QTcF) of > 430 msec (for males) and > 450 msec (for females). History of unexplained syncope, cardiac arrest, unexplained cardiac arrhythmias or torsade de pointes, structural heart disease or a family history of Long QT Syndrome. Positive serology test for hepatitis B surface antigen (HBsAg), anti-hepatitis A virus (HAV), immunoglobulin M (IgM), anti-hepatitis C virus (HCV) or anti-human immunodeficiency virus (HIV). Known or suspected hypersensitivity to KM-819, or any components of the formulation(s) used. Patient has a serious medical or surgical condition. Patients unable to understand the consent form, and determined by investigator with too serious problems for participating in the study. Patients unable to visit the clinical site on schedule due to the no ability mobilize. Patients who had brain surgery history.

Sites / Locations

  • CHA Bundang Medical Center, CHA UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

Experimental

Arm Label

Main Study: KM-819

Main Study: Placebo

Ancillary Study: KM-819

Arm Description

Subjects will receive 400 mg of KM-819 orally from Week 0 to Week 36.

Subjects will receive visually identical placebo pills of KM-819 orally.

Subjects will receive 400 mg of KM-819 orally from Week 40 to Week 76.

Outcomes

Primary Outcome Measures

Percentage change from baseline in putaminal [18F]FP-CIT (18F-FP-CIT Positron Emission Tomography for Correlating Motor and Cognitive Symptoms of Parkinson's Disease) binding
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The putaminal [18F]FP-CIT binding will allow quantification of MSA progression during 36 weeks.

Secondary Outcome Measures

Change from baseline in the Unified Multiple System Atrophy Rating Scale (UMSARS) scores (UMSARS I + II)
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-I total score is 48 and UMSARS-II total score is 56. Higher scores on the UMSARS indicate greater disability.
Change from baseline in the UMSARS I scores
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-I total score is 48. Higher scores on the UMSARS indicate greater disability.
Change from baseline in the UMSARS II scores
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-II total score is 56. Higher scores on the UMSARS indicate greater disability.
Percentage change from baseline in putaminal glucose metabolism
To evaluate the efficacy of KM-819 compared to placebo for slowing the putaminal of MSA, as measured by [18F]FDG PET (fluorodeoxyglucose (FDG)-positron emission tomography (PET)).
Percentage change from baseline in cerebellar glucose metabolism
To further evaluate the efficacy of KM-819 compared to placebo for slowing the cerebellar progression of MSA, as measured by [18F]FDG PET.
Change from baseline in the Unified Parkinson Disease Rating Scale (UPDRS) III score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The UPDRS is the most widely applied rating instrument for PD. The Total UPDRS III scale includes 18 items. Each item scores 0-4. UPDRS III total score is 72. The highest score refers to the most severe level of disability due to Parkinson's disease.
Change from baseline in the Scale for the Assessment and Rating of Ataxia (SARA) score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The SARA is a tool for assessing ataxia. It has eight categories with an accumulative scores ranging from 0 (no ataxia) to 40 (most severe ataxia). The eight categories were: Gait (0-8 score); Stance (0-6 score); Sitting (0-4 score); Speech disturbance (0-6 score); Finger chase(0-4 score); Nose-finger test (0-4 score); Fast alternating hand movements (0-4 score); Heel-shin slide (0-4 score). Mild dependence: 5.5 or lower, Moderate dependence: 14.25 or lower, Maximal dependence: 23 of higher.
Change from baseline in the Montreal Cognitive Assessment (MoCA) score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. MoCA can be used to detect dementia in a clinical setting. A total score of 30 with over 26 is normal. The lower score refers the severe cognitive impairment.
Change from baseline in the Beck's Depression Inventory (BDI-II) score
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The BDI-II is scored by summing the ratings for the 21 items. Each item is rated on a 4-point scale ranging from 0 to 3. The maximum total score is 63. Measures of 0-13: Minimal, 14-19: Mild, 20-28: Moderate, 29-63: Severe.
Number of subjects with adverse events (AEs) and serious AEs (SAEs)
To evaluate the safety of KM-819 in subjects with MSA.
Maximum observed concentration (Cmax)
To describe the pharmacokinetics parameter (Cmax) of KM-819 using sparse PK sampling.
Area under the concentration-time curve (AUC)
To describe the pharmacokinetics parameter (AUC) of KM-819 using sparse PK sampling.
Time of maximum observed concentration (Tmax)
To describe the pharmacokinetics parameter (Tmax) of KM-819 using sparse PK sampling.

Full Information

First Posted
December 22, 2022
Last Updated
March 9, 2023
Sponsor
Kainos Medicine Inc.
Collaborators
Parexel
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1. Study Identification

Unique Protocol Identification Number
NCT05695378
Brief Title
Trial to Evaluate the Efficacy and Safety of KM-819 Treatment to Slow the Progression of Multiple System Atrophy (MSA)
Official Title
A Phase 2, Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate the Efficacy and Safety of KM-819 Treatment to Slow the Progression of Multiple System Atrophy
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 27, 2023 (Actual)
Primary Completion Date
October 28, 2024 (Anticipated)
Study Completion Date
November 18, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Kainos Medicine Inc.
Collaborators
Parexel

4. Oversight

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

5. Study Description

Brief Summary
This trial will the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA.
Detailed Description
This is a randomized, double-blind, placebo-controlled phase II trial. This trial will be performed in two part: Main study and Ancillary study. Main Study: Following a 4-week screening period, subjects will be stratified by MSA subtype (MSA-P, -C [MSA-Parkinsonian type, MSA-cerebellar ataxia]) and randomly assigned in a 1:1 ratio either to KM-819 or Placebo groups. During a treatment period of 36 weeks, subjects will receive pills of either KM-819 or Placebo for oral administration every day from baseline visit. Following this, there will be a safety follow-up period at Week 40. Ancillary Study: This ancillary study will provide additional information on the continuing efficacy and safety of KM-819. Subjects in either treatment group in the main study who complete the study are eligible to participate in a follow-up, all-subjects-on-treatment (KM-819), open-label ancillary study. All subjects in the ancillary study will receive KM-819 for additional 36 weeks regardless of their treatment allocation during the main study. During a treatment period of 36 weeks, subjects will receive pills of KM-819 for oral administration every day from visit at Weeks 40.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple System Atrophy
Keywords
neurodegenerative disorder, Fas-associated factor 1 (FAF1), autonomic dysfunction, KM-819

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
78 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Main Study: KM-819
Arm Type
Experimental
Arm Description
Subjects will receive 400 mg of KM-819 orally from Week 0 to Week 36.
Arm Title
Main Study: Placebo
Arm Type
Placebo Comparator
Arm Description
Subjects will receive visually identical placebo pills of KM-819 orally.
Arm Title
Ancillary Study: KM-819
Arm Type
Experimental
Arm Description
Subjects will receive 400 mg of KM-819 orally from Week 40 to Week 76.
Intervention Type
Drug
Intervention Name(s)
KM-819
Intervention Description
Subjects will receive KM-819 400 mg orally daily.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Subjects will receive Placebo orally daily.
Primary Outcome Measure Information:
Title
Percentage change from baseline in putaminal [18F]FP-CIT (18F-FP-CIT Positron Emission Tomography for Correlating Motor and Cognitive Symptoms of Parkinson's Disease) binding
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The putaminal [18F]FP-CIT binding will allow quantification of MSA progression during 36 weeks.
Time Frame
From Baseline to Week 36
Secondary Outcome Measure Information:
Title
Change from baseline in the Unified Multiple System Atrophy Rating Scale (UMSARS) scores (UMSARS I + II)
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-I total score is 48 and UMSARS-II total score is 56. Higher scores on the UMSARS indicate greater disability.
Time Frame
From Baseline to Week 36
Title
Change from baseline in the UMSARS I scores
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-I total score is 48. Higher scores on the UMSARS indicate greater disability.
Time Frame
From Baseline to Week 36
Title
Change from baseline in the UMSARS II scores
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA. The Unified Multiple System Atrophy Rating Scale (UMSARS) was developed to provide a surrogate measure of disease progression in multiple system atrophy. It is composed of four subscales: UMSARS-I (12 items) rates patient-reported functional disability (Historical Review), UMSARS-II (14 items) assesses motor impairment based on a clinical examination. Each item scores 0-4. UMSARS-II total score is 56. Higher scores on the UMSARS indicate greater disability.
Time Frame
From Baseline to Week 36
Title
Percentage change from baseline in putaminal glucose metabolism
Description
To evaluate the efficacy of KM-819 compared to placebo for slowing the putaminal of MSA, as measured by [18F]FDG PET (fluorodeoxyglucose (FDG)-positron emission tomography (PET)).
Time Frame
From Baseline to Week 36
Title
Percentage change from baseline in cerebellar glucose metabolism
Description
To further evaluate the efficacy of KM-819 compared to placebo for slowing the cerebellar progression of MSA, as measured by [18F]FDG PET.
Time Frame
From Baseline to Week 36
Title
Change from baseline in the Unified Parkinson Disease Rating Scale (UPDRS) III score
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The UPDRS is the most widely applied rating instrument for PD. The Total UPDRS III scale includes 18 items. Each item scores 0-4. UPDRS III total score is 72. The highest score refers to the most severe level of disability due to Parkinson's disease.
Time Frame
From Baseline to Week 36
Title
Change from baseline in the Scale for the Assessment and Rating of Ataxia (SARA) score
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The SARA is a tool for assessing ataxia. It has eight categories with an accumulative scores ranging from 0 (no ataxia) to 40 (most severe ataxia). The eight categories were: Gait (0-8 score); Stance (0-6 score); Sitting (0-4 score); Speech disturbance (0-6 score); Finger chase(0-4 score); Nose-finger test (0-4 score); Fast alternating hand movements (0-4 score); Heel-shin slide (0-4 score). Mild dependence: 5.5 or lower, Moderate dependence: 14.25 or lower, Maximal dependence: 23 of higher.
Time Frame
From Baseline to Week 36
Title
Change from baseline in the Montreal Cognitive Assessment (MoCA) score
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. MoCA can be used to detect dementia in a clinical setting. A total score of 30 with over 26 is normal. The lower score refers the severe cognitive impairment.
Time Frame
From Baseline to Week 36
Title
Change from baseline in the Beck's Depression Inventory (BDI-II) score
Description
To evaluate the efficacy of KM-819 compared to placebo in subjects with MSA for slowing the progression of MSA, measured by clinical scales. The BDI-II is scored by summing the ratings for the 21 items. Each item is rated on a 4-point scale ranging from 0 to 3. The maximum total score is 63. Measures of 0-13: Minimal, 14-19: Mild, 20-28: Moderate, 29-63: Severe.
Time Frame
From Baseline to Week 36
Title
Number of subjects with adverse events (AEs) and serious AEs (SAEs)
Description
To evaluate the safety of KM-819 in subjects with MSA.
Time Frame
From Screening (Day -4) to Week 40
Title
Maximum observed concentration (Cmax)
Description
To describe the pharmacokinetics parameter (Cmax) of KM-819 using sparse PK sampling.
Time Frame
From Baseline to Week 36
Title
Area under the concentration-time curve (AUC)
Description
To describe the pharmacokinetics parameter (AUC) of KM-819 using sparse PK sampling.
Time Frame
From Baseline to Week 36
Title
Time of maximum observed concentration (Tmax)
Description
To describe the pharmacokinetics parameter (Tmax) of KM-819 using sparse PK sampling.
Time Frame
From Baseline to Week 36

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must be diagnosed as probable or possible MSA, according to the second consensus criteria for diagnosis of MSA Patients who are able to visit the clinic during the study period to be in the study. ≥ 30 years and ≤ 80 years of age at the time of signing the Informed Consent Antiparkinsonian medications should be stable for, at least, one month before enrollment. Body Mass Index (BMI) range of 18.5 to 30 kg/m^2 inclusive at Screening Patient agrees to use acceptable contraceptive methods during the study For women, menopause, sterilization confirmed. For childbearing women, older than 40, and agreed with more than 2 methods of contraception below and agreed with no desire to be pregnant during and after the study, and, agreed with maintaining medically acceptable methods of contraception during for 90 days after the study. Cognitive ability for possible to make self-decision, understand and follow the instruction, to make written signature on consent form. If no ability to walk, patients must be accompanied by caregiver by wheelchair on schedule. Exclusion Criteria: A diagnosis of drug induced parkinsonism by typical neuroleptic treatment or haloperidol medication. Women who are pregnant or lactating History of suicide attempt. Any recent suicidal ideation (a level of 4 or 5) within the last 3 months prior to Day 1, or has a positive response ('Yes') to either question 4 or 5 of the Columbia Suicide Severity Rating Scale (C-SSRS) at check-in (Day 1), or who is at significant risk to commit suicide, as judged by the Investigator using the C-SSRS at Screening. Febrile illness or symptomatic viral, bacterial (including upper respiratory infection) or fungal (non-cutaneous) infection. Any clinically significant abnormality following the Investigator's review of the physical examination and protocol-defined clinical laboratory tests at Screening or site check-in. Patient has a mean pulse rate < 40 Patient has a mean corrected QT interval using Fridericia's formula (QTcF) of > 430 msec (for males) and > 450 msec (for females). History of unexplained syncope, cardiac arrest, unexplained cardiac arrhythmias or torsade de pointes, structural heart disease or a family history of Long QT Syndrome. Positive serology test for hepatitis B surface antigen (HBsAg), anti-hepatitis A virus (HAV), immunoglobulin M (IgM), anti-hepatitis C virus (HCV) or anti-human immunodeficiency virus (HIV). Known or suspected hypersensitivity to KM-819, or any components of the formulation(s) used. Patient has a serious medical or surgical condition. Patients unable to understand the consent form, and determined by investigator with too serious problems for participating in the study. Patients unable to visit the clinical site on schedule due to the no ability mobilize. Patients who had brain surgery history.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
JAE MOON LEE
Phone
+82-2-567-7419
Email
Jlee@kainosmedicine.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Chong Sik Lee
Organizational Affiliation
PI
Official's Role
Principal Investigator
Facility Information:
Facility Name
CHA Bundang Medical Center, CHA University
City
Seongnam-si
State/Province
Gyeonggi-do
ZIP/Postal Code
13497
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chong Sik Lee

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Trial to Evaluate the Efficacy and Safety of KM-819 Treatment to Slow the Progression of Multiple System Atrophy (MSA)

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