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Study of the Safety and Efficacy of an Adeno-Associated Viral Vector Carrying the SMN Gene After a Single Intravenous Administration of Escalating Doses in Children With Spinal Muscular Atrophy (BLUEBELL) (BLUEBELL)

Primary Purpose

Spinal Muscular Atrophy (SMA)

Status
Recruiting
Phase
Phase 1
Locations
Russian Federation
Study Type
Interventional
Intervention
ANB-004, dose 1
ANB-004, dose 2
ANB-004, dose 3
Sponsored by
Biocad
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Muscular Atrophy (SMA)

Eligibility Criteria

undefined - 240 Days (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Informed consent form for participation in the study signed by the subject's legal representative; Subjects of either sex under the age of 240 days at the time of signing the Information Sheet for the Legal Representative of the Clinical Study Subject with Informed Consent Form; A diagnosis of 5q-SMA established clinically and confirmed by molecular genetic testing (homozygous deletion of exon 7 of the SMN1 gene or heterozygous deletion of exon 7 + confirmed point mutation of the SMN1 gene) and 2 copies of the SMN2 gene, with an age of onset up to 180 days from birth; The ability of the subject's legal representative, in the Investigator's opinion, to perceive information and follow the Protocol procedures. Exclusion Criteria: A diagnosis of HIV infection, hepatitis B, hepatitis C, congenital syphilis in the study subject, as well as a documented diagnosis of HIV infection in the study subject's mother. Note: documented hepatitis B and/or hepatitis C and/or syphilis in the mother of a study subject is not an exclusion criterion in this clinical study, provided that standard breastfeeding rules are followed or the subject is not breastfed due to the low risk of transmission of hepatitis B and C viruses and Treponema pallidum from mother to child with breast milk; Unwillingness of the legal representative to use alternative feeding methods (nasogastric tube, gastrostomy) in case of swallowing disorders and a risk of aspiration; Anti-AAV9 antibody titer >1:50 determined by ELISA. Note: if a subject's screening anti-AAV9 antibody titer is >1:50, the anti-AAV9 antibody titer may be determined again. Subjects with anti-AAV9 antibody titers ≤1:50 in the second test may be included in the study; Need for respiratory support for ≥16 hours per day or tracheostomy ; Treatment with nusinersen, risdiplam, branaplam, onasemnogene abeparvovec or other antisense oligonucleotides/selective SMN2 splicing modifiers or gene therapy drugs for SMN1 transduction or other AAV-based gene therapy drugs regardless of serotype used previously (from birth) or planned for the main study period, i.e., within 12 months after the administration of the investigational product. A need to use any medications for the treatment of myopathy or neuropathy, drugs for the treatment of diabetes, ongoing immunosuppressive therapy, or the need for immunosuppressive therapy after the start of the study (for example, glucocorticoids (except for premedication and post-medication), cyclosporine, tacrolimus, methotrexate, cyclophosphamide, intravenous immunoglobulin, rituximab, etc.); Subjects with the following laboratory test results at screening: increased activity of transaminases (ALT, AST) or GGT >2×ULN; total bilirubin level ≥34 µmol/L; creatinine level ≥160 µmol/L; hemoglobin <80 g/L and >180 g/L; WBC count >20x109/L; Troponin I level > ULN. Any concomitant diseases that, in the Investigator's opinion, may affect the safety of ANB-004 in the subject or have a significant impact on the assessment of the outcomes of SMA therapy; A diagnosis of acute or chronic hepatic failure at screening; A known allergy or intolerance to any components of the investigational product or pre- and post-medication drug (glucocorticoids); Simultaneous participation of the subject in other clinical studies or previous participation in another clinical study using an experimental therapy.

Sites / Locations

  • State Autonomous Healthcare Institution Sverdlovsk Regional Children's Clinical HospitalRecruiting
  • Federal State Autonomous Educational Institution of Higher Education "Pirogov Russian National Research Medical University" of the Ministry of Heathcare of the Russian Federation. Children's clinical hospital.Recruiting
  • Federal State Autonomous Educational Institution of Higher Education "Pirogov Russian National Research Medical University" of the Ministry of Heathcare of the Russian FederationRecruiting
  • National Medical Research Center for Children's Health" of the Ministry of Healthcare of the Russian FederationRecruiting
  • Federal State budgetary Educational Institution of Higher Education "St. Peterburg State Pediatric Medical University" of the Ministry of Heathcare of the Russian FederationRecruiting
  • Federal State Budgetary Institution "Almazov National Medical Research Centre" of the Ministry of Health of the Russian FederationRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Cohort 1

Cohort 2

Cohort 3

Arm Description

Subjects in Cohort 1 will receive ANB-004 at a dose 1. Depending on the DLT, the cohort may include 1 to 6 subjects in the first stage and 9 to 12 in the second stage.

Subjects in Cohort 2 will receive ANB-004 at a dose 2. The dose for Cohort 2 will be determined at the IDMC meeting. Depending on the DLT, the cohort may include 1 to 6 subjects in the first stage and 9 to 12 in the second stage.

Subjects of Cohort 3, if included, will receive the drug at a dose 3. The dose for Cohort 3 will be determined at the IDMC meeting. Depending on the DLT, the cohort may include 1 to 6 subjects in the first stage and 9 to 12 in the second stage.

Outcomes

Primary Outcome Measures

Proportion of subjects with adverse reactions
Proportion of subjects with serious adverse reactions
Proportion of subjects with CTCAE 5.0 or DAIDS grade 3 or higher adverse reactions
Since some of the severity criteria used in the CTCAE are not applicable to the pediatric population, it is proposed to use the 2017 Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events of the National Institute of Allergy and Infectious Diseases.
Time from date of birth to event
Time from date of birth to onset of a fatal event or the need for invasive respiratory support using tracheostomy or the need for non-invasive respiratory support for at least 16 hours a day for ≥14 consecutive days (in the absence of acute reversible disease and excluding surgery).
Motor development score
The assessment will be made using the motor development scale of a healthy child, which reflects the motor development milestones from birth to a certain age.
Change in the The Hammersmith Infant Neurological Examination (HINE) score
To assess the motor skills of study subjects, Section 2 of this scale will be used; the assessment will be made in subjects aged 3 to 24 months.

Secondary Outcome Measures

Event occurrence
No fatal event, no need for invasive respiratory support using tracheostomy or non-invasive respiratory support for at least 16 hours a day for ≥14 consecutive days (in the absence of acute reversible disease and excluding surgery).
Documented evidence of efficacy
Changes in functional and motor abilities: percentage and age of children who can turn over and sit without support for more than 5, 10, 20 and 30 seconds on video records obtained during a visit to the study center and/or by a legal representative of the study participant outside the study center.

Full Information

First Posted
February 14, 2023
Last Updated
April 14, 2023
Sponsor
Biocad
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1. Study Identification

Unique Protocol Identification Number
NCT05747261
Brief Title
Study of the Safety and Efficacy of an Adeno-Associated Viral Vector Carrying the SMN Gene After a Single Intravenous Administration of Escalating Doses in Children With Spinal Muscular Atrophy (BLUEBELL)
Acronym
BLUEBELL
Official Title
An Open-Label, Non-Comparative Clinical Study of the Safety and Efficacy of an Adeno-Associated Viral Vector Carrying the SMN Gene (ANB-004 (JSC BIOCAD, Russia)) After a Single Intravenous Administration of Escalating Doses in Children With Spinal Muscular Atrophy
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 2, 2023 (Actual)
Primary Completion Date
September 2025 (Anticipated)
Study Completion Date
August 2030 (Anticipated)

3. Sponsor/Collaborators

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

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
The goal of this multicenter, open-label, non-comparative, cohort study is to investigate the safety, immunogenicity, and efficacy of ANB-004 in children with spinal muscular atrophy. The study will have a standard 3+3 dose-escalation design.
Detailed Description
The study will be conducted in 2 stages: Stage 1: pilot efficacy and safety study of different doses to select a potentially therapeutic dose for further study. Stage 2: study of the efficacy and safety of ANB-004 at the selected potentially therapeutic dose. At the first stage, the study will have a "3+3" design and involve dose escalation in two cohorts, with the possibility of including a third cohort. Three subjects are to be included in each cohort, each of whom will receive a pre-specified cohort dose of ANB-004 as a single intravenous infusion. Subjects will be monitored for dose-limiting toxicity (DLT) events for 3 weeks after the drug infusion. In this study, DLT will include any of the CTCAE 5.0 grade 3 or higher adverse events (AEs) at least possibly related to the administration of the investigational product, except for an increase in body temperature at least possibly related to the administration of the investigational product, which will be classified as DLT starting from CTCAE 5.0 grade 4. At the first stage, in the absence of DLT events in three subjects in the same cohort, an ID will be assigned, and an infusion will be administered to the first subject in subsequent cohort. If DLT events occur in 1 of 3 subjects in the same cohort, this cohort will additionally include 3 subjects who will receive the same ANB-004 dose with which the DLT event was observed. If DLT events occur in 2 or more of 3 subjects within the same cohort, the assignment of ID/infusion in subsequent subjects/study is suspended. AT the second stage, if the IDMC judges that the potentially therapeutic dose was previously used in one of the cohorts, an additional 6 subjects will be included in this cohort.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
"3+3" design
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
Subjects in Cohort 1 will receive ANB-004 at a dose 1. Depending on the DLT, the cohort may include 1 to 6 subjects in the first stage and 9 to 12 in the second stage.
Arm Title
Cohort 2
Arm Type
Experimental
Arm Description
Subjects in Cohort 2 will receive ANB-004 at a dose 2. The dose for Cohort 2 will be determined at the IDMC meeting. Depending on the DLT, the cohort may include 1 to 6 subjects in the first stage and 9 to 12 in the second stage.
Arm Title
Cohort 3
Arm Type
Experimental
Arm Description
Subjects of Cohort 3, if included, will receive the drug at a dose 3. The dose for Cohort 3 will be determined at the IDMC meeting. Depending on the DLT, the cohort may include 1 to 6 subjects in the first stage and 9 to 12 in the second stage.
Intervention Type
Genetic
Intervention Name(s)
ANB-004, dose 1
Intervention Description
Adeno-associated viral vector carrying the SMN gene single infusion at dose 1. The duration of the infusion is about 60 minutes.
Intervention Type
Genetic
Intervention Name(s)
ANB-004, dose 2
Intervention Description
Adeno-associated viral vector carrying the SMN gene single infusion at dose 2. The duration of the infusion is about 60 minutes.
Intervention Type
Genetic
Intervention Name(s)
ANB-004, dose 3
Intervention Description
Adeno-associated viral vector carrying the SMN gene single infusion at dose 3. The duration of the infusion is about 60 minutes.
Primary Outcome Measure Information:
Title
Proportion of subjects with adverse reactions
Time Frame
12 months
Title
Proportion of subjects with serious adverse reactions
Time Frame
12 months
Title
Proportion of subjects with CTCAE 5.0 or DAIDS grade 3 or higher adverse reactions
Description
Since some of the severity criteria used in the CTCAE are not applicable to the pediatric population, it is proposed to use the 2017 Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events of the National Institute of Allergy and Infectious Diseases.
Time Frame
12 months
Title
Time from date of birth to event
Description
Time from date of birth to onset of a fatal event or the need for invasive respiratory support using tracheostomy or the need for non-invasive respiratory support for at least 16 hours a day for ≥14 consecutive days (in the absence of acute reversible disease and excluding surgery).
Time Frame
12 months
Title
Motor development score
Description
The assessment will be made using the motor development scale of a healthy child, which reflects the motor development milestones from birth to a certain age.
Time Frame
12 months
Title
Change in the The Hammersmith Infant Neurological Examination (HINE) score
Description
To assess the motor skills of study subjects, Section 2 of this scale will be used; the assessment will be made in subjects aged 3 to 24 months.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Event occurrence
Description
No fatal event, no need for invasive respiratory support using tracheostomy or non-invasive respiratory support for at least 16 hours a day for ≥14 consecutive days (in the absence of acute reversible disease and excluding surgery).
Time Frame
12 months
Title
Documented evidence of efficacy
Description
Changes in functional and motor abilities: percentage and age of children who can turn over and sit without support for more than 5, 10, 20 and 30 seconds on video records obtained during a visit to the study center and/or by a legal representative of the study participant outside the study center.
Time Frame
12 months
Other Pre-specified Outcome Measures:
Title
Proportion of subjects with detectable IgM and IgG to the AAV9 protein capsid
Time Frame
12 months
Title
Proportion of subjects with detectable IgM and IgG to the SMN1 protein
Time Frame
12 months
Title
Proportion of subjects with detectable T cells specific to the AAV9 capsid
Time Frame
12 months
Title
Proportion of subjects with detectable T cells specific to the product of the SMN transgene
Time Frame
12 months
Title
Presence of the AAV9 vector in various body fluids (serum, saliva, urine, feces)
Time Frame
12 months

10. Eligibility

Sex
All
Maximum Age & Unit of Time
240 Days
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Informed consent form for participation in the study signed by the subject's legal representative; Subjects of either sex under the age of 240 days at the time of signing the Information Sheet for the Legal Representative of the Clinical Study Subject with Informed Consent Form; A diagnosis of 5q-SMA established clinically and confirmed by molecular genetic testing (homozygous deletion of exon 7 of the SMN1 gene or heterozygous deletion of exon 7 + confirmed point mutation of the SMN1 gene) and 2 copies of the SMN2 gene, with an age of onset up to 180 days from birth; The ability of the subject's legal representative, in the Investigator's opinion, to perceive information and follow the Protocol procedures. Exclusion Criteria: A diagnosis of HIV infection, hepatitis B, hepatitis C, congenital syphilis in the study subject, as well as a documented diagnosis of HIV infection in the study subject's mother. Note: documented hepatitis B and/or hepatitis C and/or syphilis in the mother of a study subject is not an exclusion criterion in this clinical study, provided that standard breastfeeding rules are followed or the subject is not breastfed due to the low risk of transmission of hepatitis B and C viruses and Treponema pallidum from mother to child with breast milk; Unwillingness of the legal representative to use alternative feeding methods (nasogastric tube, gastrostomy) in case of swallowing disorders and a risk of aspiration; Anti-AAV9 antibody titer >1:50 determined by ELISA. Note: if a subject's screening anti-AAV9 antibody titer is >1:50, the anti-AAV9 antibody titer may be determined again. Subjects with anti-AAV9 antibody titers ≤1:50 in the second test may be included in the study; Need for respiratory support for ≥16 hours per day or tracheostomy ; Treatment with nusinersen, risdiplam, branaplam, onasemnogene abeparvovec or other antisense oligonucleotides/selective SMN2 splicing modifiers or gene therapy drugs for SMN1 transduction or other AAV-based gene therapy drugs regardless of serotype used previously (from birth) or planned for the main study period, i.e., within 12 months after the administration of the investigational product. A need to use any medications for the treatment of myopathy or neuropathy, drugs for the treatment of diabetes, ongoing immunosuppressive therapy, or the need for immunosuppressive therapy after the start of the study (for example, glucocorticoids (except for premedication and post-medication), cyclosporine, tacrolimus, methotrexate, cyclophosphamide, intravenous immunoglobulin, rituximab, etc.); Subjects with the following laboratory test results at screening: increased activity of transaminases (ALT, AST) or GGT >2×ULN; total bilirubin level ≥34 µmol/L; creatinine level ≥160 µmol/L; hemoglobin <80 g/L and >180 g/L; WBC count >20x109/L; Troponin I level > ULN. Any concomitant diseases that, in the Investigator's opinion, may affect the safety of ANB-004 in the subject or have a significant impact on the assessment of the outcomes of SMA therapy; A diagnosis of acute or chronic hepatic failure at screening; A known allergy or intolerance to any components of the investigational product or pre- and post-medication drug (glucocorticoids); Simultaneous participation of the subject in other clinical studies or previous participation in another clinical study using an experimental therapy.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Maria Morozova, MD, PhD
Phone
+7 (985) 910 28 13
Email
morozovama@biocad.ru
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Arina V Zinkina-Orikhan, PhD
Organizational Affiliation
Director of Clinical Development Department, BIOCAD
Official's Role
Study Director
Facility Information:
Facility Name
State Autonomous Healthcare Institution Sverdlovsk Regional Children's Clinical Hospital
City
Ekaterinburg
ZIP/Postal Code
620149
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Olga Lvova
Email
olvova@bk.ru
Facility Name
Federal State Autonomous Educational Institution of Higher Education "Pirogov Russian National Research Medical University" of the Ministry of Heathcare of the Russian Federation. Children's clinical hospital.
City
Moscow
ZIP/Postal Code
117997
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Svetlana Mikhailova
Email
svetychvital@mail.ru
Facility Name
Federal State Autonomous Educational Institution of Higher Education "Pirogov Russian National Research Medical University" of the Ministry of Heathcare of the Russian Federation
City
Moscow
ZIP/Postal Code
117997
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dmitry Vlodavets
Email
mityaus@gmail.com
Facility Name
National Medical Research Center for Children's Health" of the Ministry of Healthcare of the Russian Federation
City
Moscow
ZIP/Postal Code
119991
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ludmila Kuzenkova
Email
l.kuzenkova@list.ru
Facility Name
Federal State budgetary Educational Institution of Higher Education "St. Peterburg State Pediatric Medical University" of the Ministry of Heathcare of the Russian Federation
City
Saint Petersburg
ZIP/Postal Code
194100
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Valentina Guzeva
Email
viktoryka@mail.ru
Facility Name
Federal State Budgetary Institution "Almazov National Medical Research Centre" of the Ministry of Health of the Russian Federation
City
Saint Petersburg
ZIP/Postal Code
197341
Country
Russian Federation
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Natalia Petrova
Email
natalja5@yandex.ru

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Study of the Safety and Efficacy of an Adeno-Associated Viral Vector Carrying the SMN Gene After a Single Intravenous Administration of Escalating Doses in Children With Spinal Muscular Atrophy (BLUEBELL)

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