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Vosoritide for Short Stature in Turner Syndrome

Primary Purpose

Turner Syndrome, Short Stature

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Vosoritide
Sponsored by
Roopa Kanakatti Shankar
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Turner Syndrome focused on measuring Turner syndrome, Short Stature, Vosoritide

Eligibility Criteria

3 Years - 11 Years (Child)FemaleDoes not accept healthy volunteers

Inclusion Criteria: Parent(s) or guardian(s) are willing and able to provide written, signed informed consent after the nature of the study has been explained and prior to performance of any research-related procedure. Also, subjects under the age of 18 are willing and able to provide assent (if required) after the nature of the study has been explained and prior to performance of any research-related procedure. Stated willingness to comply with all study procedures and availability for the duration of the study Age >3 years 0 days AND <10 years 364 days Pre-pubertal defined as Tanner Stage 1 breasts in females. Patient height <-2 SDS. All height SDS values are calculated using the CDC growth charts/data tables. Patients must have a confirmed diagnosis of Turner Syndrome based on a karyotype with a minimum of 30 cells or on a chromosomal microarray. Subjects with Turner Syndrome mosaicism (such as a 46,XX/45,X karyotype) must have a minimum of 10% mosaicism of 45,X cell line in order to participate in the study. Subjects must either be naïve to growth hormone or have a poor response to growth hormone therapy defined as either: Subjects completed at least one year of treatment with GH and first year height velocity (HV) below -1 SD according to the National Cooperative Growth Study TS 1st year response to growth hormone height velocity curve. Subjects receiving GH for more than a year with AGV in the last 6 months < 50%ile for US girls for age/sex). Subjects meeting this criterion are no longer showing catch up growth and may benefit from an alternative form of therapy. Exclusion Criteria: Growth plate fusion - Defined as a bone age via the Greulich and Pyle method of 13 years. These patients have limited remaining growth potential. Concomitant treatment with growth hormone or recombinant IGF-1. Patients may have been previously treated with growth hormone or IGF-1 therapy. If the patient is currently on one of these therapies, they will be required to discontinue at least 1 week prior to the screening visit. That decision will be deferred to their treating clinical endocrinologists in conjunction with the patient's guardians. We anticipate that only patients who are having a poor response to their therapy will be interested in enrolling in the current study as there is no rationale for a patient who is receiving growth hormone therapy and having a positive response to enroll in the current study. Prior or concomitant treatment with any form of estrogen, GnRH analog, aromatase inhibitor or oxandrolone History of any type of malignancy Subjects known to have Y-chromosome material unless they have undergone gonadectomy and have fully external female genitalia Chronic medical condition known to affect growth including but not limited to: A. Cystic fibrosis B. Diabetes C. Inflammatory Bowel Disease D. Untreated Celiac Disease - If a subject has been diagnosed with celiac disease and has been on a gluten free diet for >12 months and has a tissue transglutaminase antibody within the normal range at screening, then they are eligible for the trial. E. Asthma requiring a daily inhaled steroid dose > 400 micrograms of inhaled budesonide per day or equivalent F. Taking daily oral glucocorticoids for any reason G. Note - ADHD treated with a stimulant and treated hypothyroidism with a normal TSH will NOT exclude the subject from participating in the trial. Subjects on either stimulant medication or thyroid hormone replacement must be on a stable dose for 3 months prior to the screening visit. H. Congenital heart disease which places the subject at increased risk of an adverse cardiac outcome in the setting of hypotension including but not limited to: hypertrophic cardiomyopathy, aortic stenosis with peak gradient >50mmHg, severe aortic regurgitation (defined as pressure half time >500ms by echocardiogram), coronary insufficiency, or any anatomy with a need for an afterload reducing agent. Any patient with baseline abnormalities on echocardiogram will be reviewed with a pediatric cardiologist for appropriateness for inclusion in the study. Malnutrition - Defined as a BMI <5th percentile (CDC growth charts) Any clinically significant abnormality on screening tests as determined by the principal investigator. Abnormal screening labs may be repeated up to 3 months after the screening visit. If those labs are normal on repeat, the subject may proceed into the trial. Known or suspected allergy to trial medication, excipients, or related products The receipt of any investigational drug within 90 days prior to this trial

Sites / Locations

  • Children's National Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Vosoritide treatment arm

Arm Description

Vosoritide will be administered daily via subcutaneous injection for 12 months using the FDA approved weight-based dosing band strategy for achondroplasia.

Outcomes

Primary Outcome Measures

Incidence of treatment-emergent adverse events
Number of treatment-emergent adverse events or serious adverse events per study participant
Change from baseline in annualized growth velocity
To evaluate the change from baseline in annualized growth velocity after 12 months of daily subcutaneous injections of vosoritide
Change from baseline in age-sex standardized height standard deviation score
To evaluate the change from baseline in age-sex standardized height standard deviation score (SDS) after 12 months of daily subcutaneous injections of vosoritide

Secondary Outcome Measures

Changes in seated height ratio
To evaluate the seated height ratio as a measure of body proportions compared to baseline after daily subcutaneous injections of vosoritide
Changes in arm span minus standing height
To evaluate the arm span minus standing height as a measure of body proportion compared to baseline after daily subcutaneous injections of vosoritide
Change in Bone Age
To evaluate changes from baseline in bone age/chronological age after 12 months of daily subcutaneous injections of vosoritide

Full Information

First Posted
April 28, 2023
Last Updated
September 11, 2023
Sponsor
Roopa Kanakatti Shankar
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1. Study Identification

Unique Protocol Identification Number
NCT05849389
Brief Title
Vosoritide for Short Stature in Turner Syndrome
Official Title
Vosoritide for Treatment of Short Stature in Girls With Turner Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
July 2024 (Anticipated)
Primary Completion Date
September 2026 (Anticipated)
Study Completion Date
September 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Roopa Kanakatti Shankar

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
Turner syndrome (TS) is characterized by a missing whole or part of the second sex chromosome in a phenotypic female, resulting in short stature due to haploinsufficiency of the SHOX gene. Growth hormone (GH) is an approved therapy for this condition, although not associated with GH deficiency, and benefits are modest. Vosoritide, a C-type natriuretic peptide (CNP) analog, targets chondrocytes within the growth plate leading to increased cell proliferation and hypertrophy. We hypothesize that patients with TS and short stature will respond to vosoritide treatment leading to increased growth velocity. This study will enroll pre-pubertal girls with TS who are either naïve to GH or have had a poor response to GH therapy. All subjects will be treated with vosoritide for 12 months and will be assessed for safety monitoring and improvement in height outcomes. Annualized growth velocity (AGV) on vosoritide will be compared to AGV in the 6-18 months prior to initiation of vosoritide based on historical data available in the medical record. Subjects with a positive response to therapy will be given the option to continue in the extension phase of the study during which they will continue to receive vosoritide until growth cessation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Turner Syndrome, Short Stature
Keywords
Turner syndrome, Short Stature, Vosoritide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Vosoritide treatment arm
Arm Type
Experimental
Arm Description
Vosoritide will be administered daily via subcutaneous injection for 12 months using the FDA approved weight-based dosing band strategy for achondroplasia.
Intervention Type
Drug
Intervention Name(s)
Vosoritide
Other Intervention Name(s)
Voxzogo
Intervention Description
Vosoritide administered daily via subcutaneous injection for 12 months using the FDA approved weight-based dosing band strategy for achondroplasia.
Primary Outcome Measure Information:
Title
Incidence of treatment-emergent adverse events
Description
Number of treatment-emergent adverse events or serious adverse events per study participant
Time Frame
12 months
Title
Change from baseline in annualized growth velocity
Description
To evaluate the change from baseline in annualized growth velocity after 12 months of daily subcutaneous injections of vosoritide
Time Frame
12 months
Title
Change from baseline in age-sex standardized height standard deviation score
Description
To evaluate the change from baseline in age-sex standardized height standard deviation score (SDS) after 12 months of daily subcutaneous injections of vosoritide
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Changes in seated height ratio
Description
To evaluate the seated height ratio as a measure of body proportions compared to baseline after daily subcutaneous injections of vosoritide
Time Frame
12 months
Title
Changes in arm span minus standing height
Description
To evaluate the arm span minus standing height as a measure of body proportion compared to baseline after daily subcutaneous injections of vosoritide
Time Frame
12 months
Title
Change in Bone Age
Description
To evaluate changes from baseline in bone age/chronological age after 12 months of daily subcutaneous injections of vosoritide
Time Frame
12 months

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
11 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Parent(s) or guardian(s) are willing and able to provide written, signed informed consent after the nature of the study has been explained and prior to performance of any research-related procedure. Also, subjects under the age of 18 are willing and able to provide assent (if required) after the nature of the study has been explained and prior to performance of any research-related procedure. Stated willingness to comply with all study procedures and availability for the duration of the study Age >3 years 0 days AND <10 years 364 days Pre-pubertal defined as Tanner Stage 1 breasts in females. Patient height <-2 SDS. All height SDS values are calculated using the CDC growth charts/data tables. Patients must have a confirmed diagnosis of Turner Syndrome based on a karyotype with a minimum of 30 cells or on a chromosomal microarray. Subjects with Turner Syndrome mosaicism (such as a 46,XX/45,X karyotype) must have a minimum of 10% mosaicism of 45,X cell line in order to participate in the study. Subjects must either be naïve to growth hormone or have a poor response to growth hormone therapy defined as either: Subjects completed at least one year of treatment with GH and first year height velocity (HV) below -1 SD according to the National Cooperative Growth Study TS 1st year response to growth hormone height velocity curve. Subjects receiving GH for more than a year with AGV in the last 6 months < 50%ile for US girls for age/sex). Subjects meeting this criterion are no longer showing catch up growth and may benefit from an alternative form of therapy. Exclusion Criteria: Growth plate fusion - Defined as a bone age via the Greulich and Pyle method of 13 years. These patients have limited remaining growth potential. Concomitant treatment with growth hormone or recombinant IGF-1. Patients may have been previously treated with growth hormone or IGF-1 therapy. If the patient is currently on one of these therapies, they will be required to discontinue at least 1 week prior to the screening visit. That decision will be deferred to their treating clinical endocrinologists in conjunction with the patient's guardians. We anticipate that only patients who are having a poor response to their therapy will be interested in enrolling in the current study as there is no rationale for a patient who is receiving growth hormone therapy and having a positive response to enroll in the current study. Prior or concomitant treatment with any form of estrogen, GnRH analog, aromatase inhibitor or oxandrolone History of any type of malignancy Subjects known to have Y-chromosome material unless they have undergone gonadectomy and have fully external female genitalia Chronic medical condition known to affect growth including but not limited to: A. Cystic fibrosis B. Diabetes C. Inflammatory Bowel Disease D. Untreated Celiac Disease - If a subject has been diagnosed with celiac disease and has been on a gluten free diet for >12 months and has a tissue transglutaminase antibody within the normal range at screening, then they are eligible for the trial. E. Asthma requiring a daily inhaled steroid dose > 400 micrograms of inhaled budesonide per day or equivalent F. Taking daily oral glucocorticoids for any reason G. Note - ADHD treated with a stimulant and treated hypothyroidism with a normal TSH will NOT exclude the subject from participating in the trial. Subjects on either stimulant medication or thyroid hormone replacement must be on a stable dose for 3 months prior to the screening visit. H. Congenital heart disease which places the subject at increased risk of an adverse cardiac outcome in the setting of hypotension including but not limited to: hypertrophic cardiomyopathy, aortic stenosis with peak gradient >50mmHg, severe aortic regurgitation (defined as pressure half time >500ms by echocardiogram), coronary insufficiency, or any anatomy with a need for an afterload reducing agent. Any patient with baseline abnormalities on echocardiogram will be reviewed with a pediatric cardiologist for appropriateness for inclusion in the study. Malnutrition - Defined as a BMI <5th percentile (CDC growth charts) Any clinically significant abnormality on screening tests as determined by the principal investigator. Abnormal screening labs may be repeated up to 3 months after the screening visit. If those labs are normal on repeat, the subject may proceed into the trial. Known or suspected allergy to trial medication, excipients, or related products The receipt of any investigational drug within 90 days prior to this trial
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Roopa Kanakatti Shankar, MBBS, MS
Phone
202-476-2121
Email
roopa.shankar@childrensnational.org
First Name & Middle Initial & Last Name or Official Title & Degree
Kimberly Boucher, RN
Phone
202-476-1403
Email
kboucher@childrensnational.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roopa Kanakatti Shankar, MBBS, MS
Organizational Affiliation
Children's National Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's National Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kimberly Boucher, RN
Phone
202-476-1403
Email
kboucher@childrensnational.org

12. IPD Sharing Statement

Plan to Share IPD
No

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Vosoritide for Short Stature in Turner Syndrome

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