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Efficacy, Safety and Tolerability of Givinostat in Non-ambulant Patients With Duchenne Muscular Dystrophy (ULYSSES)

Primary Purpose

Duchenne Muscular Dystrophy

Status
Not yet recruiting
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
Givinostat
Placebo
Sponsored by
Italfarmaco
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Duchenne Muscular Dystrophy

Eligibility Criteria

9 Years - 17 Years (Child)MaleDoes not accept healthy volunteers

Inclusion Criteria: Children and adolescent males aged ≥ 9 to <18 years at screening Are able to give informed assent (ie, parent/legal guardian) and/or consent, according to local regulations A genetic diagnosis of DMD Non-ambulant defined as being wheelchair bound and: Unable to perform the 10-meter walk/run test (10MWT), or Unable to complete the 10MWT in 30 seconds or less, without any support or devices Performance of the Upper Limb test (PUL version 2.0) entry item scores 3 to 6 If on medication for DMD-associated cardiomyopathy (eg, ACE inhibitor, β-blocker, diuretics), stable for ≥1 month immediately prior to start of study treatment, if any Stable corticosteroids, defined as: Receiving systemic corticosteroids for a minimum of 6 months immediately prior to start of study treatment No significant change in dose or dosing regimen (except for adjustments due to body weight change) for a minimum of 6 months immediately prior to start of study treatment Willing to use adequate contraception. Effective contraceptive methods must be used from randomisation visit through 3 months after the last dose of study drug. Exclusion Criteria: Exposure to another investigational drug within 3 months prior to start of study treatment Have exposure to any dystrophin restoration product (eg, Ataluren, Exon skipping) within 6 months prior to the start of study treatment Having received any gene therapy (eg, Adeno-associated viruses Micro-dystrophin delivery) prior to start of study treatment Use of any pharmacologic treatment or supplement, other than corticosteroids, that might have had an effect on muscle strength or function within 3 months prior to the start of study treatment (eg, growth hormone) Use of testosterone, unless used as a replacement therapy for the treatment of delayed puberty. The testosterone dose and regimen should be stable within 6 months prior to the start of study treatment, and circulating testosterone levels should be within the normal ranges for the patient's age Elbow-flexion contractures >30° in the dominant arm Inability to perform consistent PUL 2.0 measurement within ±2 points without shoulder domain or within ±3 points with shoulder domain during paired testing at screening Forced Vital Capacity (FVC) % of predicted <40% Requirement for daytime ventilator assistance. Note: Night ventilator assistance and use of bi-level positive airway pressure therapy is allowed Episode of respiratory failure within the 8 weeks prior to screening Symptomatic cardiomyopathy or heart failure and/or left ventricular ejection fraction <45% Baseline corrected QT interval using Fredericia's formula (QTcF) >450 msec (as the mean of 3 consecutive readings 5 minutes apart) or history of additional risk factors for torsades de pointes (eg, heart failure, hypokalaemia, or family history of long QT syndrome) Major surgical procedure (including scoliosis surgery) planned within 1 year of the start of study treatment Poorly controlled asthma or underlying lung disease such as bronchitis, bronchiectasis, emphysema, recurrent pneumonia that in the opinion of the Investigator might impact respiratory function Platelets, white blood cells and/or haemoglobin < lower limit of normal (LLN) at screening (Note: for abnormal screening laboratory test results <LLN, the platelets count, white blood cell, and haemoglobin will be repeated once; if the repeat test result is still <LLN, the patient should be excluded) Fasting triglycerides >300 mg/dL (3.42 mmol/L) at screening (Note: if the value is >300 mg/dL, the triglycerides will be repeated once; if the repeated test result is still >300 mg/dL, the patient should be excluded) Current or history of liver disease or impairment, including but not limited to a baseline elevated total bilirubin (ie, >1.5 × upper limit of normal [ULN]), unless secondary to Gilbert disease or pattern consistent with Gilbert disease Inadequate renal function, as defined by serum Cystatin C result >2 × ULN (Note: if the value is >2 × ULN, the serum Cystatin C will be repeated once; if the repeated test result is still >2 × ULN, the patient should be excluded) Positive test for hepatitis B surface antigen, hepatitis C antibody, or human immunodeficiency virus at screening Hypersensitivity to any component of study medication Sorbitol intolerance or malabsorption, or the hereditary form of fructose intolerance Diagnosis of other uncontrolled neurological diseases or presence of relevant uncontrolled somatic disorders that are not related to DMD, based on Investigator judgement Psychiatric illness or social situations rendering the potential patient unable to understand and comply with the muscle function tests and/or with the study protocol procedures, based on Investigator judgement Have contraindications to Magnetic Resonance Imaging (MRI) scan (eg, claustrophobia, metal implants, or uncontrolled seizure disorder), based on Investigator's judgement.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Givinostat

    Placebo

    Arm Description

    Outcomes

    Primary Outcome Measures

    Change of Performance of Upper Limb 2.0 (PUL) total score after 18 months of treatment of givinostat compared to placebo group.
    The PUL examines 3 major "dimensions" of upper extremity function: shoulder, middle, and distal functions. It includes 21 scored items; a score of 42 (12 for shoulder; 17 for mid-level, and 13 for distal) indicates the highest level of independent function and 0 the lowest.

    Secondary Outcome Measures

    Full Information

    First Posted
    June 16, 2023
    Last Updated
    July 14, 2023
    Sponsor
    Italfarmaco
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05933057
    Brief Title
    Efficacy, Safety and Tolerability of Givinostat in Non-ambulant Patients With Duchenne Muscular Dystrophy
    Acronym
    ULYSSES
    Official Title
    Randomised, Double-blind, Placebo-controlled, Multicentre Study to Evaluate the Efficacy, Safety and Tolerability of Givinostat in Non-ambulant Patients With Duchenne Muscular Dystrophy
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    December 2023 (Anticipated)
    Primary Completion Date
    December 2027 (Anticipated)
    Study Completion Date
    December 2027 (Anticipated)

    3. Sponsor/Collaborators

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

    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
    This is a randomised, double-blind, placebo-controlled, multicentre study to evaluate the efficacy, safety, and tolerability of givinostat in non-ambulant male paediatric (aged 9 to <18 years) patients with DMD. It is anticipated that 138 patients will be randomised 2:1 to givinostat or placebo and will be treated for 18 months with an oral suspension of study drug twice daily (bid) in a fed state. Primary Objective of the study is to demonstrate the efficacy of givinostat in reducing muscle decline in non-ambulant DMD patients, as measured by Performance of the Upper Limb (PUL) 2.0. Secondary Objectives of the study are to evaluate the safety and tolerability of givinostat in non-ambulant DMD patients, and to further explore the efficacy of givinostat in non-ambulant DMD patients.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Duchenne Muscular Dystrophy

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    138 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Givinostat
    Arm Type
    Experimental
    Arm Title
    Placebo
    Arm Type
    Placebo Comparator
    Intervention Type
    Drug
    Intervention Name(s)
    Givinostat
    Other Intervention Name(s)
    ITF2357
    Intervention Description
    Givinostat has to be administered twice daily in a fed state according to a flexible dose regimen based on patient weight. Starting dose could be reduced based on predefined safety rules.
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Intervention Description
    Placebo, manufactured to mimic givinostat, has to be administered twice daily in a fed state according to a flexible dose regimen based on patient weight. Starting dose could be reduced based on predefined safety rules.
    Primary Outcome Measure Information:
    Title
    Change of Performance of Upper Limb 2.0 (PUL) total score after 18 months of treatment of givinostat compared to placebo group.
    Description
    The PUL examines 3 major "dimensions" of upper extremity function: shoulder, middle, and distal functions. It includes 21 scored items; a score of 42 (12 for shoulder; 17 for mid-level, and 13 for distal) indicates the highest level of independent function and 0 the lowest.
    Time Frame
    Baseline and 18 months

    10. Eligibility

    Sex
    Male
    Minimum Age & Unit of Time
    9 Years
    Maximum Age & Unit of Time
    17 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Children and adolescent males aged ≥ 9 to <18 years at screening Are able to give informed assent (ie, parent/legal guardian) and/or consent, according to local regulations A genetic diagnosis of DMD Non-ambulant defined as being wheelchair bound and: Unable to perform the 10-meter walk/run test (10MWT), or Unable to complete the 10MWT in 30 seconds or less, without any support or devices Performance of the Upper Limb test (PUL version 2.0) entry item scores 3 to 6 If on medication for DMD-associated cardiomyopathy (eg, ACE inhibitor, β-blocker, diuretics), stable for ≥1 month immediately prior to start of study treatment, if any Stable corticosteroids, defined as: Receiving systemic corticosteroids for a minimum of 6 months immediately prior to start of study treatment No significant change in dose or dosing regimen (except for adjustments due to body weight change) for a minimum of 6 months immediately prior to start of study treatment Willing to use adequate contraception. Effective contraceptive methods must be used from randomisation visit through 3 months after the last dose of study drug. Exclusion Criteria: Exposure to another investigational drug within 3 months prior to start of study treatment Have exposure to any dystrophin restoration product (eg, Ataluren, Exon skipping) within 6 months prior to the start of study treatment Having received any gene therapy (eg, Adeno-associated viruses Micro-dystrophin delivery) prior to start of study treatment Use of any pharmacologic treatment or supplement, other than corticosteroids, that might have had an effect on muscle strength or function within 3 months prior to the start of study treatment (eg, growth hormone) Use of testosterone, unless used as a replacement therapy for the treatment of delayed puberty. The testosterone dose and regimen should be stable within 6 months prior to the start of study treatment, and circulating testosterone levels should be within the normal ranges for the patient's age Elbow-flexion contractures >30° in the dominant arm Inability to perform consistent PUL 2.0 measurement within ±2 points without shoulder domain or within ±3 points with shoulder domain during paired testing at screening Forced Vital Capacity (FVC) % of predicted <40% Requirement for daytime ventilator assistance. Note: Night ventilator assistance and use of bi-level positive airway pressure therapy is allowed Episode of respiratory failure within the 8 weeks prior to screening Symptomatic cardiomyopathy or heart failure and/or left ventricular ejection fraction <45% Baseline corrected QT interval using Fredericia's formula (QTcF) >450 msec (as the mean of 3 consecutive readings 5 minutes apart) or history of additional risk factors for torsades de pointes (eg, heart failure, hypokalaemia, or family history of long QT syndrome) Major surgical procedure (including scoliosis surgery) planned within 1 year of the start of study treatment Poorly controlled asthma or underlying lung disease such as bronchitis, bronchiectasis, emphysema, recurrent pneumonia that in the opinion of the Investigator might impact respiratory function Platelets, white blood cells and/or haemoglobin < lower limit of normal (LLN) at screening (Note: for abnormal screening laboratory test results <LLN, the platelets count, white blood cell, and haemoglobin will be repeated once; if the repeat test result is still <LLN, the patient should be excluded) Fasting triglycerides >300 mg/dL (3.42 mmol/L) at screening (Note: if the value is >300 mg/dL, the triglycerides will be repeated once; if the repeated test result is still >300 mg/dL, the patient should be excluded) Current or history of liver disease or impairment, including but not limited to a baseline elevated total bilirubin (ie, >1.5 × upper limit of normal [ULN]), unless secondary to Gilbert disease or pattern consistent with Gilbert disease Inadequate renal function, as defined by serum Cystatin C result >2 × ULN (Note: if the value is >2 × ULN, the serum Cystatin C will be repeated once; if the repeated test result is still >2 × ULN, the patient should be excluded) Positive test for hepatitis B surface antigen, hepatitis C antibody, or human immunodeficiency virus at screening Hypersensitivity to any component of study medication Sorbitol intolerance or malabsorption, or the hereditary form of fructose intolerance Diagnosis of other uncontrolled neurological diseases or presence of relevant uncontrolled somatic disorders that are not related to DMD, based on Investigator judgement Psychiatric illness or social situations rendering the potential patient unable to understand and comply with the muscle function tests and/or with the study protocol procedures, based on Investigator judgement Have contraindications to Magnetic Resonance Imaging (MRI) scan (eg, claustrophobia, metal implants, or uncontrolled seizure disorder), based on Investigator's judgement.

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Efficacy, Safety and Tolerability of Givinostat in Non-ambulant Patients With Duchenne Muscular Dystrophy

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