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The ENERGY 3 Study: Evaluation of Efficacy and Safety of INZ-701 in Children With ENPP1 Deficiency

Primary Purpose

Ectonucleotide Pyrophosphatase/Phosphodiesterase1 Deficiency, Autosomal Recessive Hypophosphatemic Rickets, Generalized Arterial Calcification of Infancy

Status
Recruiting
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
INZ-701
Control Arm (Conventional Therapy)
Sponsored by
Inozyme Pharma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ectonucleotide Pyrophosphatase/Phosphodiesterase1 Deficiency focused on measuring Ectonucleotide Pyrophosphatase/Phosphodiesterase1 Deficiency, Hypopyrophosphatemia, ENPP1, Autosomal Recessive Hypophosphatemic Rickets Type 2, ARHR2, Generalized Arterial Calcification of Infancy, GACI

Eligibility Criteria

1 Year - 12 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria Study participants must meet all of the following inclusion criteria: Caregiver's written or electronic informed consent after the nature of the study has been explained, and prior to any research-related procedures, per International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) Study participant's assent in accordance with local regulations A confirmed postnatal molecular genetic diagnosis of ENPP1 Deficiency with biallelic mutations (ie, homozygous or compound heterozygous) performed by a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA) certified laboratory or regional equivalent Males and females ≥1 year and <13 years of age at Study Day 1 Open growth plates of the distal femur and proximal tibia in both legs Plasma PPi concentration of <1400 nM at Screening 25-hydroxyvitamin D (25[OH]D) levels of ≥12 ng/mL at Screening Radiographic evidence of skeletal abnormalities based on an RSS ≥2 Female participants of childbearing potential must have a negative serum pregnancy test at Screening and must not be breastfeeding Study participants of childbearing potential who are sexually active must agree to use a highly effective form of contraception in accordance with Clinical Trials Facilitation and Coordination Group (CTFG) guidance and local guidelines for the duration of the study In the opinion of the Investigator, able to complete all aspects of the study Exclusion Criteria Study participants meeting any of the following exclusion criteria will not be eligible to participate in the study: In the opinion of the Investigator, has clinically significant disease or laboratory abnormality not associated with ENPP1 Deficiency that will preclude study participation and/or may confound the interpretation of study results If receiving any of the following prohibited medications as indicated in the protocol: systemic corticosteroids (>5 mg prednisone equivalent per day), anti-fibroblast growth factor 23 (FGF23), and oral and/or IV bisphosphonates Unable or unwilling to discontinue calcitriol or other active forms of vitamin D3 (or analogs) within 7 days prior to Study Day 1 and/or oral phosphate supplements within 36 hours prior to Study Day 1 if randomized to the INZ-701 arm Planned orthopedic surgery that may confound the interpretation of study results during the 52-week Randomized Treatment Period Known intolerance to INZ-701 or any of its excipients A positive COVID-19 test within 5 days prior to Randomization, only if required as per local regulations or institutional policy Previous treatment with INZ-701 Concurrent participation in another interventional clinical study and/or has received an investigational drug within 5 half-lives of the last dose or within 4 weeks prior to Randomization, whichever is longer, or use of an investigational device

Sites / Locations

  • Cook Children's HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

INZ-701

Control Arm (Conventional Therapy)

Arm Description

Subjects randomized to the INZ-701 arm will be administered a 2.4 mg/kg once weekly dose by subcutaneous (SC) injection for the duration of the 52-week Randomized Treatment Period and the Open-label Extension Period.

Subjects randomized to the control arm will continue taking their conventional therapy as clinically indicated by their treating physician for the duration of the 52-week Randomized Treatment Period.

Outcomes

Primary Outcome Measures

Change from Baseline in Plasma Inorganic Pyrophosphate (PPi) concentration through Week 52
For each subject, plasma PPi will be measured via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.

Secondary Outcome Measures

Change from Baseline in skeletal abnormalities as measured by the Radiographic Global Impression of Change (RGI-C) global score through Week 52
The RGI-C is an overall radiographic score which can be used to monitor response to a therapeutic intervention comparing scores from 2 time points. A determination of healing on a scale of 0 to +3 with 0 being no change or healing and +3 being complete healing; worsening is also measured on a scale of 0 to -3 with 0 being no change and -3 being severe worsening.
Change from Baseline in rickets as measured by Rickets Severity Score (RSS) total score through Week 52
The RSS assesses rickets severity by utilizing a scoring system that uses a scale from 0 to 4 for the wrists and 0 to 6 for the knees, to generate a total score of 0 to 10, where 0 is normal and 10 is the worst score possible ie, most severe skeletal abnormalities observed radiographically.
Change from Baseline in growth Z-score (height/body length and weight) through Week 52
A Z-score represents the degree to which that particular measurement for that individual differs from the reference value in the general population. (height/body length and weight) through Week 52
Area under the Plasma Concentration versus Time Curve (AUC) of INZ-701
For each subject, variation of concentration of INZ-701 in the plasma will be measured via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.
Maximum Plasma Concentration (Cmax) of INZ-701
For each subject, the maximum concentration of INZ-701 in the plasma will be measured via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.
Change from Baseline in ENPP1 activity (µM/min) through week 52
For each subject, the activity of INZ-701 (µM/min) in the serum will be assessed through hydrolysis of a substrate to the enzyme, via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.

Full Information

First Posted
August 28, 2023
Last Updated
October 2, 2023
Sponsor
Inozyme Pharma
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1. Study Identification

Unique Protocol Identification Number
NCT06046820
Brief Title
The ENERGY 3 Study: Evaluation of Efficacy and Safety of INZ-701 in Children With ENPP1 Deficiency
Official Title
The ENERGY 3 Study: A Randomized, Controlled, Open-Label, Phase 3 Study to Evaluate the Efficacy and Safety of INZ-701 in Children With Ectonucleotide Pyrophosphatase/Phosphodiesterase 1 (ENPP1) Deficiency
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 22, 2023 (Anticipated)
Primary Completion Date
May 2025 (Anticipated)
Study Completion Date
June 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Inozyme Pharma

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
The primary purpose of Study INZ701-106 (The ENERGY 3 Study) is to assess the efficacy and safety of INZ-701 in children with ENPP1 Deficiency.
Detailed Description
INZ-701 is an ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) enzyme replacement therapy (ERT) in development for the treatment of ENPP1 Deficiency, an ultra-rare genetic disorder with an incidence of 1 in 64,000 pregnancies. Study INZ701-106 (The ENERGY 3 Study) is a multi-center, randomized in a 2:1 ratio, controlled, open-label Phase 3 study to evaluate the efficacy and safety of INZ-701 in children with ENPP1 Deficiency. The study will consist of a Screening Period of up to 52 days (including a washout period of up to 7 days for prohibited medications post-Randomization) and a Randomized Treatment Period (INZ-701 or control) of 52 weeks, followed by an Open-label Extension Period during which all study participants may receive INZ-701, and an End of Study (EOS) Safety visit 30 days after the last dose of INZ-701.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ectonucleotide Pyrophosphatase/Phosphodiesterase1 Deficiency, Autosomal Recessive Hypophosphatemic Rickets, Generalized Arterial Calcification of Infancy
Keywords
Ectonucleotide Pyrophosphatase/Phosphodiesterase1 Deficiency, Hypopyrophosphatemia, ENPP1, Autosomal Recessive Hypophosphatemic Rickets Type 2, ARHR2, Generalized Arterial Calcification of Infancy, GACI

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Study INZ701-106 (ENERGY 3) is a multicenter, randomized in a 2:1 ratio, controlled, open-label Phase 3 study to evaluate the efficacy and safety of INZ-701 in children with ENPP1 Deficiency.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
33 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
INZ-701
Arm Type
Experimental
Arm Description
Subjects randomized to the INZ-701 arm will be administered a 2.4 mg/kg once weekly dose by subcutaneous (SC) injection for the duration of the 52-week Randomized Treatment Period and the Open-label Extension Period.
Arm Title
Control Arm (Conventional Therapy)
Arm Type
Active Comparator
Arm Description
Subjects randomized to the control arm will continue taking their conventional therapy as clinically indicated by their treating physician for the duration of the 52-week Randomized Treatment Period.
Intervention Type
Drug
Intervention Name(s)
INZ-701
Other Intervention Name(s)
(rhENPP1-Fc).
Intervention Description
Recombinant fusion protein that contains the extracellular domains of human ENPP1 coupled with an Fc fragment from an immunoglobulin gamma-1 (IgG1) antibody.
Intervention Type
Drug
Intervention Name(s)
Control Arm (Conventional Therapy)
Intervention Description
Conventional therapy is defined as oral phosphate supplements and calcitriol or other active forms of vitamin D3 (or analogs). No other agents for treatment of ENPP1 Deficiency are allowed in the control arm.
Primary Outcome Measure Information:
Title
Change from Baseline in Plasma Inorganic Pyrophosphate (PPi) concentration through Week 52
Description
For each subject, plasma PPi will be measured via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.
Time Frame
52 weeks (Baseline through Week 52)
Secondary Outcome Measure Information:
Title
Change from Baseline in skeletal abnormalities as measured by the Radiographic Global Impression of Change (RGI-C) global score through Week 52
Description
The RGI-C is an overall radiographic score which can be used to monitor response to a therapeutic intervention comparing scores from 2 time points. A determination of healing on a scale of 0 to +3 with 0 being no change or healing and +3 being complete healing; worsening is also measured on a scale of 0 to -3 with 0 being no change and -3 being severe worsening.
Time Frame
Baseline, Week 26, Week 52
Title
Change from Baseline in rickets as measured by Rickets Severity Score (RSS) total score through Week 52
Description
The RSS assesses rickets severity by utilizing a scoring system that uses a scale from 0 to 4 for the wrists and 0 to 6 for the knees, to generate a total score of 0 to 10, where 0 is normal and 10 is the worst score possible ie, most severe skeletal abnormalities observed radiographically.
Time Frame
Baseline, Week 26, Week 52
Title
Change from Baseline in growth Z-score (height/body length and weight) through Week 52
Description
A Z-score represents the degree to which that particular measurement for that individual differs from the reference value in the general population. (height/body length and weight) through Week 52
Time Frame
Baseline, Day 29, Week 8, Week 13, Week 26, Week 39, Week 52
Title
Area under the Plasma Concentration versus Time Curve (AUC) of INZ-701
Description
For each subject, variation of concentration of INZ-701 in the plasma will be measured via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.
Time Frame
52 weeks (Randomized Treatment Period)
Title
Maximum Plasma Concentration (Cmax) of INZ-701
Description
For each subject, the maximum concentration of INZ-701 in the plasma will be measured via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.
Time Frame
52 weeks (Randomized Treatment Period)
Title
Change from Baseline in ENPP1 activity (µM/min) through week 52
Description
For each subject, the activity of INZ-701 (µM/min) in the serum will be assessed through hydrolysis of a substrate to the enzyme, via a series of blood samples obtained throughout the study, comparing the subject's baseline value over time.
Time Frame
52 weeks (Randomized Treatment Period)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Study participants must meet all of the following inclusion criteria: Caregiver's written or electronic informed consent after the nature of the study has been explained, and prior to any research-related procedures, per International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) Study participant's assent in accordance with local regulations A confirmed postnatal molecular genetic diagnosis of ENPP1 Deficiency with biallelic mutations (ie, homozygous or compound heterozygous) performed by a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA) certified laboratory or regional equivalent Males and females ≥1 year and <13 years of age at Study Day 1 Open growth plates of the distal femur and proximal tibia in both legs Plasma PPi concentration of <1400 nM at Screening 25-hydroxyvitamin D (25[OH]D) levels of ≥12 ng/mL at Screening Radiographic evidence of skeletal abnormalities based on an RSS ≥2 Female participants of childbearing potential must have a negative serum pregnancy test at Screening and must not be breastfeeding Study participants of childbearing potential who are sexually active must agree to use a highly effective form of contraception in accordance with Clinical Trials Facilitation and Coordination Group (CTFG) guidance and local guidelines for the duration of the study In the opinion of the Investigator, able to complete all aspects of the study Exclusion Criteria Study participants meeting any of the following exclusion criteria will not be eligible to participate in the study: In the opinion of the Investigator, has clinically significant disease or laboratory abnormality not associated with ENPP1 Deficiency that will preclude study participation and/or may confound the interpretation of study results If receiving any of the following prohibited medications as indicated in the protocol: systemic corticosteroids (>5 mg prednisone equivalent per day), anti-fibroblast growth factor 23 (FGF23), and oral and/or IV bisphosphonates Unable or unwilling to discontinue calcitriol or other active forms of vitamin D3 (or analogs) within 7 days prior to Study Day 1 and/or oral phosphate supplements within 36 hours prior to Study Day 1 if randomized to the INZ-701 arm Planned orthopedic surgery that may confound the interpretation of study results during the 52-week Randomized Treatment Period Known intolerance to INZ-701 or any of its excipients A positive COVID-19 test within 5 days prior to Randomization, only if required as per local regulations or institutional policy Previous treatment with INZ-701 Concurrent participation in another interventional clinical study and/or has received an investigational drug within 5 half-lives of the last dose or within 4 weeks prior to Randomization, whichever is longer, or use of an investigational device
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Inozyme Clinical Trial Information
Phone
+1 857 330 4340
Email
clinicaltrials@inozyme.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alex Lai, MD
Organizational Affiliation
Inozyme Pharma, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Cook Children's Hospital
City
Fort Worth
State/Province
Texas
ZIP/Postal Code
76104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Joel Steelman
Phone
682-885-7960
Email
Joel.Steelman@cookchildrens.org

12. IPD Sharing Statement

Learn more about this trial

The ENERGY 3 Study: Evaluation of Efficacy and Safety of INZ-701 in Children With ENPP1 Deficiency

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