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A Double-blind, Randomized, Intra-subject Placebo-controlled, Multicenter, Multiple Dose Study, Evaluating Safety, Proof of Mechanism, Preliminary Efficacy and Systemic Exposure in Subjects With Confirmed DDEB or RDEB Diagnosis With One or More Pathogenic Mutations in Exon 73 in the COL7A1 Gene

Primary Purpose

Epidermolysis Bullosa Dystrophica, Recessive, Epidermolysis Bullosa Dystrophica, Dominant

Status
Terminated
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
QR-313
Placebo
Sponsored by
Phoenicis Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Epidermolysis Bullosa Dystrophica, Recessive focused on measuring Recessive Dystrophic Epidermolysis Bullosa, EB, COL7A1, RNA Therapies, Antisense oligonucleotide, Exon skipping, WINGS, Topical treatment, RDEB, Exon 73, Mutations in exon 73, Dominant Dystrophic Epidermolysis Bullosa, DDEB

Eligibility Criteria

4 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female, ≥ 4 years of age at Screening with a clinical diagnosis of DDEB or RDEB and at least one pathogenic mutation in exon 73 of the COL7A1 gene.
  2. Have at least one TWA, ie, a skin area of 7 x 7 cm that ishows no signs of local infection, and contains a target wound that is either new or shows dynamic wound healing and complies to the following additional criteria:

    1. surface area of the target wound ranging from 5 to 30 cm2, located centrally in the selected 7 x 7 cm TWA.
    2. exposed sub-epidermal tissue to allow absorption of the IMP.
    3. no suspicion of current squamous cell carcinoma (SCC) upon visual inspection.

Exclusion Criteria:

  1. Pregnant or breast-feeding female
  2. Hemoglobin level at Screening requiring transfusion. The subject may be rescreened when the condition is considered stable.
  3. Use of aminoglycosides, by any route of administration, except eye drops, 7 days or 5 half-lives, whichever is longer, prior to Baseline visit.
  4. Untreated carcinoma of the TWA or history of carcinoma within 5 years prior to Screening, except adequately treated cutaneous squamous or basal cell carcinoma.
  5. Life expectancy less than 6 months, as assessed by the Investigator
  6. Current or known history of clinically significant hepatic or renal disease, that in the opinion of the Investigator, could impact subject safety or study participation.
  7. Treatment with any systemic immunomodulators, immunosuppressants or cytotoxic chemotherapy within 2 months prior to the Baseline visit.
  8. Use of any investigational drug or device within 28 days or 5 half-lives of the Baseline visit, whichever is longer, or plans to participate in another study of a drug or device during the study period. The washout of 5 half-lives does not apply to gene and cell therapy.
  9. Known hypersensitivity to oligonucleotide treatment or excipients of the IMP.
  10. Bleeding disorder or condition requiring the use of anticoagulants to be confirmed by aPTT by local lab within 48 hours of first treatment.
  11. Use of systemic or topical steroids within 1 month prior to the baseline visit (inhaled and ophthalmic drops of corticosteroids or low dose topical solution of budesonide for esophagial strictures may be allowed).

Sites / Locations

  • Stanford University School of Medicine, LPCH
  • Children's Hospital Colorado
  • Journey Clinic, Center for Pediatric Blood and Marrow Transplantation
  • Cincinnati Children's Hospital
  • Hopital Necker Enfants Malades
  • Hospital Universitario La Paz

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

First TWA (A)

Second TWA (B)

Arm Description

In each subject up to two target wound areas (TWA) are randomized, one each to active treatment or placebo. In the first arm; randomization of the first selected TWA to active treatment or placebo

In each subject, in the second arm; allocation of the second selected target wound area (TWA) to the alternative treatment. Second arm in the same subject as the first arm.

Outcomes

Primary Outcome Measures

Incidence of treatment emergent adverse events/serious adverse events
Assessment of treatment emergent adverse events/serious adverse events
To assess the effect of QR-313 on the exclusion (skipping) of exon 73 from COL7A1 mRNA
Absence of exon 73 in COL7A1 mRNA, detected by droplet digital polymerase chain reaction (ddPCR)

Secondary Outcome Measures

Assessment of wound healing and skin strength measured in surface area (cm2)
Wound size (surface area in cm2)
Assessment of wound healing and skin strength as assessed by Physician Subjective Assessment of Severity (PSAS)
Wound severity as assessed by Physician Subjective Assessment of Severity (PSAS), a 3-point Likert static scale that classifies a wound in mild, moderate or severe
Assessment of wound healing and skin strength as assessed by Physician Subjective Assessment of Change (PSAC)
Wound change in severity as assessed by Physician Subjective Assessment of Change (PSAC), a 3-point Likert static scale that classifies a wound as mild, moderate or severe.
Assessment of wound healing and skin strength measuring onset of (re)blistering of a healed wound
Onset of (re)blistering of a healed wound
Assessment of wound healing and skin strength as assessed by Short Wound Specific Questionnaire (SWSQ)
Wound status as assessed by Short Wound Specific Questionnaire (SWSQ) addressing three domains: pruritus, pain, and inflammation. Pruritus and pain are recorded as a Patient Reported Outcome (PRO) measure. Inflammation is reported as an Observer Reported Outcome (ObsRO) measure.
Assessment of systemic exposure after topical administration of QR-313 to the target wound area (TWA)
Serum levels of QR-313
Assessment of the effect of QR-313 on the presence of collagen type VII protein and anchoring fibrils
Presence of collagen type VII protein expression (IIF microscopy)
Assessment of the effect of QR-313 on the presence of collagen type VII protein and anchoring fibrils
Presence of anchoring fibrils (TEM)

Full Information

First Posted
June 25, 2018
Last Updated
August 19, 2021
Sponsor
Phoenicis Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT03605069
Brief Title
A Double-blind, Randomized, Intra-subject Placebo-controlled, Multicenter, Multiple Dose Study, Evaluating Safety, Proof of Mechanism, Preliminary Efficacy and Systemic Exposure in Subjects With Confirmed DDEB or RDEB Diagnosis With One or More Pathogenic Mutations in Exon 73 in the COL7A1 Gene
Official Title
A First in Human, Double-blind, Randomized, Intra-subject Placebo-controlled, Multiple Dose Study of QR-313 Evaluating Safety, Proof of Mechanism, Preliminary Efficacy and Systemic Exposure in Subjects With DDEB or RDEB Due to Mutation(s) in Exon 73 of the COL7A1 Gene
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Terminated
Why Stopped
Low enrollment
Study Start Date
July 2, 2018 (Actual)
Primary Completion Date
December 17, 2018 (Actual)
Study Completion Date
December 17, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Phoenicis Therapeutics

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
A double-blind, randomized, intra-subject placebo-controlled, multicenter, multiple dose study, evaluating safety, proof of mechanism, preliminary efficacy and systemic exposure in subjects with confirmed DDEB or RDEB diagnosis with one or more pathogenic mutations in exon 73 in the COL7A1 gene.
Detailed Description
This clinical trial will evaluate the safety and tolerability, proof of mechanism, systemic exposure and preliminary efficacy following topical application of QR-313 to subjects with confirmed DDEB or RDEB with one or more pathogenic mutations in exon 73 in the COL7A1 gene. Up to two Target Wound Areas (TWAs) per subject will be selected and randomized. Each TWA will be treated with IMP for 8 weeks, either QR-313 or matching placebo. All subjects will continue to be followed up for 8 weeks post last dose. Subjects will be monitored through home visits and site visits. An imaging system will be used to assess the target wound at all home and study site visits. QR-313 is a 21-nucleotide antisense oligonucleotide (AON) designed to hybridize to a specific sequence in the COL7A1 pre-messengerRNA (pre-mRNA).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Epidermolysis Bullosa Dystrophica, Recessive, Epidermolysis Bullosa Dystrophica, Dominant
Keywords
Recessive Dystrophic Epidermolysis Bullosa, EB, COL7A1, RNA Therapies, Antisense oligonucleotide, Exon skipping, WINGS, Topical treatment, RDEB, Exon 73, Mutations in exon 73, Dominant Dystrophic Epidermolysis Bullosa, DDEB

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
intra-subject, placebo-controlled
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
First TWA (A)
Arm Type
Other
Arm Description
In each subject up to two target wound areas (TWA) are randomized, one each to active treatment or placebo. In the first arm; randomization of the first selected TWA to active treatment or placebo
Arm Title
Second TWA (B)
Arm Type
Other
Arm Description
In each subject, in the second arm; allocation of the second selected target wound area (TWA) to the alternative treatment. Second arm in the same subject as the first arm.
Intervention Type
Drug
Intervention Name(s)
QR-313
Intervention Description
QR-313 will be applied topically once daily for 8 weeks of treatment.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo will be applied topically once daily for 8 weeks of treatment.
Primary Outcome Measure Information:
Title
Incidence of treatment emergent adverse events/serious adverse events
Description
Assessment of treatment emergent adverse events/serious adverse events
Time Frame
through 8 weeks after last dose of IMP (EOS)
Title
To assess the effect of QR-313 on the exclusion (skipping) of exon 73 from COL7A1 mRNA
Description
Absence of exon 73 in COL7A1 mRNA, detected by droplet digital polymerase chain reaction (ddPCR)
Time Frame
after 4 weeks of treatment with IMP
Secondary Outcome Measure Information:
Title
Assessment of wound healing and skin strength measured in surface area (cm2)
Description
Wound size (surface area in cm2)
Time Frame
through 8 weeks after last dose of IMP (EOS)
Title
Assessment of wound healing and skin strength as assessed by Physician Subjective Assessment of Severity (PSAS)
Description
Wound severity as assessed by Physician Subjective Assessment of Severity (PSAS), a 3-point Likert static scale that classifies a wound in mild, moderate or severe
Time Frame
through 8 weeks after last dose of IMP (EOS)
Title
Assessment of wound healing and skin strength as assessed by Physician Subjective Assessment of Change (PSAC)
Description
Wound change in severity as assessed by Physician Subjective Assessment of Change (PSAC), a 3-point Likert static scale that classifies a wound as mild, moderate or severe.
Time Frame
through 8 weeks after last dose of IMP (EOS)
Title
Assessment of wound healing and skin strength measuring onset of (re)blistering of a healed wound
Description
Onset of (re)blistering of a healed wound
Time Frame
through 8 weeks after last dose of IMP (EOS)
Title
Assessment of wound healing and skin strength as assessed by Short Wound Specific Questionnaire (SWSQ)
Description
Wound status as assessed by Short Wound Specific Questionnaire (SWSQ) addressing three domains: pruritus, pain, and inflammation. Pruritus and pain are recorded as a Patient Reported Outcome (PRO) measure. Inflammation is reported as an Observer Reported Outcome (ObsRO) measure.
Time Frame
through 8 weeks after last dose of IMP (EOS)
Title
Assessment of systemic exposure after topical administration of QR-313 to the target wound area (TWA)
Description
Serum levels of QR-313
Time Frame
Day 1 and after 4 and 8 weeks of treatment and EOS
Title
Assessment of the effect of QR-313 on the presence of collagen type VII protein and anchoring fibrils
Description
Presence of collagen type VII protein expression (IIF microscopy)
Time Frame
after 8 weeks of treatment
Title
Assessment of the effect of QR-313 on the presence of collagen type VII protein and anchoring fibrils
Description
Presence of anchoring fibrils (TEM)
Time Frame
after 8 weeks of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
4 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, ≥ 4 years of age at Screening with a clinical diagnosis of DDEB or RDEB and at least one pathogenic mutation in exon 73 of the COL7A1 gene. Have at least one TWA, ie, a skin area of 7 x 7 cm that ishows no signs of local infection, and contains a target wound that is either new or shows dynamic wound healing and complies to the following additional criteria: surface area of the target wound ranging from 5 to 30 cm2, located centrally in the selected 7 x 7 cm TWA. exposed sub-epidermal tissue to allow absorption of the IMP. no suspicion of current squamous cell carcinoma (SCC) upon visual inspection. Exclusion Criteria: Pregnant or breast-feeding female Hemoglobin level at Screening requiring transfusion. The subject may be rescreened when the condition is considered stable. Use of aminoglycosides, by any route of administration, except eye drops, 7 days or 5 half-lives, whichever is longer, prior to Baseline visit. Untreated carcinoma of the TWA or history of carcinoma within 5 years prior to Screening, except adequately treated cutaneous squamous or basal cell carcinoma. Life expectancy less than 6 months, as assessed by the Investigator Current or known history of clinically significant hepatic or renal disease, that in the opinion of the Investigator, could impact subject safety or study participation. Treatment with any systemic immunomodulators, immunosuppressants or cytotoxic chemotherapy within 2 months prior to the Baseline visit. Use of any investigational drug or device within 28 days or 5 half-lives of the Baseline visit, whichever is longer, or plans to participate in another study of a drug or device during the study period. The washout of 5 half-lives does not apply to gene and cell therapy. Known hypersensitivity to oligonucleotide treatment or excipients of the IMP. Bleeding disorder or condition requiring the use of anticoagulants to be confirmed by aPTT by local lab within 48 hours of first treatment. Use of systemic or topical steroids within 1 month prior to the baseline visit (inhaled and ophthalmic drops of corticosteroids or low dose topical solution of budesonide for esophagial strictures may be allowed).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Clinical Operations
Organizational Affiliation
Phoenicis Therapeutics
Official's Role
Study Director
Facility Information:
Facility Name
Stanford University School of Medicine, LPCH
City
Palo Alto
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
Children's Hospital Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Journey Clinic, Center for Pediatric Blood and Marrow Transplantation
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55454
Country
United States
Facility Name
Cincinnati Children's Hospital
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
15005
Country
United States
Facility Name
Hopital Necker Enfants Malades
City
Paris
ZIP/Postal Code
75015
Country
France
Facility Name
Hospital Universitario La Paz
City
Madrid
ZIP/Postal Code
28046
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
31215818
Citation
Miah KM, Hyde SC, Gill DR. Emerging gene therapies for cystic fibrosis. Expert Rev Respir Med. 2019 Aug;13(8):709-725. doi: 10.1080/17476348.2019.1634547. Epub 2019 Jun 27.
Results Reference
derived

Learn more about this trial

A Double-blind, Randomized, Intra-subject Placebo-controlled, Multicenter, Multiple Dose Study, Evaluating Safety, Proof of Mechanism, Preliminary Efficacy and Systemic Exposure in Subjects With Confirmed DDEB or RDEB Diagnosis With One or More Pathogenic Mutations in Exon 73 in the COL7A1 Gene

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