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Dose-Finding Study to Evaluate the Safety, Efficacy, & Tolerability of Multiple Doses of rAvPAL-PEG in Subjects With PKU

Primary Purpose

Phenylketonuria

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
rAvPAL-PEG 0.001 mg/kg
rAvPAL-PEG 0.003 mg/kg
rAvPAL-PEG 0.01 mg/kg
rAvPAL-PEG 0.03 mg/kg
rAvPAL-PEG 0.1 mg/kg
Sponsored by
BioMarin Pharmaceutical
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Phenylketonuria focused on measuring PKU, PEG PAL, BioMarin

Eligibility Criteria

16 Years - 55 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • For subjects who did not participate in PAL-001, diagnosis of PKU with both of the following: Current blood Phe concentration of ≥ 600 mmol/L at Screening and average blood Phe concentration of ≥ 600 µmol/L over the past 3 years, using available data.
  • For subjects who did not participate in PAL-001, evidence that the subject is a non-responder to Kuvan® treatment (ie, 4 weeks of treatment with 20 mg/kg/day of Kuvan®, insufficient response per investigator determination, and treatment end date ≥ 14 days prior to Day 1 [ie, first dose]). Subjects who have had a previous response to Kuvan® treatment but are not currently taking Kuvan® because of noncompliance and have been off treatment for ≥ 6 months prior to Screening are eligible for participation.
  • Willing and able to provide written, signed informed consent, or, in the case of participants under the age of 18, provide written assent (if required) and written informed consent by a parent or legal guardian, after the nature of the study has been explained, and prior to any research-related procedures.
  • Between the ages of 16 and 55 years, inclusive.
  • Females of childbearing potential must have a negative pregnancy test at Screening and be willing to have additional pregnancy tests during the study. Females considered not of childbearing potential include those who have been in menopause at least 2 years, or had tubal ligation at least 1 year prior to Screening, or who have had total hysterectomy.
  • Sexually active subjects must be willing to use an acceptable method of contraception while participating in the study.
  • Maintained a stable diet with no significant modifications during the 4 weeks preceding the administration of study drug.
  • In generally good health as evidenced by physical examination, clinical laboratory evaluations (hematology, chemistry, and urinalysis), and electrocardiogram (ECG) at Screening.
  • Willing and able to comply with study procedures.

Exclusion Criteria:

  • Use of any investigational product (with the exception of rAvPAL-PEG) or investigational medical device within 30 days prior to Screening, or requirement for any investigational agent prior to completion of all scheduled study assessments.
  • Use of any medication that is intended to treat PKU within 14 days prior to the administration of study drug.
  • Use or planned use of any injectable drugs containing PEG (other than rAvPAL-PEG), including Depo-Provera, within 3 months prior to Screening and during study participation.
  • A prior reaction that included systemic symptoms (eg, respiratory or gastrointestinal problems, hypotension, angioedema, anaphylaxis) to rAvPAL-PEG or a PEG containing product. Subjects with a prior systemic reaction of generalized rash may be eligible for participation per the discretion of the Principal Investigator in consultation with the Sponsor's Medical Officer.
  • Pregnant or breastfeeding at Screening or planning to become pregnant (self or partner) or to breastfeed at any time during the study.
  • Concurrent disease or condition that would interfere with study participation or safety (eg, history or presence of clinically significant cardiovascular, pulmonary, hepatic, renal, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurological, oncologic, or psychiatric disease).
  • Any condition that, in the view of the PI, places the subject at high risk of poor treatment compliance or of not completing the study.
  • Alanine aminotransferase (ALT) concentration > 2 times the upper limit of normal.
  • Creatinine > 1.5 times the upper limit of normal.

Sites / Locations

  • The Children's Hospital
  • Emory Universty
  • Children's Memorial Hospital
  • University of Minnesota Medical Center-Fairview
  • Washington University Center for Applied Research Sciences
  • Albany Medical Center
  • Mount Sinai School of Medicine
  • Akron Children's Hospital
  • Oregon Health & Science University
  • University of Pittsburgh Medical Center
  • University of Utah Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

rAvPAL-PEG 0.001 mg/kg

rAvPAL-PEG 0.003 mg/kg

rAvPAL-PEG 0.01 mg/kg

rAvPAL-PEG 0.03 mg/kg

rAvPAL-PEG 0.1 mg/kg

Arm Description

Subjects will start on rAvPAL-PEG 0.001 mg/kg

Subjects will start on rAvPAL-PEG 0.003 mg/kg

Subjects will start on rAvPAL-PEG 0.01 mg/kg

Subjects will start on rAvPAL-PEG 0.03 mg/kg

Subjects will start on rAvPAL-PEG 0.1 mg/kg

Outcomes

Primary Outcome Measures

Blood Phenylalanine Concentrations

Secondary Outcome Measures

Study Drug Related Adverse Events
Number of Participants With Positive PAL IgG Antibody
Antibody against PAL (phenylalanine ammonia lyase) measured over time
Number of Participants With Positive PAL IgM Antibody
Antibody positivity over time
Number of Participants With Positive PEG IgM Antibody
Antibody positivity over time
Number of Participants With Positive PEG IgG Antibody
Antibody positivity over time
Percentage of Participants With Positive Neutralizing Antibodies [NAb]
Antibody positivity over time
Percentage of Participants With Positive PAL IgE Antibody
Antibody positivity over time
Percentage of Participants With Positive Anti-PAL-PEG IgE Antibodies
Antibody positivity over time

Full Information

First Posted
June 17, 2009
Last Updated
February 4, 2019
Sponsor
BioMarin Pharmaceutical
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1. Study Identification

Unique Protocol Identification Number
NCT00925054
Brief Title
Dose-Finding Study to Evaluate the Safety, Efficacy, & Tolerability of Multiple Doses of rAvPAL-PEG in Subjects With PKU
Official Title
Phase 2, Open-Label Dose-Finding Study to Evaluate the Safety, Efficacy, and Tolerability of Multiple Subcutaneous (SC) Doses of rAvPAL-PEG in Subjects With PKU
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
June 2015 (Actual)
Study Completion Date
June 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
BioMarin Pharmaceutical

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to evaluate whether weekly injections of phenylalanine ammonia lyase (rAvPAL-PEG) can reduce blood phenylalanine concentrations in PKU subjects and whether repeated administration is safe.
Detailed Description
This is a 2 part, Phase 2, open-label dose-finding study in approximately 35 subjects with PKU. Seven dose cohorts are planned, each consisting of 5 subjects. In Part 1, the planned starting dose levels are those tested in PAL 001 (0.001, 0.003, 0.01, 0.03, 0.1, 0.3, and 1.0 mg/kg), provided no dose limiting toxicity was observed in PAL 001. In Parts 1 and 2, study drug will be administered by clinic staff. Subjects who completed participation in PAL 001 will receive priority to participate in PAL 002. rAvPAL PEG naïve subjects will be enrolled to fill any dose cohort vacancies resulting from subjects who did not complete PAL 001 or who chose not to continue into PAL 002. In addition, if the number of dose cohorts determined in PAL 001 is less than 7, additional naïve subjects may be added to the existing dose cohorts to provide a total of approximately 35 subjects entering Part 1 of PAL 002. Furthermore, if serial dosing of cohorts in Part 1 of PAL 002 is stopped, additional subjects (either naïve subjects or PAL 001 subjects) may be added to the existing cohorts so that total study enrollment is approximately 35 subjects. In any of these cases, additional subjects will be enrolled sequentially from lowest to highest dose cohort. Diet will not be altered during the course of this study, except as necessary for safety. Subjects will be evaluated for safety and for blood Phe concentrations throughout the study. Toxicity will be measured according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3. A Data Monitoring Committee will monitor the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Phenylketonuria
Keywords
PKU, PEG PAL, BioMarin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
40 (Actual)

8. Arms, Groups, and Interventions

Arm Title
rAvPAL-PEG 0.001 mg/kg
Arm Type
Experimental
Arm Description
Subjects will start on rAvPAL-PEG 0.001 mg/kg
Arm Title
rAvPAL-PEG 0.003 mg/kg
Arm Type
Experimental
Arm Description
Subjects will start on rAvPAL-PEG 0.003 mg/kg
Arm Title
rAvPAL-PEG 0.01 mg/kg
Arm Type
Experimental
Arm Description
Subjects will start on rAvPAL-PEG 0.01 mg/kg
Arm Title
rAvPAL-PEG 0.03 mg/kg
Arm Type
Experimental
Arm Description
Subjects will start on rAvPAL-PEG 0.03 mg/kg
Arm Title
rAvPAL-PEG 0.1 mg/kg
Arm Type
Experimental
Arm Description
Subjects will start on rAvPAL-PEG 0.1 mg/kg
Intervention Type
Drug
Intervention Name(s)
rAvPAL-PEG 0.001 mg/kg
Intervention Description
In Part 1, the planned starting dose levels is 0.001 mg/kg
Intervention Type
Drug
Intervention Name(s)
rAvPAL-PEG 0.003 mg/kg
Intervention Description
In Part 1, the planned starting dose levels is 0.003 mg/kg
Intervention Type
Drug
Intervention Name(s)
rAvPAL-PEG 0.01 mg/kg
Intervention Description
In Part 1, the planned starting dose levels is 0.01 mg/kg
Intervention Type
Drug
Intervention Name(s)
rAvPAL-PEG 0.03 mg/kg
Intervention Description
In Part 1, the planned starting dose levels is 0.03 mg/kg
Intervention Type
Drug
Intervention Name(s)
rAvPAL-PEG 0.1 mg/kg
Intervention Description
In Part 1, the planned starting dose levels is 0.1 mg/kg
Primary Outcome Measure Information:
Title
Blood Phenylalanine Concentrations
Time Frame
Baseline, Week 1/Day 5, Week 7, Week 16/Day 106
Secondary Outcome Measure Information:
Title
Study Drug Related Adverse Events
Time Frame
Screening, Weeks 1-22
Title
Number of Participants With Positive PAL IgG Antibody
Description
Antibody against PAL (phenylalanine ammonia lyase) measured over time
Time Frame
Baseline, Week 12
Title
Number of Participants With Positive PAL IgM Antibody
Description
Antibody positivity over time
Time Frame
Baseline, Week 12
Title
Number of Participants With Positive PEG IgM Antibody
Description
Antibody positivity over time
Time Frame
Baseline, Week 16
Title
Number of Participants With Positive PEG IgG Antibody
Description
Antibody positivity over time
Time Frame
Baseline, Week 16
Title
Percentage of Participants With Positive Neutralizing Antibodies [NAb]
Description
Antibody positivity over time
Time Frame
Baseline, Week 12
Title
Percentage of Participants With Positive PAL IgE Antibody
Description
Antibody positivity over time
Time Frame
Baselline, Week 12
Title
Percentage of Participants With Positive Anti-PAL-PEG IgE Antibodies
Description
Antibody positivity over time
Time Frame
Baseline, Week 12
Other Pre-specified Outcome Measures:
Title
Trough Concentration of BMN 165
Description
Plasma concentrations of rAvPAL-PEG (BMN 165)
Time Frame
Baseline, Baseline/pre-dose, Week 7, and Week 16/Day 106

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Maximum Age & Unit of Time
55 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: For subjects who did not participate in PAL-001, diagnosis of PKU with both of the following: Current blood Phe concentration of ≥ 600 mmol/L at Screening and average blood Phe concentration of ≥ 600 µmol/L over the past 3 years, using available data. For subjects who did not participate in PAL-001, evidence that the subject is a non-responder to Kuvan® treatment (ie, 4 weeks of treatment with 20 mg/kg/day of Kuvan®, insufficient response per investigator determination, and treatment end date ≥ 14 days prior to Day 1 [ie, first dose]). Subjects who have had a previous response to Kuvan® treatment but are not currently taking Kuvan® because of noncompliance and have been off treatment for ≥ 6 months prior to Screening are eligible for participation. Willing and able to provide written, signed informed consent, or, in the case of participants under the age of 18, provide written assent (if required) and written informed consent by a parent or legal guardian, after the nature of the study has been explained, and prior to any research-related procedures. Between the ages of 16 and 55 years, inclusive. Females of childbearing potential must have a negative pregnancy test at Screening and be willing to have additional pregnancy tests during the study. Females considered not of childbearing potential include those who have been in menopause at least 2 years, or had tubal ligation at least 1 year prior to Screening, or who have had total hysterectomy. Sexually active subjects must be willing to use an acceptable method of contraception while participating in the study. Maintained a stable diet with no significant modifications during the 4 weeks preceding the administration of study drug. In generally good health as evidenced by physical examination, clinical laboratory evaluations (hematology, chemistry, and urinalysis), and electrocardiogram (ECG) at Screening. Willing and able to comply with study procedures. Exclusion Criteria: Use of any investigational product (with the exception of rAvPAL-PEG) or investigational medical device within 30 days prior to Screening, or requirement for any investigational agent prior to completion of all scheduled study assessments. Use of any medication that is intended to treat PKU within 14 days prior to the administration of study drug. Use or planned use of any injectable drugs containing PEG (other than rAvPAL-PEG), including Depo-Provera, within 3 months prior to Screening and during study participation. A prior reaction that included systemic symptoms (eg, respiratory or gastrointestinal problems, hypotension, angioedema, anaphylaxis) to rAvPAL-PEG or a PEG containing product. Subjects with a prior systemic reaction of generalized rash may be eligible for participation per the discretion of the Principal Investigator in consultation with the Sponsor's Medical Officer. Pregnant or breastfeeding at Screening or planning to become pregnant (self or partner) or to breastfeed at any time during the study. Concurrent disease or condition that would interfere with study participation or safety (eg, history or presence of clinically significant cardiovascular, pulmonary, hepatic, renal, hematologic, gastrointestinal, endocrine, immunologic, dermatologic, neurological, oncologic, or psychiatric disease). Any condition that, in the view of the PI, places the subject at high risk of poor treatment compliance or of not completing the study. Alanine aminotransferase (ALT) concentration > 2 times the upper limit of normal. Creatinine > 1.5 times the upper limit of normal.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ari Gershman, MD
Organizational Affiliation
BioMarin Pharmaceutical
Official's Role
Study Director
Facility Information:
Facility Name
The Children's Hospital
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Emory Universty
City
Decatur
State/Province
Georgia
ZIP/Postal Code
30033
Country
United States
Facility Name
Children's Memorial Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60614
Country
United States
Facility Name
University of Minnesota Medical Center-Fairview
City
Minneapolis
State/Province
Minnesota
ZIP/Postal Code
55455
Country
United States
Facility Name
Washington University Center for Applied Research Sciences
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Albany Medical Center
City
Albany
State/Province
New York
ZIP/Postal Code
12208
Country
United States
Facility Name
Mount Sinai School of Medicine
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Akron Children's Hospital
City
Akron
State/Province
Ohio
ZIP/Postal Code
44308
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
University of Pittsburgh Medical Center
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15213
Country
United States
Facility Name
University of Utah Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
32593547
Citation
Burton BK, Longo N, Vockley J, Grange DK, Harding CO, Decker C, Li M, Lau K, Rosen O, Larimore K, Thomas J; PAL-002 and PAL-004 Investigators. Pegvaliase for the treatment of phenylketonuria: Results of the phase 2 dose-finding studies with long-term follow-up. Mol Genet Metab. 2020 Aug;130(4):239-246. doi: 10.1016/j.ymgme.2020.06.006. Epub 2020 Jun 16.
Results Reference
derived
PubMed Identifier
24743000
Citation
Longo N, Harding CO, Burton BK, Grange DK, Vockley J, Wasserstein M, Rice GM, Dorenbaum A, Neuenburg JK, Musson DG, Gu Z, Sile S. Single-dose, subcutaneous recombinant phenylalanine ammonia lyase conjugated with polyethylene glycol in adult patients with phenylketonuria: an open-label, multicentre, phase 1 dose-escalation trial. Lancet. 2014 Jul 5;384(9937):37-44. doi: 10.1016/S0140-6736(13)61841-3. Epub 2014 Apr 14.
Results Reference
derived

Learn more about this trial

Dose-Finding Study to Evaluate the Safety, Efficacy, & Tolerability of Multiple Doses of rAvPAL-PEG in Subjects With PKU

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