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Efficacy & Safety Study of Bilateral IVT Injection of GS010 in LHON Subjects Due to the ND4 Mutation for up to 1 Year (REFLECT)

Primary Purpose

Leber Hereditary Optic Neuropathy

Status
Active
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
GS010
Placebo
Sponsored by
GenSight Biologics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Leber Hereditary Optic Neuropathy focused on measuring Heredity Optic Atrophy, Leber Hereditary Optic Atrophy, Leber Hereditary Optic Neuropathy, LHON, Eye Diseases, Hereditary Eye Diseases, Inherited retinal dystrophies or degeneration, Inborn Genetic Disease, Gene Therapy, Intravitreal Injections, Mitochondrial Disease, AAV2 Vectors, Nervous System Diseases, Neurodegenerative Disease, Heredodegenerative Disorders of the Nervous System, Atrophy, Pathological Conditions, Anatomical, Anesthetics, Central Nervous System Depressants, Physiological Effects of Drugs

Eligibility Criteria

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

Main Selection Criteria:

  • Age 15 years or older on the date of signed informed consent.
  • Clinically manifested vision loss due to ND4 LHON, to any extent, in at least one eye.
  • Vision loss duration of ≤ 365 days (i.e. ≤ 1 year) in each affected eye at Inclusion Visit (Visit 2).

Main Non-Selection Criteria:

  • Contraindication to intravitreal injection in any eye.
  • Subjects refusing to discontinue idebenone.
  • Previous vitrectomy in either eye.
  • Narrow angle in any eye contra-indicating pupillary dilation.
  • Presence of known/documented mutations, other than the G11778A ND4 LHON-causing mutation, which are known to cause pathology of the optic nerve, retina or afferent visual system.
  • History of recurrent uveitis (idiopathic or immune-related) or active ocular inflammation.

Main Inclusion Criteria:

  • Vision loss duration of ≤ 365 days (i.e. ≤ 1 year) in each affected eye at Inclusion Visit (Visit 2).
  • Each eye of the subject must maintain at least Hand Motion (HM) visual acuity, as defined by the study's SOP for visual acuity testing.
  • Documented results of genotyping showing the presence of the G11778A mutation in the ND4 gene and the absence of the other primary LHON-associated mutations (ND1 or ND6) in the subject's mitochondrial DNA.

Main Exclusion Criteria:

  • Light Perception (LP) or No Light Perception (NLP) visual acuity in any eye, as defined by the study's standard operating procedure (SOP) for visual acuity testing.
  • Presence of active infectious conjunctivitis, keratitis, scleritis or endophthalmitis in either eye.
  • Presence of alcoholism, alcohol dependence, or alcohol or drug abuse (excluding nicotine).

Sites / Locations

  • Doheny Eye Center UCLA Pasadena
  • University of Colorado Health Eye Center
  • Emory Healthcare - The Emory Clinic
  • Massachusetts Eye and Ear Infirmary
  • Icahn School of Medicine at Mount Sinai
  • Wills Eye Institute - Ocular Oncology Service
  • Vanderbilt Eye Institute
  • Universitair Ziekenhuis Gent
  • CHNO Les Quinze Vingts
  • IRCCS Istituto delle Scienze Neurologiche di Bologna UOC Clinica Neurologica
  • Hospital Universitario Ramon y Cajal
  • Taipei Veterans General Hospital
  • Moorfields Eye Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Treatment Arm 1

Treatment Arm 2

Arm Description

Subjects will be randomized to treatment arm 1 or treatment arm 2 in a 1:1 allocation. Subjects in treatment arm 1 will receive intravitreal GS010 in both eyes.

Subjects will be randomized to treatment arm 1 or treatment arm 2 in a 1:1 allocation. Subjects in treatment arm 2 will receive GS010 in one eye and placebo intravitreal injection in the other eye.

Outcomes

Primary Outcome Measures

Best-Corrected Visual Acuity (BCVA) reported using Log of the Minimal Angle of Resolution (LogMAR) - 1 year
The primary efficacy endpoint will be the change from baseline (Visit 2) BCVA reported with LogMAR at 1.5 years post-treatment in second affected/not yet affected eyes of ND4 LHON subjects with vision loss up to one year. The change from baseline (Visit 2) in second affected/not yet affected eyes receiving GS010 and placebo will be the primary response of interest. LogMAR BCVA will be used to represent BCVA.

Secondary Outcome Measures

Best-Corrected Visual Acuity (BCVA) reported with LogMAR - 2 years
Change from baseline in LogMAR BCVA at each timepoint of the follow-up period and at 2 years post-treatment.
Responder Analysis
Response status at each timepoint of the follow-up period and at 2 years post-treatment. Definitions of responder eyes include: Eyes whose LogMAR BCVA improves (i.e. decreases) by ≥ 0.3 LogMAR (equivalent to a gain of ≥ 15 ETDRS letters) compared to baseline. Eyes whose LogMAR BCVA does not increase (i.e. worsen) by ≥ 0.3 LogMAR (equivalent to eyes that lose ≤ 15 ETDRS letters) compared to baseline. Eyes whose LogMAR visual acuity is < 1.0 (i.e. better than LogMAR 1.0, equivalent to better than Snellen acuity of 20/200).
Spectral-Domain - Optical Coherence Tomography (SD-OCT) parameter
Parameters measured with SD-OCT over time and at 1.5 and 2-years post baseline treatment. The change from baseline will be the response. Analysis will be performed mainly for second affected/not yet affected eyes treated with GS010 versus placebo and also for first affected eyes receiving GS010 as well
Humphrey Visual Field (HVF) parameter
Parameters measured with HVF 30-2 over time and at 1.5 and 2-years post baseline treatment. The change from baseline will be the response. Analysis will be performed mainly for second affected/not yet affected eyes treated with GS010 versus placebo and also for first affected eyes receiving GS010 as well
Pelli Robson Low Vision Contrast Sensitivity parameter
Parameters measured with Pelli Robson Low Vision Contrast Sensitivity over time and at 1.5 and 2-years post baseline treatment. The change from baseline will be the response. Analysis will be performed mainly for second affected/not yet affected eyes treated with GS010 versus placebo and also for first affected eyes receiving GS010 as well
Quality of Life: Visual Functioning Questionnaire-25
Visual Functioning Questionnaire-25 at 1.5 and 2-years post-treatment
Quality of Life: 36-Item Short Form Health Survey, version 2 Questionnaire
36-Item Short Form Health Survey, version 2 Questionnaire at 1 and 2-years post-treatment.

Full Information

First Posted
September 19, 2017
Last Updated
August 2, 2022
Sponsor
GenSight Biologics
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1. Study Identification

Unique Protocol Identification Number
NCT03293524
Brief Title
Efficacy & Safety Study of Bilateral IVT Injection of GS010 in LHON Subjects Due to the ND4 Mutation for up to 1 Year
Acronym
REFLECT
Official Title
Efficacy and Safety of Bilateral Intravitreal Injection of GS010: A Randomized, Double-Masked, Placebo-Controlled Trial in Subjects Affected With G11778A ND4 Leber Hereditary Optic Neuropathy for Up to One Year
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 12, 2018 (Actual)
Primary Completion Date
June 30, 2024 (Anticipated)
Study Completion Date
June 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
GenSight Biologics

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 goal of this clinical trial is to assess the safety and efficacy of GS010, a gene therapy, in improving the retina functional & structural outcomes in subjects with LHON due to the G11778A ND4 mitochondrial mutation when vision loss duration is present up to one year.
Detailed Description
GS-LHON-CLIN-05 is a Phase III, global, multi-center randomized, double-masked for the primary analysis, placebo-controlled, clinical study. As LHON is a neurodegenerative disease, the goal is to administer GS010 as soon as possible upon confirmation of the LHON diagnosis and the causative mutation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Leber Hereditary Optic Neuropathy
Keywords
Heredity Optic Atrophy, Leber Hereditary Optic Atrophy, Leber Hereditary Optic Neuropathy, LHON, Eye Diseases, Hereditary Eye Diseases, Inherited retinal dystrophies or degeneration, Inborn Genetic Disease, Gene Therapy, Intravitreal Injections, Mitochondrial Disease, AAV2 Vectors, Nervous System Diseases, Neurodegenerative Disease, Heredodegenerative Disorders of the Nervous System, Atrophy, Pathological Conditions, Anatomical, Anesthetics, Central Nervous System Depressants, Physiological Effects of Drugs

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment Arm 1
Arm Type
Experimental
Arm Description
Subjects will be randomized to treatment arm 1 or treatment arm 2 in a 1:1 allocation. Subjects in treatment arm 1 will receive intravitreal GS010 in both eyes.
Arm Title
Treatment Arm 2
Arm Type
Placebo Comparator
Arm Description
Subjects will be randomized to treatment arm 1 or treatment arm 2 in a 1:1 allocation. Subjects in treatment arm 2 will receive GS010 in one eye and placebo intravitreal injection in the other eye.
Intervention Type
Genetic
Intervention Name(s)
GS010
Other Intervention Name(s)
Lenadogene nolparvovec
Intervention Description
GS010 is a recombinant adeno-associated viral vector serotype 2 (rAAV2/2) containing the wild-type ND4 gene (rAAV2/2-ND4). GS010 will be administrated via intravitreal injection containing 9E10 viral genomes in 90μL balanced salt solution (BSS) as a single baseline intravitreal injection.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
The placebo is a BSS, sterile, apyrogenic solution and used for ocular surgery. The placebo will be administered via intravitreal injection in a volume of 90 μL.
Primary Outcome Measure Information:
Title
Best-Corrected Visual Acuity (BCVA) reported using Log of the Minimal Angle of Resolution (LogMAR) - 1 year
Description
The primary efficacy endpoint will be the change from baseline (Visit 2) BCVA reported with LogMAR at 1.5 years post-treatment in second affected/not yet affected eyes of ND4 LHON subjects with vision loss up to one year. The change from baseline (Visit 2) in second affected/not yet affected eyes receiving GS010 and placebo will be the primary response of interest. LogMAR BCVA will be used to represent BCVA.
Time Frame
at 1.5 Year post baseline treatment
Secondary Outcome Measure Information:
Title
Best-Corrected Visual Acuity (BCVA) reported with LogMAR - 2 years
Description
Change from baseline in LogMAR BCVA at each timepoint of the follow-up period and at 2 years post-treatment.
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Title
Responder Analysis
Description
Response status at each timepoint of the follow-up period and at 2 years post-treatment. Definitions of responder eyes include: Eyes whose LogMAR BCVA improves (i.e. decreases) by ≥ 0.3 LogMAR (equivalent to a gain of ≥ 15 ETDRS letters) compared to baseline. Eyes whose LogMAR BCVA does not increase (i.e. worsen) by ≥ 0.3 LogMAR (equivalent to eyes that lose ≤ 15 ETDRS letters) compared to baseline. Eyes whose LogMAR visual acuity is < 1.0 (i.e. better than LogMAR 1.0, equivalent to better than Snellen acuity of 20/200).
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Title
Spectral-Domain - Optical Coherence Tomography (SD-OCT) parameter
Description
Parameters measured with SD-OCT over time and at 1.5 and 2-years post baseline treatment. The change from baseline will be the response. Analysis will be performed mainly for second affected/not yet affected eyes treated with GS010 versus placebo and also for first affected eyes receiving GS010 as well
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Title
Humphrey Visual Field (HVF) parameter
Description
Parameters measured with HVF 30-2 over time and at 1.5 and 2-years post baseline treatment. The change from baseline will be the response. Analysis will be performed mainly for second affected/not yet affected eyes treated with GS010 versus placebo and also for first affected eyes receiving GS010 as well
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Title
Pelli Robson Low Vision Contrast Sensitivity parameter
Description
Parameters measured with Pelli Robson Low Vision Contrast Sensitivity over time and at 1.5 and 2-years post baseline treatment. The change from baseline will be the response. Analysis will be performed mainly for second affected/not yet affected eyes treated with GS010 versus placebo and also for first affected eyes receiving GS010 as well
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Title
Quality of Life: Visual Functioning Questionnaire-25
Description
Visual Functioning Questionnaire-25 at 1.5 and 2-years post-treatment
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Title
Quality of Life: 36-Item Short Form Health Survey, version 2 Questionnaire
Description
36-Item Short Form Health Survey, version 2 Questionnaire at 1 and 2-years post-treatment.
Time Frame
at 1.5-Year and 2-Years post baseline treatment
Other Pre-specified Outcome Measures:
Title
Adverse events (AEs) and serious adverse events (SAEs)
Description
Adverse events (AEs) and serious adverse events (SAEs), including those that are treatment-emergent and non-treatment-emergent, throughout the study period and at each study visit. Incidence and severity of systemic and local (ocular) AEs and SAEs will be determined at each clinical site and for the entire study cohort.
Time Frame
up to 2-Years post baseline treatment
Title
Physical examinations
Description
Results of physical examinations
Time Frame
At 2-Years post baseline treatment
Title
Electrocardiograms
Description
Results of Electrocardiograms (ECGs)
Time Frame
At 2-Years post baseline treatment
Title
Laboratory results
Description
Results of laboratory tests from blood collection
Time Frame
At 2-Years post baseline treatment
Title
Immune response evaluations
Description
Results of immune response evaluations Time course of the humoral immune response measured with Neutralizing Antibodies (Nab) against Adeno-associated virus vector 2 (AAV2) Time course of the cellular immune response against AAV2
Time Frame
Up to 2-Years post baseline treatment
Title
Blood Bio-dissemination of AAV2 Vector DNA
Description
Results of bio-dissemination testing up to 4-weeks post-treatment
Time Frame
up to 4 weeks post-treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
15 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Main Selection Criteria: Age 15 years or older on the date of signed informed consent. Clinically manifested vision loss due to ND4 LHON, to any extent, in at least one eye. Vision loss duration of ≤ 365 days (i.e. ≤ 1 year) in each affected eye at Inclusion Visit (Visit 2). Main Non-Selection Criteria: Contraindication to intravitreal injection in any eye. Subjects refusing to discontinue idebenone. Previous vitrectomy in either eye. Narrow angle in any eye contra-indicating pupillary dilation. Presence of known/documented mutations, other than the G11778A ND4 LHON-causing mutation, which are known to cause pathology of the optic nerve, retina or afferent visual system. History of recurrent uveitis (idiopathic or immune-related) or active ocular inflammation. Main Inclusion Criteria: Vision loss duration of ≤ 365 days (i.e. ≤ 1 year) in each affected eye at Inclusion Visit (Visit 2). Each eye of the subject must maintain at least Hand Motion (HM) visual acuity, as defined by the study's SOP for visual acuity testing. Documented results of genotyping showing the presence of the G11778A mutation in the ND4 gene and the absence of the other primary LHON-associated mutations (ND1 or ND6) in the subject's mitochondrial DNA. Main Exclusion Criteria: Light Perception (LP) or No Light Perception (NLP) visual acuity in any eye, as defined by the study's standard operating procedure (SOP) for visual acuity testing. Presence of active infectious conjunctivitis, keratitis, scleritis or endophthalmitis in either eye. Presence of alcoholism, alcohol dependence, or alcohol or drug abuse (excluding nicotine).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nancy Newman, MD
Organizational Affiliation
Emory University Hospital Atlanta, Georgia, United States, 30322
Official's Role
Principal Investigator
Facility Information:
Facility Name
Doheny Eye Center UCLA Pasadena
City
Pasadena
State/Province
California
ZIP/Postal Code
91105
Country
United States
Facility Name
University of Colorado Health Eye Center
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Emory Healthcare - The Emory Clinic
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Massachusetts Eye and Ear Infirmary
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Wills Eye Institute - Ocular Oncology Service
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Vanderbilt Eye Institute
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232
Country
United States
Facility Name
Universitair Ziekenhuis Gent
City
Gent
ZIP/Postal Code
9000
Country
Belgium
Facility Name
CHNO Les Quinze Vingts
City
Paris
ZIP/Postal Code
75012
Country
France
Facility Name
IRCCS Istituto delle Scienze Neurologiche di Bologna UOC Clinica Neurologica
City
Bologna
ZIP/Postal Code
40139
Country
Italy
Facility Name
Hospital Universitario Ramon y Cajal
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Taipei Veterans General Hospital
City
Taipei
ZIP/Postal Code
11217
Country
Taiwan
Facility Name
Moorfields Eye Hospital
City
London
State/Province
Greater London
ZIP/Postal Code
EC1V 2PD
Country
United Kingdom

12. IPD Sharing Statement

Links:
URL
http://www.gensight-biologics.com
Description
GenSight Biologics website

Learn more about this trial

Efficacy & Safety Study of Bilateral IVT Injection of GS010 in LHON Subjects Due to the ND4 Mutation for up to 1 Year

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