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Extension Study of HGT-HIT-045 Evaluating Long-Term Safety and Clinical Outcomes of Idursulfase-IT in Conjunction With Elaprase in Pediatric Participants With Hunter Syndrome and Cognitive Impairment

Primary Purpose

Hunter Syndrome

Status
Active
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Idursulfase-IT
Elaprase
Sponsored by
Shire
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hunter Syndrome focused on measuring MPS II, MPS 2, lysosomal storage disorder, mps symptoms, enlarged adenoids, elaprase, hunter's syndrome, MPS2, hunters disease, hunter's disease treatment, hunter syndrome therapy, iduronate sulfatase, mps society, MPSII, hunter syndrome treatment, hunter's disease, iduronate 2 sulfatase, mucopolysaccharides, mps diagnosis, chronic ear infection, hunters syndrome, ert treatment, lysosomal storage disease, hunter disease, enzyme replacement therapy, idursulfase, hunter's syndrome treatment

Eligibility Criteria

3 Years - 18 Years (Child, Adult)MaleDoes not accept healthy volunteers

Inclusion Criteria:

  • Participant must have completed all study requirements and end of study assessments for study HGT-HIT-045 prior to enrolling in Study HGT-HIT-046 and must have no safety or medical issues that contraindicate participation.
  • The participant's parent(s) or legally authorized guardian(s) must have voluntarily signed an Institutional Review Board (IRB)/Independent Ethics Committee(IEC)-approved informed consent form after all relevant aspects of the study have been explained and discussed. Consent of the participant's parent(s) or legally authorized guardian(s) and the participant's assent, as relevant, must be obtained.
  • The participant has received and tolerated a minimum of 12 months of treatment with weekly IV infusions of Elaprase and has received 80% of the total planned infusions within the last 6 months.

Exclusion Criteria:

  • The participant is enrolled in another clinical study that involves clinical investigations or use of any investigational product (drug or device) other than the PORT-A-CATH IDDD within 30 days prior to study enrollment or at any time during the study.
  • The participant is unable to comply with the protocol (eg, is unable to return for safety evaluations, or is otherwise unlikely to complete the study) as determined by the investigator.
  • The participant has experienced an adverse reaction to study drug in Study HGT-HIT-045 that contraindicates further treatment with intrathecal idursulfase-IT.
  • The participant has a known hypersensitivity to any of the components of idursulfase-IT.
  • The participant has any known or suspected hypersensitivity to anesthesia or is thought to be at an unacceptably high risk for anesthesia due to airway compromise or other conditions.
  • The participant has a condition that is contraindicated as described in the SOPH-A-PORT Mini S IDDD Instructions for Use, including:

    1. The participant has had, or may have, an allergic reaction to the materials of construction of the SOPH-A-PORT Mini S device
    2. The participant's body size is too small to support the size of the SOPH-A-PORT Mini S Access Port, as judged by the investigator
    3. The participant's drug therapy requires substances known to be incompatible with the materials of construction
    4. The participant has a known or suspected local or general infection
    5. The participant is at risk of abnormal bleeding due to a medical condition or therapy
    6. The participant has one or more spinal abnormalities that could complicate safe implantation or fixation
    7. The participant has a functioning CSF shunt device
    8. The participant has shown an intolerance to an implanted device
  • The participant has an opening CSF pressure upon lumbar puncture that exceeds 30.0 centimeter (cm) water (H2O).

Sites / Locations

  • Ann & Robert H Lurie Childrens Hospital of Chicago
  • University of North Carolina at Chapel Hill
  • Legacy Emanuel Hospital
  • Children's Hospital of Pittsburgh of UPMC
  • Vanderbilt Children's Hospital
  • University of Utah Hospital
  • Seattle Children's Hospital
  • British Columbia Children's Hospital
  • Birmingham Children's Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Idursulfase-IT

Arm Description

Idursulfase-IT will be administered once monthly and weekly IV infusions of Elaprase at the dose used in study HGT-HIT-045 via intrathecal drug delivery device (IDDD).

Outcomes

Primary Outcome Measures

Number of Participants With Treatment-emergent Adverse Events (TEAEs)
An adverse event (AE) is any noxious, pathologic, or unintended change in anatomical, physiologic, or metabolic function as indicated by physical signs, symptoms, and/or laboratory changes occurring in any phase of a clinical trial, and whether or not considered study drug-related. Treatment-emergent AEs are defined as all AEs occurring on or after the first IDDD surgery date or first dose (whichever is earlier) for the participant (whether it is in this extension study or in HGT HIT-045 [NCT00920647]) and before the end of the study (EOS) visit (+30 days).

Secondary Outcome Measures

Area Under the Curve Extrapolated to Infinity (AUC0-infinity) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Area under the curve extrapolated to infinity, calculated using the observed value of the last non-zero concentration (AUC0-infinity) of idursulfase will be assessed.
Area Under the Curve From the Time of Dosing to the Last Measureable Concentration (AUC0-t) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Area under the curve from the time of dosing to the last measureable concentration (AUC0-t) of idursulfase will be assessed.
Maximum Observed Concentration (Cmax) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Maximum Observed Concentration (Cmax) of idursulfase will be assessed.
Time of Maximum Observed Concentration (tmax) of Idursulfase Administered in as Intrathecal and in Conjunction With Elaprase
Time of maximum observed concentration (tmax) of idursulfase will be assessed.
Total Body Clearance for Extravascular Administration Divided by the Fraction of Dose Absorbed (Cl/F) of Idursulfase-IT Administered as Intrathecal and in Conjunction With Elaprase
Total body clearance for extravascular administration divided by the fraction of dose absorbed (Cl/F) of idursulfase will be assessed.
Volume of Distribution Associated With the Terminal Slope Following Extravascular Administration Divided by the Fraction of Dose Absorbed (Vz/F) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Volume of distribution associated with the terminal slope following extravascular administration divided by the fraction of dose absorbed (Vz/F) of idursulfase will be assessed.
First Order Rate Constant (Lambda z) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
First order rate constant (Lambda z) of idursulfase will be assessed.
Terminal Half-life (t1/2) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Terminal half-life (t1/2) of idursulfase will be assessed.
Total Body Clearance (Cl) of Elaprase
Total body clearance (Cl) of Elaprase will be assessed.
Volume of Distribution (Vz) of Elaprase
Volume of distribution associated with the terminal slope (Vz) of Elaprase will be assessed.
Observed Steady-state Volume of Distribution (Vss) of Elaprase
Observed steady-state volume of distribution (Vss) of Elaprase will be assessed.
Mean Residence Time (MRT) of Elaprase
Mean residence time (MRT) of Elaprase will be assessed.
Change From Baseline in CSF Biomarkers
Change from baseline in CSF biomarkers glycosaminoglycan (GAG [HS/DS]) will be assessed.
Change From Baseline in Urinary Glycosaminoglycan (GAG)
Change from baseline in urinary GAG will be assessed.

Full Information

First Posted
December 15, 2011
Last Updated
May 24, 2023
Sponsor
Shire
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1. Study Identification

Unique Protocol Identification Number
NCT01506141
Brief Title
Extension Study of HGT-HIT-045 Evaluating Long-Term Safety and Clinical Outcomes of Idursulfase-IT in Conjunction With Elaprase in Pediatric Participants With Hunter Syndrome and Cognitive Impairment
Official Title
An Open-Label Extension of Study HGT-HIT-045 Evaluating Long-Term Safety and Clinical Outcomes of Intrathecal Idursulfase-IT Administered in Conjunction With Intravenous Elaprase® in Pediatric Patients With Hunter Syndrome and Cognitive Impairment
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 1, 2010 (Actual)
Primary Completion Date
December 15, 2023 (Anticipated)
Study Completion Date
December 15, 2023 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This extension study of HGT-HIT-045 is designed to collect long-term safety data in pediatric participants with Hunter syndrome and cognitive impairment who are receiving intrathecal (IT) idursulfase-IT and intravenous (IV) Elaprase enzyme replacement therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hunter Syndrome
Keywords
MPS II, MPS 2, lysosomal storage disorder, mps symptoms, enlarged adenoids, elaprase, hunter's syndrome, MPS2, hunters disease, hunter's disease treatment, hunter syndrome therapy, iduronate sulfatase, mps society, MPSII, hunter syndrome treatment, hunter's disease, iduronate 2 sulfatase, mucopolysaccharides, mps diagnosis, chronic ear infection, hunters syndrome, ert treatment, lysosomal storage disease, hunter disease, enzyme replacement therapy, idursulfase, hunter's syndrome treatment

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Idursulfase-IT
Arm Type
Experimental
Arm Description
Idursulfase-IT will be administered once monthly and weekly IV infusions of Elaprase at the dose used in study HGT-HIT-045 via intrathecal drug delivery device (IDDD).
Intervention Type
Drug
Intervention Name(s)
Idursulfase-IT
Intervention Description
Participants will receive Idursulfase-IT once monthly at the dose used in study HGT-HIT-045 via intrathecal drug delivery device (IDDD).
Intervention Type
Drug
Intervention Name(s)
Elaprase
Intervention Description
Participants will receive weekly IV infusions of commercially available Elaprase.
Primary Outcome Measure Information:
Title
Number of Participants With Treatment-emergent Adverse Events (TEAEs)
Description
An adverse event (AE) is any noxious, pathologic, or unintended change in anatomical, physiologic, or metabolic function as indicated by physical signs, symptoms, and/or laboratory changes occurring in any phase of a clinical trial, and whether or not considered study drug-related. Treatment-emergent AEs are defined as all AEs occurring on or after the first IDDD surgery date or first dose (whichever is earlier) for the participant (whether it is in this extension study or in HGT HIT-045 [NCT00920647]) and before the end of the study (EOS) visit (+30 days).
Time Frame
From start of study drug administration up to follow-up (169 months)
Secondary Outcome Measure Information:
Title
Area Under the Curve Extrapolated to Infinity (AUC0-infinity) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Description
Area under the curve extrapolated to infinity, calculated using the observed value of the last non-zero concentration (AUC0-infinity) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Area Under the Curve From the Time of Dosing to the Last Measureable Concentration (AUC0-t) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Description
Area under the curve from the time of dosing to the last measureable concentration (AUC0-t) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Maximum Observed Concentration (Cmax) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Description
Maximum Observed Concentration (Cmax) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Time of Maximum Observed Concentration (tmax) of Idursulfase Administered in as Intrathecal and in Conjunction With Elaprase
Description
Time of maximum observed concentration (tmax) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Total Body Clearance for Extravascular Administration Divided by the Fraction of Dose Absorbed (Cl/F) of Idursulfase-IT Administered as Intrathecal and in Conjunction With Elaprase
Description
Total body clearance for extravascular administration divided by the fraction of dose absorbed (Cl/F) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Volume of Distribution Associated With the Terminal Slope Following Extravascular Administration Divided by the Fraction of Dose Absorbed (Vz/F) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Description
Volume of distribution associated with the terminal slope following extravascular administration divided by the fraction of dose absorbed (Vz/F) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
First Order Rate Constant (Lambda z) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Description
First order rate constant (Lambda z) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Terminal Half-life (t1/2) of Idursulfase Administered as Intrathecal and in Conjunction With Elaprase
Description
Terminal half-life (t1/2) of idursulfase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Months 19, 31, and 43
Title
Total Body Clearance (Cl) of Elaprase
Description
Total body clearance (Cl) of Elaprase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Month 19
Title
Volume of Distribution (Vz) of Elaprase
Description
Volume of distribution associated with the terminal slope (Vz) of Elaprase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Month 19
Title
Observed Steady-state Volume of Distribution (Vss) of Elaprase
Description
Observed steady-state volume of distribution (Vss) of Elaprase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Month 19
Title
Mean Residence Time (MRT) of Elaprase
Description
Mean residence time (MRT) of Elaprase will be assessed.
Time Frame
15 minutes prior to IT injection, 1, 2, 3, 4, 6, 8, 12, 24, 30 and 36 hours (h) following IT injection on Weeks 3 and 23, Day 2 of Month 19
Title
Change From Baseline in CSF Biomarkers
Description
Change from baseline in CSF biomarkers glycosaminoglycan (GAG [HS/DS]) will be assessed.
Time Frame
Baseline, Day 2 of Week 1, Day 2 Pre dose on Weeks 3, 7, 11, 15, 19, 23, 27, Months 7 - 169
Title
Change From Baseline in Urinary Glycosaminoglycan (GAG)
Description
Change from baseline in urinary GAG will be assessed.
Time Frame
Baseline, Day 1 Pre dose on Weeks 3, 7, 11, 15, 19, 23, 27, Months 7 - 169

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participant must have completed all study requirements and end of study assessments for study HGT-HIT-045 prior to enrolling in Study HGT-HIT-046 and must have no safety or medical issues that contraindicate participation. The participant's parent(s) or legally authorized guardian(s) must have voluntarily signed an Institutional Review Board (IRB)/Independent Ethics Committee(IEC)-approved informed consent form after all relevant aspects of the study have been explained and discussed. Consent of the participant's parent(s) or legally authorized guardian(s) and the participant's assent, as relevant, must be obtained. The participant has received and tolerated a minimum of 12 months of treatment with weekly IV infusions of Elaprase and has received 80% of the total planned infusions within the last 6 months. Exclusion Criteria: The participant is enrolled in another clinical study that involves clinical investigations or use of any investigational product (drug or device) other than the PORT-A-CATH IDDD within 30 days prior to study enrollment or at any time during the study. The participant is unable to comply with the protocol (eg, is unable to return for safety evaluations, or is otherwise unlikely to complete the study) as determined by the investigator. The participant has experienced an adverse reaction to study drug in Study HGT-HIT-045 that contraindicates further treatment with intrathecal idursulfase-IT. The participant has a known hypersensitivity to any of the components of idursulfase-IT. The participant has any known or suspected hypersensitivity to anesthesia or is thought to be at an unacceptably high risk for anesthesia due to airway compromise or other conditions. The participant has a condition that is contraindicated as described in the SOPH-A-PORT Mini S IDDD Instructions for Use, including: The participant has had, or may have, an allergic reaction to the materials of construction of the SOPH-A-PORT Mini S device The participant's body size is too small to support the size of the SOPH-A-PORT Mini S Access Port, as judged by the investigator The participant's drug therapy requires substances known to be incompatible with the materials of construction The participant has a known or suspected local or general infection The participant is at risk of abnormal bleeding due to a medical condition or therapy The participant has one or more spinal abnormalities that could complicate safe implantation or fixation The participant has a functioning CSF shunt device The participant has shown an intolerance to an implanted device The participant has an opening CSF pressure upon lumbar puncture that exceeds 30.0 centimeter (cm) water (H2O).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Shire Physician
Organizational Affiliation
Shire
Official's Role
Study Director
Facility Information:
Facility Name
Ann & Robert H Lurie Childrens Hospital of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
University of North Carolina at Chapel Hill
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Legacy Emanuel Hospital
City
Portland
State/Province
Oregon
ZIP/Postal Code
97227
Country
United States
Facility Name
Children's Hospital of Pittsburgh of UPMC
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Facility Name
Vanderbilt Children's Hospital
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37232-9559
Country
United States
Facility Name
University of Utah Hospital
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States
Facility Name
Seattle Children's Hospital
City
Seattle
State/Province
Washington
ZIP/Postal Code
98105
Country
United States
Facility Name
British Columbia Children's Hospital
City
Vancouver
State/Province
British Columbia
Country
Canada
Facility Name
Birmingham Children's Hospital
City
Birmingham
ZIP/Postal Code
B46NH
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Takeda provides access to the de-identified individual participant data (IPD) for eligible studies to aid qualified researchers in addressing legitimate scientific objectives (Takeda's data sharing commitment is available on https://clinicaltrials.takeda.com/takedas-commitment?commitment=5). These IPDs will be provided in a secure research environment following approval of a data sharing request, and under the terms of a data sharing agreement.
IPD Sharing Access Criteria
IPD from eligible studies will be shared with qualified researchers according to the criteria and process described on https://vivli.org/ourmember/takeda/. For approved requests, the researchers will be provided access to anonymized data (to respect patient privacy in line with applicable laws and regulations) and with information necessary to address the research objectives under the terms of a data sharing agreement.
IPD Sharing URL
https://vivli.org/ourmember/takeda/
Citations:
PubMed Identifier
17185020
Citation
Muenzer J, Gucsavas-Calikoglu M, McCandless SE, Schuetz TJ, Kimura A. A phase I/II clinical trial of enzyme replacement therapy in mucopolysaccharidosis II (Hunter syndrome). Mol Genet Metab. 2007 Mar;90(3):329-37. doi: 10.1016/j.ymgme.2006.09.001. Epub 2006 Dec 20.
Results Reference
background
PubMed Identifier
16912578
Citation
Muenzer J, Wraith JE, Beck M, Giugliani R, Harmatz P, Eng CM, Vellodi A, Martin R, Ramaswami U, Gucsavas-Calikoglu M, Vijayaraghavan S, Wendt S, Puga AC, Ulbrich B, Shinawi M, Cleary M, Piper D, Conway AM, Kimura A. A phase II/III clinical study of enzyme replacement therapy with idursulfase in mucopolysaccharidosis II (Hunter syndrome). Genet Med. 2006 Aug;8(8):465-73. doi: 10.1097/01.gim.0000232477.37660.fb. Erratum In: Genet Med. 2006 Sep;8(9):599. Wendt, Suzanne [corrected to Wendt, Susanne]; Puga, Antonio [corrected to Puga, Ana Cristina]; Conway, Ann Marie [corrected to Conway, Anne Marie].
Results Reference
background
PubMed Identifier
35588317
Citation
Muenzer J, Vijayaraghavan S, Stein M, Kearney S, Wu Y, Alexanderian D. Long-term open-label phase I/II extension study of intrathecal idursulfase-IT in the treatment of neuronopathic mucopolysaccharidosis II. Genet Med. 2022 Jul;24(7):1437-1448. doi: 10.1016/j.gim.2022.04.002. Epub 2022 May 20.
Results Reference
derived
Links:
URL
https://clinicaltrials.takeda.com/study-detail/5f6b5fce4db2bf003ab46749
Description
To obtain more information on the study, click here/on this link

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Extension Study of HGT-HIT-045 Evaluating Long-Term Safety and Clinical Outcomes of Idursulfase-IT in Conjunction With Elaprase in Pediatric Participants With Hunter Syndrome and Cognitive Impairment

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