Safety & Efficacy Study of rAAV1-CB-hAAT for Alpha-1 Antitrypsin Deficiency
Primary Purpose
Alpha-1 Antitrypsin Deficiency
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
rAAV1-CB-hAAT
Sponsored by
About this trial
This is an interventional treatment trial for Alpha-1 Antitrypsin Deficiency focused on measuring Alpha-1 antitrypsin deficiency, Adeno-associated virus vector, AAV, Gene therapy, Human gene transfer
Eligibility Criteria
Inclusion Criteria:
- Have a diagnosis of AAT-deficiency, as defined by a serum AAT level of less than 11 µM and a phenotype or genotype either homozygous for PI*Z or compound heterozygous consisting of PI*Z and another allele known to be associated with disease
- Be at least 18 and not more than 75 years of age
- Have a forced expiratory volume at one second (FEV1) >25% of predicted value (post bronchodilator)
- Weigh ≤ 90 kg
- Not receiving AAT augmentation therapy currently or with the past 3 months, and not planning to begin such therapy for at least 12 months after administration of rAAV1-CB-hAAT
- Be willing to discontinue aspirin, aspirin-containing products, and other drugs that may alter platelet function, 7 days prior to dosing, resuming no earlier than 24 hours after the dose has been administered
Have acceptable laboratory parameters:
- Hemoglobin ≥ 11.2 g/dL for females, ≥ 12.8 g/dL for males,
- White blood cell count 3,300 - 12,000 cells/mm3,
- Platelet count 125,000 - 550,000/mm3,
- Serum creatine kinase (CK) ≤ 3 times upper normal range for study laboratory,
- Alanine aminotransferase (ALT) ≤ 2 times upper normal range for study laboratory,
- Serum bilirubin ≤ 1.5 times upper normal range for study laboratory,
- Serum creatinine within normal range for study laboratory,
Prothrombin time (PT) ≤ 14.5 seconds and partial thromboplastin time (PTT)
≤ 36 seconds,
- Normal urine dipstick (negative glucose, negative hemoglobin, and negative or trace protein),
For females of childbearing potential:
- A negative pregnancy test (urine or serum) at screening and at baseline (within 2 days before administration of study agent)
- Agreement to consistently use barrier contraception (condoms, diaphragm or cervical cap with spermicide) or another form of contraception (e.g. intrauterine device or hormonal contraception) from the screening visit until 12 months after administration of rAAV1-CB-hAAT, for sexual activity that could lead to pregnancy
- For males of reproductive potential, agreement to consistently use barrier contraception (condoms with spermicide) for 12 months after administration of rAAV1-CB-hAAT, for sexual activity that could lead to pregnancy,
- Provide signed informed consent before screening
Exclusion Criteria:
- Prior receipt of any AAV gene therapy product
- Use of anticoagulants or anti-platelet agents within 7 days prior to study agent administration
- History of immune response to human AAT augmentation therapy as indicated by clinical history of an adverse immune response to infusion and/or decreased therapeutic effect in combination with documentation of serum anti-AAT antibodies
- Use of acute oral or intravenous antibiotic therapy for a respiratory infection within 28 days prior to study agent administration (long-term maintenance or chronic suppressive oral antibiotics, and antibiotics for a non-respiratory indication, are allowed)
- Use of oral or systemic corticosteroids within 28 days prior to study agent administration
- Use of any investigational agent, or any immunosuppressive drug(s), within 3 months prior to enrollment
- For females of childbearing potential, a positive pregnancy test at screening or baseline (within 2 days before rAAV1-CB-hAAT administration) Note: At the Cincinnati Children's Hospital Medical Center site, women of childbearing potential were not permitted to enroll in the study.
- Females who are breast feeding
- Have a significant abnormal EKG finding at screening and/or cardiac disease (e.g. recent myocardial infarction or CHF) within past 6 months
- Have had pulmonary edema or a pulmonary embolism within the past 6 months
- Have a history of immunodeficiency or other medical condition which leads the investigator to believe that the participant cannot comply with the protocol requirements or that may place the participant at an unacceptable risk for participation
Sites / Locations
- National Jewish Health
- University of Massachusetts Medical Center
- Cincinnati Children's Hospital Medical Center
- Beaumont Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Experimental
Arm Label
Low dose
Middle dose
High dose
Arm Description
rAAV1-CB-hAAT at dosage level of 6 x 10e11 vg/kg
rAAV1-CB-hAAT at dosage level of 1.9 x 10e12 vg/kg
rAAV1-CB-hAAT at dosage level of 6 x 10e12 vg/kg
Outcomes
Primary Outcome Measures
Frequency of Grade 3 or 4 Adverse Events
Secondary Outcome Measures
Changes in Serum M-specific Alpha-1 Antitrypsin Concentration
Results are the mean ± SD for pre-treatment (Screening and Baseline) and Months 6-12 values and mean ± SE for the difference between the pre-treatment and months 6-12 means for 2 subjects in the low dose group and 3 subjects in each of the other two groups. The monoclonal antibody used to determine serum M-specific AAT concentrations has very little cross-reactivity with Z type AAT but cross-reacts strongly with S type AAT, causing results for this assay to be spuriously high for subject 303 in the low dose group.
Changes in Serum Total Alpha-1 Antitrypsin Concentrations
Results are the mean ± SD for pre-treatment (Screening and Baseline) and Months 6-12 data and mean ± SE for the difference between the pre-treatment and months 6-12 means for 3 subjects per group.
Full Information
NCT ID
NCT01054339
First Posted
January 21, 2010
Last Updated
March 18, 2019
Sponsor
Applied Genetic Technologies Corp
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
1. Study Identification
Unique Protocol Identification Number
NCT01054339
Brief Title
Safety & Efficacy Study of rAAV1-CB-hAAT for Alpha-1 Antitrypsin Deficiency
Official Title
A Multiple-Site, Phase 2, Safety and Efficacy Trial of a Recombinant Adeno-associated Virus Vector Expressing Alpha-1 Antitrypsin (rAAV1-CB-hAAT) in Patients With Alpha-1 Antitrypsin Deficiency
Study Type
Interventional
2. Study Status
Record Verification Date
July 2016
Overall Recruitment Status
Completed
Study Start Date
June 2010 (undefined)
Primary Completion Date
October 2011 (Actual)
Study Completion Date
October 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Applied Genetic Technologies Corp
Collaborators
National Heart, Lung, and Blood Institute (NHLBI)
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Assessment of the safety and efficacy of intramuscular (IM) administration of a recombinant adenoassociated virus (rAAV) alpha-1 antitrypsin (AAT) vector (rAAV1-CB-hAAT) in AAT-deficient adults at three dosage levels [6.0 × 10e11, 1.9 × 10e12 and 6.0 × 10e12 vector genome particles (vg) per kg body weight].
Funding Sources - The FDA Office of Orphan Products Development and NIH National Heart, Lung, and Blood Institute
Detailed Description
The study is a non-randomized, open-label, multi-center, sequential, three-arm, Phase 2 clinical trial evaluating the safety and efficacy of administration of a rAAV1-CB-hAAT vector administered by IM injection. Each participant will receive rAAV1-CB-hAAT on a single occasion. Three groups of three subjects each will receive rAAV1-CB-hAAT at dosage levels of 6 x 10e11 vg/kg, 1.9 x 10e12 vg/kg or 6 x 10e12 vg/kg by IM injection. Subjects in group 1 will receive a total of 10 IM injections distributed across a single muscle site, subjects in group 2 will receive a total of 32 IM injections distributed across three muscle sites, and subjects in group 3 will receive 100 IM injections distributed across 10 muscle sites. Each injection will be given in a volume of 1.35 mL, at the appropriate vector concentration to achieve the desired total vector dose.
The three groups were enrolled sequentially, with review of safety data by a Data and Safety Monitoring Board before enrollment of each higher dosage level group.
Safety was monitored by evaluation of adverse events, hematology and clinical chemistry parameters, histological examination of muscle biopsies, and measurement of serum antibodies to AAT. Efficacy was measured by evaluation of serum concentrations of M-specific AAT and total AAT, and serum AAT phenotype determined on isoelectric focusing gels. Additional information collected included presence of the vector in blood or semen, changes in serum anti-AAV antibody titers, and changes in T cell responses to AAV and AAT.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Alpha-1 Antitrypsin Deficiency
Keywords
Alpha-1 antitrypsin deficiency, Adeno-associated virus vector, AAV, Gene therapy, Human gene transfer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
9 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Low dose
Arm Type
Experimental
Arm Description
rAAV1-CB-hAAT at dosage level of 6 x 10e11 vg/kg
Arm Title
Middle dose
Arm Type
Experimental
Arm Description
rAAV1-CB-hAAT at dosage level of 1.9 x 10e12 vg/kg
Arm Title
High dose
Arm Type
Experimental
Arm Description
rAAV1-CB-hAAT at dosage level of 6 x 10e12 vg/kg
Intervention Type
Drug
Intervention Name(s)
rAAV1-CB-hAAT
Intervention Description
Recombinant adeno-associated virus vector expressing human alpha-1 antitrypsin
Primary Outcome Measure Information:
Title
Frequency of Grade 3 or 4 Adverse Events
Time Frame
During 1 year after study agent administration
Secondary Outcome Measure Information:
Title
Changes in Serum M-specific Alpha-1 Antitrypsin Concentration
Description
Results are the mean ± SD for pre-treatment (Screening and Baseline) and Months 6-12 values and mean ± SE for the difference between the pre-treatment and months 6-12 means for 2 subjects in the low dose group and 3 subjects in each of the other two groups. The monoclonal antibody used to determine serum M-specific AAT concentrations has very little cross-reactivity with Z type AAT but cross-reacts strongly with S type AAT, causing results for this assay to be spuriously high for subject 303 in the low dose group.
Time Frame
During months 6-12 after study agent adminsitration
Title
Changes in Serum Total Alpha-1 Antitrypsin Concentrations
Description
Results are the mean ± SD for pre-treatment (Screening and Baseline) and Months 6-12 data and mean ± SE for the difference between the pre-treatment and months 6-12 means for 3 subjects per group.
Time Frame
During months 6-12 after study agent adminstration
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Have a diagnosis of AAT-deficiency, as defined by a serum AAT level of less than 11 µM and a phenotype or genotype either homozygous for PI*Z or compound heterozygous consisting of PI*Z and another allele known to be associated with disease
Be at least 18 and not more than 75 years of age
Have a forced expiratory volume at one second (FEV1) >25% of predicted value (post bronchodilator)
Weigh ≤ 90 kg
Not receiving AAT augmentation therapy currently or with the past 3 months, and not planning to begin such therapy for at least 12 months after administration of rAAV1-CB-hAAT
Be willing to discontinue aspirin, aspirin-containing products, and other drugs that may alter platelet function, 7 days prior to dosing, resuming no earlier than 24 hours after the dose has been administered
Have acceptable laboratory parameters:
Hemoglobin ≥ 11.2 g/dL for females, ≥ 12.8 g/dL for males,
White blood cell count 3,300 - 12,000 cells/mm3,
Platelet count 125,000 - 550,000/mm3,
Serum creatine kinase (CK) ≤ 3 times upper normal range for study laboratory,
Alanine aminotransferase (ALT) ≤ 2 times upper normal range for study laboratory,
Serum bilirubin ≤ 1.5 times upper normal range for study laboratory,
Serum creatinine within normal range for study laboratory,
Prothrombin time (PT) ≤ 14.5 seconds and partial thromboplastin time (PTT)
≤ 36 seconds,
Normal urine dipstick (negative glucose, negative hemoglobin, and negative or trace protein),
For females of childbearing potential:
A negative pregnancy test (urine or serum) at screening and at baseline (within 2 days before administration of study agent)
Agreement to consistently use barrier contraception (condoms, diaphragm or cervical cap with spermicide) or another form of contraception (e.g. intrauterine device or hormonal contraception) from the screening visit until 12 months after administration of rAAV1-CB-hAAT, for sexual activity that could lead to pregnancy
For males of reproductive potential, agreement to consistently use barrier contraception (condoms with spermicide) for 12 months after administration of rAAV1-CB-hAAT, for sexual activity that could lead to pregnancy,
Provide signed informed consent before screening
Exclusion Criteria:
Prior receipt of any AAV gene therapy product
Use of anticoagulants or anti-platelet agents within 7 days prior to study agent administration
History of immune response to human AAT augmentation therapy as indicated by clinical history of an adverse immune response to infusion and/or decreased therapeutic effect in combination with documentation of serum anti-AAT antibodies
Use of acute oral or intravenous antibiotic therapy for a respiratory infection within 28 days prior to study agent administration (long-term maintenance or chronic suppressive oral antibiotics, and antibiotics for a non-respiratory indication, are allowed)
Use of oral or systemic corticosteroids within 28 days prior to study agent administration
Use of any investigational agent, or any immunosuppressive drug(s), within 3 months prior to enrollment
For females of childbearing potential, a positive pregnancy test at screening or baseline (within 2 days before rAAV1-CB-hAAT administration) Note: At the Cincinnati Children's Hospital Medical Center site, women of childbearing potential were not permitted to enroll in the study.
Females who are breast feeding
Have a significant abnormal EKG finding at screening and/or cardiac disease (e.g. recent myocardial infarction or CHF) within past 6 months
Have had pulmonary edema or a pulmonary embolism within the past 6 months
Have a history of immunodeficiency or other medical condition which leads the investigator to believe that the participant cannot comply with the protocol requirements or that may place the participant at an unacceptable risk for participation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Terence R. Flotte, MD
Organizational Affiliation
University of Massachusetts Medical School, Worcester, MA
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Bruce C. Trapnell, MD
Organizational Affiliation
Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Robert A. Sandhaus, MD, PhD
Organizational Affiliation
National Jewish Health, Denver, CO
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Noel G. McElvaney, MB, BCh, BAO
Organizational Affiliation
Beaumont Hospital, Dublin, Ireland
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Jewish Health
City
Denver
State/Province
Colorado
ZIP/Postal Code
80206
Country
United States
Facility Name
University of Massachusetts Medical Center
City
Worcester
State/Province
Massachusetts
ZIP/Postal Code
01655
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Facility Name
Beaumont Hospital
City
Dublin
ZIP/Postal Code
2
Country
Ireland
12. IPD Sharing Statement
Citations:
PubMed Identifier
19706466
Citation
Brantly ML, Chulay JD, Wang L, Mueller C, Humphries M, Spencer LT, Rouhani F, Conlon TJ, Calcedo R, Betts MR, Spencer C, Byrne BJ, Wilson JM, Flotte TR. Sustained transgene expression despite T lymphocyte responses in a clinical trial of rAAV1-AAT gene therapy. Proc Natl Acad Sci U S A. 2009 Sep 22;106(38):16363-8. doi: 10.1073/pnas.0904514106. Epub 2009 Aug 12. Erratum In: Proc Natl Acad Sci U S A. 2009 Oct 13;106(41):17606.
Results Reference
background
PubMed Identifier
21609134
Citation
Flotte TR, Trapnell BC, Humphries M, Carey B, Calcedo R, Rouhani F, Campbell-Thompson M, Yachnis AT, Sandhaus RA, McElvaney NG, Mueller C, Messina LM, Wilson JM, Brantly M, Knop DR, Ye GJ, Chulay JD. Phase 2 clinical trial of a recombinant adeno-associated viral vector expressing alpha1-antitrypsin: interim results. Hum Gene Ther. 2011 Oct;22(10):1239-47. doi: 10.1089/hum.2011.053. Epub 2011 Aug 24.
Results Reference
result
PubMed Identifier
24231351
Citation
Mueller C, Chulay JD, Trapnell BC, Humphries M, Carey B, Sandhaus RA, McElvaney NG, Messina L, Tang Q, Rouhani FN, Campbell-Thompson M, Fu AD, Yachnis A, Knop DR, Ye GJ, Brantly M, Calcedo R, Somanathan S, Richman LP, Vonderheide RH, Hulme MA, Brusko TM, Wilson JM, Flotte TR. Human Treg responses allow sustained recombinant adeno-associated virus-mediated transgene expression. J Clin Invest. 2013 Dec;123(12):5310-8. doi: 10.1172/JCI70314. Epub 2013 Nov 15.
Results Reference
result
Links:
URL
http://agtc.com
Description
Applied Genetic Technologies Corporation
Learn more about this trial
Safety & Efficacy Study of rAAV1-CB-hAAT for Alpha-1 Antitrypsin Deficiency
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