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    Clinical Trial Results:
    A phase I/II, open label, escalating dose, pilot study to assess the effect, safety, tolerability and pharmacokinetics of multiple subcutaneous doses of drisapersen in patients with Duchenne muscular dystrophy and to assess the potential for intravenous dosing as an alternative route of administration

    Summary
    EudraCT number
    2007-004819-54
    Trial protocol
    BE   NL   SE  
    Global end of trial date
    04 Aug 2016

    Results information
    Results version number
    v1
    This version publication date
    23 Mar 2017
    First version publication date
    23 Mar 2017
    Other versions
    v2

    Trial information

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    Trial identification
    Sponsor protocol code
    PRO051-02
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01254019
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    Nederlands Trialregister: NTR1241, Protocol code: DMD114673
    Sponsors
    Sponsor organisation name
    BioMarin Pharmaceutical Inc.
    Sponsor organisation address
    105 Digital Drive, Novato, United States, CA94949
    Public contact
    Clinical Trails Information, BioMarin Pharmaceutical Inc., clinicaltrials@bmrn.com
    Scientific contact
    Clinical Trails Information, BioMarin Pharmaceutical Inc., clinicaltrials@bmrn.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    17 Jan 2017
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    04 Aug 2016
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    Core study: To preliminarily assess the effect of PRO051 at different dose levels in patients with DMD. To assess the safety and tolerability of PRO051 at different dose levels in patients with DMD. To determine the pharmacokinetics of PRO051 at different dose levels after SC administration in patients with DMD. Administration of PRO051 beyond the core study period (SC administration): To assess the effect of PRO051 after SC administration at 6 mg/kg or capped at 300 mg in patients with DMD. To assess the safety and tolerability of PRO051 after SC at 6 mg/kg or capped at 300 mg in patients with DMD. To determine the pharmacokinetics of PRO051 after SC administration at 6 mg/kg in patients with DMD. Administration of PRO051 beyond the core study period (IV administration): IV dosing will be investigated as an alternative route of administration: Please refer to page no.25 of protocol.
    Protection of trial subjects
    Not applicable
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Mar 2008
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Belgium: 7
    Country: Number of subjects enrolled
    Sweden: 5
    Worldwide total number of subjects
    12
    EEA total number of subjects
    12
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    2
    Adolescents (12-17 years)
    10
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    Patient selection will first be based on a search in a coded database with DNA diagnostic data of DMD patients. Patients will be asked for consent and subsequently screened according to the in- and exclusion criteria. Screening includes a full DNA diagnostic report, an interview and the assessments described in the schedule of assessment.

    Period 1
    Period 1 title
    PRO051-02 (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    No

    Arm title
    Received IV Dose
    Arm description
    Received IV Dose
    Arm type
    Experimental

    Investigational medicinal product name
    drisapersen
    Investigational medicinal product code
    BMN051
    Other name
    PRO051, GSK2402968
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use, Subcutaneous use
    Dosage and administration details
    This was an open-label study in which all study subjects received active treatment. All subjects initially received the same dose of drisapersen (6 mg/kg/week) either S.C. or I.V. in the Continued Treatment phase.

    Arm title
    Received SC Dose
    Arm description
    Received SC Dose
    Arm type
    Experimental

    Investigational medicinal product name
    drisapersen
    Investigational medicinal product code
    BMN051
    Other name
    PRO051, GSK2402968
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use, Subcutaneous use
    Dosage and administration details
    This was an open-label study in which all study subjects received active treatment. All subjects initially received the same dose of drisapersen (6 mg/kg/week) either S.C. or I.V. in the Continued Treatment phase.

    Number of subjects in period 1
    Received IV Dose Received SC Dose
    Started
    10
    12
    Completed
    0
    0
    Not completed
    10
    12
         Consent withdrawn by subject
    -
    1
         Other
    10
    11

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Received IV Dose
    Reporting group description
    Received IV Dose

    Reporting group title
    Received SC Dose
    Reporting group description
    Received SC Dose

    Reporting group values
    Received IV Dose Received SC Dose Total
    Number of subjects
    10 12 12
    Age categorical
    Units: Subjects
        Age <= 7 years
    0 0 0
        Age > 7 and <= 12 years
    4 4 4
        Age > 12 years
    6 8 8
    Age continuous
    Units: Years
        arithmetic mean (standard deviation)
    13.3 ± 2.36 13.3 ± 2.14 -
    Gender categorical
    Units: Subjects
        Female
    0 0 0
        Male
    10 12 12
    Weight
    Units: kg
        arithmetic mean (standard deviation)
    35.5 ± 14.17 36.2 ± 12.96 -
    Length
    Units: cm
        arithmetic mean (standard deviation)
    130.5 ± 11.88 130.8 ± 11.1 -

    End points

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    End points reporting groups
    Reporting group title
    Received IV Dose
    Reporting group description
    Received IV Dose

    Reporting group title
    Received SC Dose
    Reporting group description
    Received SC Dose

    Primary: 6 MWD

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    End point title
    6 MWD [1]
    End point description
    The safety data provided for this study is split per route of administration, IV or SC. This gives the appearance of there having been 2 arms, but in this study, all subjects could have received both SC and IV administrations. Therefore the efficacy information should be represented as a single arm. Counts of 0 have been inserted for 2 arms for the primary efficacy endpoint, as a value is required by the system. The total distance walked in 6 minutes throughout the extension phase is represented for each subject in the attached chart.
    End point type
    Primary
    End point timeframe
    Long term extension study
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Summary statistics have been presented by visit where applicable.
    End point values
    Received IV Dose Received SC Dose
    Number of subjects analysed
    10
    12
    Units: Meter
    0
    0
    Attachments
    6MWD data 673
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Study Period
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    Received IV Dose
    Reporting group description
    -

    Reporting group title
    Received SC Dose
    Reporting group description
    -

    Serious adverse events
    Received IV Dose Received SC Dose
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 10 (40.00%)
    0 / 12 (0.00%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    Investigations
    Transaminases increased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Femur fracture
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Hypotension
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Gastritis
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Psychiatric disorders
    Suicide attempt
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Received IV Dose Received SC Dose
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    10 / 10 (100.00%)
    12 / 12 (100.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Hypotension
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Surgical and medical procedures
    Central venous catheterisation
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Tooth extraction
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Wisdom teeth removal
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    Atrophy
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Chills
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Device occlusion
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 12 (16.67%)
         occurrences all number
    1
    2
    Discomfort
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Extravasation
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Fatigue
         subjects affected / exposed
    1 / 10 (10.00%)
    3 / 12 (25.00%)
         occurrences all number
    1
    3
    Fibrosis
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Gait disturbance
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Inflammation
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Influenza like illness
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    2
    Injection site atrophy
         subjects affected / exposed
    5 / 10 (50.00%)
    6 / 12 (50.00%)
         occurrences all number
    8
    18
    Injection site bruising
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Injection site calcification
         subjects affected / exposed
    4 / 10 (40.00%)
    7 / 12 (58.33%)
         occurrences all number
    5
    15
    Injection site discolouration
         subjects affected / exposed
    0 / 10 (0.00%)
    3 / 12 (25.00%)
         occurrences all number
    0
    7
    Injection site erythema
         subjects affected / exposed
    5 / 10 (50.00%)
    5 / 12 (41.67%)
         occurrences all number
    6
    8
    Injection site haematoma
         subjects affected / exposed
    2 / 10 (20.00%)
    4 / 12 (33.33%)
         occurrences all number
    2
    15
    Injection site induration
         subjects affected / exposed
    4 / 10 (40.00%)
    8 / 12 (66.67%)
         occurrences all number
    5
    22
    Injection site inflammation
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Injection site irritation
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Injection site pain
         subjects affected / exposed
    0 / 10 (0.00%)
    3 / 12 (25.00%)
         occurrences all number
    0
    4
    Injection site pruritus
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Injection site rash
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Injection site reaction
         subjects affected / exposed
    1 / 10 (10.00%)
    4 / 12 (33.33%)
         occurrences all number
    1
    5
    Injection site swelling
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Injection site ulcer
         subjects affected / exposed
    2 / 10 (20.00%)
    2 / 12 (16.67%)
         occurrences all number
    3
    2
    Injection site vesicles
         subjects affected / exposed
    0 / 10 (0.00%)
    3 / 12 (25.00%)
         occurrences all number
    0
    3
    Local swelling
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Mass
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Pain
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Pyrexia
         subjects affected / exposed
    3 / 10 (30.00%)
    1 / 12 (8.33%)
         occurrences all number
    4
    1
    Swelling
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Ulcer
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    4 / 10 (40.00%)
    1 / 12 (8.33%)
         occurrences all number
    6
    1
    Epistaxis
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    3
    Oropharyngeal pain
         subjects affected / exposed
    2 / 10 (20.00%)
    5 / 12 (41.67%)
         occurrences all number
    4
    5
    Productive cough
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Psychiatric disorders
    Anger
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Depression
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Insomnia
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Investigations
    Activated partial thromboplastin time prolonged
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Alanine aminotransferase increased
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Albumin urine present
         subjects affected / exposed
    4 / 10 (40.00%)
    0 / 12 (0.00%)
         occurrences all number
    5
    0
    Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Blood albumin decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Blood alkaline phosphatase increased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Blood creatinine decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Blood fibrinogen increased
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Blood iron decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    C-reactive protein increased
         subjects affected / exposed
    5 / 10 (50.00%)
    6 / 12 (50.00%)
         occurrences all number
    13
    8
    Complement factor C3 decreased
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Complement factor decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Cystatin C abnormal
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Cystatin C increased
         subjects affected / exposed
    8 / 10 (80.00%)
    2 / 12 (16.67%)
         occurrences all number
    11
    2
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Globulin urine present
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Glutamate dehydrogenase increased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Haematocrit decreased
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Haemoglobin decreased
         subjects affected / exposed
    6 / 10 (60.00%)
    1 / 12 (8.33%)
         occurrences all number
    11
    1
    Haptoglobin increased
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Light chain analysis increased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Mean cell haemoglobin concentration decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Mean cell haemoglobin decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Monocyte count increased
         subjects affected / exposed
    4 / 10 (40.00%)
    1 / 12 (8.33%)
         occurrences all number
    5
    1
    Platelet count decreased
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Protein urine present
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Red blood cell count decreased
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Red blood cells urine
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Red blood cells urine positive
         subjects affected / exposed
    4 / 10 (40.00%)
    0 / 12 (0.00%)
         occurrences all number
    6
    0
    Transferrin decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Transferrin saturation decreased
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Urine albumin/creatinine ratio increased
         subjects affected / exposed
    4 / 10 (40.00%)
    0 / 12 (0.00%)
         occurrences all number
    6
    0
    Urine protein/creatinine ratio increased
         subjects affected / exposed
    6 / 10 (60.00%)
    1 / 12 (8.33%)
         occurrences all number
    18
    1
    Vitamin B6 abnormal
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    White blood cell count increased
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    White blood cells urine positive
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Injury, poisoning and procedural complications
    Concussion
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Contusion
         subjects affected / exposed
    3 / 10 (30.00%)
    2 / 12 (16.67%)
         occurrences all number
    5
    2
    Femur fracture
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Foot fracture
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Heat stroke
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Infusion related reaction
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Joint dislocation
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Joint injury
         subjects affected / exposed
    0 / 10 (0.00%)
    2 / 12 (16.67%)
         occurrences all number
    0
    2
    Limb injury
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Lower limb fracture
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Nail injury
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Procedural pain
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Tibia fracture
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Ulna fracture
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Wound
         subjects affected / exposed
    4 / 10 (40.00%)
    2 / 12 (16.67%)
         occurrences all number
    7
    2
    Cardiac disorders
    Bundle branch block left
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Left ventricular failure
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Supraventricular tachycardia
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Tachycardia
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Ventricular tachycardia
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    2 / 10 (20.00%)
    2 / 12 (16.67%)
         occurrences all number
    2
    3
    Headache
         subjects affected / exposed
    5 / 10 (50.00%)
    3 / 12 (25.00%)
         occurrences all number
    17
    8
    Hypokinesia
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Migraine
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Migraine with aura
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Paraesthesia
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Thrombocytopenia
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    6
    2
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Vertigo
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Eye disorders
    Cataract
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Panophthalmitis
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Gastrointestinal disorders
    Abdominal discomfort
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    2
    Abdominal pain
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Abdominal pain upper
         subjects affected / exposed
    3 / 10 (30.00%)
    3 / 12 (25.00%)
         occurrences all number
    6
    3
    Constipation
         subjects affected / exposed
    4 / 10 (40.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Diarrhoea
         subjects affected / exposed
    2 / 10 (20.00%)
    3 / 12 (25.00%)
         occurrences all number
    2
    4
    Epigastric discomfort
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Gastritis
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Gastrointestinal disorder
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    2
    Gingival pain
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Haemorrhoids
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Inguinal hernia
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Nausea
         subjects affected / exposed
    3 / 10 (30.00%)
    1 / 12 (8.33%)
         occurrences all number
    4
    1
    Oesophageal pain
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Toothache
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Vomiting
         subjects affected / exposed
    5 / 10 (50.00%)
    4 / 12 (33.33%)
         occurrences all number
    7
    8
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    1 / 10 (10.00%)
    3 / 12 (25.00%)
         occurrences all number
    1
    3
    Dry skin
         subjects affected / exposed
    0 / 10 (0.00%)
    2 / 12 (16.67%)
         occurrences all number
    0
    2
    Eczema
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Erythema
         subjects affected / exposed
    3 / 10 (30.00%)
    1 / 12 (8.33%)
         occurrences all number
    4
    2
    Hair texture abnormal
         subjects affected / exposed
    0 / 10 (0.00%)
    2 / 12 (16.67%)
         occurrences all number
    0
    2
    Ingrowing nail
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    3
    1
    Keratosis pilaris
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Madarosis
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 12 (16.67%)
         occurrences all number
    1
    3
    Pruritus
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 12 (16.67%)
         occurrences all number
    1
    3
    Rash
         subjects affected / exposed
    2 / 10 (20.00%)
    2 / 12 (16.67%)
         occurrences all number
    2
    3
    Skin discolouration
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Skin lesion
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Skin mass
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Skin ulcer
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    2
    1
    Renal and urinary disorders
    Albuminuria
         subjects affected / exposed
    6 / 10 (60.00%)
    6 / 12 (50.00%)
         occurrences all number
    12
    6
    Microalbuminuria
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Proteinuria
         subjects affected / exposed
    10 / 10 (100.00%)
    7 / 12 (58.33%)
         occurrences all number
    41
    11
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    5 / 10 (50.00%)
    1 / 12 (8.33%)
         occurrences all number
    8
    1
    Back pain
         subjects affected / exposed
    4 / 10 (40.00%)
    1 / 12 (8.33%)
         occurrences all number
    4
    1
    Clubbing
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Groin pain
         subjects affected / exposed
    2 / 10 (20.00%)
    0 / 12 (0.00%)
         occurrences all number
    3
    0
    Muscle spasms
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 12 (16.67%)
         occurrences all number
    1
    2
    Muscle tightness
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Muscular weakness
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Musculoskeletal stiffness
         subjects affected / exposed
    1 / 10 (10.00%)
    2 / 12 (16.67%)
         occurrences all number
    1
    2
    Pain in extremity
         subjects affected / exposed
    4 / 10 (40.00%)
    3 / 12 (25.00%)
         occurrences all number
    8
    5
    Tendon pain
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Conjunctivitis
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Ear infection
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Fungal infection
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Fungal skin infection
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    2
    Gastroenteritis
         subjects affected / exposed
    1 / 10 (10.00%)
    7 / 12 (58.33%)
         occurrences all number
    2
    8
    Gastrointestinal infection
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Infection
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Influenza
         subjects affected / exposed
    2 / 10 (20.00%)
    1 / 12 (8.33%)
         occurrences all number
    3
    1
    Injection site abscess
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    2
    Injection site infection
         subjects affected / exposed
    3 / 10 (30.00%)
    0 / 12 (0.00%)
         occurrences all number
    4
    0
    Injection site pustule
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    2
    0
    Localised infection
         subjects affected / exposed
    3 / 10 (30.00%)
    2 / 12 (16.67%)
         occurrences all number
    3
    2
    Nail infection
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Nasopharyngitis
         subjects affected / exposed
    6 / 10 (60.00%)
    4 / 12 (33.33%)
         occurrences all number
    11
    5
    Onychomycosis
         subjects affected / exposed
    2 / 10 (20.00%)
    4 / 12 (33.33%)
         occurrences all number
    2
    4
    Oral fungal infection
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Respiratory tract infection
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    2
    Rhinitis
         subjects affected / exposed
    0 / 10 (0.00%)
    2 / 12 (16.67%)
         occurrences all number
    0
    2
    Sinusitis
         subjects affected / exposed
    0 / 10 (0.00%)
    1 / 12 (8.33%)
         occurrences all number
    0
    1
    Skin infection
         subjects affected / exposed
    2 / 10 (20.00%)
    2 / 12 (16.67%)
         occurrences all number
    2
    2
    Tinea versicolour
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 10 (30.00%)
    5 / 12 (41.67%)
         occurrences all number
    6
    13
    Wound infection
         subjects affected / exposed
    1 / 10 (10.00%)
    1 / 12 (8.33%)
         occurrences all number
    1
    1
    Wound infection staphylococcal
         subjects affected / exposed
    1 / 10 (10.00%)
    0 / 12 (0.00%)
         occurrences all number
    1
    0

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    02 Sep 2009
    Changes in safety parameters for potential adverse effects of drisapersen in the treatment beyond study period (Continued Treatment phase). These changes included addition of measurements of troponin, fibrinogen, haptoglobin and CRP plus extra measurements of aPTT, cystatin C and ECG recordings, and Addition of echocardiography. Minor formatting and typographical errors to improve the clarity and accuracy of the protocol text. Assessment of drisapersen levels in muscle tissue was to be assessed at the Prosensa laboratory in the remaining material from the muscle biopsy after the results were obtained for the mRNA production and dystrophin expression in the muscle tissue. However, this assessment was not performed as the assay was still being optimized. drisapersen levels in the remaining muscle tissue were to be measured at a later time point and the results reported separately. The anti-dystrophin antibody assay was planned to detect potential IgM and IgG antibodies against dystrophin. IgM antibodies were however not assessed. Different to the original protocol, an assay for IgG but not IgM anti-dystrophin reactivity was performed, because IgM control dystrophin antibodies were not available. Formation of antibodies to dystrophin in blood was to be determined at Visits 13, 25, 37 and 61.
    16 Jul 2010
    • Enhanced safety monitoring. • Addition of stopping criteria. • Addition of alternative injection sites for drug administration. • Addition of DEXA scans. • Additional muscle biopsy at 12 months. • Dose capping according to weight. • Allowance for intermittent dosing for any subject reaching any of the study stopping criteria. • Addition of a parent questionnaire. • Change in Clinical Research Manager. • Other minor clarification and corrections. The enhanced safety monitoring was to enable the Sponsor to closely monitor for early signs of potentially drug-related hepatotoxicity and nephrotoxicity as well as thrombocytopenia. Enhanced monitoring consisted of more frequent assessments as well as some changes to the parameters themselves e.g. addition of glutamate dehydrogenase, albumin/globulin ratio and PTT (international normalized ratio [INR]). Changes to urinalysis parameters were also made including removal of the dipstick analysis, and addition of quantitative analysis of glucose, albumin, protein, creatinine, 1 microglobulin, protein/creatinine ratio and microscopy of urine sediment for erythrocytes, leukocytes and casts. The requirement for troponin I concentrations (introduced in Amendment 5) was removed as the relationship of any change in troponin levels in DMD patients (which may be very variable) is not understood relative to any cardiac condition (personal communication, Kate Bushby, Professor of Neuromuscular Genetics, Newcastle University), and were considered to be unlikely to be useful in detecting incipient cardiac damage.
    15 Nov 2010
    Further additions to the enhanced safety monitoring implemented in Amendment 6. •Additional detail for stopping criteria. •Change in dosing regimen for all subjects. •Addition of pre-dose pharmacokinetic sampling on a monthly basis from Visit 85 (or as soon as approval of Amendment 7). Ad hoc pharmacokinetic sampling. •Additional instructions on the assessment of local injection site reactions. •Change in blood volumes. •Additions to safety monitoring. •Muscle function (adjustment in visit schedule) •Other minor clarifications and corrections. The amended dosing regimen involved an 8 week washout period for all subjects (Visits 86-93 inclusive). Subjects were then restarted on an intermittent regimen involving 8 weeks of once weekly treatment followed by 4 weeks off drug. New safety monitoring included addition of blood smear for schistocytes (haematology), kidney injury molecule-1 (KIM-1) and cystatin C (urinalysis) and MCP 1 (inflammatory response). Fibrin split products and D dimer were also to be assessed if predefined criteria were met.
    09 Mar 2011
    • Extension of the study until 2013. • Change in frequency of efficacy measured in order to reduce the • burden on the subjects. • Change in visit schedule in order to reduce the travel burden on the • families. • Change in blood volumes. • Other minor clarifications and corrections. The frequency of the efficacy measures was changed to every 12 weeks in order to fit in with the new assessment schedule and to assess the effect of the intermittent dosing regimen introduced in Amendment 7. Subjects did not have to return to the hospital for laboratory safety testing during the 4 week treatment break unless there was a medical/safety concern, in which case the subject would be asked to return for further monitoring as determined by the investigator.
    14 Apr 2011
    •Change in legal sponsorship from Prosensa Therapeutics B.V. to GlaxoSmithKline (implemented on 21 July 2011). •Change in supply of drisapersen. •Change in frequency of cystatin C measurements to enhance safety monitoring (every 4 weeks rather than every 12 weeks). •Other minor clarifications and corrections.
    10 Aug 2011
    •Enhanced safety monitoring and stopping criteria. •Enhanced monitoring and stopping criteria for inflammation. •Modified stopping criteria for coagulation. •Modified stopping criteria for hepatic toxicity. •Change in primary medical contact. •Change in definition of serious adverse events (SAEs). •Other minor clarifications
    17 May 2012
    •Enhanced safety monitoring and stopping criteria •Enhanced renal monitoring •Modified renal stopping criteria •Clarification to the Disseminated Intravascular Coagulation criteria •Update sponsor signature page •Change in Definition of AEs •Change in study schedule for taking subject height and weight / Parent questionnaire added to flowchart •Option to return to weekly dosing at 6 mg/kg drisapersen
    01 Dec 2012
    1. Updated protocol title to include intravenous dosing as an alternative route of administration. 2. Inclusion of intravenous dose escalation (0.5 mg/kg, 2.0 mg/kg and 6 mg/kg) over a 4 hour infusion period • Reduction of infusion time to 2 hours • Reduction of infusion time to 1 hour. 3. Added text to better describe the treatment beyond study period • Added text for intravenous administration. 4. Laboratory Safety Parameter Stopping and Follow-up Criteria • Added text for ECG 5. Other minor clarifications and corrections.
    12 Jul 2013
    The amendment will assess the potential for intravenous dosing of PRO051 as an alternative route of administration. A summary of the changes is provided below. 1. Update sponsor signatory details 2. Increased length of study 3. Adjustment of blood volumes 4. Addition of informed consent for subjects 18 years of age 5. Update to Safety Laboratory: a. removal of several biomarker tests (- exploratory biomarkers not used in clinical practice which have not provided an additional positive effect with respect to safety monitoring) b. renal criteria timing c. removal of echocardiography (acknowledgement that this continues to be part of the subjects’ clinical standard of care) d. removal of DEXA (has been less informative than hoped) e. removal of antibody to dystrophin determination (subjects have now had long term exposure without positive antibodies to dystrophin, so extended monitoring not required) 6. Addition of a second central laboratory 7. Other minor clarifications and corrections
    09 Oct 2013
    Instructions for investigators for subject management during the time period while dosing is on hold per drisapersen Dear Investigator Letter dated 20 September 2013

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    24 Sep 2013
    This substantial amendment is to request a temporary halt of study PRO051-02. This is due to data recently obtained from study DMD114044 (a double-blind, placebo-controlled, Phase III study) in which a total of 186 boys were randomised to drisapersen at a dose of 6mg/kg/week (N=125) or placebo (N=61) via subcutaneous injection over 48 weeks. The difference in the primary endpoint of 6 minute walking distance between drisapersen and placebo groups did not reach statistical significance. There was no treatment difference in key secondary assessments. In addition, a greater proportion of subjects in the drisapersen treatment group reported injection site and renal adverse events compared to placebo. In other studies, severe thrombocytopenia has been reported in drisapersen-treated subjects. GSK are committed to fully analyzing the data in order to determine whether there may be a favourable benefit to risk profile for a subgroup of subjects. Full evaluation of the benefit-to-risk profile of drisapersen treatment across all studies is anticipated to be completed by the end of 2013. Until then, all dosing in ongoing drisapersen studies including PRO051-02 has been halted.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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