E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Stargardt Macular Degeneration, also known as Stargardt Macular Dystrophy, fundus flavimaculatus or Stargardt disease. |
|
E.1.1.1 | Medical condition in easily understood language |
Inherited juvenile macular degeneration, leading to deterioration of central vision, and legally-defined blindness in young adults. |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Eye Diseases [C11] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10062766 |
E.1.2 | Term | Stargardt's disease |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
|
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the safety and tolerability of ascending doses of SAR422459 in patients with Stargardt's Macular Degeneration. |
|
E.2.2 | Secondary objectives of the trial |
To evaluate for possible biological activity of SAR422459. |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
-Signed and dated written informed consent obtained from the patient and/or the patient's legally acceptable representative.
-Diagnosis of Stargardt's Macular Degeneration (SMD), with at least one pathogenic mutant ABCA4 allele on each chromosome.
-Women of childbearing potential must have a negative pregnancy test at Day -1, and agree to use an effective form of contraception for at least three months, or be surgically sterile or postmenopausal, with the last menstrual period being over two years prior to enrollment .
-Males must agree with their partner to use two forms of contraception for at least three months following SAR422459 administration.
-Patients must agree to not donate blood, organs, tissues or cells for at least three months following SAR422459 administration
-Patients enrolled in France must be affiliated to or benefit from a social security regimen.
-Specific Inclusion Criteria Patient Group A:
-Patients (18 years or older) with Advanced Stargardt's Macular degeneration.
-Visual acuity ≤20/200 in the worst eye
-Severe cone-rod dysfunction with no detectable or severely abnormal full-field electroretinogram responses.
-Specific Inclusion Criteria Patient Group B:
-Patients (18 years or older) with Stargardt’s Macular Degeneration.
-Visual Acuity ≤20/200 in the worst eye.
-Abnormal full-field electroretinogram responses.
-Specific Inclusion Criteria Patient Group C:
-Patients (18 years or older) with Stargardt’s Macular Degeneration.
-Visual acuity ≤20/100 in the worst eye.
-Abnormal full-field electroretinogram responses.
-Specific Inclusion Criteria Patient Group D:
-Symptomatic patients (from 6 years to 26 years old) with early or childhood-onset SMD (age at disease onset < 18 years) with at least one pathogenic mutant ABCA4 allele on each chromosome confirmed by direct sequencing and co-segregation analysis within the patient’s family.
-Visual acuity of ≥20/200 in both eyes at the time of the screening visit.
-Patients are anticipated to experience rapid deterioration in visual function and/or retinal structure as determined by an annual progression rate in at least one of the following parameters occurring in at least one eye (assessments recorded up to 2 years prior to the screening visit date may be considered to document evidence of rapid deterioration):
-Loss of ≥1 line of Snellen visual acuity (equivalent to 5 ETDRS letters).
-Reduction in macular mean sensitivity of ≥1.2 dB as assessed by microperimetry.
-Reduction in macular mean sensitivity of ≥5 dB or reduction in hill of vision by >14 dB-sr as assessed by static perimetry.
-Enlargement in the area of macular RPE atrophy by fundus autofluorescence at a rate of ≥0.5 mm^2.
-Enlargement in the area of central macular retinal thinning/photoreceptor loss by ocular coherence tomography at a rate of ≥0.5 mm^2.
-All eligible patients must demonstrate an ability to understand, willingness to cooperate and ability to reliably perform required study procedures as judged and confirmed by the study investigator.
- Specific inclusion criteria Patient Group E
-Symptomatic patients (between 6 years and 17 years old) with early or childhood-onset SMD with at least one pathogenic mutant ABCA4 allele on each chromosome confirmed by direct sequencing and co-segregation analysis within the patient's family.
-Visual acuity of ≥20/100 in both eyes at the time of screening visit.
-Patients are anticipated to experience rapid deterioration in visual function and/or retinal structure as determined by an annual progression rate in at least one of the following parameters occurring in at least one eye (assessments recorded up to 2 years prior to the screening visit date may be considered to document evidence of rapid deterioration):
-Loss of ≥1 line of Snellen visual acuity (equivalent to 5 ETDRS letters).
-Reduction in macular mean sensitivity of ≥1.2 dB as assessed by microperimetry.
-Reduction in macular mean sensitivity of ≥5 dB or reduction in hill of vision by >14 dB-sr as assessed by static perimetry.
-Enlargement in the area of macular RPE atrophy by fundus autofluorescence at a rate of ≥0.5 mm2.
-Enlargement in the area of central macular retinal thinning/photoreceptor loss by ocular coherence tomography at a rate of ≥0.5 mm2.
-All eligible patients must demonstrate an ability to understand, willingness to cooperate and ability to reliably perform required study procedures as judged and confirmed by the study investigator.
|
|
E.4 | Principal exclusion criteria |
-Pre-existing eye conditions that would preclude the planned surgery or interfere with the interpretation of study endpoints.
-Cataract surgery with intraocular lens implantation within 6 months of enrolment.
-Aphakia or prior vitrectomy in the study eye.
-Concomitant systemic diseases including those in which the disease itself, or the treatment for the disease, can alter ocular function.
-Any intraocular surgery or laser in either eye planned within 6 months of Day 0.
-Any contraindication to pupil dilation in either eye.
-Any known allergy to any component of the delivery vehicle or diagnostic agents used during the study, or medications planned for use in the peri-operative period, particularly topical, injected or systemic corticosteroids.
-Any injectable intravitreal treatment to the treated eye or intravitreal device in the treated eye within 6 months prior to screening.
-Any periocular injections of corticosteroids to the treated eye within 4 months prior to screening.
-Laboratory test abnormalities or abnormalities in electrocardiogram, chest X rays that in the opinion of the principal investigator, would make the patient unsuitable for participation in the study.
-Significant intercurrent illness or infection during the 28 days prior to enrolment.
-Pre-menopausal or non-surgically sterile women who are unwilling to use an effective form of contraception such as the contraceptive pill or intrauterine device.
-Alcohol or other substance abuse.
-Contraindications to use of anaesthesia (local or general, as appropriate).
-Concurrent anti-retroviral therapy that would inactivate the investigational agent.
-History of any investigational agent within 28 days prior to SAR422459 administration.
-Participation in a prior ocular gene transfer therapy study.
-Enrollment in any other clinical treatment study throughout the duration of the SAR422459 study.
-Current or anticipated treatment with anticoagulant therapy or the use of anticoagulation therapy within the four weeks prior to surgery.
-A past medical history of human immunodeficiency virus (HIV) or hepatitis A, B or C infection.
-Women who are pregnant or are breastfeeding.
-History or signs consistent with unilateral amblyopia (strabismic, anisometropic or stimulus deprivation). |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Number of patients with treatment emergent adverse events
Change from baseline in ocular safety assessments
Measured as change from baseline in Best Corrected Visual Acuity, Slit-lamp, Ophthalmoscopy, Fundus Photography, Intraocular Pressure, Microperimetry, full-field static and kinetic perimetry, OCT and ERG
|
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
Delay in retinal degeneration
Measured as change from baseline in function relative to untreated contralateral eye on: BCVA, microperimetry, full-field static/kinetic perimetry, OCT and FAF |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Yes |
E.7.1.1 | First administration to humans | Yes |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
Will this trial be conducted at a single site globally?
| Yes |
E.8.4 | Will this trial be conducted at multiple sites globally? | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |
France |
Italy |
Netherlands |
United States |
|
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
Last visit last subject in the trial |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.2 | In all countries concerned by the trial years | 8 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |