E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Spinal Muscular Atrophy |
Spinale spieratrofie |
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E.1.1.1 | Medical condition in easily understood language |
motor neuron disease |
motor neuron ziekte |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
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 |
Part 1
To determine the safety and tolerability of ascending weekly doses and estimate the MTD of oral/enteral LMI070 in infants with type 1 SMA.
Part 2
To evaluate the safety and tolerability of multiple dose weekly regimens of oral/enteral LMI070 for 12 weeks in patients with type 1 SMA. |
Deel 1
De veiligheid en verdraagbaarheid van toenemende wekelijkse doses te bepalen en de MTD van oraal/enteraal LMI070 bij baby’s met type 1 SMA te schatten.
Deel 2
De veiligheid en verdraagbaarheid van meerdere dosisschema’s van oraal/enteraal LMI070 te evalueren gedurende 12 weken bij patiënten met type 1 SMA. |
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E.2.2 | Secondary objectives of the trial |
Part 1
-To evaluate LMI070 pharmacokinetics in serum after single and repeated doses of LMI070.
-To evaluate the effect of LMI070 on muscle by ultrasound.
-To evaluate the effect of LMI070 on growth parameters.
-To evaluate the effect of LMI070 on respiratory function
-To evaluate the effect of LMI070 on infant motor development.
Part 2:
-To evaluate the efficacy of LMI070 on motor and developmental milestones
-To evaluate the efficacy of LMI070 on ulnar nerve compound action potential [CMAP] (optional) |
Deel 1
- De farmacokinetiek van LMI070 in het serum evalueren na één dosis en herhaalde doses van LMI070.
- Het effect van LMI070 op de spier evalueren op basis van echografie.
- Het effect van LMI070 op groeiparameters evalueren
- Het effect van LMI070 op de ademhalingsfunctie evalueren
- Het effect van LMI070 op de motorische ontwikkeling van de baby evalueren.
Deel 2
- De werkzaamheid van LMI070 op mijlpalen van de motoriek en ontwikkeling evalueren
- De werkzaamheid van LMI070 op de samengestelde actiepotentiaal (compound muscle action potential; CMAP) van de nervus ulnaris evalueren (optioneel) |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Written informed consent must be obtained from the parent / guardian before any assessment is performed.
- Type 1 SMA, diagnosed clinically (symptom onset <6 months of age) and confirmed genetically (homozygous SMN1 gene deletion or mutation) plus SMN2 copy number of 2.
- Best supportive care in place and stable for at least 14 days before screening.
- Age at screening between 1 and 7 months, plus or minus 2 weeks.
- Must be able to demonstrate antigravity strength in both biceps.
- Must have or agree to have placement of feeding tube for enteral access via nasogastric (NG), nasojejunal (NJ), percutaneous gastrostomy (PEG), or percutaneous jejunostomy (PEJ) tube. |
- Er moet een schriftelijke toestemming zijn verkregen van de ouderr/voogd voordat er onderzoeksprocedures worden uitgevoerd.
- Type 1 SMA, klinisch gediagnostiseerd (ontstaan van symptomen <6 maanden oud) en genetisch bevestigd (homozygote deletie of mutatie van SMN1-gen) plus 2 kopieën van SMN2.
- Aanwezigheid goede ondersteunende zorg en is stabiel gedurende ten minste 14 dagen vóór de screening.
- Leeftijd bij screening tussen 1 en 7 maanden ± 2 weken.
- Moet in staat zijn aan te tonen dat beide biceps sterker zijn dan de zwaartekracht.
- Moet een voedingssonde hebben of instemmen met de plaatsing daarvan voor enterale toegang via een nasogastrische (NG), nasojejunale (NJ), percutane gastrostomie (PEG) of percutane jejunostomiesonde (PEJ). |
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E.4 | Principal exclusion criteria |
- Use of other investigational drugs within 14 days.
- Neurologic, neuromuscular or genetic disorders other than SMA
- Anemia (Hgb < 8 g/dL), leukopenia (ANC < 2000/ml), or thrombocytopenia (< 100,000/mL).
- Hepatic dysfunction (AST or ALT > 1.5 x ULN; total bilirubin > ULN).
- Renal dysfunction (eGFR < 80 ml/min).
- Clinically significant abnormalities in hematology or clinical chemistry parameters, as assessed by the Site Investigator, at screening that would render the subject unsuitable for inclusion
- Hypoxemia (O2 saturation awake <92% or O2 saturation asleep <91%,without ventilation support) or requiring oral suctioning >2 per day
- Presence of an untreated or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy at any time during the screening period.
- Excluding SMA, any medically unstable condition including cardiomyopathy, hepatic dysfunction, kidney disorder, endocrine disorder, GI disorders, prematurity of <32 weeks gestation, metabolic disorders, severe respiratory compromise and significant brain abnormalities or injuries including hypoxic-ischemic encephalopathy.
- Ongoing medical condition that according to the Site Investigator would interfere with the conduct and assessments of the study. Examples are medical disability other than SMA that would interfere withthe assessment of safety or would compromise the ability of the subject to undergo study procedures including be assessed by CHOP-INTEND motor scale. |
- Gebruik van andere onderzoeksmiddelen binnen 14 dagen.
- Andere neurologische, neuromusculaire of genetische aandoeningen dan SMA.
- Anemie (Hb <8 g/dl), leukopenie (absolute neutrofielentelling < 2000/ml) of trombocytopenie (< 100.000/ml).
- Leverinsufficiëntie (ASAT of ALAT > 1,5 x bovengrens van de normaalwaarde; totale bilirubine > bovengrens van de normaalwaarde).
- Nierinsufficiëntie (eGFR < 80 ml/min).
- Klinisch significante afwijkingen in parameters van de hematologie of klinische chemie bij de screening, zoals beoordeeld door de onderzoeker van het centrum, die de proefpersoon ongeschikt zouden maken voor inclusie
- Hypoxemie (zuurstofverzadiging wakker <92% of zuurstofverzadiging in slaap <91% zonder ondersteuning van een beademingsapparaat) of orale suctie >2 keer per dag nodig
- Aanwezigheid van een onbehandelde of onvoldoende behandelde actieve infectie waarvoor een systemische antivirale of antibacteriële behandeling nodig is op enig moment tijdens de screeningperiode.
- Een medisch onstabiele aandoening, met uitzondering van SMA, waaronder cardiomyopathie, leverinsufficiëntie, nieraandoening endocriene stoornis, maag-darmstelselaandoeningen, prematuur geboren (<32 weken zwangerschap), stofwisselingsstoornissen, ernstige ademhalingsproblemen en belangrijke hersenafwijkingen of hersenletsel waaronder hypoxisch-ischemische encefalopathie.
- Huidige medische aandoening die naar het oordeel van de onderzoeker van het centrum de uitvoering en beoordelingen van het onderzoek zou verstoren. Voorbeelden hiervan zijn een medische handicap (met uitzondering van SMA) die de beoordeling van de veiligheid zou verstoren of het vermogen van de proefpersoon om onderzoeksprocedures te ondergaan negatief zou beïnvloeden, waaronder evaluatie aan de hand van de CHOP-INTEND motoriekschaal. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary endpoints Part 1:
Physical Exam: Screening, D1 – D85 + EOS
Vital signs: Screening, D1 – D85 + EOS
ECG: Screening, D1, D8, D85 + EOS
Safety: Screening, Baseline, D3, D8, D15, D29, D43, D57, D71, D85 + EOS
Adverse Events: All Visits
Primary endpoints Part 2:
Physical Exam: Screening, Baseline, D1 – D88 + EOS
Vital signs: Screening, Baseline, D1 – D88 + EOS
ECG: Screening, D1, D8, D88 + EOS
Safety: Screening, Baseline, D8, d15, D2, D29, D36, D43, D50, D57, D64, D71, D88 + EOS
Adverse Events: All Visits
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Primaire eindpunten Deel 1:
Lichamelijk onderzoek: Screening, D1 - D85 + EOS
Vitale functies: Screening, D1 - D85 + EOS
ECG: Screening, D1, D8, D85 + EOS
Veiligheid: Screening, Baseline, D3, D8, D15, D29, D43, D57, D71, D85 + EOS
Bijwerkingen: Alle bezoeken
Primaire eindpunten Deel 2:
Lichamelijk onderzoek: Screening, Baseline, D1 - D88 + EOS
Vitale functies: Screening, Baseline, D1 - D88 + EOS
ECG: Screening, D1, D8, D88 + EOS
Veiligheid: Screening, Baseline, D8, D15, D2, D29, D36, D43, D50, D57, D64, D71, D88 + EOS
Bijwerkingen: Alle bezoeken |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
See Above (E.5.1) |
Zie hierboven (E.5.1) |
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E.5.2 | Secondary end point(s) |
Secondary Endpoints Part 1:
PK: D1 (Pre-dose + 1, 2, 4, 8 & 24 hours post-dose), D2, D3, D5, D8, D29, D43
Ultrasound: Baseline, D85 + EOS
Growth measurements: Screening, D1, D8-D85 + EOS
Respiratory function: Baseline, D8-D85 +EOS
CHOP-INTEND: Baseline, D36, D85 + EOS
Secondary Endpoints Part 2:
PK: D1 (Pre-dose + 1, 2, 4, 8 & 24 hours post-dose), D2, D3, D5, D8, D29, D43, D57 (Pre-dose + 2, 4, 8 & 24 hours post-dose), D59, D62
Ultrasound: Baseline, D88 + EOS
Growth measurements: Screening, D1, D8-D57, D64, D71, D88 + EOS
Respiratory function: Baseline, D8-D57, D64, D71, D88 + EOS
CHOP-INTEND: Baseline, D15, D36, D57, D88 + EOS
CMAP: Baseline, D88 + EOS
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Secundaire eindpunten Deel 1:
PK: D1 (Pre-dosis + 1, 2, 4, 8 en 24 uur na toediening), D2, D3, D5, D8, D29, D43
Echografie: Baseline, D85 + EOS
Groei metingen: Screening, D1, D8-D85 + EOS
Ademhalingsfunctie: Baseline, D8-D85 + EOS
CHOP-PLAN: Baseline, D36, D85 + EOS
Secundaire eindpunten Deel 2:
PK: D1 (Dalconcentraties + 1, 2, 4, 8 en 24 uur na toediening), D2, D3, D5, D8, D29, D43, D57 (Dalconcentraties + 2, 4, 8 en 24 uur na -dose), D59, D62
Echografie: Baseline, D88 + EOS
Groei metingen: Screening, D1, D8-D57, D64, D71, D88 + EOS
Longfunctie: Baseline, D8-D57, D64, D71, D88 + EOS
CHOP-PLAN: Baseline, D15, D36, D57, D88 + EOS
CMAP: Baseline, D88 + EOS |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
See above (E.5.2) |
Zie hierboven (E.5.2) |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
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 | Yes |
E.6.13.1 | Other scope of the trial description |
Tolerability |
Verdraagbaarheid |
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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 | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 8 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Belgium |
Denmark |
Germany |
Italy |
Netherlands |
United States |
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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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 15 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
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 |