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    Clinical Trial Results:
    A Long-Term Open-Label Treatment and Extension Study of UX003 rhGUS Enzyme Replacement Therapy in Subjects with MPS 7

    Summary
    EudraCT number
    2015-001875-32
    Trial protocol
    Outside EU/EEA   PT  
    Global end of trial date
    14 Jan 2019

    Results information
    Results version number
    v1(current)
    This version publication date
    26 Jul 2019
    First version publication date
    26 Jul 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    UX003-CL202
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02432144
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Ultragenyx Pharmaceutical Inc.
    Sponsor organisation address
    60 Leveroni Court, Novato, United States, California 94949
    Public contact
    Medical Information, Ultragenyx Pharmaceutical Inc., +1 888-756-8567, medinfo@ultragenyx.com
    Scientific contact
    Medical Information, Ultragenyx Pharmaceutical Inc., +1 888-756-8567, medinfo@ultragenyx.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-001540-PIP01-13
    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
    14 Jan 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    14 Jan 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study was to evaluate long-term safety of UX003 in subjects with mucopolysaccharidosis type 7 (MPS 7).
    Protection of trial subjects
    The trial was designed, conducted, recorded, and reported in accordance with the principles established by the 18th World Medical Association General Assembly (Helsinki, 1964) and subsequent amendments and clarifications adopted by the General Assemblies. The investigators made every effort to ensure that the study was conducted in full conformance with Helsinki principles, International Council for Harmonization (ICH) Good Clinical Practice (GCP) guidelines, current Food and Drug Administration (FDA) regulations, EU Clinical Trial Directive 2001/20/EC, and local ethical and regulatory requirements. Each investigator was thoroughly familiar with the appropriate administration and potential risks of administration of the study drug, as described in the protocol and Investigator’s Brochure, prior to the initiation of the study. The method of obtaining and documenting informed consent and the contents of the informed consent form (ICF) complied with ICH GCP guidelines, the requirements of 21 CFR Part 50, “Protection of Human Subjects,” the Health Insurance Portability and Accountability Act regulations, and all other applicable regulatory requirements. Investigators were responsible for preparing the ICF and submitting it to the Sponsor for approval prior to submission to the Institutional Review Board (IRB). All ICFs were written in regional language and contained the minimum elements for consent as mandated by the ICH guidelines. An IRB-approved ICF was provided by the Sponsor prior to initiation of the study. Investigators obtained signed written informed consent from each potential study subject prior to the conduct of any study procedures and after the methods, objectives, requirements, and potential risks of the study were fully explained to each potential subject. Consent for participation could be withdrawn at any time for any reason by the subject.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    10 Nov 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 12
    Worldwide total number of subjects
    12
    EEA total number of subjects
    0
    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)
    3
    Adolescents (12-17 years)
    4
    Adults (18-64 years)
    5
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects with MPS 7 who were who were UX003 treatment-naïve or previously enrolled and treated in a prior clinical study of UX003 could enroll into this treatment and extension study provided all eligibility criteria had been met for a given subject. All subjects enrolled in USA, but 3 subjects later transferred to sites outside of USA.

    Pre-assignment
    Screening details
    Ten of 12 subjects entered this extension study at study Week 0 with ongoing UX003 treatment for the prior 24 or 48 weeks in study UX003-CL301 [2014-005638-71]; 2 subjects had a large gap between studies (61 weeks between doses).

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    UX003
    Arm description
    4 mg/kg UX003 every other week (QOW)
    Arm type
    Experimental

    Investigational medicinal product name
    UX003
    Investigational medicinal product code
    Other name
    recombinant human beta-glucoronidase, rhGUS, Mepsevii ™, vestronidase alfa, vestronidase alfa-vjbk
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    UX003 was administered QOW by slow IV infusion over approximately 4 hours.

    Number of subjects in period 1
    UX003
    Started
    12
    Completed
    11
    Not completed
    1
         Subject non-compliance
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall Study
    Reporting group description
    4 mg/kg UX003 QOW

    Reporting group values
    Overall Study Total
    Number of subjects
    12 12
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    16.56 ( 5.466 ) -
    Gender categorical
    Units: Subjects
        Female
    8 8
        Male
    4 4
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    6 6
        Not Hispanic or Latino
    6 6
        Unknown or Not Reported
    0 0
    Race
    Units: Subjects
        White
    9 9
        Other, not specified
    3 3
    Urinary Glycosaminoglycans (uGAG)
    Units: g GAG/g creatinine
        arithmetic mean (standard deviation)
    1.54848 ( 0.413237 ) -

    End points

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    End points reporting groups
    Reporting group title
    UX003
    Reporting group description
    4 mg/kg UX003 every other week (QOW)

    Subject analysis set title
    Full Analysis Set
    Subject analysis set type
    Full analysis
    Subject analysis set description
    All enrolled subjects who received at least one dose of investigational product in this study.

    Primary: Number of Subjects With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and TEAEs Leading to Discontinuation

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    End point title
    Number of Subjects With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and TEAEs Leading to Discontinuation [1]
    End point description
    An adverse event (AE) is defined as any untoward medical occurrence, whether or not considered drug related. A serious AE is an AE that at any dose, results in any of the following outcomes: death; a life-threatening AE; inpatient hospitalization or prolongation of existing hospitalization; persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions; a congenital anomaly/birth defect; or is an important medical event. AEs were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (life-threatening), Grade 5 (death). TEAEs were defined as reported AEs with onset during the treatment.
    End point type
    Primary
    End point timeframe
    From first dose of study drug until 30 days after the last dose of study drug. Mean duration of UX003 treatment was 100.5 weeks.
    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: Descriptive statistics are presented, per protocol.
    End point values
    Full Analysis Set
    Number of subjects analysed
    12
    Units: subjects
        TEAEs
    12
        Serious TEAEs
    4
        Treatment-Related TEAEs
    9
        Treatment-Related Serious TEAEs
    1
        Grade 3 or 4 TEAEs
    3
        TEAEs Leading to Treatment Discontinuation
    0
        TEAEs Leading to Study Discontinuation
    0
        TEAEs Leading to Death
    0
    No statistical analyses for this end point

    Secondary: Percent Change From Baseline Over Time in Urinary Glycosaminoglycan (uGAG) Excretion (Liquid Chromatography-Tandem Mass Spectrometry, Dermatan Sulfate)

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    End point title
    Percent Change From Baseline Over Time in Urinary Glycosaminoglycan (uGAG) Excretion (Liquid Chromatography-Tandem Mass Spectrometry, Dermatan Sulfate)
    End point description
    First morning void urine was evaluated for uGAG concentration and normalized to urinary creatinine concentration.
    End point type
    Secondary
    End point timeframe
    (prior to the first dose of study drug in UX003-CL301), Weeks 0, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144
    End point values
    Full Analysis Set
    Number of subjects analysed
    12 [2]
    Units: percentage change in uGAG excretion
    arithmetic mean (standard deviation)
        Week 0; n=12
    -62.19 ( 16.133 )
        Week 12; n=11
    -67.31 ( 13.953 )
        Week 24; n=12
    -64.03 ( 14.669 )
        Week 36; n=11
    -60.58 ( 23.552 )
        Week 48; n=10
    -57.04 ( 23.611 )
        Week 60; n=9
    -72.25 ( 18.609 )
        Week 72; n=9
    -78.52 ( 10.367 )
        Week 84; n=8
    -80.89 ( 10.023 )
        Week 96; n=8
    -82.39 ( 6.011 )
        Week 108; n=7
    -82.19 ( 6.551 )
        Week 120; n=5
    -88.74 ( 4.023 )
        Week 132; n=4
    -89.22 ( 3.662 )
        Week 144; n=4
    -91.62 ( 1.827 )
    Attachments
    Untitled (Filename: Percent Change from BL in uGAG Excretion Stat Analyses.docx)
    Notes
    [2] - n=subjects with an assessment at given time point
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first dose of study drug until 30 days after the last dose of study drug. Mean duration of UX003 treatment was 100.5 weeks.
    Adverse event reporting additional description
    TEAEs, defined as reported AEs with onset during the treatment, are presented.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0.0
    Reporting groups
    Reporting group title
    Total
    Reporting group description
    PLACEHOLDER

    Serious adverse events
    Total
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 12 (33.33%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Injury, poisoning and procedural complications
    Head Injury
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Interstitial Lung Disease
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchospasm
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Asthmatic Crisis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Urticaria
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Gastroenteritis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Total
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    12 / 12 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acrochordon
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Skin Papilloma
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Vascular disorders
    Hypertension
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Hypotension
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Chest Pain
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Gait Disturbance
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Infusion Site Extravasation
         subjects affected / exposed
    5 / 12 (41.67%)
         occurrences all number
    17
    Infusion Site Swelling
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Pyrexia
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    3
    Oedema Peripheral
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Immune system disorders
    Seasonal Allergy
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Bronchospasm
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Asthma
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Cough
         subjects affected / exposed
    4 / 12 (33.33%)
         occurrences all number
    7
    Epistaxis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Nasal Congestion
         subjects affected / exposed
    3 / 12 (25.00%)
         occurrences all number
    3
    Rhinitis Allergic
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    3
    Rhinorrhoea
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    4
    Upper Respiratory Tract Congestion
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Sleep Apnoea Syndrome
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Sinus Congestion
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Somnambulism
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Arthropod Bite
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Fall
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Head Injury
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Laceration
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Ligament Sprain
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Skin Abrasion
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    4
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Pericardial Effusion
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Nervous system disorders
    Brain Compression
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Cervical Cord Compression
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Headache
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Hydrocephalus
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Memory Impairment
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Lethargy
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    3
    Paraesthesia
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Sinus Headache
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Sensory Disturbance
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Eosinophilia
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Ear Pain
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    3
    Otorrhoea
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Eye disorders
    Conjunctivitis Allergic
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Eye Pruritus
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    3
    Lacrimation Increased
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    7
    Gastrointestinal disorders
    Dyspepsia
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Diarrhoea
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Aphthous Ulcer
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Gastrooesophageal Reflux Disease
         subjects affected / exposed
    3 / 12 (25.00%)
         occurrences all number
    4
    Gingival Bleeding
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Haematochezia
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Lip Ulceration
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Nausea
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    4
    Oesophagitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Tooth Discolouration
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Toothache
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Tooth Loss
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Vomiting
         subjects affected / exposed
    4 / 12 (33.33%)
         occurrences all number
    4
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Dermatitis Atopic
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Macule
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    39
    Erythema
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    2
    Papule
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    4
    Rash
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Pruritus
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Rash Maculo-Papular
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    2
    Rash Papular
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    3
    Rash Pruritic
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    5
    Urticaria
         subjects affected / exposed
    4 / 12 (33.33%)
         occurrences all number
    6
    Renal and urinary disorders
    Pollakiuria
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Musculoskeletal and connective tissue disorders
    Dactylitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    2
    Back Pain
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Arthralgia
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    4
    Joint Range Of Motion Decreased
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Joint Stiffness
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Joint Swelling
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Muscle Twitching
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Pain In Extremity
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Scoliosis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Spinal Instability
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Trigger Finger
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Infections and infestations
    Acarodermatitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Abscess Neck
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Conjunctivitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    2
    Ear Infection
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    3
    Folliculitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Furuncle
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Impetigo
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Otitis Media
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Otitis Externa
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Nasopharyngitis
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    4
    Otitis Media Acute
         subjects affected / exposed
    2 / 12 (16.67%)
         occurrences all number
    2
    Pharyngitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    4
    Rhinitis
         subjects affected / exposed
    3 / 12 (25.00%)
         occurrences all number
    4
    Root Canal Infection
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Sinusitis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    2
    Soft Tissue Infection
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Tinea Pedis
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    2
    Upper Respiratory Tract Infection
         subjects affected / exposed
    7 / 12 (58.33%)
         occurrences all number
    17
    Tooth Infection
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1
    Viral Infection
         subjects affected / exposed
    1 / 12 (8.33%)
         occurrences all number
    1

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Dec 2015
    1. Administrative and Contact Information: The protocol was updated to provide the EudraCT number (2015-001875-32) for the study. Contact information for the medical monitor and drug safety was updated. 2. Study Population: Inclusion criterion #7 was modified to clarify that for UX003 treatment naïve subjects the elevated uGAG excretion must have been a minimum of 2 fold over mean normal levels for age (at Week 0). Inclusion criteria # 7 and #8 were combined; UX003 naïve participants must have been at least 5 years of age at enrollment. 3. Study Visit Schedule: The Early Termination Visit was renamed the Termination Visit. Visit qualifiers were modified such that if a subject withdrew from the study, or if the study was terminated prior to Week 144, the termination visit should have been completed within 30 days of the last dose of study drug. Assessments performed within 30 days of the termination visit were not to be repeated unless clinically indicated. 4. Study Procedures and Assessments: Several updates were to clarify or remove procedures and the associated Schedule of Events. Language regarding the assessments to be performed throughout this extension study was broadened for applicability to subjects who enrolled from additional feeder trials with UX003. In general, efficacy assessments not performed during the primary trial were not required for this long-term treatment and extension study; safety assessments were to be conducted on all subjects as indicated in the protocol. Modifications to specific study procedures and assessments specified in the protocol text are summarized below: • Serum GAG was removed from the study. • Weight for drug preparation could be obtained up to 15 days prior to the indicated visit and was removed from the Termination Visit procedures
    18 Dec 2015
    (continued) • The frequency of serum biomarker assessments was reduced from 12-week intervals to 24-week intervals throughout the study. A qualifier was inserted to perform if indicated based on prior studies. • Physician Clinical Global Impression was removed as an assessment in the study. • The frequency of qualitative assessments of the liver and spleen was reduced from 12-week intervals to 48-week intervals except for naïve patients; the assessment was separated from physical examinations in the Schedule of Events. 5. Reporting and Follow-up of Adverse Drug Events: Additional guidance and alignment with AE reporting requirements was added, including text to clarify that hospitalizations planned prior to study enrollment were not considered SAEs, simplification of the categories for attributions of AE relatedness to study drug, and the addition of a new section to provide direction on the reporting requirements for suspected unexpected serious adverse reactions (SUSAR) to appropriate Regulatory Authorities (including Competent Authorities in all Member States concerned), IRBs/ECs, and Investigators as per local laws and regulations.
    04 Mar 2016
    1. Study Design and Methodology: The protocol was updated to remove reference to availability of commercial drug in the subject’s territory as a reason for study termination. In addition “end of trial” was defined as the last visit of the last subject undergoing evaluation in the study. As the planned duration of treatment in this study was up to 144 weeks, the end of trial was defined as the Week 144 visit of the last subject. In the event the study was terminated by the Sponsor prior to Week 144, all subjects were to complete a termination visit and the date of the last termination visit of the last subject would define the end of the trial. 2. Study Population: Inclusion criterion #2 was updated to clarify that written informed consent by a legally authorized representative could be provided for subjects, including adult subjects, who are intellectually impaired. Inclusion criterion #4 was updated to specify that sexually active subjects must have been willing to use a highly effective method of contraception. In addition, the list of examples of highly effective methods of contraception was updated to remove barrier methods and include bilateral tubal occlusion. Inclusion criterion #5 was updated to remove tubal ligation as a reason that female subjects would be considered not of childbearing potential and to clarify the definition of those considered not of childbearing potential.
    04 Mar 2016
    (continued) 3. Pregnancy During Study. The study procedures were updated to indicate that female subjects who became pregnant during the study would be withdrawn from study drug. At the conclusion of the pregnancy, a decision would be made if the female subject could resume study drug based on study treatment risk-benefit evaluation and willingness of the subject to comply with the contraceptive requirements. In the event of a pregnancy in the partner of a male subject, the male subject could continue with study drug and, as previously stated in the protocol, the Investigator must have made every effort to follow the pregnancy of either subject or partner through resolution of the pregnancy (delivery or termination) and report the resolution to Ultragenyx or its designee. 4. Record Retention: Study procedures were updated to state that all study records must be retained for at least 25 years after the end of the clinical trial or in accordance with national law.
    28 Jul 2016
    1. Title Page. The Coordinating Investigator was updated. 2. Pregnancy Testing and Contraception. The description of highly effective methods of contraception was updated to clarify that hormonal contraceptives should be associated with the inhibition of ovulation. 3. Criteria for Evaluation: Measurement of Anti-Drug Antibody (ADA) Types. ADA testing, as one of the safety assessments (primary objective), was clarified to indicate that clinically significant changes from UX003 CL301 Baseline in levels of all anti-drug antibodies (ADAs), not only the immunoglobulin G (IgG) isotype, would be evaluated. 4. Serum Biomarkers of Inflammation. Blood for analysis of serum biomarkers of inflammation would not be collected after Week 48. 5. Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). This test of motor proficiency would not be conducted after Week 48. 6. Childhood Health Assessment Questionnaire (CHAQ). The person responsible for completing the CHAQ was clarified as the subject’s parent or caregiver. 7. Health Assessment Questionnaire (HAQ). The mode of administration of the HAQ and the persons permitted to complete the HAQ were clarified. 8. Record Retention. Updated to clarify the responsibilities of the Investigator, Institution, and Ultragenyx with regard to record retention.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    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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