E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Spinal Muscular Atrophy (SMA) |
|
E.1.1.1 | Medical condition in easily understood language |
Spinal Muscular Atrophy, a genetic progressive neuromuscular disease characterized by profound weakness and muscle atrophy that is the leading genetic cause of death in babies and toddlers. |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
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 | 10041582 |
E.1.2 | Term | Spinal muscular atrophy |
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 |
Part 1:
•To evaluate the safety, tolerability, Pharmacokinetics (PK) and Pharmacodynamics (PD) of RO7034067 in patients with Type 2 and Type 3 (ambulant or non-ambulant) SMA, and to select the dose for Part 2 of the study
Part 2:
•To evaluate efficacy of RO7034067 compared to placebo in terms of motor function in Type 2 and non-ambulant Type 3 SMA patients, as assessed by the change from baseline in the total score of the Motor Function Measure (MFM) at 12 months
|
|
E.2.2 | Secondary objectives of the trial |
Part 2:
•To investigate the PK/PD relationship of RO7034067 by PK/PD modeling
•To investigate the efficacy of 12 month treatment with RO7034067 in terms of motor function as assessed by the Hammersmith Functional Motor Scale Expanded (HFMSE), the revised upper limb module (RULM) and responder analyses of the MFM
•To investigate the efficacy of 12 month treatment with RO7034067 in terms of respiratory function as assessed by Sniff nasal inspiratory pressure (SNIP) and, in patients aged 6 years and older,by Forced vital capacity (FVC),Forced expiratory volume (FEV1) and Peak cough flow (PCF)
•To investigate the proportion of patients who experience a pre-specified disease related adverse event by Month 12
•To investigate the effect of RO7034067 on patient-reported quality of life at Month 12,as assessed by the Pediatric Quality of Life Inventory (PedsQL) 3.0 Neuromuscular module and the PedsQL 4.0 Generic Core Scale
•To investigate the safety and tolerability of RO7034067 treatment |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Males and females 2 to 25 years of age inclusive
- For Part 1: Type 2 or 3 SMA ambulant or non-ambulant. For Part 2: Type 2 or 3 SMA non-ambulant.
Non-ambulant is defined as not having the ability to walk unassisted for 10 m or more
- Confirmed diagnosis of 5q-autosomal recessive SMA
- Negative blood pregnancy test at screening and agreement to comply with measures to prevent pregnancy and restrictions on sperm donation
|
|
E.4 | Principal exclusion criteria |
- Concomitant or previous participation in any investigational drug or device study within 90 days
prior to screening, or 5 half-lives of the drug, whichever is longer
- Concomitant or previous participation at any time in a Survival of motor neuron (SMN)-2 targeting antisense oligonucleotide, SMN2 splicing modifier or gene therapy study
- Any history of cell therapy
- Hospitalization for a pulmonary event within the last 2 months or planned at time of screening
- Surgery for scoliosis or hip fixation in the one year preceding screening or planned within the next 18 months
- Unstable gastrointestinal, renal, hepatic, endocrine, or cardiovascular system diseases as considered to be clinically significant by the Investigator
- Presence of clinically significant ECG abnormalities before study drug administration from average of triplicate measurement or cardiovascular disease indicating a safety risk for patients as determined by the Investigator
- History of malignancy if not considered cured
- Significant risk for suicidal behavior, in the opinion of the Investigator as assessed by the C-SSRS (>6 years of age)
- Any major illness within one month before the screening examination or any febrile illness within one week prior to screening and up to first dose administration
- Taking any nutrients known to modulate Cytochrome P450 (CYP) 3A activity (e.g., grapefruit juice; Seville orange) within 2 weeks prior to administration of study drugs
- Any inhibitor of CYP3A4 taken within 2 weeks (or within 5 times the elimination half-life, whichever is longer) prior to dosing, including but not limited to: ketoconazole, miconazole, itraconazole, fluconazole, erythromycin, clarithromycin, ranitidine, cimetidine
- Any inducer of CYP3A4 taken within 4 weeks (or within 5 times the elimination half-life, whichever is longer) prior to dosing, including but not limited to: rifampicin, rifabutin, glucocorticoids, carbamazepine, phenytoin, phenobarbital, St. John's wort
- Any Organic cation transporter (OCT)-2 and multidrug and toxin extrusion (MATE) substrates within 2 weeks before dosing
- Use of the following medications within 90 days prior to randomization: riluzole, valproic acid, hydroxyurea, sodium phenylbutyrate, butyrate derivatives, creatine, carnitine, growth hormone, anabolic steroids, probenecid, agents anticipated to increase or decrease muscle strength, agents with known or presumed histone deacetylase (HDAC) inhibitory effect, and medications with known phototoxicity liabilities
- Recently initiated treatment (within < 6 months prior to randomization) with oral salbutamol or another β2-adrenergic agonist taken orally
- Any prior use of chloroquine, hydroxychloroquine, retigabin, vigabatrin or thioridazine, is not allowed.
- Clinically significant abnormalities in laboratory test results
- Donation or loss of blood >= 10% of blood volume within three months prior to screening
- Ascertained or presumptive hypersensitivity (e.g., anaphylactic reaction) to RO7034067 or to the constituents of its formulation
- Recent history (less than one year) of ophthalmological diseases |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Part 1
1. Incidence of adverse events and serious adverse events
2. Maximum plasma concentration (Cmax) of RO7034067
3. Area under the curve (AUC) of RO7034067
4. Concentration at the end of a dosing interval (Ctrough) of RO7034067
Part 2
5. Change from baseline in the total MFM 32 score at Month 12 |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
1. Up to 24 months
2-4. Days 1, 7, 14, 28, 56, 120, 246, 365, 490, 609, and 729
5. Baseline (Day -1) and Month 12 |
|
E.5.2 | Secondary end point(s) |
Part 2
1. SMN2 mRNA in blood
2. SMN protein levels in blood
3. Change from baseline in total score of HFMSE at Month 12
4. Change from baseline in the total score of the revised upper limb module (RULM) at Month 12
5. Proportion of patients who achieve stabilization or improvement (i.e., a change from baseline >= 0) on the total MFM score at Month 12
6. Change from baseline in the MFM domain scores of D1, D2, D3 and the total combined score of (D1 + D2) at Month 12.
7. Change from baseline in the best SNIP (expressed as a percentage of the predicted value) at Month 12.
8. Change from baseline in FEV1 in patients aged 6 to 25 years at Month 12
9. Change from baseline in FVC in patients aged 6 to 25 years at Month 12.
10. Change from baseline in the peak cough flow (PCF) in patients aged 6 to 25 years at Month 12.
11. Change from baseline in the patient (aged 8-18 years only) self-reported “About my Neuromuscular Disease” domain score of the PedsQL 3.0 Neuromuscular module at Month 12
12. Change from baseline in the patient (aged 8-18 years only) self-reported Total score of the PedsQL 4.0 Generic Core Scale at Month 12
13. Proportion of patients who experience at least one disease related adverse event by Month 12
|
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
1. Part 1: Days -1, 1, 7, 14, 28, 120, 246, 365, 729; Part 2: Days -1, 1, 7, 28, 120, 246, 365, 729
2. Part 1: Days -1, 7, 14, 28, 120, 246, 365, 729; Part 2: Days -1, 7, 28, 120, 246, 365, 729
3-12. Baseline (Day-1) and Month 12
13. Up to Month 12
|
|
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 | 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 |
|
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
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 | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
|
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
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 |
Australia |
Belgium |
Canada |
France |
Germany |
Italy |
Netherlands |
Spain |
Sweden |
Switzerland |
Turkey |
United Kingdom |
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
|
Since this study includes an OLE phase for all enrolled patients, it will continue until RO7034067 is commercially available in the patient’s country, or as per local regulation, or per the Sponsor’s decision to terminate RO7034067 development. In any case the study will not exceed 4 years (or less as per country specific requirements) after the last patient is enrolled in the study.
The end of this study is defined as the date when the last patient last visit (LPLV) occurs.
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 4 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |