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    Clinical Trial Results:
    An Open-label Ascending Dose Cohort Study to Assess the Safety, Pharmacokinetics, and Preliminary Efficacy of Avalglucosidase Alfa (NeoGAA, GZ402666) in Patients with Infantile-onset Pompe Disease Treated with Alglucosidase Alfa Who Demonstrate Clinical Decline or Sub-optimal Clinical Response

    Summary
    EudraCT number
    2016-003475-21
    Trial protocol
    GB   DE   FR   Outside EU/EEA  
    Global end of trial date

    Results information
    Results version number
    v1(current)
    This version publication date
    08 Mar 2022
    First version publication date
    08 Mar 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ACT14132
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03019406
    WHO universal trial number (UTN)
    U1111-1179-4616
    Sponsors
    Sponsor organisation name
    Genzyme Corporation
    Sponsor organisation address
    50 Binney Street, Cambridge, Massachusetts, United States, 02142
    Public contact
    Trial Transparency Team, Sanofi aventis recherche & développement, Contact-US@sanofi.com
    Scientific contact
    Trial Transparency Team, Sanofi aventis recherche & développement, Contact-US@sanofi.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-000360-PIP20-21
    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
    Interim
    Date of interim/final analysis
    22 Nov 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Sep 2019
    Global end of trial reached?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the safety profile of avalglucosidase alfa in subjects with infantile-onset Pompe disease previously treated with alglucosidase alfa.
    Protection of trial subjects
    The study was conducted by investigators experienced in the treatment of paediatric subjects. The parent(s) or guardian(s) as well as the children were fully informed of all pertinent aspects of the clinical trial as well as the possibility to discontinue at any time. In addition to the consent form for the parent(s)/guardian(s), an assent form in child-appropriate language was provided and explained to the child. Repeated invasive procedures were minimised. The number of blood samples as well as the amount of blood drawn were adjusted according to age and weight. A topical anesthesia may have been used to minimise distress and discomfort.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    12 Oct 2017
    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
    United Kingdom: 2
    Country: Number of subjects enrolled
    France: 4
    Country: Number of subjects enrolled
    Taiwan: 5
    Country: Number of subjects enrolled
    Japan: 2
    Country: Number of subjects enrolled
    United States: 9
    Worldwide total number of subjects
    22
    EEA total number of subjects
    4
    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)
    2
    Children (2-11 years)
    20
    Adolescents (12-17 years)
    0
    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
    The study was conducted at 10 active centres in 5 countries. Total of 22 subjects were screened between 12 October 2017 and 03 April 2019. None of the subjects were screen failed. Subjects were assigned to treatment by using interactive response technology system.

    Pre-assignment
    Screening details
    Cohorts 1:avalglucosidase alfa 20 milligrams per kilogram (mg/kg) every other week (qow) & Cohort 2:avalglucosidase alfa 40 mg/kg qow. No randomisation for Cohort 1 & 2. Cohort 3(stratified by gender):avalglucosidase alfa 40 mg/kg qow(3a) or current stable alglucosidase alfa dose regimen(3b). Data reported for primary completion date (30-Sep-2019).

    Period 1
    Period 1 title
    Primary Analysis Period (PAP):upto 25 Wk
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg
    Arm description
    Avalglucosidase alfa, 20 mg/kg intravenous (IV) infusion qow for 25 weeks (Wk) in PAP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    20 mg/kg, IV infusion qow for a total of 13 doses.

    Arm title
    PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg
    Arm description
    Avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in the PAP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    40 mg/kg, IV infusion qow for a total of 13 doses.

    Arm title
    PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Arm description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received avalglucosidase alfa 40 mg/kg (the highest tolerated dose) IV infusion qow for 25 weeks in PAP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    40 mg/kg, IV infusion qow for a total of 13 doses.

    Arm title
    PAP: Cohort 3b: Alglucosidase Alfa
    Arm description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in PAP.
    Arm type
    Active comparator

    Investigational medicinal product name
    Alglucosidase alfa
    Investigational medicinal product code
    GZ419829
    Other name
    Myozyme® and Lumizyme®
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Dose between 20 mg/kg qow and 40 mg/kg weekly (qw) as per physician, IV infusion qow/qw for a total of 13 or 25 doses, respectively.

    Number of subjects in period 1
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Started
    6
    5
    5
    6
    Treated
    6
    5
    5
    6
    Completed
    6
    5
    5
    6
    Period 2
    Period 2 title
    Extension treatment period(ETP):from26Wk
    Is this the baseline period?
    No
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    ETP: Cohort 1: Avalglucosidase Alfa 20 mg/kg
    Arm description
    Included all subjects of PAP Cohort 1 who received avalglucosidase alfa 20 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    20 mg/kg, IV infusion qow up to 60 infusions.

    Arm title
    ETP: Cohort 2: Avalglucosidase Alfa 40 mg/kg
    Arm description
    Included all subjects of PAP Cohort 2 who received avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    40 mg/kg, IV infusion qow up to 60 infusions.

    Arm title
    ETP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Arm description
    Included all subjects of PAP Cohort 3a who received avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    40 mg/kg, IV infusion qow up to 60 infusions.

    Arm title
    ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP
    Arm description
    Included all subjects of Cohort 3b who received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in the PAP and after PAP, subjects were switched to receive avalglucosidase alfa 40 mg/kg IV infusion qow from Week 26 up to Week 371 in ETP.
    Arm type
    Experimental

    Investigational medicinal product name
    Avalglucosidase Alfa
    Investigational medicinal product code
    GZ402666
    Other name
    Nexviadyme and Nexviazyme
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    40 mg/kg, IV infusion qow up to 60 infusions.

    Number of subjects in period 2 [1]
    ETP: Cohort 1: Avalglucosidase Alfa 20 mg/kg ETP: Cohort 2: Avalglucosidase Alfa 40 mg/kg ETP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP
    Started
    6
    5
    5
    3
    Completed
    0
    0
    0
    0
    Not completed
    6
    5
    5
    3
         Ongoing
    6
    5
    5
    3
    Notes
    [1] - The number of subjects starting the period is not consistent with the number completing the preceding period. It is expected the number of subjects starting the subsequent period will be the same as the number completing the preceding period.
    Justification: Subjects who completed PAP and accepted to receive avalglucosidase alfa treatment in ETP.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg
    Reporting group description
    Avalglucosidase alfa, 20 mg/kg intravenous (IV) infusion qow for 25 weeks (Wk) in PAP.

    Reporting group title
    PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    Avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in the PAP.

    Reporting group title
    PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received avalglucosidase alfa 40 mg/kg (the highest tolerated dose) IV infusion qow for 25 weeks in PAP.

    Reporting group title
    PAP: Cohort 3b: Alglucosidase Alfa
    Reporting group description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in PAP.

    Reporting group values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa Total
    Number of subjects
    6 5 5 6 22
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    7.6 ( 3.4 ) 8.1 ( 4.1 ) 6.9 ( 2.7 ) 4.7 ( 3.2 ) -
    Gender categorical
    Units: Subjects
        Female
    1 2 3 4 10
        Male
    5 3 2 2 12
    Race
    Units: Subjects
        Asian
    3 3 2 0 8
        Black or African American
    0 0 0 2 2
        White
    3 2 3 4 12

    End points

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    End points reporting groups
    Reporting group title
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg
    Reporting group description
    Avalglucosidase alfa, 20 mg/kg intravenous (IV) infusion qow for 25 weeks (Wk) in PAP.

    Reporting group title
    PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    Avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in the PAP.

    Reporting group title
    PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received avalglucosidase alfa 40 mg/kg (the highest tolerated dose) IV infusion qow for 25 weeks in PAP.

    Reporting group title
    PAP: Cohort 3b: Alglucosidase Alfa
    Reporting group description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in PAP.
    Reporting group title
    ETP: Cohort 1: Avalglucosidase Alfa 20 mg/kg
    Reporting group description
    Included all subjects of PAP Cohort 1 who received avalglucosidase alfa 20 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.

    Reporting group title
    ETP: Cohort 2: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    Included all subjects of PAP Cohort 2 who received avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.

    Reporting group title
    ETP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    Included all subjects of PAP Cohort 3a who received avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.

    Reporting group title
    ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP
    Reporting group description
    Included all subjects of Cohort 3b who received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in the PAP and after PAP, subjects were switched to receive avalglucosidase alfa 40 mg/kg IV infusion qow from Week 26 up to Week 371 in ETP.

    Subject analysis set title
    Pooled Arm ETP: Avalglucosidase Alfa 40 mg/kg
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Pooled arm included all subjects of Cohorts 2 and 3a who received avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.

    Primary: PAP: Number of Subjects With Treatment-emergent Adverse Events (TEAEs), Serious Treatment-emergent Adverse Events, and Adverse Event of Special Interest (AESI)

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    End point title
    PAP: Number of Subjects With Treatment-emergent Adverse Events (TEAEs), Serious Treatment-emergent Adverse Events, and Adverse Event of Special Interest (AESI) [1]
    End point description
    AE: any untoward medical occurrence in subject received study drug & did not necessarily had to have causal relationship with treatment. TEAEs: AEs developed/worsened in grade/become serious during PAP period (from the time of 1st study drug dose up to Week 25). Serious AE(SAE): any untoward medical occurrence at any dose resulted in death, was life-threatening, required inpatient hospitalisation, prolongation of existing hospitalisation, resulted in persistent or significant disability/incapacity, was congenital anomaly/birth defect or was medically important event. TEAEs included SAEs & non-SAEs. AESI:AE (serious/non-serious) of scientific & medical concern specific to Sponsor’s product/program, for which ongoing monitoring & immediate notification by Investigator to Sponsor required. Safety population.
    End point type
    Primary
    End point timeframe
    From Baseline to Week 25
    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: As the endpoint was descriptive in nature, no statistical analysis was provided.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: subjects
        Any TEAEs
    5
    5
    5
    5
        Any Serious TEAEs
    1
    3
    0
    2
        Any AESI
    0
    2
    1
    1
    No statistical analyses for this end point

    Primary: PAP: Number of Subjects With Infusion-associated Reactions (IARs)

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    End point title
    PAP: Number of Subjects With Infusion-associated Reactions (IARs) [2]
    End point description
    IARs were defined as AESIs that occurred during either the infusion or the observation period following the infusion which were deemed to be related or possibly related to the study drug. Protocol-defined IARs: An AESIs that occurred during either the infusion or the observation period following the infusion which were deemed to be related or possibly related to study drug. Algorithm-defined IARs: any TEAE meeting either 1 or 2 criteria: 1) event occurred from the start of infusion to the end of infusion plus 24 hours, and considered related to study drug, 2) If an AE time component was missing, compared AE start date with infusion start date and infusion end date. If an AE start date was between infusion start date and infusion end date plus one day, and it was related to study drug. Analysis was performed on safety population which included subjects who had received at least 1 infusion (partial or total) and were analysed according to treatment received.
    End point type
    Primary
    End point timeframe
    From Baseline to Week 25
    Notes
    [2] - 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: As the endpoint was descriptive in nature, no statistical analysis was provided.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: subjects
        Protocol-defined IARs
    0
    2
    1
    1
        Algorithm-defined IARs
    0
    2
    1
    1
    No statistical analyses for this end point

    Secondary: PAP: Number of Subjects With Anti-drug Antibody (ADA) Response

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    End point title
    PAP: Number of Subjects With Anti-drug Antibody (ADA) Response
    End point description
    Anti-drug antibody response was categorised as: Treatment induced ADAs: ADAs developed de novo (seroconversion) following administration of study drug. Treatment boosted ADAs: pre-existing ADAs that were boosted at least two titer steps from Baseline (i.e., 4-fold increase in titers) followed by administration of study drug. Analysis was performed on the ADA evaluable population which included subjects who had received at least 1 infusion (partial or total) and had at least one ADA sample taken post-baseline after drug administration that was appropriate for ADA testing with a reportable result.
    End point type
    Secondary
    End point timeframe
    From Baseline to Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: subjects
        Treatment boosted ADA response
    0
    0
    1
    2
        Treatment induced ADA response
    0
    1
    3
    1
    No statistical analyses for this end point

    Secondary: PAP: Pharmacokinetic (PK) Parameter: Maximum Observed Plasma Concentration (Cmax) of Avalglucosidase Alfa

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    End point title
    PAP: Pharmacokinetic (PK) Parameter: Maximum Observed Plasma Concentration (Cmax) of Avalglucosidase Alfa [3]
    End point description
    Cmax is the maximum observed plasma concentration. Analysis was performed on PK population which included PAP subjects who had received at least 1 infusion (partial or total) and had evaluable drug concentration data. Here, ‘n’ = number of subjects with data available for each specified category. Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point type
    Secondary
    End point timeframe
    Cohort 1: pre-dose; at end of infusion; and at 2, 4, 6 and 8 hours after end of infusion on Day 1 (Week 1) and Week 25 Cohort 2 and 3: pre-dose; at end of infusion; and at 2, 4, 6, 8 and 12 to 16 hours after end of infusion on Day 1 (Week 1) and Week 25
    Notes
    [3] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    6
    5
    5
    Units: nanograms per millilitre
    arithmetic mean (standard deviation)
        Week 1 (n = 5, 4, 4)
    189000 ( 56700 )
    403000 ( 171000 )
    250000 ( 45100 )
        Week 25 (n = 5, 5, 5)
    175000 ( 65900 )
    297000 ( 60100 )
    356000 ( 84700 )
    No statistical analyses for this end point

    Secondary: PAP: Pharmacokinetic Parameter: Time to Achieve Maximum Observed Plasma Concentration (Tmax) of Avalglucosidase Alfa

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    End point title
    PAP: Pharmacokinetic Parameter: Time to Achieve Maximum Observed Plasma Concentration (Tmax) of Avalglucosidase Alfa [4]
    End point description
    Tmax is the time to achieve maximum plasma concentration. Analysis was performed on PK population. Here, ‘n’ = number of subjects with available data for each specified category. Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point type
    Secondary
    End point timeframe
    Cohort 1: pre-dose; at end of infusion; and at 2, 4, 6 and 8 hours after end of infusion on Day 1 (Week 1) and Week 25 Cohort 2 and 3: pre-dose; at end of infusion; and at 2, 4, 6, 8 and 12 to 16 hours after end of infusion on Day 1 (Week 1) and Week 25
    Notes
    [4] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    6
    5
    5
    Units: hours
    median (full range (min-max))
        Week 1 (n = 5, 4, 4)
    4.43 (3.90 to 5.33)
    7.00 (6.00 to 7.25)
    6.83 (6.65 to 7.22)
        Week 25 (n = 5, 5, 5)
    3.97 (3.77 to 4.75)
    7.13 (5.67 to 7.98)
    6.87 (5.03 to 7.43)
    No statistical analyses for this end point

    Secondary: PAP: Pharmacokinetic Parameter: Area Under the Plasma Concentration Versus Time Curve From Time 0 to the Time of Last Quantifiable Concentration (AUC0-last) of Avalglucosidase Alfa

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    End point title
    PAP: Pharmacokinetic Parameter: Area Under the Plasma Concentration Versus Time Curve From Time 0 to the Time of Last Quantifiable Concentration (AUC0-last) of Avalglucosidase Alfa [5]
    End point description
    AUC0-last is the area under the plasma concentration versus time curve from time 0 to the time of last quantifiable concentration. Analysis was performed on PK population. Here, ‘n’ = subjects with available data for each specified category. Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point type
    Secondary
    End point timeframe
    Cohort 1: pre-dose; at end of infusion; and at 2, 4, 6, and 8 hours after end of infusion on Day 1 (Week 1) and Week 25, Cohort 2 & 3: pre-dose; at end of infusion; and at 2, 4, 6, 8, and 12 to 16 hours after end of infusion on Day 1 (Week 1) and Week 25
    Notes
    [5] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    6
    5
    5
    Units: nanograms*hours per millilitre
    arithmetic mean (standard deviation)
        Week 1 (n=5,4,4)
    923000 ( 352000 )
    2630000 ( 972000 )
    1720000 ( 255000 )
        Week 25 (n=5,5,5)
    805000 ( 295000 )
    1930000 ( 348000 )
    2200000 ( 533000 )
    No statistical analyses for this end point

    Secondary: PAP: Pharmacokinetic Parameter: Terminal Half-life (t1/2) of Avalglucosidase Alfa

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    End point title
    PAP: Pharmacokinetic Parameter: Terminal Half-life (t1/2) of Avalglucosidase Alfa [6]
    End point description
    t1/2 is the time required for the plasma concentration of a drug to decrease by half of its initial concentration. Analysis was performed on PK population. Here, ‘n’ = subjects with available data for each specified category. Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point type
    Secondary
    End point timeframe
    Cohort 1: pre-dose; at end of infusion; and at 2, 4, 6, and 8 hours after end of infusion on Day 1 (Week 1) and Week 25; Cohort 2 & 3: pre-dose; at end of infusion; and at 2, 4, 6, 8, and 12 to 16 hours after end of infusion on Day 1 (Week 1) and Week 25
    Notes
    [6] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    6
    5
    5
    Units: hours
    arithmetic mean (standard deviation)
        Week 1 (n=5,4,4)
    0.703 ( 0.291 )
    1.15 ( 0.523 )
    0.806 ( 0.248 )
        Week 25 (n=5,5,5)
    0.601 ( 0.256 )
    1.04 ( 0.248 )
    1.19 ( 0.472 )
    No statistical analyses for this end point

    Secondary: PAP: Pharmacokinetic Parameter: Clearance (CL) of Avalglucosidase Alfa

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    End point title
    PAP: Pharmacokinetic Parameter: Clearance (CL) of Avalglucosidase Alfa [7]
    End point description
    CL is defined as a quantitative measure of the rate at which a drug substance is removed from the body. Analysis was performed on PK population. Here, ‘n’ = subjects with available data for each specified category. Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point type
    Secondary
    End point timeframe
    Cohort 1: pre-dose; at end of infusion; and at 2, 4, 6, and 8 hours after end of infusion on Day 1 (Week 1) and Week 25; Cohort 2 and 3: pre-dose; at end of infusion; and at 2, 4, 6, 8, and 12 to 16 hours after end of infusion on Day 1 (Week 1) and Week 2
    Notes
    [7] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    6
    5
    5
    Units: millilitres per hours
    arithmetic mean (standard deviation)
        Week 1 (n=5,4,4)
    673 ( 222 )
    562 ( 152 )
    529 ( 150 )
        Week 25 (n=5,5,5)
    696 ( 203 )
    683 ( 345 )
    526 ( 125 )
    No statistical analyses for this end point

    Secondary: PAP: Pharmacokinetic Parameter: Volume of Distribution at Steady State (Vss) of Avalglucosidase Alfa

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    End point title
    PAP: Pharmacokinetic Parameter: Volume of Distribution at Steady State (Vss) of Avalglucosidase Alfa [8]
    End point description
    Steady state volume of distribution (Vss) is defined as the theoretical volume in which the total amount of drug would need to be uniformly distributed to produce the desired plasma concentration of a drug. Analysis was performed on PK population. Here, ‘n’ = subjects with available data for each specified category. Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point type
    Secondary
    End point timeframe
    Cohort 1: pre-dose; at end of infusion; and at 2, 4, 6, and 8 hours after end of infusion on Day 1 (Week 1) and Week 25; Cohort 2 & 3: pre-dose; at end of infusion; and at 2, 4, 6, 8, and 12 to 16 hours after end of infusion on Day 1 (Week 1) and Week 25
    Notes
    [8] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: Data for this endpoint was not planned to be collected and analysed for PAP: Cohort 3b: Alglucosidase Alfa arm.
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    6
    5
    5
    Units: millilitres
    arithmetic mean (standard deviation)
        Week 1 (n=5,4,4)
    3550 ( 927 )
    4500 ( 882 )
    4300 ( 1420 )
        Week 25 (n=5,5,5)
    3520 ( 1180 )
    5350 ( 2270 )
    4020 ( 1390 )
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Gross Motor Function Measure-88 (GMFM-88) Test Scores at Week 25

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    End point title
    PAP: Change From Baseline in Gross Motor Function Measure-88 (GMFM-88) Test Scores at Week 25
    End point description
    GMFM-88 was developed specifically to detect quantitative changes in gross motor function. The GMFM-88 consisted of 88 items organised into 5 dimensions; lying and rolling (17 items); sitting (20 items); crawling and kneeling (14 items); standing (13 items) and walking, running and jumping (24 items). Each item was scored on a 4-point Likert scale with scores range: 0= cannot do; 1 = initiates less then [<] 10 percentage [%] of the task; 2 = partially completes [10% to <100% of the task] and 3 = task completion. The score for each dimension was expressed as a % of the maximum score for that dimension. Total percentage score was obtained by adding the percentage scores for each dimension and dividing the sum by the total number of dimensions. Total scores ranged from 0% to 100%; where higher scores indicated better motor functions. Analysis was performed on safety population. Here, ‘number of subjects analysed’ = subjects with available data for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    4
    6
    Units: percentage of total score
        arithmetic mean (standard deviation)
    6.50 ( 22.24 )
    9.80 ( 13.99 )
    11.00 ( 10.80 )
    17.00 ( 8.44 )
    No statistical analyses for this end point

    Secondary: PAP: Number of Subjects in Gross Motor Function Classification System-Expanded and Revised (GMFCS-E and R) Scores at Baseline and Week 25

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    End point title
    PAP: Number of Subjects in Gross Motor Function Classification System-Expanded and Revised (GMFCS-E and R) Scores at Baseline and Week 25
    End point description
    GMFCS-E and R was a 5 level classification system for specific age ranges; observations were performed on 5 levels based on self-initiated movement, with emphasis on sitting, transfers, and mobility: Level I (walks without limitations), Level II (walks with limitations), Level III (walks using a hand-held mobility device), Level IV (self-mobility with limitations; may use powered mobility) and level V (transported in a manual wheel chair) (I to V). The distinctions between levels were based on functional limitations, the need for assistive mobility devices, and to a much lesser extent, quality of movement, and were designed to be meaningful in daily life. The lower level represented good motor functioning and higher level represented low motor functioning. Number of subjects in each level of classification at Baseline and Week 25 were reported. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: subjects
        Baseline: Level I
    1
    1
    2
    3
        Baseline: Level II
    1
    2
    1
    0
        Baseline: Level III
    1
    0
    1
    1
        Baseline: Level IV
    2
    2
    0
    1
        Baseline: Level V
    1
    0
    1
    1
        Week 25: Level I
    1
    1
    2
    3
        Week 25: Level II
    1
    2
    1
    0
        Week 25: Level III
    2
    1
    0
    1
        Week 25: Level IV
    1
    1
    1
    1
        Week 25: Level V
    1
    0
    1
    1
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Pompe Paediatric Evaluation of Disability Inventory (Pompe-PEDI) Functional Skills Scale: Mobility Domain Test Score-Scaled Score at Week 25

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    End point title
    PAP: Change From Baseline in Pompe Paediatric Evaluation of Disability Inventory (Pompe-PEDI) Functional Skills Scale: Mobility Domain Test Score-Scaled Score at Week 25
    End point description
    Pompe-PEDI: disease specific version to assess functional capabilities and performance in children with Pompe disease from 2 months through adolescence. It comprised of Functional Skills Scale and Caregiver Assistance Scale; both scales had 3 domains: Self Care, Mobility, and Social Function. Mobility domain was used to measure change in mobility due to changes in muscle strength; consisted of 160 mobility items for subject/legal guardian. The total number of mobility items the child was capable of, was converted to a scaled score with a range of 0 to 100, where scores near "0" indicated low capability and scores near "100" indicated high capability), where higher score was indicative of greater functional ability. Scaled scores were used to interpret individual function and progress over time. Analysis was performed on safety population. Here, ‘number of subjects analysed’ = subjects with available data for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    3
    6
    Units: score on a scale
        arithmetic mean (standard deviation)
    6.19 ( 10.55 )
    2.12 ( 4.04 )
    2.60 ( 1.72 )
    5.20 ( 5.95 )
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Quick Motor Function Test (QMFT) Scores at Week 25

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    End point title
    PAP: Change From Baseline in Quick Motor Function Test (QMFT) Scores at Week 25
    End point description
    QMFT was observer administered test comprised of 16 items specifically difficult for subjects with Pompe disease. Each item was scored on 5-point ordinal scale ranged from 0 to 4 (higher score indicated better outcome). Total QMFT score was obtained by adding the scores of all items and ranged from 0 (unable to perform motor function tests) to 64 (normal muscle function), where higher score indicated better outcome/greater motor function. Analysis was performed on safety population. Here, ‘number of subjects analysed’ = subjects with available data for this endpoint.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    4
    6
    Units: score on a scale
        arithmetic mean (standard deviation)
    -0.17 ( 4.45 )
    3.20 ( 4.55 )
    4.25 ( 3.30 )
    5.17 ( 4.54 )
    No statistical analyses for this end point

    Secondary: PAP: Echo-Left Ventricular Mass Z-Score (LVM Z-score) M-mode at Baseline, Week 25, and Change From Baseline at Week 25

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    End point title
    PAP: Echo-Left Ventricular Mass Z-Score (LVM Z-score) M-mode at Baseline, Week 25, and Change From Baseline at Week 25
    End point description
    Cardiac function was evaluated using LVM Z-score as assessed by echocardiogram in M-mode. Z-Scores indicated the number of standard deviations (SD) from the mean in a normal distribution. The normal range is -2 to 2 and greater than 2 may indicate left ventricular hypertrophy. A negative change from Baseline indicated a decrease and positive change from Baseline indicated an increase in LVM Z-score. In this end-point, absolute scores at Baseline and Week 25 along with change from Baseline at Week 25 in LVM Z-score were reported. Analysis was performed on safety population. Here, ‘n’ = subjects with available data for each specified category.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: Z-score
    arithmetic mean (standard deviation)
        Baseline (n=6,3,5,4)
    -1.10 ( 1.07 )
    0.13 ( 2.39 )
    -0.78 ( 0.70 )
    -0.43 ( 0.92 )
        Week 25 (n=5,4,5,4)
    -1.74 ( 2.01 )
    -1.05 ( 2.61 )
    -1.36 ( 0.99 )
    0.15 ( 1.07 )
        Change from Baseline at Week 25 (n=5,2,5,3)
    -0.60 ( 2.16 )
    -0.60 ( 0.71 )
    -0.58 ( 0.76 )
    0.47 ( 1.76 )
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Eyelid Position Measurements: Interpalpebral Fissure Distance (IPFD) - Left Non-Flash and Right Non-Flash at Week 25

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    End point title
    PAP: Change From Baseline in Eyelid Position Measurements: Interpalpebral Fissure Distance (IPFD) - Left Non-Flash and Right Non-Flash at Week 25
    End point description
    IPFD is the widest vertical distance (in millimetres) between the upper eyelid and the lower eyelid when the subject is looking in “primary gaze” (i.e. normal gaze when looking straight forward). Images were taken while the subject was wearing a pair of empty eyeglass frames with millimetres rulers attached as a standardised tool to measure eyelid position without camera flash. A negative change from Baseline indicated a decrease and positive change from Baseline indicated an increase in measured distance. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: millimetres
    arithmetic mean (standard deviation)
        Left non-Flash
    -0.67 ( 1.54 )
    1.30 ( 1.48 )
    1.30 ( 0.76 )
    -0.50 ( 0.77 )
        Right non-Flash
    -0.92 ( 1.66 )
    0.70 ( 1.25 )
    0.90 ( 1.14 )
    -0.25 ( 1.13 )
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Eyelid Position Measurements: Left and Right Margin Reflex Distance (MRD) at Week 25

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    End point title
    PAP: Change From Baseline in Eyelid Position Measurements: Left and Right Margin Reflex Distance (MRD) at Week 25
    End point description
    The MRD is the vertical distance (in millimetres) between the light reflex and the upper eyelid when the subject was looking in “primary gaze” while fixating on a light source. Images were taken while the subjects was wearing a pair of empty eyeglass frames with millimetres rulers attached as a standardised tool to measure eyelid position. A negative change from Baseline indicated a decrease and positive change from Baseline indicated an increase in measured distance. Analysis was performed on safety population. Here, ‘n’ = subjects with available data for each specified category.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: millimetres
    arithmetic mean (standard deviation)
        Left MRD (n=6,4,4,6)
    -0.08 ( 1.53 )
    -0.38 ( 0.85 )
    0.88 ( 1.11 )
    0.08 ( 0.74 )
        Right MRD (n=6,5,4,6)
    -0.50 ( 1.61 )
    -0.50 ( 1.27 )
    0.63 ( 1.03 )
    -0.08 ( 0.74 )
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Eyelid Position Measurements Assessed by Margin Pupil Distance (MPD) - Left Non- Flash and Right Non-Flash at Week 25

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    End point title
    PAP: Change From Baseline in Eyelid Position Measurements Assessed by Margin Pupil Distance (MPD) - Left Non- Flash and Right Non-Flash at Week 25
    End point description
    The MPD is the vertical distance (in millimetres) between the center of the pupil and the upper eyelid margin. Images were taken while the subject was wearing a pair of empty eyeglass frames with millimetres rulers attached as a standardised tool to measure eyelid position without camera flash. A negative change from Baseline indicated a decrease and positive change from Baseline indicated an increase in measured distance. Analysis was performed on safety population. Here, ‘n’ = subjects with available data for each specified category.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: millimetres
    arithmetic mean (standard deviation)
        MPD Left Non-Flash (n=6,4,5,6)
    -0.83 ( 1.44 )
    0.75 ( 1.19 )
    0.40 ( 0.42 )
    -0.50 ( 0.32 )
        MPD Right Non-Flash (n=6,5,5,6)
    -0.25 ( 1.41 )
    0.50 ( 1.06 )
    0.30 ( 0.91 )
    0.00 ( 0.71 )
    No statistical analyses for this end point

    Secondary: PAP: Change From Baseline in Creatine Kinase Value at Week 25

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    End point title
    PAP: Change From Baseline in Creatine Kinase Value at Week 25
    End point description
    Change from Baseline in Creatine kinase value (to assess muscle damage) at Week 25 were reported in this endpoint. Analysis was performed on safety population.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 25
    End point values
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa
    Number of subjects analysed
    6
    5
    5
    6
    Units: international units per liters
        arithmetic mean (standard deviation)
    -208.67 ( 382.34 )
    -476.60 ( 467.20 )
    -421.40 ( 413.39 )
    -1.33 ( 51.20 )
    No statistical analyses for this end point

    Secondary: ETP: Number of Subjects With Treatment-emergent Adverse Events, Serious Treatment-emergent Adverse Events, and Adverse Event of Special Interest

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    End point title
    ETP: Number of Subjects With Treatment-emergent Adverse Events, Serious Treatment-emergent Adverse Events, and Adverse Event of Special Interest
    End point description
    Data for this endpoint will be reported at the time of anticipated last subject last visit results posting (December 2025).
    End point type
    Secondary
    End point timeframe
    From Week 26 to Week 371
    End point values
    ETP: Cohort 1: Avalglucosidase Alfa 20 mg/kg ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP Pooled Arm ETP: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    0 [9]
    0 [10]
    0 [11]
    Units: subjects
    Notes
    [9] - Data will be reported at time of anticipated last subject last visit results posting (Dec 2025).
    [10] - Data will be reported at time of anticipated last subject last visit results posting (Dec 2025).
    [11] - Data will be reported at time of anticipated last subject last visit results posting (Dec 2025).
    No statistical analyses for this end point

    Secondary: ETP: Number of Subjects With Infusion-associated Reactions

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    End point title
    ETP: Number of Subjects With Infusion-associated Reactions
    End point description
    Data for this endpoint will be reported at the time of anticipated last subject last visit results posting (December 2025).
    End point type
    Secondary
    End point timeframe
    From Week 26 to Week 371
    End point values
    ETP: Cohort 1: Avalglucosidase Alfa 20 mg/kg ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP Pooled Arm ETP: Avalglucosidase Alfa 40 mg/kg
    Number of subjects analysed
    0 [12]
    0 [13]
    0 [14]
    Units: subjects
    Notes
    [12] - Data will be reported at time of anticipated last subject last visit results posting (Dec 2025).
    [13] - Data will be reported at time of anticipated last subject last visit results posting (Dec 2025).
    [14] - Data will be reported at time of anticipated last subject last visit results posting (Dec 2025).
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From Day 1 to Week 25 in PAP and from Week 26 to 102 in ETP. Safety data were planned to be collected and analysed for pooled population of subjects who received avalglucosidase alfa 40 mg/kg (Cohorts 2 and 3a of PAP) in ETP. AE collection still ongoing.
    Adverse event reporting additional description
    TEAEs:AEs that developed/worsened in grade/become serious during treatment epoch(PAP:1st study drug dose in ETP/4 weeks after last infusion for those who didn’t get into ETP/2 weeks after last infusion in PAP)(ETP:1st dose of study drug in ETP to last dose of study drug+4 weeks/2 weeks if subject got enrolled in another study/received ERT). Safety.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22.0
    Reporting groups
    Reporting group title
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg
    Reporting group description
    Avalglucosidase alfa 20 mg/kg IV infusion qow for 25 weeks in PAP.

    Reporting group title
    PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    Avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP

    Reporting group title
    PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received avalglucosidase alfa 40 mg/kg (the highest tolerated dose) IV infusion qow for 25 weeks in PAP.

    Reporting group title
    PAP: Cohort 3b: Alglucosidase Alfa
    Reporting group description
    After determination of the highest tolerated avalglucosidase alfa dose in Cohort 1 and Cohort 2 (after at least 5 subjects in each Cohort 1 and Cohort 2 had received the 7th dose of avalglucosidase alfa or completed Week 13 with a minimum of 6 infusions), subjects received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in PAP. After PAP subjects received avalglucosidase alfa 40 mg/kg IV infusion qow from Week 26 up to Week371 in ETP.

    Reporting group title
    ETP: Avalglucosidase Alfa dose 20 mg/kg
    Reporting group description
    Included all subjects of Cohort 1 who received avalglucosidase alfa 20 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.

    Reporting group title
    Pooled Arm ETP: Avalglucosidase Alfa 40 mg/kg
    Reporting group description
    Pooled arm included all subjects of Cohorts 2 and 3a who received avalglucosidase alfa 40 mg/kg IV infusion qow for 25 weeks in PAP, followed by same treatment from Week 26 up to Week 371 in ETP.

    Reporting group title
    ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP
    Reporting group description
    Included all subjects of Cohort 3b who received alglucosidase alfa at their current stable dose (defined as dose [between 20 mg/kg qow and 40 mg/kg weekly as per physician] administered regularly for a minimum of 6 months immediately prior to entry in this study) IV infusion for 25 weeks in the PAP and after PAP, switched to receive avalglucosidase alfa 40 mg/kg IV infusion qow from Week 26 up to Week 371 in ETP.

    Serious adverse events
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa ETP: Avalglucosidase Alfa dose 20 mg/kg Pooled Arm ETP: Avalglucosidase Alfa 40 mg/kg ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 6 (16.67%)
    3 / 5 (60.00%)
    0 / 5 (0.00%)
    2 / 6 (33.33%)
    4 / 6 (66.67%)
    2 / 10 (20.00%)
    1 / 3 (33.33%)
         number of deaths (all causes)
    0
    0
    0
    0
    0
    0
    0
         number of deaths resulting from adverse events
    Injury, poisoning and procedural complications
    Femur Fracture
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Joint Dislocation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Post Procedural Haemorrhage
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Cardiac disorders
    Atrial Thrombosis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    0 / 0
    0 / 3
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Ear and labyrinth disorders
    Tympanic Membrane Perforation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Eye disorders
    Eyelid Ptosis
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 5 (40.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Strabismus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Adenoidal Hypertrophy
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Lung Consolidation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory Distress
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Tonsillar Hypertrophy
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Gastroenteritis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Lung Infection Pseudomonal
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Otitis Media
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Pneumonia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    2 / 6 (33.33%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 2
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Respiratory Tract Infection Viral
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Urinary Tract Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Product issues
    Device Malfunction
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    PAP: Cohort 1: Avalglucosidase Alfa 20 mg/kg PAP: Cohort 2: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3a: Avalglucosidase Alfa 40 mg/kg PAP: Cohort 3b: Alglucosidase Alfa ETP: Avalglucosidase Alfa dose 20 mg/kg Pooled Arm ETP: Avalglucosidase Alfa 40 mg/kg ETP:Alglucosidase Alfa in PAP Then Avalglucosidase Alfa in ETP
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    5 / 6 (83.33%)
    5 / 5 (100.00%)
    5 / 5 (100.00%)
    4 / 6 (66.67%)
    6 / 6 (100.00%)
    7 / 10 (70.00%)
    3 / 3 (100.00%)
    General disorders and administration site conditions
    Asthenia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Catheter Site Oedema
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    2
    0
    0
    0
    0
    0
    Device Related Thrombosis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Fatigue
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Feeling Hot
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Infusion Site Swelling
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    1
    0
    Injection Site Pain
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    1
    0
    0
    Malaise
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Oedema Peripheral
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Pyrexia
         subjects affected / exposed
    2 / 6 (33.33%)
    1 / 5 (20.00%)
    2 / 5 (40.00%)
    1 / 6 (16.67%)
    2 / 6 (33.33%)
    2 / 10 (20.00%)
    0 / 3 (0.00%)
         occurrences all number
    4
    4
    2
    1
    9
    3
    0
    Reproductive system and breast disorders
    Genital Erosion
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Respiratory, thoracic and mediastinal disorders
    Asthma
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    3
    0
    0
    Atelectasis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Bronchiectasis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Cough
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 5 (20.00%)
    2 / 5 (40.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    1
    4
    0
    13
    0
    0
    Epistaxis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    2 / 10 (20.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    2
    3
    0
    Increased Upper Airway Secretion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Laryngeal Oedema
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Lower Respiratory Tract Congestion
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Nasal Congestion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Oropharyngeal Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    2 / 5 (40.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    3
    0
    0
    0
    0
    0
    Productive Cough
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    3
    0
    0
    Pulmonary Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Respiratory Tract Congestion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Rhinorrhoea
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    1
    0
    0
    0
    Tachypnoea
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    1
    0
    Tonsillar Hypertrophy
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Upper Respiratory Tract Congestion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Psychiatric disorders
    Enuresis
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Nightmare
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Staring
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Product issues
    Device Occlusion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    0
    0
    Investigations
    Alpha-1 Acid Glycoprotein Increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Faecal Calprotectin Increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Gamma-Glutamyltransferase Increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Haemoglobin Decreased
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Heart Rate Increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Injury, poisoning and procedural complications
    Arthropod Bite
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Arthropod Sting
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    2
    0
    0
    0
    3
    0
    Contusion
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    1
    0
    Craniocerebral Injury
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Fall
         subjects affected / exposed
    2 / 6 (33.33%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    2 / 6 (33.33%)
    2 / 10 (20.00%)
    1 / 3 (33.33%)
         occurrences all number
    2
    2
    0
    0
    2
    2
    1
    Ligament Sprain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Muscle Strain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Procedural Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Skin Abrasion
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    3
    0
    0
    0
    0
    0
    Sunburn
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Thermal Burn
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Vascular Access Complication
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Wound
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Cardiac disorders
    Pericardial Effusion
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    2
    0
    14
    1
    0
    Presyncope
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Seizure
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Blood and lymphatic system disorders
    Lymph Node Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Neutropenia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Ear and labyrinth disorders
    Cerumen Impaction
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Deafness
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Ear Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Excessive Cerumen Production
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    1
    3
    0
    0
    Middle Ear Effusion
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    1
    0
    0
    0
    Otorrhoea
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    0
    0
    0
    0
    0
    Eye disorders
    Conjunctivochalasis
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Eye Discharge
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Eye Irritation
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    0
    0
    Keratopathy
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Lacrimation Increased
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Gastrointestinal disorders
    Abdominal Hernia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Abdominal Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    1
    0
    1
    1
    0
    Aphthous Ulcer
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Constipation
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Dental Caries
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Diarrhoea
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    2 / 5 (40.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    2
    0
    4
    3
    0
    Dysphagia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Faeces Soft
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Loose Tooth
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Mucous Stools
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Nausea
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    1
    6
    0
    0
    Regurgitation
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Teething
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Toothache
         subjects affected / exposed
    1 / 6 (16.67%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    5
    0
    0
    0
    1
    0
    Vomiting
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    2 / 5 (40.00%)
    3 / 6 (50.00%)
    1 / 6 (16.67%)
    2 / 10 (20.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    3
    2
    3
    3
    3
    0
    Skin and subcutaneous tissue disorders
    Alopecia Areata
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Blister
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Dermatitis Atopic
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Dermatitis Contact
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    2
    0
    0
    0
    0
    Dermatitis Diaper
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    3
    0
    0
    2
    0
    0
    Eczema
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    0
    0
    2
    0
    0
    Erythema
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    1
    0
    0
    Intertrigo
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Pruritus
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Rash
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    2 / 5 (40.00%)
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    2 / 10 (20.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    1
    3
    2
    1
    3
    1
    Urticaria
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Renal and urinary disorders
    Dysuria
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Haematuria
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Neurogenic Bladder
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Back Pain
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    2
    1
    0
    Foot Deformity
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Musculoskeletal Chest Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Musculoskeletal Pain
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Myalgia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Osteopenia
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Pain In Extremity
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    3
    0
    1
    0
    0
    0
    1
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    2 / 6 (33.33%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    3
    0
    0
    Bronchitis Viral
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    1
    0
    Conjunctivitis
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    0
    0
    0
    0
    0
    Enterovirus Infection
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Fungal Skin Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    1
    Gastroenteritis
         subjects affected / exposed
    0 / 6 (0.00%)
    1 / 5 (20.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    0
    0
    Hand-Foot-And-Mouth Disease
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Influenza
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Lower Respiratory Tract Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Lung Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Lung Infection Pseudomonal
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Nail Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    0
    0
    0
    1
    Nasopharyngitis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Otitis Externa
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    1
    0
    0
    Otitis Media
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    2 / 6 (33.33%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    1
    0
    0
    1
    2
    0
    1
    Parainfluenzae Virus Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Pneumonia
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0
    Pneumonia Pseudomonal
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Rhinitis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    1
    0
    0
    Sepsis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Stoma Site Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    1 / 6 (16.67%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    1
    0
    0
    0
    Tinea Pedis
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    0
    0
    0
    1
    0
    Tonsillitis
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    0
    0
    0
    0
    0
    Upper Respiratory Tract Infection
         subjects affected / exposed
    2 / 6 (33.33%)
    0 / 5 (0.00%)
    2 / 5 (40.00%)
    1 / 6 (16.67%)
    1 / 6 (16.67%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    5
    0
    3
    1
    3
    1
    0
    Urinary Tract Infection
         subjects affected / exposed
    2 / 6 (33.33%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    1 / 10 (10.00%)
    0 / 3 (0.00%)
         occurrences all number
    2
    0
    0
    0
    0
    1
    0
    Urinary Tract Infection Bacterial
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    1 / 5 (20.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    0
    0
    Viral Infection
         subjects affected / exposed
    0 / 6 (0.00%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    2 / 6 (33.33%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    1 / 3 (33.33%)
         occurrences all number
    0
    0
    0
    2
    0
    0
    1
    Viral Rash
         subjects affected / exposed
    1 / 6 (16.67%)
    0 / 5 (0.00%)
    0 / 5 (0.00%)
    0 / 6 (0.00%)
    0 / 6 (0.00%)
    0 / 10 (0.00%)
    0 / 3 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    0
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    27 Jul 2018
    Following changes were made: - Changed the sample size: Cap of 5 subjected per cohort in Stage 1, Cohort 1 and Cohort 2, was removed to alleviate constraints in conduct of the study and maximise the collection of data in pediatric subjects. At least 10 subjects will be included in Cohort 3. -Changes to endpoints: Face, Legs, Activity, Cry, and Consolability scale assessment was removed from the protocol to reduce subjects and investigational staff burden due to the limited expected value of the assessment. -Changed sampling for pharmacodynamic variables: Collection of dry blood spot had been added for determination of exploratory biomarkers in addition to samples of urine and plasma to develop alternative assays and potentially reduce blood volume needed for testing in the future. -Change to inclusion/exclusion criteria: Beta-blockers are no longer a prohibited concomitant medication as they are considered standard of care in this IOPD subject population.
    24 Mar 2020
    Following changes were made: - In order to allow study subjects to continue to receive the investigational medicinal product (IMP) after Week 145, the study had been extended to an additional period of up to 226 weeks (Week 371) or until avalglucosidase alfa was approved in the subject's country, whichever came first. - In countries where it was permitted, home infusion of avalglucosidase alfa in the extension period might be allowed. - Clarifications were given regarding the conditions for temporary IMP discontinuation with DMC consultation. - Clarifications were given regarding AESI related to LFT values that can fluctuate as part of the underlying Pompe disease. - Clarification was given in the tertiary endpoints that the Motor Skills Checklist was completed in concert with the Gross Motor Function Classification System, Expanded and Revised. - Clarification was given in the description of some tertiary endpoints. - Clarification was given regarding the possibility of additional interim analysis for regulatory purpose during the extension period. - Clarification was given regarding the order of motor assessments. - As subjects were no longer treated with alglucosidase alfa after Week 25 when entering the extension period, the collection of samples for analysis of anti-alglucosidase alfa antibodies was removed from the follow-up after PAP. - Relevant sections were updated to reflect practices as outlined in the current protocol template.
    05 Jan 2021
    Following changes were made: - Included the recommendations that were developed for the Covid-19 pandemic period and shared with the sites/Investigators. These recommendations remained applicable after the end of the pandemic, especially regarding the post-infusion surveillance period. - Relevant sections wordings were updated that were compliant with general guidance, including monitoring techniques. - Updated home infusion to harmonize across the different studies included in the avalglucosidase alfa development program.

    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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