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    Clinical Trial Results:
    A Randomized, Double-Blind, Placebo-Controlled, Multiple Dose Efficacy, Safety, Tolerability, and Pharmacokinetics Study of AVI-4658 (Eteplirsen), a Phosphorodiamidate Morpholino Oligomer, Administered Over 28 Weeks in the Treatment of Ambulant Subjects with Duchenne Muscular Dystrophy

    Summary
    EudraCT number
    2016-005000-26
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    29 Feb 2012

    Results information
    Results version number
    v2(current)
    This version publication date
    01 Aug 2019
    First version publication date
    28 Mar 2019
    Other versions
    v1
    Version creation reason
    • Correction of full data set
    Update to Sponsor phone number

    Trial information

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    Trial identification
    Sponsor protocol code
    4658-us-201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01396239
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Sarepta Therapeutics, Inc.
    Sponsor organisation address
    215 First St., Cambridge, United States, MA 02142
    Public contact
    Medical Director, Sarepta Therapeutics, Inc., +1 888-727-3782, clinicaltrials@sarepta.com
    Scientific contact
    Medical Director, Sarepta Therapeutics, Inc., +1 888-727-3782, clinicaltrials@sarepta.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-001722-PIP01-14
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    01 Oct 2014
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    29 Feb 2012
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To assess the efficacy, safety, tolerability, and pharmacokinetics (PK) of AVI-4658 (eteplirsen) at 50 and 30 mg/kg/week (wk) doses in subjects diagnosed with Duchenne muscular dystrophy (DMD).
    Protection of trial subjects
    Written informed consent from each patient or patient’s parent(s) or legal guardian(s), if applicable, and written assent from each patient, if applicable, were obtained before any study-specific screening or baseline period evaluations were performed. The anonymity of participating patients will be maintained to the extent required by applicable laws and in accordance with current HIPAA standards. This study was designed and monitored in accordance with Sponsor procedures, which complied with the ethical principles of Good Clinical Practice (GCP) as required by the major regulatory authorities, and in accordance with the Declaration of Helsinki.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    18 Jul 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 12
    Worldwide total number of subjects
    12
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    12
    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
    -

    Pre-assignment
    Screening details
    The study was conducted at single center in the United States from 18 July 2011 to 10 August 2011.

    Period 1
    Period 1 title
    24 Weeks Blinded (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    AVI-4658 (Eteplirsen) 30 mg/kg
    Arm description
    30 milligram per kilogram (mg/kg) eteplirsen for 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    AVI-4658
    Investigational medicinal product code
    Other name
    Eteplirsen
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    30 mg/kg eteplirsen once weekly for 24 weeks via a 60-minute IV infusion.

    Arm title
    AVI-4658 (Eteplirsen) 50 mg/kg
    Arm description
    50 milligram per kilogram (mg/kg) eteplirsen for 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    AVI-4658
    Investigational medicinal product code
    Other name
    Eteplirsen
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    50 mg/kg eteplirsen once weekly for 24 weeks via a 60-minute IV infusion.

    Arm title
    Placebo
    Arm description
    Placebo: phosphate buffered saline solution identical in appearance to eteplirsen for 24 weeks.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Placebo matched to AVI-4658 once weekly for 24 weeks via a 60-minute IV infusion.

    Number of subjects in period 1
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Started
    4
    4
    4
    Completed
    4
    4
    4

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    AVI-4658 (Eteplirsen) 30 mg/kg
    Reporting group description
    30 milligram per kilogram (mg/kg) eteplirsen for 24 weeks.

    Reporting group title
    AVI-4658 (Eteplirsen) 50 mg/kg
    Reporting group description
    50 milligram per kilogram (mg/kg) eteplirsen for 24 weeks.

    Reporting group title
    Placebo
    Reporting group description
    Placebo: phosphate buffered saline solution identical in appearance to eteplirsen for 24 weeks.

    Reporting group values
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo Total
    Number of subjects
    4 4 4 12
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    9.3 ± 0.5 8.5 ± 1.29 8.5 ± 1.73 -
    Gender categorical
    Units: Subjects
        Female
    0 0 0 0
        Male
    4 4 4 12

    End points

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    End points reporting groups
    Reporting group title
    AVI-4658 (Eteplirsen) 30 mg/kg
    Reporting group description
    30 milligram per kilogram (mg/kg) eteplirsen for 24 weeks.

    Reporting group title
    AVI-4658 (Eteplirsen) 50 mg/kg
    Reporting group description
    50 milligram per kilogram (mg/kg) eteplirsen for 24 weeks.

    Reporting group title
    Placebo
    Reporting group description
    Placebo: phosphate buffered saline solution identical in appearance to eteplirsen for 24 weeks.

    Subject analysis set title
    Placebo - Week 12 Biopsy
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Placebo - Biopsied after 12 weeks of dosing.

    Subject analysis set title
    Placebo - Week 24 Biopsy
    Subject analysis set type
    Full analysis
    Subject analysis set description
    Placebo: Biopsied after 24 weeks of dosing.

    Primary: Change From Baseline in the Percentage (%) of Dystrophin Positive Fibers

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    End point title
    Change From Baseline in the Percentage (%) of Dystrophin Positive Fibers [1] [2]
    End point description
    The primary efficacy end point was based on the pre-treatment and post-treatment change in the percentage (%) of dystrophin-positive fibers as measured in the muscle biopsy tissue on immunohistochemistry (IHC). The sample size for the study was selected based on the Proof of Principle approach.
    End point type
    Primary
    End point timeframe
    After 12 weeks for 4 subjects who received 50 mg/kg and 2 subjects who received placebo. After 24 weeks for 4 subjects who received 30 mg/kg and 2 subjects who received placebo.
    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: Only descriptive data was planned to be reported for this endpoint.
    [2] - 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: Only arms applicable for this endpoint are reported.
    End point values
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo - Week 12 Biopsy Placebo - Week 24 Biopsy
    Number of subjects analysed
    4
    4
    2
    2
    Units: Percentage of dystrophin Pos. fibers
        least squares mean (full range (min-max))
    23 (15.9 to 29.0)
    0.79 (-9.3 to 7.4)
    -0.63 (-5.8 to 4.5)
    -7.48 (-8.5 to -6.5)
    No statistical analyses for this end point

    Secondary: Change From Baseline: 6 Minute Walk Test (6MWT) - Intent to Treat Population (ITT)

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    End point title
    Change From Baseline: 6 Minute Walk Test (6MWT) - Intent to Treat Population (ITT)
    End point description
    Secondary end points was based on the pre-treatment and post-treatment Change from baseline: 6 Minute Walk Test (6MWT) - Intent to Treat population (ITT).
    End point type
    Secondary
    End point timeframe
    24 weeks
    End point values
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Number of subjects analysed
    4
    4
    4
    Units: Meters
        arithmetic mean (standard error)
    -134.8 ± 72.36
    -2.3 ± 14.95
    -17.3 ± 14.03
    No statistical analyses for this end point

    Secondary: Change From Baseline: 6 Minute Walk Test (6MWT) - Modified Intent to Treat Population (mITT)

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    End point title
    Change From Baseline: 6 Minute Walk Test (6MWT) - Modified Intent to Treat Population (mITT)
    End point description
    Secondary end points was based on the pre-treatment and post-treatment of the 6MWT distance. Change from baseline: 6MWT - modified Intent-to-Treat population (mITT). The mITT population excludes 2 subjects in the 30 mg/kg arm who showed rapid disease progression within weeks of enrollment, and were unable to complete assessments that required ambulation at or beyond Week 24.
    End point type
    Secondary
    End point timeframe
    24 weeks
    End point values
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Number of subjects analysed
    2
    4
    4
    Units: Meters
        arithmetic mean (standard error)
    -12.5 ± 1.50
    -2.3 ± 14.95
    -17.3 ± 14.03
    No statistical analyses for this end point

    Secondary: Post-Hoc: Adverse Events >30%

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    End point title
    Post-Hoc: Adverse Events >30%
    End point description
    Adverse events that occurred in >30% of the overall subject population across treatment arms. Safety Population included all randomized subjects who received any amount of study drug. Analyses performed on the safety population were done according to the treatment actually received.
    End point type
    Secondary
    End point timeframe
    24 Weeks
    End point values
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Number of subjects analysed
    4
    4
    4
    Units: subjects
        Procedural Pain
    1
    3
    3
        Oropharyngeal Pain
    3
    0
    3
        Hypokalemia (a known side effect of steroids)
    2
    2
    2
        Cough
    1
    1
    2
        Extremity Pain
    0
    1
    3
    No statistical analyses for this end point

    Post-hoc: Post-Hoc: Frequency of AEs Related to Eteplirsen

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    End point title
    Post-Hoc: Frequency of AEs Related to Eteplirsen
    End point description
    Frequency of AEs that the study physician considered to be any of the following: Related; Possibly related; or Probably related to eteplirsen. Safety Population included all randomized subjects who received any amount of study drug. Analyses performed on the safety population were done according to the treatment actually received.
    End point type
    Post-hoc
    End point timeframe
    24 Weeks
    End point values
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Number of subjects analysed
    4
    4
    4
    Units: Number of subjects
        Intermittent Nausea (mild)
    0
    0
    1
        Other AEs related to eteplirsen
    0
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    24 weeks
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    14.0
    Reporting groups
    Reporting group title
    AVI-4658 (Eteplirsen) 30 mg/kg
    Reporting group description
    30 milligram per kilogram (mg/kg) eteplirsen once weekly for 24 weeks via a 60-minute IV infusion.

    Reporting group title
    AVI-4658 (Eteplirsen) 50 mg/kg
    Reporting group description
    50 milligram per kilogram (mg/kg) eteplirsen once weekly for 24 weeks via a 60-minute IV infusion.

    Reporting group title
    Placebo
    Reporting group description
    Placebo: phosphate buffered saline solution identical in appearance to eteplirsen for 24 weeks.

    Serious adverse events
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         number of deaths (all causes)
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    AVI-4658 (Eteplirsen) 30 mg/kg AVI-4658 (Eteplirsen) 50 mg/kg Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    4 / 4 (100.00%)
    4 / 4 (100.00%)
    4 / 4 (100.00%)
    Vascular disorders
    Haematoma
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 4 (25.00%)
    1 / 4 (25.00%)
         occurrences all number
    1
    1
    1
    General disorders and administration site conditions
    Injection site pain
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Malaise
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Non-cardiac chest pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Pain
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Pyrexia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    2 / 4 (50.00%)
         occurrences all number
    1
    0
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 4 (25.00%)
    1 / 4 (25.00%)
    2 / 4 (50.00%)
         occurrences all number
    1
    1
    5
    Nasal congestion
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    2 / 4 (50.00%)
         occurrences all number
    1
    0
    2
    Oropharyngeal pain
         subjects affected / exposed
    3 / 4 (75.00%)
    0 / 4 (0.00%)
    3 / 4 (75.00%)
         occurrences all number
    4
    0
    4
    Sinus congestion
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Upper respiratory tract congestion
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Injury, poisoning and procedural complications
    Arthropod bite
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Back injury
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Fall
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    1
    0
    1
    Foot fracture
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Incision site pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    1
    0
    1
    Joint injury
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Procedural pain
         subjects affected / exposed
    1 / 4 (25.00%)
    3 / 4 (75.00%)
    3 / 4 (75.00%)
         occurrences all number
    1
    3
    3
    Wound dehiscence
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    0
    1
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Nervous system disorders
    Balance disorder
         subjects affected / exposed
    1 / 4 (25.00%)
    2 / 4 (50.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    2
    0
    Dizziness
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    0
    1
    Headache
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    2 / 4 (50.00%)
         occurrences all number
    1
    0
    3
    Somnolence
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Ear and labyrinth disorders
    Motion sickness
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    2 / 4 (50.00%)
         occurrences all number
    0
    0
    2
    Diarrhoea
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    2
    1
    Nausea
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    1
    1
    Vomiting
         subjects affected / exposed
    1 / 4 (25.00%)
    2 / 4 (50.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    3
    0
    Skin and subcutaneous tissue disorders
    Dermatitis contact
         subjects affected / exposed
    2 / 4 (50.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    2
    0
    0
    Petechiae
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Urticaria thermal
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Renal and urinary disorders
    Polyuria
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Proteinuria
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Back pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    2 / 4 (50.00%)
         occurrences all number
    1
    0
    2
    Bone pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Muscle spasms
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    0 / 4 (0.00%)
         occurrences all number
    0
    1
    0
    Musculoskeletal pain
         subjects affected / exposed
    1 / 4 (25.00%)
    0 / 4 (0.00%)
    0 / 4 (0.00%)
         occurrences all number
    1
    0
    0
    Pain in extremity
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    3 / 4 (75.00%)
         occurrences all number
    0
    2
    3
    Infections and infestations
    Enterobiasis
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    0
    2
    Nasopharyngitis
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    0
    1
    Rhinitis
         subjects affected / exposed
    0 / 4 (0.00%)
    1 / 4 (25.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    2
    1
    Soft tissue infection
         subjects affected / exposed
    0 / 4 (0.00%)
    0 / 4 (0.00%)
    1 / 4 (25.00%)
         occurrences all number
    0
    0
    1
    Metabolism and nutrition disorders
    Hypokalaemia
         subjects affected / exposed
    2 / 4 (50.00%)
    2 / 4 (50.00%)
    2 / 4 (50.00%)
         occurrences all number
    2
    2
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    21 Apr 2011
    Version 2 (Amendment 1) * Changed the dosing regimen from 50 or 100 mg/kg/wk eteplirsen administered for 12 weeks to 30 or 50 mg/kg/wk administered for 24 weeks. * Changed the overall duration of the study from 30 to 28 weeks. * Changed the design of the study from a dose escalation study to a randomized, double-blind, placebo-controlled, multiple-dose, efficacy, safety, tolerability, and PK study. * Changed the number of subjects from 5 subjects each in 4 groups to 4 subjects each in 3 groups (30 mg/kg/wk, 50 mg/kg/wk, and placebo), i.e., from an N of 20 to an N of 12 * Changed the age range for subject enrollment from 5 to 15 years of age to 7 to 13 years of age. * Added the requirement that subjects be able to walk between 200 and 350 meters on the 6MWT to the entry criteria. * Changed the entry requirement that subjects be on a stable dose of corticosteroids for at least 12 weeks before study entry to at least 24 weeks before study entry. * Added the requirement that the QTc interval at study entry not exceed 450 millisecond to the entry criteria. * Changed the infusion of study medication from “60 minutes for an IV infusion or 2 minutes for an IV bolus” to an IV infusion duration of 30 minutes. * Increased the frequency of laboratory assessments. * Modified the timing and frequency of PK sample collection. * Added post-treatment muscle biopsies to the list of required assessments. * Specified that the primary efficacy end point would be dystrophin production.
    25 May 2011
    Version 3 (Amendment 2) * Changed the infusion time from 30 to 60 minutes. * Condensed the Screening assessments into 1 visit (Visit 1) to be performed within 4 weeks of week 1: day 1. * Added the Timed 4-Step Test to the efficacy assessments. * Expanded the maximum distance on the 6MWT inclusion criterion from 350 to 400 meters. * Changed the Week 24 brief physical examination to a full physical examination.
    22 Jun 2011
    Version 4.0 (Amendment 3) * Clarified the frequency of urine collection for assessment of cystatin C. * Added urine kidney injury molecule -1 (KIM-1) analysis to the list of safety laboratory assessments.
    10 Aug 2011
    Version 5.0 (Amendment 4) * Clarified that the 6MWT would be administered twice during the Screening visit and that the mean of the 2 assessments ± 10% of the lower or upper limit (200 m, 400 m) would be the value used to determine qualification. * Specified that the Screening Holter monitor recording would be reviewed prior to the subject undergoing a muscle biopsy, and that if the average heart rate during the recording exceeded 100 beats per minute (bpm), the subject would either be started on β-blockers and rescreened in 4 weeks or excluded from the study. * Increased the clinically significant range on 24-hour Holter monitoring from 100 to greater than equal to >= 110 bpm and symptomatic. * Added collection of serum cystatin C to the list of safety laboratory assessments.
    08 Sep 2011
    Version 6.0 (Amendment 5) * Clarified that maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) would be measured, not % predicted MIP and MEP. * Clarified that vital signs would not be collected 4 hours after dosing if subject had been allowed to leave the site prior to that time. * Deleted the 24-hour total urine protein collection from the protocol, because the results from the initial collection were confounded by the presence of nitrogen in eteplirsen.
    04 Nov 2011
    Version 7.0 (Amendment 6) * Removed pulmonary function test (PFT) from the list of safety assessments as it was already included in the list of efficacy assessments. * Made the 6MWT a secondary end point. * Modified the statistical method to the Wilcoxon rank-sum test, because it was more appropriate for the sample size of this study. * Permitted subjects to be released 1 hour after completion of the study drug infusion after the first 4 doses at the discretion of the Principal Investigator if there were no infusion site reactions or other events associated with drug administration. * Removed peak inspiratory and expiratory flow from the list of PFT assessments, because these tests are measures for pulmonary obstruction, not intercostal or diaphragmatic muscle function. * The Extended upper limit of the window for the muscle biopsy was extended to 96 hours post dosing to allow the same surgeon to perform all biopsies. * Updated planned statistical analyses. * Removed the “mITT” and “per protocol” populations from the list of analysis populations and added a “full analysis population”, which, like the safety population, included all subjects who received any study medication.
    07 Jan 2012
    Version 8.0 (Amendment 7) * Extended the duration of the study from 24 to 28 weeks. * Specified that beginning Week 25, subjects who received placebo for the first 24 weeks of the study would begin receiving the same dose of eteplirsen to which they were placebo-matched while those who received 50 or 30 mg/kg/wk eteplirsen for the first 24 weeks would continue to receive the same dose regimen of eteplirsen without interruption. * Specified that treatment assignment during the first 24 weeks of the study (eteplirsen vs. placebo) would remain blinded until the study was completed and the database had been locked. * Provided a schedule of assessments and guidance on the administration of study medication for Weeks 25 to 28.

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/23907995
    http://www.ncbi.nlm.nih.gov/pubmed/26573217
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