E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Mucopolysaccharidosis (MPS) type VI. |
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E.1.1.1 | Medical condition in easily understood language |
Mucopolysaccharidosis (MPS) type VI. |
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E.1.1.2 | Therapeutic area | Body processes [G] - Genetic Phenomena [G05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10056892 |
E.1.2 | Term | Mucopolysaccharidosis VI |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of the study is to assess the safety and efficacy of two doses of odiparcil in MPS VI patients and to provide evidence to enable the selection of the relevant dose of odiparcil for phase III study. |
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E.2.2 | Secondary objectives of the trial |
The secondary objective of this study is to characterize the dose response, PK and PD of odiparcil. |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Optional pharmacogenomic sub-study |
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E.3 | Principal inclusion criteria |
1. Male or female gender. 2. Age ≥18 years. 3. Diagnosis of MPS VI. 4. Urine GAG above upper limit of normal (ULN) based on historical data. 5. Willing and able to provide written, dated, signed informed consent, after the nature of the study has been explained, and prior to any research-related procedures or study assessment. 6. Able to comply with all study procedures. 7. Women with childbearing potential (i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy) must agree to use a highly effective method of birth control during the study and at least 4 weeks after last administration.The following can be considered to be examples of highly effective methods of contraception preferably with low user dependency: - combined (estrogen and progestogen containing) hormonal contraception associated wiht inhibition of ovulation (oral, intravanginal or transdermal) - progestogen-only hormonal contraceptioni associated with inhibition of ovulation (oral, injectable, implantable) 1 - Intrauternine device (IUD) 1 - Intrauterine hormone-releasing system (IUS) 1 - Bilateral tubal occulusion 1 - Vasectomised partner 1 - Sexual abstinence These methods of contraception must be supplemented with a barrier method (preferably male condom).
1 Contraception methods that are considered to have low user dependency.
Inclusion criteria for Enzyme Replacement Therapy (ERT) receiving group 1. Patients with MPS Type VI receiving enzyme replacement therapy (Naglazyme) for at least 6 months on the licensed dosage or as per local guidelines.
Inclusion criteria for not ERT receiving group: Patients with MPS Type VI not receiving enzyme replacement therapy for the following reasons: 1. Patients not treated with ERT (treatment naive) or previously treated with ERT but having discontinued for more than 3 months before inclusion, either due to medical decision or personal choice (e.g. for quality of life preferences). Under no circumstances patients will be taken of ERT for the only purpose of participating to the study. Reason for not receiving ERT should be specified by the invetigator. 2. Patients allergic to ERT therapy 3. Patients that have had a previous hematopoietic stem cell transplant (HSCT)
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E.4 | Principal exclusion criteria |
Exclusion criteria for the entire cohort 1. Use of any investigational product or investigational medical device within 30 days prior to screening. This will include product bought over the counter specifically compounds like genistein and pentosane polysulphate which may not be considered as investigational products by patients and some health care professionals. 2. Concurrent disease or condition that would interfere with study participation or pose a safety concern for example patient with: severe cardiac insufficiency as define NYHA class > II, and severe restrictive chronic respiratory insufficiency as reflected by serum [HCO3-] ≥28 mEq/L. 3. Subjects who had surgery within 3 months before study starts, or for whom surgery is planned during study period. 4. Patient with spinal cord compression requiring surgical intervention. 5. Subjects with the following liver test abnomalies: any ALT, AST > 3 x ULN or bilirubin >1.5 x ULN (except if Gilbert syndrome) at screening visit. 6. Evidence of an immunosuppressive state, including known HIV infection, agammaglubilinemias, T-Cell deficiencies. 7. Subjects with history of chronic infections, including but not limited to subjects with history of viral hepatitis C, or B, with recent history of serious or life-threatening infection or any current signs or symptoms that may indicate infection at visit V-1 of study as per investigators clinical judgement. 8. History of malignant cancer except of cervical carcinoma in situ, basal cell carcinoma, dermatological squamous cell carcinoma. 9. Subjects with significant haematologic abnormalities, such as hemoglobin <8 g/dL, or WBC<2000 /mm3 or absolute neutrophil count <1300 /mm3, or platelet <30.000 /mm3. Subjects with other haematological abnormalities not corresponding to the above criteria should not be included in preliminary safety assessment. 10. International Normalized Ratio (INR), activated partial thromboplastin time (aPTT) or thrombin time (TT) values above the central laboratory reference range at screening considered as clinically significant by the investigator. For patients on anticoagulants, they should be within their target effect on INR and be stable. 11. Any history of bleeding diathesis. 12. Patient with coexistence of corneal pathologies other than corneal clouding (e.g. exposure keratopathy) 13. An unwillingness on the part of male patients to abstain from sexual intercourse with pregnant or lactating women; or an unwillingness to use highly effective form of birth control if engaging in sexual intercourse with a woman who could become pregnant from the time of the first dose of study medication until completion of follow-up procedures. 14. An unwillingness on the part of female patients to use highly effective form of birth control if engaging in sexual intercourse and to have a monthly pregnancy test during treatment and until completion of follow-up procedures. 15. Pregnant or lactating women. 16. Have a known hypersensitivity to any of the ingredients or excipients of the IMP including: Microcrystalline Cellulose, Povidone, Sodium starch glycolate (type A), Magnesium stearate, Opadry™ II 85F18422
Exclusion criteria for ERT treated group: 1. Previous hematopoietic stem cell transplant (HSCT) |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Preliminary safety assessment The goal of preliminary safety assessment is to focus on clinical tolerance and lab safety such as coagulation, liver enzymes and cristalluria. 2. Core study a. Safety outcomes: a1. Safety outcomes will be evaluated on the following safety variables: incidence of AEs/SAEs, patient withdrawals from study due to AEs/SAEs, change from baseline in laboratory safety test, change from baseline in vital signs parameters. a2.1 Twelve-lead-ECG a2.2 Bone biomarkers (osteocalcin, beta-crosslaps, bone-specific alkaline phosphatase (BSAP), N-terminal propeptide of type 1 collagen (P1NP)).
b. Efficacy outcomes: b1. Mobility: 6-minute walk test, 9-hole PEG test, range of motion of the shoulder b2. Pain assessment: Brief Pain Inventory BPI b3. Respiratory function: FEV1, FVC, MVV b4. Cardiac and vascular tests: echochardiogram and carotid intima media thickness b5. Audiology assessments: pure tone audiometry and whisper voice test b6. Ophthalmology assessments: corneal opacification, level of retinopathy and optic nerve involvement, intra-ocular pressure, and visual acuity b7. Questionnaires: EQ-5D-5L, Zarit caregiver burden, Fatigue Severity Scale
c. Pharmacokinetic endpoints: c1. Odiparcil concentration in plasma and its metabolites. c2. Pre-dose samples will be collected to measure the odiparcil concentration remaining c3. Metabolite identification
d. Pharmacodynamic endpoints: d1. GAG concentrations in urine and leukocytes isolated from peripheral blood d2. GAG content in skin biopsies d3. Anti-thrombin IIa activity in plasma d4. Thrombin generation assay (TGA) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
1. Preliminary safety assessment V-1, V0, Va (D1), Vb (D7), Vc (D14) 2. Core study a. Safety: a1. V-1, V0, V1, V2, V4, V5, V6, V7 and V8 a2.1 V-1, V0, V2, V4, V7 and V8 a2.2 V0 and V7
b. Efficacy outcomes: b1. V-1, V0, V2, V4, V7 and V8 b2. V0, V7 b3. V-1, V0 and V7 b4. V0 and V7 b5. V0 and V7 b6. V0 and V7 b7. V-1, V0, V4 and V7
c. Pharmacokinetic endpoints: c1. V2 (0, 0.5, 1, 2, 3, 4, 8, 12 h post dose) c2. V4 and V7 c3. V2
d. Pharmacodynamic endpoints d1. V-1, V0, V2, V4, V7 and V8 d2. V6 and V7 d3. V-1, V0, V2, V4, V7 and V8 d4. V-1, V0, V1, V2, V3, V4, V5, V6, V7 and V8
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E.5.2 | Secondary end point(s) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Preliminary Safety assessment open-label. Core study 1st cohort double blind 2nd cohort open label. |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 4 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 4 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of the study is defined as completion of the last follow-up visit by the last patient |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 8 |