E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Mucopolysaccharidosis Type IIIA |
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E.1.1.1 | Medical condition in easily understood language |
Sanfilippo syndrome type A |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
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 | 10056890 |
E.1.2 | Term | Mucopolysaccharidosis III |
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 |
To assess the efficacy of intracerebral delivery of AAVrh.10-SGSH gene therapy (LYS-SAF302) in improving or stabilizing the neurodevelopmental status of MPS IIIA patients after 24 months (main cohort), compared to the expected evolution based on natural history data. |
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E.2.2 | Secondary objectives of the trial |
To assess the safety and tolerability of intracerebral delivery of LYS-SAF302 and to assess the treatment efficacy on the behavioral, sleep disturbances of the patients, treatment effect on brain imaging, biomarkers and on quality of life for both patient and parents |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Documented MPS IIIA diagnosis based on genotyping confirming the SGSH gene mutations 2. Age ≥ 30 months at screening (main cohort) or ≥ 24 months and < 30 months (ancillary cohort) 3. Cognitive DQ score on BSID-III ≥ 50% 4. Signed written informed consent before any study related procedure is performed 5. Medical status sufficiently stable, in the opinion of the Investigator, to adhere to the study visit schedule and protocol procedures. 6. Confirmation by the study neurosurgeon and anesthesiologist of the feasibility of the neurosurgical procedure.
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E.4 | Principal exclusion criteria |
1. Homozygous for the S298P mutation or non-severe form of MPS IIIA, based on investigator judgement 2. Past participation in another gene or cell therapy clinical trial 3. Past use of SGSH enzyme replacement therapy for a cumulative period exceeding 3 months. In addition, a washout period of at least 2 months is required prior to screening 4. Current participation in a clinical trial of another investigational medicinal product. NOTE: Nutritional supplements, including Genistein, are permitted if they are taken outside the context of an investigational trial 5. History of bleeding disorder or current use of medications that, in the opinion of the investigator, place them at risk of bleeding following surgery 6. Presence of concomitant medical condition precluding lumbar puncture 7. Presence of any item (e.g., metal braces) precluding undergoing MRI 8. Any condition that would contraindicate treatment with immunosuppressants such as tacrolimus, mycophenolate mofetil or steroids 9. History of significant non-MPS IIIA related CNS impairment or behavioral disturbances that would confound scientific rigor or interpretation of results 10. Rare and unrelated serious comorbidities, e.g., Down syndrome, intraventricular hemorrhage in the new-born period, or extreme low birth weight (<1500 grams) 11. History of poorly controlled seizure disorder 12. Any vaccination 1 month prior to the planned surgery 13. Serology consistent with HIV exposure or consistent with active hepatitis B or C infection 14. Grade 2 or higher lab abnormalities for LFT, bilirubin, creatinine, hemoglobin, WBC count, platelet count, PT, and a PTT 15. Visual or hearing impairment sufficient, in the clinical judgment of the investigator, to preclude cooperation with neurodevelopmental testing. Use of hearing aids is permitted.
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the observed (post-surgery) evolution of cognitive developmental quotient (DQ) expressed by the ratio (DQ24/DQ0) between baseline and 24 months. Actual values will be compared to the ones expected based on modeling from natural history studies.
Cognitive DQ will be assessed by neurocognitive testing using the Bayley Scale for Infant and Toddler Development, 3rd Edition (BSID-III) or the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II), depending on child’s age and ability. Primary and secondary analyses will be performed separately on the main and the ancillary cohorts. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Primary endpoint between baseline and 24 months. |
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E.5.2 | Secondary end point(s) |
- The change from baseline in the cognitive developmental age (DA) and cognitive developmental quotient (DQ) assessed by neurocognitive tests (BSID III or KABCII) at all timepoints - The change from baseline in other DA and DQ (language and motor) assessed byneurocognitive tests (BSID III or KABC-II) at all timepoints -The percentage of patients with at least stabilized developmental age (DA) at 12 months and 24 months - The change from baseline in the total adaptive behavior composite standard score as measured by the Vineland Adaptive Behavior Scales (VABS-II) at 12 months and 24 months and change from baseline in total behavior problem as measured by the Child Behavior Checklist (CBCL) at 12 and 24 months - The change from baseline in sleep pattern as measured by the Children Sleep Habits Questionnaire (CSHQ) at 12 months and 24 months - The change from baseline in the patient/parent quality of life - The change from baseline in total cortical grey matter volume and white matter volume on MRI at 12 months and 24 months - The change from baseline in relevant disease biomarkers in serum, CSF and urine |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
BSID III, KABC-II and biomarkers will be assessed at all timepoints
DA, VABS-II, CBCL, CSHQ, ITQOL-SF47, GHQ, HUI-3, PSI-4-SF, MRI at 12 and 24 months for the main cohort. Corresponding timepoint of primary interest for the young cohort will be when all patients from the young cohort have reached 4 years of age.
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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 | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
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) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
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 | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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 | 3 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
United States |
France |
Germany |
Netherlands |
United Kingdom |
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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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Subjects will be followed for 5 years post treatment for safety. |
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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 | 6 |
E.8.9.1 | In the Member State concerned months | 5 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 6 |
E.8.9.2 | In all countries concerned by the trial months | 5 |