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    Clinical Trial Results:
    Phase 2 Active Treatment Study to Evaluate the Efficacy and Safety of SRK-015 in Patients with Later-Onset Spinal Muscular Atrophy

    Summary
    EudraCT number
    2018-004383-65
    Trial protocol
    NL   ES   DE   IT  
    Global end of trial date
    28 Feb 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    02 Jan 2025
    First version publication date
    02 Jan 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SRK-015-002
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Scholar Rock, Inc.
    Sponsor organisation address
    31 Binney Street, 3rd Floor, Cambridge, United States, MA 02142
    Public contact
    Bert Yao, Scholar Rock, Inc., +1 9195939950, byao@scholarrock.com
    Scientific contact
    Bert Yao, Scholar Rock, Inc., +1 9195939950, byao@scholarrock.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    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
    03 Oct 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Feb 2024
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Feb 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objectives of the trial were: - Assess the safety and tolerability of apitegromab in subjects with Type 2 and Type 3 SMA over 12 months - Assess the efficacy of apitegromab based on changes in motor-function outcome measures over 12 months
    Protection of trial subjects
    This study was designed and monitored in accordance with Sponsor procedures, which comply with the ethical principles of the International Council for Harmonisation (ICH) on GCP guidance and in accordance with the Declaration of Helsinki (Version 2013). The study was also conducted in accordance with national and local legal requirements and in accordance with United States (US) Investigational New Drug regulations (21 Code of Federal Regulations [CFR] 56) and the European Union (EU)’s Commission Directive 2005/28/EC of 8 April 2005.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    22 Apr 2019
    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 States: 41
    Country: Number of subjects enrolled
    Netherlands: 2
    Country: Number of subjects enrolled
    Spain: 6
    Country: Number of subjects enrolled
    Italy: 9
    Worldwide total number of subjects
    58
    EEA total number of subjects
    17
    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)
    39
    Adolescents (12-17 years)
    13
    Adults (18-64 years)
    6
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Sixty-five subjects at 16 study sites in the US and EU (Italy, Netherlands, and Spain) were screened. There were 7 screen failures and 58 subjects enrolled who received treatment.

    Pre-assignment
    Screening details
    - Age 5 through 21 years old for Cohorts 1 and 2; Age ≥2 years old for Cohort 3 - Documented diagnosis of 5q SMA - Diagnosed as later-onset SMA prior to receiving any therapy approved for SMA - For Cohort 1, RHS score no greater than 63 at Screening - For Cohort 2 and 3, HFMSE score no less than 10 at Screening

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    Cohorts 1 and 2 are open-label cohorts which are directly assigned to the 20 mg/kg dose of SRK-015 while Cohort 3 patients will be randomized (1:1) in a double-blind manner to receive either 2 mg/kg or 20 mg/kg SRK-015 via an Interactive Web-based Randomization System (IWRS). The Sponsor, patients, caregivers, Investigators, and site personnel, with the exception of the Pharmacist, will be blinded to Cohort 3 SRK-015 dose level assignments.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Cohort 1 SRK-015 20 mg/kg
    Arm description
    Ambulatory Type 3 subjects, ages 5 to 21 years, who were not receiving nusinersen (SRK-015 alone). ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.
    Arm type
    Experimental

    Investigational medicinal product name
    SRK-015
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    SRK-015 will be administered to patients at 20 mg/kg, according to the cohort assignments. Doses will be diluted in normal saline and administered by IV over 2 hours (+10-minute window). All doses will be administered via peripheral IV (or via long-term IV access device such as a peripherally inserted central catheter or port, if the patient has such a device for their background medical care).

    Arm title
    Cohort 1 SRK-015 20mg/kg + SMN therapy
    Arm description
    Ambulatory Type 3 subjects, ages 5 to 21 years, who were already receiving an SMN therapy (ie, nusinersen) that they would receive in the current study that was initiated when the subject was ≥5 years old (SRK-015 + nusinersen). ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.
    Arm type
    Experimental

    Investigational medicinal product name
    SRK-015
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    SRK-015 will be administered to patients at 20 mg/kg, according to the cohort assignments. Doses will be diluted in normal saline and administered by IV over 2 hours (+10-minute window). All doses will be administered via peripheral IV (or via long-term IV access device such as a peripherally inserted central catheter or port, if the patient has such a device for their background medical care).

    Arm title
    Cohort 2 SRK-015 20mg/kg + SMN therapy
    Arm description
    Type 2 or non-ambulatory Type 3 subjects ages 5 to 21 years who were already receiving nusinersen that was initiated after the subject turned 5 years of age. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.
    Arm type
    Experimental

    Investigational medicinal product name
    SRK-015
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    SRK-015 will be administered to patients at 20 mg/kg, according to the cohort assignments. Doses will be diluted in normal saline and administered by IV over 2 hours (+10-minute window). All doses will be administered via peripheral IV (or via long-term IV access device such as a peripherally inserted central catheter or port, if the patient has such a device for their background medical care).

    Arm title
    Cohort 3 SRK-015 2mg/kg + SMN therapy
    Arm description
    Type 2 non-ambulatory subjects ages ≥2 years already receiving nusinersen that was initiated when the subject was <5 years old. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.
    Arm type
    Experimental

    Investigational medicinal product name
    SRK-015
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    SRK-015 will be administered to patients at 2 mg/kg, according to the cohort assignments. Doses will be diluted in normal saline and administered by IV over 2 hours (+10-minute window). All doses will be administered via peripheral IV (or via long-term IV access device such as a peripherally inserted central catheter or port, if the patient has such a device for their background medical care).

    Arm title
    Cohort 3 SRK-015 20 mg/kg + SMN therapy
    Arm description
    Type 2 non-ambulatory subjects ages ≥2 years already receiving nusinersen that was initiated when the subject was <5 years old. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.
    Arm type
    Experimental

    Investigational medicinal product name
    SRK-015
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    SRK-015 will be administered to patients at 20 mg/kg, according to the cohort assignments. Doses will be diluted in normal saline and administered by IV over 2 hours (+10-minute window). All doses will be administered via peripheral IV (or via long-term IV access device such as a peripherally inserted central catheter or port, if the patient has such a device for their background medical care).

    Number of subjects in period 1
    Cohort 1 SRK-015 20 mg/kg Cohort 1 SRK-015 20mg/kg + SMN therapy Cohort 2 SRK-015 20mg/kg + SMN therapy Cohort 3 SRK-015 2mg/kg + SMN therapy Cohort 3 SRK-015 20 mg/kg + SMN therapy
    Started
    11
    12
    15
    10
    10
    Completed
    11
    11
    15
    10
    10
    Not completed
    0
    1
    0
    0
    0
         Consent withdrawn by subject
    -
    1
    -
    -
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Cohort 1 SRK-015 20 mg/kg
    Reporting group description
    Ambulatory Type 3 subjects, ages 5 to 21 years, who were not receiving nusinersen (SRK-015 alone). ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 1 SRK-015 20mg/kg + SMN therapy
    Reporting group description
    Ambulatory Type 3 subjects, ages 5 to 21 years, who were already receiving an SMN therapy (ie, nusinersen) that they would receive in the current study that was initiated when the subject was ≥5 years old (SRK-015 + nusinersen). ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 2 SRK-015 20mg/kg + SMN therapy
    Reporting group description
    Type 2 or non-ambulatory Type 3 subjects ages 5 to 21 years who were already receiving nusinersen that was initiated after the subject turned 5 years of age. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 3 SRK-015 2mg/kg + SMN therapy
    Reporting group description
    Type 2 non-ambulatory subjects ages ≥2 years already receiving nusinersen that was initiated when the subject was <5 years old. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 3 SRK-015 20 mg/kg + SMN therapy
    Reporting group description
    Type 2 non-ambulatory subjects ages ≥2 years already receiving nusinersen that was initiated when the subject was <5 years old. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group values
    Cohort 1 SRK-015 20 mg/kg Cohort 1 SRK-015 20mg/kg + SMN therapy Cohort 2 SRK-015 20mg/kg + SMN therapy Cohort 3 SRK-015 2mg/kg + SMN therapy Cohort 3 SRK-015 20 mg/kg + SMN therapy Total
    Number of subjects
    11 12 15 10 10 58
    Age categorical
    Units: Subjects
        In utero
    0 0 0 0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0 0 0 0
        Newborns (0-27 days)
    0 0 0 0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0 0 0 0
        Children (2-11 years)
    5 5 9 10 10 39
        Adolescents (12-17 years)
    5 4 4 0 0 13
        Adults (18-64 years)
    1 3 2 0 0 6
        From 65-84 years
    0 0 0 0 0 0
        85 years and over
    0 0 0 0 0 0
    Gender categorical
    Units: Subjects
        Female
    8 7 8 3 5 31
        Male
    3 5 7 7 5 27

    End points

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    End points reporting groups
    Reporting group title
    Cohort 1 SRK-015 20 mg/kg
    Reporting group description
    Ambulatory Type 3 subjects, ages 5 to 21 years, who were not receiving nusinersen (SRK-015 alone). ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 1 SRK-015 20mg/kg + SMN therapy
    Reporting group description
    Ambulatory Type 3 subjects, ages 5 to 21 years, who were already receiving an SMN therapy (ie, nusinersen) that they would receive in the current study that was initiated when the subject was ≥5 years old (SRK-015 + nusinersen). ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 2 SRK-015 20mg/kg + SMN therapy
    Reporting group description
    Type 2 or non-ambulatory Type 3 subjects ages 5 to 21 years who were already receiving nusinersen that was initiated after the subject turned 5 years of age. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 3 SRK-015 2mg/kg + SMN therapy
    Reporting group description
    Type 2 non-ambulatory subjects ages ≥2 years already receiving nusinersen that was initiated when the subject was <5 years old. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Reporting group title
    Cohort 3 SRK-015 20 mg/kg + SMN therapy
    Reporting group description
    Type 2 non-ambulatory subjects ages ≥2 years already receiving nusinersen that was initiated when the subject was <5 years old. ITT population - All enrolled/randomized subjects (enrolled for Cohorts 1 and 2 and randomized for Cohort 3) who received at least 1 dose of SRK-015.

    Primary: Change from Baseline in the RHS total score at Day 364 (Visit 15)

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    End point title
    Change from Baseline in the RHS total score at Day 364 (Visit 15) [1] [2]
    End point description
    The end point was summarized using descriptive statistics for all treated subjects who did not miss 3 consecutive doses due to site access restrictions caused by COVID-19. Last observation carried forward (LOCF) was used for patients missing data for other reasons.
    End point type
    Primary
    End point timeframe
    Primary efficacy endpoint was assessed at Month 12 (Day 364)
    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: The primary endpoint results were summarized using descriptive statistics by cohort and by dose for Cohort 2 and 3. No statistical hypothesis analysis has been conducted.
    [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: This primary endpoint was only for assessment of Cohort 1.
    End point values
    Cohort 1 SRK-015 20 mg/kg Cohort 1 SRK-015 20mg/kg + SMN therapy
    Number of subjects analysed
    11
    12
    Units: RHS score
        arithmetic mean (standard deviation)
    -0.1 ( 5.01 )
    0.0 ( 2.56 )
    No statistical analyses for this end point

    Primary: Change from Baseline in HFMSE total score at Day 364 (Visit 15)

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    End point title
    Change from Baseline in HFMSE total score at Day 364 (Visit 15) [3] [4]
    End point description
    The end point was summarized using descriptive statistics for all treated subjects who did not miss 3 consecutive doses due to site access restrictions caused by COVID-19. Last observation carried forward (LOCF) was used for patients missing data for other reasons.
    End point type
    Primary
    End point timeframe
    Primary efficacy endpoint was assessed at Month 12 (Day 364)
    Notes
    [3] - 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: The primary endpoint results were summarized using descriptive statistics by cohort and by SMN therapy for Cohort 1. No statistical hypothesis analysis has been conducted.
    [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: This primary endpoint was only for assessment of Cohort 2 and 3.
    End point values
    Cohort 2 SRK-015 20mg/kg + SMN therapy Cohort 3 SRK-015 2mg/kg + SMN therapy Cohort 3 SRK-015 20 mg/kg + SMN therapy
    Number of subjects analysed
    14
    9
    8
    Units: HFMSE total score
        arithmetic mean (standard deviation)
    0.6 ( 3.50 )
    5.3 ( 8.93 )
    7.1 ( 6.42 )
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    During the 48-month study period.
    Adverse event reporting additional description
    The adverse events (AEs) described in this section correspond to treatment-emergent adverse events (TEAEs).
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.1
    Reporting groups
    Reporting group title
    Safety Population
    Reporting group description
    All subjects who received at least 1 dose of SRK-015.

    Serious adverse events
    Safety Population
    Total subjects affected by serious adverse events
         subjects affected / exposed
    28 / 58 (48.28%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Injury, poisoning and procedural complications
    Joint dislocation
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Pneumothorax traumatic
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Post lumbar puncture syndrome
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Congenital, familial and genetic disorders
    Developmental hip dysplasia
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Scoliosis surgery
         subjects affected / exposed
    7 / 58 (12.07%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 0
    Joint dislocation reduction
         subjects affected / exposed
    2 / 58 (3.45%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Adenoidectomy
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hospitalisation
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Spinal fusion surgery
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Spinal implantation
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Gait inability
         subjects affected / exposed
    2 / 58 (3.45%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    2 / 58 (3.45%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Acute respiratory failure
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Asthma
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Atelectasis
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Obstructive sleep apnoea syndrome
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sleep apnoea syndrome
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Tonsillar hypertrophy
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Liver injury
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Major depression
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Suicidal ideation
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Scoliosis
         subjects affected / exposed
    5 / 58 (8.62%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Joint contracture
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Respiratory syncytial virus infection
         subjects affected / exposed
    2 / 58 (3.45%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 58 (3.45%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory tract infection viral
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Rhinovirus infection
         subjects affected / exposed
    1 / 58 (1.72%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Safety Population
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    57 / 58 (98.28%)
    Vascular disorders
    Hypotension
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    5 / 58 (8.62%)
         occurrences all number
    6
    Vaccination site pain
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Pyrexia
         subjects affected / exposed
    26 / 58 (44.83%)
         occurrences all number
    72
    Immune system disorders
    Seasonal allergy
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    23 / 58 (39.66%)
         occurrences all number
    53
    Nasal congestion
         subjects affected / exposed
    11 / 58 (18.97%)
         occurrences all number
    25
    Oropharyngeal pain
         subjects affected / exposed
    11 / 58 (18.97%)
         occurrences all number
    24
    Rhinitis allergic
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Rhinorrhoea
         subjects affected / exposed
    9 / 58 (15.52%)
         occurrences all number
    20
    Tonsillar hypertrophy
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Investigations
    Heart rate increased
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    15 / 58 (25.86%)
         occurrences all number
    71
    Ligament sprain
         subjects affected / exposed
    5 / 58 (8.62%)
         occurrences all number
    6
    Post lumbar puncture syndrome
         subjects affected / exposed
    6 / 58 (10.34%)
         occurrences all number
    10
    Contusion
         subjects affected / exposed
    6 / 58 (10.34%)
         occurrences all number
    7
    Procedural pain
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Joint dislocation
         subjects affected / exposed
    8 / 58 (13.79%)
         occurrences all number
    8
    Skin laceration
         subjects affected / exposed
    5 / 58 (8.62%)
         occurrences all number
    6
    Tibia fracture
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    5
    Femur fracture
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    6 / 58 (10.34%)
         occurrences all number
    8
    Nervous system disorders
    Headache
         subjects affected / exposed
    24 / 58 (41.38%)
         occurrences all number
    59
    Dizziness
         subjects affected / exposed
    7 / 58 (12.07%)
         occurrences all number
    13
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    18 / 58 (31.03%)
         occurrences all number
    27
    Diarrhoea
         subjects affected / exposed
    9 / 58 (15.52%)
         occurrences all number
    15
    Abdominal pain upper
         subjects affected / exposed
    8 / 58 (13.79%)
         occurrences all number
    11
    Constipation
         subjects affected / exposed
    9 / 58 (15.52%)
         occurrences all number
    10
    Toothache
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Vomiting
         subjects affected / exposed
    18 / 58 (31.03%)
         occurrences all number
    43
    Abdominal pain
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4
    Gastritis
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Gastrooesophageal reflux disease
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    5
    Dental caries
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    14 / 58 (24.14%)
         occurrences all number
    22
    Erythema
         subjects affected / exposed
    6 / 58 (10.34%)
         occurrences all number
    7
    Eczema
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    5
    Pruritus
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Musculoskeletal and connective tissue disorders
    Scoliosis
         subjects affected / exposed
    15 / 58 (25.86%)
         occurrences all number
    19
    Arthralgia
         subjects affected / exposed
    9 / 58 (15.52%)
         occurrences all number
    16
    Pain in extremity
         subjects affected / exposed
    9 / 58 (15.52%)
         occurrences all number
    18
    Joint contracture
         subjects affected / exposed
    8 / 58 (13.79%)
         occurrences all number
    13
    Muscle spasms
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4
    Myalgia
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Back pain
         subjects affected / exposed
    8 / 58 (13.79%)
         occurrences all number
    9
    Muscle contracture
         subjects affected / exposed
    10 / 58 (17.24%)
         occurrences all number
    13
    Osteopenia
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4
    Infections and infestations
    COVID-19
         subjects affected / exposed
    26 / 58 (44.83%)
         occurrences all number
    29
    Upper respiratory tract infection
         subjects affected / exposed
    24 / 58 (41.38%)
         occurrences all number
    50
    Nasopharyngitis
         subjects affected / exposed
    22 / 58 (37.93%)
         occurrences all number
    65
    Gastroenteritis
         subjects affected / exposed
    7 / 58 (12.07%)
         occurrences all number
    7
    Ear infection
         subjects affected / exposed
    6 / 58 (10.34%)
         occurrences all number
    13
    Gastroenteritis viral
         subjects affected / exposed
    5 / 58 (8.62%)
         occurrences all number
    5
    Otitis media
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    6
    Pharyngitis streptococcal
         subjects affected / exposed
    5 / 58 (8.62%)
         occurrences all number
    8
    Respiratory tract infection
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    6
    Urinary tract infection
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    5
    Viral rash
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Influenza
         subjects affected / exposed
    13 / 58 (22.41%)
         occurrences all number
    16
    Viral infection
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4
    Viral upper respiratory tract infection
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    4
    Respiratory syncytial virus infection
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Rhinovirus infection
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    5
    Metabolism and nutrition disorders
    Iron deficiency
         subjects affected / exposed
    3 / 58 (5.17%)
         occurrences all number
    3
    Vitamin D deficiency
         subjects affected / exposed
    4 / 58 (6.90%)
         occurrences all number
    4

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Jul 2019
    The SRK-015-002 protocol was amended under version 2.0 as follows: • Increased time between dosing and conducting motor function outcome measures in order to reduce patient burden and add scheduling flexibility. • Updated inclusion criteria to include prolonged contraception in female and male populations. • Added definition of Women of Childbearing Potential (WOCBP). • Added pregnancy test sensitivity to provide additional clarification and details on pregnancy test used in the study. • Updated exclusion criteria to ensure patients with prior hypersensitivity reaction to SRK-015 or excipients of SRK-015 are excluded and to ensure adequate washout of prior investigational drugs and potential muscle enhancing drugs. • Updated currently available treatments to include newly approved SMA treatment. • Updated endpoint language to clarify score utilization in evaluations. • Added language for several endpoints that were previously not included. • Updated Phase 1 study (SRK015-001) data to include results from the completedstudy. • Increased time between dosing and weight measurement in order to reduce patient burden and add scheduling flexibility. • Specified that height is collected at visits where the motor function outcome measures are conducted to ensure consistent collection of height throughout the study. • Updated PK and PD blood sample collection language in order to provide additional samples to further support PK, PD and/or ADA assay validation and to enhance the meaningfulness of the analyses. • Removed Crystatin A as a safety assessment. • Added data protection language to clarify procedures. • Various typographical and formatting corrections as well as corrections for consistency made throughout the document.
    21 Nov 2019
    The SRK-015-002 protocol was amended as follows: - An optional extension period, with treatment for an additional 52 weeks, to observe long-term safety and efficacy effects of SRK-015 has been added - Minor clarifications throughout the protocol have been included
    13 Nov 2020
    The primary reasons for amending the SRK-015-002 protocol are to: • Revise the dosing for patients in Cohort 3 from low-dose (2 mg/kg) to high-dose (20 mg/kg) SRK-015 after completion of the Treatment Period. This dosing change is based on the results of the prespecified 6-month safety and efficacy interim analyses. Due to the variability in timing of regulatory authority and/or Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approvals, the timepoint at which patients who received the low dose (2 mg/ kg) will begin receiving the high dose (20 mg/ kg) during Extension Period A or B will vary. • Extend the Extension Period for an additional 52 weeks (as Extension Period B; Extension Visits EB1-15) to allow for collection and analysis of longer-term safety and efficacy data (104 weeks in total). To distinguish between the separate Extension Periods, the original Extension Period (Extension Visits E1-15) is now referred to as Extension Period A. • Add optional assessments to Unscheduled Visits, as follows: − Pharmacokinetic (PK)/Pharmacodynamic (PD)/antidrug antibody (ADA) sampling to provide the maximum confidence in population analyses and dosing predictions − Motor Function Outcome Measures and Quality-of-Life (QOL) questionnaires to allow for these assessments to be completed at a subsequent visit in the event that a protocol-specific visit is missed/skipped − Electrocardiograms (ECGs), as clinically necessary for safety
    03 Aug 2021
    The primary reasons for amending the SRK-015-002 protocol are to: • Extend the Extension Period for an additional 52 weeks (as Extension Period C; Extension Visits EC1-15) to allow for collection and analysis of longer-term safety and efficacy data (224 weeks in total duration). • Revise the frequency for SST review of safety data based on the schedule recommended by the pharmacovigilance and medical teams.

    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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