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
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EudraCT number |
2018-004383-65 |
Trial protocol |
NL ES DE IT |
Global end of trial date |
28 Feb 2024
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Results information
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Results version number |
v1(current) |
This version publication date |
02 Jan 2025
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First version publication date |
02 Jan 2025
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
SRK-015-002
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Scholar Rock, Inc.
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Sponsor organisation address |
31 Binney Street, 3rd Floor, Cambridge, United States, MA 02142
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Public contact |
Bert Yao, Scholar Rock, Inc., +1 9195939950, byao@scholarrock.com
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Scientific contact |
Bert Yao, Scholar Rock, Inc., +1 9195939950, byao@scholarrock.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
03 Oct 2024
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
28 Feb 2024
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Global end of trial reached? |
Yes
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Global end of trial date |
28 Feb 2024
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Was the trial ended prematurely? |
No
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General information about the trial
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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
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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.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
22 Apr 2019
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
United States: 41
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Country: Number of subjects enrolled |
Netherlands: 2
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Country: Number of subjects enrolled |
Spain: 6
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Country: Number of subjects enrolled |
Italy: 9
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Worldwide total number of subjects |
58
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EEA total number of subjects |
17
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
39
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Adolescents (12-17 years) |
13
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Adults (18-64 years) |
6
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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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
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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
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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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.
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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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
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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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).
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Arm title
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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
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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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).
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Arm title
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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
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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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).
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Arm title
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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
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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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).
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Arm title
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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
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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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).
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Baseline characteristics reporting groups
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Reporting group title |
Cohort 1 SRK-015 20 mg/kg
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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
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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
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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
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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
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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. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Cohort 1 SRK-015 20 mg/kg
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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
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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
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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
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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
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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. |
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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.
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End point type |
Primary
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End point timeframe |
Primary efficacy endpoint was assessed at Month 12 (Day 364)
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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. |
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No statistical analyses for this end point |
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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.
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End point type |
Primary
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End point timeframe |
Primary efficacy endpoint was assessed at Month 12 (Day 364)
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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. |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
During the 48-month study period.
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Adverse event reporting additional description |
The adverse events (AEs) described in this section correspond to treatment-emergent adverse events (TEAEs).
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
26.1
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Reporting groups
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Reporting group title |
Safety Population
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Reporting group description |
All subjects who received at least 1 dose of SRK-015. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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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. |
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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
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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 |
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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. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported |