E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
|
E.1.1.1 | Medical condition in easily understood language |
A type of dementia that causes problems with behaviour and language |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10068968 |
E.1.2 | Term | Frontotemporal dementia |
E.1.2 | System Organ Class | 10029205 - Nervous system disorders |
|
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 evaluate the safety and tolerability of intravenous (IV) administration of AL001 over 96 weeks in asymptomatic and symptomatic carriers of a granulin (GRN) mutation causative of frontotemporal dementia (FTD) and in symptomatic carriers of a C9orf72 mutation causative of FTD. |
|
E.2.2 | Secondary objectives of the trial |
The secondary objectives of this study are to evaluate the effect of IV
administration of AL001 over 96 weeks in asymptomatic and
symptomatic carriers of a GRN mutation causative of FTD and in
symptomatic carriers of a C9orf72 mutation causative of FTD on the
following:
•Pharmacokinetics (PK)
•Longitudinal plasma and CSF PGRN concentration levels
•Longitudinal levels of Sortilin in WBCs |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Participants must meet all of the criteria specific to their applicable participant category.
1) Participant completed Study AL001-1 through the Day 57 visit and did not experience AEs that the investigator deems would prevent safe participation in Study AL001-2
2) Participant meets 1 or more of the 6 behavioral/cognitive symptoms required for a diagnosis of possible behavioral variant frontotemporal dementia (bvFTD; Rascovsky 2011) or has diagnosis of primary progressive aphasia (PPA; Gorno Tempini 2011)
3) Participant completed Study AL001-1 through the Day 43 visit and did not experience AEs that the investigator deems would prevent safe participation in Study AL001-2
4) Participant is a carrier of a loss of function GRN mutation causative of FTD and knows their mutation status
5) Participant has a CDR® plus NACC global score of 0.5, 1, or 2; and 1 or more of the 6 behavioral/cognitive symptoms required for a diagnosis of possible bvFTD (Rascovsky 2011) or a diagnosis of PPA (Gorno Tempini 2011)
In addition, this is the list of the important inclusion criteria
• Participants are 18 to 85 years of age
• At screening, female participants must be nonpregnant and nonlactating, and at least one of the following conditions must apply
- Participant is not a woman of childbearing potential (WOCBP) (either surgically sterilized or physiologically incapable of becoming pregnant, or at least 1 year postmenopausal [amenorrhea duration of 12 consecutive months with no identified cause other than menopause])
- Participant is a WOCBP and using an acceptable contraceptive method from screening until 8 weeks after the last dose of study drug. Acceptable contraception is defined as using hormonal contraceptives or an intrauterine device combined with at least 1 of the following forms of contraception: a diaphragm or cervical cap, or a condom. In addition, total abstinence, in accordance with the lifestyle of the participant, is acceptable
- A WOCBP must have a serum pregnancy test conducted at screening Additional requirements for pregnancy testing during and after study intervention are located in the Schedule of Assessments ( in the protocol)
• Male participants, if not surgically sterilized, must agree to use acceptable contraception and not donate sperm from Day 1 until 8 weeks after the last dose of study drug. Acceptable contraception for the male participant (and his female partner) is defined as using hormonal contraceptives or an intrauterine device combined with at least 1 of the following forms of contraception: a diaphragm or cervical cap, or a condom. In addition, total abstinence, in accordance with the lifestyle of the participant, is acceptable
•Participant agrees not to donate blood or blood products for transfusion for the duration of the study and for 1 year after final dose of study drug
•Participant is willing and has the ability to comply with the study protocol requirements, in the opinion of the investigator
• Participant is willing and able to give informed consent. If the study participant is not competent, a legally authorized representative must provide informed consent on their behalf, and the participant must provide assent, in accordance with the local regulations, guidelines, and institutional review board (IRB) or independent ethics committee (IEC)
•Participant has availability of a person (“study partner”) who has frequent and sufficient contact with the participant (at least 5 hours per week of in person contact), can provide accurate information regarding the participant’s cognitive and functional abilities as well as their health throughout the study, agrees to provide information at site visits that require partner input for COA completion, and signs the necessary consent form. (Note: asymptomatic participants require the study partner at the COA visits only; symptomatic participants require the study partner at each visit)
Inclusion criteria applicable to those UK, US, or Canadian participants participating in the optional Winterlight Lab Speech Assessment (WLA) and Summerlight Lab Speech Assessment (SLA) only:
-participant has available and willing study partner to administer the WLA
-participant has WiFi access in their residence or WiFi access in a private area where the testing can take place
-US, UK, or Canadian participants who are proficient in English in the investigator’s opinion |
|
E.4 | Principal exclusion criteria |
• Participant has a known history of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric, human, or humanized antibodies or fusion proteins.
• Participant has history of substance use disorder (drug or alcohol) within the past 2 years, with the exception of nicotine, as defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria (American Psychiatric Association 2013).
•Participant currently has or has had an acute illness or infection that requires oral or IV antibiotics within 30 days prior to study drug administration that may affect safety assessments.
•Participant has a medical condition or extenuating circumstance that, in the opinion of the investigator, might compromise their ability to comply with the protocol required testing or procedures or compromise the participant's well-being, safety, or clinical interpretability.
•Participant has had any surgery or hospitalization during the 30 days prior to study drug administration
• Participant has history of cancer
• Participant has history or presence of intracranial tumor that is clinically relevant (e.g. glioma, cerebral metastasis).
• Participant is positive for hepatitis B surface antigen, hepatitis C virus antibodies, or human immunodeficiency virus 1 and 2 antibodies or antigen, or history of spirochetal infection of the CNS.
• Participant has significant kidney disease as indicated by a screening creatinine clearance <30 mL/min as calculated by the central laboratory using the Cockcroft Gault formula, which remains <30 mL/min if retested.
• Participant has impaired hepatic function as indicated by screening aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≥2.5 the upper limit of normal (ULN) or total bilirubin ≥2.0 × ULN, which remains above either of these limits if retested or other abnormalities in synthetic function that are clinically significant.
•Participant has had unstable or clinically significant cardiovascular disease (e.g., myocardial infarction, angina pectoris, New York Heart Association Class III or more cardiac failure) within the last 2 years.
• Participant has uncontrolled hypertension.
• Participant has history or presence of an abnormal ECG that is clinically significant including complete left bundle branch block, second- or third degree heart atrioventricular block, or evidence of prior acute or subacute myocardial infarction or ischemia. |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Primary Safety Endpoints:
To assess the potential effect of cumulative exposure on the safety profile of AL001, the following will be evaluated by dose, such as by using tertiles of the actual dose (normalized to weight) received:
• Incidence, nature, and severity of AEs and SAEs
• Incidence of treatment discontinuations and study discontinuations due to AEs
• Physical examination abnormalities
• Neurological examination abnormalities
• Changes in vital signs from baseline over time
• Changes in ECGs from baseline over time
• MRI abnormalities after dosing relative to baseline
• Changes in clinical laboratory tests from baseline over time
• Sheehan Suicidality Tracking Scale (Sheehan-STS)
• Incidence of ADAs to AL001 |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
AEs: will be summarized if applicable
Laboratory data: at base line and at scheduled timepoints
Vital signs: at base line and at scheduled timepoints
ECG: at baseline and at scheduled timepoints
Physical examinations: at Screening and at scheduled timepoints or as clinically indicated
Neurological examinations and Sheehan-STS: At Screening and at scheduled timepoints
ADA: at baseline and at scheduled timepoints
|
|
E.5.2 | Secondary end point(s) |
Secondary Pharmacokinetic (PK) Endpoints:
• Serum concentration of AL001 at specified time
points
• AL001 PK parameters (if data permit)
- Cmax
- Ctrough
- AUCss
Secondary Pharmacodynamic (PD) Biomarker Endpoints:
• The overall change from baseline in PGRN in CSF
• The overall change from baseline in PGRN in plasma
•The overall change from baseline in SORT1 in WBCs
Exploratory PD Biomarker Endpoints:
•The overall change from baseline in exploratory biomarkers of neurodegeneration, lysosomal function, and glial activity in blood, plasma, and CSF
•Global and regional brain MRI atrophy measures
•Neuroinflammation assessed by TSPO-PET (for UK participants who agree to participate in the optional imaging assessment only; see Appendix 3 [Section 14.3]
•Correlations among exploratory fluid biomarkers, imaging measures, and COAs
Exploratory Clinical Endpoints:
The overall change from baseline on the scores of the instruments in the COAs
•Clinical Dementia Rating Dementia Staging Instrument PLUS National Alzheimer’s Disease Coordinating Center Frontotemporal Lobar Degeneration Behavior and Language Domains (CDR® plus NACC FTLD)
•Frontotemporal Dementia Rating Scale (FRS)
•Clinical Global Impression-Improvement (CGI I)
•Clinical Global Impression-Severity (CGI S)
•Color Trails Test (CTT) Part 2
•Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
•Winterlight and Summerlight Lab Speech Assessments (WLA and SLA; for participants who agree to participate in these optional assessments only) |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
For Pharmacokinetic (PK), at day 1, day 10, day 29, day 57, day 85, day 113, day 141, day 169, day 197, day 225, day 253, day 281, day 309, day 337 and at study completion.
For Pharmacodynamic (PD), at day 1, day 10, day 29, day 57, day 85, day 113, day 141, day 169, day 197, day 225, day 253, day 281, day 309, day 337 and at study completion. |
|
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 | No |
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 | No |
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 | 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.8.3 |
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 | 5 |
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 |
Canada |
United States |
Germany |
Italy |
Netherlands |
United Kingdom |
|
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
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 41 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 41 |