E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Primary hyperoxaluria is where the liver overproduces oxalate. As a result calcium-oxalate crystals form in the urinary system and lead to the formation of kidney stones and impaired kidney function. |
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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 | 10020703 |
E.1.2 | Term | Hyperoxaluria |
E.1.2 | System Organ Class | 10038359 - Renal and urinary 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 characterize the safety of DCR-PHXC in participants with PH1 or PH2 and severe renal impairment, with or without hemodialysis or peritoneal dialysis |
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E.2.2 | Secondary objectives of the trial |
1. To assess the efficacy of DCR-PHXC in lowering Pox in participants with PH1 or PH2 and severe renal impairment, with or without hemodialysis or peritoneal dialysis 2. To assess the multiple dose PK of DCR-PHXC and its metabolites in participants with PH1 or PH2 and severe renal impairment, with or without hemodialysis or peritoneal dialysis 3. To assess the effect of DCR-PHXC on the hemodialysis or peritoneal dialysis regimen of participants with PH1 or PH2 undergoing hemodialysis or peritoneal dialysis
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
In order to be eligible to participate in this study, an individual must meet all of the following criteria: Age 1. Four age groups of participants will be enrolled, in sequence: a. adults and adolescents (aged ≥ 12 years; 6 participants) b. children 6 to 11 years of age (2 participants) c. children 2 to 5 years of age (2 participants) and d. infants and newborns from birth to < 2 years of age (2 participants). Type of Participant and Disease Characteristics 2. Documented diagnosis of PH1 or PH2, confirmed by genotyping (historically available genotype information is acceptable for study eligibility) 3. Estimated GFR at Screening < 30 mL/min normalized to 1.73 m2 BSA. See Section 8.2.6.2 for equations. For infants aged less than 12 months, serum creatinine above the 97th percentile of a healthy population (Boer et al., 2010) 4. Plasma oxalate > 30 μmol/L 5. For participants receiving hemodialysis or peritoneal dialysis, total duration of hemodialysis or peritoneal dialysis must be less than 18 months. Sex 6. Male or female Male participants: A male participant with a female partner of childbearing potential must agree to use contraception, as detailed in Section 10.4.2, during the treatment period and for at least 12 weeks after the last dose of study intervention and refrain from donating sperm during this period. Female participants: A female participant is eligible to participate if she is not pregnant (see Section 10.4.3), not breastfeeding, and at least one of the following conditions applies: Not a woman of childbearing potential (WOCBP) as defined in Section 10.4.1.1. OR A WOCBP who agrees to follow the contraceptive guidance in Section 10.4.2.2 for the 4 weeks prior to randomization, during the treatment period, and for at least 12 weeks after the last dose of study intervention and agrees to refrain from harvesting/freezing eggs during this period. Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. Informed Consent/Assent 7. Participant (and/or participant’s parent or legal guardian if participant is a minor [defined as patient < 18 years of age, or younger than the age of majority according to local regulations]) is capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. a. Adolescents (12 to < 18 years of age, or older than 12 years but younger than the age of majority according to local regulations) must be able to provide written assent for participation. b. For children younger than 12 years of age, assent will be based on local regulations. |
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E.4 | Principal exclusion criteria |
An individual who meets any of the following criteria will be excluded from participation in this study: Medical Conditions 1. Prior hepatic transplantation; or scheduled transplantation within 6 months of Day 1. Prior renal transplantation is allowed. 2. Documented evidence of severe systemic oxalosis, defined as overt signs of bone oxalate deposition in a plain x-ray of the left hand, as evidenced by large diffuse metaphyseal bands 3. Presence of any condition or comorbidities that would interfere with study compliance or data interpretation or potentially impact patient safety including, but not restricted to: a. Severe intercurrent illness b. Known causes of active liver disease/injury (e.g., alcoholic liver disease, nonalcoholic fatty liver disease/steatohepatitis) c. Physician concerns about intake of drugs of abuse or excessive alcohol intake, or history of excessive alcohol intake in the 2 years prior to enrollment (defined as ≥ 21 units of alcohol per week in men and ≥ 14 units of alcohol per week in women; where a “unit” of alcohol is equivalent to a 12-ounce beer, 4-ounce glass of wine, or 1-ounce shot of hard liquor) Prior/Concomitant Therapy 4. Routine or chronic use of more than 3 grams of acetaminophen/paracetamol daily 5. Use of an RNAi drug, other than DCR-PHXC, within the last 6 months 6. History of one or more of the following reactions to an oligonucleotide-based therapy: a. Severe thrombocytopenia (platelet count ≤ 100,000/μL) b. Hepatotoxicity, defined as alanine transaminase (ALT) or aspartate transaminase (AST) > 3 times the upper limit of normal (ULN) and total bilirubin > 2 × ULN or international normalized ratio (INR) >1.5 c. Severe flu-like symptoms leading to discontinuation of therapy d. Localized skin reaction from the injection (graded severe) leading to discontinuation of therapy e. Coagulopathy/clinically significant prolongation of clotting time Prior/Concurrent Clinical Study Experience 7. Participation in any clinical study in which they received an investigational medicinal product (IMP) other than DCR-PHXC within 4 months before Screening. Diagnostic Assessments 8. Liver function test abnormalities: ALT and/or AST >1.5 × ULN for age and gender 9. Positive anti-double-stranded deoxyribonucleic acid (anti-dsDNA) antibody test at Screening Other Exclusions 10. Known hypersensitivity to DCR-PHXC or any of its ingredients 11. Inability or unwillingness to comply with the specified study procedures, including the lifestyle considerations detailed in Section 5.3. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Incidence and severity of TEAEs and SAEs, and the change from Baseline in 12-lead ECG, physical examination findings, vital signs, and clinical laboratory tests |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
The primary endpoint is safety and will be evaluated during the whole study |
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E.5.2 | Secondary end point(s) |
1. Change from Baseline in Pox 2. Plasma PK parameters for DCR-PHXC and its metabolites (e.g., Cmax and AUC, based on NCA or POP-PK analysis) 3. The change in the duration and number of weekly hemodialysis or peritoneal dialysis sessions from Baseline to Month 12 and quarterly thereafter in the long-term extension |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
The secondary endpoints evaluation will be based on: - Change in Pox from Baseline to Day 180 - Change in the duration and number of weekly hemodialysis or peritoneal dialysis sessions |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | 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) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
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
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 8 |
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 |
Australia |
France |
Germany |
Italy |
Japan |
Romania |
Spain |
United Kingdom |
United States |
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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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A participant is considered to have completed the study if he or she has completed the 6-month treatment period of the study including the last scheduled visit (Day 180) or the last scheduled procedure shown in the Schedule of Activities (SoA), Table 1. Participants completing the Day 180 (End of Study [EOS]) Visit will enter into the long-term follow-up period. The end of the study overall is defined by the locking of the clinical database. |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 8 |