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    Clinical Trial Results:
    A DOUBLE-BLIND, PLACEBO-CONTROLLED, STUDY TO EVALUATE THE EFFICACY AND SAFETY OF 24 WEEKS TREATMENT WITH REN001 IN PATIENTS WITH PRIMARY MITOCHONDRIAL MYOPATHY (PMM)

    Summary
    EudraCT number
    2020-002855-40
    Trial protocol
    FR   CZ   DK   HU   BE   IT   ES   NL   NO  
    Global end of trial date
    05 Oct 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    15 Dec 2024
    First version publication date
    15 Dec 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    REN001-201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04535609
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Reneo Pharma Ltd.
    Sponsor organisation address
    6707 Winchester Circle Suite 400, Boulder, United States, 80301
    Public contact
    Ann Howell, OnKure Inc, 01 720-307-2892, ahowell@onkure.com
    Scientific contact
    Ann Howell, OnKure Inc, 01 720-307-2892, ahowell@onkure.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
    23 Jan 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    12 Sep 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Oct 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To evaluate the efficacy of REN001 in subjects with PMM treated for 24 weeks, assessed by the effect on exercise endurance.
    Protection of trial subjects
    Review of blinded subject safety data (including adverse events [AEs], electrocardiograms, laboratory safety tests, vital signs, and physical and ophthalmologic examinations) was performed by the Reneo Safety Review Committee (SRC) in accordance with the REN001-201 SRC Charter. Safety reviews were conducted throughout the study in order to identify any potential safety signals during the trial that may have impacted the safety of the participants. The SRC couldmake recommendations concerning continuation, termination or other study modifications based on these reviews.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    12 Apr 2021
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 21
    Country: Number of subjects enrolled
    Spain: 18
    Country: Number of subjects enrolled
    Belgium: 9
    Country: Number of subjects enrolled
    Czechia: 11
    Country: Number of subjects enrolled
    France: 22
    Country: Number of subjects enrolled
    Germany: 10
    Country: Number of subjects enrolled
    Hungary: 7
    Country: Number of subjects enrolled
    Italy: 41
    Country: Number of subjects enrolled
    Australia: 12
    Country: Number of subjects enrolled
    Canada: 8
    Country: Number of subjects enrolled
    New Zealand: 5
    Country: Number of subjects enrolled
    United Kingdom: 19
    Country: Number of subjects enrolled
    United States: 24
    Country: Number of subjects enrolled
    Norway: 2
    Country: Number of subjects enrolled
    Denmark: 3
    Worldwide total number of subjects
    212
    EEA total number of subjects
    144
    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)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    196
    From 65 to 84 years
    16
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Recruitment was done from across 41 centers worldwide.

    Pre-assignment
    Screening details
    One subject completed all screening procedures, was randomized in error (to placebo treatment) and was removed from the study before any study procedures were completed. This subject is not included in the reporting groups.

    Period 1
    Period 1 title
    Treatment (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Carer, Assessor
    Blinding implementation details
    REN001 and placebo was provided as visually matched capsules. All study drug was supplied in identical bottles thereby maintaining the double blind conditions for the participant and investigator.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    REN001
    Arm description
    100 mg REN001 as 2 x 50 mg capsules administered once daily with food for 24 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    REN001
    Investigational medicinal product code
    Other name
    Mavodelpar, HPP593
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    100 mg REN001 capsules as 2 x 50 mg once daily with food for 24 weeks.

    Arm title
    Placebo
    Arm description
    2 placebo capsules administered once daily with food for 24 weeks.
    Arm type
    Placebo

    Investigational medicinal product name
    placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    2 placebo capsules administered once daily with food for 24 weeks.

    Number of subjects in period 1
    REN001 Placebo
    Started
    108
    104
    Week 24
    100
    98
    Completed
    99
    97
    Not completed
    9
    7
         Adverse event, serious fatal
    1
    -
         Consent withdrawn by subject
    3
    1
         Adverse event, non-fatal
    2
    3
         Wish to become pregnant
    -
    1
         Lost to follow-up
    1
    2
         Protocol deviation
    2
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    REN001
    Reporting group description
    100 mg REN001 as 2 x 50 mg capsules administered once daily with food for 24 weeks.

    Reporting group title
    Placebo
    Reporting group description
    2 placebo capsules administered once daily with food for 24 weeks.

    Reporting group values
    REN001 Placebo Total
    Number of subjects
    108 104 212
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    97 99 196
        Adults (>=65 years)
    11 5 16
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    46.8 ( 13.69 ) 46.3 ( 11.93 ) -
    Gender categorical
    Gender Categorical, Male or Female
    Units: Subjects
        Female
    75 76 151
        Male
    33 28 61

    End points

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    End points reporting groups
    Reporting group title
    REN001
    Reporting group description
    100 mg REN001 as 2 x 50 mg capsules administered once daily with food for 24 weeks.

    Reporting group title
    Placebo
    Reporting group description
    2 placebo capsules administered once daily with food for 24 weeks.

    Primary: Change in distance walked during 12 minute walk test

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    End point title
    Change in distance walked during 12 minute walk test
    End point description
    Change from baseline at Week 24 in distance walked during the 12-minute walk test (12MWT). The analysis was based on the full analysis set (FAS) including subjects in the randomized set who received at least one dose of study drug and were not subsequently discontinued from the study for failing eligibility criteria.
    End point type
    Primary
    End point timeframe
    24 weeks
    End point values
    REN001 Placebo
    Number of subjects analysed
    106 [1]
    104 [2]
    Units: meters
        arithmetic mean (confidence interval 95%)
    26.75 (12.97 to 40.53)
    30.89 (15.03 to 46.74)
    Notes
    [1] - Subjects in the FAS with data at Week 24 (N=2 missing, N=2 withdrawn). N=102 analysed.
    [2] - Subjects in the FAS with data at Week 24 (N=4 missing, N=2 withdrawn). N=98 analysed.
    Statistical analysis title
    Estimated difference between treatment groups
    Statistical analysis description
    REN-001 minus placebo for the change from baseline. Missing values were imputed.
    Comparison groups
    REN001 v Placebo
    Number of subjects included in analysis
    210
    Analysis specification
    Pre-specified
    Analysis type
    equivalence [3]
    P-value
    = 0.8962
    Method
    Mixed models analysis
    Parameter type
    Mean difference (final values)
    Point estimate
    1.59
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -22.24
         upper limit
    25.42
    Variability estimate
    Standard error of the mean
    Dispersion value
    12.158
    Notes
    [3] - The changes from baseline in distance walked during the 12MWT for the FAS were analyzed using a mixed effect model for repeated measures (MMRM). The model included fixed terms for treatment, visit and the treatment-by-visit interaction. The model also included the stratification mutation factor and continuous baseline distance walked during the 12MWT as covariates. Missing values were imputed prior to analysis using multiple imputation or imputations for intercurrent events.

    Secondary: Change in PROMIS Short Form - fatigue 13a (FACIT-fatigue) scores

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    End point title
    Change in PROMIS Short Form - fatigue 13a (FACIT-fatigue) scores
    End point description
    Change from baseline at Week 24 in PROMIS® Short Form – Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue 13a T-score. The analysis was based on the FAS including subjects in the randomized set who received at least one dose of study drug and were not subsequently discontinued from the study for failing eligibility criteria.
    End point type
    Secondary
    End point timeframe
    24 weeks
    End point values
    REN001 Placebo
    Number of subjects analysed
    106 [4]
    104 [5]
    Units: score on a scale
        arithmetic mean (confidence interval 95%)
    -0.98 (-2.03 to 0.08)
    -2.60 (-3.80 to -1.40)
    Notes
    [4] - Subjects in the FAS with data at Week 24 (N=3 missing, N=2 withdrawn). N=101 analysed.
    [5] - Subjects in the FAS with data at Week 24 (N=3 missing, N=2 withdrawn). N=99 analysed.
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From Day 1 until follow-up visit 21 to 28 days after the last study dose
    Adverse event reporting additional description
    The incidence, causality and severity of treatment-emergent AEs, including treatment-emergent serious AEs and AEs of special interest was documented.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.1
    Reporting groups
    Reporting group title
    REN001
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    REN001 Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    8 / 108 (7.41%)
    7 / 104 (6.73%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    1
    0
    Injury, poisoning and procedural complications
    Concussion
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Humerus fracture
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cervical vertebral fracture
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Limb injury
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rib fracture
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrioventricular block
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Coronary artery disease
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nodal rhythm
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Hospitalisation
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cranial operation
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebrovascular accident
         subjects affected / exposed
    2 / 108 (1.85%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Epilepsy
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Seizure
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Death
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Gastrointestinal disorders
    Haematemesis
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pancreatitis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pyelonephritis acute
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    COVID-19
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia influenzal
         subjects affected / exposed
    0 / 108 (0.00%)
    1 / 104 (0.96%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Diabetic ketoacidosis
         subjects affected / exposed
    1 / 108 (0.93%)
    0 / 104 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    REN001 Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    85 / 108 (78.70%)
    81 / 104 (77.88%)
    Investigations
    Blood creatine phosphokinase increased
         subjects affected / exposed
    11 / 108 (10.19%)
    3 / 104 (2.88%)
         occurrences all number
    11
    3
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    6 / 108 (5.56%)
    1 / 104 (0.96%)
         occurrences all number
    9
    1
    Nervous system disorders
    Headache
         subjects affected / exposed
    10 / 108 (9.26%)
    13 / 104 (12.50%)
         occurrences all number
    13
    21
    Dizziness
         subjects affected / exposed
    7 / 108 (6.48%)
    3 / 104 (2.88%)
         occurrences all number
    7
    3
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    7 / 108 (6.48%)
    9 / 104 (8.65%)
         occurrences all number
    7
    10
    Eye disorders
    Refraction disorder
         subjects affected / exposed
    20 / 108 (18.52%)
    15 / 104 (14.42%)
         occurrences all number
    28
    18
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    10 / 108 (9.26%)
    3 / 104 (2.88%)
         occurrences all number
    10
    3
    Nausea
         subjects affected / exposed
    10 / 108 (9.26%)
    4 / 104 (3.85%)
         occurrences all number
    10
    4
    Vomiting
         subjects affected / exposed
    7 / 108 (6.48%)
    5 / 104 (4.81%)
         occurrences all number
    8
    5
    Skin and subcutaneous tissue disorders
    Rash
         subjects affected / exposed
    8 / 108 (7.41%)
    0 / 104 (0.00%)
         occurrences all number
    10
    0
    Musculoskeletal and connective tissue disorders
    Back pain
         subjects affected / exposed
    9 / 108 (8.33%)
    4 / 104 (3.85%)
         occurrences all number
    9
    5
    Myalgia
         subjects affected / exposed
    9 / 108 (8.33%)
    6 / 104 (5.77%)
         occurrences all number
    15
    9
    Arthralgia
         subjects affected / exposed
    2 / 108 (1.85%)
    6 / 104 (5.77%)
         occurrences all number
    2
    7
    Infections and infestations
    Nasopharyngitis
         subjects affected / exposed
    5 / 108 (4.63%)
    11 / 104 (10.58%)
         occurrences all number
    5
    9
    COVID-19
         subjects affected / exposed
    20 / 108 (18.52%)
    13 / 104 (12.50%)
         occurrences all number
    21
    13
    Metabolism and nutrition disorders
    Vitamin D deficiency
         subjects affected / exposed
    6 / 108 (5.56%)
    3 / 104 (2.88%)
         occurrences all number
    6
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    24 Jun 2022
    - removed the requirement for at least 40% of subjects in study REN001-201 to have the m.3243A>G genotype - update on eye examination to delete redundant text and clarify lens grading and visual acuity - update on statistical methods: primary analysis updated to MMRM; update of analysis model secondary endpoint (MFIS physical subscale) - clarified that re-screened subjects are not required to repeat their Screening eye examinations or Dual-energy X-ray absorptiometery scans within 6 months of the original assessments - reflected that the REN001 open-label extension study is available, for subjects who complete REN001-201, in countries where the extension study is approved - clarified that study centers can complete the Baseline, Week 12, Week 24 and Early Termination visits over two days at the Investigator’s discretion - clarified the postmenopausal definition for consistency with the central lab to women of 45 years and older and amenorrhoeic for 1 year in addition to an FSH level indicating postmenopausal state - Belgium ethics committee requested that the reason for ethnicity being collected (regarding estimated Glomerular Filtration Rate calculation) is mentioned in the protocol - was added

    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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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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