E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Angelman syndrome is a neurogenetic disorder caused by a loss of function of the maternally inherited UBE3A gene (chromosome 15) which codes for UBE3A ubiquitin protein ligase. AS presents early in life severe developmental delays (motor, language and cognitive functioning, seizures and ataxia with happy demeanor and sociability). It is a non-degenerative, life-long disorder resulting in complete dependence on a caregiver that generally remains clinically unchanged with a normal life expectancy. |
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E.1.1.1 | Medical condition in easily understood language |
Angelman syndrome is a genetic disorder that mainly affects the nervous system. Symptoms include severe intellectual disability and developmental disability with normal life expectancy. |
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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 | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10049004 |
E.1.2 | Term | Angelman's syndrome |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic 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 evaluate the safety and tolerability of single and multiple dose-levels of multiple intrathecal bolus (ITB) administrations of ION582 in patients with Angelman syndrome (AS) based on incidence and severity of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs), changes in vital signs, and changes in clinical laboratory parameters. |
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E.2.2 | Secondary objectives of the trial |
Secondary Objective Characterize the pharmacokinetics (PK) in cerebrospinal fluid (CSF), plasma and urine of ascending dose-levels of multiple IT bolus administrations of ION582 in patients with AS.
Exploratory Objective To evaluate the effects of ION582 on AS biomarkers and clinical features including motor, language, cognitive functioning, sleep, and electroencephalogram (EEG) patterns in patients with AS. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patient has a documented and certified diagnosis of Angelman Syndrome (AS) (ubiquitin-protein ligase E3A [UBE3A] deletion or UBE3A mutation) provided by the Investigator. 2. Male or female between the ages of 2-50 years of age, with signed informed consent from parent(s) or legal guardian(s). 3. Currently receiving stable standard of care treatments, such as stable doses of anti-epileptic medication, behavioral management medications, sleep medications, gabapentin, cannabidiol, and including special diets, supplements or nutritional support for at least 3 months prior to first dose. 4. Follow good study practice and not participate in sharing of personal or study information on social media platforms, such as any website or social media (e.g., Facebook, Instagram, Twitter, YouTube, etc.) until notified that the study is completed. |
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E.4 | Principal exclusion criteria |
1. Has documented molecular AS confirmation of paternal uniparental disomy (UPD) or imprinting defect (ID). 2. Any clinically significant (CS) cardiovascular, endocrine, hepatic, renal, pulmonary, gastrointestinal, neurologic, malignant, metabolic, psychiatric condition, or other condition that, in the judgement of the Investigator, will pose a safety risk, will make the patient unsuitable for participation, and/or unable to complete the study procedures. Has poorly controlled seizures as determined by the Investigator or has documented Status Epilepticus in the past 6 months that could pose a safety risk while on the study. 3. Known bone, spine, bleeding or other disorder that exposes the patient to risk of injury or unsuccessful lumbar puncture. Previous treatment with an oligonucleotide (including small interfering ribonucleic acid, ASOs). COVID-19 vaccinations are allowed. 4. Any prior use of gene therapy. Have any other conditions, which, in the opinion of the investigator would make the participant unsuitable for inclusion or could interfere with the participant taking part in or completing the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint will be the assessment of patient safety and tolerability of ION582 by determining the incidence and severity of the below parameters: • Incidence and severity of TEAEs and SAEs, as well as changes in concomitant medications • Physical examination and standard neurological assessment • Vital signs (body temperature, heart rate [HR], blood pressure [BP], weight) • Electrocardiograms (ECGs) • CSF safety labs (cell counts, protein, glucose) • Laboratory tests (clinical chemistry, hematology, urinalysis) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Secondary Endpoints Pharmacokinetic parameters of ION582 will be evaluated through the collection of CSF, plasma and urine samples. ION582 concentration in CSF will be summarized. Plasma maximum concentration (Cmax), area under the curve (AUC), elimination half-life and trough and post-distribution ION582 levels will be assessed, where appropriate and possible. Amount of ION582 excreted in urine, percent of dose excreted, and renal clearance (if possible) following first dose will be summarized, as appropriate. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Secondary Endpoints For the Part 1: CSF and plasma samples will be collected pre-dose on each dosing day (day 1, 29 and 85) for PK analyses. Additional plasma samples will be collected on Study Day 1 (1, 3, and 6 hours post-ITB injection), Study Day 2 (24 hours post-ITB injection), and Study Days 113, 169, and 309 (any 1 time point during the visit). Urine will be collected for 24 hours on Day 1 starting at the time of dosing, only for patients in Cohorts D and E and if they are able.
For the Part 2: CSF and plasma samples will be collected pre-dose on each dosing day (days 1 ,85, 169, 253 and 337)) for PK analyses. Additional plasma samples will be collected on Study Day 1 ( 3 and 6 hours post-ITB injection), and at 3 mo and 8 mo visits (any 1 time point during the visit). |
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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 | Yes |
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) | Yes |
E.7.1.1 | First administration to humans | Yes |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | Yes |
E.7.1.3.1 | Other trial type description |
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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 | 4 |
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 |
Canada |
Israel |
United States |
France |
Netherlands |
Germany |
Italy |
United Kingdom |
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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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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 | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |