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    Summary
    EudraCT Number:2022-001314-19
    Sponsor's Protocol Code Number:VO659-CT01
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Ongoing
    Date on which this record was first entered in the EudraCT database:2023-02-09
    Trial results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2022-001314-19
    A.3Full title of the trial
    A phase 1/2a, open-label trial to investigate the safety, tolerability, pharmacokinetics and pharmacodynamics of multiple ascending doses of intrathecally administered VO659 in participants with spinocerebellar ataxia types 1, 3 and Huntington’s disease
    Un ensayo abierto de fase 1/2a para investigar la seguridad, tolerabilidad, farmacocinética y farmacodinámica de múltiples dosis ascendentes de VO659 administrado por vía intratecal en participantes con ataxia espinocerebelosa tipos 1, 3 y enfermedad de Huntington
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A first-in-human trial to test how safe a new drug called VO659 is for people with genetic disorders called spinocerebellar ataxia type 1, 3 or Huntington’s disease
    Primer ensayo en humanos para evaluar como de seguro es un nuevo medicamento llamado VO659 en personas con desórdenes genéticos llamados ataxia espinocerebelosa tipos 1, 3 y enfermedad de Huntington
    A.3.2Name or abbreviated title of the trial where available
    Phase 1/2a open-label trial of VO659 in participants with SCA1, SCA3 and HD
    Ensayo abierto de fase 1/2a de VO659 en participantes con SCA1, SCA3 y EH
    A.4.1Sponsor's protocol code numberVO659-CT01
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorVICO Therapeutics B.V.
    B.1.3.4CountryNetherlands
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportVICO Therapeutics B.V.
    B.4.2CountryNetherlands
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationJasper
    B.5.2Functional name of contact pointRenz
    B.5.3 Address:
    B.5.3.1Street AddressJ.H. Oortweg 21
    B.5.3.2Town/ cityLeiden
    B.5.3.3Post code2333 CH
    B.5.3.4CountryNetherlands
    B.5.6E-mailVO659-CT01@vicotx.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community Yes
    D.2.5.1Orphan drug designation numberEU/3/21/2398
    D.3 Description of the IMP
    D.3.1Product nameVO659
    D.3.2Product code VO659
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPIntrathecal use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INN-
    D.3.9.1CAS number 1479142-52-3
    D.3.9.2Current sponsor codeVO659
    D.3.9.3Other descriptive namePS659
    D.3.9.4EV Substance CodeSUB254591
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product Yes
    D.3.11.13.1Other medicinal product typeantisense oligonucleotide (solution) provided with diluent artificial cerebrospinal fluid (aCSF).
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    spinocerebellar ataxia types 1, 3 and Huntington’s disease
    ataxia espinocerebelosa tipos 1, 3 y enfermedad de Huntington
    E.1.1.1Medical condition in easily understood language
    spinocerebellar ataxia types 1 or 3 and Huntington’s disease
    on ataxia espinocerebelosa tipos 1, 3 y enfermedad de Huntington
    E.1.1.2Therapeutic area Diseases [C] - Nervous System Diseases [C10]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 23.0
    E.1.2Level LLT
    E.1.2Classification code 10057660
    E.1.2Term Spinocerebellar ataxia
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10070668
    E.1.2Term Huntington's disease
    E.1.2System Organ Class 10010331 - Congenital, familial and genetic disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Primary: To evaluate the safety and tolerability of multiple doses of intrathecal lumbar bolus administrations of VO659 in participants with clinically manifest SCA1, SCA3, or Huntington’s disease (HD).
    Primario: Evaluar la seguridad y tolerabilidad de la administración de múltiples dosis intratecales lumbares en bolo de VO659 en participantes con SCA1, SCA3 o enfermedad de Huntington (EH) clínicamente manifiestas.
    E.2.2Secondary objectives of the trial
    Secondary: To characterise the CSF and blood pharmacokinetic (PK) profile of single and multiple doses of intrathecal lumbar bolus administrations of VO659 in participants with clinically manifest SCA1, SCA3 or HD.
    Exploratory:
    • To assess the pharmacodynamic (PD) profile of single and multiple doses of intrathecal lumbar bolus administrations of VO659, including target engagement and off-target effects based on biochemical biomarkers, and MRI neuroimaging assessments in participants with clinically manifest SCA1, SCA3 or HD.
    • To assess effects on clinical outcome assessments of intrathecal lumbar bolus administrations of VO659 in participants with clinically manifest SCA1, SCA3 or HD
    Secundario: Caracterizar el perfil farmacocinético (FC) en LCR y sangre tras dosis únicas y múltiples de administraciones intratecales lumbares en bolo de VO659 en participantes con SCA1, SCA3 o EH clínicamente manifiestas.
    Exploratorios:
    • Evaluar el perfil farmacodinámico (FD) de la administración de una única dosis y múltiples de dosis intratecales lumbares en bolo de VO659, incluyendo el compromiso del objetivo y los efectos fuera del objetivo basados en biomarcadores bioquímicos y evaluaciones de neuroimagen por RMN en participantes con SCA1, SCA3 o EH clínicamente manifiestas.
    • Evaluar los efectos mediante evaluaciones clínicas de las administraciones intratecales lumbares en bolo de VO659 en participantes con SCA1, SCA3 o EH clínicamente manifiestas
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Provide written informed consent (signed and dated).
    2. Is ≥25 and ≤60 years of age inclusive, of any gender, at the time of signing the informed consent.
    3. Have SCA1, SCA3 or HD meeting one of the following criteria:
    a. SCA1 and SCA3: mild to moderate disease with a Scale for Assessment and Rating of Ataxia (SARA) score of ≥3 and ≤18
    b. HD: early manifest, Stage I disease with a Total Functional Capacity (TFC) Score of ≥11 and ≤13 and a Unified Huntington’s Disease Rating Scale (UHDRS) Diagnostic Confidence Level (DCL) of 4.
    4. Have genetically confirmed disease, defined by increased cytosine, adenine, and guanine (CAG) repeat length in the disease-causing allele by direct DNA testing. For each indication the requirements are:
    a. SCA1: ≥41 contiguous, uninterrupted CAG repeats in ATXN1
    b. SCA3: ≥61 repeats in ATXN3
    c. HD: ≥36 CAG repeats in HTT.
    5. Have good general health, in the opinion of the investigator, apart from having SCA1, SCA3, or HD.
    6. Body weight of ≥50 kg and body mass index (BMI) within the range of 18-32 kg/m2 (inclusive).
    7. Is willing to follow contraceptive requirements per local regulations regarding the methods of contraception for those participating in clinical trials. In case local regulations deviate from the contraception methods listed in Section ‎10.4, local regulations apply and will be described in the Informed Consent Form (ICF).
    1. Proporcionar consentimiento informado por escrito (firmado y fechado).
    2. Tener ≥25 y ≤60 años inclusive, de cualquier género, en e momento de firmar el consentimiento informado.
    3. Tener SCA1, SCA3 o HD que cumpla con uno de los siguientes criterios:
    a. SCA1 y SCA3: enfermedad de leve a moderada con una puntuación de Scale for Assessment and Rating of Ataxia (SARA) de ≥3 y ≤18
    b. HD: de manifestación temprana, enfermedad en estadío I con una puntuación de capacidad funcional total (TFC) de ≥11 y ≤13 y un nivel de confianza diagnóstica (DCL) de la escala de calificación de la enfermedad de Huntington unificada (UHDRS) de 4.
    4. Tener una enfermedad confirmada genéticamente, definida por un aumento en la longitud de las repeticiones de citosina, adenina y guanina (CAG) en el alelo que causa la enfermedad mediante pruebas directas de ADN. Para cada indicación los requisitos son:
    a. SCA1: ≥41 repeticiones CAG contiguas e ininterrumpidas en ATXN1
    b. SCA3: ≥61 repeticiones en ATXN3
    c. HD: ≥36 repeticiones CAG en HTT.
    5. Gozar de buen estado de salud general, a juicio del investigador, además de tener SCA1, SCA3 o HD.
    6. Peso corporal ≥50 kg e índice de masa corporal (IMC) dentro del rango de 18-32 kg/m2 (inclusive).
    7. Está dispuesto a seguir los requisitos anticonceptivos según las reglamentaciones locales con respecto a los métodos anticonceptivos para quienes participan en ensayos clínicos. En caso de que las reglamentaciones locales se desvíen de los métodos anticonceptivos enumerados en la Sección ‎10.4, se aplicarán las reglamentaciones locales y se describirán en el Formulario de consentimiento informado (ICF).
    E.4Principal exclusion criteria
    1. Have any condition that would prevent participation in trial assessments.
    2. Have acute infection or febrile illness at the time of each dosing, or ongoing systemic antiviral or antimicrobial therapy that will not be completed at least three days prior to dosing.
    3. Have one or more pathogenic mutation(s) in another polyQ disease gene, i.e., ATXN2, CACNA1A, ATXN7, TBP, AR, and ATN1, plus either ATXN3 and HTT (for patients with SCA1), ATXN1 and HTT (for participants with SCA3), or ATXN1 and ATXN3 (for participants with HD), in addition to the disease-causing mutation in the ATXN1 (patients with SCA1), ATXN3 (patients with SCA3) or HTT (patients with HD) gene.
    4. Have clinical diagnosis of moderate or severe chronic migraines or history of the post-lumbar-puncture headache of moderate or severe intensity requiring hospitalisation or blood patch.
    5. Have a brain, spinal or systemic disorder that would interfere with the LP process, CSF circulation, or safety assessments.
    6. Have history of bleeding diathesis or coagulopathy, platelet count less than the lower limit of normal unless stable and assessed by the investigator and the Medical Monitor to be not clinically significant.
    7. Have a history of any malignancy or obligatory precancerous condition of any organ system, except cervical carcinoma of Stage 1B or less, or non-invasive basal cell or squamous cell skin carcinoma that has been successfully treated.
    8. Have inherited or acquired immunodeficiency, including human immunodeficiency virus (HIV) infection.
    9. Have positive serology for hepatitis B surface antigen (HbsAg) or active hepatitis C infection.
    10. Have any known history of hypersensitivity or allergies to the antisense oligonucleotide (AON) (VO659) or any excipient contained in the IMP.
    11. Have any significant (moderate or severe) acute or chronic liver or kidney disease.
    12. Have deviations of any of the following laboratory parameters at screening:
    • Aspartate aminotransferase (AST) >2.0 x Upper Limit of normal range (ULN)
    • Alanine aminotransferase (ALT) >2.0 x ULN
    • Total bilirubin >2 mg/dL
    • Platelets <100,000/µl (i.e., <100 x 10^9/L)
    • Estimated glomerular filtration rate (eGFR) <45 mL/min/1.73m2 based on the modification of diet in renal disease (MDRD) formula
    13. Have uncompensated cardiovascular disorder, any past or present cardiac arrhythmia, QTcF values on screening ECG of >470 ms, familial history of long QT syndrome or sudden unexpected death.
    14. Have a history of uncontrolled hypokalaemia or hypomagnesaemia.
    15. Have a history of hospitalisation for any major medical or surgical procedure involving general anaesthesia within 6 weeks of screening or planned during the trial.
    16. Have clinical evidence of acute COVID-19 or confirmed presence of COVID-19 / SARS-CoV-2 infection at any time during the screening period or have long-term neurological consequences of COVID-19 / SARS-CoV-2 infection that have not resolved or stabilised at the time of screening.
    17. Have a history of attempted suicide, suicidal ideation with a plan that required hospital admission and/or change in level of care within 12 months prior to screening. For patients with (i) a suicide ideation score ≥4 on the Columbia Suicide Severity Rating Scale (C-SSRS) within the last 12 months, or (ii) suicidal behaviours within the last 12 months (as measured by the answer “Yes” on any of the C-SSRS Suicidal Behaviour Items), a risk assessment should be done by an appropriately-qualified mental health professional (e.g., a psychiatrist or licensed clinical psychologist) to assess whether it is safe for the patient to participate in the trial.
    18. Have a history of psychosis, bipolar disorder or schizophrenia and patients deemed to be at significant risk of an acute depressive episode, confusional state or violent behaviour.
    19. Have medical, psychiatric, or other conditions that, in the judgement of the investigator, may compromise the patient’s ability to understand the patient information sheet, to give informed consent, to comply with all trial requirements, or to complete the trial.
    See protocol for additional exclusion criteria on "prior/concomitant therapy", "prior concurrent clinical trial experience", "other exclusions", "exclusion criteria to be checked before each IMP administration"
    1. Tener cualquier condición que impida la participación en las evaluaciones del ensayo.
    2. Tener una infección aguda o una enfermedad febril en el momento de cada dosificación, o estar con una terapia antiviral o antimicrobiana sistémica en curso que no se completará al menos tres días antes de la dosificación.
    3. Tener una o más mutaciones patogénicas en otro gen de la enfermedad polyQ, es decir, ATXN2, CACNA1A, ATXN7, TBP, AR y ATN1, además de ATXN3 y HTT (para pacientes con SCA1), ATXN1 y HTT (para pacientes con SCA3), o ATXN1 y ATXN3 (para pacientes con HD), además de la mutación causante de la enfermedad en el gen ATXN1 (pacientes con SCA1), ATXN3 (pacientes con SCA3) o HTT (pacientes con HD).
    4. Tener diagnóstico clínico de migraña crónica moderada o severa o antecedentes de cefalea post-punción lumbar de intensidad moderada o severa que requiera hospitalización o parche hemático.
    5. Tener un trastorno cerebral, espinal o sistémico que podría interferir con el proceso de PL, la circulación del LCR o las evaluaciones de seguridad.
    6. Tener antecedentes de diátesis hemorrágica o coagulopatía, recuento de plaquetas por debajo del límite inferior normal a menos que esté estable y el investigador y el monitor médico evalúen que no es clínicamente significativo.
    7. Tener antecedentes de cualquier malignidad o condición precancerosa obligatoria de cualquier sistema orgánico, excepto carcinoma de cuello uterino de estadio 1B o menos, o carcinoma de piel de células basales o de células escamosas no invasivo que haya sido tratado con éxito.
    8. Tener inmunodeficiencia hereditaria o adquirida, incluida la infección por el virus de la inmunodeficiencia humana (VIH).
    9. Serología positiva para antígeno de superficie de hepatitis B (HbsAg) o infección por hepatitis C activa.
    10. Tener antecedentes conocidos de hipersensibilidad o alergias al oligonucleótido antisentido (AON) (VO659) o cualquier excipiente contenido en el IMP.
    11. Tiene alguna enfermedad hepática o renal significativa (moderada o grave) aguda o crónica.
    12. Tener desviaciones en cualquiera de los siguientes parámetros de laboratorio en la selección:
    • Aspartato aminotransferasa (AST) >2,0 x Límite superior del rango normal (LSN)
    • Alanina aminotransferasa (ALT) >2,0 x LSN
    • Bilirrubina total >2 mg/dL
    • Plaquetas <100 000/µl (es decir, <100 x 10^9/L)
    • Tasa de filtración glomerular estimada (TFGe) <45 ml/min/1,73 m2 basada en la fórmula de modificación de la dieta en la enfermedad renal (MDRD)
    13. Tener un trastorno cardiovascular no compensado, cualquier arritmia cardíaca presente o pasada, valores de QTcF en el ECG de detección de >470 ms, antecedentes familiares de síndrome de QT largo o muerte súbita inesperada.
    14. Tener antecedentes de hipopotasemia o hipomagnesemia no controlada.
    15. Tener antecedentes de hospitalización por cualquier procedimiento médico o quirúrgico importante que involucre anestesia general dentro de las 6 semanas previas a la selección o planificado durante el ensayo.
    16. Tener evidencia clínica de COVID-19 agudo o presencia confirmada de infección por COVID-19/SARS-CoV-2 en cualquier momento durante el período de selección o tener consecuencias neurológicas a largo plazo de infección por COVID-19/SARS-CoV-2 que no se han resuelto o estabilizado en el momento de la selección.
    17. Tener antecedentes de intento de suicidio, ideación suicida con un plan que requirió ingreso hospitalario y/o cambio en el nivel de atención dentro de los 12 meses anteriores a la selección. Para pacientes con (i) una puntuación de ideación suicida ≥4 en la Escala de calificación de gravedad del suicidio de Columbia (C-SSRS) en los últimos 12 meses, o (ii) comportamientos suicidas en los últimos 12 meses (medidos por la respuesta "Sí" en cualquiera de los ítems de comportamiento suicida de la C-SSRS), un profesional de la salud mental debidamente calificado debe realizar una evaluación de riesgos (p. ej., un psiquiatra o un psicólogo clínico con licencia) para evaluar si es seguro que el paciente participe en el ensayo. .
    18. Tener antecedentes de psicosis, trastorno bipolar o esquizofrenia y pacientes considerados de riesgo significativo de sufrir un episodio depresivo agudo, estado confusional o comportamiento violento.
    19. Tener condiciones médicas, psiquiátricas o de otro tipo que, a juicio del investigador, puedan comprometer la capacidad del paciente para comprender la hoja de información del paciente, dar su consentimiento informado, cumplir con todos los requisitos del ensayo o completar el ensayo.
    Consulte el protocolo para conocer los criterios de exclusión adicionales sobre "terapia previa/concomitante", "experiencia previa en ensayos clínicos concurrentes", "otras exclusiones", "criterios de exclusión que deben verificarse antes de cada administración del IMP"
    E.5 End points
    E.5.1Primary end point(s)
    Primary endpoints:
    1. Incidence and dose relationships of treatment-related:
    o AEs,
    o Serious adverse events (SAEs),
    o Adverse events of special interest (AESI),
    o Severe events (NCI-CTCAE Grade 3 or higher).
    2. Changes in clinical safety parameters including physical and neurological examinations, vital signs, body weight, ECG (including QTcF-PK relationship analysis and other interval analyses), cardiac monitoring, suicidal ideation and behaviour risk monitoring by the Columbia Suicide Severity Rating Scale (C-SSRS), and review of structural MRI scans
    3. Changes in laboratory safety parameters in blood (haematology, haemostasis, clinical chemistry), CSF (cell counts, protein, glucose), and urine (urinalysis).
    4. Adverse changes in clinical status based on exploratory clinical, biochemical and neuroimaging assessments
    Criterios de valoración principales:
    1. Relaciones de incidencia y dosis de los siguientes aspectos relacionados con el tratamiento:
    o Acontecimientos Adversos (AAs),
    o Acontecimientos Adversos Graves (AAG),
    o Acontecimientos Adversos de especial interés (AAEI),
    o Acontecimientos graves (NCI- CTCAE grado 3 o superior).
    2. Cambios en los parámetros clínicos de seguridad, incluyendo exploraciones físicas y neurológicas, signos vitales, peso corporal, ECG (incluyendo análisis de la relación QTcF-FC y otros análisis de intervalos), monitorización cardíaca, ideación suicida y seguimiento del riesgo de comportamiento según la Escala Columbia para Evaluar el Riesgo de suicidio C-SSRS y revisión de las RMN estructurales
    3. Cambios en los parámetros de seguridad de laboratorio en sangre (hematología, hemostasis, bioquímica clínica), LCR (recuento de células, proteínas, glucosa) y orina (análisis de orina)
    4. Cambios adversos en el estado clínico basados en evaluaciones exploratorias clínicas, bioquímicas y de neuroimagen
    E.5.1.1Timepoint(s) of evaluation of this end point
    1. All visits
    2. All visits except D3 of all doses and PDV2
    3. All visits except D3 of all doses and PDV2
    4. All visits
    1. Todas las visitas
    2. Todas las visitas excepto D3 en todas las dosificaciones y en post-dosificacion 2 (PDV2)
    3. Todas las visitas excepto D3 en todas las dosificaciones y en PDV2
    4. Todas las visitas
    E.5.2Secondary end point(s)
    Secondary endpoints:
    1. The CSF concentration-time profile of VO659, including the derived PK parameter of elimination half-life (t1/2), if possible.
    2. The plasma concentration-time profile of VO659, including the derived PK parameters such as the area under the curve (AUC), maximum plasma concentration (Cmax), t1/2
    3. Changes in mutant ATXN1 (in participants with SCA1) mutant ATXN3 (in participants with SCA3) or mutant HTT (in participants with HD) in CSF and blood
    4. Changes in total ATXN1, total ATXN3, total HTT in CSF and blood
    5. Changes in biomarkers indicative of neurodegeneration, such as NfL, total tau, GFAP, and UCH-L1 in CSF and the blood
    6. Changes in biomarkers indicative of inflammation, such as C3a, IL-1β, IL-6, TNFα and YKL-40 (CH3-L1) in CSF and the blood
    7. Changes in neuroimaging outcomes, such as the volume of whole brain and brain regions of interest (including but not limited to the cerebellum, pons, brainstem, and striatum), diffusion MRI, quantitative MRI for iron content (R2* mapping), MRS (optional, only at select trial sites), and OCT (only at select trial sites)
    8. Changes in clinical outcome measures, such as SARA, 9-HPT, FARS (part I & II), INAS (participants with SCA1 or SCA3); UHDRS TFC, FAS, IS, TMS/DCL (participants with HD), MoCA, SDMT, CGI-S, and CGI-C (all participants).
    9. Changes in Patient-reported outcomes, such as PGI-S and PGI-C
    Criterios de valoración secundarios:
    1. El perfil de concentración-tiempo en LCR de VO659, incluido el parámetro PK derivado de la vida media de eliminación (t1/2), si es posible.
    2. El perfil de concentración plasmática-tiempo de VO659, incluidos los parámetros farmacocinéticos derivados, como el área bajo la curva (AUC), la concentración plasmática máxima (Cmax), t1/2
    3. Cambios en ATXN1 mutante (en pacientes con SCA1) ATXN3 mutante (en pacientes con SCA3) o HTT mutante (en pacientes con HD) en LCR y sangre
    4. Cambios en ATXN1 total, ATXN3 total, HTT total en LCR y sangre
    5. Cambios en biomarcadores indicativos de neurodegeneración, como NfL, tau total, GFAP y UCH-L1 en LCR y sangre
    6. Cambios en biomarcadores indicativos de inflamación, como C3a, IL-1β, IL-6, TNFα y YKL-40 (CH3-L1) en LCR y sangre
    7. Cambios en los resultados de las neuroimágenes, como el volumen de todo el cerebro y las regiones cerebrales de interés (incluidos, entre otros, el cerebelo, la protuberancia, el tronco encefálico y el cuerpo estriado), RMN de difusión, RMN cuantitativa para el contenido de hierro (mapeo R2*), RM de espectroscopía (opcional, solo en centros seleccionados) y OCT (solo en centros seleccionados)
    8. Cambios en las valoracones de resultados clínicos, como SARA, 9-HPT, FARS (parte I y II), INAS (pacientes con SCA1 o SCA3); UHDRS TFC, FAS, IS, TMS/DCL (pacientes con HD), MoCA, SDMT, CGI-S y CGI-C (todos los pacientes).
    9. Cambios en los resultados reporteados por el paciente, como PGI-S y PGI-C
    E.5.2.1Timepoint(s) of evaluation of this end point
    1. D1 of all doses, PDV1, PDV3, PDV4, ED
    2. D1, D2, D8 of dose 1 and 4; D1 and D8 of dose 2 and 3; PDV1, PDV3, PDV4, ED
    3. D-1, D2, D8 of all doses, PDV1, PDV3, PDV4, ED
    4. D-1, D2, D8 of all doses, PDV1, PDV3, PDV4, ED
    5. D-1, D2, D8 of all doses, PDV1, PDV3, PDV4, ED
    6. D-1, D2, D8 of all doses, PDV1, PDV3, PDV4, ED
    7. Screening, PDV1, PDV4, ED
    8. Screening, D-1, PDV1, PDV4, ED
    9. D-1, PDV1, PDV4, ED
    1. D1 en todas las dosificaciones, PDV1, PDV3, PDV4, FT
    2. D1, D2, D8 de las dosificaciones 1 y 4; el D1 y D8 de las dosificaciones 2 y 3; PDV1, PDV3, PDV4, FT
    3. D-1, D2, D8 en todas las dosificaciones, PDV1, PDV3, PDV4, FT
    4. D-1, D2, D8 en todas las dosificaciones, PDV1, PDV3, PDV4, FT
    5. D-1, D2, D8 en todas las dosificaciones, PDV1, PDV3, PDV4, FT
    6. D-1, D2, D8 en todas las dosificaciones, PDV1, PDV3, PDV4, FT
    7. Selección, PDV1, PDV4, FT
    8. Selección, D-1, PDV1, PDV4, FT
    9. D-1, PDV1, PDV4, FT
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis Yes
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) Yes
    E.7.1.1First administration to humans Yes
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled No
    E.8.1.1Randomised No
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over No
    E.8.1.7Other Yes
    E.8.1.7.1Other trial design description
    Dose-escalation
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo No
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial1
    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.8.4.1Number of sites anticipated in Member State concerned1
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA7
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    United Kingdom
    E.8.7Trial 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
    The date of the last visit of the last participant in the trial or the last scheduled procedure shown in the SoA (Table 1 of protocol) for the last participant in the trial globally, whichever occurs last.
    La fecha de la última visita del último paciente en el ensayo o el último procedimiento programado según se muestra en la Tabla 1 del protocolo para el último paciente en el ensayo a nivel mundial, lo que ocurra en último lugar.
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years2
    E.8.9.1In the Member State concerned months9
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years2
    E.8.9.2In all countries concerned by the trial months9
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 95
    F.1.3Elderly (>=65 years) No
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state8
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 87
    F.4.2.2In the whole clinical trial 95
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    As VO659 is an IMP under investigation, no treatment with VO659 will be offered outside of this trial. After the end of the trial, participants will return to standard of care at the discretion of the treating physician. If further clinical development of VO659 in polyQ SCA will be continued, and a phase 2/3 trial in SCA1/3 and/or HD will be conducted then all participants who completed this trial completely will be offered participation in a separate follow-up trial.
    Como VO659 es un IMP en investigación, no se ofrecerá ningún tratamiento con VO659 fuera de este ensayo. Después del final del ensayo, los pacientes volverán al estándar de atención a discreción del médico tratante. Si se continúa con el desarrollo clínico adicional de VO659 en polyQ SCA y se realiza un ensayo de fase 2/3 en SCA1/3 y/o HD, a todos los participantes que completaron este ensayo por completo se les ofrecerá participar en un ensayo de seguimiento por separado. .
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2024-01-15
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2023-12-01
    P. End of Trial
    P.End of Trial StatusOngoing
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