Elaprase (idursulfase), a large molecular protein, is not expected to cross the blood brain barrier at therapeutic levels when administered intravenously. A new formulation of idursulfase, idursulfase-IT, that differs from that of the intravenous (IV) formulation, Elaprase, has been developed to be suitable for delivery into the cerebrospinal fluid (CSF) via intrathecal administration. This Phase I/II study is designed to obtain necessary safety and exposure data, as well as secondary and exploratory outcome measures, to be interpreted and used in the design of subsequent clinical trials.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
3 dose cohorts were planned. Within each dose cohort, patients will be randomized to 1 of 2 treatment options: treatment with study drug or no treatment with 4 treated patients per dose group and a total of 4 untreated patients (1-2 untreated patients will be assigned in each dose cohort). They will not undergo surgical placement of an Intrathecal Drug Delivery Device (IDDD), and will not receive Idursulfase-IT.
The original design of the study was to test the dose levels of 10, 30 and 100 mg. This was based on a calculation of a minimally effective dose around 10 mg, with subsequent dose levels being chosen as increasing half-log steps. During the conduct of the study; however, it became clear that the 10 mg dose elicited a strong Pharmacodynamic response, as measured by a dramatic and sustained drop in the CSF GAG levels. This indicated the need to explore a lower level as a minimally effective dose level, leading to the introduction of the 1 mg group. Enrollment of patients in this dose cohort will commence after the last patient has been enrolled in 30 mg dose cohort. 4 patients will be undergo surgical placement of an IDDD and receive 1 mg idursulfase-IT as an IT injection via an IDDD once per month (ie, every 28 days) for 6 month.
Patients will be enrolled in 10 mg dose cohort and 30 mg dose cohort in a sequential, escalating fashion. 4 patients will undergo surgical placement of an IDDD and receive 10 mg idursulfase-IT as an intrathecal (IT) injection via an IDDD once per month (ie, every 28 days) for 6 month.
Patients will be enrolled in 10 mg dose cohort and 30 mg dose cohort in a sequential, escalating fashion. 4 patients will undergo surgical placement of an IDDD and receive 30 mg idursulfase-IT as an IT injection via an IDDD once per month (ie, every 28 days) for 6 month.
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States
Birmingham Children's Hospital
Birmingham, United Kingdom
Birmingham Children's Hospital NHS Foundation Trust
Birmingham, United Kingdom
Number of Serious Adverse Event (SAE)
Time frame: 6 months
Number of Treatment Emergent Adverse Event (AE)
ITT patient population
Time frame: Baseline to week 23
Safety Changes in Cerebrospinal Fluid (CSF)- White Blood Cells (WBC)
White blood cell count in CSF was monitored throughout the study as a way of assessing any potential inflammation of the meninges induced by idursulfase-IT.
Time frame: 6 months
Safety: Development of Anti-idursulfase Antibodies (CSF)
Reflects development of anti-idursulfase antibodies post baseline.
Time frame: 6 months
Safety: Development of Anti-idursulfase Antibodies (Serum)
Time frame: 6 months
Clinically Significant ECG Findings at Any Time During the Study.
Electrocardiogram (ECG) parameters included: heart rate, sinus rhythm, atrial/ventricular hypertrophy, PR, QRS, QT and QTc intervals.
Time frame: 6 months
Change From Baseline in CSF Glycosaminoglycans [GAGs] at Week 27
Percent Change from Baseline to Week 27
Time frame: Baseline to Week 27
Level of Idursulfase in the CSF Compartment Resulting From Monthly Idursulfase IT Administrations
Samples collected from patients treated at doses of 1 mg and 30 mg, as well as the control group, were below the lower limit of detection of the bioanalytical method (3.13 ng/mL)
Time frame: Week 27 (end of study)
Concentration of Idursulfase in Serum After Single Administration (Week 3) in Conjunction With Elaprase
Values below lower limit of quantitation (LLOQ) are listed as 0.
Time frame: Weeks 3
Concentration of Idursulfase in Serum After Repeated Doses of Intrathecal Idursulfase-IT Given in Conjunction With Elaprase
Time frame: Weeks 23
% Change From Baseline in Urinary GAG
Time frame: Baseline to Week 27
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