Open-Label Study of mRNA-3927 in Participants With Propionic Acidemia

Phase 2RecruitingNCT04159103

ModernaTX, Inc.77 enrolled

Overview

This 3-part, Phase 1/2 study is designed to characterize the safety, tolerability, and pharmacological activity (as assessed by biomarker measurements) and to determine the selected dose of mRNA-3927 in participants with genetically confirmed propionic acidemia (PA). After establishing a dose with an acceptable safety and pharmacodynamic (PD) response for participants ≥1 year of age in Part 1, participants will be enrolled in Part 2 (which will serve as the pivotal study) to allow for determination of the efficacy, safety, and PD of mRNA-3927. Part 3 will evaluate the safety, efficacy and PD response of mRNA-3927 in infants (\<1 year of age).

During the Dose Optimization Stage, after each dose cohort is fully enrolled (≥1 year of age), and the dose-limiting toxicity (DLT) observation window of at least 14 days is complete for the final participant in that cohort, the Sponsor will review the totality of available safety data in conjunction with all available PK/PD data. Based on this review, the Sponsor will recommend a revised dose and/or dosing interval. The Sponsor will abide by predefined constraints as to the maximum percentage change in dose and dose interval. A maximum of 9 cohorts will be enrolled in Part 1 (Dose Optimization). Upon establishment of a dose with an acceptable safety and PD activity in Part 1 (participants ≥1 year of age), additional participants will be enrolled into the study in Part 2 (participants ≥1 year of age) to allow for determination of the safety, efficacy, and PD of mRNA-3927. Part 3 will evaluate the safety, efficacy and PD response in infants (\<1 year of age). Participants in all the phases will participate in a predosing observational period, followed by a treatment period, and then a follow-up period after withdrawal of treatment.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: Participants ≥1 year of age are eligible to be included in the study only if all of the following criteria apply: * ≥ 8 years of age at the time of consent/assent if enrolled as 1 of the first 2 participants in Part 1. * ≥1 year of age at the time of consent/assent if enrolled after the first 2 participants in Part 1. * Confirmed diagnosis of PA based on diagnosis by molecular genetic testing via central laboratory (PCCA and/or PCCB mutations). * Part 2 only: At least one documented MDE in the 12-month period before consent. Participants \<1 Year of Age : * Identification by newborn screening shortly after birth or having suspected PA by presenting with a spectrum of metabolic symptoms, and having a sibling diagnosed with PA. Participant may enter the Screening Period while awaiting genetic testing results, provided that all other eligibility criteria are met but would not be enrolled until diagnosis of PA is confirmed. * For infants in the neonatal intensive care unit (NICU) only: ≥37 weeks gestational age at the time of birth without other conditions/comorbidities that in the opinion of the Investigator may interfere with the interpretation of study results. * Body weight ≥3 kilograms (kg) at Screening. * At least 1 documented PA-related event prior to Screening defined as the following criteria: * Clinical signs of metabolic deterioration consistent with PA (for example, vomiting, not feeding well/poor suck, heavy breathing, lethargy, absence of proper perfusion, abnormal movements including bicycling, abnormal tone, low body temperature, seizure\[s\]), OR * Meeting the criteria of MDE definition, OR * Evidence of laboratory abnormalities as evidenced by at least one of the following: * Metabolic acidosis with elevated anion gap. * Acute hyperammonemia. * Neutropenia or thrombocytopenia. Exclusion Criteria: Participants of all ages are excluded from the study if during Screening any of the following criteria apply: * Any individual with laboratory abnormalities considered to be clinically significant (for example, markedly out of range, associated with clinical symptoms) in the Investigator or Sponsor's opinion that could interfere with or limit the participation in the study. * Estimated glomerular filtration rate (eGFR) \<30 milliliters (mL)/minute/1.73 square meter (m\^2) for participants of all ages receiving chronic dialysis. * History of organ transplantation or planned organ transplantation during the period of study participation. * Corrected QT interval (QTc) \>480 milliseconds (ms) using Bazett's correction. * Grade 3 or 4 heart failure according to the Modified Ross Heart Failure Classification for Children or the New York Heart Association Classification. * Pregnant or breastfeeding. * Other clinically significant conditions that in the Investigator's opinion could interfere with the safety of the participant, the interpretation of study results, or limit the participation in the study.

Locations (35)

UCSD Altman Clinical and Transalational Research Institute Building

Los Angeles, California, United States

NOT_YET_RECRUITING

Ronald Reagan UCLA Medical Center

Los Angeles, California, United States

RECRUITING

Lucile Packard Children's Hospital Stanford

Stanford, California, United States

RECRUITING

Nicklaus Children's Hospital

Miami, Florida, United States

Outcomes

Primary Outcomes

Part 1: Number of Participants with Treatment-emergent Adverse Event (TEAE), Serious Adverse Events (SAE) and TEAEs Leading to Discontinuation

Time frame: Day 1 (initial mRNA-3927 dose) up to Week 150 (End of Study)

Part 2: Change in Annualized Frequency of Clinical Event Committee (CEC)-adjudicated Metabolic Decompensation Events (MDEs) During 12-month Treatment Period With mRNA-3927 Compared to Annualized Frequency of CEC-adjudicated MDE During Pretreatment Period

Time frame: Pretreatment period (12 months before consent to first mRNA-3927 dose in the study) up to Month 12

Part 3: Number of Participants with TEAEs, SAEs, Adverse Events (AEs) of Special Interest (AESIs) and TEAEs Leading to Discontinuation

Time frame: Day 1 up to Week 73

Secondary Outcomes

Part 1: Change From Baseline in Plasma 2-Methylcitrate (2-MC) and 3-Hydroxypropionic Acid (3-HP) Levels After Single and Repeated Administrations of mRNA-3927

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Maximum Observed Effect (Emax) of 2-MC and 3-HP After Single and Repeated Administrations of mRNA-3927

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Area Under the Effect Versus Time Curve (AUEC) of 2-MC and 3-HP After Single and Repeated Administrations of mRNA-3927

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Duration of Response (DOR) After Single and Repeated Administrations of mRNA-3927

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Maximum Observed Concentration (Cmax) of Propionyl-CoA Carboxylase Subunit α (PCCA) and Propionyl-CoA Carboxylase Subunit β (PCCB) mRNAs

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Time of Cmax (Tmax) of PCCA and PCCB mRNAs

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Area Under the Plasma Concentration-Time Curve (AUC) of PCCA and PCCB mRNAs

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: SM-86 Concentration After Single and Repeated Administrations of mRNA-3927

Baseline (predose levels) to postdose levels measured after single and after repeated administrations of mRNA-3927

Time frame: Baseline up to Week 40

Part 1: Frequency of Anti-Polyethylene Glycol and Anti-Propionyl-CoA Carboxylase Antibodies

Time frame: Day 1 (initial mRNA-3927 dose) up to Week 150 (End of Study)

Part 2: Change in Annualized Frequency of CEC-adjudicated MDE-related Hospitalizations During the 12-month Treatment Period With mRNA-3927 Compared to the Annualized Frequency of CEC-adjudicated MDE-related Hospitalizations During the Pretreatment Period

Time frame: Pretreatment period (12 months before consent to first mRNA-3927 dose in the study) up to Month 12

Part 2: Change in Annualized Frequency of CEC-adjudicated PA-related Hospitalizations During the 12-month Treatment Period With mRNA-3927 Compared to the Annualized Frequency of CEC-adjudicated PA-related Hospitalizations During the Pretreatment Period

Time frame: Pretreatment period (12 months before consent to first mRNA-3927 dose in the study) up to Month 12

Part 2: Change in Annualized Frequency of CEC-adjudicated MDEs During 12-month Treatment Period With mRNA-3927 Compared to Annualized Frequency of CEC-adjudicated MDE During Pretreatment Period by the Following Severity Grades: Grade 1, Grade 2, Grade 3

Time frame: Pretreatment period (12 months before consent to first mRNA-3927 dose in the study) up to Month 12

Parts 2 and 3: Change from Baseline in Pediatric Quality of Life Inventory (PedsQL) Total Score and Physical Function Score