The main aim of this study is to evaluate the ability of a prophylactic immune tolerizing regimen (ITR) to prevent or reduce the development of high titer anti-idursulfase antibodies in treatment-naïve participants with Hunter syndrome. In this open label, single arm study, all participants will receive ELAPRASE treatment and a prophylactic ITR. Participants will be treated with ELAPRASE for up to 104 weeks. The prophylactic ITR will start 1 day prior to the start of ELAPRASE. The prophylactic ITR will consist of a 5-week cycle of: Rituximab (intravenously \[IV\], weekly for 4 weeks); Methotrexate (oral, 3 times per week for 5 weeks) and intravenous immunoglobulin (IVIG) (IV, every 4 weeks of the cycle). Following the completion of 1 cycle, an assessment will be made at Month 6, 12, and 18 regarding the need for administering another 5-week cycle of the ITR. Participants will be in the study for approximately 112 weeks (including 6 weeks for screening, up to 104 weeks for treatment, and 2 weeks for follow-up).
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Participants will receive 0.5 milligram per kilogram (mg/kg) of body weight of ELAPRASE, intravenous, infusion for 104 weeks.
Participants will receive 375 milligram per square meter per dose (mg/m\^2/dose) of intravenous rituximab weekly for 4 weeks in 5-week cycle.
Participants will receive 0.4 mg/kg of methotrexate by mouth (PO) 3 times per week for 5 weeks in each cycle.
Participants will receive 500 mg/kg of IVIG every 4 weeks in 5-week cycle.
Phoenix Childrens Hospital
Phoenix, Arizona, United States
Children's Hospital and Research Center at Oakland
Oakland, California, United States
Rady Childrens Hospital San Diego - PIN
San Diego, California, United States
The Lundquist Institute for BioMedical Innovation at Harbor-UCLA Medical Center
Torrance, California, United States
Ann and Robert H Lurie Childrens Hospital of Chicago
Chicago, Illinois, United States
Children's Hospitals and Clinics of Minnesota
Minneapolis, Minnesota, United States
NewYork-Presbyterian Morgan Stanley Children's Hospital
New York, New York, United States
The Cleveland Clinic Foundation
Twinsburg, Ohio, United States
Rate of Anti-Idursulfase Antibodies Formation, Including Anti-Idursulfase Antibodies That Have Enzyme Neutralizing Activity
Serum samples will be collected for evaluation of anti-idursulfase antibodies including binding antibodies and neutralizing antibodies. Analysis of anti-idursulfase antibodies will be conducted using validated 3-tier immunoassay methods. Rate will be defined as the number of participants having positive antibodies compared to the total number of participants.
Time frame: Up to 24 months
Correlation Between Anti-drug Antibody (ADA) Responses and Iduronate-2-Sulfatase (IDS) Gene Mutations and Clinical Outcomes
Correlation between ADA responses and IDS gene mutations and clinical outcomes (efficacy and safety) every 6 months in comparison to historical results from Study SHPELA- 401 (NCT02455622) without immune tolerance treatment will be reported. Analysis of covariance will be performed to correlate ADA response, IDS gene mutation and clinical outcomes.
Time frame: Every 6 months up to 24 months
Change From Baseline in Urinary Glycosaminoglycan (uGAG) Levels Normalized to Urine Creatinine
Urine samples will be collected for the determination of uGAG levels and urine creatinine monthly prior to dosing. Change from baseline in uGAG levels normalized to urine creatinine will be reported.
Time frame: Up to 24 months
Change From Baseline in Normalized uGAG per Upper Limit of Normal for age (uGAG)/ULN)
Urine samples will be collected for the determination of uGAG levels monthly prior to dosing. Change from baseline in normalized uGAG/ULN will be reported.
Time frame: Up to 24 months
Change From Baseline in Liver Volume
Liver volume will be measured using abdominal ultrasonography. Change from baseline values for liver volume will be reported.
Time frame: Up to 24 months
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