RGX-202 is a gene therapy designed to deliver a transgene for a novel microdystrophin that includes functional elements of naturally-occurring dystrophin including the C-Terminal (CT) domain. This is a multicenter, open-label dose evaluation clinical study to assess the safety, tolerability, and clinical efficacy of a one-time intravenous (IV) dose of RGX-202 in participants with Duchenne.
Duchenne muscular dystrophy (Duchenne) is a rare genetic disorder, caused by mutations in the gene responsible for making dystrophin, a protein of central importance for muscle cell structure and function. The absence of functional dystrophin protein in individuals with Duchenne results in cell damage during muscle contraction leading to cell death, inflammation, and fibrosis in muscle tissues, and ultimately progressive muscle weakness. RGX-202 is designed to use the AAV8 vector to deliver a transgene to muscle cells that encodes a novel microdystrophin that includes the functional elements of naturally occurring dystrophin including the C-Terminal (CT) domain. This is a multicenter, phase I/II/III, open-label study to evaluate the safety, tolerability, pharmacodynamics (microdystrophin protein levels), pharmacokinetic, and clinical efficacy of RGX-202 when administered IV as one-time dose to ambulant male participants with Duchenne. Enrollment is complete for Parts 1, 2 and 3 of the study. A comprehensive, short-term, prophylactic immunosuppression regimen will be administered during treatment to mitigate a potential immune response. This study is being conducted in three sequential parts: a phase I/II study (Part 1), a phase 3 pivotal study (Part 2) and a confirmatory study (Part 3). Part 1 will study a one-time dose of RGX-202 (1x10\^14 or 2x10\^14 GC/kg) in up to 15 participants with Duchenne. In part 1, the primary objective is to evaluate the safety and tolerability of RGX-202 through 52 weeks. Part 2 (Pivotal Expansion) will study a single dose of RGX-202 (2x10\^14 GC/kg) in approximately 30 participants. After the last Part 2 participant is dosed, enrollment into the confirmatory study (Part 3) will be initiated. The target enrollment for the confirmatory study (Part 3) is approximately 30 participants. Participants will be assessed at various time points for 104 weeks after receiving RGX-202. All participants will be given the opportunity to enroll in a separate long-term follow-study in accordance with the US federal government guidelines for the safety follow-up of patients receiving gene therapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
65
RGX-202 is a recombinant AAV8 containing a transgene encoding a novel microdystrophin
Arkansas Children's Hospital
Little Rock, Arkansas, United States
Part 1 Safety measured by incidence of Adverse Events and Serious Adverse Events
Evaluate incidences of AEs and SAEs
Time frame: 52 weeks
Part 2 and 3 Pharmacodynamic
Proportion of participants whose RGX-202 microdystrophin protein expression determined in their muscle biopsy is ≥ 10% relative to dystrophin level in non-DMD participants
Time frame: 12 weeks
Time to Stand (TTSTAND)
Values will include time (seconds) and velocity (tasks/second)
Time frame: 52 Weeks (Part 1); 52 and 104 Weeks (Part 2 &3)
Time to Walk/Run 10 meters (TTWR)
Values will include time (seconds) and velocity (meters/second)
Time frame: 52 Weeks (Part 1) and 104 Weeks (Part 2 &3)
Time to Climb 4 Stairs (TTCLIMB)
Values will include time (seconds) and velocity (tasks/second)
Time frame: 52 Weeks (Part 1); 52 and 104 Weeks (Part 2 &3)
North Star Ambulatory Assessment (NSAA)
Performance-based assessment of muscle strength and function using a 17-item scale, with all items rated 0,1, or 2, with higher score indicating better performance. The NSAA total score is the sum of the 17 items, ranging from 0 to 34. NSAA linearized score ranges from 0 to 100.
Time frame: 52 Weeks (Part 1) and; 52 and 104 Weeks (Part 2 &3)
Peabody Developmental Motor Scale, Third Edition (PDMS-3); Body Control Subtest
The PDMS-3 is a norm-referenced developmental assessment that measures motor skills of young children. The Body Control subtest measures the child's ability to maintain balance and postural reactions in a variety of positions. Motor skills appropriate for the child's developmental level are administered and rated 0, 1, or 2, with higher score indicating better performance. Body Control subtest total raw scores range from 0 to 112. Age equivalent and scaled scores will also be generated. PDMS-3 Body Control subtests is included for participants age \<4 at screening.
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Children's Hospital of Orange County
Orange, California, United States
Stanford School of Medicine /Division of Neuromuscular Medicine
Palo Alto, California, United States
Children's Hospital Colorado
Aurora, Colorado, United States
University of Florida
Gainesville, Florida, United States
Rare Disease Research
Atlanta, Georgia, United States
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
University of Iowa
Iowa City, Iowa, United States
University of Kansas Medical Center
Kansas City, Kansas, United States
University of Massachusetts Chan Medical School
Worcester, Massachusetts, United States
...and 13 more locations
Time frame: 52 Weeks (Part 1); 52 and 104 Weeks (Part 2 &3)
Peabody Developmental Motor Scale, Third Edition (PDMS-3); Body Transport Subtest
The PDMS-3 is a norm-referenced developmental assessment that measures motor skills of young children. The Body Transport subtest measures the child's ability to move from one place to another, including walking, running, jumping forward, and skipping. Motor skills appropriate for the child's developmental level are administered and rated 0, 1, or 2, with higher score indicating better performance. Body Transport subtest total raw score ranges from 0 to 63. Age equivalent and scaled scores will also be generated. PDMS-3 Body Control subtests is included for participants age \<4 at screening.
Time frame: 52 Weeks (Part 1); 52 and 104 Weeks (Part 2 &3)
Part 2 and 3: Stride velocity 95th centile
Assessment of peak ambulatory performance captured by wearable activity monitoring device. For velocity measures, higher values indicate greater function.
Time frame: 104 weeks
Part 1 Microdystrophin protein expression
RGX-202 microdystrophin protein levels determined in muscle biopsy.
Time frame: 12 weeks
Part 1 Pharmacokinetics (PK)
Vector genome concentrations as measured by polymerase chain reaction \[PCR\] to RGX-202 deoxyribonucleic acid \[DNA\] in muscle and serum.
Time frame: 12 weeks (muscle) and 52 weeks (serum)
Part 1 Vector Shedding
Vector genome concentrations as measured by polymerase chain reaction \[PCR\] to RGX-202 deoxyribonucleic acid \[DNA\] in urine.
Time frame: 52 weeks
Part 2 and 3 Microdystrophin protein expression
RGX-202 microdystrophin protein levels determined in muscle biopsy.
Time frame: 12 weeks
Part 2 and 3 Safety measured by incidence of Adverse Events and Serious Adverse Events
Evaluate incidences of AEs and SAEs
Time frame: 104 weeks
Part 2 and 3 Pharmacokinetics (PK)
Vector genome concentrations as measured by polymerase chain reaction \[PCR\] to RGX-202 deoxyribonucleic acid \[DNA\] in muscle and serum.
Time frame: 12 weeks (muscle) 52 weeks (serum)
Part 2 and 3 Vector Shedding
Vector genome concentrations as measured by polymerase chain reaction \[PCR\] to RGX-202 deoxyribonucleic acid \[DNA\] in urine, feces, and saliva.
Time frame: 52 weeks