The purpose of this study is to evaluate the efficacy and safety of autologous hemotopoietic stem cell (HSC) gene therapy, AVR-RD-02, compared to enzyme replacement therapy, for the treatment of Gaucher disease Type 3 in male and female participants aged 2 to 25 years. The study will consist of 2 parts - Core (Part 1) followed by the ERT-crossover (Part 2)
Core (Part 1) Once a participant consents, he/she will complete the screening period within 30 days. Eligible participants will have baseline assessments completed 30 days later and then will be randomized into one of two treatment arms: AVR-RD-02 arm or ERT control arm. If randomized to the AVR-RD-02 arm, the participant will enter the pre-gene therapy infusion period (approximately 15 weeks), which consists of mobilization, apheresis, AVR-RD-02 preparation and testing for release, discontinuation of ERT, and conditioning. The participant will then receive the AVR-RD-02 gene therapy (1 day) followed by a 52-week follow-up period in which periodic safety and efficacy assessments will be performed. Participants will not receive ERT after gene therapy infusion unless indicated by pre-specified laboratory and clinical criteria. If randomized to the ERT Control arm, the participant will remain on their prescribed ERT regimen for 52-week observation period with approximately 4 study visits during this time. ERT-crossover (Part 2) After 52 weeks of observation in Part 1, participants in the ERT Control Arm will have the opportunity to enter Part 2 and receive AVR-RD-02. They will start with baseline assessments and follow a similar schedule to the schedule followed by participants assigned to AVR-RD-02 in the Core Study (Part 1).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
AVR-RD-02 Drug product: active substance is autologous CD34+ enriched hematopoietic stem cells (HSCs) that have been genetically modified ex vivo with a lentiviral vector (LV) to contain a ribonucleic acid (RNA) transcript that, after reverse transcription, results in codon-optimized, complementary deoxyribonucleic acid (cDNA) that, upon its integration into human genome, encodes for functional human glucocerebrosidase (GCase)
A hydrolytic lysosomal glucocerebrosidase-specific enzyme
Change from baseline in a multidomain endpoint as assessed by Global Statistical Test (GST)
The multidomain endpoint consists of the following 4 domains: I. Change in modified Scale for Assessment and Rating of Ataxia total score (mSARA) II. Percent change in diffusing capacity of the lung for carbon monoxide (DLco) for the assessment of interstitial lung disease (ILD) III. Percent change in spleen volume by Magnetic Resonance Imaging (MRI) IV. Percent change in a liver volume by MRI
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion (AVR-RD-02 arm) or Baseline to 52 weeks (ERT arm)
Change from Baseline in Lyso-Gb1 level in cerebrospinal fluid (CSF) as assessed by liquid chromatography tandem mass spectrometry (LC/MS/MS)
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion (AVR-RD-02 arm) or Baseline to 52 weeks (ERT arm)
Change from baseline in clinical improvement as assessed by Clinical Global Impression -Improvement (CGI-I scale)
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion (AVR-RD-02 arm) or Baseline to 52 weeks (ERT arm)
Change from baseline in pain as assessed by Brief Pain Inventory-Short Form (BPI-SF) questionnaire scores
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion (AVR-RD-02 arm) or Baseline to 52 weeks (ERT arm)
Vector Copy Number (VCN) - Engraftment of genetically-modified hematopoietic stem cells (HSCs) in peripheral blood leukocytes (PBL) as assessed by droplet digital polymerase chain reaction (ddPCR)
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion
Vector Copy Number (VCN) - Engraftment of genetically-modified hematopoietic stem cells (HSCs) in bone marrow as assessed by digital droplet polymerase chain reaction (ddPCR)
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion
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Incidence of clinically significant AEs and SAEs
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion
Number of participants with clinically relevant abnormalities as assessed by clinical laboratory tests
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion
Number of participants with clinically relevant abnormalities as assessed by vital signs
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion
Number of participants with clinically relevant abnormalities as assessed by electrocardiograms (ECGs)
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion
Number of participants with clinically relevant abnormalities as assessed by physical examinations findings
Time frame: Baseline to 52 weeks post AVR-RD-02 infusion