The goal of this first-in-human clinical trial is to assess the safety and tolerability of four doses of a new study drug called VO659 in people with genetic disorders called spinocerebellar ataxia type 1, type 3 or Huntington's disease. Another aim is to determine the concentrations of the study drug in the cerebral spinal fluid and blood after single and multiple doses. Study drug will be administered by lumbar intrathecal bolus injections.
Spinocerebellar ataxia types 1 and 3 (SCA1 and SCA3), as well as Huntington's disease (HD) are severely debilitating, monogenic, neurodegenerative diseases that presently have no treatments to slow or stop clinical progression. Preclinical data suggest that VO659 may be a disease-modifying therapy in these disorders through its binding to the expansion of CAG repeats in the RNA transcripts of the causative genes, thus interfering with RNA translation and reducing the intracellular level of the harmful mutant proteins. The present trial is the first-in-human (FiH) evaluation of VO659. This is an open-label, multiple ascending dose, multi-centre phase 1/2a trial investigate the safety, tolerability and pharmacokinetics and explore the pharmacodynamics of intrathecally administered study drug VO659. The trial population comprises generally ambulatory participants with mild to moderate SCA1 or SCA3, or early manifest HD. Participants are assigned to dose-ascending treatment cohorts based on the order of enrolment. Dose-escalation is planned in up to five dose levels. Dose-level cohorts one and two will comprise participants with SCA3 only, and from dose-level cohorts three onwards participants with SCA1, SCA3 and HD will be enrolled. The total duration of trial participation for each participant in Dose-level Cohorts 1-3 is up to approximately 45 weeks, consisting of a screening period of up to 6 weeks, a 14-week dosing period, and a 25-week post-dosing period. The total duration of trial participation for each participant in Dose-level Cohort 4 is up to approximately 58 weeks, consisting of a screening period of up to 7 weeks, a 26-week dosing period, and a 25-week post dosing period. The total duration of trial participation for each participant in Dose-level Cohort 5 is up to approximately 58 weeks, consisting of a screening period of up to 7 weeks, a single dosing followed by a 51-week period of non-dosing, observational visits (split into a 26-week 'dosing period' and a 25-week 'post-dosing period' for consistency in the SoA with Dose-level Cohort 4).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
68
VO659 is an antisense oligonucleotide targeting CAG repeats in mRNA transcripts
Rigshospitalet
Copenhagen, Denmark
RECRUITINGCentre Hospitalier Universitaire dÁngers
Angers, France
RECRUITINGCHU Gui de Chauliac Montpellier- Expert Center of Neurogenetic diseases, Department of Neurology
Montpellier, France
RECRUITINGUniverstiry Hospitals Pitie Salpetriere - Charles foix - Paris
Paris, France
RECRUITINGKatholisches Klinikum Bochum
Bochum, Germany
RECRUITINGDeutsches Zentrum fur Neurodegenerative Erkrankungen (DZNE)
Bonn, Germany
RECRUITINGUniversitatsklinikum Essen - Neurologie
Essen, Germany
RECRUITINGUniversitatsklinikum Tübingen
Tübingen, Germany
RECRUITINGMeir Medical Center
Kfar Saba, Israel
RECRUITINGSourmansky Medical Center
Tel Aviv, Israel
RECRUITING...and 4 more locations
Incidence & dose relationships of treatment-related AEs, SAEs, AEs of special interest (AESI), severe events (NCI- CTCAE Grade 3 or higher).
As measured in each dose group and overall. Unit of measurement: proportion
Time frame: Day 0-253
Vital signs
temperature in centigrade, heart rate in beats per minute (BPM), systolic and diastolic blood pressure blood pressure, respiratory rate in breaths per minute
Time frame: Day 0-253
Body weight
In kilograms
Time frame: Day 0-253
Electrocardiogram (ECG) RR interval
In milliseconds (ms)
Time frame: Day 0-253
Electrocardiogram (ECG) - PR interval
In milliseconds (ms)
Time frame: Day 0-253
Electrocardiogram (ECG) - QTc interval
In milliseconds (ms)
Time frame: Day 0-253
Laboratory safety parameters in blood - white blood cell count
In cells/mL
Time frame: Day 0-253
Laboratory safety parameters in blood - hemoglobin
In g/dL
Time frame: Day 0-253
Laboratory safety parameters in blood - platelets
In cells/cL
Time frame: Day 0-253
Laboratory safety parameters in blood - prothrombin time (PT)
In seconds
Time frame: Day 0-253
Laboratory safety parameters in blood - activated partial thromboplastin clotting time (aPTT)
In seconds
Time frame: Day 0-253
Laboratory safety parameters in blood - international normalised ratio (INR)
as a ration
Time frame: Day 0-253
Laboratory safety parameters in blood - blood urea nitrogen
In mg/dL
Time frame: Day 0-253
Laboratory safety parameters in blood - carbon dioxide
In mEq/L
Time frame: Day 0-253
Laboratory safety parameters in blood - creatinine
In mg/dL
Time frame: Day 0-253
Laboratory safety parameters in blood - glucose
In mg/dL
Time frame: Day 0-253
Laboratory safety parameters in blood - chloride
In mEq/L
Time frame: Day 0-253
Laboratory safety parameters in blood - potassium
In mEq/L
Time frame: Day 0-253
Laboratory safety parameters in blood - sodium
In mEq/L
Time frame: Day 0-253
white blood cell (WBC) count in cerebrospinal fluid (CSF)
1/µL
Time frame: Day 0-253
Protein levels in cerebrospinal fluid (CSF)
in g/L
Time frame: Day 0-253
Structural imaging assessment of any new abnormalities
Structural MRI sequences to assess safety as qualitatively assessed by a trained neuroradiologist (3D T1 weighted, 3D T2weighted-FLAIR and susceptibility-weighted imaging (SWI) sequences)
Time frame: Day 0-253
Percentage of participants with suicidal ideation or behaviour, as assessed by the Columbia suicide severity rating scale (C-SSRS).
The C-SSRS is a structured tool to assess suicidal ideation and behavior. Four constructs are measured: severity of ideation, intensity of ideation, behavior, and lethality of actual suicide attempts. Binary (yes/no) data are collected for 10 categories, and composite endpoints based on the categories are followed over time to monitor patient safety.
Time frame: Day 0-253
Concentrations of VO659 in cerebrospinal fluid (CSF)
in µg/mL
Time frame: _Day 1, 29, 57, 85, 120, 204, 253
Concentrations of VO659 in plasma
in µg/mL
Time frame: _Day 1, 29, 57, 85, 120, 204, 253
Maximum plasma concentration (Cmax) for VO659
in µg/mL
Time frame: Day 1, Day 85
Time to maximum plasma concentration (Tmax) for VO659
in days
Time frame: Day 1, Day 85]
Area under the plasma concentration time curve for VO659 from time 0 to last quantifiable concentration of (AUC0-t)
µg\*h/L
Time frame: Days 1, 2, 8, Days 85, 86, 92]
Terminal half-life (t1/2) of VO659 in plasma
In days
Time frame: Days 1, 2, 8
Terminal half-life (t1/2) of VO659 in cerebrospinal fluid (CSF)
in days
Time frame: Day 1 through Day 253
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