A dose escalation study to evaluate the safety, tolerability, and pharmacologic properties of Ambroxol in adult participants with Sanfilippo disease(s) (MPS3).
This is a dose escalation study in which open label Ambroxol 30mg (study drug) will be administered to adult patients with Sanfilippo Disease (MPS3). Administration route of study drug will be either crushed and mixed with soft foods or as an Ambroxol suspension through a feeding tube, if applicable. Study Timeline - Screening: 4 weeks (28 days) Treatment Period: 52 weeks Post-Treatment (after Week 52): 4 weeks withdrawal/safety follow-up period Patients will be screened at which point a thorough review of the Informed Consent form will be completed, sNFL levels, urinary GAGs, and serum HS results/data from the previous 12 months will be reviewed, urine and blood will be collected, complete questionnaires, Motor skills assessments, and evaluation by the Principal Investigator (PI). Eligible patients will proceed to receive the initial Ambroxol dose of 9mg/kg/day (maximum dose of 150 mg TID) divided into three equal doses per day, on-site. Other assessments including blood and urine collection, ECG, motor skills assessments, hearing test, questionnaires, and evaluation by the PI will be completed. Following the first day of dosing, a virtual visit will be performed via Telemedicine within 1 week of dose start to assess safety. At Weeks 12 and 24, enrolled patients will return to site for Ambroxol dose escalation to 18mg/kg/day (max dose of 300 mg TID) and 27mg/kg/day (max dose of 1350 mg/day), respectively. Assessments including blood and urine collection, ECG, motor skills assessments, hearing test, questionnaires, and evaluation by the PI will be completed at these visits. Telemedicine visits will take place at Weeks 13 and 25, to assess safety. At Week 36, a safety visit will be performed in which blood and urine will be collected. At Week 52, end of study assessments will be completed which includes blood and urine collection, motor skills assessments, hearing test questionnaires, and evaluation by the PI will be conducted and treatment will be stopped. A safety follow-up visit will be done 4 weeks after Week 52 visit is completed in which the patient will be evaluated by the PI.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Ambroxol Hydrochloride 30 mg oral pill/tablet - 9 mg/kg/day
Ambroxol Hydrochloride 30 mg oral pill/tablet - 18 mg/kg/day
Ambroxol Hydrochloride 30 mg oral pill/tablet - 27 mg/kg/day
Lysosomal & Rare Disorders Research & Treatment Center, Inc.
Fairfax, Virginia, United States
RECRUITINGSafety and Tolerability
1\. Safety and tolerability as measured by number of Participants with at least one serious and at least one non-serious Treatment Emergent Adverse Events (TEAEs), assessed by CTCAE v4.0.
Time frame: From baseline to 52 weeks
Changes in physical examination from baseline in motor capabilities and disease state: Physician (Clinician) Global Impression of Change
Physician (Clinician) Global Impression of Change (scale: 0-very much worse - 7-Very much improved).
Time frame: From baseline to 52 weeks
Change from baseline in EQ-5D-5L™ or EQ-5D-Y™
Change from baseline in EQ-5D-5L™ or EQ-5D-Y™
Time frame: From baseline to 52 weeks
Change from baseline in VABS-III age equivalent scores (AEqs)
Vineland Adaptive Behavior scale-III
Time frame: From baseline to 52 weeks
Assessment of Pharmacokinetics of Ambroxol in subjects with MPS III
Plasma PK parameter estimates for oral Ambroxol include the area under the curve (AUC).
Time frame: From baseline to 52 weeks
Assessment of Pharmacokinetics of Ambroxol in subjects with MPS III
Plasma PK parameter estimates for oral Ambroxol include maximum concentration (Cmax).
Time frame: From baseline to 52 weeks
Assessment of Pharmacokinetics of Ambroxol in subjects with MPS III
Plasma PK parameter estimates for oral Ambroxol include time to maximum dose concentration (Tmax).
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Time frame: From baseline to 52 weeks
Assessment of Pharmacokinetics of Ambroxol in subjects with MPS III
Plasma PK parameter estimates for oral Ambroxol include terminal half-life (t1/2).
Time frame: From baseline to 52 weeks
Assessment of Pharmacodynamics of Ambroxol in subjects with MPS III
Changes from baseline in Urinary GAG levels as measured by total quantified concentration. Changes from baseline will be analyzed using main effects, fixed for treatment (dose), categorical visit number, treatment-by-visit interaction, baseline value as covariate, and subject as the random effect.
Time frame: From baseline to 52 weeks
Assessment of Pharmacodynamics of Ambroxol in subjects with MPS III
Serum Heparan sulfate (HS) level changes from baseline as measured by total quantified concentration. Changes from baseline will be analyzed using main effects, fixed for treatment (dose), categorical visit number, treatment-by-visit interaction, baseline value as covariate, and subject as the random effect.
Time frame: From baseline to 52 weeks
Change from baseline in Timed up and go (TUG) test
Change from baseline in Timed up and go (TUG) test and in ABR at Week 52 may also be tested for correlations.
Time frame: From baseline to 52 weeks
Change from baseline in 10-meter walk test
Change from baseline in 10-meter walk test, may also be tested for correlations.
Time frame: From baseline to 52 weeks
Change from baseline in SBRS
Change from baseline in SBRS
Time frame: From baseline to 52 weeks