This study will evaluate the safety, tolerability, preliminary efficacy and pharmacokinetics (PK) of ART5803 in adult participants with a confirmed diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis (ANRE) or anti-NMDAR autoantibody-associated psychiatric disease
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most common causes of autoimmune encephalitis. The disease is caused by the development of autoantibodies against the amino (N)-terminal domain (NTD) of the NMDAR subunit 1 (NR1) that bind and cross link the receptors, leading to receptor internalization and loss of function. Arialys has developed a monovalent (one-armed) antibody, ART5803, that binds to the NTD of the NMDAR NR1 subunit without causing NMDAR inhibition, activation, or receptor internalization, while simultaneously blocking the ability of the pathogenic anti-NMDAR autoantibodies to bind to the receptor. There is also an increasing body of data supporting the potential link between broader psychiatric diseases and the presence of autoantibodies against the NMDAR.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
A monovalent (one-armed) antibody, that binds to the NTD of the NMDAR NR1 subunit without causing NMDAR inhibition, activation, or receptor internalization, while simultaneously blocking the ability of the pathogenic anti-NMDAR autoantibodies to bind to the receptor. 1. Sentinel participants: 30 mg/kg 2. Subsequent participants: up to 60 mg/kg 3. Schedule: Q1W for 4 doses then Q2W for 4 doses
A monovalent (one-armed) antibody, that binds to the NTD of the NMDAR NR1 subunit without causing NMDAR inhibition, activation, or receptor internalization, while simultaneously blocking the ability of the pathogenic anti-NMDAR autoantibodies to bind to the receptor. Participants receive ART5803 by intravenous infusion once a week for 4 weeks, then every 2 weeks for 8 weeks, for a total of 8 doses. Sentinel participants receive 30 mg per kg. Additional participants may receive up to 60 mg per kg based on Safety Review Committee guidance.
Seoul National University Hospital
Seoul, South Korea
RECRUITINGTo assess the safety and tolerability of ART5803
Incidence and severity of Treatment-Emergent Adverse Events (TEAEs)
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Clinically significant changes in physical examination findings.
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Clinically significant changes in neurological examination findings
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Vital signs - Systolic and diastolic blood pressure
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Vital signs- Pulse rate
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Vital signs- Body temperature
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Vital signs- Respiratory rate
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Clinical laboratory outcomes - Serum anti-ART5803 binding antibodies (ADA)
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Concomitant medications
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Change in suicidal tendency as measured by the incidence of positive responses (Yes) to Item 4 or 5 on the Columbia-Suicide Severity Rating Scale (C-SSRS) from baseline (Score range: 0-5 per item. Higher score indicated better symptoms)
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Presence of anti-drug antibodies (ADAs)
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Clinical laboratory outcomes - Hematology
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
Clinical laboratory outcomes - Serum Chemistry
Time frame: 26 weeks
To assess the safety and tolerability of ART5803
12-lead Electrocardiogram (ECG) findings - QRS interval \>120 ms
Time frame: 26 weeks
To assess the effects of ART5803 on Patient Reported Outcomes (PROs)
Change from baseline in patient reported endpoints: Short Form Health Survey, Version 2 (SF-36-II) mental component domain score (Score range: 0-100. Higher score indicated better symptoms) (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on Patient Reported Outcomes (PROs)
Change from baseline in patient reported endpoints: Trail Making Test, Part A (TMT-A) scores (Time to complete (higher = worse)) (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on Patient Reported Outcomes (PROs)
Change from baseline in patient reported endpoints: European Quality of Life, 5-dimension, 5-level (EQ-5D-5L) scores (Score range: -0.281 to 1. Higher score indicated better symptoms) (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on Patient Reported Outcomes (PROs)
Change from baseline in patient reported endpoints: Beck Depression Inventory-II (BDI-II) scores (Score range: 0-63. Higher score indicated worse symptoms) (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints: Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) Digit Span (Score varies) (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints: Rey Auditory Verbal Learning Test (RAVLT) immediate recall 1 to 5 and delayed recall (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints: Rey-Osterrieth Complex Figure Test (36-point scoring) (ROCF-36) delayed recall component score (Score range: 0-36. Higher score indicated better symptoms) (Cohort A only)
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Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints: Brief Social Aptitude Test (BSAT) number of errors (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints: Boston Naming Test score (Score range: 0-60. Higher score indicated better symptoms) (Cohort A only)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints: Verbal Fluency Test score (Score varies) (Cohort A only)
Time frame: 13 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints at Weeks 5 and 11: Positive and Negative Syndrome Scale (PANSS) score (Score range: 30-210. Higher score indicated worse symptoms)
Time frame: 26 weeks
To assess the changes in neurological and behavioral outcomes following ART5803 administration
Change from baseline in Clinical Assessment Scale for Autoimmune Encephalitis (CASE) outcomes (Score range: 0-27. Higher score indicated worse symptoms)
Time frame: 11 weeks
To assess the changes in neurological and behavioral outcomes following ART5803 administration
Change from baseline in Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score (Score range: 40-160. Higher score indicated better symptoms)
Time frame: 26 weeks
To assess changes in mobility and disability in basic and instrumental activities in daily living outcomes following ART5803 administration
In absence of rescue therapy: Proportion of participants with ≥1 point improvement in mRS from baseline to Week 11 Change from baseline in mRS score at Week 1, 3, 7, 11, 16, 20, 26 and ET/EOS as determined by rank analyses, integrating need for rescue therapy and time to achievement of the mRS Time to mRS improvement from baseline by ≥1 point (Speed of Recovery) Time to mRS ≤2
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints at Weeks 5 and 11: Scale for the Assessment of Negative Symptoms (SANS) score (Score range: 0-125. Higher score indicated worse symptoms) (Cohort D only)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints at Weeks 5 and 11: Clinical Global Impression-Severity (CGI-S) score (Score range: 1-7. Higher score indicated worse symptoms)
Time frame: 26 weeks
To assess the effects of ART5803 on neuropsychological assessments
Change from baseline in neuropsychological endpoints at Weeks 5 and 11: Change in neuropsychological endpoint Clinical Global Impression-Improvement (CGI-I) score (Score range: 1-7. Higher score indicated worse symptoms)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by maximum concentration (Cmax)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by last time point with measurable concentration (Clast)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by by last time point with minimum concentration (Cmin)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by time at which Cmax is observed (tmax)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by area under the curve from time 0 to the last measurable concentration (AUC0-t)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by area under the curve from time 0 extrapolated to infinity (AUC0-∞)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by the half-life (t½)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by the volume of distribution (Vd)
Time frame: 26 weeks
Serum PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by clearance (CL)
Time frame: 26 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by maximum concentration (Cmax)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by last time point with measurable concentration (Clast)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by by last time point with minimum concentration (Cmin)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by time at which Cmax is observed (tmax)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by area under the curve from time 0 to the last measurable concentration (AUC0-t)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by area under the curve from time 0 extrapolated to infinity (AUC0-∞)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by the half-life (t½)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by the volume of distribution (Vd)
Time frame: 12 weeks
Cerebrospinal Fluid (CSF) PK parameters of ART5803
To characterize and compare the PK profile of ART5803 as measured by clearance (CL)
Time frame: 12 weeks