Venglustat in Combination With Cerezyme in Adult Patients With Gaucher Disease Type 3 With Venglustat Monotherapy Extension

Study Overview
=================
Brief Summary
-----------------
Part 1: Biomarker evaluation/screening phase Primary Objectives: Evaluate cerebrospinal fluid (CSF) biomarkers in adult Gaucher disease Type 3 (GD3) patients that distinguish GD3 from adult Gaucher disease Type 1 (GD1) patients Screen adult GD3 patients who qualify for treatment with venglustat in Parts 2, Part 3, and Part 4 Parts 2 and 3: Combination treatment phases Primary objectives: Evaluate short-term (Part 2) and long-term (Part 3) safety and tolerability of venglustat in combination with Cerezyme in adult GD3 patients Evaluate the change in CSF central nervous system (CNS) biomarkers (glucosylceramide [GL-1] and lyso-glucosylceramide [lyso-GL-1]) from adult GD3 patients receiving venglustat in combination with Cerezyme (Part 2 only) Part 4: Extended treatment phase with monotherapy Primary objectives: • Evaluate safety and tolerability of venglustat monotherapy in adult GD3 patients who have remained systemically stable on venglustat in combination with Cerezyme Parts 2 and 3: Combination treatment phases Secondary Objectives: Evaluate the pharmacokinetics (PK) of venglustat in adult GD3 patients Explore the efficacy of venglustat in combination with Cerezyme in infiltrative lung disease (ILD) in adult GD3 patients (Part 2 only) Explore the efficacy of venglustat in combination with Cerezyme in systemic disease in adult GD3 patients Explore the efficacy of venglustat in combination with Cerezyme on neurological function in adult GD3 patients Explore plasma biomarkers (lyso-GL-1 and GL-1) in adult GD3 patients Explore CSF biomarkers other than lyso-GL-1 and GL-1 in adult GD3 patients (Part 2 only) Part 4: Extended treatment phase with monotherapy Secondary objectives: Explore the efficacy of venglustat in systemic disease in adult GD3 patients Explore the efficacy of venglustat on neurological function in adult GD3 patients Explore plasma biomarkers (lyso-GL-1 and GL-1) in adult GD3 patients

Detailed Description
-----------------
The total duration for GD1 participants is 45 days (Part 1), while for GD3 participants the total duration is up to approximately 8.7 years

Official Title
-----------------
A 4-part, Open-label, Multicenter, Multinational Study of the Safety, Tolerability, Pharmacokinetics, Pharmacodynamic, and Exploratory Efficacy of Venglustat in Combination With Cerezyme in Adult Patients With Gaucher Disease Type 3 With Venglustat Monotherapy Extension

Conditions
-----------------
Gaucher Disease Type 1, Gaucher Disease Type 3

Intervention / Treatment
-----------------
* Drug: venglustat (GZ402671)
* Drug: imiglucerase


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: GD3 and GD1 patients must meet the following criteria to be eligible for this study: GD1 participant is ≥18 and ≤40 years of age. GD3 participant is ≥18 years of age. Participant must provide written informed consent prior to any study-related procedures being performed. Participant has a clinical diagnosis of Gaucher disease Type 1 (GD1) or Gaucher disease Type 3 (GD3) and documented deficiency of acid beta-glucosidase activity confirming this diagnosis. Participant has received ERT (Cerezyme or other ERT; as deemed appropriate by local regulations) for at least 3 years prior to enrollment, on a stable dose for at least 6 months and is within the therapeutic goals defined below, and is deemed clinically stable for at least 1 year by the Investigator. Participant has reached Gaucher disease therapeutic goals defined as all of the following to be eligible for this study: Hemoglobin level of ≥11.0 g/dL for females and ≥12.0 g/dL for males. Platelet count ≥100,000/mm3. Spleen volume <10 multiples of normal (MN), or total splenectomy (provided the splenectomy occurred >3 years prior to randomization). Liver volume <1.5 MN. No bone crisis and free of symptomatic bone disease such as bone pain attributable to osteonecrosis and/or pathological fractures within 3 months prior to screening. Participant has maintained GD therapeutic goals defined as all of the following to be eligible for entering Part 4 of this study: Hemoglobin level of ≥11.0 g/dL for females and ≥12.0 g/dL for males Platelet count ≥100 000/mm3 Spleen volume <10 multiples of normal (MN), or total splenectomy Liver volume <1.5 MN No bone crisis and free of symptomatic bone disease such as bone pain attributable to osteonecrosis and/or pathological fractures within 3 months prior to entering Part 4 Participant, if female and of childbearing potential, must have a negative pregnancy test [urine beta-human chorionic gonadotropin (β-hCG)] at baseline. If participant has a history of seizures, except for myoclonic seizures, they are well controlled under appropriate medication not identified as a strong or moderate inducer or inhibitor of cytochrome P450 (CYP) 3A. Participant is willing to abstain from consumption of grapefruit, grapefruit juice, or grapefruit containing products for 72 hours prior to administration of the first dose of venglustat and for the duration of the treatment period. Oculomotor apraxia characterized by a horizontal saccade abnormality. Female participants of childbearing potential and male patients must be willing to practice true abstinence in line with their preferred and usual lifestyle, or use 2 acceptable effective methods of contraception for the duration of the study and for at least 6 weeks for females and 90 days for males following their last dose of venglustat. Exclusion Criteria: Participants are excluded from the study if any of the following criteria apply: Substrate reduction therapy or chaperone therapy for GD within 6 months prior to enrollment. Participant has had a partial or total splenectomy within 3 years prior to randomization. Participant is blood transfusion-dependent. Prior esophageal varices or liver infarction or current liver enzymes (alanine aminotransferase [ALT]/ aspartate aminotransferase [AST]) or total bilirubin >2 times the upper limit of normal, unless the patient has a diagnosis of Gilbert Syndrome. Participant has any clinically significant disease, other than GD, including cardiovascular (congenital cardiac defect, coronary artery disease, valve disease or left sided heart failure; clinically significant arrhythmias or conduction defect), hepatic, gastrointestinal, pulmonary, neurologic, endocrine, metabolic (eg, hypokalemia, hypomagnesemia) or psychiatric disease, other medical conditions, or serious intercurrent illnesses that may preclude participation. Participant has renal insufficiency, as defined by an estimated glomerular filtration rate <30 mL/min/1.73m2 at the screening visit. Participant has received an investigational product within 30 days prior to enrollment. Participant has a history of cancer, with the exception of basal cell carcinoma. Participant has myoclonic seizures. Participant is pregnant or lactating. Participant has, according to World Health Organization (WHO) Grading, a cortical cataract > one-quarter of the lens circumference (Grade cortical cataract-2) or a posterior subcapsular cataract >2 mm (Grade posterior subcapsular cataract-2). Patients with nuclear cataracts will not be excluded. Participant requires use of invasive ventilatory support. Participant requires use of noninvasive ventilator support while awake for longer than 12 hours daily. Participant is unable to receive treatment with Cerezyme due to a known hypersensitivity or is unwilling to receive Cerezyme treatment to ensure maintenance of Gaucher treatment goals. Participant is currently receiving potentially cataractogenic medications (corticosteroids, psoralens used in dermatology with ultraviolet light therapy [PUVA], typical antipsychotics, and glaucoma medications) or any medication that may worsen the vision of a patient with cataract (eg, alphaadrenergic glaucoma medications). Participant has received strong or moderate inducers or inhibitors of CYP3A within 15 days or 5 half-lives from screening, whichever is longer, prior to enrolment in Part 2. This also includes the consumption of grapefruit, grapefruit juice, or grapefruit containing products within 72 hours of starting venglustat administration in Parts 2 and 3. Participant is scheduled for in-patient hospitalization including elective surgery, during the study. Participant has had a major organ transplant (e.g., bone marrow or liver). Participant, in the opinion of the investigator, is unable to adhere to the requirements of the study or unable to undergo study assessments (e.g., contraindications for magnetic resonance imaging).

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Open label (OL) venglustat<br>Administered once a day orally for up to approximately 8.7 years. Patients will continue their usual dose of Cerezyme during Part 1, Part 2 and Part 3. There is no administration of Cerezyme in Part 4 unless administrated as rescue treatment. | Drug: venglustat (GZ402671)<br>* Pharmaceutical form: capsule Route of administration: oral<br>Drug: imiglucerase<br>* Pharmaceutical form: sterile lyophilized product Route of administration: intravenous<br>* Other names: Cerezyme;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients with Treatment Emergent Adverse Events (TEAEs) |  | From screening up to end of study, up to approximately 8.7 years | 
| Assessment of pharmacodynamic (PD) parameter: Lyso-glucosylceramide (lyso-GL1) and glucosylceramide (GL-1) in cerebrospinal fluid (CSF) |  | From screening through Week 52 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of pharmacodynamic (PD) parameter: Lyso-glucosylceramide (lyso-GL1) and glucosylceramide (GL-1) in plasma | Change from baseline in plasma lyso-GL1 and GL1 | From screening up to end of study, up to approximately 8.7 years | 
| Assessment of plasma pharmacokinetic parameter: Cmax | Plasma maximum concentration (Cmax) | Day 1, Week 4, Week 26, and Week 52 | 
| Assessment of plasma pharmacokinetic parameter: Tmax | Plasma time at Cmax (Tmax) | Day 1, Week 4, Week 26, and Week 52 | 
| Assessment of plasma pharmacokinetic parameter: AUC | Plasma area under the curve (AUC) | Day 1, Week 4, Week 26, and Week 52 | 
| Assessment of plasma pharmacokinetic parameter: Ctrough | Plasma trough concentration (Ctrough) | Weeks 12 and 39 (Part 2), and on Weeks 78, 104, and 156 (for Part 3) | 
| Assessment of CSF pharmacokinetic parameter: Cmax | CSF maximum concentration (Cmax) | Day 1, Week 4, Week 26, and Week 52 | 
| Assessment of pharmacokinetic parameter: CSF time at Cmax (Tmax) |  | Day 1, Week 4, Week 26, and Week 52 | 
| Assessment of pharmacokinetic parameter: CSF area under the curve (AUC) |  | Day 1, Week 4, Week 26, and Week 52 |