Phase 1/2 Clinical Trial of LY3884963 in Patients With Frontotemporal Dementia With Progranulin Mutations (FTD-GRN)

Study Overview
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Brief Summary
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Study J4B-MC-OKAA is a Phase 1/2, multi-center, open-label ascending dose, first-in-human study that will evaluate the safety and effect of intra-cisternal LY3884963 administration on progranulin protein (PGRN) levels in patients with frontotemporal dementia with progranulin mutations (FTD-GRN). Two escalating dose (low dose and medium dose) cohorts are planned, as well as one bridging cohort which will allocate patients to receive either low or medium dose. The duration of the study is 5 years. During the first year, patients will be evaluated for the effect of LY3884963 on safety, tolerability, immunogenicity, biomarkers, and efficacy. Patients will follow up for an additional 4 years to monitor safety and changes on selected biomarkers and clinical outcomes.

Official Title
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A Phase 1/2 Ascending Dose Study to Evaluate the Safety and Effects on Progranulin Levels of LY3884963 in Patients With Fronto-Temporal Dementia With Progranulin Mutations (FTD-GRN)

Conditions
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Frontotemporal Dementia

Intervention / Treatment
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* Biological: LY3884963
* Drug: Methylprednisolone
* Drug: Optional Sirolimus
* Drug: Optional Prednisone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men or women aged 30 to 85 years (inclusive), at the time of informed consent. Body weight range of ≥40 kg (88 lbs) to ≤110 kg (242 lb) and a BMI of 18 to 34 kg/m2. Has symptomatic frontotemporal dementia (FTD), including mild behavioral, cognitive, motor or language impairment per Investigator's assessment (behavioral-variant FTD, primary progressive aphasia-FTD, FTD with corticobasal syndrome, or a combination of syndromes are allowed for enrollment). Score ≥0.5 and ≤15 on CDR plus NACC FTLD sum of boxes. Stable use of background medications at least 8 weeks prior to LY3884963 dosing. Carrier of a pathogenic progranulin gene (GRN) mutation. Negative screening test for Mycobacterium tuberculosis (MTB) or documented negative MTB test within 1year prior to screening. Age- and gender-appropriate cancer screenings are up-to-date and completed. Patient and/or patient's legally authorized representative has the ability to understand the purpose and risks of the study, and provide written informed consent and authorization to use protected health information. Patient has a reliable study partner/informant (e.g. family member, friend) willing and able to participate in the study as a source of information on the patient's health status and cognitive and functional abilities. Patient is not dependent on a walker or wheelchair. Patient is living in the community (i.e. not in nursing home); some levels of assisted living may be permitted at the discretion of the investigator. Pneumococcal pneumonia and shingles vaccines are required within 10 years of Screening (allowed to be performed during Screening but must be given at least 4 weeks prior to initiation of immunosuppressant regimen). Exclusion Criteria: Diagnosis of a significant CNS (central nervous system) disease other than frontotemporal dementia (FTD) that may cause FTD symptoms or confound study objectives. Brain or cervical spine magnetic resonance image (MRI)/MRA imaging showing clinically significant abnormality considered to prevent intracisternal magna (ICM) injection. Hypersensitivity or contraindications to corticosteroid, and/or sirolimus use. Clinical evidence of peripheral symmetric sensory polyneuropathy (stable sensory mononeuropathies and radiculopathies are not exclusionary). Concomitant disease or condition within 6 months of screening that could interfere with, or treatment of which might interfere with, the conduct of the study or that would, in the opinion of the investigator, pose an unacceptable safety risk to the patient or interfere with the patient's ability to comply with study procedures Clinically significant laboratory test result abnormalities assessed at screening. Participation within 3 months prior to screening in another therapeutic investigational drug or device study with purported disease-modifying effects on FTD, unless it can be documented that the patient received placebo only. Any type of prior gene or cell therapy. Live vaccines in the 4 weeks prior to Screening. NOTE: Pneumococcal vaccine and/or shingles vaccine administration is allowed at least 4 weeks prior to initiation of immunosuppressant regimen. Use of blood thinners in the 2 weeks prior to screening, or anticipated use of blood thinners during the study. Antiplatelet therapies are acceptable if the patient is medically able to temporarily stop 48 hours to 7 days (depending on the antiplatelet medication used) prior to and at least 48 hours after ICM injection and LP. Note: the use of blood thinners as part of prophylaxis or treatment of an emergent VTE or another AE during the study does not exclude the patient, unless there is a baseline high risk of thromboembolic events, and use of blood thinners is highly anticipated in the opinion of the Investigator. Contraindications or intolerance to imaging methods (MRA, MRI, and/or computed tomography [CT]), including claustrophobia and intolerance to contrast agents used for MRI, MRA, or CT (including, but not limited to, gadolinium contrast agents and iohexol). Contraindications to general anesthesia or deep sedation. Positive urine test for drugs of abuse (including opiates, amphetamines, cocaine, barbiturates, and phencyclidine) without prescription at Screening and on Day 1. Other protocol-defined inclusion/exclusion criteria may apply

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Initial Cohort - Low dose<br> | Biological: LY3884963<br>* Participants will receive a single dose of LY3884963, administered intra cisterna magna<br>Drug: Methylprednisolone<br>* IV pulses every 2 weeks in the first 3 months.<br>Drug: Optional Sirolimus<br>* At the investigators discretion following steroid tolerability issues, patients may receive a loading dose, followed by maintenance dose, followed by dose tapering; administered as concomitant medication<br>Drug: Optional Prednisone<br>* If needed and at the investigator discretion, Oral Prednisone may be added to the immunosuppression regimen<br>|
| Experimental: Initial Cohort - Medium dose<br> | Biological: LY3884963<br>* Participants will receive a single dose of LY3884963, administered intra cisterna magna<br>Drug: Methylprednisolone<br>* IV pulses every 2 weeks in the first 3 months.<br>Drug: Optional Sirolimus<br>* At the investigators discretion following steroid tolerability issues, patients may receive a loading dose, followed by maintenance dose, followed by dose tapering; administered as concomitant medication<br>Drug: Optional Prednisone<br>* If needed and at the investigator discretion, Oral Prednisone may be added to the immunosuppression regimen<br>|
| Experimental: Bridging Cohort - Low dose<br>Participants enrolled in the Bridging Cohort will be assigned to either low or medium dose in an alternating manner | Biological: LY3884963<br>* Participants will receive a single dose of LY3884963, administered intra cisterna magna<br>Drug: Methylprednisolone<br>* IV pulses every 2 weeks in the first 3 months.<br>Drug: Optional Sirolimus<br>* At the investigators discretion following steroid tolerability issues, patients may receive a loading dose, followed by maintenance dose, followed by dose tapering; administered as concomitant medication<br>Drug: Optional Prednisone<br>* If needed and at the investigator discretion, Oral Prednisone may be added to the immunosuppression regimen<br>|
| Experimental: Bridging Cohort - Medium dose<br>Participants enrolled in the Bridging Cohort will be assigned to either low or medium dose in an alternating manner | Biological: LY3884963<br>* Participants will receive a single dose of LY3884963, administered intra cisterna magna<br>Drug: Methylprednisolone<br>* IV pulses every 2 weeks in the first 3 months.<br>Drug: Optional Sirolimus<br>* At the investigators discretion following steroid tolerability issues, patients may receive a loading dose, followed by maintenance dose, followed by dose tapering; administered as concomitant medication<br>Drug: Optional Prednisone<br>* If needed and at the investigator discretion, Oral Prednisone may be added to the immunosuppression regimen<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Adverse Events (AEs), Serious Adverse Events (SAEs), and Adverse Events Leading to discontinuation |  | 5 Years | 
| Sum of adverse reactions (ARs) and suspected ARs |  | 5 years | 
| Sum of serious ARs and serious suspected ARs |  | 5 years | 
| Incidence of procedure or treatment-emergent AEs | Measured by brain and spine MRI | 5 years | 
| Change in PGRN immunogenicity in blood | PGRN: progranulin protein. Measured by level of antibodies and ELISPOT | Baseline and Month 12 | 
| Change in PGRN immunogenicity in CSF | CSF: cerebrospinal fluid | Baseline and Month 12 | 
| Change in AAV9 immunogenicity in blood | Measured by level of antibodies and ELISPOT. | Baseline and Month 12 | 
| Change in AAV9, PGRN, and NfL immunogenicity in CSF | Measured by levels of antibodies. | Baseline and Month 12 | 
| Change in PGRN levels in blood |  | Baseline and Month 12 | 
| Change in PGRN levels in CSF |  | Baseline and Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in CDR plus NACC FTLD | CDR: Clinical Dementia Rating staging instrument. NACC FTLD: National Alzheimer's Coordinating Center frontotemporal lobar degeneration domains | Baseline and Month 12 | 
| Change in NfL levels in blood | NfL: neurofilament light chain | Baseline and Month 12 | 
| Change in NfL levels in CSF |  | Baseline and Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fronto-Temporal Dementia, Frontotemporal Dementia, Progranulin Mutations, FTD-GRN, Gene Therapy, Dementia Gene Therapy, AAV9