Trial of AAV5-hFIX in Severe or Moderately Severe Hemophilia B

Study Overview
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Brief Summary
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This study evaluates how safe gene therapy treatment with AAV5-hFIX is in adult patients with severe or moderately severe hemophilia B and severe bleeding type.

Official Title
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A Phase I/II, Open-label, Uncontrolled, Single-dose, Dose-ascending, Multi-centre Trial Investigating an Adeno-associated Viral Vector Containing a Codon-optimized Human Factor IX Gene (AAV5-hFIX) Administered to Adult Patients With Severe or Moderately Severe Hemophilia B

Conditions
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Hemophilia B

Intervention / Treatment
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* Genetic: AAV5-hFIX


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male Age ≥ 18 years Patients with congenital hemophilia B classified as one of the following: Known severe FIX deficiency with plasma FIX activity level < 1% and a severe bleeding phenotype defined by one of the following: Currently on prophylactic FIX replacement therapy for a history of bleeding Currently on on-demand therapy with a current or past history of frequent bleeding defined as four or more bleeding episodes in the last 12 months or chronic hemophilic arthropathy (pain, joint destruction, and loss of range of motion) in one or more joints Known moderately severe FIX deficiency with plasma FIX activity level between ≥ 1% and ≤ 2% and a severe bleeding phenotype defined by one of the following: Currently on prophylactic FIX replacement therapy for a history of bleeding Currently on on-demand therapy with a current or past history of frequent bleeding defined as four or more bleeding episodes in the last 12 months or chronic hemophilic arthropathy (pain, joint destruction, and loss of range of motion) in one or more joints More than 150 previous exposure days of treatment with FIX protein. Acceptance to use a condom during sexual intercourse in the period from Investigational Medicinal Product (IMP) administration until AAV5 has been cleared from semen, as evidenced by the central laboratory from negative analysis results for at least 3 consecutively collected semen samples (this criterion is applicable also for subjects who are surgically sterilized) Following receipt of verbal and written information about the trial, the subject has provided signed informed consent before any trial related activity is carried out. Exclusion Criteria: History of FIX inhibitors measured to be ≥ 0.6 Bethesda Units (BU)/mL FIX inhibitors ≥ 0.6 BU/mL at Visit 1 (measured by the local laboratory) Neutralizing antibodies against AAV5 at Visit 1 (measured by the central laboratory) Visit 1 laboratory values (measured by the central laboratory): alanine aminotransferase > 2 times upper normal limit aspartate aminotransferase > 2 times upper normal limit total bilirubin > 2 times upper normal limit alkaline phosphatase > 2 times upper normal limit creatinine > 1.5 times upper normal limit Positive HIV serological test at Visit 1, not controlled with anti-viral therapy as shown by cluster of differentiation 4+ counts ≤ 200 per μL or by a viral load of >200 copies per mL (measured by the central laboratory) Active infection with Hepatitis B or C virus as reflected by Hepatitis B Surface Antigen (HBsAg), Hepatitis B extracellular Antigen (HBeAg), Hepatitis B Virus DeoxyriboNucleic Acid (HBV DNA) or Hepatitis C Virus RiboNucleic Acid (HCV RNA) positivity, respectively, at Visit 1 (measured by the central laboratory). History of Hepatitis B or C exposure, currently controlled by antiviral therapy Any coagulation disorder other than hemophilia B Thrombocytopenia, defined as a platelet count below 50 × 10E9 / L, at Visit 1 (measured by the central laboratory) Body mass index < 16 or ≥ 35 kg/m2 Planned surgery for the initial 6 months after IMP administration in this trial Previous arterial or venous thrombotic event (e.g. acute myocardial infarction, cerebrovascular disease and venous thrombosis) Active severe infection or any other significant concurrent, uncontrolled medical condition including, but not limited to, renal, hepatic, haematological, gastrointestinal, endocrine, pulmonary, neurological, cerebral or psychiatric disease, alcoholism, drug dependency or any other psychological disorder evaluated by the investigator to interfere with adherence to the protocol procedures or with the degree of tolerance to the IMP Known significant medical condition including disseminated intravascular coagulation, fibrinolysis and liver fibrosis which, in the opinion of the investigator, may confound, contraindicate or limit the interpretation of either safety or efficacy data Known history of an allergic reaction or anaphylaxis to FIX products Known uncontrolled allergic conditions or allergy/hypersensitivity to any component of the IMP excipients Previous gene therapy treatment and/or previous participation in a gene therapy clinical trial Receipt of an experimental agent within 60 days prior to Visit 1 Current participation or anticipated participation within one year after IMP administration in this trial in any other interventional clinical trial involving drugs or devices.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

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: Cohort 1<br>AAV5-hFIX 5 × 10E12 gc/kg intravenous single infusion | Genetic: AAV5-hFIX<br>* AAV5hFIX gene therapy<br>* Other names: AAV5 containing a codon-optimized human factor IX gene;|
| Experimental: Cohort 2<br>AAV5-hFIX 2 × 10E13 gc/kg intravenous single infusion | Genetic: AAV5-hFIX<br>* AAV5hFIX gene therapy<br>* Other names: AAV5 containing a codon-optimized human factor IX gene;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Adverse Events |  | From AMT-060 infusion through end of study (5 years post-dose) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FIX-replacement-therapy-free FIX Activity | FIX activity measured any time from 72 hours after latest FIX replacement therapy administration and until next administration of FIX replacement therapy. Only assessments performed more than 10 days after most recent FIX-replacement therapy administration included. | From AMT-060 infusion through end of study (5 years post-dose) | 
| Total Annualized Bleeding Rate (ABR) | Annualized: Sum of post-treatment bleeding episodes divided by subjects' average number of years (365.25 days) from treatment start to until the data cutoff date. | From AMT-060 infusion through end of study (5 years post-dose) | 
| Total Consumption of FIX Replacement Therapy |  | From AMT-060 infusion through end of study (5 years post dose). | 
| Change From Baseline in Short Form-36 (SF-36) Quality of Life (QoL) Scores | Scores range from 0 to 100, with a higher score defining a more favorable health state. | From AMT-060 infusion through the end of study (5 years post dose) | 
| Time to Vector DNA Stopped Shedding From Blood, Nasal Secretions, Saliva, Urine, Feces, and Semen |  | From AMT-060 infusion through end of study (5 years post dose). | 
| Number of Subjects Developing Neutralizing Antibodies to AAV5 |  | From AMT-060 infusion through end of study (5 years post dose) | 
| Total IgG and IgM Antibody Titers to AAV5 | For subjects with a titer of 109350 and 50, the actual titer is >109350 and <50. | AMT-060 infusion through end of study (5 years post dose) | 
| Number of Subjects With a Positive AAV5 Capsid-specific T Cell Response | Specific AAV5 response (results >17 SFC/million PBMCs) were regarded as positive. | From AMT-060 infusion through 26 weeks post-dose | 
| Number of Subjects With Antibodies to FIX |  | From AMT-060 infusion through the end of study (5 years post dose) | 
| Number of Subjects With FIX Inhibitors |  | From AMT-060 infusion through the end of study (5 years post dose) | 
| Number of Subjects With Clinically Significant Inflammatory Markers: IL-1β, IL-2, IL-6, INFγ, MCP-1 |  | From AMT-060 infusion through 18 weeks post dose | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hemophilia B, gene therapy