An Open-label Safety, Tolerability, and Dose-range Finding Study of Nusinersen (ISIS 396443) in Participants With Spinal Muscular Atrophy (SMA)

Study Overview
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Brief Summary
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This objectives of this study are to evaluate the safety, tolerability, and pharmacokinetics of a single dose of nusinersen (ISIS 396443) administered intrathecally to participants with Spinal Muscular Atrophy (SMA).

Detailed Description
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This study was conducted and the protocol was registered by Ionis Pharmaceuticals, Inc. In August 2016, sponsorship of the trial was transferred to Biogen.

Official Title
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An Open-label, Escalating Dose Study to Assess the Safety, Tolerability and Dose-range Finding of a Single Intrathecal Dose of ISIS 396443 in Patients With Spinal Muscular Atrophy

Conditions
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Spinal Muscular Atrophy

Intervention / Treatment
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* Drug: nusinersen


Participation Criteria
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Eligibility Criteria
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Key Inclusion Criteria: Documented Survival Motor Neuron1 (SMN1) homozygous gene deletion Clinical signs attributable to Spinal Muscular Atrophy (SMA) Able to complete all study procedures, measurements and visits and parent/participant has adequately supportive psychosocial circumstances, in the opinion of the investigator Estimated life expectancy > 2 years from Screening Meets age-appropriate institutional criteria for use of anesthesia/sedation, if use is planned for study procedure Key Exclusion Criteria: Respiratory insufficiency defined by the need for invasive or non-invasive ventilation during a 24 hour period Presence of a gastric feeding tube Previous scoliosis surgery or scoliosis surgery planned during the duration of the study that would interfere with the lumbar puncture (LP) injection procedure Hospitalization for surgery or pulmonary event within the last 2 months or planned during the study Presence of an untreated or inadequately treated active infection requiring systemic antiviral or antimicrobial therapy History of brain or spinal cord disease that would interfere with LP procedures or cerebrospinal fluid (CSF) circulation Presence of an implanted shunt for the draining of CSF or an implanted Central Nervous System (CNS) catheter History of bacterial meningitis Clinically significant abnormalities in hematology or clinical chemistry parameters Treatment with another investigational drug, biological agent, or device within 1-month of Screening or 5 half-lives of study agent whichever is longer. Any history of gene therapy or cell transplantation Ongoing medical condition that would interfere with the conduct and assessments of the study. Examples are medical disability (e.g. wasting or cachexia, severe anemia, etc.) that would interfere with the assessment of safety or would compromised the ability of the participant to undergo study procedures NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 14 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: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cohort 1 (n=6)<br> | Drug: nusinersen<br>* Administered by intrathecal (IT) injection<br>* Other names: ISIS SMNRx;|
| Experimental: Cohort 2 (n=6)<br> | Drug: nusinersen<br>* Administered by intrathecal (IT) injection<br>* Other names: ISIS SMNRx;|
| Experimental: Cohort 3 (n=6)<br> | Drug: nusinersen<br>* Administered by intrathecal (IT) injection<br>* Other names: ISIS SMNRx;|
| Experimental: Cohort 4 (n=10)<br> | Drug: nusinersen<br>* Administered by intrathecal (IT) injection<br>* Other names: ISIS SMNRx;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants that experience Adverse Events (AEs) and Serious Adverse Events |  | Up to 88 Days | 
| Number of participants with clinically significant neurological examination abnormalities |  | Up to 88 Days | 
| Number of participants with clinically significant vital sign abnormalities |  | Up to 88 Days | 
| Number of participants with clinically significant physical examination abnormalities |  | Up to 88 Days | 
| Number of participants with clinically significant weight abnormalities |  | Up to 88 Days | 
| Number of participants with clinically significant laboratory parameters |  | Up to 88 Days | 
| Number or participants with clinically significant cerbrospinal fluid (CSF) laboratory parameters |  | Up to 88 Days | 
| Number of participants with clinically significant electrocardiograms (ECGs) abnormalities |  | Up to 88 Days | 
| Number of participants who use concomitant medications |  | Up to 88 Days | 
| PK parameters of nusinersen (ISIS 396443): Maximum observed plasma drug concentration (Cmax) |  | Plasma at 1, 2, 4 and 20 hours after dosing | 
| PK parameters of nusinersen: Time to reach maximum observed concentration (Tmax) |  | Plasma at 1, 2, 4 and 20 hours after dosing | 
| PK parameters of nusinersen: Area under the plasma concentrations time curve from the time of the intrathecal (IT) dose to the last collected sample (AUCinf) |  | Plasma at 1, 2, 4 and 20 hours after dosing | 
| PK parameters of nusinersen (ISIS 396443): Apparent terminal elimination half-life (t1/2), if possible |  | Plasma at 1, 2, 4 and 20 hours after dosing | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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SMA, SMN, Spinal Muscular Atrophy, SMNRx, ISIS-SMNRx, ISIS-SMN Rx, ISIS 396443, IONIS-SMNRx, IONIS-SMN Rx, Spinraza