Clinical trial NCT05293626: Gene Therapy Clinical Trial for the Treatment of Leber's Hereditary Optic Neuropathy Associated With ND4 Mutations
Official title: A Phase 1/2, Single-Arm, Open-Label, Dose-Finding Clinical Trial to Evaluate the Safety and Efficacy of Gene Therapy for Leber's Hereditary Optic Neuropathy (LHON) Associated With ND4 Mutation
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE1
PHASE2
Conditions: Leber Hereditary Optic Neuropathy (LHON)
Lead sponsor: Neurophth Therapeutics Inc
Sponsor class: OTHER
First posted: 2022-03-24
Enrollment: 12
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SEQUENTIAL
Intervention model description: 0.5E9 vg, 0.05 mL/eye/dose (low dose) 1.5E9 vg, 0.05 mL/eye/dose (starting dose) 3.0E9 vg, 0.05 mL/eye/dose (intermediate dose) 4.5E9 vg, 0.05 mL/eye/dose (high dose)
Primary purpose: TREATMENT

Brief summary: The objective of this clinical study is to evaluate the safety and efficacy of NR082 in the treatment of LHON caused by mitochondrial ND4 gene mutation. This study will enroll subjects aged ≥ 18 years old and ≤ 75 years old to receive a single unilateral intravitreal (IVT) injection of NR082 to evaluate its safety and efficacy. The clinical manifestations of all subjects are to be reduced visual acuity caused by LHON associated with ND4 mutation, with laboratory test showing G11778A mutation (a CLIA-certified laboratory) and reduced visual acuity lasted for \> 6 months and \< 10 years.

Detailed description: At the dose-finding stage, the principle is that the Safety Review Committee (SRC) will decide whether to make dose adjustment based on the safety data of the starting dose. The starting dose is 1.5×109 vg, 0.05 mL eye/dose.The safety of the starting dose will be reviewed by the SRC, and dose escalation or de-escalation is by recommendation of the SRC.The safety of the starting dose will first be performed in 6 evaluable subjects.

Criteria for Dose Modification:

Dose Escalation:

If drug-related dose-limiting toxicity (DLT) events are observed in ≤ 2 of the 6 evaluable subjects within 6 weeks after the dosing of NR082 at the starting dose, the dose can be escalated to 4.5×109 vg, 0.05 mL eye/dose (high dose) after the approval by SRC.

Dose De-escalation:

If drug-related dose-limiting toxicity (DLT) events are observed in \> 2 of the 6 evaluable subjects within 6 weeks after the dosing of NR082 at the starting dose, the dose can be de-escalated to 0.5×109 vg, 0.05 mL eye/dose (low dose) after the approval by SRC.

If drug-related dose-limiting toxicity (DLT) events are observed in \> 2 of the 6 evaluable subjects within 6 weeks after the dosing of NR082 at the high dose, the dose can be de-escalated to 3.0×109vg, 0.05 mL eye/dose (intermediate dose) after the approval by SRC.

Enrollment Sequence:

* The enrollment sequence of any dose group (6 subjects) is that the 2nd subject and the 3rd subject will be enrolled at least 7 days after the enrollment of the 1st subject;
* The 4th, 5th and 6th subjects will be enrolled at least 7 days after the enrollment of the 2nd and the 3rd subjects.

The 7-day interval is to avoid acute safety events to the greatest possible extent

Eligibility criteria: Inclusion Criteria:

1. Age at the time of signing the informed consent form: the age of the subjects must be ≥ 18 years old and ≤ 75 years old.
2. The clinical manifested vision loss due to LHON, and any eye BCVA ≥ 0.5 LogMAR
3. The genotype testing result shows the presence of G11778A mutation in the ND4 gene, and the absence of the other primary LHON associated mutations in the mitochondrial DNA (mtDNA) (ND1 \[G3460A\] or ND6 \[T14484C\]) (confirmed by a CLIA-certified international laboratory
4. The vision loss in the eye with worse visual acuity lasted \> 6 months and \< 10 years at screening
5. Pupils can be adequately dilated for a thorough ocular examination and visual acuity test
6. Each eye of the subject must maintain at least Hand Motion VA (≤ 2.3 LogMAR) as defined in the ocular/vision examination manual (operating manual for refraction and VA examinations) in this study
7. Willingness to comply with the clinical study protocol and 5 years of long-term follow-up after administration
8. Male or female

   1. A male subject must agree to take contraceptive measures at least 6 months after the treatment visit;
   2. A female subject is eligible to participate if she is not pregnant , not breastfeeding, and at least one of the following conditions applies:i)Not a woman of childbearing potential (WOCBP) ;ii) A WOCBP who agrees to follow the contraception guidance for at least 6 months after the treatment visit
9. Written informed consent form must be obtained from the subject or his/her parent/legal guardian before any study-related procedures are performed.If the subject is legally blind (\> 1.0 LogMAR or the readings of decimal visual acuity chart \<0.1), an impartial witness must be present throughout the informed consent process and discussion process.

Exclusion Criteria:

1. Any known allergy and/or hypersensitivity to the study drug or its constituents
2. Contraindication to IVT injection in any eye
3. IVT drug delivery to any eye within 30 days prior to the screening visit
4. History of vitrectomy in either eye
5. Narrow anterior chamber angle in any eye contra-indicating pupillary dilation
6. Presence of disorders or diseases of the eye or adnexa, excluding LHON, which may interfere with visual or ocular assessments, including spectral-domain optical coherence tomography (SD-OCT), during the study
7. Presence of known/documented mutations, other than the LHON-related mutation, which are known to cause pathology of the optic nerve, retina or afferent visual system
8. Presence of systemic or ocular/vision diseases, disorders, or pathologies, other than LHON, known to cause or be associated with vision loss, or whose associated treatment(s) or therapy(ies) is/are known to cause or be associated with vision loss
9. Presence of optic neuropathy from any cause other than LHON
10. Presence of illness or disease that, in the opinion of the investigator, include symptoms and/or the associated treatments that can alter visual function, for instance cancers or pathology of the central nervous system (CNS), including multiple sclerosis (diagnosis of multiple sclerosis must be based on the 2010 Revisions to the McDonald Criteria) , and/or diseases or conditions that affect the safety of subjects participating in the study
11. History of recurrent uveitis (idiopathic or immune-related) or active ocular inflammation
12. Participated in another clinical study and receive an IMP within 90 days prior to the screening visit

    a) Exceptions: Subjects who have completed the clinical study of idebenone as IMP \> 90 days prior to the screening visit and has completely discontinued idebenone at least 7 days prior to dosing are still eligible to participate in the study.
13. Any eye has previously received ocular gene therapy
14. Subjects who refused to stop using idebenone
15. Have undergone ocular surgery of clinical relevance (per investigator's assessment) within 90 days prior to the screening visit
16. Female subjects who are breastfeeding or plan to breastfeed within the first 6 months after the administration of NR082 Injection
17. History of drug or alcohol abuse (including heavy smoking, i.e., \> 20 cigarettes per day or \>20 pack-years \[equivalent to one pack a day for 20 years or 2 packs a day for 10 years\])
18. Human immunodeficiency virus (HIV) antibody, syphilis antibody and HCV antibody positive are excluded; hepatitis B test that shows a clinically significant active infection requiring treatment (defined as the presence of hepatitis B core antibody \[HBcAb\] positive or hepatitis B surface antigen \[HBsAg\] positive, and hepatitis B virus deoxyribonucleic acid \[HBV-DNA\]) \> 1000 copies/mL or according to local laboratory method above lower limit of quantitative detection) are excluded
19. Unable to tolerate (e.g., immunomodulatory regimen) or unable or unwilling to comply with all the protocol requirements
20. Subjects from the study site fail to comply with or do not agree to comply with local and institutional guidelines for suspected 2019 novel coronavirus (COVID-19) infection/testing
21. Any other exclusions determined by the investigator

Primary outcomes:
measure: Incidence of adverse events (AEs)
timeFrame: 52 weeks
measure: Incidence of serious adverse events (SAEs)
timeFrame: 52 weeks
measure: Incidence of dose-limiting toxicities (DLT)
timeFrame: 52 weeks
Secondary outcomes:
measure: Proportion (percent) of subjects with an improvement of ≥ 0.3 LogMAR from baseline in Best corrected visual acuity(BCVA) in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Mean change from baseline in BCVA (LogMAR) in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Mean change in BCVA (LogMAR) compared to nadir*
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Change from baseline in thepattern standard deviation (PSD)in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Change from baseline in the visual field index (VFI) in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Change from baseline in the mean deviation (MD) in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Change from baseline in spatial frequency parameters of contrast sensitivity in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: Change from baseline in visual evoked potential (VEP) parameters in the study eye
timeFrame: At Weeks 2, 6,12, 26, 40, 52, 78, 104, 156, 208, and 260
measure: To evaluate immunogenicity
timeFrame: At Weeks 1, 2, and 6
measure: To evaluate immunogenicity
timeFrame: At Weeks 1, 2, 6, 12, 26, 40, and 52
measure: To evaluate vector shedding
timeFrame: At Weeks 1, 2, 6, 12, 26, 40, and 52
measure: To evaluate biodistribution
timeFrame: At Weeks 1, 2, 6, 12, 26, 40, and 52
measure: To evaluate the improvement in BCVA of the study eye (< 0.3 LogMAR)
timeFrame: At Weeks 52, 78, 104, 156, 208, and 260
measure: To evaluate the change from baseline in VFQ-25
timeFrame: At Weeks 2, 26, 52, 104, 156, 208, and 260
measure: To evaluate the change from baseline in quality of SF-36
timeFrame: At Weeks 2, 26, 52, 104, 156, 208, and 260
measure: Change from baseline in retinal nerve fiber layer (RNFL) thickness of the study eye
timeFrame: At Weeks 2, 6,12, 26, 52, 104, 156, 208, and 260
measure: Change from baseline in retinal ganglion cell complex thickness of the study eye
timeFrame: At Weeks 2, 6,12, 26, 52, 104, 156, 208, and 260
measure: To evaluate the visual function improvement after NR082 treatment
timeFrame: At Weeks 2, 6,12, 26, 52, 104, 156, 208, and 260
Other outcomes:
Locations:
city: Palo Alto
country: United States
facility: Stanford Byers Eye Institute
state: California
city: Aurora
country: United States
facility: University of Colorado Health Eye Center
state: Colorado
city: Philadelphia
country: United States
facility: Wills Eye Hospital, Neuro Ophthalmology Department
state: Pennsylvania
Study officials:
References: