Familial Amyloid Polyneuropathy
Conditions
Keywords
FAP, Fx-1006A, transthyretin, TTR, amyloid, polyneuropathy, V30M, familial, hereditary, amyloidosis, FoldRx
Brief summary
This study will examine whether Fx-1006A is effective in halting the progression of Familial Amyloid Polyneuropathy (FAP). Deposition of TTR amyloid is associated with a variety of human diseases. Deposition of amyloid fibrils of variant TTR (primarily V30M) in peripheral nerve tissue produces the condition called FAP. The prevention of the formation of amyloid by stabilization of the TTR native state should constitute an effective therapy for amyloid diseases. Therapeutic intervention with a TTR stabilizer drug, such as Fx-1006A, is hypothesized to stop progression of the disease in FAP patients. FAP is a uniformly fatal disease and Fx-1006A is intended to halt the relentless neurological deterioration FAP patients experience. This Phase 2/3 study will enroll early to mid-stage FAP patients in order to interrupt and stabilize the disease at a point in time where progression of motor and autonomic dysfunction can be maximally effected. Male and female patients with FAP with documented V30M TTR mutation will receive Fx-1006A or placebo once daily for a period of eighteen (18) months.
Detailed description
Deposition of TTR amyloid is associated with a variety of human diseases. Deposition of amyloid fibrils of variant TTR (primarily V30M) in peripheral nerve tissue produces the condition called FAP. The prevention of the formation of amyloid by stabilization of the TTR native state should constitute an effective therapy for amyloid diseases. Therapeutic intervention with a TTR stabilizer drug, such as Fx-1006A, is hypothesized to stop progression of the disease in FAP patients. FAP is a uniformly fatal disease and Fx-1006A is intended to halt the relentless neurological deterioration FAP patients experience. This Phase 2/3 study will enroll early to mid-stage FAP patients in order to interrupt and stabilize the disease at a point in time where progression of motor and autonomic dysfunction can be maximally effected. Male and female patients with FAP with documented V30M TTR mutation will receive Fx-1006A or placebo once daily for a period of eighteen (18) months.
Interventions
DRUGFx-1006A
Fx-1006A 20mg or matched placebo once daily (at the same time each day) for a period of 18 Months
DRUGPlacebo
Fx-1006A 20mg or matched placebo once daily (at the same time each day) for a period of 18 Months
Sponsors
Pfizer
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Amyloid documented by biopsy. 2. Documented V30M TTR mutation. 3. Peripheral and/or autonomic neuropathy with a Karnofsky Performance Status ≥50. 4. Patient is 18-75 years old. 5. If female, patient is post-menopausal, surgically sterilized, or willing to use an acceptable method of birth control. If male with a female partner of childbearing potential, willing to use an acceptable method of birth control for the duration of the study. For both females and males, birth control must be used for at least 3 months after the last dose of study medication. 6. Patient is, in the opinion of the investigator, willing and able to comply with the study medication regimen and all other study requirements.
Exclusion criteria
1. Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs). 2. Primary amyloidosis. 3. If female, patient is pregnant or breast feeding. 4. Prior liver transplantation. 5. No recordable sensory threshold for vibration perception in both feet, as measured by CASE IV. 6. Positive results for hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV). 7. Renal insufficiency or liver function test abnormalities. 8. New York Heart Association (NYHA) Functional Classification ≥III. 9. Other causes of sensorimotor neuropathy (B12 deficiency, Diabetes Mellitus, HIV treated with retroviral medications, thyroid disorders, alcohol abuse, and chronic inflammatory diseases). 10. Co-morbidity anticipated to limit survival to less than 18 months. 11. Patient received an investigational drug/device and/or participated in another clinical investigational study within 60 days before Baseline.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 18 | Month 18 | Response to treatment was indicated by either improvement (decrease from baseline) or stabilization (change from baseline of 0 to less than\[\<\] 2) in NIS-LL score, based on mean of 2 scores in 1 week period. NIS-LL: assessed muscle weakness, reflexes, sensation. Each item scored separately for left, right limbs. Components of muscle weakness scored on 0(normal) to 4(paralysis) scale, higher score=greater weakness. Components of reflexes, sensation scored 0=normal, 1=decreased, or 2=absent. Total NIS-LL score range 0-88, higher score=greater impairment. |
| Change From Baseline in Norfolk Quality of Life- Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 18 | Baseline, Month 18 | Norfolk QOL-DN: 35-item participant-rated questionnaire used to assess impact of diabetic neuropathy on the quality of life of participants with diabetic neuropathy; Item 1 to 7: related to symptoms and presence of symptom was assessed as 1 and absence was assessed as 0. Item 8-35: related to activities of daily living and scored on a 5-point Likert scale, where 0= no problem and 4= severe problem (except item 32, where -2= much better, 0=about the same, 2=much worse). TQOL= sum of all the items, total possible score range= -2 to 138, where higher score=worse quality of life. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Baseline, Month 6, 12 | Norfolk QOL-DN: 35-item participant-rated questionnaire used to assess impact of diabetic neuropathy on the quality of life of participants with diabetic neuropathy; Item 1 to 7: related to symptoms and presence of symptom was assessed as 1 and absence was assessed as 0. Item 8-35: related to activities of daily living and scored on a 5-point Likert scale, where 0= no problem and 4= severe problem (except item 32, where -2= much better, 0=about the same, 2=much worse). TQOL= sum of all the items, total possible score range= -2 to 138, where higher score=worse quality of life. |
| Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline, Month 6, 12, 18 | Norfolk QOL-DN:35-item participant-rated questionnaire to assess impact of DN on QOL; Item 1-7:scored as 1=symptom present, 0=symptom absent. Item 8-35: scored on 5-point Likert scale: 0=no problem, 4=severe problem (except item 32: -2=much better, 0=about same, 2=much worse). Norfolk QOL-DN summarized in 5 domains(score range):physical functioning/large fiber neuropathy(-2 to 58), activities of daily living(ADLs) (0 to 20), symptoms(0 to 32), small fiber neuropathy(0 to 16), autonomic neuropathy(0 to 12); higher score=greater impairment, for each. Total score=-2 to138(higher score=worse QOL). |
| Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Baseline, Month 6, 12, 18 | Summated 7 score: composite score included five Nerve Conduction Studies (NCS) attributes (peroneal nerve distal motor latency, peroneal nerve compound muscle action potential, peroneal nerve motor conduction velocity, tibial nerve distal motor latency, and sural nerve sensory nerve action potential amplitude) along with Vibration Detection Threshold (VDT) obtained in great toes, and Heart Rate Response to Deep Breathing (HRDB) value. Score was determined through reference to normal values for age, sex and height. Total score range= -26 to 26, where higher score=worse nerve function. |
| Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Baseline, Month 6, 12, 18 | NIS-LL: assessed muscle weakness, reflexes and sensation; scored separately for left and right limbs. Components of muscle weakness (hip and knee flexion, hip and knee extension, ankle dorsiflexors, ankle plantar flexors, toe extensors, toe flexors) are scored on 0(normal) to 4(paralysis) scale, higher score=greater weakness. Components of reflexes (quadriceps femoris, triceps surae) and sensation (touch pressure, pin-prick, vibration, joint position) were scored 0 = normal, 1= decreased, or 2 = absent. Total possible NIS-LL score range 0-88, higher score=greater impairment. |
| Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Baseline, Month 6, 12, 18 | BMI was calculated by weight divided by height squared. mBMI was calculated by multiplying BMI by serum albumin levels to compensate for edema formation associated with malnutrition. A progressive decline in mBMI indicated worsening of disease severity. |
| Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Week 8, Month 6, 12, 18 | TTR tetramer was assessed using a validated immunoturbidimetric assay. The Fraction of Initial (FOI) is the ratio of the measured TTR tetramer concentration after denaturation to the measured TTR tetramer concentration before denaturation. TTR tetramer stabilization is based on the difference between the on-treatment FOI and the baseline FOI expressed as a percentage of the baseline FOI. |
| Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Baseline, Month 6, 12, 18 | Summated 3 Nerve Tests Small Fiber Normal Deviates Score (NTSFnds) included cooling threshold for the lower limbs, heat pain threshold for the lower limbs and HRDB. Total score range= -11.2 to 11.2, where higher score=worse nerve function. |
| Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 6 and 12 | Month 6, 12 | Response to treatment was indicated by either improvement (decrease from baseline) or stabilization (change from baseline of 0 to \<2) in NIS-LL score, based on mean of 2 scores in 1 week period. NIS-LL: assessed muscle weakness, reflexes, sensation. Each item scored separately for left, right limbs. Components of muscle weakness scored on 0 (normal) to 4 (paralysis) scale, higher score=greater weakness. Components of reflexes, sensation scored 0=normal, 1=decreased, or 2=absent. Total NIS-LL score range 0-88, higher score=greater impairment. |
Countries
Argentina, Brazil, France, Germany, Portugal, Spain, Sweden, United Kingdom, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Tafamidis Tafamidis (Fx-1006A) 20 milligram (mg) capsule orally once daily for 18 months. | 64 |
| Placebo Placebo, matched to tafamidis (Fx-1006A) 20 mg capsule, orally once daily for 18 months. | 61 |
| Total | 125 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 4 | 3 |
| Overall Study | Liver transplantation | 13 | 13 |
| Overall Study | Negative genotype | 0 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 2 |
Baseline characteristics
| Characteristic | Placebo | Tafamidis | Total |
|---|---|---|---|
| Age, Customized Greater than 65 years | 3 participants | 5 participants | 8 participants |
| Age, Customized Less than or equal to 65 years | 58 participants | 59 participants | 117 participants |
| Sex: Female, Male Female | 35 Participants | 32 Participants | 67 Participants |
| Sex: Female, Male Male | 26 Participants | 32 Participants | 58 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 57 / 65 | 56 / 63 |
| serious Total, serious adverse events | 6 / 65 | 5 / 63 |
Outcome results
Primary
Change From Baseline in Norfolk Quality of Life- Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 18
Norfolk QOL-DN: 35-item participant-rated questionnaire used to assess impact of diabetic neuropathy on the quality of life of participants with diabetic neuropathy; Item 1 to 7: related to symptoms and presence of symptom was assessed as 1 and absence was assessed as 0. Item 8-35: related to activities of daily living and scored on a 5-point Likert scale, where 0= no problem and 4= severe problem (except item 32, where -2= much better, 0=about the same, 2=much worse). TQOL= sum of all the items, total possible score range= -2 to 138, where higher score=worse quality of life.
Time frame: Baseline, Month 18
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death or LT. LOCF method was used.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Norfolk Quality of Life- Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 18 | Baseline | 27.3 units on a scale | Standard Deviation 24.2 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life- Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 18 | Change at Month 18 | 2.4 units on a scale | Standard Deviation 14.6 |
| Placebo | Change From Baseline in Norfolk Quality of Life- Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 18 | Baseline | 30.8 units on a scale | Standard Deviation 26.7 |
| Placebo | Change From Baseline in Norfolk Quality of Life- Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 18 | Change at Month 18 | 6.9 units on a scale | Standard Deviation 22.9 |
Primary
Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 18
Response to treatment was indicated by either improvement (decrease from baseline) or stabilization (change from baseline of 0 to less than\[\<\] 2) in NIS-LL score, based on mean of 2 scores in 1 week period. NIS-LL: assessed muscle weakness, reflexes, sensation. Each item scored separately for left, right limbs. Components of muscle weakness scored on 0(normal) to 4(paralysis) scale, higher score=greater weakness. Components of reflexes, sensation scored 0=normal, 1=decreased, or 2=absent. Total NIS-LL score range 0-88, higher score=greater impairment.
Time frame: Month 18
Population: ITTset:randomized participants received atleast(\>=)1 dose of study drug, had \>=1 post-baseline efficacy assessment for NIS-LL,Norfolk Quality of Life-Diabetic Neuropathy(QOL-DN) or discontinued study due to death/liver transplant(LT).Last-observation-carried-forward(LOCF) used;participant who discontinued due to death/LT was set non-responder.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Tafamidis | Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 18 | 45.3 percentage of participants |
| Placebo | Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 18 | 29.5 percentage of participants |
Secondary
Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18
BMI was calculated by weight divided by height squared. mBMI was calculated by multiplying BMI by serum albumin levels to compensate for edema formation associated with malnutrition. A progressive decline in mBMI indicated worsening of disease severity.
Time frame: Baseline, Month 6, 12, 18
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death/LT. 'n' = those participants who were evaluable for this measure at given time points for each group respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Baseline (n=64, 61) | 1004.6 (kilogram/square meter)*(gram/liter) | Standard Deviation 165.2 |
| Tafamidis | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Change at Month 12 (n=49, 50) | 19.4 (kilogram/square meter)*(gram/liter) | Standard Deviation 71.8 |
| Tafamidis | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Change at Month 6 (n=60, 56) | 17.1 (kilogram/square meter)*(gram/liter) | Standard Deviation 68.4 |
| Tafamidis | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Change at Month 18 (n=49, 46) | 37.9 (kilogram/square meter)*(gram/liter) | Standard Deviation 73.7 |
| Placebo | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Change at Month 6 (n=60, 56) | -29.8 (kilogram/square meter)*(gram/liter) | Standard Deviation 69.7 |
| Placebo | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Baseline (n=64, 61) | 1011.5 (kilogram/square meter)*(gram/liter) | Standard Deviation 212.9 |
| Placebo | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Change at Month 18 (n=49, 46) | -32.7 (kilogram/square meter)*(gram/liter) | Standard Deviation 88.6 |
| Placebo | Change From Baseline in Modified Body Mass Index (mBMI) at Month 6, 12 and 18 | Change at Month 12 (n=49, 50) | -30.8 (kilogram/square meter)*(gram/liter) | Standard Deviation 74.9 |
Secondary
Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18
NIS-LL: assessed muscle weakness, reflexes and sensation; scored separately for left and right limbs. Components of muscle weakness (hip and knee flexion, hip and knee extension, ankle dorsiflexors, ankle plantar flexors, toe extensors, toe flexors) are scored on 0(normal) to 4(paralysis) scale, higher score=greater weakness. Components of reflexes (quadriceps femoris, triceps surae) and sensation (touch pressure, pin-prick, vibration, joint position) were scored 0 = normal, 1= decreased, or 2 = absent. Total possible NIS-LL score range 0-88, higher score=greater impairment.
Time frame: Baseline, Month 6, 12, 18
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death/LT. 'n' = those participants who were evaluable for this measure at given time point for each group respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Baseline (n=64, 61) | 8.359 units on a scale | Standard Deviation 11.399 |
| Tafamidis | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Change at Month 6 (n=60, 57) | 1.260 units on a scale | Standard Deviation 3.007 |
| Tafamidis | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Change at Month 12 (n=49, 50) | 1.005 units on a scale | Standard Deviation 3.964 |
| Tafamidis | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Change at Month 18 (n=48, 47) | 2.193 units on a scale | Standard Deviation 4.372 |
| Placebo | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Change at Month 18 (n=48, 47) | 5.402 units on a scale | Standard Deviation 8.661 |
| Placebo | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Baseline (n=64, 61) | 11.445 units on a scale | Standard Deviation 13.544 |
| Placebo | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Change at Month 12 (n=49, 50) | 4.835 units on a scale | Standard Deviation 7.697 |
| Placebo | Change From Baseline in Neuropathy Impairment Score- Lower Limb (NIS-LL) Score at Month 6, 12 and 18 | Change at Month 6 (n=60, 57) | 2.075 units on a scale | Standard Deviation 6.407 |
Secondary
Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18
Norfolk QOL-DN:35-item participant-rated questionnaire to assess impact of DN on QOL; Item 1-7:scored as 1=symptom present, 0=symptom absent. Item 8-35: scored on 5-point Likert scale: 0=no problem, 4=severe problem (except item 32: -2=much better, 0=about same, 2=much worse). Norfolk QOL-DN summarized in 5 domains(score range):physical functioning/large fiber neuropathy(-2 to 58), activities of daily living(ADLs) (0 to 20), symptoms(0 to 32), small fiber neuropathy(0 to 16), autonomic neuropathy(0 to 12); higher score=greater impairment, for each. Total score=-2 to138(higher score=worse QOL).
Time frame: Baseline, Month 6, 12, 18
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death or LT. 'n' = those participants who were evaluable for this measure at given time points for each group respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: physical functioning(n=64,61) | 14.3 units on a scale | Standard Deviation 13.8 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: ADLs(n=64,61) | 1.3 units on a scale | Standard Deviation 2.9 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: symptoms(n=64,61) | 7.2 units on a scale | Standard Deviation 5.5 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: small fiber neuropathy(n=64,61) | 2.7 units on a scale | Standard Deviation 3.6 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: autonomic neuropathy(n=64,61) | 1.9 units on a scale | Standard Deviation 2.4 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: physical functioning(n=60,57) | -0.6 units on a scale | Standard Deviation 8 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: ADLs(n=60,57) | 0.4 units on a scale | Standard Deviation 1.9 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: symptoms(n=60,56) | 0.8 units on a scale | Standard Deviation 5.5 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: small fiber neuropathy(n=60,57) | 0.4 units on a scale | Standard Deviation 2.2 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: autonomic neuropathy(n=60,57) | 0.2 units on a scale | Standard Deviation 1.8 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: physical functioning(n=49,50) | -0.9 units on a scale | Standard Deviation 7.4 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: ADLs(n=49,50) | 1.0 units on a scale | Standard Deviation 2.4 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: symptoms(n=49,49) | 0.4 units on a scale | Standard Deviation 5 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12:small fiber neuropathy(n=49,50) | 0.7 units on a scale | Standard Deviation 2.8 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: autonomic neuropathy(n=49,50) | -0.1 units on a scale | Standard Deviation 1.8 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: physical functioning(n=48,47) | -0.1 units on a scale | Standard Deviation 8.5 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: ADLs(n=48,47) | 1.2 units on a scale | Standard Deviation 2.4 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: symptoms(n=48,47) | -0.1 units on a scale | Standard Deviation 4.9 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18:small fiber neuropathy(n=48,47) | 0.8 units on a scale | Standard Deviation 2.6 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: autonomic neuropathy(n=48,47) | 0.2 units on a scale | Standard Deviation 1.9 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: symptoms(n=48,47) | 1.2 units on a scale | Standard Deviation 5.4 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: physical functioning(n=64,61) | 16.6 units on a scale | Standard Deviation 14.7 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: physical functioning(n=49,50) | 0.6 units on a scale | Standard Deviation 10.7 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: ADLs(n=64,61) | 1.6 units on a scale | Standard Deviation 3.8 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: physical functioning(n=48,47) | 3.0 units on a scale | Standard Deviation 14 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: symptoms(n=64,61) | 7.6 units on a scale | Standard Deviation 6.1 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: ADLs(n=49,50) | 0.7 units on a scale | Standard Deviation 3 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: small fiber neuropathy(n=64,61) | 3.1 units on a scale | Standard Deviation 4 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: autonomic neuropathy(n=48,47) | 0.4 units on a scale | Standard Deviation 2.8 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Baseline: autonomic neuropathy(n=64,61) | 2.0 units on a scale | Standard Deviation 2.6 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: symptoms(n=49,49) | 1.4 units on a scale | Standard Deviation 4.5 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: physical functioning(n=60,57) | -0.9 units on a scale | Standard Deviation 9.8 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18: ADLs(n=48,47) | 1.2 units on a scale | Standard Deviation 4.2 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: ADLs(n=60,57) | 0.3 units on a scale | Standard Deviation 1.7 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12:small fiber neuropathy(n=49,50) | 1.5 units on a scale | Standard Deviation 3.1 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: symptoms(n=60,56) | 0.2 units on a scale | Standard Deviation 4.4 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 18:small fiber neuropathy(n=48,47) | 1.4 units on a scale | Standard Deviation 3.6 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: small fiber neuropathy(n=60,57) | 0.5 units on a scale | Standard Deviation 2.5 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 12: autonomic neuropathy(n=49,50) | 0.4 units on a scale | Standard Deviation 2.8 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Domain Scores at Month 6, 12 and 18 | Change at Month 6: autonomic neuropathy(n=60,57) | 0.0 units on a scale | Standard Deviation 1.7 |
Secondary
Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12
Norfolk QOL-DN: 35-item participant-rated questionnaire used to assess impact of diabetic neuropathy on the quality of life of participants with diabetic neuropathy; Item 1 to 7: related to symptoms and presence of symptom was assessed as 1 and absence was assessed as 0. Item 8-35: related to activities of daily living and scored on a 5-point Likert scale, where 0= no problem and 4= severe problem (except item 32, where -2= much better, 0=about the same, 2=much worse). TQOL= sum of all the items, total possible score range= -2 to 138, where higher score=worse quality of life.
Time frame: Baseline, Month 6, 12
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death/LT. 'n' = those participants who were evaluable for this measure at given time point for each group respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Baseline (n=64, 61) | 27.3 units on a scale | Standard Deviation 24.2 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Change at Month 6 (n=60, 57) | 1.2 units on a scale | Standard Deviation 15.6 |
| Tafamidis | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Change at Month 12 (n=49, 50) | 1.1 units on a scale | Standard Deviation 14.7 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Baseline (n=64, 61) | 30.8 units on a scale | Standard Deviation 26.7 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Change at Month 6 (n=60, 57) | 0.2 units on a scale | Standard Deviation 15.1 |
| Placebo | Change From Baseline in Norfolk Quality of Life - Diabetic Neuropathy (QOL-DN) Total Quality of Life (TQOL) Score at Month 6 and 12 | Change at Month 12 (n=49, 50) | 4.6 units on a scale | Standard Deviation 19 |
Secondary
Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18
Summated 3 Nerve Tests Small Fiber Normal Deviates Score (NTSFnds) included cooling threshold for the lower limbs, heat pain threshold for the lower limbs and HRDB. Total score range= -11.2 to 11.2, where higher score=worse nerve function.
Time frame: Baseline, Month 6, 12, 18
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death/LT. 'n' = those participants who were evaluable for this measure at given time points for each group respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Baseline (n=64, 61) | 5.514 units on a scale | Standard Deviation 4.535 |
| Tafamidis | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 6 (n=60, 57) | 0.240 units on a scale | Standard Deviation 1.679 |
| Tafamidis | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 18 (n=48, 46) | 0.290 units on a scale | Standard Deviation 2.13 |
| Tafamidis | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 12 (n=48, 50) | 0.375 units on a scale | Standard Deviation 2.048 |
| Placebo | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 18 (n=48, 46) | 1.489 units on a scale | Standard Deviation 2.519 |
| Placebo | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Baseline (n=64, 61) | 5.624 units on a scale | Standard Deviation 4.085 |
| Placebo | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 6 (n=60, 57) | 0.716 units on a scale | Standard Deviation 2.202 |
| Placebo | Change From Baseline in Summated 3 Score for Small Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 12 (n=48, 50) | 1.250 units on a scale | Standard Deviation 2.01 |
Secondary
Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18
Summated 7 score: composite score included five Nerve Conduction Studies (NCS) attributes (peroneal nerve distal motor latency, peroneal nerve compound muscle action potential, peroneal nerve motor conduction velocity, tibial nerve distal motor latency, and sural nerve sensory nerve action potential amplitude) along with Vibration Detection Threshold (VDT) obtained in great toes, and Heart Rate Response to Deep Breathing (HRDB) value. Score was determined through reference to normal values for age, sex and height. Total score range= -26 to 26, where higher score=worse nerve function.
Time frame: Baseline, Month 6, 12, 18
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death/LT. 'n' = those participants who were evaluable for this measure at given time points for each group respectively.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Tafamidis | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Baseline (n=64, 61) | 7.787 units on a scale | Standard Deviation 9.063 |
| Tafamidis | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 6 (n=60, 57) | 0.581 units on a scale | Standard Deviation 3.542 |
| Tafamidis | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 12 (n=48, 50) | 0.833 units on a scale | Standard Deviation 3.963 |
| Tafamidis | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 18 (n=48, 46) | 1.159 units on a scale | Standard Deviation 3.853 |
| Placebo | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 18 (n=48, 46) | 3.333 units on a scale | Standard Deviation 4.997 |
| Placebo | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Baseline (n=64, 61) | 8.718 units on a scale | Standard Deviation 8.533 |
| Placebo | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 12 (n=48, 50) | 2.959 units on a scale | Standard Deviation 3.879 |
| Placebo | Change From Baseline in Summated 7 Score for Large Nerve Fiber Function at Month 6, 12 and 18 | Change at Month 6 (n=60, 57) | 1.934 units on a scale | Standard Deviation 3.846 |
Secondary
Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 6 and 12
Response to treatment was indicated by either improvement (decrease from baseline) or stabilization (change from baseline of 0 to \<2) in NIS-LL score, based on mean of 2 scores in 1 week period. NIS-LL: assessed muscle weakness, reflexes, sensation. Each item scored separately for left, right limbs. Components of muscle weakness scored on 0 (normal) to 4 (paralysis) scale, higher score=greater weakness. Components of reflexes, sensation scored 0=normal, 1=decreased, or 2=absent. Total NIS-LL score range 0-88, higher score=greater impairment.
Time frame: Month 6, 12
Population: ITT population included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline efficacy assessment for NIS-LL and Norfolk QOL-DN or discontinued study due to death/LT. LOCF method was used; participant who discontinued due to death/LT was set non-responder.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tafamidis | Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 6 and 12 | Month 6 | 60.9 percentage of participants |
| Tafamidis | Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 6 and 12 | Month 12 | 54.7 percentage of participants |
| Placebo | Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 6 and 12 | Month 6 | 54.1 percentage of participants |
| Placebo | Percentage of Participants With Response to Treatment as Measured by Neuropathy Impairment Score - Lower Limb (NIS-LL) at Month 6 and 12 | Month 12 | 32.8 percentage of participants |
Secondary
Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer
TTR tetramer was assessed using a validated immunoturbidimetric assay. The Fraction of Initial (FOI) is the ratio of the measured TTR tetramer concentration after denaturation to the measured TTR tetramer concentration before denaturation. TTR tetramer stabilization is based on the difference between the on-treatment FOI and the baseline FOI expressed as a percentage of the baseline FOI.
Time frame: Week 8, Month 6, 12, 18
Population: ITT population. 'N' (number of participants analyzed) signifies those participants who were evaluable for this measure. 'n' = those participants who were evaluable for this measure at given time points for each group respectively.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Tafamidis | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Month 6 (n= 59, 58) | 100.0 percentage of participants |
| Tafamidis | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Month 12 (n=48, 50) | 97.9 percentage of participants |
| Tafamidis | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Month 18 (n=48, 44) | 97.9 percentage of participants |
| Tafamidis | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Week 8 (n=63, 60) | 98.4 percentage of participants |
| Placebo | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Week 8 (n=63, 60) | 6.7 percentage of participants |
| Placebo | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Month 6 (n= 59, 58) | 5.2 percentage of participants |
| Placebo | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Month 18 (n=48, 44) | 0.0 percentage of participants |
| Placebo | Percentage of Participants With Stabilized Transthyretin (TTR) Tetramer | Month 12 (n=48, 50) | 2.0 percentage of participants |