Genetic Syndrome, Nervous System Disorder
Conditions
Keywords
Ataxia Teleangiectasia, AT, ERY-DEX, Dexamethasone, Dexamethasone sodium phosphate
Brief summary
The study has the aim to evaluate the improvement in CNS symptoms measured by International Co-operative Ataxia Rating Scale (ICARS) in patients with ataxia teleangectasia (AT), during a period of treatment with ERY-DEX (dexamethasone sodium phosphate ex vivo encapsulated into human autologous erythrocytes).
Detailed description
This is a multi-centre, single arm, open label, 6 months, phase II study to evaluate the effect of ERY-DEX in improving Central Nervous System (CNS) symptoms in patients with Ataxia Teleangectasia (AT). The study consists of a screening period (max duration of 30 days) and a treatment period (duration 6 months).
Interventions
Dexamethasone sodium phosphate (2 vials, 250 mg/10 ml each) to be administered via encapsulation into autologous erythrocytes (ERY-DEX system). Final amount administered to the patient: about 10-15 mg of dexamethasone sodium phosphate, encapsulated into autologous blood (2 vials of 250 mg each of dexamethasone sodium phosphate will be used in the ex vivo process together with 50 ml of blood previously taken from the same patient). The treatment has to be repeated at intervals of 30 days (±10 days)
Sponsors
Study design
Eligibility
Inclusion criteria
* neurological signs of AT * patients in autonomous gait or helped by a support * proven molecular diagnosis of AT * Males and females aged \> 3 years * Body weight \>15 kg * Plasma levels of Lymphocytes CD4+/mm3 \> 500 (for patients aged 3-6 years) or \> 200 (older than 6 years) * written IC to participate.
Exclusion criteria
* Current or previous neoplastic disease * History of severe impairment of the immunological system * Chronic conditions representing a contraindication to the use of steroid drugs * Non compliance with the study request * Any previous steroid assumption within 30 days before starting ERY-DEX * Have any other significant disease that in the Investigator's opinion would exclude the patient from the trial * Females of childbearing potential who were pregnant, breast-feeding or were not using adequate contraceptive methods
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - ITT Population | At visits 2 (day 30), 4 (day 90) and 7 (final visit, day 180) | ICARS ia a 100-point semiquantitative scale, which goes from 0 to 100, offering a compartimentalised quantification of 4 subscores: Posture and Gait Disturbances (maximum score = 34), Kinetic Functions (maximum score = 52), Speech Disorders (maximum score = 8), and Oculomotor Disorders (maximum score = 6) for a possible total score of 100 points. The minimum score is 0 (normal), while the maximum score is 100 and corresponds to the worst status of the patient. This means that for each subscale, higher scores indicate higher levels of impairment. |
| Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - PP Population | At visits 2 (day 30), 4 (day 90) and 7 (final visit, day 180) | ICARS ia a 100-point semiquantitative scale, which goes from 0 to 100, offering a compartimentalised quantification of 4 subscores: Posture and Gait Disturbances (maximum score = 34), Kinetic Functions (maximum score = 52), Speech Disorders (maximum score = 8), and Oculomotor Disorders (maximum score = 6) for a possible total score of 100 points. The minimum score is 0 (normal), while the maximum score is 100 and corresponds to the worst status of the patient. This means that for each subscale, higher scores indicate higher levels of impairment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Change From V4 to V7 in Ocular Motility - ITT Population | At visit 7 (final visit, day 180) | An evaluation of ocular motility measured by an ad hoc form was performed at V4 and V7. At V4 and V7, ocular motility was assessed through a 5-point qualitative scale: very much improved (1), slightly improved (2), no change (3), slightly worsened (4), very much worsened (5). |
| Mean Change From V4 to V7 in Ocular Motility - PP Population | At visit 7 (final visit, day 180) | An evaluation of ocular motility measured by an ad hoc form was performed at V4 and V7. At V4 and V7, ocular motility was assessed through a 5-point qualitative scale: very much improved (1), slightly improved (2), no change (3), slightly worsened (4), very much worsened (5). |
| Change From V4 to V7 in Investigator Global Assessment (IGA) - ITT Population | At visit 7 (final visit, day 180) | An evaluation of the global health status of the patients by the IGA was performed. IGA consisted of an evaluation of neurological signs and symptoms as neuromotor disorders, posture and deambulation, disturbances of the oro-pharyngeal apparatus, presence of peripheral neuropathy, neurodevelopmental disturbances, intellectual level, and behavior disturbances based only on a subjective judgment of the Investigator on a single scale: a 5-point qualitative scale as: * very much improved (1), * slightly improved (2), * no change (3), * slightly worsened (4), * very much worsened (5) was used to assess changes from V4 to V7. The higher the score, the worse the outcome. |
| Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - PP Population | At visits 4 (90 days) and 7 (180 days, final visit) | VABS aggregate scale is used. VABS is divided into 4 adaptive domains and 11 subdomains: 1. Communication: Receptive, Expressive, Written; 2. Daily Living Skills: Personal, Domestic, Community; 3. Socialisation: Interpersonal Relationships, Play & Leisure Time, Coping Skills; 4. Motor Skills: Gross, Fine. For each \*question\* in each of the 11 subdomains, score ranges from 0 to 4 (the higher the value the better the outcome): * 0 = the subject never performs the behaviour without help or reminders; * 1 = rarely performs (as above); * 2 = sometimes performs (as above); * 3 = often performs (as above); * 4 = almost always performs (as above); The total subdomain score is the sum of each \*question\* scores and the total domain score is the sum of each subdomains' scores. Domains min-max interval scores: 0-74 Communication, 0-74 Daily Living Skills, 0-62 Socialization, 0-111 Motor Skills, Sum-of-domains score 0-321(the higher the score, the better the outcome) |
| Count of Participants on ERY-DEX Showing Treatment Emergent Adverse Events (TEAEs) Including Serious Adverse Events (SAEs) | Throughout the study, until the end of 6 months of treatment (day 180) | The effect of ERY-DEX on treatment emergent adverse events was expressed as the number of patients showing at least one TEAE or 1 serious AE |
| Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - ITT Population | At visits 4 (90 days) and 7 (180 days, final visit) | VABS aggregate scale is used. VABS is divided into 4 adaptive domains and 11 subdomains: 1. Communication: Receptive, Expressive, Written; 2. Daily Living Skills: Personal, Domestic, Community; 3. Socialisation: Interpersonal Relationships, Play & Leisure Time, Coping Skills; 4. Motor Skills: Gross, Fine. For each \*question\* in each of the 11 subdomains, score ranges from 0 to 4 (the higher the value the better the outcome): * 0 = the subject never performs the behaviour without help or reminders; * 1 = rarely performs (as above); * 2 = sometimes performs (as above); * 3 = often performs (as above); * 4 = almost always performs (as above); The total subdomain score is the sum of each \*question\* scores and the total domain score is the sum of each subdomains' scores. Domains min-max interval scores: 0-74 Communication, 0-74 Daily Living Skills, 0-62 Socialization, 0-111 Motor Skills, Sum-of-domains score 0-321(the higher the score, the better the outcome) |
| Change From V4 to V7 in Investigator Global Assessment (IGA) - PP Population | At visit 7 (final visit, day 180) | An evaluation of the global health status of the patients by the IGA was performed. IGA consisted of an evaluation of neurological signs and symptoms as neuromotor disorders, posture and deambulation, disturbances of the oro-pharyngeal apparatus, presence of peripheral neuropathy, neurodevelopmental disturbances, intellectual level, and behavior disturbances based only on a subjective judgment of the Investigator on a single scale: a 5-point qualitative scale as: * very much improved (1), * slightly improved (2), * no change (3), * slightly worsened (4), * very much worsened (5) was used to assess changes from V4 to V7. The higher the score, the worse the outcome. |
Countries
Italy
Participant flow
Recruitment details
Study was carried out in 2 Italian Hospitals. Recruitment started on February 2011 and LPLV was performed on August 2011.
Pre-assignment details
Patients had 30 days of wash-out from steroid assumption before starting the treatment. 26 patients were screened, 4 of them resulted screening failure, due to lymphocytes value below the limit (3) and concomitant disease (1).
Participants by arm
| Arm | Count |
|---|---|
| ERY-DEX Patients treated with monthly treatment of ERY-DEX (dexamethasone sodium phosphate encapsulated in autologous erythrocytes) | 22 |
| Total | 22 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 2 |
| Overall Study | Protocol Violation | 2 |
Baseline characteristics
| Characteristic | ERY-DEX |
|---|---|
| Age, Categorical <=18 years | 21 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 1 Participants |
| Age, Continuous | 11.2 years STANDARD_DEVIATION 3.5 |
| Region of Enrollment Italy | 22 participants |
| Sex: Female, Male Female | 11 Participants |
| Sex: Female, Male Male | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 22 |
| other Total, other adverse events | 15 / 22 |
| serious Total, serious adverse events | 2 / 22 |
Outcome results
Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - ITT Population
ICARS ia a 100-point semiquantitative scale, which goes from 0 to 100, offering a compartimentalised quantification of 4 subscores: Posture and Gait Disturbances (maximum score = 34), Kinetic Functions (maximum score = 52), Speech Disorders (maximum score = 8), and Oculomotor Disorders (maximum score = 6) for a possible total score of 100 points. The minimum score is 0 (normal), while the maximum score is 100 and corresponds to the worst status of the patient. This means that for each subscale, higher scores indicate higher levels of impairment.
Time frame: At visits 2 (day 30), 4 (day 90) and 7 (final visit, day 180)
Population: Intent to treat population (ITT) patients receiving at least one treatment
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ERY-DEX | Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - ITT Population | V2 | -2.2 units on a scale | Standard Deviation 5.6 |
| ERY-DEX | Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - ITT Population | V4 | -3.4 units on a scale | Standard Deviation 7.3 |
| ERY-DEX | Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - ITT Population | V7 | -4.0 units on a scale | Standard Deviation 7.5 |
Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - PP Population
ICARS ia a 100-point semiquantitative scale, which goes from 0 to 100, offering a compartimentalised quantification of 4 subscores: Posture and Gait Disturbances (maximum score = 34), Kinetic Functions (maximum score = 52), Speech Disorders (maximum score = 8), and Oculomotor Disorders (maximum score = 6) for a possible total score of 100 points. The minimum score is 0 (normal), while the maximum score is 100 and corresponds to the worst status of the patient. This means that for each subscale, higher scores indicate higher levels of impairment.
Time frame: At visits 2 (day 30), 4 (day 90) and 7 (final visit, day 180)
Population: The PP Population includes 18 patients who have been treated according to protocol and fulfill the following criteria:~* compliance with all entry criteria~* absence of major protocol violations~* adequate compliance with trial medication (at most one missed or out-of-window infusion of the study preparation).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ERY-DEX | Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - PP Population | V4 | -3.9 units on a scale | Standard Deviation 7.1 |
| ERY-DEX | Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - PP Population | V2 | -2.4 units on a scale | Standard Deviation 4.9 |
| ERY-DEX | Mean Change From Baseline in Neurological Symptoms Assessed by Using International Cooperative Ataxia Rating Scale (ICARS) Score - PP Population | V7 | -5.2 units on a scale | Standard Deviation 7 |
Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - ITT Population
VABS aggregate scale is used. VABS is divided into 4 adaptive domains and 11 subdomains: 1. Communication: Receptive, Expressive, Written; 2. Daily Living Skills: Personal, Domestic, Community; 3. Socialisation: Interpersonal Relationships, Play & Leisure Time, Coping Skills; 4. Motor Skills: Gross, Fine. For each \*question\* in each of the 11 subdomains, score ranges from 0 to 4 (the higher the value the better the outcome): * 0 = the subject never performs the behaviour without help or reminders; * 1 = rarely performs (as above); * 2 = sometimes performs (as above); * 3 = often performs (as above); * 4 = almost always performs (as above); The total subdomain score is the sum of each \*question\* scores and the total domain score is the sum of each subdomains' scores. Domains min-max interval scores: 0-74 Communication, 0-74 Daily Living Skills, 0-62 Socialization, 0-111 Motor Skills, Sum-of-domains score 0-321(the higher the score, the better the outcome)
Time frame: At visits 4 (90 days) and 7 (180 days, final visit)
Population: The ITT Population includes all 22 patients enrolled into the study.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ERY-DEX | Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - ITT Population | V4 | 1.0 units on a scale | Standard Deviation 0.9 |
| ERY-DEX | Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - ITT Population | V7 | 1.3 units on a scale | Standard Deviation 1.3 |
Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - PP Population
VABS aggregate scale is used. VABS is divided into 4 adaptive domains and 11 subdomains: 1. Communication: Receptive, Expressive, Written; 2. Daily Living Skills: Personal, Domestic, Community; 3. Socialisation: Interpersonal Relationships, Play & Leisure Time, Coping Skills; 4. Motor Skills: Gross, Fine. For each \*question\* in each of the 11 subdomains, score ranges from 0 to 4 (the higher the value the better the outcome): * 0 = the subject never performs the behaviour without help or reminders; * 1 = rarely performs (as above); * 2 = sometimes performs (as above); * 3 = often performs (as above); * 4 = almost always performs (as above); The total subdomain score is the sum of each \*question\* scores and the total domain score is the sum of each subdomains' scores. Domains min-max interval scores: 0-74 Communication, 0-74 Daily Living Skills, 0-62 Socialization, 0-111 Motor Skills, Sum-of-domains score 0-321(the higher the score, the better the outcome)
Time frame: At visits 4 (90 days) and 7 (180 days, final visit)
Population: The PP Population includes 18 patients who have been treated according to protocol and fulfill the following criteria:~* compliance with all entry criteria~* absence of major protocol violations~* adequate compliance with trial medication (at most one missed or out-of-window infusion of the study preparation).
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ERY-DEX | Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - PP Population | V4 | 1.1 units on a scale | Standard Deviation 0.9 |
| ERY-DEX | Change From Baseline for Vineland Adaptive Behaviour Scale (VABS) Total Score - PP Population | V7 | 1.5 units on a scale | Standard Deviation 1.1 |
Change From V4 to V7 in Investigator Global Assessment (IGA) - ITT Population
An evaluation of the global health status of the patients by the IGA was performed. IGA consisted of an evaluation of neurological signs and symptoms as neuromotor disorders, posture and deambulation, disturbances of the oro-pharyngeal apparatus, presence of peripheral neuropathy, neurodevelopmental disturbances, intellectual level, and behavior disturbances based only on a subjective judgment of the Investigator on a single scale: a 5-point qualitative scale as: * very much improved (1), * slightly improved (2), * no change (3), * slightly worsened (4), * very much worsened (5) was used to assess changes from V4 to V7. The higher the score, the worse the outcome.
Time frame: At visit 7 (final visit, day 180)
Population: The ITT Population includes all 22 patients enrolled into the study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ERY-DEX | Change From V4 to V7 in Investigator Global Assessment (IGA) - ITT Population | 0.2 units on a scale | Standard Deviation 0.6 |
Change From V4 to V7 in Investigator Global Assessment (IGA) - PP Population
An evaluation of the global health status of the patients by the IGA was performed. IGA consisted of an evaluation of neurological signs and symptoms as neuromotor disorders, posture and deambulation, disturbances of the oro-pharyngeal apparatus, presence of peripheral neuropathy, neurodevelopmental disturbances, intellectual level, and behavior disturbances based only on a subjective judgment of the Investigator on a single scale: a 5-point qualitative scale as: * very much improved (1), * slightly improved (2), * no change (3), * slightly worsened (4), * very much worsened (5) was used to assess changes from V4 to V7. The higher the score, the worse the outcome.
Time frame: At visit 7 (final visit, day 180)
Population: The PP Population includes 18 patients who have been treated according to protocol and fulfill the following criteria:~* compliance with all entry criteria~* absence of major protocol violations~* adequate compliance with trial medication (at most one missed or out-of-window infusion of the study preparation).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ERY-DEX | Change From V4 to V7 in Investigator Global Assessment (IGA) - PP Population | 0.2 units on a scale | Standard Deviation 0.6 |
Count of Participants on ERY-DEX Showing Treatment Emergent Adverse Events (TEAEs) Including Serious Adverse Events (SAEs)
The effect of ERY-DEX on treatment emergent adverse events was expressed as the number of patients showing at least one TEAE or 1 serious AE
Time frame: Throughout the study, until the end of 6 months of treatment (day 180)
Population: The SP includes the 22 patients who have received at least one dose of planned trial treatment.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| ERY-DEX | Count of Participants on ERY-DEX Showing Treatment Emergent Adverse Events (TEAEs) Including Serious Adverse Events (SAEs) | Participants with at least 1 TEAE | 15 Participants |
| ERY-DEX | Count of Participants on ERY-DEX Showing Treatment Emergent Adverse Events (TEAEs) Including Serious Adverse Events (SAEs) | Participants with at least 1 serious AE | 2 Participants |
Mean Change From V4 to V7 in Ocular Motility - ITT Population
An evaluation of ocular motility measured by an ad hoc form was performed at V4 and V7. At V4 and V7, ocular motility was assessed through a 5-point qualitative scale: very much improved (1), slightly improved (2), no change (3), slightly worsened (4), very much worsened (5).
Time frame: At visit 7 (final visit, day 180)
Population: The ITT Population includes all 22 patients enrolled into the study.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ERY-DEX | Mean Change From V4 to V7 in Ocular Motility - ITT Population | -0.3 units on a scale | Standard Deviation 0.5 |
Mean Change From V4 to V7 in Ocular Motility - PP Population
An evaluation of ocular motility measured by an ad hoc form was performed at V4 and V7. At V4 and V7, ocular motility was assessed through a 5-point qualitative scale: very much improved (1), slightly improved (2), no change (3), slightly worsened (4), very much worsened (5).
Time frame: At visit 7 (final visit, day 180)
Population: The PP Population includes 18 patients who have been treated according to protocol and fulfill the following criteria:~* compliance with all entry criteria~* absence of major protocol violations~* adequate compliance with trial medication (at most one missed or out-of-window infusion of the study preparation).
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| ERY-DEX | Mean Change From V4 to V7 in Ocular Motility - PP Population | -0.3 units on a scale | Standard Deviation 0.5 |