Clinical Study In Infants With Rapidly Progressive Lysosomal Acid Lipase Deficiency

A Phase 2, Open Label, Multicenter Study to Evaluate the Safety, Tolerability, Efficacy, and Pharmacokinetics of Sebelipase Alfa in Infants With Rapidly Progressive Lysosomal Acid Lipase Deficiency

Status

Terminated

Phases

Phase 2

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT02193867

Enrollment

Registered

2014-07-18

Start date

2014-06-06

Completion date

2018-10-30

Last updated

2019-11-18

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Lysosomal Acid Lipase Deficiency

Keywords

LIPA, Wolman Disease, Wolman Phenotype, Acid Lipase Deficiency, Acid Cholesteryl Hydrolase, Acid Lipase Disease Deficiency, type 2, Cholesteryl Ester Storage Disease (CESD), Cholesteryl Ester Hydrolase Deficiency, Early Onset Lysosomal Acid Lipase Deficiency (Wolman Disease), LAL Deficiency, Late Onset Lysosomal Acid Lipase Deficiency (CESD), Wolman Disease (early onset LAL Deficiency), Related Disorders:, Non-alcoholic Fatty Liver Disease (NAFLD), Non-alcoholic Steatohepatitis (NASH), Alcoholic Liver Disease, Cryptogenic Cirrhosis, Niemann-Pick Disease (NPD) Type C, Chanarin Dorfman Syndrome

Brief summary

This was an open-label, repeat-dose, study of sebelipase alfa in infants with rapidly progressive lysosomal acid lipase deficiency (LAL-D). Eligible participants received once-weekly infusions of sebelipase alfa for up to 3 years.

Detailed description

Lysosomal acid lipase deficiency is a rare autosomal recessive lipid storage disorder that is caused by a marked decrease or complete absence of the LAL enzyme, leading to the accumulation of lipids, predominately cholesteryl esters and triglycerides, in various tissues and cell types. In the liver, accumulation of lipids in hepatocytes and macrophages leads to hepatomegaly, fibrosis, cirrhosis, liver dysfunction, and hepatic failure. In the small intestine, lipid-laden macrophage accumulation in the lamina propria leads to profound malabsorption. Lysosomal acid lipase deficiency presenting in infancy is an extremely rare form of the disease characterized by profound malabsorption, growth failure, and hepatic failure that is usually fatal within the first 6 months of life.

Interventions

DRUGSebelipase Alfa

Sebelipase alfa is a recombinant human lysosomal acid lipase. The investigational medicinal product is an enzyme replacement therapy intended for treatment of participants with LAL-D. Dosing occurred once weekly for up to 3 years.

Study design

Allocation

Intervention model

SINGLE_GROUP

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

No minimum to 8 Months

Healthy volunteers

Inclusion criteria

1. Participant's parent or legal guardian (if applicable) consent to participation in the study 2. Confirmation of documented decreased LAL activity relative to the normal range of the lab performing the assay or confirmation of LAL-D diagnosis as determined by a Sponsor-approved central laboratory 3. Substantial clinical concerns, in the opinion of Investigator and Sponsor, of rapid disease progression requiring urgent medical intervention including, but not restricted to the following: * Marked abdominal distension and hepatomegaly * Failure to thrive * Disturbance of coagulation * Severe anemia * Sibling with rapidly progressive course of LAL-D

Exclusion criteria

1. Clinically important concurrent disease 2. Participant was \> 8 months of age at the time of first dosing 3. Participant received an investigational medicinal product other than sebelipase alfa within 14 days prior to the first dose of sebelipase alfa in this study 4. Myeloablative preparation, or other systemic pre-transplant conditioning, for hematopoietic stem cell or liver transplantation 5. Previous hematopoietic stem cell or liver transplant 6. Known hypersensitivity to eggs

Design outcomes

Primary

Measure	Time frame	Description
Participants Experiencing Severe Treatment-emergent Adverse Events (TEAEs)	Screening through Month 37	The number of participants experiencing severe TEAEs is presented for participants who received sebelipase alfa in this open-label study. Adverse events were obtained through spontaneous reporting or elicited by specific questioning or examination of the participant's parent or legal guardian. An adverse event was defined as any new untoward medical occurrence or worsening of a pre-existing medical condition in a participant, whether or not causally related to administration of study drug. Adverse event severity was graded by the Investigator as mild, moderate, or severe based on definitions developed from Clinical Data Interchange Standards Consortium Study Data Tabulation Model standard terminology v3.1.1. Adverse events reporting was from the date of informed consent until completion of the follow-up visit at approximately 30 days after the last dose of study drug. A summary of all serious and other nonserious AEs regardless of causality is located in the Reported AE module.

Secondary

Measure	Time frame	Description
Median Age At Death	Baseline through Month 36	Age at death for participants who died during the study. All deaths were assessed by the Investigator as unrelated to study drug.
Change From Baseline In Percentiles For Weight For Age (WFA) At 12, 24, And 36 Months	Baseline, Month 12, Month 24, and Month 36	This outcome measure evaluated the effects of sebelipase alfa on growth by measuring the changes from baseline in percentiles for WFA. Percentiles for WFA were summarized as observed values by visit. Baseline was defined as the last available assessment prior to the first infusion of sebelipase alfa.
Number Of Participants With Stunting, Wasting, Or Underweight At Baseline, 12, 24, And 36 Months	Baseline to Month 12, Month 24, and Month 36	The number of participants who met criteria for the following 3 dichotomous indicators of under nutrition were reported. These indicators included the following: 1. Stunting was defined as at least 2 standard deviations below the median for length-for-age/height-for-age. 2. Wasting was defined as wasting at least 2 standard deviations below the median for weight-for-length/weight-for-height. 3. Underweight was defined as at least 2 standard deviations below the median for WFA.
Percentage Of Participants Surviving To 12, 18, 24, And 36 Months Of Age	Baseline through Month 12, Month 18, Month 24, and Month 36	The percentage of participants in the FAS who survived to 12, 18, 24, and 36 months of age. The exact confidence interval was calculated using the Clopper-Pearson method. Participants with unknown survival status at the age specified in the analysis were excluded. At 36 months, there were 2 participants who were alive and still on study who had not yet reached the age specified in the analysis. As such, these participants were excluded from the calculation of percent surviving.
Change From Baseline In Serum Ferritin At Month 12, 24, And 36	Baseline, Month 12, Month 24, and Month 36	The median change in the inflammatory marker serum ferritin from Baseline to Months 12, 24, and 36 is presented. The number of participants analyzed reflects only those from the FAS who had both a baseline value and a value at the indicated timepoint (Months 12, 24, and 36). Results are reported in micrograms (ug)/L.
Number Of Participants Achieving And Maintaining Transfusion-free Hemoglobin Normalization (TFHN)	Baseline through Month 36	The number of participants achieving and maintaining TFHN are presented. For TFHN to be achieved, the participant had to meet the following criteria: 1. Two post baseline measurements of hemoglobin, at least 4 weeks apart, were above the age-adjusted lower limit of normal (LLN); 2. No known additional measurements of hemoglobin were below the age-adjusted LLN during the (minimum) 4 week period; 3. No transfusions were administered to the participant during the (minimum) 4 week period, or for 2 weeks prior to the first hemoglobin measurement in the (minimum) 4 week period. If all 3 criteria were met, a participant was considered to have achieved TFHN on the date of the first hemoglobin assessment in the 4 week period. A participant was considered to have maintained TFHN if he/she was transfusion free at Week 6 and had no abnormally low hemoglobin levels (levels below the age adjusted LLN) beginning at Week 8 of the study and continuing for at least 13 weeks (3 months).
Change From Baseline In Serum Transaminases (ALT And AST) At Month 12, 24, And 36	Baseline, Month 12, Month 24, and Month 36	This outcome measure evaluated the effects of sebelipase alfa on liver function by measuring the change from baseline in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at months 12, 24, and 36. Results are reported in units/liter (U/L).

Countries

Finland, Italy, United Kingdom, United States

Participant flow

Recruitment details

A total of 6 sites were initiated, and participants were treated at 5 sites in 4 countries (United Kingdom \[UK\], United States \[US\], Finland, Italy). One study site in the US was initiated but did not screen or treat any participants.

Pre-assignment details

The study consisted of a screening period of up to 3 weeks. Participants who met all eligibility criteria were enrolled, treated, and analyzed.

Participants by arm

Arm	Count
Open-Label Sebelipase Alfa All participants initiated qw IV infusions with sebelipase alfa at a dose of 1 mg/kg qw. A participant who met protocol defined dose escalation criteria at a dose of 1 mg/kg qw could be considered for a dose escalation to 3 mg/kg qw. If a participant continued to meet dose escalation criteria after at least 4 infusions at a dose of 3 mg/kg qw, the participant could be considered for a further dose escalation to 5 mg/kg qw. Under country-specific provisions (UK only), participants could be considered for a further dose escalation to 7.5 mg/kg qw if a thorough case review indicated that a participant continued to have evidence of disease progression at a dose of 5 mg/kg qw. All dose escalations were contingent upon acceptable safety and tolerability of preceding infusions and were undertaken by mutual agreement of the Investigator and Sponsor and after approval by an independent safety committee.	10
Total	10

Arm

Count

Open-Label Sebelipase Alfa

All participants initiated qw IV infusions with sebelipase alfa at a dose of 1 mg/kg qw. A participant who met protocol defined dose escalation criteria at a dose of 1 mg/kg qw could be considered for a dose escalation to 3 mg/kg qw. If a participant continued to meet dose escalation criteria after at least 4 infusions at a dose of 3 mg/kg qw, the participant could be considered for a further dose escalation to 5 mg/kg qw. Under country-specific provisions (UK only), participants could be considered for a further dose escalation to 7.5 mg/kg qw if a thorough case review indicated that a participant continued to have evidence of disease progression at a dose of 5 mg/kg qw. All dose escalations were contingent upon acceptable safety and tolerability of preceding infusions and were undertaken by mutual agreement of the Investigator and Sponsor and after approval by an independent safety committee.

Total

Withdrawals & dropouts

Period	Reason	FG000
Overall Study	Death	2
Overall Study	Sponsor Study Termination	2

Baseline characteristics

Characteristic	Open-Label Sebelipase Alfa
Age, Continuous	4.13 months STANDARD_DEVIATION 2.859
Race/Ethnicity, Customized Race/Ethnicity American Indian or Alaska Native	1 Participants
Race/Ethnicity, Customized Race/Ethnicity Asian	6 Participants
Race/Ethnicity, Customized Race/Ethnicity Egyptian	1 Participants
Race/Ethnicity, Customized Race/Ethnicity Turkish Kurdish	1 Participants
Race/Ethnicity, Customized Race/Ethnicity White	1 Participants
Sex: Female, Male Female	5 Participants
Sex: Female, Male Male	5 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk	EG003 affected / at risk
deaths Total, all-cause mortality	1 / 10	0 / 9	1 / 7	0 / 1
other Total, other adverse events	9 / 10	9 / 9	7 / 7	1 / 1
serious Total, serious adverse events	8 / 10	8 / 9	7 / 7	1 / 1

Outcome results

Primary

Participants Experiencing Severe Treatment-emergent Adverse Events (TEAEs)

The number of participants experiencing severe TEAEs is presented for participants who received sebelipase alfa in this open-label study. Adverse events were obtained through spontaneous reporting or elicited by specific questioning or examination of the participant's parent or legal guardian. An adverse event was defined as any new untoward medical occurrence or worsening of a pre-existing medical condition in a participant, whether or not causally related to administration of study drug. Adverse event severity was graded by the Investigator as mild, moderate, or severe based on definitions developed from Clinical Data Interchange Standards Consortium Study Data Tabulation Model standard terminology v3.1.1. Adverse events reporting was from the date of informed consent until completion of the follow-up visit at approximately 30 days after the last dose of study drug. A summary of all serious and other nonserious AEs regardless of causality is located in the Reported AE module.

Time frame: Screening through Month 37