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Study of Eteplirsen in DMD Patients

An Open-Label, Multi-Center, Study With a Concurrent Untreated Control Arm to Evaluate the Efficacy and Safety of Eteplirsen in Duchenne Muscular Dystrophy

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02255552
Acronym
PROMOVI
Enrollment
109
Registered
2014-10-02
Start date
2014-11-17
Completion date
2019-06-14
Last updated
2021-01-25

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

Conditions

Duchenne Muscular Dystrophy (DMD)

Keywords

DMD, Duchenne, Eteplirsen, dystrophy, dystrophin, exon 51

Brief summary

The main objective of this study is to provide evidence of efficacy of eteplirsen (AVI-4658) in Duchenne muscular dystrophy (DMD) patients that are amenable to skipping exon 51. Additional objectives include evaluation of safety, biomarkers and the long-term effects of eteplirsen up to 96 weeks, followed by a safety extension (not to exceed 48 weeks).

Detailed description

This is an open-label, multi-center study to evaluate the efficacy and safety of eteplirsen in patients with genotypically confirmed Duchenne muscular dystrophy (DMD) with genetic deletions amenable to exon 51 skipping (treated group), with a concurrent control arm of DMD patients not amenable to exon 51 skipping (untreated group). Following primary efficacy endpoints, dosing will continue to week 144 to evaluate the long term effects of eteplirsen. Patients in the treated group will receive once weekly intravenous (IV) infusions of 30 mg/kg Eteplirsen for 96 weeks, followed by a safety extension (not to exceed 48 weeks). Patients in the untreated group will not receive treatment. Clinical efficacy will be assessed at regularly scheduled study visits, including functional tests such as the six minute walk test. Patients in the treated group will undergo a muscle biopsy at Baseline and a second muscle biopsy over the course of the study. Patients in the untreated group will not undergo muscle biopsy. Safety, including adverse event monitoring and routine laboratory assessments, will be continuously monitored for all patients.

Interventions

Eteplirsen 30 mg/kg will be administered as an IV infusion once a week for 96 weeks, followed by a safety extension (not to exceed 48 weeks).

Sponsors

Sarepta Therapeutics, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
MALE
Age
7 Years to 16 Years
Healthy volunteers
No

Inclusion criteria

* Male 7-16 years old * Diagnosed with DMD, genotypically confirmed * Stable dose of corticosteroids for at least 24 weeks * Have intact right and left alternative upper muscle groups * Mean 6MWT greater than 300m (primary analysis on 300 to 450 meters) * Stable pulmonary and cardiac function: predicted FVC equal to or greater than 50% and LVEF of greater than 50%

Exclusion criteria

* Previous treatment with drisapersen or any other RNA antisense agent or any gene therapy within the last 6 months * Participation in any other DMD interventional clinical study within 12 weeks * Major surgery within 3 months * Presence of other clinically significant illness * Major change in the physical therapy regime within 3 months Other inclusion/

Design outcomes

Primary

MeasureTime frameDescription
Change From Baseline in the 6 Minute Walk Test (6MWT) Distance at Week 96Baseline, Week 966MWT was performed by standardized procedures for all participants. Participants were asked to walk a set course of 25 meters for 6 minutes (timed), and the distance walked (in meters) was recorded. Change from baseline in 6MWT distance at Week 96 was reported.

Secondary

MeasureTime frameDescription
Number of Participants Having Ability to Rise Independently From the Floor Determined Based on North Star Ambulatory Assessment (NSAA) at Week 96Week 96NSAA is a clinician-administered scale that rates participant performance on 17-items and included assessments of abilities such as 10-meter walk/run, rising from a sit to stand, standing on 1 leg, climbing a box step, descending a box step, rising from lying to sitting, rising from the floor, lifting the head, standing on heels, and jumping. For all activities, participants were graded as follows: 0 = unable to achieve goal independently; 1 = modified method but achieves goal independent of physical assistance from another and 2 = normal, no obvious modification of activity. Number of participants having ability to rise independently from the floor indicated by a NSAA Rise from floor sub score greater than 0 (unable to achieve goal independently) was reported.
Number of Participants Who Lost Ambulation (LOA) by Week 96Up to Week 96Number of participants who lost ambulation (LOA) by Week 96 was reported. Participant were considered non-ambulatory if each of the 3 conditions below were met: NSAA walk subscore was 0 (unable to achieve goal independently) on 2 consecutive days within a visit or NSAA was not done due to reason related to non-ambulation; 6MWT was not done with any reason related to permanent non-ambulation; and no later data showing this participant was still ambulatory. This was not required if non ambulatory status occurred at the time of early withdrawal or at the end of Week 96 assessment. NSAA is a 17-item scale to assess the participant's abilities; total score range from 0 (if all the activities are failed) to 34 (if all the activities are achieved) with higher scores indicating better performance on the assessment/ fully-independent function.
Change From Baseline in Dystrophin Protein Levels Determined by Western Blot at Week 96Baseline, Week 96Change from baseline in dystrophin protein levels (in muscle biopsy samples) were determined by Western blot. For each time point, 2 blocks of tissues were analyzed by Western blot, each with 2 replicates of gels to determine the dystrophin level as compared to a healthy individual (Percent Normal). The block average value from 2 replicate gels was computed. The overall average was calculated as the mean of the block average values. The overall average values were used for all analyses. In case only 1 gel was available for a block, then that value was used as the block average value.
Change From Baseline in North Star Ambulatory Assessment (NSAA) Total Scores at Week 96Baseline, Week 96NSAA is a clinician-administered scale that rates participant performance on 17-items and included assessments of abilities such as 10-meter walk/run, rising from a sit to stand, standing on 1 leg, climbing a box step, descending a box step, rising from lying to sitting, rising from the floor, lifting the head, standing on heels, and jumping. Participant were graded as follows: 0 = unable to achieve goal independently; 1 = modified method but achieves goal independent of physical assistance from another and 2 = normal, no obvious modification of activity. NSAA total score was derived by summing the scores for all the individual items and range from 0 (if all the activities are failed) to 34 (if all the activities are achieved) with higher scores indicating better performance on the assessment/ fully-independent function.
Change From Baseline in Dystrophin Intensity Levels Determined by Immunohistochemistry (IHC) at Week 96Baseline, Week 96Change from baseline in dystrophin intensity levels (in muscle biopsy samples) was determined by Immunohistochemistry.
Change From Baseline in Forced Vital Capacity Percent (FVC%) Predicted at Weeks 96Baseline, Week 96FVC is the total amount of air exhaled during the forced expiratory volume test that is measured during spirometry; and is the most important measurement of lung function. This test requires participant to breath into a tube connected to a machine that measures the amount of air that can be moved in and out of the lungs after taking an inhaled bronchodilator medicine which is used to dilate participant's bronchial (breathing) tubes. Percent of predicted FVC = (observed value) / (predicted value) \* 100%.

Countries

United States

Participant flow

Recruitment details

The study was conducted at 40 sites in the United States.

Pre-assignment details

A total of 109 participants were enrolled in the study. Only 79 participants were treated and the remaining participants were not applicable for treatment as those participants assessed under Untreated arm.

Participants by arm

ArmCount
Eteplirsen 30 mg/kg
Participants with genotypically confirmed Duchenne muscular dystrophy (DMD) with genetic deletions amenable to treatment by exon 51 skipping received Eteplirsen as an Intravenous (IV) infusion, at a dose of 30 milligram per kilogram (mg/kg) once weekly for 96 weeks.
79
Untreated Control Group (Non-exon 51 Amenable Participants)
DMD participants with mutations amenable to skipping of any exon(s) except exon 51 did not receive any treatment, but completed study assessments up to 96 weeks.
30
Total109

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyParticipants enrolled into another study011
Overall StudyWithdrawal by Subject14

Baseline characteristics

CharacteristicEteplirsen 30 mg/kgTotalUntreated Control Group (Non-exon 51 Amenable Participants)
Age, Continuous9.1 Years
STANDARD_DEVIATION 2.04
9.0 Years
STANDARD_DEVIATION 1.96
8.8 Years
STANDARD_DEVIATION 1.76
Ethnicity (NIH/OMB)
Hispanic or Latino
7 Participants13 Participants6 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
71 Participants95 Participants24 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
1 Participants1 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
5 Participants6 Participants1 Participants
Race (NIH/OMB)
Black or African American
2 Participants2 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
2 Participants2 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
3 Participants6 Participants3 Participants
Race (NIH/OMB)
White
67 Participants93 Participants26 Participants
Region of Enrollment
United States
79 Participants109 Participants30 Participants
Sex: Female, Male
Female
0 Participants0 Participants0 Participants
Sex: Female, Male
Male
79 Participants109 Participants30 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 790 / 30
other
Total, other adverse events
78 / 7924 / 30
serious
Total, serious adverse events
11 / 792 / 30

Outcome results

Primary

Change From Baseline in the 6 Minute Walk Test (6MWT) Distance at Week 96

6MWT was performed by standardized procedures for all participants. Participants were asked to walk a set course of 25 meters for 6 minutes (timed), and the distance walked (in meters) was recorded. Change from baseline in 6MWT distance at Week 96 was reported.

Time frame: Baseline, Week 96

Population: Primary efficacy set: all participants in the efficacy set (all participants in eteplirsen-treated and untreated control groups who had at least 1 post-baseline functional assessment) who had a Baseline 6MWT distance of 300 to 450 meters, inclusive. Here, Overall Number of Participants Analyzed=participants evaluable for this outcome measure.

ArmMeasureValue (MEAN)Dispersion
Eteplirsen 30 mg/kgChange From Baseline in the 6 Minute Walk Test (6MWT) Distance at Week 96-117.91 metersStandard Deviation 128.488
Untreated Control Group (Non-exon 51 Amenable Participants)Change From Baseline in the 6 Minute Walk Test (6MWT) Distance at Week 96-133.56 metersStandard Deviation 129.333
Secondary

Change From Baseline in Dystrophin Intensity Levels Determined by Immunohistochemistry (IHC) at Week 96

Change from baseline in dystrophin intensity levels (in muscle biopsy samples) was determined by Immunohistochemistry.

Time frame: Baseline, Week 96

Population: Analysis Set consisted of a subset of participants who received at least 1 dose of eteplirsen and had both baseline and 1 post-dose muscle biopsy samples evaluable for dystrophin expression at Week 96. Here, Overall Number of Participants Analyzed signifies number of participants who were evaluable for this outcome measure. Data for this outcome measure was not planned to be collected and analyzed for the Untreated Control group.

ArmMeasureValue (MEAN)Dispersion
Eteplirsen 30 mg/kgChange From Baseline in Dystrophin Intensity Levels Determined by Immunohistochemistry (IHC) at Week 960.030 Percent dystrophin positive fibersStandard Deviation 0.036
Secondary

Change From Baseline in Dystrophin Protein Levels Determined by Western Blot at Week 96

Change from baseline in dystrophin protein levels (in muscle biopsy samples) were determined by Western blot. For each time point, 2 blocks of tissues were analyzed by Western blot, each with 2 replicates of gels to determine the dystrophin level as compared to a healthy individual (Percent Normal). The block average value from 2 replicate gels was computed. The overall average was calculated as the mean of the block average values. The overall average values were used for all analyses. In case only 1 gel was available for a block, then that value was used as the block average value.

Time frame: Baseline, Week 96

Population: Analysis Set consisted of a subset of participants who received at least 1 dose of eteplirsen and had both baseline and 1 post-dose muscle biopsy samples evaluable for dystrophin expression at Week 96. Here, Overall Number of Participants Analyzed signifies number of participants who were evaluable for this outcome measure. Data for this outcome measure was not planned to be collected and analyzed for the Untreated Control group.

ArmMeasureValue (MEAN)Dispersion
Eteplirsen 30 mg/kgChange From Baseline in Dystrophin Protein Levels Determined by Western Blot at Week 960.516 Percent Normal Dystrophin Protein LevelStandard Deviation 0.7236
Secondary

Change From Baseline in Forced Vital Capacity Percent (FVC%) Predicted at Weeks 96

FVC is the total amount of air exhaled during the forced expiratory volume test that is measured during spirometry; and is the most important measurement of lung function. This test requires participant to breath into a tube connected to a machine that measures the amount of air that can be moved in and out of the lungs after taking an inhaled bronchodilator medicine which is used to dilate participant's bronchial (breathing) tubes. Percent of predicted FVC = (observed value) / (predicted value) \* 100%.

Time frame: Baseline, Week 96

Population: Primary efficacy set: all participants in the efficacy set (all participants in eteplirsen-treated and untreated control groups who had at least 1 post-baseline functional assessment) who had a Baseline 6MWT distance of 300 to 450 meters, inclusive. Here, Overall Number of Participants Analyzed=participants evaluable for this outcome measure.

ArmMeasureValue (MEAN)Dispersion
Eteplirsen 30 mg/kgChange From Baseline in Forced Vital Capacity Percent (FVC%) Predicted at Weeks 96-3.413 Percentage of predicted FVCStandard Deviation 12.4011
Untreated Control Group (Non-exon 51 Amenable Participants)Change From Baseline in Forced Vital Capacity Percent (FVC%) Predicted at Weeks 96-2.461 Percentage of predicted FVCStandard Deviation 9.6
Secondary

Change From Baseline in North Star Ambulatory Assessment (NSAA) Total Scores at Week 96

NSAA is a clinician-administered scale that rates participant performance on 17-items and included assessments of abilities such as 10-meter walk/run, rising from a sit to stand, standing on 1 leg, climbing a box step, descending a box step, rising from lying to sitting, rising from the floor, lifting the head, standing on heels, and jumping. Participant were graded as follows: 0 = unable to achieve goal independently; 1 = modified method but achieves goal independent of physical assistance from another and 2 = normal, no obvious modification of activity. NSAA total score was derived by summing the scores for all the individual items and range from 0 (if all the activities are failed) to 34 (if all the activities are achieved) with higher scores indicating better performance on the assessment/ fully-independent function.

Time frame: Baseline, Week 96

Population: Primary efficacy: all participants in the efficacy set (all participants in eteplirsen-treated and untreated control groups who had at least 1 post-baseline functional assessment) who had a Baseline 6MWT distance of 300 to 450 meters, inclusive. Here, Overall Number of Participants Analyzed=participants evaluable for this outcome measure.

ArmMeasureValue (MEAN)Dispersion
Eteplirsen 30 mg/kgChange From Baseline in North Star Ambulatory Assessment (NSAA) Total Scores at Week 96-7.23 Unit on scaleStandard Deviation 5.173
Untreated Control Group (Non-exon 51 Amenable Participants)Change From Baseline in North Star Ambulatory Assessment (NSAA) Total Scores at Week 96-8.44 Unit on scaleStandard Deviation 9.812
Secondary

Number of Participants Having Ability to Rise Independently From the Floor Determined Based on North Star Ambulatory Assessment (NSAA) at Week 96

NSAA is a clinician-administered scale that rates participant performance on 17-items and included assessments of abilities such as 10-meter walk/run, rising from a sit to stand, standing on 1 leg, climbing a box step, descending a box step, rising from lying to sitting, rising from the floor, lifting the head, standing on heels, and jumping. For all activities, participants were graded as follows: 0 = unable to achieve goal independently; 1 = modified method but achieves goal independent of physical assistance from another and 2 = normal, no obvious modification of activity. Number of participants having ability to rise independently from the floor indicated by a NSAA Rise from floor sub score greater than 0 (unable to achieve goal independently) was reported.

Time frame: Week 96

Population: Primary efficacy set: all participants in the efficacy set (all participants in eteplirsen-treated and untreated control groups who had at least 1 post-baseline functional assessment) who had a Baseline 6MWT distance of 300 to 450 meters, inclusive. Here, Overall Number of Participants Analyzed=participants evaluable for this outcome measure.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Eteplirsen 30 mg/kgNumber of Participants Having Ability to Rise Independently From the Floor Determined Based on North Star Ambulatory Assessment (NSAA) at Week 9633 Participants
Untreated Control Group (Non-exon 51 Amenable Participants)Number of Participants Having Ability to Rise Independently From the Floor Determined Based on North Star Ambulatory Assessment (NSAA) at Week 963 Participants
Secondary

Number of Participants Who Lost Ambulation (LOA) by Week 96

Number of participants who lost ambulation (LOA) by Week 96 was reported. Participant were considered non-ambulatory if each of the 3 conditions below were met: NSAA walk subscore was 0 (unable to achieve goal independently) on 2 consecutive days within a visit or NSAA was not done due to reason related to non-ambulation; 6MWT was not done with any reason related to permanent non-ambulation; and no later data showing this participant was still ambulatory. This was not required if non ambulatory status occurred at the time of early withdrawal or at the end of Week 96 assessment. NSAA is a 17-item scale to assess the participant's abilities; total score range from 0 (if all the activities are failed) to 34 (if all the activities are achieved) with higher scores indicating better performance on the assessment/ fully-independent function.

Time frame: Up to Week 96

Population: Primary efficacy set consisted of all participants in the efficacy set (all participants in eteplirsen-treated and untreated control groups who had at least 1 post-baseline functional assessment) who had a Baseline 6MWT distance of 300 to 450 meters, inclusive.

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Eteplirsen 30 mg/kgNumber of Participants Who Lost Ambulation (LOA) by Week 9612 Participants
Untreated Control Group (Non-exon 51 Amenable Participants)Number of Participants Who Lost Ambulation (LOA) by Week 961 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026