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Safety, Tolerability, Efficacy of MTP-131 for Treatment of Mitochondrial Disease in Subjects From the MMPOWER Study

A Phase 2 Randomized, Double-Blind, Placebo-Controlled Crossover Study to Evaluate Safety, Tolerability, and Efficacy of Subcutaneous Injections of MTP-131 in Subjects With Mitochondrial Myopathy Previously Treated in the SPIMM-201 Study

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02805790
Acronym
MMPOWER-2
Enrollment
30
Registered
2016-06-20
Start date
2016-08-22
Completion date
2017-03-23
Last updated
2020-07-17

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

Conditions

Primary Mitochondrial Disease

Keywords

Primary Mitochondrial Disease, Mitochondrial Myopathy, Elamipretide, MTP-131, Bendavia™

Brief summary

This randomized, double-blind, placebo-controlled, crossover study screened 32 subjects with primary mitochondrial myopathy (PMM) to evaluate the safety, tolerability, pharmacokinetics (PK), and efficacy of subcutaneous elamipretide in this patient population.

Detailed description

This randomized, double-blind, placebo-controlled, crossover study screened 32 subjects with primary mitochondrial myopathy (PMM) who had completed participation in the SPIMM-201 study where they had received 5 days of intravenous (IV) elamipretide (0.01, 0.10, or 0.25 mg/kg/hour infused for 2 hours) or placebo (randomized 3:1). The primary objective was to evaluate the effect of single daily subcutaneous (SC) doses of elamipretide administered for 4 weeks on the 6-minute walking distance (6MWD). Subjects were randomized (1:1) to one of two sequence groups: 4-weeks of treatment with 40 mg elamipretide administered once daily SC in Treatment Period 1 followed by 4-weeks of treatment with placebo administered once daily SC in Treatment Period 2 (separated by a 4-week washout period), or vice versa. Each sequence group went through 5 distinct periods: Screening, Treatment Period 1, Washout, Treatment Period 2, and Follow-Up. Safety, tolerability, pharmacokinetics (PK), and efficacy of subcutaneous elamipretide in this patient population were analyzed.

Interventions

4 weeks of treatment with 40 mg elamipretide administered once daily subcutaneously

DRUGPlacebo

4 weeks of treatment with placebo administered once daily subcutaneously

Sponsors

Stealth BioTherapeutics Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Subject completed participation in the SPIMM-201 study without a significant protocol deviation that would suggest the subject may not be able to complete all study requirements in the opinion of the Sponsor * Subject must reside in North America for the duration of the study * Subject has not received study drug in the SPIMM-201 study within 3 weeks prior to Screening * Women of childbearing potential must agree to use 1 of the methods of birth control specified in the protocol from the date they sign the informed consent form (ICF) until two months after the last dose of study drug * Subject has been on stable (unchanged and constant) medications (including over-the counter treatments, vitamins, or supplements) for at least 1 month prior to the Baseline Visit

Exclusion criteria

* Subject has any prior or current medical condition that, in the judgment of the Investigator, would prevent the subject from safely participating in and/or completing all study requirements (i.e. unstable angina or recent myocardial infarction) * Subject has received any investigational compound and/or has participated in another interventional clinical study within 30 days prior to the Baseline Visit or is concurrently enrolled in any non-interventional research of any type judged to be scientifically or medically incompatible with the study as deemed by the Investigator in consultation with the Sponsor * Subject experienced an adverse reaction to study drug in the SPIMM-201 study that contraindicates further treatment with elamipretide in the opinion of the Investigator and/or Sponsor * Female subjects who are pregnant, planning to become pregnant, or lactating * Subject has undergone an in-patient hospitalization within the 1 month prior to the Screening Visit or is likely to need in-patient hospitalization or a surgical procedure during the course of the study * Subject has a creatinine clearance ≤30 mL/min as calculated by the Cockcroft Gault equation * Subject has a corrected QT interval (QTc) elongation defined as a QTc \>450 msec in male subjects and \>480msec in female subjects. Note: At the initial electrocardiogram (ECG), if QTc exceeds these parameters, the ECG may be repeated 2 more times, and the average of the 3 QTc values used to determine the subjects eligibility * Subject has uncontrolled hypertension in the judgment of the Investigator (e.g. elevated above \>160 mmHg systolic or \>100 mmHg diastolic despite appropriate treatment on two consecutive readings) * Subject has a history of clinically significant hypersensitivity or allergy to any of the excipients contained in the study drug * Subject has a history of active alcoholism or drug addiction during the year before the Screening Visit

Design outcomes

Primary

MeasureTime frameDescription
Distance Walked on the 6-minute Walk Test (6MWT) by VisitEnd of Week 4 and End of Week 12Distance in meters walked on the 6-minute walk test (6MWT) at end of treatment, where end of treatment means end of week 4 for Period 1 and end of week 12 for Period 2.

Secondary

MeasureTime frameDescription
Wrist Accelerometer Counts by DayLast 7 days prior to the date of end of treatment visitWrist Accelerometer Counts by the last 7 days prior to the date of the end of treatment visit; End of treatment being end of Week 4 for Treatment Period 1 and end of Week 12 for Treatment Period 2. Subjects wore an activity monitor, or wrist accelerometer, on their wrist daily (from the Screening Visit to the End-of-Study/Early Discontinuation Visit). As a measure of physical activity and mobility, subjects wore an activity monitor, or wrist accelerometer, which measured mean vector magnitude of accelerations per daywith higher counts indicating a more active status. Raw acceleration data was converted into proprietary counts which was used to estimate physical activity. The data was transformed from 30 Hz data into 1 minute epoch data; this 1 minute epoch data were used for the analysis of as the vector magnitude of the wrist data.
Average Hip Accelerator Counts by DayLast 7 days prior to the date of end of treatment visitAverage Hip Accelerator Counts by last 7 days predose, and prior to end of treatment; End of treatment being Week 4 for Treatment Period 1 and Week 12 for Treatment Period 2. As a measure of physical activity and mobility, subjects wore an activity monitor, or hip accelerometer, on their hip (or belt line) daily during waking hours (minimum of at least 7 consecutive days immediately prior to study drug administration in each Treatment Period \[Predose; at Visit 2 for Treatment Period 1 and at Visit 4 for Treatment Period 2\]), and at the end of each Treatment Period \[at Visit 3 for Treatment Period 1 and Visit 5 for Treatment Period 2\]), which measured average acceleration per day, with higher counts indicating a more active status. Raw acceleration data was converted into proprietary counts which was used to estimate physical activity. The data was transformed from 30 Hz data into 1 minute epoch data; this 1 minute epoch data was used for the analysis of mean vertical axis (Y) cou
Neuro-QoL Fatigue Short Form Score: Total T-Scores (Question 1-8)End of Week 4 and End of Week 12Participants respond to the following statements of the Quality of Life in Neurological Disorders Fatigue Assessment (Neuro-QOL Fatigue Item Bank at end of treatment: I felt exhausted;I felt that I had no energy; I felt fatigued; I was too tired to do my household chores;I was too tired to leave the house;I was frustrated by being too tired to do the things I wanted to do; I felt tired; I had to limit my social activity because I was tired.Individual response options range from a score of 1 to 5, where 1=Never, 2=Rarely, 3=Sometimes, 4=Often, and 5=Always for end of treatment, where end of treatment period is end of week 4 for period 1, and end of week 12 for period 2. Raw scores are calculated as simple summed scores to an Item Response Theory Metric referred to as the T-score metric. Higher T-score means more fatigue, which means a worse outcome, with possible scores ranging from 29.5 to 74.1. Mean population T-score and standard deviation was reported.
Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) Total Fatigue Score by WeekLast 7 days of Week 4 and Last 7 days of Week 12Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) Total Fatigue score at end of treatment (sum of Q1 to Q4; tiredness/muscle weakness) is scored as follows: 1=Not at all, 2=Mild, 3=Moderate, and 4=Severe. Total score range is 4-16; lower score means less fatigue and better outcome, higher score means more fatigue and worse outcome. Participants rate the following: Tiredness at rest, Tiredness during activities, Muscle weakness at rest, Muscle weakness during activities, at the end of each treatment period, where end of treatment period is the weekly average of the last 7 days of week 4 for period 1 and the last 7 days of week 12 for period 2.
Triple Timed Up and Go (3TUG) Test by VisitEnd of Week 4 and End of Week 12Participant performed 3TUG test after the 6MWT, and after at least 15 minutes rest prior to study drug administration in each Treatment Period (End of Week 4 for Period 1 and End of Week 12 for Period 2.) Participant was directed to stand up from chair, walk at normal pace to the line on the floor 3 meters away,turn, walk back to the chair at normal pace, sit down again; activity was timed, in seconds. Activity is repeated 3 times consecutively without rest and an average time is calculated.
Patient Global Assessment [PGA] Score by Visit, ContinuousEnd of Week 4 and End of Week 12Patient-reported current health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2. PGA Scale is as follows: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher score means worse health status, means worse outcome.
Patient Global Assessment by Visit, CategoricalEnd of Week 4 and End of Week 12Patient-reported current health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2. PGA Scale is as follows: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher score means worse health status, means worse outcome. Excellent means excellent health, means better outcome; poor means poor health, means worse outcome.
Physician Global Assessment (PhGA) By Visit, ContinuousEnd of Week 4 and End of Week 12Physician Global Assessment (PhGA) Physician-reported overall health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2.: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher scores equal worse outcome.
Physician Global Assessment (PhGA) By Visit, CategoricalEnd of Week 4 and End of Week 12Physician Global Assessment (PhGA) Physician-reported overall health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2.: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher scores equal worse outcome. Excellent means excellent health, means better outcome; poor means poor health, means worse outcome.

Countries

United States

Participant flow

Participants by arm

ArmCount
Elamipretide, Then Placebo
Participants first received 40 mg of elamipretide once daily subcutaneously for 4 weeks. After a washout period of 4 weeks, they then received placebo administered once daily subcutaneously for 4 weeks.
14
Placebo, Then Elamipretide
Participants first received placebo once daily subcutaneously for 4 weeks. After a washout period of 4 weeks, they then received 40 mg of elamipretide once daily subcutaneously for 4 weeks.
16
Total30

Withdrawals & dropouts

PeriodReasonFG000FG001
Second Intervention (4 Weeks)Physician Decision01

Baseline characteristics

CharacteristicElamipretide, Then PlaceboPlacebo, Then ElamipretideTotal
Age, Continuous41.5 years
STANDARD_DEVIATION 16.67
48.6 years
STANDARD_DEVIATION 9.68
45.3 years
STANDARD_DEVIATION 13.63
Body Mass Index22.8 kg/m^2
STANDARD_DEVIATION 5.19
25.3 kg/m^2
STANDARD_DEVIATION 5.46
24.1 kg/m^2
STANDARD_DEVIATION 5.39
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
13 Participants16 Participants29 Participants
Region of Enrollment
United States
14 participants16 participants30 participants
Sex: Female, Male
Female
10 Participants15 Participants25 Participants
Sex: Female, Male
Male
4 Participants1 Participants5 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 300 / 30
other
Total, other adverse events
30 / 3015 / 30
serious
Total, serious adverse events
0 / 300 / 30

Outcome results

Primary

Distance Walked on the 6-minute Walk Test (6MWT) by Visit

Distance in meters walked on the 6-minute walk test (6MWT) at end of treatment, where end of treatment means end of week 4 for Period 1 and end of week 12 for Period 2.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom the distance walked on the 6MWT was measured.

ArmMeasureValue (MEAN)Dispersion
ElamipretideDistance Walked on the 6-minute Walk Test (6MWT) by Visit394.1 metersStandard Deviation 134.16
PlaceboDistance Walked on the 6-minute Walk Test (6MWT) by Visit378.2 metersStandard Deviation 125.1
Secondary

Average Hip Accelerator Counts by Day

Average Hip Accelerator Counts by last 7 days predose, and prior to end of treatment; End of treatment being Week 4 for Treatment Period 1 and Week 12 for Treatment Period 2. As a measure of physical activity and mobility, subjects wore an activity monitor, or hip accelerometer, on their hip (or belt line) daily during waking hours (minimum of at least 7 consecutive days immediately prior to study drug administration in each Treatment Period \[Predose; at Visit 2 for Treatment Period 1 and at Visit 4 for Treatment Period 2\]), and at the end of each Treatment Period \[at Visit 3 for Treatment Period 1 and Visit 5 for Treatment Period 2\]), which measured average acceleration per day, with higher counts indicating a more active status. Raw acceleration data was converted into proprietary counts which was used to estimate physical activity. The data was transformed from 30 Hz data into 1 minute epoch data; this 1 minute epoch data was used for the analysis of mean vertical axis (Y) cou

Time frame: Last 7 days prior to the date of end of treatment visit

Population: All participants for whom hip accelerometer counts by day was measured.

ArmMeasureGroupValue (MEAN)Dispersion
ElamipretideAverage Hip Accelerator Counts by DayPredose384.2 counts by dayStandard Deviation 130.7
ElamipretideAverage Hip Accelerator Counts by DayEnd of Treatment150.6 counts by dayStandard Deviation 162.13
PlaceboAverage Hip Accelerator Counts by DayPredose380.6 counts by dayStandard Deviation 126.43
PlaceboAverage Hip Accelerator Counts by DayEnd of Treatment148.1 counts by dayStandard Deviation 115.04
Secondary

Neuro-QoL Fatigue Short Form Score: Total T-Scores (Question 1-8)

Participants respond to the following statements of the Quality of Life in Neurological Disorders Fatigue Assessment (Neuro-QOL Fatigue Item Bank at end of treatment: I felt exhausted;I felt that I had no energy; I felt fatigued; I was too tired to do my household chores;I was too tired to leave the house;I was frustrated by being too tired to do the things I wanted to do; I felt tired; I had to limit my social activity because I was tired.Individual response options range from a score of 1 to 5, where 1=Never, 2=Rarely, 3=Sometimes, 4=Often, and 5=Always for end of treatment, where end of treatment period is end of week 4 for period 1, and end of week 12 for period 2. Raw scores are calculated as simple summed scores to an Item Response Theory Metric referred to as the T-score metric. Higher T-score means more fatigue, which means a worse outcome, with possible scores ranging from 29.5 to 74.1. Mean population T-score and standard deviation was reported.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom Neuro-QoL Fatigue Short Form Score was measured.

ArmMeasureValue (MEAN)Dispersion
ElamipretideNeuro-QoL Fatigue Short Form Score: Total T-Scores (Question 1-8)50.9 T-scoreStandard Deviation 7.69
PlaceboNeuro-QoL Fatigue Short Form Score: Total T-Scores (Question 1-8)54.7 T-scoreStandard Deviation 10.35
Secondary

Patient Global Assessment by Visit, Categorical

Patient-reported current health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2. PGA Scale is as follows: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher score means worse health status, means worse outcome. Excellent means excellent health, means better outcome; poor means poor health, means worse outcome.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom the Patient Global Assessment was measured.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
ElamipretidePatient Global Assessment by Visit, CategoricalExcellent1 Participants
ElamipretidePatient Global Assessment by Visit, CategoricalFair11 Participants
ElamipretidePatient Global Assessment by Visit, CategoricalGood12 Participants
ElamipretidePatient Global Assessment by Visit, CategoricalPoor3 Participants
ElamipretidePatient Global Assessment by Visit, CategoricalVery Good2 Participants
PlaceboPatient Global Assessment by Visit, CategoricalPoor7 Participants
PlaceboPatient Global Assessment by Visit, CategoricalVery Good2 Participants
PlaceboPatient Global Assessment by Visit, CategoricalExcellent1 Participants
PlaceboPatient Global Assessment by Visit, CategoricalGood8 Participants
PlaceboPatient Global Assessment by Visit, CategoricalFair12 Participants
Secondary

Patient Global Assessment [PGA] Score by Visit, Continuous

Patient-reported current health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2. PGA Scale is as follows: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher score means worse health status, means worse outcome.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom the Patient Global Assessment was measured.

ArmMeasureValue (MEAN)Dispersion
ElamipretidePatient Global Assessment [PGA] Score by Visit, Continuous3.4 score on a scaleStandard Deviation 0.91
PlaceboPatient Global Assessment [PGA] Score by Visit, Continuous3.7 score on a scaleStandard Deviation 1.01
Secondary

Physician Global Assessment (PhGA) By Visit, Categorical

Physician Global Assessment (PhGA) Physician-reported overall health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2.: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher scores equal worse outcome. Excellent means excellent health, means better outcome; poor means poor health, means worse outcome.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom the Physician Global Assessment was measured.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
ElamipretidePhysician Global Assessment (PhGA) By Visit, CategoricalPoor2 Participants
ElamipretidePhysician Global Assessment (PhGA) By Visit, CategoricalExcellent0 Participants
ElamipretidePhysician Global Assessment (PhGA) By Visit, CategoricalVery Good6 Participants
ElamipretidePhysician Global Assessment (PhGA) By Visit, CategoricalGood17 Participants
ElamipretidePhysician Global Assessment (PhGA) By Visit, CategoricalFair4 Participants
PlaceboPhysician Global Assessment (PhGA) By Visit, CategoricalFair10 Participants
PlaceboPhysician Global Assessment (PhGA) By Visit, CategoricalGood13 Participants
PlaceboPhysician Global Assessment (PhGA) By Visit, CategoricalExcellent0 Participants
PlaceboPhysician Global Assessment (PhGA) By Visit, CategoricalPoor2 Participants
PlaceboPhysician Global Assessment (PhGA) By Visit, CategoricalVery Good5 Participants
Secondary

Physician Global Assessment (PhGA) By Visit, Continuous

Physician Global Assessment (PhGA) Physician-reported overall health status at end of treatment, where end of treatment means End of Week 4 for Period 1 and End of Week 12 for Period 2.: 1=Excellent, 2=Very good, 3=Good, 4=Fair, and 5=Poor. Higher scores equal worse outcome.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom the Physician Global Assessment was measured.

ArmMeasureValue (MEAN)Dispersion
ElamipretidePhysician Global Assessment (PhGA) By Visit, Continuous3.1 score on a scaleStandard Deviation 0.8
PlaceboPhysician Global Assessment (PhGA) By Visit, Continuous3.3 score on a scaleStandard Deviation 0.84
Secondary

Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) Total Fatigue Score by Week

Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) Total Fatigue score at end of treatment (sum of Q1 to Q4; tiredness/muscle weakness) is scored as follows: 1=Not at all, 2=Mild, 3=Moderate, and 4=Severe. Total score range is 4-16; lower score means less fatigue and better outcome, higher score means more fatigue and worse outcome. Participants rate the following: Tiredness at rest, Tiredness during activities, Muscle weakness at rest, Muscle weakness during activities, at the end of each treatment period, where end of treatment period is the weekly average of the last 7 days of week 4 for period 1 and the last 7 days of week 12 for period 2.

Time frame: Last 7 days of Week 4 and Last 7 days of Week 12

Population: All participants for whom PMMSA was measured at end of treatment.

ArmMeasureValue (MEAN)Dispersion
ElamipretidePrimary Mitochondrial Myopathy Symptom Assessment (PMMSA) Total Fatigue Score by Week9.1 score on a scaleStandard Deviation 2.35
PlaceboPrimary Mitochondrial Myopathy Symptom Assessment (PMMSA) Total Fatigue Score by Week10.7 score on a scaleStandard Deviation 2.88
Secondary

Triple Timed Up and Go (3TUG) Test by Visit

Participant performed 3TUG test after the 6MWT, and after at least 15 minutes rest prior to study drug administration in each Treatment Period (End of Week 4 for Period 1 and End of Week 12 for Period 2.) Participant was directed to stand up from chair, walk at normal pace to the line on the floor 3 meters away,turn, walk back to the chair at normal pace, sit down again; activity was timed, in seconds. Activity is repeated 3 times consecutively without rest and an average time is calculated.

Time frame: End of Week 4 and End of Week 12

Population: All participants for whom the 3TUG test was measured.

ArmMeasureValue (MEAN)Dispersion
ElamipretideTriple Timed Up and Go (3TUG) Test by Visit35.3 secondsStandard Deviation 16.66
PlaceboTriple Timed Up and Go (3TUG) Test by Visit35.2 secondsStandard Deviation 15.79
Secondary

Wrist Accelerometer Counts by Day

Wrist Accelerometer Counts by the last 7 days prior to the date of the end of treatment visit; End of treatment being end of Week 4 for Treatment Period 1 and end of Week 12 for Treatment Period 2. Subjects wore an activity monitor, or wrist accelerometer, on their wrist daily (from the Screening Visit to the End-of-Study/Early Discontinuation Visit). As a measure of physical activity and mobility, subjects wore an activity monitor, or wrist accelerometer, which measured mean vector magnitude of accelerations per daywith higher counts indicating a more active status. Raw acceleration data was converted into proprietary counts which was used to estimate physical activity. The data was transformed from 30 Hz data into 1 minute epoch data; this 1 minute epoch data were used for the analysis of as the vector magnitude of the wrist data.

Time frame: Last 7 days prior to the date of end of treatment visit

Population: All participants for whom wrist accelerometer counts by day was measured.

ArmMeasureValue (MEAN)Dispersion
ElamipretideWrist Accelerometer Counts by Day1329.4 counts by dayStandard Deviation 505.28
PlaceboWrist Accelerometer Counts by Day1286.3 counts by dayStandard Deviation 507.83

Source: ClinicalTrials.gov · Data processed: Feb 12, 2026