Huntington Disease
Conditions
Brief summary
The primary purpose of this study is to assess the magnitude of the baseline difference between participants with early Huntington's Disease (HD) and healthy participants (HP) with respect to measures of cognitive performance.
Interventions
SAGE-718 oral softgel lipid capsules
SAGE-718-matching oral capsules
Sponsors
Study design
Eligibility
Inclusion criteria
For all 1. Agree to refrain from drugs of abuse for the duration of the study and from alcohol during the 48 hours preceding each study visit. Additional criteria for participants with HD only: 2. Be ambulatory, able to travel to the study center, and, judged by the investigator, is likely to be able to continue to travel to the study center to complete study visits for the duration of the study. 3. Have: 1. Genetically confirmed disease with cytosine, adenine, and guanine (CAG) expansion ≥36. 2. At screening, Unified Huntington's Disease Rating Scale (UHDRS) Total Functional Capacity (TFC) \>6 and \<13, suggesting no more than a moderate level of functional impairment. 3. No features of juvenile HD. 4. CAG-Age-Product (CAP) score \>70, as calculated using the CAP formula: Age × (CAG - 30) / 6.49. 5. Score of 15 to 25 (inclusive) on the Montreal Cognitive Assessment (MoCA) at screening, indicating the presence of cognitive impairment. Additional criteria for HP only: 1. Score ≥26 on the MoCA at screening. 2. Have no known family history of HD; or, have known family history of HD but have genetic test results available that show a normal CAG repeat length for both Huntingtin (HTT) alleles (\<36).
Exclusion criteria
For All 1. Receive any prohibited medications within 30 days of Screening and during participation in the study 2. Have participated in a previous clinical study of SAGE-718, have previous exposure to gene therapy; or have participated in any HD investigational drug, biologic, or device trial within 180 days, or a non-HD drug, biologic, or device trial within 30 days or 5 half-lives (whichever is longer). (Note: participants with confirmation of enrolment in the placebo arm of these trials would not be excluded.) 3. Is known to be allergic to any of SAGE-718 excipients, including soy lecithin. Additional criteria for participants with HD only: 1. Had gastric bypass surgery, has a gastric sleeve or lap band, or has had any related procedures that interfere with gastrointestinal transit. 2. Receive any prohibited medications within 30 days of Screening and during participation in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference in Huntington's Disease Cognitive Assessment Battery (HD-CAB) Composite Score Between Participants With HD vs HP at Baseline | Baseline | HD-CAB assesses cognitive function using 6 subtests:Symbol Digit Modalities Test-correctly coded items(0-110); One Touch Stockings of Cambridge(OTS)-mean time to reach correct response(range not defined); Trail Making Test Trail B (TMT-B)-time to complete task(0-240 sec); Hopkins Verbal Learning Test Revised-total correct recall trials(0-48); Paced Tapping Test-reciprocal of standard deviation(SD) of intertap intervals (range not defined); Emotion Recognition Test-negative emotions correctly identified(0-24). Values of OTS & TMT B are multiplied by -1 to represent higher is better direction as other tests. Each of 6 subtests scores was transformed to z-score(range not defined;low negative value represents cognitive impairment), which is calculated by subtracting mean and dividing by SD of HP at baseline. HD-CAB composite=average of 6 z-scores. Negative HD-CAB of HD participants=decline in cognitive function relative to HP. Assessment is relative to reference group(healthy population). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With HD With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs | Up to Day 42 | An adverse event (AE) is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. Treatment-emergent adverse events are defined as any adverse events with onset on or after the first dose of IP. A serious TEAE is any untoward medical occurrence that at any dose results in death, places the participant at immediate risk of death (a life-threatening event), requires in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability or incapacity, results in a congenital abnormality or birth defect. |
| Number of Participants With HD With Clinically Significant Change From Baseline in Vital Sign Measurements | Up to Day 42 | Vital signs including oral temperature, respiratory rate, heart rate (supine and standing), and blood pressures (supine and standing). Number of participants with clinically significant change in vital signs measurements which were deemed clinically significant by the investigator were reported. |
| Number of Participants With HD With Clinically Significant Change From Baseline in Clinical Laboratory Assessments | Up to Day 42 | Clinical laboratory assessments including hematology, serum chemistry, coagulation, and urinalysis were performed. Number of participants with clinically significant change in laboratory assessments which were deemed clinically significant by the investigator were reported. |
Countries
Canada, United States
Participant flow
Recruitment details
Participants were enrolled at 14 investigative sites in the United States and Canada from 26 May 2022 to 10 April 2024.
Pre-assignment details
A total of 69 adult participants, comprising 29 healthy participants (HP) and 40 participants with Huntington's disease (HD) were enrolled in the study. Participants with HD received either SAGE-718 or placebo. As pre-specified in the protocol, HP enrolled in the study followed the same assessment schedule as participants with HD, but did not receive any investigational product (IP) (SAGE-718 or placebo).
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants with HD received SAGE-718-matching placebo, orally, once daily for up to 28 days. | 19 |
| SAGE-718 Participants with HD received SAGE-718 1.2 mg, orally, once daily for up to 28 days. | 21 |
| Healthy Participants HP enrolled in this study did not receive any IP (SAGE-718 or placebo). | 29 |
| Total | 69 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Withdrawal by Subject | 0 | 1 | 0 |
| Overall Study | Withdrawal of Consent | 0 | 0 | 1 |
Baseline characteristics
| Characteristic | Placebo | SAGE-718 | Healthy Participants | Total |
|---|---|---|---|---|
| Age, Continuous | 49.5 years STANDARD_DEVIATION 8.45 | 49.5 years STANDARD_DEVIATION 7.44 | 43.5 years STANDARD_DEVIATION 11.15 | 47.0 years STANDARD_DEVIATION 9.76 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 1 Participants | 4 Participants | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 15 Participants | 20 Participants | 25 Participants | 60 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants | 0 Participants | 2 Participants | 2 Participants |
| Race/Ethnicity, Customized Black or African American | 1 Participants | 0 Participants | 5 Participants | 6 Participants |
| Race/Ethnicity, Customized Multiple | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 1 Participants | 1 Participants | 2 Participants |
| Race/Ethnicity, Customized White | 18 Participants | 20 Participants | 20 Participants | 58 Participants |
| Sex: Female, Male Female | 9 Participants | 10 Participants | 14 Participants | 33 Participants |
| Sex: Female, Male Male | 10 Participants | 11 Participants | 15 Participants | 36 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 19 | 0 / 21 | 0 / 29 |
| other Total, other adverse events | 6 / 19 | 7 / 21 | 4 / 29 |
| serious Total, serious adverse events | 0 / 19 | 0 / 21 | 0 / 29 |
Outcome results
Difference in Huntington's Disease Cognitive Assessment Battery (HD-CAB) Composite Score Between Participants With HD vs HP at Baseline
HD-CAB assesses cognitive function using 6 subtests:Symbol Digit Modalities Test-correctly coded items(0-110); One Touch Stockings of Cambridge(OTS)-mean time to reach correct response(range not defined); Trail Making Test Trail B (TMT-B)-time to complete task(0-240 sec); Hopkins Verbal Learning Test Revised-total correct recall trials(0-48); Paced Tapping Test-reciprocal of standard deviation(SD) of intertap intervals (range not defined); Emotion Recognition Test-negative emotions correctly identified(0-24). Values of OTS & TMT B are multiplied by -1 to represent higher is better direction as other tests. Each of 6 subtests scores was transformed to z-score(range not defined;low negative value represents cognitive impairment), which is calculated by subtracting mean and dividing by SD of HP at baseline. HD-CAB composite=average of 6 z-scores. Negative HD-CAB of HD participants=decline in cognitive function relative to HP. Assessment is relative to reference group(healthy population).
Time frame: Baseline
Population: FAS included all randomized participants with HD \& all HP who met eligibility criteria \& had at least 1 baseline assessment of HD-CAB (participants with HD \& HP). As primary analysis was to estimate baseline differences between participants with HD \& HP in HD-CAB composite score, data from SAGE-718 \& placebo arms were combined for analysis. Baseline for HD participants=last non-missing measurement prior to first dose of IP. Baseline for HP=last non-missing measurement on or prior to Day 1.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Participants With HD | Difference in Huntington's Disease Cognitive Assessment Battery (HD-CAB) Composite Score Between Participants With HD vs HP at Baseline | -3.3657 Z score | Standard Deviation 1.4613 |
| Healthy Participants | Difference in Huntington's Disease Cognitive Assessment Battery (HD-CAB) Composite Score Between Participants With HD vs HP at Baseline | 0.0000 Z score | Standard Deviation 0.5673 |
Number of Participants With HD With Clinically Significant Change From Baseline in Clinical Laboratory Assessments
Clinical laboratory assessments including hematology, serum chemistry, coagulation, and urinalysis were performed. Number of participants with clinically significant change in laboratory assessments which were deemed clinically significant by the investigator were reported.
Time frame: Up to Day 42
Population: Safety Set included all participants with HD who were administered IP or HP who met eligibility criteria and was used to describe the safety data.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Participants With HD | Number of Participants With HD With Clinically Significant Change From Baseline in Clinical Laboratory Assessments | 0 Participants |
| Healthy Participants | Number of Participants With HD With Clinically Significant Change From Baseline in Clinical Laboratory Assessments | 0 Participants |
Number of Participants With HD With Clinically Significant Change From Baseline in Vital Sign Measurements
Vital signs including oral temperature, respiratory rate, heart rate (supine and standing), and blood pressures (supine and standing). Number of participants with clinically significant change in vital signs measurements which were deemed clinically significant by the investigator were reported.
Time frame: Up to Day 42
Population: Safety Set included all participants with HD who were administered IP or HP who met eligibility criteria and was used to describe the safety data.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Participants With HD | Number of Participants With HD With Clinically Significant Change From Baseline in Vital Sign Measurements | 0 Participants |
| Healthy Participants | Number of Participants With HD With Clinically Significant Change From Baseline in Vital Sign Measurements | 0 Participants |
Number of Participants With HD With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs
An adverse event (AE) is any untoward medical occurrence in a participant administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment. Treatment-emergent adverse events are defined as any adverse events with onset on or after the first dose of IP. A serious TEAE is any untoward medical occurrence that at any dose results in death, places the participant at immediate risk of death (a life-threatening event), requires in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability or incapacity, results in a congenital abnormality or birth defect.
Time frame: Up to Day 42
Population: Safety Set included all participants with HD who were administered IP or HP who met eligibility criteria and was used to describe the safety data.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Participants With HD | Number of Participants With HD With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs | TEAEs | 6 Participants |
| Participants With HD | Number of Participants With HD With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs | Serious TEAEs | 0 Participants |
| Healthy Participants | Number of Participants With HD With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs | TEAEs | 11 Participants |
| Healthy Participants | Number of Participants With HD With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs | Serious TEAEs | 0 Participants |