MPS-IH (Hurler Syndrome)
Conditions
Keywords
MPS-IH, Hurler, MPS-I, Mucopolysaccharidoses, Mucopolysaccharidosis type I, Hurler syndrome, Mucopolysaccharidosis IH, Gene Therapy, Transplantation, Autologous Lentiviral vector
Brief summary
A multi-center randomized clinical trial to compare OTL-203 (gene therapy) with stem cell transplant (standard of care) in patients with MPS-IH (Hurler syndrome).
Detailed description
The study is a multi-center, randomized, active controlled clinical trial designed to evaluate the efficacy and safety of OTL-203 in patients with mucopolysaccharidosis type I, Hurler syndrome (MPS-IH) compared to standard of care with allogeneic hematopoietic stem cell transplantation (allo-HSCT). A total of 40 patients with a confirmed diagnosis of MPS-IH who meet the study inclusion criteria will be randomized to receive either OTL-203 or allo-HSCT. The trial will comprise of a screening, baseline, and treatment period, with a follow-up period of 5 years post-treatment, and primary analysis performed at 2 years follow-up of the last treated subject.
Interventions
GENETICExperimental: OTL-203
Experimental: OTL-203: Autologous CD34+ enriched cell fraction that contains hematopoietic stem and progenitor cells transduced ex vivo using lentiviral vector encoding the human IDUA gene
GENETICActive Comparator: Allo-HSCT
Active Comparator: Allogeneic hematopoietic stem cell transplantation
Sponsors
Orchard Therapeutics
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Parallel assignment
Eligibility
Sex/Gender
ALL
Age
28 Days to 30 Months
Healthy volunteers
No
Inclusion criteria
1. Norm-referenced cognitive standard score of ≥70 measured by age-appropriate cognitive domains of either Bayley Scale of Infant Development (BSID)-III or Wechsler Preschool and Primary Scale of Intelligence (WPPSI)-IV. 2. Confirmed laboratory diagnosis of MPS-IH as demonstrated by biallelic mutation(s) in the gene coding for IDUA enzyme 3. Final confirmation of MPS-IH diagnosis by a Diagnostic Review Committee (DRC).
Exclusion criteria
1. Previous allo-HSCT or gene therapy 2. Current enrollment or past treatment in any other interventional study/trial using a novel investigational agent and/or treated with prohibited medications listed in the protocol 3. Positivity to serological testing for Human Immunodeficiency Virus (HIV)-1 or HIV-2, Human T Lymphotropic Virus (HTLV)-1 or HTLV-2, Hepatitis B Virus (HBV) core, Hepatitis C Virus (HCV), mycoplasma, active tuberculosis (TB) and not meeting the microbiology biological screening requirements. 4. Malignant neoplasia (except local skin cancer). 5. Myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) 6. History of uncontrolled seizures 7. Subjects with an active infection not responsive to treatment, end-organ damage, or any other disease that contraindicates performance of any of the procedures detailed in the protocol, or medical conditions or extenuating circumstances that, in the opinion of the Investigator, might compromise the subject's well-being or safety, or the interpretability of the subject's clinical data. 8. Subjects, who in the opinion of the Investigator, may not be able to comply with protocol requirements or cooperate fully with the study procedures and necessary long-term follow up
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Event-free survival | 2 years | Defined by events of death, rescue transplant, treatment failure, immunological complications, severe cognitive and/or growth impairment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline to Year 2 in the ratio to the upper limit of normal (ULN) of urinary heparan sulfate levels | Day 30 and multiple visits up to 5 years post-treatment | Urinary heparan sulfate levels will be used to measure post-treatment clearance of glycosaminoglycans accumulated within tissues and organs due to IDUA enzymatic deficiency |
| Safety of OTL-203 compared to allo-HSCT procedure | Up to 5 years post-treatment | Measured by Overall incidence of adverse events (AEs) whether or not considered related to the study treatment, including conditioning regimen-related AEs, Study Procedure-related AEs, Disease-related AEs, Treatment related AEs, Serious adverse events (SAEs) |
| Change from baseline to Year 2 in α-L-iduronidase (IDUA) activity in leukocytes | Day 30 and multiple visits up to 5 years post-treatment | IDUA activity in leukocytes will be used to measure post-treatment systemic correction of the biochemical defect that causes the disease |
| Replication Competent Lentivirus (RCL) | Up to 5 years post-treatment | Presence of RCL will be evaluated in subjects treated with OTL-203 |
| Immune response against IDUA enzyme | Up to 5 years post-treatment | Anti-IDUA antibodies analysis will be evaluated in all subjects. |
| Malignancy or abnormal clonal proliferation (ACP) using different tests and procedures (e.g., general clinical evaluation, blood counts, and specialized assessments such as integration site analysis). | Up to 5 years post-treatment | Malignancy or ACP due to insertional oncogenesis will be evaluated in subjects treated with OTL-203. |
Countries
Italy, Netherlands, United Kingdom, United States
Outcome results
None listed