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Phase 3 N=20 Randomized Quadruple-blind Treatment

An Efficacy, Safety, Tolerability, Pharmacokinetics and Pharmacodynamics Study of BIIB067 (Tofersen) in Adults With Inherited Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis

Enrolled (actual)
20
Serious AEs
14.0%
Results posted
Jul 2023
Primary outcome: Primary: Parts A and B: Number of Participants Experiencing Adverse Events (AEs) and Serious Adverse Events (SAEs) — 2; 2; 3; 3 Participants

Study Design & Population

Study type
Interventional
Phase
Phase 3
Interventions
Tofersen (Drug); Placebo (Drug)
Age
Adult, Older Adult · 18+ yrs
Sex
All
Sponsor
Biogen
Primary completion
Jul 2021

Outcome Measures

OutcomeResultp-value
PRIMARY
Parts A and B: Number of Participants Experiencing Adverse Events (AEs) and Serious Adverse Events (SAEs)
2; 2; 3; 3; 6; 12
PRIMARY
Parts A and B: Number of Participants With Clinically Significant Laboratory Abnormalities
0; 0; 0; 0; 0; 0
PRIMARY
Parts A and B: Number of Participants With Clinically Significant Vital Sign Abnormalities
0; 0; 0; 0; 0; 0
PRIMARY
Parts A and B: Number of Participants With Clinically Significant Physical Examination Abnormalities
0; 0; 0; 0; 0; 1
PRIMARY
Parts A and B: Number of Participants With Clinically Significant Neurological Examination Abnormalities
0; 0; 0; 0; 1; 0
PRIMARY
Parts A and B: Number of Participants With Clinically Significant 12-lead Electrocardiograms (ECGs) Abnormalities
0; 0; 0; 0; 0; 3
PRIMARY
Parts A and B: PK Parameter of BIIB067 in Plasma: Maximum Observed Concentration (Cmax)
64.94; 75.06; 202.09; 529.63; 80.75; 229.41
PRIMARY
Parts A and B: PK Parameter of BIIB067 in Plasma: Time to Reach Maximum Observed Concentration (Tmax)
4.58; 4.16; 6.00; 2.70; 7.01; 3.68
PRIMARY
Parts A and B: PK Parameter of BIIB067 in Plasma: Area Under the Concentration-Time Curve From Time Zero to 24 Hours (AUC0-24h)
879.86; 1027.18; 2873.77; 5196.11; 1009.85; 2875.13
PRIMARY
Parts A and B: PK Parameter of BIIB067 in Plasma: Area Under the Concentration-time Curve From Time Zero to Infinity (AUCinf)
NA; NA; NA; NA; NA; NA
PRIMARY
Parts A and B: PK Parameter of BIIB067 in Plasma: Area Under the Concentration-time Curve From Time Zero to the Time of the Last Measurable Concentration (AUClast)
NA; NA; NA; NA; NA; NA
PRIMARY
Parts A and B: PK Parameter of BIIB067 in Plasma: Apparent Terminal Elimination Half-life (t1/2)
NA; NA; NA; NA; NA; NA
PRIMARY
Parts A and B: PK Parameters of BIIB067 in CSF Levels: Terminal Elimination Half-life (t1/2)
NA; NA; NA; NA; NA; NA
PRIMARY
Part C: Change From Baseline in Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) Total Score at Week 28
-8.1; -7.0 = 0.9689
SECONDARY
Part B: CSF Levels of Total SOD1 Protein Concentration Ratio to Baseline
0.97; 0.99; 0.73; 0.79; 0.64 < 0.0001 sig
SECONDARY
Part C: CSF Levels of Total SOD1 Protein Concentration Ratio to Baseline
1.16; 0.71 < 0.0001 sig
SECONDARY
Part C: Neurofilament Light Chain (NfL) Plasma Concentration Ratio to Baseline
1.20; 0.40 < 0.0001 sig
SECONDARY
Part C: Change From Baseline in Percent Predicted Slow Vital Capacity (SVC) at Week 28
-22.20; -14.31 = 0.3233
SECONDARY
Part C: Change From Baseline in Handheld Dynamometry (HHD) Megascore as Measured by the HHD Device at Week 28
-0.37; -0.34 = 0.8390
SECONDARY
Part C: Time to Death or Permanent Ventilation
NA; NA
SECONDARY
Part C: Time to Death
NA; NA
SECONDARY
Part C: Number of Participants Experiencing AEs and SAEs
34; 69; 5; 13

Summary

The primary objectives of Parts A and B of this study are to evaluate the safety, tolerability, and pharmacokinetics (PK) of ascending doses of tofersen in adults with ALS and a documented superoxide dismutase 1 (SOD1) mutation. The primary objective of Part C of this study is to evaluate the clinical efficacy of tofersen administered to adults with ALS and a confirmed SOD1 mutation. The secondary objective of Parts A and B of this study is to evaluate the effects of tofersen on levels of total SOD1 protein in the cerebrospinal fluid (CSF). The secondary objectives of Part C are to evaluate the safety, tolerability, pharmacodynamic (PD), and biomarker effects of tofersen.

Eligibility Criteria

Key Inclusion Criteria: Part A and B

  • Weakness attributable to ALS and documented SOD1 mutation at Screening Visit 2.
  • A forced vital capacity (FVC) ≥50% of predicted value as adjusted for sex, age, and height (from the sitting position). Participants with stable FVC <50% but ≥45%, whose FVC has not declined by more than 5% in the last 6 months may be considered for inclusion, at the discretion of the Investigator.
  • If taking riluzole, participant must be on a stable dose for ≥30 days prior to Day 1 and expected to remain at that dose until the final study visit.
  • Medically able to undergo the study procedures, and to adhere to the visit schedule at the time of study entry, as determined by the Investigator.

Key Exclusion Criteria: Part A and B

  • History of or positive test result for human immunodeficiency virus.
  • History of, or positive test result at Screening, for hepatitis C virus antibody.
  • Current hepatitis B infection (defined as positive for hepatitis B surface antigen [HBsAg] and/or hepatitis B core antibody [HBcAb]). Participants with immunity to hepatitis B from previous natural infection (defined as negative HBsAg, positive hepatitis B surface antibody immunoglobulin G, and positive HBcAb) or vaccination (defined as positive anti-HBs) are eligible to participate in the study.
  • Treatment with another investigational drug, biological agent, or device within 1 month or 5 half-lives of study agent, whichever is longer. Specifically, no prior treatment with small interfering ribonucleic acid, stem cell therapy, or gene therapy is allowed.
  • Current enrollment in any other interventional study.
  • Current or recent (within 1 month) use, or anticipated need, in the opinion of the Investigator, of copper (II) (diacetyl-bis (N4-methylthiosemicarbazone)) or pyrimethamine.
  • Current or anticipated need, in the opinion of the Investigator, of a diaphragm pacing system (DPS) during the study period.

Key Inclusion Criteria: Part C

  • Weakness attributable to ALS and confirmed SOD1 mutation at Screening Visit.
  • If taking riluzole, participant must be on a stable dose for ≥30 days prior to Day 1 and expected to remain at that dose until the final study visit.
  • If taking edaravone, participant must have initiated edaravone ≥60 days (2 treatment cycles) prior to Day 1 and expected to remain at that dose until the final study visit, unless the Investigator determines that edaravone should be discontinued for medical reasons, in which case it may not be restarted during the study. Edaravone may not be administered on dosing days of this study.
  • Medically able to undergo the study procedures and to adhere to the visit schedule at the time of study entry, as determined by the Investigator.

Key Exclusion Criteria: Part C

  • History of or positive test result for human immunodeficiency virus.
  • Current hepatitis C infection (defined as positive hepatitis C virus [HCV] antibody and detectable HCV ribonucleic acid [RNA]). Participants with positive HCV antibody and undetectable HCV RNA are eligible to participate in the study (United States Centers for Disease Control and Prevention).
  • Current hepatitis B infection (defined as positive for HBsAg and/or anti-HBc). participants with immunity to hepatitis B from previous natural infection (defined as negative HBsAg, positive anti-HBc, and positive anti-HBs) or vaccination (defined as negative HBsAg, negative anti-HBc, and positive anti-HBs) are eligible to participate in the study.
  • Treatment with another investigational drug (including investigational drugs for ALS through compassionate use programs), biological agent, or device within 1 month or 5 half-lives of study agent, whichever is longer. Specifically, no prior treatment with small interfering RNA, stem cell therapy, or gene therapy is allowed.
  • Current enrollment in any other interventional study.
  • Current or recent (within 1 month) use, or anticipated need, in the opinion of the Investigator, of copper (II) (diacet
View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT02623699). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.

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