A Phase 1/2, Multi-regional, Single-Arm, Open-Label, Dose-Finding Clinical Trial to Evaluate the Safety, Tolerability and Efficacy of Gene Therapy for Leber's Hereditary Optic Neuropathy (LHON) Associated With ND1 Mutation
Overview
- Phase
- Phase 1
- Intervention
- NFS-02 Injection
- Conditions
- Leber Hereditary Optic Neuropathy (LHON)
- Sponsor
- Neurophth Therapeutics Inc
- Enrollment
- 18
- Locations
- 4
- Primary Endpoint
- Incidence of adverse events (AEs)
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The objective of this clinical study is to evaluate the safety, tolerability and preliminary efficacy of NFS-02 in the treatment of LHON caused by mitochondrial ND1 gene mutation. This study will enroll subjects aged ≥ 18 years old and ≤ 75 years old to receive a single unilateral intravitreal (IVT) injection of NFS-02 to evaluate its safety, tolerability and preliminary efficacy. The clinical manifestations of all subjects are to be reduced visual acuity caused by LHON associated with ND1 mutation, with laboratory test showing G3460A mutation (a CLIA-certified laboratory) and reduced visual acuity lasted for > 6 months and < 10 years.
Detailed Description
At the dose-finding stage, the principle is that the Safety Review Committee (SRC) will decide whether to make dose adjustment based on the safety data of the starting dose. The starting dose is 1.5×108 vg, 0.05 mL eye/dose. The safety of the starting dose will be reviewed by the SRC, and dose escalation or de-escalation is by recommendation of the SRC. The safety of the starting dose will first be performed in 6 evaluable subjects. Criteria for Dose Modification: Dose Escalation: If drug-related dose-limiting toxicity (DLT) events are observed in \< 2 of the 6 evaluable subjects within 6 weeks after the dosing of NFS-02 at the starting dose, the dose can be escalated to 5.0×108 vg, 0.05 mL eye/dose after the approval by SRC. If drug-related dose-limiting toxicity (DLT) events are observed in \< 2 of the 6 evaluable subjects within 6 weeks after the dosing of NFS-02 at the 5.0×108 vg, 0.05 mL eye/dose, the dose can be escalated to 1.5×109 vg, 0.05 mL eye/dose after the approval by SRC. Dose De-escalation: If drug-related dose-limiting toxicity (DLT) events are observed in ≥ 2 of the 6 evaluable subjects within 6 weeks after the dosing of NFS-02 at the starting dose, the dose can be de-escalated to 5.0×107 vg, 0.05 mL eye/dose after the approval by SRC. Enrollment Sequence: * The enrollment sequence of any dose group (6 subjects) is that the 2nd subject and the 3rd subject will be enrolled at least 7 days after the enrollment of the 1st subject. * The 4th, 5th and 6th subjects will be enrolled at least 7 days after the enrollment of the 2nd and the 3rd subjects. The 7-day interval is to avoid acute safety events to the greatest possible extent.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age at the time of signing the informed consent form: the age of the subjects must be ≥ 18 years old and ≤ 75 years old Type of Subject and Disease Characteristics
- •The clinical manifested vision loss due to LHON, and any eye BCVA ≥ 0.5 LogMAR
- •The genotype testing result shows the presence of G3460A mutation in the ND1 gene, and the absence of the other primary LHON associated mutations in the mitochondrial DNA (mtDNA) (ND4 \[G11778A\] or ND6 \[T14484C\]) (confirmed by a CLIA-certified international laboratory)
- •The vision loss in the eye with worse visual acuity lasted \> 6 months and \< 10 years at screening
- •Pupils can be adequately dilated for a thorough ocular examination and visual acuity test
- •Each eye of the subject must maintain at least Hand Motion visual acuity (VA) (≤ 2.3 LogMAR) as defined in the ocular/vision examination manual (operating manual for refraction and VA examinations) in this study
- •Willingness to comply with the clinical study protocol and 5 years of long-term follow-up after administration Sex
- •Male or female
- •Male subjects:
- •A male subject must agree to take contraceptive measures at least 6 months after the treatment visit, see Appendix 5 for details
Exclusion Criteria
- •Any known allergy and/or hypersensitivity to the study drug or its constituents
- •Contraindication to IVT injection in any eye
- •IVT drug delivery to any eye within 30 days prior to the screening visit
- •History of vitrectomy in either eye
- •Narrow anterior chamber angle in any eye contra-indicating pupillary dilation
- •Presence of disorders or diseases of the eye or adnexa, excluding LHON, which may interfere with visual or ocular assessments, including spectral-domain optical coherence tomography (SD-OCT), during the study
- •Presence of known/documented mutations, other than the LHON-related mutation, which are known to cause pathology of the optic nerve, retina, or afferent visual system
- •Presence of systemic or ocular/vision diseases, disorders, or pathologies, other than LHON, known to cause or be associated with vision loss, or whose associated treatment(s) or therapy(ies) is/are known to cause or be associated with vision loss
- •Presence of optic neuropathy from any cause other than LHON
- •Presence of illness or disease that, in the opinion of the investigator, include symptoms and/or the associated treatments that can alter visual function, for instance cancers or pathology of the central nervous system (CNS), including multiple sclerosis (diagnosis of multiple sclerosis must be based on the 2010 Revisions to the McDonald Criteria) (Polman C H et al., 2011), and/or diseases or conditions that affect the safety of subjects participating in the study
Arms & Interventions
NFS-02 Injection
Potential doses at the dose-finding stage: 5.0×107 vg, 0.05 mL/eye/dose (low dose) 1.5×108 vg, 0.05 mL/eye/dose (starting dose) 5.0×108 vg, 0.05 mL/eye/dose (intermediate dose) 1.5×109 vg, 0.05 mL/eye/dose (high dose)
Intervention: NFS-02 Injection
Outcomes
Primary Outcomes
Incidence of adverse events (AEs)
Time Frame: 52 weeks
Incidence of adverse events (AEs) within 52 weeks of NFS-02 intravitreal injection at different doses
Incidence of serious adverse events (SAEs)
Time Frame: 52 weeks
Incidence of serious adverse events (SAEs)within 52 weeks of NFS-02 intravitreal injection at different doses
Incidence of dose-limiting toxicities (DLT)
Time Frame: 52 weeks
Incidence of dose-limiting toxicities (DLT) (ocular and non-ocular) within 52 weeks of NFS-02 intravitreal injection at different doses
Secondary Outcomes
- Proportion (%) of subjects with an improvement of ≥ 0.3 LogMAR from baseline in BCVA in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- Mean change from baseline in BCVA (LogMAR) in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- Mean change in BCVA (LogMAR) compared to nadir in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- Change from baseline in the parameter of microperimetry in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- Proportion (%) of subjects with a clinically meaningful improvement of injected eye from baseline in microperimetry in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- Change from baseline in contrast sensitivity in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- Change from baseline in visual evoked potential (VEP) parameters in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 40, 52, 78, 104, 130, 156, 182, 208, 234, and 260)
- To evaluate immunogenicity(At Weeks 1, 2, 6, 12, 26, 40, and 52)
- To evaluate vector shedding(At Weeks 1, 2, 6, 12, 26, 40, and 52)
- To evaluate biodistribution(At Weeks 1, 2, 6, 12, 26, 40, and 52)
- To evaluate the improvement in BCVA in the injected eye and non-injected eye (< 0.3 LogMAR)(At Weeks 52, 78, 104, 130, 156, 182, 208, 234 and 260)
- Change from baseline in retinal nerve fiber layer (RNFL) thickness in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 52, 78, 104, 130, 156, 182, 208, 234 and 260)
- Change from baseline in retinal ganglion cell complex thickness in the injected eye and non-injected eye(At Weeks 2, 6,12, 26, 52, 78, 104, 130, 156, 182, 208, 234 and 260)
- To evaluate the change from baseline in VFQ-25(At Weeks 12, 26，52, 78, 104, 130, 156, 182, 208, 234 and 260)
- To evaluate the change from baseline in quality of SF-36(At Weeks 12, 26，52, 78, 104, 130, 156, 182, 208, 234 and 260)