To study the effectiveness and safety of REN001 in PMM patients after 24 weeks of treatment

Phase 1

Conditions: Primary Mitochondrial Myopathy
MedDRA version: 20.0Level: PTClassification code 10027710Term: Mitochondrial myopathySystem Organ Class: 10010331 - Congenital, familial and genetic disorders
Therapeutic area: Diseases [C] - Congenital, Hereditary, and Neonatal Diseases and Abnormalities [C16]

Registration Number: EUCTR2020-002855-40-NL

Lead Sponsor: Reneo Pharma Ltd.

Brief Summary: Not available

Detailed Description: Not available

Recruitment & Eligibility

Status: ot Recruiting

Sex: All

Target Recruitment: 200

Inclusion Criteria

1. Subjects aged 18 years or older with PMM
2. A confirmed PMM diagnosis due to known pathogenic gene mutation or deletion of the mitochondrial genome.
3. Documented PMM primarily characterized by exercise intolerance or active muscle pain.
4. Subjects must be ambulatory and able to perform the 12MWT independently (walking aids are allowed).
5. Distance walked of =1000 meters at Screening in the 12MWT (must be obtained at least 4 weeks before randomization).
6. Have no changes to any therapeutic exercise regimen within 30 days prior to Day 1 and be willing to remain on the same therapeutic exercise regimen for the duration of the study.
7. Be willing and able to swallow gelatin capsules.
8. Females should be either of non-child-bearing potential or must agree to use highly effective methods of contraception from Screening through to 30 days after last dose in the study. Males with partners who are WOCBP must also use contraception.
9. Concomitant medications (including supplements) must be stable for at least 1 month prior to enrolment and throughout participation in the study.
10. For subjects under 25 years of age, confirmation of bone growth plate closure by wrist radiograph
11. Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
Are the trial subjects under 18? no
Number of subjects for this age range: 0
F.1.2 Adults (18-64 years) yes
F.1.2.1 Number of subjects for this age range 180
F.1.3 Elderly (>=65 years) yes
F.1.3.1 Number of subjects for this age range 20

Exclusion Criteria

1. Participation in a prior REN001 study.
2. Currently taking or anticipated to need a PPAR agonist during the study.
3. Bone deformities or motor abnormalities other than related to the mitochondrial myopathy that may interfere with the outcome measures.
4. Treatment with an investigational drug within 3 months or 5 drug half-lives, whichever is longer, prior to Day 1.
5. Anticipated to need a prescription and/or non-prescription drug that might interfere with the study endpoints
6. Currently taking drugs with a narrow therapeutic index and BCRP mediated ADME
7. Clinically significant kidney disease or impairment with an eGFR less than 60ml/min/1.73m2 using the CKD-EPI creatinine equation at Screening.
8. Clinically significant liver disease or impairment of AST or ALT Grade 2 or above (>2.5 x ULN), or Total bilirubin > 1.6 x ULN or >ULN with other signs and symptoms of hepatotoxicity at Screening.
9. Uncontrolled diabetes and/or a Screening HbA1c of =11%.
10. Uncontrolled epilepsy.
11. Evidence of significant concomitant clinical disease that may need a change in management during the study or could interfere with the conduct or safety of this study.
12. A history of cancer. A history of in situ basal cell carcinoma in the skin is allowed.
13. Have been hospitalized within the 3 months prior to Screening for any major medical condition (as deemed by the Investigator).
14. Clinically significant cardiac disease and/or clinically significant ECG abnormalities including a screening QTcF of = 450 msec, 2nd degree heart block, symptomatic tachyarrhythmia or unstable arrythmia that in the opinion of the Investigator should exclude the subject from completing exercise tests (i.e. study 12 MWT and 30 STS tests).
15. Any condition possibly reducing drug absorption.
16. Evidence of hospitalization for rhabdomyolysis within the year prior to enrolment.
17. Positive HBsAg, HBcAb or hepatitis C or HIV at Screening.
18. Pregnant or nursing females.
19. History of sensitivity to PPAR agonists.
20. Donation or intent to donate blood, or blood components during the study or within one month after completion of the study.
21. A history of drug dependency. Use of opiates/cannabis for medical reasons is acceptable with prescription evidence or at the Investigators discretion.
22. A history of alcohol dependency.
23. Significant impairment due to central or peripheral nervous system involvement that would interfere with the exercise tests.
24. Significant weakness not caused by the underlying primary muscle disease such as post stroke or neurogenic weakness.
25. Have had an organ transplant.
26. Are not eligible or have a contraindication for cataract surgery.
27. A history of osteoporosis as evidenced by non-traumatic (stress) fractures or a prior T-score of -2.5 or worse which has not been adequately addressed.
28. Inability to comprehend or unwilling to follow the study requirements including restrictions on treatments, attendance at the study center, completion of questionnaires and participation in laboratory testing as called for by the protocol.
29. Any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the Investigator and in discussion with the Medical Monitor, would make the subject inappropriate for entry into this st

Study & Design

Study Type: Interventional clinical trial of medicinal product

Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Main Objective: To evaluate the efficacy of REN001 in subjects with PMM treated for 24 weeks, assessed by the effect on exercise endurance.;Secondary Objective: To evaluate the efficacy of REN001 in subjects with PMM treated for 24 weeks, assessed by the effect on fatigue.;Primary end point(s): Change from baseline in distance walked during the 12 minute walk test;Timepoint(s) of evaluation of this end point: at 24 weeks

Secondary Outcome Measures

Name	Time	Method
Secondary end point(s): Change from Baseline in the Modified Fatigue Impact Scale (MFIS) Physical sub-scale score.<br>Patient Global Impression of Change (PGIC) score (muscle symptoms).;Timepoint(s) of evaluation of this end point: Change from Baseline in the MFIS Physical sub-scale score:evaluation timepoint = 24 weeks<br>PGIC score (muscle symptoms): evaluation timepoint = End of Treatment

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