Safety and Efficacy of Monthly Long-acting IM Injection of 25mg or 40 mg GA Depot in Subjects With PPMS

• ClinicalTrials.gov Identifier: NCT03362294
• Recruitment Status: Active, not recruiting
• First Posted: December 5, 2017
• Last Update Posted: November 15, 2023
• Sponsor: Mapi Pharma Ltd.
• Information provided by (Responsible Party): Mapi Pharma Ltd.

Study Description

Brief Summary:

This is a phase IIa study with GA Depot in subjects with Primary Progressive MS. GA Depot will be administered intramuscularly (IM), once every four weeks for 148 weeks.

The purpose of this study is to assess the safety and efficacy of GA Depot to slow the accumulation of disability progression in subjects with Primary Progressive MS.

Condition or disease	Intervention/treatment	Phase
Primary Progressive Multiple Sclerosis	Drug: GA Depot 40mg once monthly; Drug: GA Depot 25mg once monthly	Phase 2

Detailed Description:

• 30 Subjects with a diagnosis of primary progressive multiple sclerosis (PPMS) who are not treated for PPMS at study entry (except for symptoms relief).
• Study product is GA long-acting injection (GA Depot) which is a combination of extended-release microspheres for injection and diluent (water for injection) for parenteral use. GA Depot will be administered intramuscularly (IM).
• The study duration for an individual subject in the core study will be 156 weeks, consisting of 4 weeks of screening evaluation (weeks -4 to 0), followed by a 148-week open-label treatment period, and a 4 weeks follow up period: through a total of 41 visits.
• Vital signs and safety assessment will be performed at each visit during the study.
• Physical examination will be performed at screening, baseline, 1 week after the second GA Depot treatment, 3 months after first GA Depot treatment and every 3 months thereafter. Last physical examination will be performed at FU visit.
• MRI will be performed at screenings and every 6 months thereafter until the end of the treatment period .
• Safety laboratory tests will be performed at screening, baseline, 1 month after first treatment, and every 3 months thereafter.
• Neurological assessment will be performed at screening, baseline, 3 months, and then every 3 months until end of treatment.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 30 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Intervention Model Description: The first 20 subjects are allocated to the 40mg arm and the last 10 subjects are allocated to the 25mg.
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Prospective, Multicenter, Two Arms, Open Label, Phase IIa Study to Assess the Safety and Efficacy of Once-a-month Long-acting Intramuscular Injection of 25 mg or 40mg Glatiramer Acetate (GA Depot) in Subjects With Primary Progressive Multiple Sclerosis (PPMS)
• Actual Study Start Date: December 11, 2017
• Estimated Primary Completion Date: August 2026
• Estimated Study Completion Date: September 2026

Arms and Interventions

Arm	Intervention/treatment
Experimental: GA Depot 40mg once monthly; Monthly IM injection	Drug: GA Depot 40mg once monthly; Once-a-month long-acting intramuscular injection of 40mg Glatiramer Acetate (GA Depot)
Experimental: GA Depot 25mg once monthly; Monthly IM injection	Drug: GA Depot 25mg once monthly; Once-a-month long-acting intramuscular injection of 25mg Glatiramer Acetate (GA Depot)

Outcome Measures

Primary Outcome Measures :

1. Safety (Adverse Events and Injection Site Reactions) [ Time Frame: 152 weeks ]
   Assessment of Adverse events (AEs) & Injection Sites Reactions (ISRs)

Secondary Outcome Measures :

1. Efficacy (Confirmed Disease Progression) [ Time Frame: 148 weeks ]
   Time to onset of Confirmed Disease Progression (CDP) assessed by Expanded Disability Status Scale (EDSS). EDSS is a method of quantifying disability in people with MS. The EDSS scale ranges from 0 to 10 in 0.5 unit increments that represent higher levels of disability.
2. Efficacy (Whole brain volume change) [ Time Frame: 148 weeks ]
   MRI assessment of percent of whole brain volume change.
3. Efficacy (Cortical volume change) [ Time Frame: 148 weeks ]
   MRI assessment of percent of cortical volume change.

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 65 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Male or female subjects diagnosed with PPMS; Diagnosis of PPMS consistent with the McDonald Criteria (revisions of 2010).
2. Age between 18 and 65 years (inclusive).
3. Subjects diagnosed with PPMS for at least 1 year and with signs of disease progression in the year prior to screening, in a rate of ≥ 1 point increase / year in the EDSS score for EDSS between 2-5 and a rate of ≥0.5 point increase / year in the EDSS scores > 5.
4. EDSS ≥2 and ≤ 6.5 (Pyramidal or Cerebellar FS ≥ 2).
5. Documented history or the presence at screening of > 1 oligoclonal band (OCB) if quantitative testing was done, or OCB+ if not quantitative testing done and/or positive IgG index in the cerebrospinal fluid (CSF).
6. Women of child bearing potential must have a negative urine pregnancy test at screening and use an adequate contraceptive method throughout the study.
7. Ability to provide written informed consent.

Exclusion Criteria:

1. Subjects with RRMS, SPMS, or PRMS.
2. Subjects with a documented history of clinical relapse events.
3. Any relevant medical, surgical, or psychiatric condition, laboratory value, or concomitant medication which, in the opinion of the investigator, makes the subject unsuitable for study entry or potentially unable to complete all aspects of the study.
4. Contraindications or inability to successfully undergo magnetic resonance imaging (MRI) scanning.
5. Subjects diagnosed with any other than MS systemic autoimmune disease that may impact the CNS with MS like lesions such as Sarcoidosis, Sjögren's syndrome, Systemic Lupus Erythematosus (SLE), Lyme disease, APLA syndrome, etc.. Subjects with stable local/organ autoimmune disease such as psoriasis, Cutaneous Lupus erythematosus, thyroiditis (Hashimoto, grave) etc. may be considered eligible upon the PI's discretion.
6. Severe anemia (hemoglobin <10 g/dL).
7. Abnormal renal function (serum creatinine >1.5xULN or creatinine clearance <30 ml/min).
8. Abnormal liver function (transaminases >2xULN).
9. Pregnant or breast-feeding women.
10. Treatment with any kind of steroids during the last month prior to screening visit.
11. History of any anaphylactic reaction and/or serious allergic reaction following a vaccination, a known hypersensitivity to any component of the study drug, e.g. glatiramer acetate (GA), polylactic-co-glycolic acid (PLGA), polyvinyl alcohol (PVA).
12. Known or suspected history of drug or alcohol abuse.
13. Known as positive for HIV, hepatitis, VDRL, or tuberculosis.
14. Active malignant disease of any kind. However, a patient, who had a malignant disease in the past, was treated and is currently disease - free for at least 7 years, may be considered eligible, upon the PI and sponsor's discretion.
15. Previous treatment with B-cell-targeting therapies (e.g. rituximab, ocrelizumab, atacicept, belimumab or ofatumumab) within 6 months prior to screening visit.
16. Previous treatment with cladribine within 2 years prior to screening visit
17. Previous treatment with azathioprine, mitoxantrone or methotrexate within 6 months prior to screening visit.
18. Previous treatment with lymphocyte-trafficking modifiers (e.g. natalizumab, fingolimod) within 6 months prior to screening visit. Subjects should have a total lymphocyte count within normal range.
19. Previous treatment with beta interferons, intravenous immunoglobulin, plasmapheresis within 2 months prior to screening visit.
20. Previous treatment with any glatiramer acetate therapy within 3 months prior to screening visit.
21. Uncontrolled diabetes.
22. Participation in an investigational study drug within 30 days prior to study entry.

Contacts and Locations

Locations

Israel

Mapi Pharma Research site 09

Haifa, Israel

Mapi Pharma Research site 07

Jerusalem, Israel

Mapi Pharma Research site 08

Petah tikva, Israel

Mapi Pharma Research site 06

Rehovot, Israel

Mapi Pharma Research site 01

Tel Aviv, Israel

Moldova, Republic of

Mapi Pharma Research site 20

Chisinau, Moldova, Republic of

Mapi Pharma Research site 22

Chisinau, Moldova, Republic of

Sponsors and Collaborators

Mapi Pharma Ltd.

Investigators

• Principal Investigator: Arnon Karni, MD; Coordinating PI

More Information

• Responsible Party: Mapi Pharma Ltd.
• ClinicalTrials.gov Identifier: NCT03362294
• Other Study ID Numbers: PPMS-GA Depot 002
• First Posted: December 5, 2017
• Last Update Posted: November 15, 2023
• Last Verified: November 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:

Multiple Sclerosis; Multiple Sclerosis, Chronic Progressive; Sclerosis; Pathologic Processes; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Nervous System Diseases; Demyelinating Diseases; Autoimmune Diseases; Immune System Diseases; Chronic Disease; Disease Attributes