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CompletedNCT02594124SHINEUpdated Oct 22, 2024Results posted

A Study for Participants With Spinal Muscular Atrophy (SMA) Who Previously Participated in Nusinersen (ISIS 396443) Investigational Studies

A Phase 3 interventional study of nusinersen in Spinal Muscular Atrophy, sponsored by Biogen. Completed at 47 sites in 14 countries. Per ClinicalTrials.gov, last updated 2024-10-22.

Sponsored by Biogen · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
292
Allocation
Non-randomized
Sex
All
01

Study summary

The primary objective is to evaluate long-term safety and tolerability of nusinersen (ISIS 396443) administered by intrathecal (IT) injection to participants with Spinal Muscular Atrophy (SMA) who previously participated in investigational studies of nusinersen. The secondary objective is to examine the long-term efficacy of nusinersen administered by IT injection to participants with SMA who previously participated in investigational studies of nusinersen.

Read the detailed description

This study was initiated and the protocol was registered by Ionis Pharmaceuticals, Inc.

In August 2016, Biogen assumed responsibility for this study.

02

Conditions studied

  • Spinal Muscular Atrophy

Keywords

  • SMA
  • SMN
  • SMNRx
  • ISIS-SMNRx
  • ISIS 396443
  • SHINE
  • IONIS-SMNRx
  • IONIS-SMN Rx
  • Spinraza
  • nusinersen
03

In context

Muscular Atrophy

494 studies on the registry are indexed under Muscular Atrophy; 94 are open to participants now.

This study's enrollment of 292 is above the median of 33 across 335 interventional studies indexed under Muscular Atrophy.

Browse Muscular Atrophy studies →

Lead sponsor

Biogen is the lead sponsor of 494 studies on the registry; 22 are open to participants now.

Of its 98 completed or terminated interventional studies of FDA-regulated products, 49 (50%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Key Inclusion Criteria:

  • Signed informed consent of parent or guardian and signed informed assent of participant, if indicated per participant's age and institutional guidelines.
  • Completion of the index study in accordance with the study protocol or as a result of Sponsor decision (e.g., early termination of the index study) within the preceding 16 weeks

Key Exclusion Criteria:

  • Have any condition or worsening condition which in the opinion of the Investigator would make the participant unsuitable for enrollment, or could interfere with the participant participating in or completing the study
  • Clinically significant abnormalities in hematology or clinical chemistry parameters or electrocardiogram (ECG), as assessed by the Site Investigator, at the Screening visit that would render the participant unsuitable for participation in the study
  • Participant's parent or legal guardian is not willing or able to meet standard of care guidelines (including vaccinations and respiratory syncytial virus prophylaxis if available), nor provide nutritional and respiratory support throughout the study
  • Treatment with another investigational agent, biological agent, or device within one month of Screening, or 5 half-lives of study agent, whichever is longer

NOTE: Other protocol defined Inclusion/Exclusion criteria may apply.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
292 participants (actual)

Study arms

  • Experimental
    Group 1

    Participants transitioned from ISIS 396443-CS3B (NCT02193074)

    Drug: nusinersen

  • Experimental
    Group 2

    Participants transitioned from ISIS 396443-CS4 (NCT02292537)

    Drug: nusinersen

  • Experimental
    Group 3

    Participants transitioned from ISIS 396443-CS12 (NCT02052791)

    Drug: nusinersen

  • Experimental
    Group 4

    Participants transitioned from ISIS 396443-CS3A (NCT01839656)

    Drug: nusinersen

  • Experimental
    Group 5

    Participants transitioned from 232SM202 (NCT02462759)

    Drug: nusinersen

Interventions

  • Drugnusinersen

    Administered by intrathecal (IT) injection

    Also known as: ISIS 396443, Spinraza, BIIB058, IONIS SMN Rx, ISIS SMNRx

06

What researchers measure

Primary outcomes

  1. Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)

    AE:unfavorable and unintended sign, symptom, or disease temporally associated with study/use of an investigational drug, whether or not it's considered related to investigational drug. SAE:AE that in view of either Investigator/Sponsor, meets any of the following criteria: results in death;is life-threatening:i.e.poses risk of death, hospitalization/it's prolongation;results in a persistent or significant incapacity or substantial disruption of normal life functions;results in congenital anomaly or birth defect in offspring;is an important event in the opinion of Investigator/Sponsor. TEAE: if it was present prior to first dose of nusinersen or first sham procedure in index study and subsequently worsened in severity/was not present prior to first dose of nusinersen or first sham procedure in index study but subsequently appeared.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  2. Number of Participants With Vital Sign Abnormalities Reported as AEs

    The vital sign assessments included blood pressure, temperature, pulse rate, and respiratory rate. Participants with abnormalities in these assessments recorded as AEs were reported.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  3. Number of Participants With Weight Abnormalities Reported as AEs

    Weight decrease was characterized by a decrease of \>=7% from baseline and weight increase was characterized by an increase of \>=7% from baseline. Participants with these abnormalities recorded as AEs were reported.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  4. Number of Participants With Neurological Abnormalities Reported as AEs

    Participants with abnormalities in neurological examinations recorded as AEs were reported.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  5. Number of Participants With Laboratory Abnormalities Reported as AEs

    Laboratory investigations included hematology, coagulation, serum chemistry and urinalysis parameters. Participants with abnormalities in these laboratory investigations recorded as AEs were reported.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  6. Number of Participants With Coagulation Parameters Reported as AEs

    Coagulation parameters included activated partial thromboplastin time (aPTT) and international normalized ratio (INR). Participants with abnormalities in these coagulation parameters recorded as AEs were reported.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  7. Number of Participants With Clinically Significant Shifts in12 Lead Electrocardiogram (ECG) Results

    Clinical significance of abnormalities in 12 lead ECG was determined based on the investigator's discretion.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

  8. Number of Participants Taking Any Concomitant Medication

    A concomitant therapy is any non-protocol-specified drug or substance (including over-the-counter medications, herbal medications, and vitamin supplements) administered between the beginning of screening and the last telephone contact or study visit.

    Time frame: From Day 1 up to the end of the study (up to 2848 days)

Secondary outcomes

  1. Mean Number of New Motor Milestones Achieved as Assessed by World Health Organization (WHO) Criteria

    The WHO motor milestones are a set of six milestones in motor development, all of which would be expected to be attained by 24 months of age in healthy children. The individual milestones are: sitting without support, standing with assistance, hands and knees crawling, walking with assistance, standing alone and walking alone. Mean of number of new milestones achieved was calculated and reported in this outcome measure.

    Time frame: MMDR Period: At Day 1800

  2. Percentage of Participants With <2 Years of Age Who Attained Motor Milestones as Assessed by Section 2 of Hammersmith Infant Neurological Examination (HINE)

    HINE is evaluated in infants between 2-24 months of age. It's a simple, standardized instrument including 26 items assessing different aspects of neurological examinations, such as cranial nerves, posture, movements, tone, and reflexes. In this study, Module 2 of HINE (HINE-2) was assessed, which evaluates 8 developmental milestones (head control, sitting, voluntary grasp, ability to kick, rolling, crawling, standing, and walking) scored on a 3, 4, or 5-point scale, with 0 indicating inability to perform task and score of 2, 3, or 4 indicating full milestone development. Total score is calculated by summing item scores to give maximum possible score of 26. Higher score indicates good neurological function.

    Time frame: At Day 309

  3. Number of Participants Who Died or Met Permanent Ventilation

    Permanent ventilation was defined as tracheostomy or \>=16 hours of ventilator support per day continuously for \>21 days in the absence of an acute reversible event.

    Time frame: MMDR Period: Up to Day 1800

  4. Number of Participants Not Requiring Permanent Ventilation

    Permanent ventilation was defined as tracheostomy or \>=16 hours of ventilator support per day continuously for \>21 days in the absence of an acute reversible event.

    Time frame: MMDR Period: Up to Day 1800

  5. Change From Baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) Motor Function Scale

    The CHOP INTEND test is designed to evaluate the motor skills of infants with significant motor weakness, including infants with SMA. Participants who are ≥2 years will be continued to be assessed until a CHOP INTEND maximum score of 64 is achieved. It includes 16 items structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0 (worst) to 4 (best). Total scores range from 0 to 64, with higher scores indicating better movement functioning.

    Time frame: Baseline, Day 2198

  6. Change From Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) Total Score

    The HFMSE consists of 33 scored activities used to assess motor function in children with SMA. Participants were asked to do a specific activity (such as rolling) and they were then graded on the quality and execution of that movement on a scale of 0=being unable, 1=performed with some compensation, and 2=unaided. The overall score is the sum of the scores for all activities with a maximum achievable score of 66. Higher scores indicate increased motor function.

    Time frame: MMDR Period: Baseline, MMDR Day 1800

  7. Change From Baseline in Revised Upper Limb Module (RULM) Total Score

    RULM Test is used in participants with SMA to assess upper limb functional ability items and has total of 20 items with an entry item that serves as functional class identification and does not contribute to total score. Remaining 19 scorable items reflect different functional domains and graded on 3-point system with score of 0 (unable), 1 (able, with modification), and 2 (able, no difficulty). There is only 1 item that is scored as a can/cannot score, with 1 as the highest score. Scorable items are summed for total score (0-37), higher scores indicating increased upper limb function. Positive change from baseline indicates improvement.

    Time frame: MMDR Period: Baseline, MMDR Day 1800

  8. Change From Baseline in Total Distance Walked Over Time as Assessed by 6-Minute Walk Test (6MWT)

    The 6MWT measures the distance an individual can walk over a total of six minutes on a hard, flat surface. The goal is for the individual to walk as far as possible in six minutes.

    Time frame: Baseline, Day 2670

  9. Number of Participants Who Experienced Contracture Assesment

    Contracture assessment is performed to assess the motor performance in SMA. The number of participants who experienced at least one contracture at any location and severe contractures in any of the five locations (hip flexors, knee flexors, ankle planter flexors, elbow flexors, forearm flexors) are reported in this outcome measure.

    Time frame: MMDR Period: At MMDR Day 1800

  10. Change From Baseline in Compound Muscular Action Potential (CMAP)

    CMAP is an electrophysiological technique that can be used to determine the approximate number of motor neurons in a muscle or group of muscles. Peroneal amplitude (PA) and ulnar amplitude (UA) data is reported in this OM. Score \<0 indicated worse response and \>0 indicated better response than the normal matched population. Score change \<0 indicated worsening and \>0 indicated improvement as compared to baseline.

    Time frame: MMDR Period: Baseline, MMDR Day 1800

  11. Change From Baseline in Body Length

    Participants were analyzed for change in growth parameter of body length to evaluate clinical efficacy. The body length was calculated using either WHO or Centers for Disease Control and Prevention (CDC) scales. The CDC scale allows to calculate the body length up to 20 years, while the WHO scale allows to calculate it only up to 10 years.

    Time frame: MMDR Period: up to Day 1800

  12. Change From Baseline in Weight

    Participants were analyzed for change in growth parameter of weight to evaluate clinical efficacy. The weight was calculated using either WHO or CDC scales. The CDC scale allows to calculate the weight up to 20 years, while the WHO scale allows to calculate it only up to 10 years.

    Time frame: MMDR Period: up to Day 1800

  13. Change From Baseline in Weight for Age Percentile

    Participants who were below the age of 36 months were analyzed for change in growth parameter of weight for age to evaluate clinical efficacy. The weight for age percentile was calculated using either WHO or CDC scales. The CDC scale allows to calculate the weight for age percentile up to 20 years, while the WHO scale allows to calculate it only up to 10 years.

    Time frame: MMDR Period: up to Day 1800

  14. Percentage of CMAP Responders

    CMAP is an electrophysiological technique that can be used to determine the approximate number of motor neurons in a muscle or group of muscles. A participant was defined as a responder if they had a peroneal amplitude ≥1 mV at last visit (including the amplitude ≥1 mV at baseline and also demonstrated as such at last visit).

    Time frame: MMDR Period: At Day 1800

  15. Number of Participants Who Achieved Motor Milestones

    Motor milestones were measured based on WHO criteria. The WHO motor milestones are a set of six milestones in motor development, all of which would be expected to be attained by 24 months of age in healthy children. The individual milestones are: sitting without support (SWS), standing with assistance (SWA), hands and knees crawling (HKC), and walking alone (WA).

    Time frame: MMDR Period: up to Day 1800

  16. Number of Participants Who Achieved Standing Alone and Walking With Assistance

    Motor milestones were measured based on WHO criteria. The WHO motor milestones are a set of six milestones in motor development, all of which would be expected to be attained by 24 months of age in healthy children. The individual milestones are: SWS, SWA, HKC, WWA, WA and standing alone (SA). SA and WWA were assessed in this outcome measure.

    Time frame: MMDR Period: up to Day 1800

  17. Total Number of Hospitalizations Due to Serious Respiratory Events

    Total number of hospitalizations is total number of serious events that occurred during study for all participants under each group. For a participant with multiple SAEs which started at the same date and led to hospitalization, it is counted as one hospitalization.

    Time frame: Up to day 2520

  18. Total Number of Hospitalizations Due to Serious Adverse Events

    Total number of hospitalizations is total number of serious events that occurred during study for all participants under each group. For a participant with multiple SAEs which started at the same date and led to hospitalization, it is counted as one hospitalization.

    Time frame: Up to day 2520

  19. Percent of Time in Hospitalization

    Time frame: Upto day 2160

  20. Change From Baseline in Cobb-Angle on X-Ray of the Thoracolumbar Spine by Visit

    Cobb angle is a measurement of the degree of side-to-side spinal curvature used to define scoliosis.

    Time frame: MMDR Period: Baseline, MMDR Day 1800

  21. Pediatric Quality of Life Inventory (PedsQL) Questionnaires Total Score by Domain

    Items on the PedsQL generic core scale are reverse scored and transformed to a 0-100 scale. The PedsQL parent (P) and self (S) reported questionnaire was collected for participants from 2 to 25 years of age. Four dimensions were collected: Physical, Emotional, Social and School functioning and each item was scored on a 5 point ordinal scale. 0 (never) =100, 1 (almost never) = 75, 2 (sometimes)= 50, 3 (often) = 25, 4 (almost always) = 0. A total score was calculated as the sum of all the items over the number of items answered on all the scales. If more than 50% of items or more were missing, the scale score was not computed. Higher scores indicated better health related quality of life.

    Time frame: MMDR Period: At Day 1800

  22. Change From Baseline in Assessment of Caregiver Experience With Neuromuscular Disease (ACEND) Questionnaire Total Score

    The ACEND is a questionnaire that includes a total of seven domains assessing physical impact (including feeding/grooming/dressing, sitting/play, transfers, and mobility) and general caregiver impact (including time, emotion, and finance) and each domain comprises several items. The total score (TS) for each domain will be calculated on a scale of 0 to 100. Higher scores indicate a greater impact on the caregiver.

    Time frame: MMDR Period: up to Day 1800

  23. Number of Participants With Disease-related Hospitalizations and AEs

    Time frame: MMDR Period: up to Day 1800

  24. Survival Rate

    Survival rate was defined as the percentage of participants alive during the study and was estimated from the Kaplan Meier (KM) curve for time to death.

    Time frame: MMDR Period: up to Day 1800

07

Results

Posted Oct 22, 2024

Participant flow

Participants were enrolled at the investigative sites in Australia, Belgium, Canada, Germany, Spain, France, United Kingdom, Hong Kong, Italy, Japan, Republic of Korea, Sweden, Turkey, and the United States from 04 November 2015 to 21 August 2023.

Participant flow — Overall Study
MilestoneInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Started13246512202542838
Completed1010427122019445
Not completed3142358523393
Withdrew: Adverse event058100220
Withdrew: Withdrawal by subject23518413190
Withdrew: Physician decision020000010
Withdrew: Commercial drug0163007112
Withdrew: Reason not specified134001161

Outcome measures

PrimaryNumber of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)

AE:unfavorable and unintended sign, symptom, or disease temporally associated with study/use of an investigational drug, whether or not it's considered related to investigational drug. SAE:AE that in view of either Investigator/Sponsor, meets any of the following criteria: results in death;is life-threatening:i.e.poses risk of death, hospitalization/it's prolongation;results in a persistent or significant incapacity or substantial disruption of normal life functions;results in congenital anomaly or birth defect in offspring;is an important event in the opinion of Investigator/Sponsor. TEAE: if it was present prior to first dose of nusinersen or first sham procedure in index study and subsequently worsened in severity/was not present prior to first dose of nusinersen or first sham procedure in index study but subsequently appeared.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Treatment-Emergent Adverse Events (AEs) and Serious Adverse Events (SAEs)
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
AEs13246512202542808
SAEs112359912626475
PrimaryNumber of Participants With Vital Sign Abnormalities Reported as AEs

The vital sign assessments included blood pressure, temperature, pulse rate, and respiratory rate. Participants with abnormalities in these assessments recorded as AEs were reported.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Vital Sign Abnormalities Reported as AEs
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Bradycardia106100100
Tachycardia245100120
Pyrexia131550510321395
Body Temperature Increased011000100
Heart Rate Increased324300200
Oxygen Saturation Decreased1920201230
Respiratory Rate Increased001000000
Tachypnoea001100100
PrimaryNumber of Participants With Weight Abnormalities Reported as AEs

Weight decrease was characterized by a decrease of \>=7% from baseline and weight increase was characterized by an increase of \>=7% from baseline. Participants with these abnormalities recorded as AEs were reported.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Weight Abnormalities Reported as AEs
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Weight Decreased003101130
Weight Increased000000500
PrimaryNumber of Participants With Neurological Abnormalities Reported as AEs

Participants with abnormalities in neurological examinations recorded as AEs were reported.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Neurological Abnormalities Reported as AEs
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Areflexia201010110
Hyporeflexia100000000
Nystagmus004100000
Motor Dysfunction001000000
Muscle Contractions Involuntary000121140
Myoclonus000010000
Paraesthesia000001011
Tremor101011130
PrimaryNumber of Participants With Laboratory Abnormalities Reported as AEs

Laboratory investigations included hematology, coagulation, serum chemistry and urinalysis parameters. Participants with abnormalities in these laboratory investigations recorded as AEs were reported.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Laboratory Abnormalities Reported as AEs
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Anaemia106120111
Leukocytosis103000120
Leukopenia010000010
Lymphopenia000000010
Neutropenia002000000
Neutrophilia002000020
Pancytopenia000000010
Thrombocytopenia001100000
Thrombocytosis000100000
Hypertransaminasaemia001000010
Pyuria000001000
Urinary Tract Infection3311121471
Alanine Aminotransferase Increased013000010
Aspartate Aminotransferase Increased012000000
Blood Albumin Decreased000100000
Blood Bicarbonate Decreased002000000
Blood Calcium Decreased001000000
Blood Osmolarity Increased000000100
Blood Potassium Abnormal010000000
Blood Potassium Decreased000100000
Blood Potassium Increased001000000
Crystal Urine Present000000460
Full Blood Count Decreased001000000
Full Blood Count Increased001000000
Gamma-Glutamyltransferase Increased023000000
Haemoglobin Decreased012100000
Hepatic Enzyme Increased001000200
Liver Function Test Increased011000000
Mean Platelet Volume Decreased000100000
Neutrophil Count Decreased000000100
Neutrophil Count Increased001000000
Platelet Count Decreased002000000
Platelet Count Increased000100000
Protein Urine Present011000130
Red Blood Cell Count Increased000100000
Transaminases Increased000000100
Urine Ketone Body Present000000100
White Blood Cell Count Increased004000000
White Blood Cells Urine001000000
White Blood Cells Urine Positive000100010
Hypercalcaemia001000000
Hyperglycaemia000000020
Hypernatraemia002000110
Hypoalbuminaemia001000000
Hypocalcaemia020000010
Hypochloraemia001100000
Hypoglycaemia205000120
Hypokalaemia1310000120
Hyponatraemia001200010
Electrolyte Imbalance001100010
Bilirubinuria000000010
Haematuria110001120
Ketonuria000000010
Leukocyturia010000020
Proteinuria017102280
Bandaemia001000000
PrimaryNumber of Participants With Coagulation Parameters Reported as AEs

Coagulation parameters included activated partial thromboplastin time (aPTT) and international normalized ratio (INR). Participants with abnormalities in these coagulation parameters recorded as AEs were reported.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Coagulation Parameters Reported as AEs
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Activated Partial Thromboplastin Time Prolonged101000020
International Normalised Ratio Abnormal001000000
International Normalised Ratio Decreased001000000
Coagulopathy001000000
PrimaryNumber of Participants With Clinically Significant Shifts in12 Lead Electrocardiogram (ECG) Results

Clinical significance of abnormalities in 12 lead ECG was determined based on the investigator's discretion.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants With Clinically Significant Shifts in12 Lead Electrocardiogram (ECG) Results
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Number of Participants With Clinically Significant Shifts in12 Lead Electrocardiogram (ECG) Results216100110
PrimaryNumber of Participants Taking Any Concomitant Medication

A concomitant therapy is any non-protocol-specified drug or substance (including over-the-counter medications, herbal medications, and vitamin supplements) administered between the beginning of screening and the last telephone contact or study visit.

Time frame:
From Day 1 up to the end of the study (up to 2848 days)
Reported as:
Count of participants · Participants
Number of Participants Taking Any Concomitant Medication
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Number of Participants Taking Any Concomitant Medication13246512202542838
SecondaryMean Number of New Motor Milestones Achieved as Assessed by World Health Organization (WHO) Criteria

The WHO motor milestones are a set of six milestones in motor development, all of which would be expected to be attained by 24 months of age in healthy children. The individual milestones are: sitting without support, standing with assistance, hands and knees crawling, walking with assistance, standing alone and walking alone. Mean of number of new milestones achieved was calculated and reported in this outcome measure.

Time frame:
MMDR Period: At Day 1800
Reported as:
Mean · motor milestone
Mean Number of New Motor Milestones Achieved as Assessed by World Health Organization (WHO) Criteria
motor milestoneInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Mean Number of New Motor Milestones Achieved as Assessed by World Health Organization (WHO) Criteria0.4 ± 0.730.0 ± 0.000.7 ± 1.150.0 ± 0.53-0.6 ± 0.79-0.1 ± 0.73-0.1 ± 0.32-0.2 ± 0.60-0.2 ± 0.75
SecondaryPercentage of Participants With <2 Years of Age Who Attained Motor Milestones as Assessed by Section 2 of Hammersmith Infant Neurological Examination (HINE)

HINE is evaluated in infants between 2-24 months of age. It's a simple, standardized instrument including 26 items assessing different aspects of neurological examinations, such as cranial nerves, posture, movements, tone, and reflexes. In this study, Module 2 of HINE (HINE-2) was assessed, which evaluates 8 developmental milestones (head control, sitting, voluntary grasp, ability to kick, rolling, crawling, standing, and walking) scored on a 3, 4, or 5-point scale, with 0 indicating inability to perform task and score of 2, 3, or 4 indicating full milestone development. Total score is calculated by summing item scores to give maximum possible score of 26. Higher score indicates good neurological function.

Time frame:
At Day 309
Reported as:
Number · percentage of participants
Percentage of Participants With <2 Years of Age Who Attained Motor Milestones as Assessed by Section 2 of Hammersmith Infant Neurological Examination (HINE)
percentage of participantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443
Head Control: Unable to Maintain Head Upright138634
Head Control: Wobbles13918
Head Control: All the Time Maintained Upright75548
Sitting: Cannot Sit1310039
Sits With Support at Hips13019
Sitting: Props008
Sitting: Stable sit13019
Sitting: Pivots (rotates)63015
Ability to Kick: No kicking06818
Ability to Kick: Kick horizontally legs do not lift133229
Ability to Kick: Upward (vertically)0010
Ability to Kick: Touches leg0011
Ability to Kick: Touches toes88032
Rolling: No Rolling259127
Rolling: Rolling to Side0937
Rolling: Prone to Supine1305
Rolling: Supine to Prone63031
Crawling: Does not Lift Head6310081
Crawling: On Elbow0013
Crawling: On Outstretched Hand002
Crawling: Crawling Flat on Abdomen1303
Crawling: Crawling on Hands and Knees2502
Standing: Does not support weight3810079
Standing: Supports weight13011
Standing: Stands with support25010
Standing: Stands unaided2500
Walking: No Walking7510095
Walking: Bouncing000
Walking: Cruising (Walks Holding on)1305
Walking: Walking Independently1300
Voluntary Grasp:No Grasp0146
Voluntary Grasp:Uses Whole Hand05518
Voluntary Grasp:Index Finger&Thumb;Immature Grasp01421
Voluntary Grasp:Pincer Grasp1001852
SecondaryNumber of Participants Who Died or Met Permanent Ventilation

Permanent ventilation was defined as tracheostomy or \>=16 hours of ventilator support per day continuously for \>21 days in the absence of an acute reversible event.

Time frame:
MMDR Period: Up to Day 1800
Reported as:
Count of participants · Participants
Number of Participants Who Died or Met Permanent Ventilation
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Later SMA Onset CS4 Previous ControlLater SMA Onset CS12 Type 2Later SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 3
Number of Participants Who Died or Met Permanent Ventilation0611101020
SecondaryNumber of Participants Not Requiring Permanent Ventilation

Permanent ventilation was defined as tracheostomy or \>=16 hours of ventilator support per day continuously for \>21 days in the absence of an acute reversible event.

Time frame:
MMDR Period: Up to Day 1800
Reported as:
Count of participants · Participants
Number of Participants Not Requiring Permanent Ventilation
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset CS12 Type 3Later SMA Onset 232SM202
Number of Participants Not Requiring Permanent Ventilation13206111204283258
SecondaryChange From Baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) Motor Function Scale

The CHOP INTEND test is designed to evaluate the motor skills of infants with significant motor weakness, including infants with SMA. Participants who are ≥2 years will be continued to be assessed until a CHOP INTEND maximum score of 64 is achieved. It includes 16 items structured to move from easiest to hardest with the grading including gravity eliminated (lower scores) to antigravity movements (higher scores). All item scores range from 0 (worst) to 4 (best). Total scores range from 0 to 64, with higher scores indicating better movement functioning.

Time frame:
Baseline, Day 2198
Reported as:
Mean · score on scale
Change From Baseline in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) Motor Function Scale
score on scaleInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443
Baseline47.4 ± 13.0917.3 ± 9.7138.8 ± 9.43
Change at Day 2198-6.0 ± NA11.5 ± 12.214.7 ± 14.18
SecondaryChange From Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) Total Score

The HFMSE consists of 33 scored activities used to assess motor function in children with SMA. Participants were asked to do a specific activity (such as rolling) and they were then graded on the quality and execution of that movement on a scale of 0=being unable, 1=performed with some compensation, and 2=unaided. The overall score is the sum of the scores for all activities with a maximum achievable score of 66. Higher scores indicate increased motor function.

Time frame:
MMDR Period: Baseline, MMDR Day 1800
Reported as:
Mean · score on scale
Change From Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) Total Score
score on scaleInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Baseline14.5 ± 13.750.0 ± 0.07.3 ± 6.886.8 ± 6.0625.6 ± 14.2353.6 ± 8.2421.1 ± 7.7526.1 ± 10.9924.5 ± 12.64
Change at MMDR Day 18003.4 ± 5.930.4 ± 0.886.0 ± 9.12-2.3 ± 3.37-7.0 ± 6.03-2.4 ± 3.41-4.7 ± 7.20-6.2 ± 6.36-1.2 ± 9.83
SecondaryChange From Baseline in Revised Upper Limb Module (RULM) Total Score

RULM Test is used in participants with SMA to assess upper limb functional ability items and has total of 20 items with an entry item that serves as functional class identification and does not contribute to total score. Remaining 19 scorable items reflect different functional domains and graded on 3-point system with score of 0 (unable), 1 (able, with modification), and 2 (able, no difficulty). There is only 1 item that is scored as a can/cannot score, with 1 as the highest score. Scorable items are summed for total score (0-37), higher scores indicating increased upper limb function. Positive change from baseline indicates improvement.

Time frame:
MMDR Period: Baseline, MMDR Day 1800
Reported as:
Mean · score on scale
Change From Baseline in Revised Upper Limb Module (RULM) Total Score
score on scaleInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Baseline11.8 ± 7.241.7 ± 1.6310.3 ± 6.057.6 ± 6.2324.1 ± 6.1435.9 ± 1.9121.1 ± 4.2623.9 ± 5.6921.4 ± 8.60
Change at MMDR Day 18009.1 ± 4.700.7 ± 0.5810.0 ± 5.383.3 ± 5.010.4 ± 3.230.9 ± 1.762.4 ± 3.971.2 ± 3.723.2 ± 2.71
SecondaryChange From Baseline in Total Distance Walked Over Time as Assessed by 6-Minute Walk Test (6MWT)

The 6MWT measures the distance an individual can walk over a total of six minutes on a hard, flat surface. The goal is for the individual to walk as far as possible in six minutes.

Time frame:
Baseline, Day 2670
Reported as:
Mean · meters
Change From Baseline in Total Distance Walked Over Time as Assessed by 6-Minute Walk Test (6MWT)
metersLater SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3
Baseline0 ± NA253.3 ± 182.74
Change at Day 2670156.5 ± NA91.5 ± 49.07
SecondaryNumber of Participants Who Experienced Contracture Assesment

Contracture assessment is performed to assess the motor performance in SMA. The number of participants who experienced at least one contracture at any location and severe contractures in any of the five locations (hip flexors, knee flexors, ankle planter flexors, elbow flexors, forearm flexors) are reported in this outcome measure.

Time frame:
MMDR Period: At MMDR Day 1800
Reported as:
Count of participants · Participants
Number of Participants Who Experienced Contracture Assesment
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
At least one contracture at any location91036813819445
Severe contractures in any of the five locations33164619162
SecondaryChange From Baseline in Compound Muscular Action Potential (CMAP)

CMAP is an electrophysiological technique that can be used to determine the approximate number of motor neurons in a muscle or group of muscles. Peroneal amplitude (PA) and ulnar amplitude (UA) data is reported in this OM. Score \<0 indicated worse response and \>0 indicated better response than the normal matched population. Score change \<0 indicated worsening and \>0 indicated improvement as compared to baseline.

Time frame:
MMDR Period: Baseline, MMDR Day 1800
Reported as:
Mean · millivolt (mV)
Change From Baseline in Compound Muscular Action Potential (CMAP)
millivolt (mV)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
PA: Baseline3.02 ± 2.2070.35 ± 0.5171.91 ± 1.3670.94 ± 0.9291.89 ± 1.3692.71 ± 1.3182.00 ± 2.1891.97 ± 1.5861.35 ± 0.948
PA: Change at MMDR Day 1800-0.41 ± 1.2900.10 ± 0.2430.30 ± 1.3950.92 ± 1.901-0.59 ± 1.069-0.08 ± 1.7990.22 ± 4.832-0.28 ± 0.9240.10 ± 1.414
UA: Baseline1.52 ± 1.5630.20 ± 0.2050.85 ± 0.9440.99 ± 0.8612.81 ± 1.7236.76 ± 2.4481.69 ± 1.1332.71 ± 2.1611.25 ± 0.935
UA: Change at MMDR Day 18000.45 ± 0.8370.20 ± 0.1880.67 ± 1.2610.15 ± 0.4360.04 ± 0.9570.04 ± 1.6410.32 ± 1.1270.52 ± 1.6002.77 ± 2.729
SecondaryChange From Baseline in Body Length

Participants were analyzed for change in growth parameter of body length to evaluate clinical efficacy. The body length was calculated using either WHO or Centers for Disease Control and Prevention (CDC) scales. The CDC scale allows to calculate the body length up to 20 years, while the WHO scale allows to calculate it only up to 10 years.

Time frame:
MMDR Period: up to Day 1800
Reported as:
Mean · centimeters (cm)
Change From Baseline in Body Length
centimeters (cm)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Change From Baseline in Body Length24.2 ± 2.8619.9 ± 6.9929.4 ± 6.3818.8 ± 10.9218.8 ± 8.5423.1 ± 023.7 ± 7.0624.6 ± 10.60-10.3 ± 57.63
SecondaryChange From Baseline in Weight

Participants were analyzed for change in growth parameter of weight to evaluate clinical efficacy. The weight was calculated using either WHO or CDC scales. The CDC scale allows to calculate the weight up to 20 years, while the WHO scale allows to calculate it only up to 10 years.

Time frame:
MMDR Period: up to Day 1800
Reported as:
Mean · kilograms (kg)
Change From Baseline in Weight
kilograms (kg)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Change From Baseline in Weight9.8 ± 3.487.7 ± 4.399.3 ± 3.259.5 ± 7.0415.1 ± 5.9613.8 ± 14.8815.4 ± 8.0515.2 ± 7.3811.7 ± 8.09
SecondaryChange From Baseline in Weight for Age Percentile

Participants who were below the age of 36 months were analyzed for change in growth parameter of weight for age to evaluate clinical efficacy. The weight for age percentile was calculated using either WHO or CDC scales. The CDC scale allows to calculate the weight for age percentile up to 20 years, while the WHO scale allows to calculate it only up to 10 years.

Time frame:
MMDR Period: up to Day 1800
Reported as:
Mean · percentile
Change From Baseline in Weight for Age Percentile
percentileInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Change From Baseline in Weight for Age Percentile5.7 ± 27.30-5.3 ± 28.970.3 ± 28.55-0.7 ± 25.32——0.9 ± 17.2220.2 ± 28.154.0 ± 33.11
SecondaryPercentage of CMAP Responders

CMAP is an electrophysiological technique that can be used to determine the approximate number of motor neurons in a muscle or group of muscles. A participant was defined as a responder if they had a peroneal amplitude ≥1 mV at last visit (including the amplitude ≥1 mV at baseline and also demonstrated as such at last visit).

Time frame:
MMDR Period: At Day 1800
Reported as:
Number · percentage of responders
Percentage of CMAP Responders
percentage of respondersInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Percentage of CMAP Responders85072336567605125
SecondaryNumber of Participants Who Achieved Motor Milestones

Motor milestones were measured based on WHO criteria. The WHO motor milestones are a set of six milestones in motor development, all of which would be expected to be attained by 24 months of age in healthy children. The individual milestones are: sitting without support (SWS), standing with assistance (SWA), hands and knees crawling (HKC), and walking alone (WA).

Time frame:
MMDR Period: up to Day 1800
Reported as:
Count of participants · Participants
Number of Participants Who Achieved Motor Milestones
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
SWS:Achieved at Baseline&Maintained to Last Visit50163132327585
SWS:Inability at Baseline, Achieved at Last visit3011000000
HKC:Achieved at Baseline&Maintained to Last Visit10004203182
HKC: Inability at Baseline, Achieved at Last Visit004001121
SWA:Achieved at Baseline&Maintained to Last Visit1030120331
SWA:Inability at Baseline, Achieved at Last Visit003000000
WA: Achieved at Baseline&Maintained to Last Visit1000116121
WA: Inability at Baseline, Achieved at Last Visit001000000
SecondaryNumber of Participants Who Achieved Standing Alone and Walking With Assistance

Motor milestones were measured based on WHO criteria. The WHO motor milestones are a set of six milestones in motor development, all of which would be expected to be attained by 24 months of age in healthy children. The individual milestones are: SWS, SWA, HKC, WWA, WA and standing alone (SA). SA and WWA were assessed in this outcome measure.

Time frame:
MMDR Period: up to Day 1800
Reported as:
Count of participants · Participants
Number of Participants Who Achieved Standing Alone and Walking With Assistance
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
SA: Achieved at Baseline & Maintained to Last Visit1000119121
SA: Inability at Baseline, Achieved at Last Visit002000000
WWA: Achieved at Baseline & Maintained to Last Visit1010119221
WWA: Inability at Baseline, Achieved at Last Visit002000000
SecondaryTotal Number of Hospitalizations Due to Serious Respiratory Events

Total number of hospitalizations is total number of serious events that occurred during study for all participants under each group. For a participant with multiple SAEs which started at the same date and led to hospitalization, it is counted as one hospitalization.

Time frame:
Up to day 2520
Reported as:
Number · number of hospitalizations
Total Number of Hospitalizations Due to Serious Respiratory Events
number of hospitalizationsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Day 1-36021230200200
Day 361-72021318110210
Day 721-108001512000120
Day 1081-1440104110110
Day 1441-1800222200030
Day 1801-2160117000010
Day 2161-2520001—0000—
SecondaryTotal Number of Hospitalizations Due to Serious Adverse Events

Total number of hospitalizations is total number of serious events that occurred during study for all participants under each group. For a participant with multiple SAEs which started at the same date and led to hospitalization, it is counted as one hospitalization.

Time frame:
Up to day 2520
Reported as:
Number · number of hospitalizations
Total Number of Hospitalizations Due to Serious Adverse Events
number of hospitalizationsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Day 1-3606268912201083
Day 361-7206196447210122
Day 721-10805296372021211
Day 1081-1440210364516103
Day 1441-1800410193305180
Day 1801-216018320226130
Day 2161-25200114—0012—
SecondaryPercent of Time in Hospitalization
Time frame:
Upto day 2160
Reported as:
Median · percentage of days
Percent of Time in Hospitalization
percentage of daysInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Day 1-3600.00 (0.00 to 2.0)1.11 (0.00 to 16.7)0.28 (0.00 to 22.8)0.28 (0.00 to 11.4)0.00 (0.00 to 2.5)0.00 (0.00 to 0.8)0.00 (0.00 to 4.4)0.00 (0.00 to 6.4)0.0 (0.0 to 2.8)
Day 361-7200.28 (0.00 to 4.7)2.08 (0.00 to 17.2)0.56 (0.00 to 19.2)0.00 (0.00 to 7.8)0.00 (0.00 to 3.1)0.00 (0.00 to 0.00)0.00 (0.00 to 10.3)0.00 (0.00 to 29.7)0.0 (0.0 to 2.5)
Day 721-10800.00 (0.00 to 1.7)0.00 (0.00 to 7.5)0.00 (0.00 to 31.3)0.00 (0.00 to 20.3)0.00 (0.00 to 6.1)0.00 (0.00 to 1.4)0.00 (0.00 to 3.6)0.00 (0.00 to 12.2)0.0 (0.0 to 11.4)
Day 1081-14400.00 (0.00 to 0.8)0.00 (0.00 to 7.5)0.00 (0.00 to 9.7)0.00 (0.00 to 48.6)0.00 (0.00 to 1.9)0.00 (0.00 to 0.8)0.00 (0.00 to 5.8)0.00 (0.00 to 35.3)0.69 (0.0 to 1.9)
Day 1441-18000.00 (0.00 to 8.3)0.00 (0.00 to 20.2)0.00 (0.00 to 22.6)0.00 (0.00 to 12.1)0.00 (0.00 to 2.0)0.00 (0.00 to 0.8)0.00 (0.00 to 5.3)0.00 (0.00 to 8.9)0.00 (0.00 to 1.7)
Day 1801-21600.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)0.00 (0.00 to 0.00)
SecondaryChange From Baseline in Cobb-Angle on X-Ray of the Thoracolumbar Spine by Visit

Cobb angle is a measurement of the degree of side-to-side spinal curvature used to define scoliosis.

Time frame:
MMDR Period: Baseline, MMDR Day 1800
Reported as:
Mean · degree
Change From Baseline in Cobb-Angle on X-Ray of the Thoracolumbar Spine by Visit
degreeInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Baseline22.7 ± 17.8616.6 ± 13.3834.8 ± 18.4349.2 ± 13.1938.5 ± 27.3629.8 ± 25.0924.3 ± 19.0826.8 ± 20.3333.0 ± 16.94
Change at MMDR day 180029.8 ± 9.4616.9 ± 27.2713.0 ± 29.91-11.6 ± 24.65-3.8 ± 17.014.0 ± 7.7819.8 ± 30.8318.8 ± 30.30-13.8 ± 0
SecondaryPediatric Quality of Life Inventory (PedsQL) Questionnaires Total Score by Domain

Items on the PedsQL generic core scale are reverse scored and transformed to a 0-100 scale. The PedsQL parent (P) and self (S) reported questionnaire was collected for participants from 2 to 25 years of age. Four dimensions were collected: Physical, Emotional, Social and School functioning and each item was scored on a 5 point ordinal scale. 0 (never) =100, 1 (almost never) = 75, 2 (sometimes)= 50, 3 (often) = 25, 4 (almost always) = 0. A total score was calculated as the sum of all the items over the number of items answered on all the scales. If more than 50% of items or more were missing, the scale score was not computed. Higher scores indicated better health related quality of life.

Time frame:
MMDR Period: At Day 1800
Reported as:
Mean · score on scale
Pediatric Quality of Life Inventory (PedsQL) Questionnaires Total Score by Domain
score on scaleInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
S: Physical Functioning Report37.1 ± 11.2622.4 ± 31.5247.5 ± 25.3132.6 ± 20.4837.5 ± 13.6852.7 ± 16.9445.4 ± 13.8539.7 ± 17.9753.7 ± 24.46
S: Emotional Functioning Report61.9 ± 12.5261.7 ± 26.3963.3 ± 20.7167.1 ± 19.5579.2 ± 14.4178.0 ± 21.2484.6 ± 15.4274.5 ± 22.8067.0 ± 16.43
S: Social Functioning67.5 ± 22.8350.8 ± 41.5267.1 ± 22.8775.7 ± 20.0977.7 ± 11.6680.8 ± 13.1183.3 ± 15.0776.3 ± 13.8880.0 ± 12.25
S: School/Work Functioning Report54.4 ± 14.2540.8 ± 33.2366.1 ± 17.6671.4 ± 14.6477.3 ± 13.3377.8 ± 15.0981.8 ± 14.8977.1 ± 15.2282.0 ± 11.51
P: Physical Functioning Report25.0 ± 27.5519.1 ± 24.5424.9 ± 22.7732.6 ± 30.0728.6 ± 14.3146.1 ± 21.4735.2 ± 18.1933.5 ± 18.4120.8 ± 5.82
P: Emotional Functioning Report68.1 ± 13.0869.5 ± 17.2358.7 ± 14.9065.0 ± 26.4672.7 ± 19.7571.8 ± 19.8478.0 ± 18.7478.2 ± 19.6074.2 ± 11.14
P: Social Functioning Report47.5 ± 12.8254.0 ± 23.6651.3 ± 20.0664.3 ± 22.6371.9 ± 24.4672.1 ± 16.9670.0 ± 20.6571.0 ± 17.5060.8 ± 13.20
P: School/Work Functioning Report48.8 ± 12.1748.5 ± 31.2351.4 ± 21.3663.6 ± 18.6476.5 ± 13.4578.5 ± 18.4478.8 ± 20.1978.0 ± 14.7579.2 ± 9.70
SecondaryChange From Baseline in Assessment of Caregiver Experience With Neuromuscular Disease (ACEND) Questionnaire Total Score

The ACEND is a questionnaire that includes a total of seven domains assessing physical impact (including feeding/grooming/dressing, sitting/play, transfers, and mobility) and general caregiver impact (including time, emotion, and finance) and each domain comprises several items. The total score (TS) for each domain will be calculated on a scale of 0 to 100. Higher scores indicate a greater impact on the caregiver.

Time frame:
MMDR Period: up to Day 1800
Reported as:
Mean · score on scale
Change From Baseline in Assessment of Caregiver Experience With Neuromuscular Disease (ACEND) Questionnaire Total Score
score on scaleInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Feeding/Grooming/Dressing TS: Change MMDR Day180014.2 ± 21.560.6 ± 2.0118.5 ± 22.079.2 ± 15.912.1 ± 14.820.6 ± 2.434.6 ± 18.905.9 ± 12.072.8 ± 7.72
Sitting/Play TS: Change at MMDR Day 18000.8 ± 10.29-0.4 ± 14.915.5 ± 28.011.5 ± 22.212.8 ± 12.040.0 ± 0.00-1.8 ± 16.481.7 ± 16.08-2.0 ± 4.90
Transfers TS: Change at MMDR Day 18000.4 ± 7.240.7 ± 1.620.0 ± 12.32-5.5 ± 6.68-5.8 ± 15.141.4 ± 9.48-3.6 ± 16.171.2 ± 18.16-4.0 ± 11.03
Mobility TS: Change at MMDR Day 1800-2.3 ± 14.930.5 ± 1.727.5 ± 22.52-12.1 ± 18.69-13.0 ± 13.83-2.2 ± 7.861.9 ± 18.47-5.8 ± 17.506.7 ± 20.66
Time TS: Change at MMDR Day 18004.4 ± 19.786.8 ± 24.76-0.7 ± 22.60-6.3 ± 21.65-2.4 ± 18.142.6 ± 18.361.4 ± 17.220.5 ± 16.78-6.3 ± 14.25
Emotion TS: Change at MMDR Day 18005.0 ± 14.806.3 ± 15.82-2.1 ± 20.982.1 ± 14.22-2.4 ± 21.001.0 ± 13.254.7 ± 12.73-2.5 ± 12.70-18.1 ± 12.01
Finance TS: Change at MMDR Day 1800-1.0 ± 17.297.3 ± 20.66-4.1 ± 22.174.4 ± 18.98-0.8 ± 20.704.1 ± 14.927.2 ± 17.922.1 ± 19.94-3.3 ± 8.16
SecondaryNumber of Participants With Disease-related Hospitalizations and AEs
Time frame:
MMDR Period: up to Day 1800
Reported as:
Count of participants · Participants
Number of Participants With Disease-related Hospitalizations and AEs
ParticipantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202
Disease-related hospitalization692759013233
Disease-related AEs1121607161236688
SecondarySurvival Rate

Survival rate was defined as the percentage of participants alive during the study and was estimated from the Kaplan Meier (KM) curve for time to death.

Time frame:
MMDR Period: up to Day 1800
Reported as:
Number · percentage of participants
Survival Rate
percentage of participantsInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202Later SMA Onset CS12 Type 2Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 3
Survival Rate10079.1687.6997.6198.7910010091.66100

Adverse events

Collected over From Day 1 up to the end of the study (up to 2848 days). Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Infantile SMA Onset CS3A0/13 (0%)11/13 (84.6%)13/13 (100%)
Infantile SMA Onset CS3B Previous Control5/24 (20.8%)23/24 (95.8%)23/24 (95.8%)
Infantile SMA Onset CS3B Previous ISIS 3964438/65 (12.3%)59/65 (90.8%)65/65 (100%)
Infantile SMA Onset 232SM2021/12 (8.3%)9/12 (75%)12/12 (100%)
Later SMA Onset 232SM2020/8 (0%)5/8 (62.5%)8/8 (100%)
Later SMA Onset CS12 Type 20/20 (0%)12/20 (60%)20/20 (100%)
Later SMA Onset CS12 Type 30/25 (0%)6/25 (24%)25/25 (100%)
Later SMA Onset CS4 Previous Control1/42 (2.4%)26/42 (61.9%)40/42 (95.2%)
Later SMA Onset CS4 Previous ISIS 3964431/83 (1.2%)47/83 (56.6%)79/83 (95.2%)
Most frequent serious events
Showing 10 of 221
Most frequent serious events
EventInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443
PneumoniaInfections and infestations3/138/2427/655/121/82/200/258/426/83
Acute respiratory failureRespiratory, thoracic and mediastinal disorders3/139/2415/652/120/82/200/253/421/83
ScoliosisMusculoskeletal and connective tissue disorders2/130/2410/653/122/86/200/2511/4222/83
Rhinovirus infectionInfections and infestations0/135/245/650/120/81/200/252/420/83
Respiratory distressRespiratory, thoracic and mediastinal disorders2/135/249/651/120/80/200/251/421/83
Respiratory syncytial virus infectionInfections and infestations1/131/2412/651/120/80/200/254/423/83
Oxygen saturation decreasedInvestigations0/134/243/650/120/80/200/250/420/83
DehydrationMetabolism and nutrition disorders0/132/243/652/120/81/200/250/421/83
Viral infectionInfections and infestations2/131/243/650/120/80/200/250/420/83
Respiratory failureRespiratory, thoracic and mediastinal disorders0/133/249/650/120/80/200/251/421/83
Most frequent other events
Showing 10 of 353
Most frequent other events
EventInfantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443
PyrexiaGeneral disorders13/1315/2450/655/125/810/203/2521/4239/83
Upper respiratory tract infectionInfections and infestations11/1314/2434/653/126/88/205/2521/4233/83
HeadacheNervous system disorders4/133/248/651/123/85/2017/2520/4224/83
Post lumbar puncture syndromeInjury, poisoning and procedural complications2/134/244/650/122/813/2015/257/4221/83
ScoliosisMusculoskeletal and connective tissue disorders6/1310/2438/653/125/86/202/2522/4233/83
CoughRespiratory, thoracic and mediastinal disorders4/134/2416/655/125/86/202/2515/4229/83
VomitingGastrointestinal disorders7/139/2423/653/124/87/204/2518/4235/83
Procedural painInjury, poisoning and procedural complications5/135/2415/652/122/86/2011/2519/4229/83
Muscle contractureMusculoskeletal and connective tissue disorders5/136/2418/652/121/86/201/2517/4237/83
Back painMusculoskeletal and connective tissue disorders1/132/247/652/121/83/2011/2511/4215/83

Baseline characteristics

The safety analysis set included all participants who were enrolled and received at least 1 dose of nusinersen or underwent sham procedure during CS11.

Age, Customized
Age, Customized(Participants)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202Total
Infants and toddlers (28 days-23 months)0246500000089
Children (2-11 years)130012191042838187
Adolescents (12-17 years)000001200012
Adults (18-64 years)0000130004
Sex: Female, Male
Sex: Female, Male(Participants)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202Total
Female61536681521463156
Male79296121021375136
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202Total
Hispanic or Latino131022604129
Not Hispanic or Latino1218477181937695232
Unknown or Not Reported038300510231
Race/Ethnicity, Customized
Race/Ethnicity, Customized(Participants)Infantile SMA Onset CS3AInfantile SMA Onset CS3B Previous ControlInfantile SMA Onset CS3B Previous ISIS 396443Infantile SMA Onset 232SM202Later SMA Onset CS12 Type 2Later SMA Onset CS12 Type 3Later SMA Onset CS4 Previous ControlLater SMA Onset CS4 Previous ISIS 396443Later SMA Onset 232SM202Total
American Indian or Alaska Native0010000012
Asian112411716033
Black or African American0030011106
White1018475182326534204
Multiple12101033011
Other1030000015
Not reported038300510231
08

Study locations

47 sites
  • David Geffen School of Medicine at UCLA
    Los Angeles, California 90095-8344, United States
  • Stanford University School of Medicine
    Palo Alto, California 94305, United States
  • Children's Hospital Colorado
    Aurora, Colorado 80045, United States
  • Connecticut Children's Medical Center
    Hartford, Connecticut 06106, United States
  • Nemours Children's Clinic
    Orlando, Florida 32827, United States
  • Ann & Robert H. Lurie Children's Hospital of Chicago
    New York, Illinois 60611, United States
  • The Johns Hopkins Hospital
    Baltimore, Maryland 21287, United States
  • Boston Children's Hospital
    Boston, Massachusetts 02115, United States
  • Gillette Children's Specialty Healthcare
    Saint Paul, Minnesota 55101, United States
  • Washington University School of Medicine
    Saint Louis, Missouri 63110, United States
  • Columbia University Medical Center
    New York, New York 10032, United States
  • Duke University School of Medicine
    Durham, North Carolina 27710, United States
  • Duke University School of Medicine
    Miyagi, North Carolina 27710, United States
  • Oregon Health Sciences University
    Durham, Oregon 97239, United States
  • Children's Hospital of Philadelphia
    Philadelphia, Pennsylvania 19104, United States
  • Children's Medical Center
    Dallas, Texas 75235, United States
  • University of Utah
    Obu, Aichi, Utah 84112, United States
  • Seattle Children's Hospital
    Seattle, Washington 98105, United States
  • Sydney Children's Hospital Clinical Research Centre
    Sydney, New South Wales 2031, Australia
  • Royal Children's Hospital
    Parkville, Victoria 3052, Australia
  • Universitair Kinderziekenhuis Koningin Fabiola
    Brussels, 1020, Belgium
  • BC Children's Hospital / UBC
    Vancouver, British Columbia V6H 3V4, Canada
  • Children's Health Research Institute
    Brussel, Ontario N6A 5W9, Canada
  • McGill University Health Centre
    Montreal, Quebec H4A 3J1, Canada
  • Armand Trousseau Hospital, I-Motion
    Paris, Paris 9 75012, France
  • LMU-Campus Innenstadt
    Muenchen, Bayern 80337, Germany
  • Universitatsklinikum Essen
    Essen, 45147, Germany
  • Universitaetsklinikum Freiburg
    Freiburg, 79106, Germany
  • The University of Hong Kong
    Hong Kong, Hong Kong SAR 999077, Hong Kong
  • Pediatric Neurology Unit, Catholic University
    Essen, 00168, Italy
  • Istituto Giannina Gaslini, Centro Traslazionale di Miologia
    Genova, 16147, Italy
  • Department of Neuroscience, Università di Messina, AOU Polic
    Messina, 98125, Italy
  • Aichi Children's Health and Medical Center
    Obu, Aichi 474-0038, Japan
  • Hyogo College of Medicine
    Nishinomiya, Hyogo 663-8501, Japan
  • Tokyo Women's Medical University
    Shinjuku-ku, Tokyo 162-8666, Japan
  • Kumamoto University Hospital
    Kumamoto, 860-8556, Japan
  • Miyagi Prefectural Children Hospital
    Miyagi, 989-3126, Japan
  • University of Miyazaki Hospital
    Miyazaki, 889-1692, Japan
  • Seoul National University Hospital
    Seoul, Korea 3080, Korea, Republic of
  • Hospital Sant Joan de Deu
    Barcelona, 08950, Spain
  • Hospital Universitario Vall de Hebron
    Hebron, 08035, Spain
  • Hospital Universitario La Paz
    Madrid, 28046, Spain
  • The Queen Silvia Children's Hospital
    Gothenburg, SE 416 86, Sweden
  • Uníversity of Hacettepe
    Ankara, 6100, Turkey
  • Marmara University Pendik Training and Research Hospital
    Istanbul, 34662, Turkey
  • MRC Centre for Neuromuscular Diseases at Newcastle
    Newcastle, Northumberland NE1 3BZ, United Kingdom
  • UCL Institute of Child Health
    London, WC1N 1EH, United Kingdom
09

References and documents

Study documents

  • Study protocol · Oct 20, 2021
  • Statistical analysis plan · Sep 6, 2023

Documents are hosted by the registry — open the source record to download them.

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 22, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02594124
Lead sponsor
Biogen
Responsible party
Sponsor
First posted
Nov 1, 2015
Start date
Nov 4, 2015
Primary completion
Aug 21, 2023
Completion
Aug 21, 2023
Results posted
Oct 22, 2024
Last update
Oct 22, 2024

Study contacts

Medical Director
study director · Biogen

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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