A Phase 3 interventional study of EryDex System in Ataxia Telangiectasia and Genetic Syndrome, sponsored by Quince Therapeutics S.p.A.. Terminated at 17 sites in 11 countries. Open to participants aged 6 Years and older. Per ClinicalTrials.gov, last updated 2024-10-08.
Sponsored by Quince Therapeutics S.p.A. · Phase 3, Interventional, and Treatment
Primary Objective
To monitor and evaluate the long-term safety and tolerability of EDS-EP in AT patients.
Secondary Objective
To evaluate the long-term effect of EDS-EP on health-related Quality of Life (QoL; EQ-5D-5L scale).
Exploratory Objective:
To evaluate the long-term effect of EDS-EP in treating central nervous system (CNS) symptoms, as measured by the "Modified" International Cooperative Ataxia Rating Scale (mICARS), and Clinical Global Impression of severity and change (CGI-S/C).
This was an international (North America, Europe, Africa, Asia and Australia), multi-center, prospective, open-label treatment study, designed to continue to provide the study medication to all patients who completed 12 months of treatment (including those treated with placebo) in the ATTeST-IEDAT-02-2015 trial, completed the study assessments, do not present safety contraindication to continuation of treatment, and provided informed consent.
The study aimed to collect information on the long-term safety and efficacy of the trial treatment.
Patients meeting all selection criteria received monthly infusions of EDS-EP (dose range of \~14-22 mg DSP/infusion). If this dose of EDS-EP was not tolerated, the patient was discontinued from the study.
During the study, long-term efficacy assessments were performed every 6 months, while safety parameters were assessed at each monthly visit. The Schedule of Visits and assessments for the first 12 months were replicated for the second year onwards for patients who continued EryDex treatment beyond 12 months.
The analysis of the EryDex long-term safety and tolerability was based on the occurrence of Treatment-Emergent Adverse Events (TEAEs), including Serious AEs and discontinuations due to AEs. The long-term effect was measured by the "Modified" International Cooperative Ataxia Rating Scale, (mICARS), Rescored mICARS, Clinical Global Impression of severity and change (CGI-S/C) and health-related Quality of Life (QoL; EQ-5D-5L scale).
The ICARS, EQ-5D-5L and the CGI-C / S were administered by a properly qualified rater identified at each site who performed the ratings on the efficacy measures. The ICARS rater remained blinded to other assessments and did not have access to the safety data. The CGI rater did not have access to the ICARS ratings or safety data but was able to refer to other scales in scoring the CGI.
All patients enrolled in this study have participated in Study ATTeST-IEDAT-02-2015, and there was no de novo enrollment of new patients.
EryDel S.p.A (now Quince Therapeutics) decided to discontinue the IEDAT-03-2018 study in India due to the COVID-19 pandemic. On 13 Apr 2022, after the last patient completed one year of EryDex treatment, EryDel S.p.A. communicated the end of the open label extension study IEDAT-03-2018 and the stop of the EryDex treatment for patients in the context of this study.
41 studies on the registry are indexed under Ataxia Telangiectasia; 6 are open to participants now.
This study's enrollment of 104 is above the median of 30 across 27 interventional studies indexed under Ataxia Telangiectasia.
Browse Ataxia Telangiectasia studies →Quince Therapeutics S.p.A. is the lead sponsor of 10 studies on the registry; none are open to participants now.
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Moreover, patients who were discontinued from the ATTeST study during the COVID-19 pandemic were eligible to receive the EryDex treatment in the IEDAT-03-2018 study, in the absence of safety contraindications to continuation of the treatment, and after signing the informed consent.
There were no de novo enrolled patients.
Exclusion Criteria:
Patients who met one or more of the following criteria were not considered to be eligible to participate in the study:
General
Females that were:
Females of childbearing potential using adequate birth control, as determined by their Health Care Provider, were eligible.
Current participation in another clinical study with another investigational drug.
Medical History and Current Status
Patients who experienced moderate / severe steroid side effects, or moderate / severe adverse events associated with the EryDex treatment administered in the ATTeST study.
Prior / Concomitant Medication
\~14-22 mg dexamethasone sodium phosphate (DSP) for 12 months. The duration of EryDex treatment could be extended further and continue until patients eventually withdrew consent, or the Investigator decided to discontinue treatment based on a risk / benefit assessment.
Combination Product: EryDex System
EryDex System was a combination product that was used to load dexamethasone sodium phosphate (DSP) into autologous erythrocytes (EDS) creating the EDS-end product which was infused into the patients. EryDex treatment consisted of a dose range correspondent to the ATTeST High Dose (obtained by loading 125 mg of DSP to the EryDex process and that, in the ATTeST, resulted in a mean of 17.4 ± 5.4 mg (mean ± standard deviation) of DSP infused to patients) administered via ex vivo encapsulation into EDS that were infused into the patient with A-T. The dose of EryDex treatment was selected to allow collection of long-term safety data on the dose of erythrocyte encapsulated DSP that was considered more effective among the two different doses that were employed in the ATTeST study, based on the analysis of the ATTeST blinded, Phase 3 study data.
Number of Treatment-Emergent Adverse Event (TEAE), Treatment-emergent Serious Adverse Events (TESAE), and Adverse Events of Special Interest (AESI) Throughout the Study
Assessment of TEAEs, treatment-emergent serious adverse events (TESAE), and adverse events of special interest (AESI) were performed throughout the study, from the time of signing of the ICF at Baseline Visit through to the Final Study Visit (Month 12 or early discontinuation). All patients were to be followed up through 30 days after the Final Visit (Month 12 or early discontinuation) or at least 60 days after the final infusion, whichever was longer.
Time frame: From Baseline (Visit 1 - Day 0) to Follow-up (~60 days after last infusion, i.e. up to 50.5 months)
Change From Baseline in Quality of Life Using EQ-5D-5L Scale to Month 36
The EQ-5D included single item measures of 5 health dimensions: * mobility, * self-care, * usual activities, * pain / discomfort, and * anxiety / depression. The EQ-5D-5L included five levels of severity (i.e., no problems, slight problems, moderate problems, severe problems, and extreme problems) for each of the five EQ-5D dimensions. These levels were scored from 1 = no problems to 5 = extreme problems: from 5, min/worst, to 25, best/max).The EQ-5D results were converted into a continuous index score: as for this index score, the closer the value is to 1, the better is the health status. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
Time frame: From Baseline (Visit 1- Day 0) to Month 36
Number of Patients With Improving, Stable or Worsening Score Using a Clinical Global Impression of Change (CGI-C) From Baseline (Visit 1- Day 0) to Month 36
The CGI-C scale assesses the change in the patient's clinical status from baseline using a 7-point scale, ranging from 1 (very much improved) to 7 (very much worse), with a score of 4 indicating no change. Clinicians were required to conduct a full clinical interview and examination of the patient. The interview and examination assessed various aspects of the patient's appearance (grooming, evidence of falls, etc.), ataxia, cognition (orientation, calculation ability, language, ability to follow commands, memory, etc.), apraxia, dysarthria, extrapyramidal motor symptoms, activities of daily living, and mood. The higher the score the worse the outcome. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
Time frame: From Baseline (Visit 1- Day 0) to Month 36
Number of Patients With None to Severe (0 to 4) Scores in Clinical Global Impression of Severity (CGI-S)-Structured of Neurological Symptoms of AT From Baseline (Visit 1 - Day 0) to Month 36
The CGI-S scale measures global severity of illness at a given point in time, and is usually rated on a 7-point, Likert-type scale ranging from 1 (normal, not ill at all) to 7 (among the most extremely ill patients). No version of the CGI-S exists which has been specifically adapted for use in patients with A-T; therefore, a 5-point version was developed that considered the severity of the following symptoms of A-T: ataxia (walking), dysarthria, dysmetria, extrapyramidal symptoms (chorea, myoclonus, dystonia, and tremor), and eye movements. Ratings of none (0), mild (1), moderate (2), severe (3), and very severe (4) were selected based on the level of symptomatology. The higher the score the worse the outcome. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
Time frame: From Baseline (Visit 1- Day 0) to Month 36
Change From Baseline of the Modified International Cooperative Ataxia Rating Scale (mICARS) Until Month 36
The International Cooperative Ataxia Rating Scale (ICARS) was an assessment of the degree of impairment in patients with cerebellar ataxia and was administered in its entirety; however, the primary efficacy assessment was based on the modified (m)ICARS, which excluded the Oculomotor domain (items 17 to 19) and items 8 to 12 of the Kinetic Functions domain of the ICARS. The mICARS was a 54 points maximum score (min 0) questionnaire divided into 3 sections: * Posture and Gait Disturbance section-7 items (min score 0, max score 34) * Kinetic Function-2 items (min 0, max 12) * Speech Disorder- 2 items (min 0, max 8). An higher scores - both for total and subscores - indicate a higher level of disease impairment. The subscores are added to give the total score. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
Time frame: From Baseline (Visit 1- Day 0) to Month 36
Out of a total of 108 patients who completed the full treatment period (including placebo treatment) in the ATTeST - IEDAT-02 study, 104 patients were enrolled in the IEDAT-03-2018 study (OLE-IEDAT) and comprised the Total Set. These patients signed the ICF, completed the ATTeST study assessments, and did not present safety contraindication prior continuation with the EryDex treatment.
| Milestone | Active Drug |
|---|---|
| Started | 104 |
| Total set | 104 |
| Safety set | 104 |
| Full analysis set | 80 |
| Month 12 | 64 |
| Month 24 | 33 |
| Month 36 | 21 |
| Month 48 | 7 |
| Month 50.5 | 1 |
| Completed | 0 |
| Not completed | 104 |
| Withdrew: Withdrawal by subject | 17 |
| Withdrew: Due to the covid-19 pandemic | 12 |
| Withdrew: Adverse event | 3 |
| Withdrew: Physician decision | 1 |
| Withdrew: Study terminated by sponsor | 71 |
Assessment of TEAEs, treatment-emergent serious adverse events (TESAE), and adverse events of special interest (AESI) were performed throughout the study, from the time of signing of the ICF at Baseline Visit through to the Final Study Visit (Month 12 or early discontinuation). All patients were to be followed up through 30 days after the Final Visit (Month 12 or early discontinuation) or at least 60 days after the final infusion, whichever was longer.
| Number of events | Overall Population (SAF) |
|---|---|
| Number of TEAEs | 1232 |
| Number of Serious TEAEs | 19 |
| Number of TEAE leading to Death | 0 |
| Number of TEAE leading to Permanent Withdrawal of Treatment | 5 |
| Adverse Events During COVID-19 Interruption - On Dose | 5 |
| Adverse Events During COVID-19 Interruption - Off Dose | 3 |
| Adverse Events During COVID-19 Interruption - Restart | 55 |
| TEAE by Worst Intensity - Mild | 1028 |
| TEAE by Worst Intensity - Moderate | 187 |
| TEAE by Worst Intensity - Severe | 17 |
| TEAE by Closest Relationship to Treatment - Probable | 283 |
| TEAE by Closest Relationship to Treatment - Possible | 167 |
| TEAE by Closest Relationship to Treatment - Unlikely | 178 |
| TEAE by Closest Relationship to Treatment - Not related | 604 |
| Number of AESI | 83 |
The EQ-5D included single item measures of 5 health dimensions: * mobility, * self-care, * usual activities, * pain / discomfort, and * anxiety / depression. The EQ-5D-5L included five levels of severity (i.e., no problems, slight problems, moderate problems, severe problems, and extreme problems) for each of the five EQ-5D dimensions. These levels were scored from 1 = no problems to 5 = extreme problems: from 5, min/worst, to 25, best/max).The EQ-5D results were converted into a continuous index score: as for this index score, the closer the value is to 1, the better is the health status. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
| score on a scale | Overall Population (Total Set) |
|---|---|
| to Month 6 | 0.015 ± 0.1131 |
| to Month 12 | -0.022 ± 0.1145 |
| to Month 18 | 0.007 ± 0.1233 |
| to Month 24 | 0.011 ± 0.1746 |
| to Month 30 | -0.021 ± 0.1117 |
| to Month 36 | 0.011 ± 0.1242 |
The CGI-C scale assesses the change in the patient's clinical status from baseline using a 7-point scale, ranging from 1 (very much improved) to 7 (very much worse), with a score of 4 indicating no change. Clinicians were required to conduct a full clinical interview and examination of the patient. The interview and examination assessed various aspects of the patient's appearance (grooming, evidence of falls, etc.), ataxia, cognition (orientation, calculation ability, language, ability to follow commands, memory, etc.), apraxia, dysarthria, extrapyramidal motor symptoms, activities of daily living, and mood. The higher the score the worse the outcome. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
| Participants | Overall Population (Total Set) |
|---|---|
| Month 6 - Improved (Score 1-3) | 9 |
| Month 6 - No change or Worsened (Score 4-7) | 68 |
| Month 12 - Improved (Score 1-3) | 14 |
| Month 12 - No change or Worsened (Score 4-7) | 45 |
| Month 18 - Improved (Score 1-3) | 6 |
| Month 18 - No change or Worsened (Score 4-7) | 41 |
| Month 24 - Improved (Score 1-3) | 5 |
| Month 24 - No change or Worsened (Score 4-7) | 26 |
| Month 30 - Improved (Score 1-3) | 2 |
| Month 30 - No change or Worsened (Score 4-7) | 17 |
| Month 36 - Improved (Score 1-3) | 3 |
| Month 36 - No change or Worsened (Score 4-7) | 16 |
The CGI-S scale measures global severity of illness at a given point in time, and is usually rated on a 7-point, Likert-type scale ranging from 1 (normal, not ill at all) to 7 (among the most extremely ill patients). No version of the CGI-S exists which has been specifically adapted for use in patients with A-T; therefore, a 5-point version was developed that considered the severity of the following symptoms of A-T: ataxia (walking), dysarthria, dysmetria, extrapyramidal symptoms (chorea, myoclonus, dystonia, and tremor), and eye movements. Ratings of none (0), mild (1), moderate (2), severe (3), and very severe (4) were selected based on the level of symptomatology. The higher the score the worse the outcome. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
| Participants | Overall Population (Total Set) |
|---|---|
| Baseline - CGI-S Score - 0 | 2 |
| Baseline - CGI-S Score - 1 | 18 |
| Baseline - CGI-S Score - 2 | 31 |
| Baseline - CGI-S Score - 3 | 23 |
| Baseline - CGI-S Score - 4 | 0 |
| Month 6 - CGI-S Score - 0 | 1 |
| Month 6 - CGI-S Score - 1 | 20 |
| Month 6 - CGI-S Score - 2 | 30 |
| Month 6 - CGI-S Score - 3 | 22 |
| Month 6 - CGI-S Score - 4 | 3 |
| Month 12 - CGI-S Score - 0 | 0 |
| Month 12 - CGI-S Score - 1 | 12 |
| Month 12 - CGI-S Score - 2 | 28 |
| Month 12 - CGI-S Score - 3 | 17 |
| Month 12 - CGI-S Score - 4 | 2 |
| Month 18 - CGI-S Score - 0 | 0 |
| Month 18 - CGI-S Score - 1 | 13 |
| Month 18 - CGI-S Score - 2 | 21 |
| Month 18 - CGI-S Score - 3 | 12 |
| Month 18 - CGI-S Score - 4 | 1 |
| Month 24 - CGI-S Score - 0 | 0 |
| Month 24 - CGI-S Score - 1 | 10 |
| Month 24 - CGI-S Score - 2 | 10 |
| Month 24 - CGI-S Score - 3 | 9 |
| Month 24 - CGI-S Score - 4 | 2 |
| Month 30 - CGI-S Score - 0 | 0 |
| Month 30 - CGI-S Score - 1 | 5 |
| Month 30 - CGI-S Score - 2 | 10 |
| Month 30 - CGI-S Score - 3 | 4 |
| Month 30 - CGI-S Score - 4 | 0 |
| Month 36 - CGI-S Score - 0 | 0 |
| Month 36 - CGI-S Score - 1 | 3 |
| Month 36 - CGI-S Score - 2 | 10 |
| Month 36 - CGI-S Score - 3 | 6 |
| Month 36 - CGI-S Score - 4 | 0 |
The International Cooperative Ataxia Rating Scale (ICARS) was an assessment of the degree of impairment in patients with cerebellar ataxia and was administered in its entirety; however, the primary efficacy assessment was based on the modified (m)ICARS, which excluded the Oculomotor domain (items 17 to 19) and items 8 to 12 of the Kinetic Functions domain of the ICARS. The mICARS was a 54 points maximum score (min 0) questionnaire divided into 3 sections: * Posture and Gait Disturbance section-7 items (min score 0, max score 34) * Kinetic Function-2 items (min 0, max 12) * Speech Disorder- 2 items (min 0, max 8). An higher scores - both for total and subscores - indicate a higher level of disease impairment. The subscores are added to give the total score. The efficacy data focus mainly up to Month 36 as afterwards the number of patients / assessments dropped below 20% of the initial sample size, which was required for the efficacy evaluations.
| score on a scale | Overall Population (Total Set) |
|---|---|
| to Month 6 | 0.7 ± 4.09 |
| to Month 12 | 1.5 ± 3.36 |
| to Month 18 | 2.7 ± 4.28 |
| to Month 24 | 3.9 ± 4.96 |
| to Month 30 | 4.5 ± 5.41 |
| to Month 36 | 34.0 ± 5.17 |
Collected over TEAEs were all the AEs reported from Baseline (Visit 1 - Day 0) to Follow-up (~60 days after last infusion, i.e. up to 50.5 months).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Overall Population (SAF) | 0/104 (0%) | 12/104 (11.5%) | 98/104 (94.2%) |
| Event | Overall Population (SAF) |
|---|---|
| Forearm fractureInjury, poisoning and procedural complications | 2/104 |
| Lower respiratory tract infectionInfections and infestations | 1/104 |
| PneumoniaInfections and infestations | 1/104 |
| Viral infectionInfections and infestations | 1/104 |
| B-Cell limphomaNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/104 |
| Hodgkin's DiseaseNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/104 |
| Odontogenic cystNeoplasms benign, malignant and unspecified (incl cysts and polyps) | 1/104 |
| Trombocytopenic PurpuraBlood and lymphatic system disorders | 1/104 |
| DysphagiaGastrointestinal disorders | 1/104 |
| PyrexiaGeneral disorders | 1/104 |
| Event | Overall Population (SAF) |
|---|---|
| PyrexiaGeneral disorders | 33/104 |
| Infusion Related ReactionInjury, poisoning and procedural complications | 28/104 |
| Upper respiratory tract infectionInfections and infestations | 23/104 |
| DiarrhoeaGastrointestinal disorders | 23/104 |
| NasopharyngitisInfections and infestations | 21/104 |
| VomitingGastrointestinal disorders | 20/104 |
| CoughRespiratory, thoracic and mediastinal disorders | 19/104 |
| Corona Virus InfectionInfections and infestations | 17/104 |
| FatigueGeneral disorders | 16/104 |
| Iron DeficiencyMetabolism and nutrition disorders | 16/104 |
In this trial, the Total or Overall Set (N=104) numerically corresponds to the Safety set, which included all patients who provided informed consent or assent and who received any dose of study medication during ATTeST-IEDAT-03-2018 study (i.e., "Date performed" given on the "EDS-EP Infusion" eCRF page at any Visit).
| Age, Categorical(Participants) | Overall Population (Total Set) |
|---|---|
| <=18 years | 104 |
| Between 18 and 65 years | 0 |
| >=65 years | 0 |
| Age, Continuous(years) | Overall Population (Total Set) |
|---|---|
| Mean | 11.4 ± 4.57 |
| Sex: Female, Male(Participants) | Overall Population (Total Set) |
|---|---|
| Female | 49 |
| Male | 55 |
| Ethnicity (NIH/OMB)(Participants) | Overall Population (Total Set) |
|---|---|
| Hispanic or Latino | 5 |
| Not Hispanic or Latino | 99 |
| Unknown or Not Reported | 0 |
| Race (NIH/OMB)(Participants) | Overall Population (Total Set) |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 21 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 3 |
| White | 80 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
| Region of Enrollment(participants) | Overall Population (Total Set) |
|---|---|
| Belgium | 3 |
| United States | 25 |
| Poland | 10 |
| Italy | 2 |
| Australia | 2 |
| Tunisia | 7 |
| Germany | 13 |
| India | 15 |
| Spain | 11 |
| Norway | 5 |
| United Kingdom | 11 |
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Quince Therapeutics S.p.A.