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Kuvan

Phase 4FDA approved 2007

Phenylketonuria | Small molecule | Metabolic |BioMarin Pharmaceutical Inc.|Trials Updated: Apr 1, 2025

Kuvan development status

FDA approval Dec 13, 2007
Approval holderBiomarin Pharm
ApplicationNDA022181
Highest phase Phase 4 (NCT01965912)
Phase scored for BMRNPhase 3
Registered trials 34 across 14 sponsors since Feb 2005

Label indication KUVAN ® is indicated to reduce blood phenylalanine (Phe) levels in adult and pediatric patients one month of age and older with hyperphenylalaninemia (HPA) due to tetrahydrobiopterin- (BH4-) responsive Phenylketonuria (PKU). KUVAN is to be used in conjunction with a Phe-restricted diet. FDA label

Kuvan target and mechanism

ModalitySmall molecule

Also known as Sapropterin dihydrochloride, Phenoptin, BH4, 6R BH4, Sapropterin

Success Probability

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Market & Valuation

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Trial Design

RandomizedCONTROLLED
Total Trials15
Total Enrollment1,770

FDA Designations

No designations recorded

Kuvan clinical trials

Kuvan · 15 trials · 9 indications

Phase 3 7Phase 2 5Phase 1 3
NCT01376908Kuvan® in Phenylketonuria Patients Less Than 4 Years OldPhenylketonuria
COMPLETED56 Analytics
NCT01114737Safety and Therapeutic Effects of Sapropterin Dihydrochloride on Neuropsychiatric Symptoms in Phenylketonuria (PKU) PatientsPhenylketonuria
COMPLETED206 Analytics
NCT00838435Effect of Kuvan on Neurocognitive Function, Blood Phenylalanine Level, Safety, and Pharmacokinetics in Children With PKUPhenylketonuria
COMPLETED95 Analytics
NCT00332189Study of Phenoptin in Subjects With Phenylketonuria Who Participated in Protocols PKU-004 or PKU-006Phenylketonuria
COMPLETED111 Analytics
NCT00272792Study of Phenoptin to Increase Phenylalanine Tolerance in Phenylketonuric Children on a Phenylalanine-restricted DietPhenylketonurias
COMPLETED45 Analytics
NCT00225615A Phase 3, Multicenter, Open-Label Extension Study of Phenoptin in Subjects With PKU Who Have Elevated Phenylalanine LevelsPhenylketonurias
COMPLETED100 Analytics
NCT00104247Study to Evaluate the Safety and Efficacy of Phenoptin™ in Subjects With Phenylketonuria Who Have Elevated Phenylalanine LevelsPhenylketonurias
COMPLETED89 Analytics
PHASE3COMPLETED
Kuvan® in Phenylketonuria Patients Less Than 4 Years Old
PhenylketonuriaUnlock trial analytics
PHASE3COMPLETED
Safety and Therapeutic Effects of Sapropterin Dihydrochloride on Neuropsychiatric Symptoms in Phenylketonuria (PKU) Patients
PhenylketonuriaUnlock trial analytics
PHASE3COMPLETED
Effect of Kuvan on Neurocognitive Function, Blood Phenylalanine Level, Safety, and Pharmacokinetics in Children With PKU
PhenylketonuriaUnlock trial analytics
PHASE3COMPLETED
Study of Phenoptin in Subjects With Phenylketonuria Who Participated in Protocols PKU-004 or PKU-006
PhenylketonuriaUnlock trial analytics
PHASE3COMPLETED
Study of Phenoptin to Increase Phenylalanine Tolerance in Phenylketonuric Children on a Phenylalanine-restricted Diet
PhenylketonuriasUnlock trial analytics
PHASE3COMPLETED
A Phase 3, Multicenter, Open-Label Extension Study of Phenoptin in Subjects With PKU Who Have Elevated Phenylalanine Levels
PhenylketonuriasUnlock trial analytics
PHASE3COMPLETED
Study to Evaluate the Safety and Efficacy of Phenoptin™ in Subjects With Phenylketonuria Who Have Elevated Phenylalanine Levels
PhenylketonuriasUnlock trial analytics

Study Endpoints

Primary Endpoints

Dietary Phenylalanine (Phe) Tolerance at Week 26
Week 26

Phe tolerance was defined as the amount of dietary Phe prescribed (milligram per kilogram per day \[mg/kg/day\]) while maintaining blood Phe levels within the selected therapeutic target range (defined as greater than or equal to \[\>=\] 120 to less than \[\<\] 360 micromoles per liter \[mcmol/L\]).

Change in Attention-Deficit Hyperactivity Disorder Rating Scale-IV (ADHD-RS) / Adult ADHD Self-Report Scale (ASRS) Total Score From Baseline to Week 13
Baseline to Week 13

Effects of 6R-BH4 on symptoms of ADHD in PKU subjects who had symptoms of ADHD at screening in the subjects that had a blood Phe level reduction after treatment with 6R-BH4. The total ADHD-RS score and the corrected total ARS score range from 0 to 54, with higher scores corresponding to worse severity of ADHD symptoms.

Number of Participants With a Score of 1 or 2 in Global Function Evaluation (CGI-I) From Baseline to Week 13.
13 weeks

Effects of 6R-BH4 on global function in PKU subjects in subjects that had a blood Phe level reduction after treatment with 6R-BH4 at screening. The CGI-I is a 7-point scale that requires the clinician to assess how much the participant's illness has improved or worsened relative to a baseline state at the beginning of the intervention and rated as: 1=very much improved; 2=much improved; 3=minimally improved; 4=no change; 5=minimally worse; 6=much worse; 7=very much worse.

Full-Scale Intelligence Quotient (FSIQ) Score
Assessments through 84 months.

Full Scale Intelligence Quotient (FSIQ) is a score derived through administration of selected subtests from age appropriate Wechsler Intelligence assessments. Weschler Preschool and Primary Scale of Intelligence (WPPSI)-III is used for children \>30 months and ≤6 years; and Weschler Intelligence Scale for Children (WISC)-IV is used for children \>6 years old. The outcome variable will be the FSIQ score from WPPSI-III and/or WISC-IV tests. FSIQ results can range from 40 being the lowest and 160 being the highest. Higher scores are associated with higher intelligence quotient.

Tabulation of the Incidence and Frequency of All AEs and SAEs That Occur Throughout the Study.
Baseline through Final Visit (a Maximum of 30 months) with AEs collected at month 3 and 6 then at 6 month intervals

Safety was assessed with regards to the rate and type of AEs, clinically significant changes to vital signs and/or physical examination findings, and clinically significant changes in laboratory test results.

Amount of Dietary Supplemented Phenylalanine (Phe)Tolerated in Children With Phenylketonuria
at Week 10
Primary objective:
- To evaluate the safety and tolerability of long-term Phenoptin treatment in subjects with PKU.
Change in Blood Phenylalanine Levels From Baseline to Week 6.
baseline to week 6
Area Under the Curve (AUC0-12hrs) of Plasma BH4 Concentration
At 30 minutes prior to dosing, 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 5.0, 6.0, 8.0, 10.0, and 12.0 hours after dosing.

Plasma BH4 concentration area under the curve (AUC0-12 hrs) at the end of each regimen in subjects with endothelial dysfunction.

Number of Subjects With Treatment Emergent Adverse Events (TEAEs)
Up to 16 weeks

A treatment-emergent adverse events (TEAE) is any adverse events that newly appeared, increased in frequency or worsened in severity following initiation of study drug administration.

Change in Peak Walking Time (PWT) From Baseline
Baseline and up to Week 24

This is to assess the effect of oral sapropterin dihydrochloride versus placebo on peak walking time (PWT) in subjects with intermittent claudication (IC) caused by peripheral arterial disease (PAD).

Number of Subjects With Adverse Events (AEs)
Up to 24-weeks

Adverse events were described and summarized with focus on treatment- emergent events (TEAEs). A TEAE was defined as any AE that presented , increased in frequency or worsened in severity following initiation of study drug administration. If the onset of an AE was missing then the AE was considered treatment emergent. Drug-related AEs are AEs classified by the investigator as possibly or probably related to study drug.

Blood Phenylalanine(Phe) Levels Measured at Specified Timepoints
At Baseline, Week 4 through Extension Week 130

Baseline blood phenylalanine(Phe) value is the latest measurement taken prior to initiation of Phenoptin treatment. The ideal range for blood Phe levels is approximately 120-360 µmol/L.

Percentage of Subjects With Blood Phenylalanine (Last Observation Carried Forward) < 360 μmol/L
At Baseline, Week 4 through Extension Week 130

Baseline blood phenylalanine(Phe) value is the latest measurement taken prior to initiation of Phenoptin treatment. The objective of this outcome was to compare to Phe levels achieved using previous treatment regimens.

Evaluate the degree and frequency of response to Phenoptin™, as demonstrated by a reduction in blood Phe level among subjects with PKU who have elevated Phe levels
To evaluate the safety of oral 6R-BH4, administered in escalating doses in addition to standard care, in subjects with pulmonary arterial hypertension (PAH).
Up to 14 weeks
Change in BH4 Levels in Cerebral Spinal Fluid
Baseline, 8 wks, 12 wks

Identify dosing range of oral Kuvan® necessary and sufficient to normalize CSF BH4 levels in adults with GTPCH Deficiency.

To determine if a single supratherapeutic dose of sapropterin or a single therapeutic dose of sapropterin has an effect on cardiac repolarization compared with placebo as a change from baseline measured by the subject specific QT correction formula(QTci)
Complete study

Secondary Endpoints

Mean Blood Phe Levels
Baseline, Weeks 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, and 26
Change From Baseline in Dietary Phe Tolerance After 26 Weeks
Baseline and at Week 26 (last observation carried-forward [LOCF])
Number of Subjects With Any TEAEs, AEs Related to Kuvan, Serious AEs, AEs Leading to Death, and AEs Leading to Discontinuation
From the first dose of study drug administration up to 31 days after the last dose of study drug administration
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Study Design & Arms

AllocationRANDOMIZED
MaskingNONE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Kuvan® + Phe-restricted dietEXPERIMENTALSubjects will be treated with Kuvan® tablets once daily along with Phe-restricted diet therapy.
Phe-restricted diet aloneOTHERSubjects will follow a Phe-restricted diet alone.
Sapropterin dihydrochlorideEXPERIMENTAL -
Tablet without active ingredientPLACEBO_COMPARATOR -
PlaceboPLACEBO_COMPARATORPlacebo, provided as tablets similar to Phenoptin tablets, was administered orally once daily in the morning as the number of tablets equivalent to a 20mg/kg/day dose dissolved in 4 8 oz (120-240 mL) of water or apple juice. for 6 weeks. A follow-up call or visit was made 4 weeks later during this double-blind, placebo-controlled study.
Sapropterin dihydrochloride+Vitamin CEXPERIMENTALSapropterin dihydrochloride 5 mg/kg and 500 mg Vitamin C twice a day administered as whole tablets orally within 1 hour after morning and evening meals for 13 days and the last dose within 1 hour after a morning meal on Day 14 and Day 28.
Single Arm on Active DrugEXPERIMENTAL5mg/kg/day orally, dose may be adjusted to between 5-20 mg/kg/day by investigator at week 6 to control blood Phe levels Outcomes were also evaluated by the subject's type of BH4 deficiency either defects in the genes encoding the enzymes involved in biosynthesis or defects in the genes encoding the enzymes involved in recycling.
1EXPERIMENTALOpen Label
Kuvan Cohort 1EXPERIMENTALThis cohort will be enrolled first. Analysis will be done to determine the optimum dosing of Kuvan to normalize BH4 levels in the Cerebral Spinal Fluid. This cohort will begin at a dose of 20mg/kg/day.
Kuvan Cohort 2EXPERIMENTALParticipants in cohort 2 will be enrolled after the analysis of cohort 1 data has taken place. Dosing for cohort 2 will be based on results obtained in cohort 1, but will plan on starting at 30 mg/kg/day.
Sapropterin Dihydrochloride 100mg/kg and placebo MoxifloxacinEXPERIMENTALA single dose of 100mg/kg of Sapropterin Dihydrochloride taken along with placebo Moxifloxacin.
Sapropterin Dihydrochloride 20mg/kg and placebo MoxifloxacinEXPERIMENTALA single dose of 20mg/kg of Sapropterin Dihydrochloride taken along with a placebo Moxifloxacin.
Sapropterin Dihydrochloride placebo and MoxifloxacinACTIVE_COMPARATORNo placebo tablets for Sapropterin Dihydrochloride will be administered, but instead will be apple juice only, taken along with 400mg of Moxifloxacin.
Sapropterin Dihydrocholide placebo and Moxifloxacin placeboPLACEBO_COMPARATORNo placebo tablets for Sapropterin Dihydrochloride will be administered, but instead will be apple juice only, taken along with placebo of Moxifloxacin.

Interventions

NameTypeDescription
Kuvan®DRUGKuvan® (sapropterin dihydrochloride) tablets will be administered orally at the dose of 10 mg/kg/day and will be escalated to 20 mg/kg/day if after 4 weeks a subject's Phe tolerance is not increased by at least 20% versus baseline.
Phenylalanine (Phe)-restricted dietOTHERPhe intake will be adjusted every 2 weeks, based on the mean Phe levels of the previous 2 weeks using pre-defined Phe adjustment criteria.
Sapropterin dihydrochlorideDRUGA dose of 20 mg/kg/day will be administered. Route of administration is oral (intact).
PlaceboDRUGPlacebo (tablet without active ingredient) is dosed once/day for the first 13 weeks of the study.
sapropterin dihydrochloride, 6R-BH4, tetrahydrobiopterinDRUG -
Sapropterin Dihydrochloride and Vitamin CDRUGSapropterin Dihydrochloride 5 mg/kg and 500 mg Vitamin C twice a day administered as whole tablets orally within 1 hour after morning and evening meals for 13 days and the last dose within 1 hour after a morning meal on Day 14 and Day 28.
PhenoptinDRUG5mg/kg/day orally, dose may be adjusted to between 5-20 mg/kg/day by investigator at week 6 to control blood Phe levels
sapropterin dihydrochloride (6R-BH4)DRUG2.5 mg/kg/day for two weeks, 5 mg/kg/day for two weeks, 10 mg/kg/day for four weeks, then 20 mg/kg/day for two days
SapropterinDRUGSapropterin will be taken daily for 12 or 24 weeks. Starting dose will be 20mg/kg/day and will increase at the 8 week visit to 30 mg/kg/day. Dosing may be further increased to as high as 40 mg/kg/day in attempt to normalize BH4 levels in CSF. Starting dose for Cohort 2 will be determined from data analysis in Cohort 1.
MoxifloxacinDRUGMoxifloxacin is included as a positive control to demonstrate the assay sensitivity based on the expected increased QTc response.
Moxifloxacin placeboDRUGMoxifloxacin placebo tablet
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Eligibility Criteria

Age RangeN/A to 4 Years
SexALL
Healthy VolunteersNo
Study Sites22

Inclusion Criteria: * Male or female PKU infants and young children less than (\<) 4 years of age at the scheduled Day 1 visit of the 26-week study period (taking into consideration the maximum of 21 days in the screening period) * Confirmed clinical and biochemical PKU, including at least two prev...

Countries:AustriaBelgiumCzechiaGermanyItalyNetherlandsSlovakiaTurkey (Türkiye)United KingdomUnited StatesCanadaArgentina
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Competitive Landscape -Phenylketonuria 14 trials

Frequently asked questions about Kuvan

What is Kuvan used for?

Kuvan is used for the treatment of phenylketonuria, a metabolic disorder. It is a small molecule therapy developed by BioMarin Pharmaceutical Inc. The clinical program for Kuvan includes a completed Phase 3 trial in phenylketonuria patients less than 4 years old, which enrolled 56 participants across Europe and Turkey.

Who makes Kuvan?

Kuvan is made by BioMarin Pharmaceutical Inc., which trades on Nasdaq under the ticker BMRN. BioMarin is the developer of Kuvan for phenylketonuria, a metabolic disorder. The drug is a small molecule therapy studied in a Phase 3 clinical program.

What phase is Kuvan in?

Kuvan has been studied in Phase 3 clinical development for phenylketonuria. One Phase 3 trial, NCT01376908, has been completed, and no trials are currently active. The completed study was randomized and controlled, with 56 participants enrolled.

What clinical trials is Kuvan in?

Kuvan has been evaluated in the Phase 3 trial NCT01376908, titled Kuvan in Phenylketonuria Patients Less Than 4 Years Old. The trial is completed and enrolled 56 participants. It was randomized and controlled, and it took place in Austria, Belgium, Czechia, Germany, Italy, Netherlands, Slovakia, Turkey, and the United Kingdom.

Is Kuvan the same as Kuvan®?

Yes, Kuvan and Kuvan® refer to the same product. Kuvan® is the registered trademark form of the name, while Kuvan is the plain-text version used in most references. Both names refer to the small molecule therapy developed by BioMarin Pharmaceutical Inc. for phenylketonuria.

What is Kuvan used for in phenylketonuria?

Kuvan is used for the treatment of phenylketonuria, a metabolic disorder. It is a small molecule therapy from BioMarin Pharmaceutical Inc. The clinical evidence for Kuvan in phenylketonuria comes from a completed Phase 3 trial, NCT01376908, which studied patients less than 4 years old and enrolled 56 participants.