Approval Probability
TA Base Rate
Adjusted LOA
ML Risk
Label indication EXONDYS 51 is indicated for the treatment of Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 51 skipping. This indication is approved under accelerated approval based on an increase in dystrophin in skeletal muscle observed in some patients treated with EXONDYS 51 [see Clinical Studies ( 14 )] . FDA label
Also known as AVI-4658 for Injection, AVI-4658 (Eteplirsen), Eteplirsen, EXONDYS 51, EXONDYS
AVI-4658 · 8 trials · 3 indications
6MWT was performed by standardized procedures for all participants. Participants were asked to walk a set course of 25 meters for 6 minutes (timed), and the distance walked (in meters) was recorded. Change from baseline in 6MWT distance at Week 96 was reported.
TEAEs were defined as adverse events (AEs) with an onset following administration of the first dose of study drug. An AE was any untoward medical occurrence in a participant, which does not necessarily have a causal relationship with the study drug. Abnormalities presented at Baseline were considered AEs if they reoccurred after resolution or worsen during the AE collection period. An SAE was defined as any AE that, in the view of either the Investigator or Sponsor, resulted in any of the following outcomes as fatal, life-threatening, required hospitalization or prolongation of existing hospitalization, persistent or significant disability/incapacity, a congenital anomaly/birth defect, or an important medical event. A summary of all SAEs and Other AEs (nonserious) regardless of causality is located in the 'Adverse Events' Section.
Clinical laboratory parameters that were evaluated included * Any Grade ≥2 (moderate) or serious event without an alternative etiology that the Investigator deemed was related to study drug * Two consecutive drug-related serum creatinine levels ≥2\*upper limit of normal (ULN) without an alternative etiology * Creatine kinase (CK) levels \>50,000 units/liter (U/L) * A confirmed, unexplained, increase in gamma glutamyl transferase (GGT) \>3\*ULN and either an increase in bilirubin \>2\*ULN or nascent prothrombin time \>2\*ULN concurrently, without an alternative etiology
The vital sign parameters that were evaluated included blood pressure, heart rate, respiration, and temperature. A summary of all SAEs and Other AEs (nonserious) regardless of causality is located in the 'Adverse Events' Section.
Data not collected during the study for this Outcome Measure. A summary of all SAEs and Other AEs (nonserious) regardless of causality is located in the 'Adverse Events' Section.
The ECG was manually reviewed and interpreted by medically qualified personnel using a central vendor according to pre-specified criteria. The Investigator determined if the findings in the centrally read ECG report were clinically significant. Clinical significance was defined as any variation in ECG findings that had medical relevance resulting in an alteration in medical care. The ECHO was reviewed and interpreted by medically qualified personnel using a central vendor according to pre-specified criteria. The Investigator determined if the findings in the ECHO report were clinically significant. Clinical significance was defined as any variation in ECHO findings that had medical relevance resulting in an alteration in medical care. A summary of all SAEs and Other AEs (nonserious) regardless of causality is located in the 'Adverse Events' Section.
Adverse Event (AE) was any untoward medical occurrence in a participant that did not necessarily have a causal relationship with the study drug. Serious adverse event (SAE) was an AE resulting in any of the following outcomes: death; Life-threatening event; required or prolonged inpatient hospitalization; persistent or significant disability/incapacity; congenital anomaly. Treatment emergent adverse events were events that developed or worsened during the on-treatment period (defined as time from first dose of study drug and up to 28 days after last dose of study drug \[up to 100 weeks\]) that were absent before treatment or that worsened relative to pre-treatment state. AEs included both serious and non-serious adverse events.
Laboratory parameters included hematology, serum chemistry (SC), urinalysis and coagulation. Number of participants with at least one potentially clinically significant abnormal findings were reported as TEAEs. The Investigator determined whether abnormal assessment results were clinically significant or not clinically significant. Clinical significance was defined as any variation in assessment results that had medical relevance resulting in an alteration in medical care.
Vital sign parameters included systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and body temperature. Number of participants with at least one potentially clinically significant abnormal vital signs findings were reported as TEAEs. The Investigator determined whether abnormal assessment results were clinically significant or not clinically significant. Clinical significance was defined as any variation in assessment results that had medical relevance resulting in an alteration in medical care.
Physical examinations, full and brief, were performed by the Investigator, a physician Sub-Investigator, or a Nurse Practitioner (if licensed in the state or province to perform physical examinations). Full physical examinations included examination of general appearance; head, ears, eyes, nose, and throat; heart; lungs; chest; abdomen; skin; lymph nodes; and musculoskeletal and neurological systems. Number of participants with at least one abnormal physical examination findings were reported. Abnormality in physical examinations was based on Investigator's discretion.
Twelve-lead ECGs and Holter ECGs were performed at a consistent time of day throughout the study. Electrocardiograms were performed only after the participant was in the supine position, resting, and quiet for a minimum of 15 minutes. The ECG was manually reviewed and interpreted by medically qualified personnel. Number of participants with at least one abnormalities in ECGs were reported as TEAEs.
Standard, 2-dimensional ECHOs were performed at a consistent time of day throughout the study. Cardiac function events included cardiomegaly, tachycardia, and dyspnoea. The ECHO was reviewed and interpreted by medically qualified personnel. Number of participants with at least one abnormalities in ECHO were reported as TEAEs.
An adverse event (AE) was any untoward medical occurrence in a participant that did not necessarily have a causal relationship with the study drug. A serious adverse event (SAE) was an AE resulting in any of the following outcomes: death; Life-threatening event; Required or prolonged inpatient hospitalization; persistent or significant disability/incapacity; congenital anomaly. Treatment-emergent AEs were events that developed or worsened during the on-treatment period (defined as time from first dose of study drug and up to 28 days after last dose of study drug (up to 100 weeks) that were absent before treatment or that worsened relative to pretreatment state. AEs included both serious and non-serious adverse events.
This study used a modified version of the 6MWT test procedure described in American Thoracic Society (ATS) 2002 guidelines, specifically adapted for patients with Duchenne muscular dystrophy. The participant was asked to walk a set course of 25 meters for 6 minutes (timed) and the distance walked in meters was recorded. Increases from baseline in 6MWT distance are indicative of improvement and decreases from baseline indicate worsening. Baseline here corresponds to the baseline in the parent study (4658-us-201, NCT01396239).
Dystrophin expression as assessed by percent dystrophin positive fibers was measured by immunohistochemistry (IHC) technique using primary anti-dystrophin antibody. Percent change from baseline is the arithmetic difference of the treatment time point minus baseline divided by baseline calculated for individual subjects. Baseline here corresponds to the baseline in the parent study (4658-us-201, NCT01396239).
The primary efficacy endpoint will be based on the pre-treatment and post-treatment change in the number (%) of dystrophin positive fibers as measured in the muscle biopsy tissue on immunohistochemistry (IHC).
Number of subjects with 1 or more Treatment Emergent Adverse Event that are possibly related to the investigational drug
Number of Patients with Treatment Emergent Adverse Events
| Arm | Type | Description |
|---|---|---|
| Part 1: Eteplirsen | EXPERIMENTAL | Participants will receive eteplirsen 100 mg/kg once weekly for at least 4 weeks, followed by eteplirsen 200 mg/kg once weekly for at least 4 weeks. |
| Part 2: Eteplirsen 30 mg/kg | ACTIVE_COMPARATOR | Randomized participants will receive eteplirsen 30 mg/kg once weekly for up to 144 weeks. |
| Part 2: Eteplirsen 100 mg/kg | EXPERIMENTAL | Randomized participants will receive eteplirsen 100 mg/kg once weekly for up to 144 weeks. |
| Part 2: Eteplirsen 200 mg/kg | EXPERIMENTAL | Randomized participants will receive eteplirsen 200 mg/kg once weekly for up to 144 weeks. |
| Treated Group | EXPERIMENTAL | Approximately 80 patients with genotypically confirmed Duchenne muscular dystrophy (DMD) with genetic deletions amenable to treatment by exon 51 skipping will receive 30 mg/kg of eteplirsen weekly for 96 weeks, followed by a safety extension (not to exceed 48 weeks). |
| Untreated Group | NO_INTERVENTION | Approximately 30 DMD patients not amenable to exon 51 skipping will not receive eteplirsen. |
| Eteplirsen | EXPERIMENTAL | Eteplirsen will be administered once every 7 days by intravenous (IV) infusion starting on Day 1 for up to 96 weeks. The starting dose will be 2 milligrams/kilogram (mg/kg) eteplirsen, with escalation to 4, 10, 20, and 30 mg/kg for 10 weeks, and then participants will continue to receive eteplirsen at 30 mg/kg for the duration of the study. |
| Open-Label | EXPERIMENTAL | Approximately 20 patients will receive weekly infusions of eteplirsen 30 mg/kg . |
| Control Group | NO_INTERVENTION | Approximately 20 patients with DMD not amenable to exon 51 skipping will be observed for 96 weeks. |
| Eteplirsen 30 mg/kg | EXPERIMENTAL | Participants will receive eteplirsen 30 mg/kg/week intravenous (IV) infusions, weekly, for up to 96 weeks. |
| AVI-4658 (Eteplirsen) | EXPERIMENTAL | Multiple-Dose Extension Study |
| Placebo / Delayed Treatment | PLACEBO_COMPARATOR | 3a. Placebo 50 mg/kg phosphate buffered saline solution identical in appearance to eteplirsen for 24 weeks followed by 50 mg/kg of eteplirsen for 4 weeks. 3b. Placebo 30 mg/kg phosphate buffered saline solution identical in appearance to eteplirsen for 24 weeks followed by 30 mg/kg of eteplirsen for 4 weeks. |
| Cohort 1 - 0.5 mg/kg/wk | EXPERIMENTAL | Subjects in this group will receive a 0.5 mg/kg/wk dose of AVI-4658 over 12 weekly IV infusions in 50 mL of normal saline solution over a 60-minute period |
| Cohort 2 - 1.0 mg/kg/wk | EXPERIMENTAL | Subjects in this group will receive a 1.0 mg/kg/wk dose of AVI-4658 over 12 weekly IV infusions in 50 mL of normal saline solution over a 60-minute period |
| Cohort 3 - 2.0 mg/kg/wk | EXPERIMENTAL | Subjects in this group will receive a 2.0 mg/kg/wk dose of AVI-4658 over 12 weekly IV infusions in 50 mL of normal saline solution over a 60-minute period |
| Cohort 4 - 4.0 mg/kg/wk | EXPERIMENTAL | Subjects in this group will receive a 4.0 mg/kg/wk dose of AVI-4658 over 12 weekly IV infusions in 50 mL of normal saline solution over a 60-minute period |
| Cohort 5 - 10.0 mg/kg/wk | EXPERIMENTAL | Subjects in this group will receive a 10.0 mg/kg/wk dose of AVI-4658 over 12 weekly IV infusions in 50 mL of normal saline solution over a 60-minute period |
| Cohort 6 - 20.0 mg/kg/wk | EXPERIMENTAL | Subjects in this group will receive a 20.0 mg/kg/wk dose of AVI-4658 over 12 weekly IV infusions in 50 mL of normal saline solution over a 60-minute period |
| Name | Type | Description |
|---|---|---|
| Eteplirsen | DRUG | Solution for intravenous (IV) infusion. |
| AVI-4658 (Eteplirsen) | DRUG | Eteplirsen will be administered once weekly via an IV infusion. There are two treatment groups, 30 mg/kg and 50 mg/kg. |
| Placebo | OTHER | sterile, isotonic, clear, colorless phosphate buffered saline solution of eteplirsen at a concentration of 100 mg/mL in single-use vials containing a nominal volume of 1.0 mL without preservatives. |
| AVI-4658 for Injection | DRUG | AVI-4658 for Injection, is packaged as 100 mg/mL in phosphate buffered saline with 1 mL per vial. Study dosages will be infused over a 1 hour period with Normal saline in 6 dose cohorts. |
Inclusion Criteria: * Be a male with an established clinical diagnosis of DMD and an out-of-frame deletion mutation of the DMD gene amenable to exon 51 skipping. * Ambulatory participant, able to perform TTRISE in 10 seconds or less at the time of screening visit. * Able to walk independently witho...
AVI-4658 is being developed for the treatment of Duchenne Muscular Dystrophy (DMD), a genetic muscle-wasting disorder. It is designed to induce dystrophin expression in selected DMD patients. The clinical program has studied males aged 5 years and older in the United States and the United Kingdom.
AVI-4658 targets dystrophin, a protein that is missing or deficient in Duchenne Muscular Dystrophy. The drug is intended to induce dystrophin expression in selected DMD patients. Dystrophin is a protein target, and the goal of the program is to restore production of this muscle protein.
AVI-4658 is being developed by Sarepta Therapeutics, Inc., which trades on the Nasdaq under the ticker SRPT. Sarepta has sponsored the clinical development program for the drug in Duchenne Muscular Dystrophy, including Phase 1 and Phase 2 studies conducted in the United States and the United Kingdom.
AVI-4658 is in Phase 2 clinical development for Duchenne Muscular Dystrophy. It is an investigational drug and has not been approved by the FDA. Three trials have been completed, including one Phase 1 study and two Phase 2 studies, and there are currently no active trials.
AVI-4658 has been studied in three completed clinical trials: NCT01540409, a Phase 2 rollover study of eteplirsen in DMD patients; NCT01396239, a Phase 2 efficacy study of AVI-4658 to induce dystrophin expression; and NCT00844597, a Phase 1 dose-ranging study in the United Kingdom. Total enrollment across the trials was 43 patients.
Yes, AVI-4658 is also known as eteplirsen and AVI-4658 for Injection. The names refer to the same investigational compound being developed by Sarepta Therapeutics for Duchenne Muscular Dystrophy. Readers searching for eteplirsen will find the same clinical program under the AVI-4658 designation.