Recent Updates
Recently added Catalysts

AVI-4658

Phase 3FDA approved 2016

Duchenne Muscular Dystrophy | Small molecule | Neurology |Sarepta Therapeutics, Inc.|Trials Updated: Feb 27, 2026

AVI-4658 development status

FDA approval Sep 19, 2016 as Exondys 51
Approval holderSarepta Theraps Inc
ApplicationNDA206488
Highest phase Phase 3 (NCT02255552)
Phase scored for SRPTPhase 2
Registered trials 8 across 2 sponsors since Oct 2014

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

AVI-4658 target and mechanism

Molecular targetdystrophin
Target classProtein
ModalitySmall molecule

Also known as AVI-4658 for Injection, AVI-4658 (Eteplirsen), Eteplirsen, EXONDYS 51, EXONDYS

Success Probability

Subscribe to view

Market & Valuation

Subscribe to view

Trial Design

RandomizedDouble-BlindCONTROLLEDDMC
Total Trials8
Total Enrollment384

FDA Designations

No designations recorded

AVI-4658 clinical trials

AVI-4658 · 8 trials · 3 indications

Phase 3 2Phase 2 5Phase 1 1
NCT03992430A Study to Compare Safety and Efficacy of High Doses of Eteplirsen in Participants With Duchenne Muscular Dystrophy (DMD) (MIS51ON)Muscular Dystrophy, Duchenne
ACTIVE NOT_RECRUITING160 Analytics
NCT02255552Study of Eteplirsen in DMD PatientsDuchenne Muscular Dystrophy (DMD)
COMPLETED109 Analytics
PHASE3ACTIVE NOT_RECRUITING
A Study to Compare Safety and Efficacy of High Doses of Eteplirsen in Participants With Duchenne Muscular Dystrophy (DMD) (MIS51ON)
Muscular Dystrophy, DuchenneUnlock trial analytics
PHASE3COMPLETED
Study of Eteplirsen in DMD Patients
Duchenne Muscular Dystrophy (DMD)Unlock trial analytics

Study Endpoints

Primary Endpoints

Part 1: Incidence of Adverse Events (AEs)
Up to Week 148
Part 2: Change From Baseline at Week 144 in the NSAA Total Score (for Final Analysis)
Baseline, Week 144
Part 2: Change from Baseline at Week 72 or Week 96 in NSAA Total Score (for Conditional Efficacy Interim Analysis)
Baseline, Week 72 or Week 96
Change From Baseline in the 6 Minute Walk Test (6MWT) Distance at Week 96
Baseline, Week 96

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.

Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious Adverse Events (SAEs), and TEAEs Leading to Discontinuation From Study Drug
Baseline up to Week 100

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.

Number of Participants With at Least 1 Potentially Clinically Significant Clinical Safety Laboratory Abnormality
Baseline up to Week 100

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

Number of Participants With at Least 1 Markedly Abnormal Vital Sign
Baseline up to Week 100

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.

Abnormal Changes From Baseline or Worsening of Physical Examination Findings
Baseline up to Week 100

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.

Number of Participants With at Least 1 Markedly Abnormal Electrocardiogram (ECG) and Echocardiogram (ECHO)
Weeks 8, 12, 24, 36, 48, 60, 72, 84, 96

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.

Number of Participants With Treatment Emergent Adverse Events (TEAEs), Serious TEAEs, and TEAEs Leading to Discontinuation
Baseline up to 100 weeks

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.

Number of Participants With Potentially Clinically Significant Laboratory Abnormalities Reported as TEAEs
Baseline up to 100 weeks

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.

Number of Participants With Potentially Clinically Significant Abnormalities in Vital Signs Reported as TEAEs
Baseline up to 100 weeks

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.

Number of Participants With at Least One Abnormal Physical Examination Finding
Baseline up to 100 weeks

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.

Number of Participants With Abnormalities in Electrocardiograms (ECGs) Reported as TEAEs
Baseline up to 96 weeks

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.

Number of Participants With Abnormalities in Echocardiograms (ECHO) Reported as TEAEs
Baseline up to 96 weeks

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.

Number of Participants With Treatment Emergent Adverse Events
From first dose of drug up to 100 weeks

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.

Change From Baseline in the 6 Minute Walk Test (6MWT) at Week 240
Parent Baseline and Week 240

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).

Change From Baseline in the Percentage of Dystrophin Positive Fibers (PDPF) at Week 48
Parent Baseline and Week 48

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).

Change in the Number (%) of Dystrophin Positive Fibers
After 12 weeks for 4 patients who received 50 mg/kg and 2 patients who received placebo. After 24 weeks for 4 patients who received 30 mg/kg and 2 patients who received placebo.

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).

Safety and Tolerability
Baseline to 6 months

Number of subjects with 1 or more Treatment Emergent Adverse Event that are possibly related to the investigational drug

Treatment Emergent Adverse Events
from Baseline to Follow up (27 weeks)

Number of Patients with Treatment Emergent Adverse Events

Secondary Endpoints

Part 2: Change From Baseline in Time to Rise From the Floor, Time to Complete 10-Meter Walk/Run, and the Timed Stair Ascend Test
Baseline, Week 144
Part 2: Change From Baseline in the Total Distance Walked During 6-Minute Walk Test (6MWT)
Baseline, Week 144
Part 2: Change from Baseline at Week 144 in Forced Vital Capacity Percent Predicted (FVC%p)
Baseline, Week 144
Unlock Study Endpoints

Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Part 1: EteplirsenEXPERIMENTALParticipants 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/kgACTIVE_COMPARATORRandomized participants will receive eteplirsen 30 mg/kg once weekly for up to 144 weeks.
Part 2: Eteplirsen 100 mg/kgEXPERIMENTALRandomized participants will receive eteplirsen 100 mg/kg once weekly for up to 144 weeks.
Part 2: Eteplirsen 200 mg/kgEXPERIMENTALRandomized participants will receive eteplirsen 200 mg/kg once weekly for up to 144 weeks.
Treated GroupEXPERIMENTALApproximately 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 GroupNO_INTERVENTIONApproximately 30 DMD patients not amenable to exon 51 skipping will not receive eteplirsen.
EteplirsenEXPERIMENTALEteplirsen 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-LabelEXPERIMENTALApproximately 20 patients will receive weekly infusions of eteplirsen 30 mg/kg .
Control GroupNO_INTERVENTIONApproximately 20 patients with DMD not amenable to exon 51 skipping will be observed for 96 weeks.
Eteplirsen 30 mg/kgEXPERIMENTALParticipants will receive eteplirsen 30 mg/kg/week intravenous (IV) infusions, weekly, for up to 96 weeks.
AVI-4658 (Eteplirsen)EXPERIMENTALMultiple-Dose Extension Study
Placebo / Delayed TreatmentPLACEBO_COMPARATOR3a. 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/wkEXPERIMENTALSubjects 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/wkEXPERIMENTALSubjects 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/wkEXPERIMENTALSubjects 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/wkEXPERIMENTALSubjects 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/wkEXPERIMENTALSubjects 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/wkEXPERIMENTALSubjects 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

Interventions

NameTypeDescription
EteplirsenDRUGSolution for intravenous (IV) infusion.
AVI-4658 (Eteplirsen)DRUGEteplirsen will be administered once weekly via an IV infusion. There are two treatment groups, 30 mg/kg and 50 mg/kg.
PlaceboOTHERsterile, 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 InjectionDRUGAVI-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.
Unlock Study Design Details

Eligibility Criteria

Age Range4 Years to 13 Years
SexMALE
Healthy VolunteersNo
Study Sites59

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...

Countries:United StatesColombiaCzechiaDenmarkFranceGermanyGreeceHungaryIndiaIrelandItalyJordanMexicoNetherlandsNew ZealandNorwayPolandRomaniaSerbiaSloveniaSouth KoreaSpainSwitzerlandTaiwanTurkey (Türkiye)United KingdomBelgium
Unlock Eligibility Criteria

Frequently asked questions about AVI-4658

What is AVI-4658 used for?

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.

What does AVI-4658 target?

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.

Who is developing AVI-4658?

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.

What phase is AVI-4658 in?

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.

What clinical trials is AVI-4658 in?

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.

Is AVI-4658 the same as eteplirsen?

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.