Clinical trial • Phase II • Ophthalmology

ULTEVURSEN for Retinitis pigmentosa

Phase II trial of ULTEVURSEN for Retinitis pigmentosa.

Overview

Trial Therapeutic Area
Ophthalmology
Trial Disease
Retinitis pigmentosa
Trial Stage
Phase II
Drug Modality
Oligonucleotide
Paediatric Trial
Yes
Orphan Drug
Yes

Key dates

Initial CTIS Submission Date
13-11-2024
First CTIS Authorization Date
20-03-2025

Trial design

Randomised, ultevursen ivt (intravitreal solution for injection; sponsor product qr-421a, active substance ultevursen [antisense oligonucleotide]; intravitreal route; dosing visits: day 1 (baseline), month 6, month 12, month 18 as per study schedule); sham procedure: sham group will undergo a procedure that will closely mimic the active injection but with no penetration of the globe.-controlled Phase II trial in France, Germany, Italy and others.

Randomised
Yes
Comparator
Ultevursen IVT (intravitreal solution for injection; sponsor product QR-421a, active substance ultevursen [antisense oligonucleotide]; intravitreal route; dosing visits: Day 1 (baseline), Month 6, Month 12, Month 18 as per study schedule); Sham procedure: sham group will undergo a procedure that will closely mimic the active injection but with no penetration of the globe.
Target Sample Size
54
Trial Duration For Participant
814

Eligibility

Recruits 54 paediatric patients.

Pregnancy Exclusion
Non-pregnant and non-breastfeeding subjects. Women of childbearing potential (WOCBP) and fertile males must comply with using highly effective methods of contraception (see Section 14.2 for definitions of WOCBP and fertile males and details on highly effective contraception methods). Women of non-childbearing potential may be included without the use of adequate birth control, provided they meet the entry criteria for the study.
Vulnerable Population
The trial includes minors (children/adolescents) aged 8 to <18 years. Consent/assent handling: adults (≥18 years) must provide informed consent; minors (8 to <18 years) must provide age-appropriate assent and a parent or legal guardian must provide written permission prior to any study procedures. Study-specific subject information and informed consent forms are provided for adult/parent, adolescents (12-17 or 12-16 depending on country), and children (8-11), and genetic testing and pregnancy information forms are available (ICF documents listed in the application).

Inclusion criteria

  • {"criterion_text":"- An adult (≥18 years) willing and able to provide informed consent for participation prior to performing any study related procedures OR A minor (8 to <18 years) able to provide age-appropriate assent for study participation with a parent or legal guardian willing and able to provide written permission for the subject’s participation prior to performing any study related procedures.\n- During the screening period, the difference of BCVA letters (based on ETDRS) from 2 measurements taken separately will need to be within 10 letters. After 3 attempts of the BCVA measurement, if a reliable baseline cannot be obtained, the eligibility of the subject will be determined in consultation with the Medical Monitor.\n- Symmetry of baseline disease in both eyes, defined as the mean BCVA (based on ETDRS) of one eye within ≤10 letters of the mean BCVA of the other eye at screening. If this is not present, the Investigator should discuss the case with the Medical Monitor to decide whether it is appropriate for the subject to participate in the study. For purposes of determining symmetry, the mean BCVA for each eye will be calculated using all BCVA measures obtained during the screening period.\n- At screening, reliable measurements in MP and SP as described in the Study Reference Manual.\n- No visually significant ocular media opacities and adequate pupillary dilation to permit good quality retinal visibility or imaging in either eye, as assessed by the Investigator.\n- Non-pregnant and non-breastfeeding subjects. Women of childbearing potential (WOCBP) and fertile males must comply with using highly effective methods of contraception (see Section 14.2 for definitions of WOCBP and fertile males and details on highly effective contraception methods). Women of non-childbearing potential may be included without the use of adequate birth control, provided they meet the entry criteria for the study.\n- An adult willing to comply with the protocol, follow study instructions, attend study visits as required and willing and able to complete all study assessments, in the opinion of the Investigator. OR A minor able to complete all study assessments and comply with the protocol and has a parent or caregiver willing and able to follow study instructions and attend study visits with the subject as required, in the opinion of the Investigator.\n- Both eyes exhibit clinical presentation consistent with RP involving Usher syndrome type 2 or NSRP based on ophthalmic, audiologic, or vestibular examinations. At screening, the Investigator will make the clinical diagnosis of “Usher syndrome type 2a,” defined as RP with congenital hearing loss, or “non-syndromic RP,” defined as RP without congenital hearing loss.\n- A molecular diagnosis of biallelic disease causing variants (pathogenic or likely pathogenic) in the USH2A gene where at least one of the variants is located on exon 13. A historic genotyping report from a certified laboratory is acceptable with Sponsor approval.\n- Clearly visible and measurable EZ width of ≥2.5 mm in both horizontal and vertical scans in both eyes as measured by SD-OCT and based on the assessment of the CRC.\n- BCVA ≥55 letters based on ETDRS (equivalent to 20/80 based on Snellen notation, or logarithm of the minimum angle of resolution [logMAR] +0.6) in both eyes.\n- Impairment of VF as assessed by SP with a mean sensitivity >4 decibels (dB) and <25 dB measured by a V4e target size in the TE.\n- Mean sensitivity >2 dB as determined by MP in the TE.\n- No limitations to SD-OCT image collection that would prevent high-quality, reliable images from being obtained in both eyes, as determined by the Investigator."}

Exclusion criteria

  • {"criterion_text":"- Presence of additional non-exon 13 USH2A pathogenic or likely pathogenic variant on the USH2A allele carrying the exon 13 mutation in subjects who have one exon 13 disease causing variant and one non-exon 13 disease causing variant.\n- Presence of additional non-exon 13 USH2A pathogenic mutation(s) on both USH2A alleles in subjects who have biallelic exon 13 mutations.\n- Presence of any of the following lens opacities in the TE based on the Age-Related Eye Disease Study (AREDS) lens grading scale: cortical opacity ≥+2, posterior subcapsular opacity ≥+2, or a nuclear sclerosis ≥+2, and which are: 1) clinically significant in the opinion of the Investigator, 2) would adequately prevent clinical and photographic evaluation of the retina.\n- History of amblyopia in the TE that has resulted in vision loss, in the opinion of the Investigator.\n- Presence of significant keratopathy or any other media or corneal opacity that would cause scattering of light or alter visual function, especially in low luminance conditions in the TE.\n- A history of glaucoma or an IOP greater than 24 mmHg in the TE that is not controlled with medication or surgery at the time of informed consent.\n- Use of any investigational drug or device within 90 days or 5 half-lives of Day 1, whichever is longer, or plans to participate in another study of a drug or device during the study.\n- Any prior receipt of genetic or stem-cell therapy for ocular or non-ocular disease.\n- Known hypersensitivity to antisense oligonucleotides or any constituents of the injection.\n- Current chronic treatment or treatment within the past 12 months with therapies known to influence the immune system (including but not limited to steroid implants, chronic systemic steroids, cytostatics, interferons, tumor necrosis factor (TNF)-binding proteins, drugs acting on immunophilins, or antibodies with known impact on the immune system). Subjects who have been treated on a short course of systemic steroids within the past 12 months or who require intermittent use of topical steroids may be considered for inclusion following approval by the Medical Monitor.\n- Current use of medications known to be toxic to the lens, retina, or optic nerve (e.g., deferoxamine, chloroquine/hydroxychloroquine [Plaquenil®], tamoxifen, phenothiazines, ethambutol, digoxin, and aminoglycosides).\n- History of malignancy within 5 years prior to Screening, except adequately treated squamous or basal cell carcinoma of the skin or carcinoma in situ of the cervix that has been successfully treated.\n- Presence of pathogenic or likely pathogenic variants in genes (other than the USH2A gene) which are known to be associated with other inherited retinal degenerative diseases or syndromes. Specifically, the presence of homozygous or compound heterozygous known disease-causing mutations in other genes involved in recessive retinal dystrophies, or the confirmed presence of a known single disease-causing variant in genes involved in dominant, X-linked, or mitochondrial retinal dystrophy genes is exclusionary.\n- Any contraindication to IVT injection according to the Investigator’s clinical judgment and the American Academy of Ophthalmology (Avery 2014). This includes any active or suspected intraocular inflammation or active or suspected ocular or periocular infection in either eye.\n- At screening, the EZ horizontal or vertical width are outside the field of the SD-OCT scan based on the assessment of the CRC.\n- Presence of any significant ocular or non-ocular disease/disorder (including medication and laboratory test abnormalities) which, in the opinion of the Investigator and with concurrence of the Medical Monitor, may either put the subject at risk because of participation in the study, may impact the subject’s ability to participate in the study, or may interfere with assessment of efficacy and safety in the study.\n- Presence of unstable concurrent cystoid macular edema (CME), or subject started on (or changed dose of) topical or systemic carbonic anhydrase inhibitor treatment in the 3 months prior to enrollment. CME is allowed if stable for 3 months (with or without treatment). However, stable CME that disrupts the EZ width measurement, as determined by CRC, is an exclusion.\n- Receipt of any prior intraocular or periocular surgery or planned intraocular surgery or procedure during the study. Subjects may be considered for inclusion if there are no clinically significant complications of surgery present and following approval by the Medical Monitor.\n- Receipt of any IVT injection prior to study entry. However, subjects who have received a prior IVT injection may be considered for inclusion following approval by the Medical Monitor."}

Endpoints

Primary endpoints

  • {"endpoint_text":"- Annualized percent change from baseline in EZ width as measured by spectral-domain optical coherence tomography (SD-OCT) up to Month 24.","definition_or_measurement_approach":"EZ width measured by spectral-domain optical coherence tomography (SD-OCT); outcome expressed as annualized percent change from baseline up to Month 24."}

Secondary endpoints

  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change in retinal sensitivity measured by static perimetry (SP) with topographic analysis (Hill of Vision [HoV])","definition_or_measurement_approach":"Retinal sensitivity measured by static perimetry (SP) with topographic analysis (HoV) at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change in retinal sensitivity measured by microperimetry (MP) with topographic analysis (HoV)","definition_or_measurement_approach":"Retinal sensitivity measured by microperimetry (MP) with topographic analysis (HoV) at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in retinal sensitivity in a pre-specified area with at least 5 loci","definition_or_measurement_approach":"Change from baseline in retinal sensitivity in a pre-specified area (≥5 loci) evaluated at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in low luminance visual acuity (LLVA) using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart","definition_or_measurement_approach":"LLVA measured using ETDRS chart; change from baseline assessed at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in best-corrected visual acuity (BCVA) using the ETDRS chart","definition_or_measurement_approach":"BCVA measured using ETDRS chart; change from baseline at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Percent change from baseline in EZ area by SD-OCT","definition_or_measurement_approach":"EZ area measured by SD-OCT; percent change from baseline at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Percent change from baseline in EZ width by SD-OCT","definition_or_measurement_approach":"EZ width measured by SD-OCT; percent change from baseline at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Annualized percent change from baseline in EZ area by SD-OCT","definition_or_measurement_approach":"Annualized percent change in EZ area measured by SD-OCT up to Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in virtual visual maze performance score using Mobility Standardized Test in Virtual Reality (MOSTVR) (applicable for sites with ability to conduct the assessment)","definition_or_measurement_approach":"MOSTVR virtual visual maze performance score; change from baseline assessed at Months 12 and 24 (site-dependent)."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in dark-adapted full-field stimulus threshold (FST) testing","definition_or_measurement_approach":"Dark-adapted full-field stimulus threshold (FST); change from baseline at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in each domain of the following PROs (for subjects ≥13 years of age): Michigan Retinal Degeneration Questionnaire (MRDQ) scores in central vision, color vision, contrast sensitivity, scotopic function, photopic peripheral vision, mesopic peripheral vision, and photosensitivity","definition_or_measurement_approach":"Patient-reported outcome MRDQ domains for subjects ≥13 years; change from baseline in specified domains at Months 12 and 24."}
  • {"endpoint_text":"- Efficacy: The following endpoints will be evaluated at Months 12 and 24, unless otherwise specified: Change from baseline in each domain of the following PROs (for subjects ≥13 years of age): Michigan Vision-Related Anxiety Questionnaire (MVAQ) scores in rod-function anxiety and cone-function anxiety","definition_or_measurement_approach":"Patient-reported outcome MVAQ domains for subjects ≥13 years; change from baseline at Months 12 and 24."}
  • {"endpoint_text":"- Safety and Tolerability: Frequency and severity of ocular and non-ocular adverse events (AEs)","definition_or_measurement_approach":"Assessment of frequency and severity of ocular and non-ocular AEs throughout study."}
  • {"endpoint_text":"- Safety and Tolerability: Incidence of anti-drug antibodies (ADAs) against ultevursen","definition_or_measurement_approach":"Incidence of ADAs against ultevursen measured during study."}
  • {"endpoint_text":"- Systemic Exposure: Systemic serum concentration of ultevursen.","definition_or_measurement_approach":"Measurement of systemic serum concentration of ultevursen."}

Recruitment

Planned Sample Size
54
Recruitment Window Months
34
Consent Approach
Adults (≥18 years) must provide informed consent. Minors (8 to <18 years) must provide age-appropriate assent and a parent or legal guardian must provide written permission prior to any study procedures. Subject information and informed consent forms (SIS and ICF) are provided for adult/parent, adolescent (12-17 or 12-16 depending on country), child (8-11), genetic testing, and pregnancy; English redacted versions and country-specific ICFs are included among submitted documents.

Geography

Total Number Of Sites
7
Total Number Of Participants
21

France

Earliest CTIS Part Ii Submission Date
05-03-2025
Latest Decision Or Authorization Date
24-03-2025
Processing Time Days
19
Number Of Sites
2
Number Of Participants
6

Sites

Site Name
Centre Hospitalier National D'Ophtalmologie Quinze-Vingts
Department Name
Centre de maladies rares CHNO des Quinze Vingt
Principal Investigator Name
Isabelle Audo
Principal Investigator Email
isabelle.audo@inserm.fr
Contact Person Name
Isabelle Audo
Contact Person Email
isabelle.audo@inserm.fr
Site Name
Centre Hospitalier Universitaire De Montpellier
Department Name
Maladies Sensorielles Génétique
Principal Investigator Name
Isabelle Meunier
Principal Investigator Email
i-meunier@chu-montpellier.fr
Contact Person Name
Isabelle Meunier
Contact Person Email
i-meunier@chu-montpellier.fr

Germany

Earliest CTIS Part Ii Submission Date
19-02-2025
Latest Decision Or Authorization Date
20-03-2025
Processing Time Days
29
Number Of Sites
1
Number Of Participants
3

Sites

Site Name
Universitaetsklinikum Tuebingen AöR
Department Name
Department für Augenheilkunde
Principal Investigator Name
Katarina Stingl
Principal Investigator Email
neuro.oph@med.uni-tuebingen.de
Contact Person Name
Katarina Stingl
Contact Person Email
neuro.oph@med.uni-tuebingen.de

Italy

Earliest CTIS Part Ii Submission Date
14-03-2025
Latest Decision Or Authorization Date
24-03-2025
Processing Time Days
10
Number Of Sites
1
Number Of Participants
6

Sites

Site Name
Azienda Socio Sanitaria Territoriale Santi Paolo E Carlo
Department Name
S.C. Ophthalmology
Principal Investigator Name
Leonardo Colombo
Principal Investigator Email
leonardo.colombo@asst-santipaolocarlo.it
Contact Person Name
Leonardo Colombo

Netherlands

Earliest CTIS Part Ii Submission Date
10-03-2025
Latest Decision Or Authorization Date
24-03-2025
Processing Time Days
14
Number Of Sites
3
Number Of Participants
6

Sites

Site Name
The Rotterdam Eye Hospital
Department Name
Rotterdams Oogheelkundig Instituut
Principal Investigator Name
LI van den Born
Principal Investigator Email
born@oogziekenhuis.nl
Contact Person Name
LI van den Born
Contact Person Email
born@oogziekenhuis.nl
Site Name
Radboud universitair medisch centrum Stichting
Department Name
Afdeling Oogheelkunde
Principal Investigator Name
Suzanne Yzer
Principal Investigator Email
Suzanne.Yzer@radboudumc.nl
Contact Person Name
Suzanne Yzer
Contact Person Email
Suzanne.Yzer@radboudumc.nl
Site Name
Amsterdam UMC Stichting
Department Name
Department of Opthalmology
Principal Investigator Name
Camiel Boon
Principal Investigator Email
camiel.boon@amsterdamumc.nl
Contact Person Name
Camiel Boon
Contact Person Email
camiel.boon@amsterdamumc.nl

Sponsor

Primary sponsor

Full Name
Laboratoires Thea
Organisation Type
Pharmaceutical company
Country Of Registered Address
France

Contract research organisations

Name
Ora Europe Limited
Responsibilities
sponsor duties codes: 1,12,2,5,6

Third parties

  • {"country":"United Kingdom","full_name":"Ora Europe Limited","duties_or_roles":"sponsor duties codes: 1,12,2,5,6","organisation_type":"Pharmaceutical company"}

Investigational products

Investigational Product Name
Ultevursen (QR-421a) - solution for injection
Active Substance
ULTEVURSEN
Modality
Oligonucleotide
Routes Of Administration
Intravitreal use
Route
Intravitreal
Orphan Designation
Yes
Dose Levels
maxDailyDoseAmount: 60 Aµg (microgram(s)); maxTotalDoseAmount: 180 Aµg (microgram(s))
Frequency
Dosing visits: Day 1 (baseline), Month 6, Month 12, Month 18
Maximum Dose
180 Aµg
Investigational Product Name
Ultevursen (QR-421a) - solution for injection (alternate presentation)
Active Substance
ULTEVURSEN
Modality
Oligonucleotide
Routes Of Administration
Intravitreal use
Route
Intravitreal
Orphan Designation
Yes
Dose Levels
maxDailyDoseAmount: 180 Aµg (microgram(s)); maxTotalDoseAmount: 180 Aµg (microgram(s))
Frequency
Dosing visits: Day 1 (baseline), Month 6, Month 12, Month 18
Maximum Dose
180 Aµg
Investigational Product Name
Sham procedure (placebo/procedure control)
Modality
Other
Route
Procedure mimicking intravitreal injection without globe penetration
Frequency
Procedure at Day 1 and sham equivalent to active injection schedule

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