Results from a phase 1 study of nusinersen (ISIS-SMN Rx) in children with spinal muscular atrophy

Claudia A. Chiriboga, Kathryn J. Swoboda, Basil T. Darras, Susan T. Iannaccone, Jacqueline Montes, Darryl C. De Vivo, Daniel A. Norris, C. Frank Bennett, Kathie M. Bishop

Research output: Contribution to journalArticle

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Abstract

Objective: To examine safety, tolerability, pharmacokinetics, and preliminary clinical efficacy of intrathecal nusinersen (previously ISIS-SMN Rx), an antisense oligonucleotide designed to alter splicing of SMN2 mRNA, in patients with childhood spinal muscular atrophy (SMA). Methods: Nusinersen was delivered by intrathecal injection to medically stable patients with type 2 and type 3 SMA aged 2-14 years in an open-label phase 1 study and its long-term extension. Four ascending single-dose levels (1, 3, 6, and 9 mg) were examined in cohorts of 6-10 participants. Participants were monitored for safety and tolerability, and CSF and plasma pharmacokinetics were measured. Exploratory efficacy endpoints included the Hammersmith Functional Motor Scale Expanded (HFMSE) and Pediatric Quality of Life Inventory. Results: A total of 28 participants enrolled in the study (n 6 in first 3 dose cohorts; n 10 in the 9-mg cohort). Intrathecal nusinersen was well-tolerated with no safety/tolerability concerns identified. Plasma and CSF drug levels were dose-dependent, consistent with preclinical data. Extended pharmacokinetics indicated a prolonged CSF drug half-life of 4-6 months after initial clearance. A significant increase in HFMSE scores was observed at the 9-mg dose at 3 months postdose (3.1 points; p 0.016), which was further increased 9-14 months postdose (5.8 points; p 0.008) during the extension study. Conclusions: Results from this study support continued development of nusinersen for treatment of SMA. Classification of evidence: This study provides Class IV evidence that in children with SMA, intrathecal nusinersen is not associated with safety or tolerability concerns.

Original languageEnglish (US)
Pages (from-to)890-897
Number of pages8
JournalNeurology
Volume86
Issue number10
DOIs
StatePublished - Mar 8 2016

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Spinal Muscular Atrophy
Spinal Muscular Atrophies of Childhood
Safety
Pharmacokinetics
Spinal Injections
Antisense Oligonucleotides
Pharmaceutical Preparations
Half-Life
Quality of Life
Pediatrics
Equipment and Supplies
Messenger RNA
ISIS 396443
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Chiriboga, C. A., Swoboda, K. J., Darras, B. T., Iannaccone, S. T., Montes, J., De Vivo, D. C., ... Bishop, K. M. (2016). Results from a phase 1 study of nusinersen (ISIS-SMN Rx) in children with spinal muscular atrophy. Neurology, 86(10), 890-897. https://doi.org/10.1212/WNL.0000000000002445

Results from a phase 1 study of nusinersen (ISIS-SMN Rx) in children with spinal muscular atrophy. / Chiriboga, Claudia A.; Swoboda, Kathryn J.; Darras, Basil T.; Iannaccone, Susan T.; Montes, Jacqueline; De Vivo, Darryl C.; Norris, Daniel A.; Bennett, C. Frank; Bishop, Kathie M.

In: Neurology, Vol. 86, No. 10, 08.03.2016, p. 890-897.

Research output: Contribution to journalArticle

Chiriboga, CA, Swoboda, KJ, Darras, BT, Iannaccone, ST, Montes, J, De Vivo, DC, Norris, DA, Bennett, CF & Bishop, KM 2016, 'Results from a phase 1 study of nusinersen (ISIS-SMN Rx) in children with spinal muscular atrophy', Neurology, vol. 86, no. 10, pp. 890-897. https://doi.org/10.1212/WNL.0000000000002445
Chiriboga, Claudia A. ; Swoboda, Kathryn J. ; Darras, Basil T. ; Iannaccone, Susan T. ; Montes, Jacqueline ; De Vivo, Darryl C. ; Norris, Daniel A. ; Bennett, C. Frank ; Bishop, Kathie M. / Results from a phase 1 study of nusinersen (ISIS-SMN Rx) in children with spinal muscular atrophy. In: Neurology. 2016 ; Vol. 86, No. 10. pp. 890-897.
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AU - Darras, Basil T.

AU - Iannaccone, Susan T.

AU - Montes, Jacqueline

AU - De Vivo, Darryl C.

AU - Norris, Daniel A.

AU - Bennett, C. Frank

AU - Bishop, Kathie M.

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N2 - Objective: To examine safety, tolerability, pharmacokinetics, and preliminary clinical efficacy of intrathecal nusinersen (previously ISIS-SMN Rx), an antisense oligonucleotide designed to alter splicing of SMN2 mRNA, in patients with childhood spinal muscular atrophy (SMA). Methods: Nusinersen was delivered by intrathecal injection to medically stable patients with type 2 and type 3 SMA aged 2-14 years in an open-label phase 1 study and its long-term extension. Four ascending single-dose levels (1, 3, 6, and 9 mg) were examined in cohorts of 6-10 participants. Participants were monitored for safety and tolerability, and CSF and plasma pharmacokinetics were measured. Exploratory efficacy endpoints included the Hammersmith Functional Motor Scale Expanded (HFMSE) and Pediatric Quality of Life Inventory. Results: A total of 28 participants enrolled in the study (n 6 in first 3 dose cohorts; n 10 in the 9-mg cohort). Intrathecal nusinersen was well-tolerated with no safety/tolerability concerns identified. Plasma and CSF drug levels were dose-dependent, consistent with preclinical data. Extended pharmacokinetics indicated a prolonged CSF drug half-life of 4-6 months after initial clearance. A significant increase in HFMSE scores was observed at the 9-mg dose at 3 months postdose (3.1 points; p 0.016), which was further increased 9-14 months postdose (5.8 points; p 0.008) during the extension study. Conclusions: Results from this study support continued development of nusinersen for treatment of SMA. Classification of evidence: This study provides Class IV evidence that in children with SMA, intrathecal nusinersen is not associated with safety or tolerability concerns.

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