Abstract Details

Title Results of a Phase 2 Study of ISIS-SMNRx in Children with Spinal Muscular Atrophy

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) (-)

Poster/Presentation
Number 006

Objective

Background ISIS-SMNRx is an antisense oligonucleotide designed to alter splicing of SMN2 mRNA to increase the amount of functional SMN protein. Results from SMA mouse models indicate ISIS-SMNRx had a significant effect on functional and histological measures of neuromuscular health when delivered to the CNS. A Phase 1 single ascending-dose study in children with SMA had previously been completed, showing acceptable safety/tolerability.

Design/Methods Multiple doses of ISIS-SMNRx (3 dose levels) were delivered by intrathecal injection to medically stable SMA patients 2-15 years of age (n=25). Subjects were dosed 2-3 times over 3 months and then followed for 6 months post-dosing and monitored for drug safety and tolerability, CSF and plasma pharmacokinetics, CSF SMN protein levels, and clinical outcome measures.

Results Overall, no safety or tolerability concerns related to ISIS-SMNRx were identified; the majority of adverse events were mild or moderate in severity and none were related to dose level of ISIS-SMNRx. No drug-related changes in neurological exams, laboratory assessments (including CSF safety), or systemic evaluations were reported. Repeated intrathecal injections were well tolerated in SMA children. CSF and plasma drug levels were dose-dependent predictable, and consistent with expected levels. HFMSE scores indicated an improvement in motor function at all doses levels, with a time and dose dependency. 6MWT and ULM functional tests also indicated improvement, although with limited data. Measurement of SMN protein levels in CSF indicated a significant increase at the highest dose (p=0.004), indicating biological activity of ISIS-SMNRx in SMA patients.

Conclusions Results from this study support continued development and further examination of ISIS-SMNRx in a Phase 2/3 controlled study in children with SMA.

Authors/Disclosures
Claudia A. Chiriboga, MD, FAAN (Columbia University)	Dr. Chiriboga has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentec. Dr. Chiriboga has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. The institution of Dr. Chiriboga has received research support from Roche. The institution of Dr. Chiriboga has received research support from Avexis/Novartis. The institution of Dr. Chiriboga has received research support from Biogen. The institution of Dr. Chiriboga has received research support from NIH. The institution of Dr. Chiriboga has received research support from Biohaven. The institution of Dr. Chiriboga has received research support from Genentec. Dr. Chiriboga has received publishing royalties from a publication relating to health care.
Kathryn J. Swoboda, MD	Dr. Swoboda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Swoboda has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Swoboda has received research support from Biogen.
	No disclosure on file
Basil T. Darras, MD (Children'S Hosp Boston Harvard Med School)	The institution of Dr. Darras has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. Dr. Darras has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Amicus. The institution of Dr. Darras has received research support from National Institutes of Health/National Institute of Neurological Disorders and Stroke,. The institution of Dr. Darras has received research support from Slaney Family Fund for SMA. The institution of Dr. Darras has received research support from Spinal Muscular Atrophy Foundation. The institution of Dr. Darras has received research support from CureSMA. The institution of Dr. Darras has received research support from Working on Walking Fund . The institution of Dr. Darras has received research support from CHERISH, CS2/CS12 . The institution of Dr. Darras has received research support from Biogen for CS11. The institution of Dr. Darras has received research support from AveXis. The institution of Dr. Darras has received research support from Sarepta Pharmaceuticals. The institution of Dr. Darras has received research support from PTC Therapeutics. The institution of Dr. Darras has received research support from Roche. The institution of Dr. Darras has received research support from Santhera. The institution of Dr. Darras has received research support from Scholar Rock. The institution of Dr. Darras has received research support from Fibrogen. The institution of Dr. Darras has received research support from Summit. Dr. Darras has received publishing royalties from a publication relating to health care. Dr. Darras has received publishing royalties from a publication relating to health care.
Susan T. Iannaccone, MD, FAAN (Department of Pediatrics)	Dr. Iannaccone has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AveXis. Dr. Iannaccone has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Iannaccone has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sarepta. Dr. Iannaccone has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AveXis. Dr. Iannaccone has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Dr. Iannaccone has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Catabasis. The institution of Dr. Iannaccone has received research support from AveXis. The institution of Dr. Iannaccone has received research support from Biogen. The institution of Dr. Iannaccone has received research support from Sarepta. The institution of Dr. Iannaccone has received research support from PTC Therapeutics. The institution of Dr. Iannaccone has received research support from FibroGen. The institution of Dr. Iannaccone has received research support from ReveraGen. The institution of Dr. Iannaccone has received research support from MDA. The institution of Dr. Iannaccone has received research support from PPMD. The institution of Dr. Iannaccone has received research support from NIH. Dr. Iannaccone has received personal compensation in the range of $0-$499 for serving as a grant reviewer with NIH.
Jacqueline Montes, PT, EdD, NCS (Columbia University Medical Center)	Ms. Montes has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Ms. Montes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for F. Hoffman LaRoche. Ms. Montes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Scholar Rock. Ms. Montes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. The institution of Ms. Montes has received research support from NIH/NICHD. The institution of Ms. Montes has received research support from Muscular Dystrophy Association. The institution of Ms. Montes has received research support from Cure SMA.
Diana Castro, MD (Neurology Rare Disease Center)	Dr. Castro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Castro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Castro has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PTC. Dr. Castro has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Dr. Castro has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Dr. Castro has received research support from Biogen. The institution of Dr. Castro has received research support from Sarepta. The institution of Dr. Castro has received research support from Fibrogen .
Nicole LaMarca	Ms. LaMarca has received personal compensation for serving as an employee of Novartis Gene Therapies.
	No disclosure on file
	No disclosure on file
Sally Dunaway, DPT (Stanford University)	Dr. Dunaway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Dunaway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche/Genentech. Dr. Dunaway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Scholar Rock. Dr. Dunaway has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cure SMA. The institution of Dr. Dunaway has received research support from Cure SMA. The institution of Dr. Dunaway has received research support from Scholar Rock. The institution of Dr. Dunaway has received research support from Ionis Pharmaceuticals.
	No disclosure on file
	No disclosure on file
Leslie Nelson	No disclosure on file
Darryl C. De Vivo, MD, FAAN (Columbia University)	Dr. De Vivo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen and Novartis. Dr. De Vivo has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aspa Therapeutics.
Dawn McGuire, MD, FAAN (NeurAccess Translational Neurotherapeutics)	No disclosure on file
	No disclosure on file
	No disclosure on file
Frank Bennett, PhD	No disclosure on file
Kathie M. Bishop, PhD	Dr. Bishop has received personal compensation for serving as an employee of Acadia Pharmaceuticals, Inc. . Dr. Bishop has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for DTx Pharma. Dr. Bishop has stock in Acadia Pharmaceuticals, Inc..

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