Current Phase of clinical trials | FDA-approved; ongoing Phase 2 and 3 Clinical trials | 2 and 3 | 1/2* | 1/2 |
Intervention | ELEVIDYS
previously known as SRP-9001 (delandistrogene moxeparvovec-rokl)
Recombinant adeno-associated virus carrying a micro-dystrophin gene | PF-06939926 (fordadistrogene movaparvovec)
Recombinant adeno-associated virus carrying a human mini-dystrophin gene | SGT-003
Recombinant adeno-associated virus containing a next-generation micro-dystrophin gene* | RGX-202 |
nNOS restoration | No | No | Yes* | No |
Promoter | MHCK7 | Hybrid muscle specific promoter | CK8* | Spc5-12, muscle specific promoter |
Vector | AAVrh74 | AAV9 | AAV-SLB101* | AAV8 |
Dose
*Doses in bold are the dose that the company considers effective and is primarily planning to use. | 2E14 vg/kg | Low dose: 1E14 vg/kg
High dose: 2E14 vg/kg | 1E14vg/kg* | 1E14vg/kg
2E14vg/kg |
Route of delivery and frequency | One time intravenous (IV) infusion | One time IV infusion | One time IV infusion* | One time IV infusion |
Age range studied (as of December 2023) | >2 years | 2-16 years | 4-7 years for SGT-003, 4-17 years for SGT-001 | 4-11 years |
Total number of boys known to be dosed thus far | > 150 | > 75 | None dosed yet for SGT-003; 9 were dosed with SGT-001 | 3 |
Genetic variant limitations in past studies | Variants were required to be within exons 18-58 for the first 4 boys, then all mutations were allowed. EMBARK excluded variants in exons 1-17 and exon 45. | None specified in past studies.
Current excluding variants in exons 9-13 and deletions of exons 29-30.
| Currently excluding deletions in exons 1-11 and exons 42-45, inclusive* | Limiting to variants in exons 18-79. |
Data 2020 | PubMed.gov: 1 year data on the first 4 boys dosed. The data showed no serious adverse events. At one year after dosing, the boys all had functional improvement of NSAA scores and reduced CK compared to prior to treatment. Muscle biopsy showed a mean of 74% of dystrophin on Western blot and 81% of fibers expressing dystrophin. | ASGCT 2020: 1 year data on 9 boys ages 6-12, high dose and low dose cohorts. In the 6 boys who had biopsy data at 12 months, mean dystrophin expression (measured by immuno-affinity mass spectrometry) was 24% in the low dose and 52% in the high dose. Mean %positive fibers were 21% in low and 51% in the high dose.
NSAA showed an average improvement of 3.5 points in the 6 boys at 12 months. MRI showed a reduction in fat fraction in the high dose group at 12 months. | | |
Data 2021 | January 2021 Study 102: Statistically significant increased dystrophin expression (mean of 28% at 12 weeks). Increase in total NSAA score at 48 weeks but not statistically significant. Boys in 4-5 age range did have a statistically significant improvement in NSAA versus the boys on placebo. In the 6-7 boys, the boys on placebo overall had higher baseline NSAA, which may have affected the data analysis.
Jan 2021 Study 101: Three of the initial 4 patients had fat fraction assessment done by MRI through ImagingDMD, independent of the Sarepta study. Minimal fat infiltration was seen compared to boys in natural history studies.
May 2021 on Endeavor: First 11 boys dosed had mean microdystrophin levels of 55% at week 12, with 71% dystrophin positive fibers.
October 2021: Study 101 found that participants (n=4, ages 4 to 7 years) improved 8.6 points on the NSAA compared to a matched natural history cohort three years after treatment. Study 102 found that treated boys (n=12, ages 6 to 7) had a positive 2.9-point difference on NSAA compared to a matched natural history cohort one year after treatment. Study 103 (ENDEAVOR) Cohort 1 (n=11, ages 4-7) found participants improved 3.0 points on NSAA six months after treatment.
| MDA March 2021: 19 boys 6-12, high and lose dose cohorts. From 6 boys, NSAA scores were generally improved or stable which was improved compared to an external control group. Starting to enroll non-ambulatory boys. | SGT-001 Data (no longer in clinical trial)
MDA March 2021: Muscle biopsies from Cohort B at 90 days showed mean dystrophin of 10%, with %positive fibers 20-70%.
March 2021: Stable NSAA, Mean increase in distance in the 6-Minute walk test, increase in %FVC.
May 2021: 3 boys in Cohort B had biopsies at 12-24 months that showed continued expression (levels of the microdystrophin were below the limit of the test, 70%, and 20%, staying stable or increasing). % positive fibers were at 10-30%, 85%, 50-60%, generally staying the same as the 12 week biopsies.
September 2021: 3 patients at 1.5 years, stability in NSAA, 6MWT, FVC. | |
Data 2022 | January 2022: Study 102 participants (n=20, ages 5 to 8) who were initially on placebo and then received gene therapy improved mean NSAA scores by 1.3 points from baseline
July 2022: Study 101 (n=4) patients showed an average of 7 point increase on NSAA over their baseline prior to treatment at 4 years post treatment. Average age of these boys is > 9 years, so their NSAA scores would be expected to be declining.
In Study 103 (n=20), participants improved an average of 4 points from their scores before therapy.
When the 53 patients in 101, 102, and 103 who were dosed the higher dose were combined, at one year after dosing the group had an average NSAA score improvement of 3 points.
| MDA March 2022: 19 boys received gene therapy (3 low-dose; 16 high-dose). At one year after dose, NSAA score increased by 1 point, in comparison to an external control cohort (placebo trial participants of similar age, weight, baseline function, and stable steroid use) who had a 4-point decline.
In 14 participants receiving high-dose gene therapy, mean minidystrophin expression at 12 months was 40%, with %positive fibers of 62%. | SGT-001 Data (no longer in clinical trial)
March 2022: Data from the first three high-dose participants suggest improved muscle and lung function at 2 years after the dose. Muscle biopsy data from 3 most recently diagnosed patients show microdystrophin levels similar to what was seen in cohort B at 90 days after dose. | Recruitment opened January 2023 |
Data 2023 | November 2023: Topline results of the EMBARK study at 52 weeks did not meet the primary endpoint (NSAA) but data showed substantial evidence of safety and effectiveness based on secondary endpoints, time function tests. | | | October 2023: At 12 weeks after dosing, muscle biopsy on the first two boys treated showed "robust" microdystrophin expression with microdystrophin present in the muscle cell membrane. |
Adverse events noted | Vomiting, decreased appetite, and nausea were most common.
Of the 84 patients who had been dosed at last data cut, 7 (8.3%) have experienced serious adverse events, which included vomiting and liver injury. An immune reaction causing inflamed muscles, muscle fatigue and weakness (myositis) was seen in one participant, which was thought to be related to the specific genetic change. Another patient had myocarditis, inflammation of the heart muscle.
Side effects required medical interventions including hospitalizations, but did resolve.
| Vomiting, dehydration, nausea, sudden kidney injury from an overactive immune response (atypical hemolytic uremic syndrome-like complement activation), low platelets in the blood (thrombocytopenia).
In early trials, interventions were required including hospitalizations, but all resolved. Steroid dosing was altered to increase dose slightly around the time of gene therapy dosing.
Three serious adverse events, including myocarditis or inflammation of the heart tissue, occurred in CIFFREO. Participants with certain genetic variants could be at higher risk for these adverse events, so exclusion of certain genetic variants was recommended.
A participant in the Phase 2 trial who was non-ambulatory died following administration of the gene therapy. Following this death, the CIFFREO study was placed on hold, which has subsequently been lifted following modification. All possible investigations were undertaken to understand this case and avoid similar future events. The protocol was modified to require that participants be in the hospital for one week after receiving the dose. | SGT-001 Data (no longer in clinical trial)
Vomiting, nausea, sudden kidney injury, thrombocytopenia.
Interventions were required including hospitalizations, but all resolved.
Because of Serious Adverse Events, the study was placed on hold from November of 2019 until October of 2020.
Changes were made to the manufacturing process, and additional medicines (Soliris and a C1 esterase inhibitor) were done before the dose. Inflammatory response seen in one boy after the changes were implemented. | |