A Study to evaluate Efficacy, Safety, Tolerability and Effects of TAK-341 in the human body in patients with Multiple System Atrophy

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Takeda Development Center Americas Inc.

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Nervous System Diseases [C10]

Trial duration

22 Nov 2022 → 29 Jul 2025

Decision date (initial)

2024-10-28

Transition trial

Yes

Low-intervention

No

Rare-disease indication

Yes

Vulnerable population

Yes

Funding sources

Takeda Development Center Americas Inc.

External identifiers

EU CT number

2023-509876-40-00

EudraCT number

2022-000336-28

ClinicalTrials.gov

NCT05526391

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Pharmacokinetic, Others, Efficacy, Pharmacodynamic, Therapy, Safety

To evaluate the efficacy of TAK-341 versus placebo, as measured by the change from baseline to Week 52 on UMSARS Part I, minus the sexual function item, with collapse of the normal and mild ratings on each item.

Secondary objectives 12

1. To evaluate the efficacy of TAK-341 vs placebo: - as measured by the change from baseline to Week 52 on the 11-item UMSARS."
2. To evaluate the efficacy of TAK-341 vs placebo: - as measured by the change from baseline to Week 52 on the total UMSARS (UMSARS Part I + Part II).
3. To evaluate the efficacy of TAK-341 vs placebo: - as measured by the change from baseline to Week 52 on the Part I UMSARS minus the sexual function item (without collapse of ratings of scale items).
4. To evaluate the efficacy of TAK-341 vs placebo: - as measured by the change from baseline to Week 52 on the Part II UMSARS.
5. To evaluate the efficacy of TAK-341 vs placebo: - CGI-S score.
6. To evaluate the efficacy of TAK-341 vs placebo: - on the Scales for Outcomes in Parkinson's Disease -Autonomic Dysfunction (SCOPA-AUT).
7. To evaluate the efficacy of TAK-341 vs placebo: - as measured by overall survival at 52 weeks.
8. To evaluate the effiect of TAK-341 vs placebo: - on levels of CSF free αSYN as measured by the change from baseline to Week 52.
9. To evaluate the efficacy of TAK-341 vs placebo: - To assess the serum PK and CSF concentrations of TAK-341 in subjects with MSA.
10. To evaluate the efficacy of TAK-341 vs placebo: - To assess the serum PK and CSF concentrations of TAK-341 in subjects with MSA.
11. To assess the safety and tolerability of TAK-341 in subjects with MSA.
12. To assess the immunogenicity of TAK-341 in subjects with MSA.

Conditions and MedDRA coding

Multiple System Atrophy

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 12

1. The subject (or, when applicable, the subject's legally acceptable representative) signs an informed (e)consent form indicating that the subject has been informed of the procedures to be followed, the experimental nature of the therapy, alternatives, potential benefits, side effects, risks, and discomforts (additionally for subjects in Germany or Austria: the subject has been informed of the nature, significance, and implications of the clinical study and is willing and able to understand and fully comply with study procedures and requirements (including digital tools and applications) in the opinion of the investigator. If the subject becomes incompetent over the course of the study, a legally authorized court-appointed representative or an appointed agent in health matters (ie, legally acceptable representative) will need to be identified and the subject will need to provide assent, in accordance withthe local regulations, guidelines, and the IRB/IEC to provide informed consent on the subject's behalf to continue in the clinical study).
2. The subject is an outpatient of either sex, at least 40 years old, at the time of consent.
3. Subjects must, in the opinion of the investigator, be able to participate in all scheduled evaluations, likely to be compliant, and likely to complete all required tests, including neuroimaging brain scans and lumbar punctures.
4. The subject has a body mass index ≥18 and ≤35 kg/m2 at screening.
5. The subject has a diagnosis of possible or probable MSA using the modified Gilman et al, 2008 diagnostic criteria.
6. The subject's onset of first MSA symptoms (including parkinsonism, cerebellar symptoms, orthostatic or urinary symptoms) occurred ≤4 years before screening as assessed by the investigator.
7. The subject's anticipated life expectancy is ≥3 years, per investigator judgment.
8. The subject has an UMSARS Part I score of ≤21 (excluding Item #11, sexual function) at screening visit (Visit 1), and additionally has: a) Severity score ≤2 on the swallowing item (#2) at screening visit (Visit 1). b) Severity score ≤2 on the ambulation item (#7) at screening visit (Visit 1). c) Severity score ≤2 on the falling item (#8) at screening visit (Visit 1).
9. The subject has an UMSARS Part IV disability score ≤3 at screening visit (Visit 1).
10. Subject has a MoCA ≥18. Additionally, subject has sufficiently intact cognition to complete study and follow study instructions, per investigator´s judgment.
11. A male subject who is nonsterilized (fertile) and sexually active with a female partner of childbearing potential is eligible to participate if he agrees to use a barrier method of contraception (ie, condom with or without spermicide) from the signing of informed (e)consent throughout the study and for 90 days plus 5 half-lives (total of 190 days) after the last dose. In addition, they must be advised not to donate sperm during this period. The female partner of a male subject should also be advised to use a highly effective method of contraception.
12. Female subjects are eligible to participate if (a) they are not pregnant or nursing and (b) they are of nonchildbearing potential or agree to use highly effective contraception from the signing of informed consent throughout the study and for 30 days plus 5 half-lives (total of 130 days) after the last dose of study drug.

Exclusion criteria 29

1. 1. The subject has serious or unstable clinically significant illness including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic or autoimmune (eg, multiple sclerosis), hematologic, or other major disease, which, in the judgment of the investigator, is poorly controlled or otherwise likely to deteriorate, compromises the subject's safety or ability to complete the study, or compromises the interpretation of the study results.
2. 2.The subject has medical problems (neurological, visual, orthopedic, psychiatric) that may significantly interfere with completion of the studyor interpretation of study endpoints or may confound diagnosis.
3. 3.The subject has a disorder that is likely to interfere with drug disposition and elimination.
4. 4. In the opinion of the investigator, the subject has a diagnosis of depression or other psychiatric disorder, as defined by DSM-5, AND this disorder is poorly controlled and of sufficient severity to interfere with completion of the study or interpretation of the endpoints.
5. 5.The subject is considered by the investigator to be a imminent risk of suicide or injury to self, others, or property, or the subject has attempted suicide within the past year before screening.
6. 6. The subject has a history of alcohol or substance use disorder (except tobacco use disorder), as defined by the DSM-5, within 1 year before screening or between screening and randomization
7. 7.The subject has positive finding on an alcohol or illicit drug screen.
8. 8. The subject has undergone surgery for the treatment of MSA (eg, pallidotomy, deep brain stimulation, fetal tissue transplantation).
9. 9. History of epilepsy or seizures, except self-limited febrile childhood seizures.
10. 10. Contraindication to lumbar puncture (as assessed by the Investigator).
11. 11. The subject has hypersensitivity to TAK-341 or any excipients used in its formulation.
12. 12.Subject has a history of cancer in the past 5 years (does not apply to participants with carcinoma in situ that has been resolved without further treatment, or basal cell carcinoma; these subjects may be included after approval by the sponsor or designee).
13. 13. Any clinically significant abnormality at screening or between screening and randomization in physical examination findings, vital signs, electrocardiograms (ECGs), or clinical laboratory test results
14. 14. Presence of any of contraindications to MRI as assessed by the Investigator.
15. 15. Ophthalmic abnormalities
16. 16.The subject has any of the following at the screening visit: estimated glomerular filtration rate (determined with the Chronic Kidney Disease Epidemiology Collaboration equation) <50 mL/min; QT interval with Fridericia correction method >450 ms for male subjects and >470 ms for female subjects; a serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) value >1.5 × the upper limit of normal (ULN).
17. 17. "Clinically significant vital sign abnormalities at screening, defined as (a) systolic blood pressure ≥160 mm Hg, (b) diastolic blood pressure ≥90 mm Hg (blood pressure assessed with the subject at rest in the seated position; may be repeated up to 3 times), or (c) pulse rate <45 or >100 beats per minute (subject at rest in the seated position; may be repeated up to 3 times).
18. 18.Positive hepatitis B surface antigen test result, known or suspected active hepatitis C infection, or known history of HIV infection.
19. 19.Brain MRI showing clinically significant evidence of malignant, ischemic, hemorrhagic, demyelinating, structural, or degenerative brain disease (other than MSA) that may confound diagnosis or compromise subject safety during the study, or the subject has findings that compromise the safety of lumbar puncture.
20. 20. Current blood clotting or bleeding disorder, including clinically significant abnormal findings in laboratory tests of coagulation.
21. 21.Poor venous access
22. 22.Participation in another study investigating active or passive immunization against αSYN for Parkinson disease or MSA.
23. 23.The subject has had immunoglobulin G therapy for any reason within6 months before screening.
24. 24.Participation in a previous study of a disease-modifying therapy (with proven receipt of active treatment)
25. 25.Any investigational compound being received that may not have completely washed out before the screening visit.
26. 26.Positive pregnancy test result at screening.
27. 27.The subject is an immediate family member, is a study site employee, or is in a dependent relationship with a study site employee who is involved in the conduct of this study
28. 28.Donation of 400 mL or more of his or her blood volume within 90 days before the start of the screening visit.
29. 29.Austrian participants without capacity of consent (ie, ability to understand and process information relevant to making an informed, voluntary decision to participate in research).

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 1

1. Change from baseline to Week 52 on UMSARS Part I, minus the sexual function item, with collapse of the normal and mild ratings on each item with TAK-341 compared with placebo.

Secondary endpoints 14

1. Change from baseline to Week 52 on the 11-item UMSARS specified by Palma et al. 2021 al 2021 with TAK-341 compared with placebo
2. Change from baseline to Week 52 on the UMSARS total score (UMSARS Part I + Part II) with TAK-341 compared with placebo.
3. Change from baseline to Week 52 on the UMSARS Part I score minus the sexual function item (without collapse of ratings of scale items) with TAK-341 compared with placebo.
4. Change from baseline to Week 52 on the UMSARS Part II score with TAK341 compared with placebo.
5. Change from baseline to Week 52 on the CGI-S score with TAK-341 compared with placebo.
6. Change from baseline to Week 52 on the SCOPA-AUT total score with TAK-341 compared with placebo.
7. Overall survival at 52 weeks with TAK-341 compared with placebo.
8. Change from baseline to Week 52 on levels of CSF free αSYN with TAK341 compared with placebo.
9. 09. Serum PK parameters, if feasible, will include but not be limited to the following: – Cmax. – tmax. – Area under the serum concentration-time curve during a dosing interval (AUCτ)."
10. CSF concentrations of TAK-341.
11. Incidence of treatment-emergent adverse events (TEAEs)
12. Incidence of clinically significant abnormal values for clinical laboratory evaluations, vital signs, ECG parameters, and the Columbia-Suicide Severity Rating Scale (C-SSRS).
13. Findings from clinical laboratory evaluations, vital signs, ECG, C-SSRS, physical examination, neurological examination
14. Incidence of ADAs

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 2

Placebo 1

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Takeda Development Center Americas Inc.

Sponsor organisation

Takeda Development Center Americas Inc.

Address

95 Hayden Avenue

City

Lexington

Postcode

02421-7942

Country

United States

Scientific contact point

Organisation

Takeda Development Center Americas Inc.

Contact name

Takeda

Public contact point

Organisation

Takeda Development Center Americas Inc.

Contact name

Takeda

Third parties 15

Locations

7 EU/EEA countries · 23 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Summary of results Art. 37(4) CTR

Layperson summary Annex V

Documents 43 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

3 submissions — initial application plus substantial / non-substantial modifications