Objective
The novel morpholino antisense oligonucleotide viltolarsen targets exon 53 of the dystrophin gene, and could be an effective treatment for patients with Duchenne muscular dystrophy (DMD). We investigated viltolarsen’s ability to induce dystrophin expression and examined its safety in DMD patients.
Methods
In this open‐label, multicenter, parallel‐group, phase 1/2, exploratory study, 16 ambulant and nonambulant males aged 5–12 years with DMD received viltolarsen 40 or 80 mg/kg/week via intravenous infusion for 24 weeks. Primary endpoints were dystrophin expression and exon 53 skipping levels.
Results
In western blot analysis, mean changes in dystrophin expression (% normal) from baseline to Weeks 12 and 24 were − 1.21 (
P
= 0.5136) and 1.46 (
P
= 0.1636), respectively, in the 40 mg/kg group, and 0.76 (
P
= 0.2367) and 4.81 (
P
= 0.0536), respectively, in the 80 mg/kg group. The increase in mean dystrophin level at Weeks 12 and 24 was significant in the 80 mg/kg group (2.78%;
P
= 0.0364). Patients receiving 80 mg/kg showed a higher mean exon 53 skipping level (42.4%) than those receiving 40 mg/kg (21.8%). All adverse events were judged to be mild or moderate in intensity and none led to study discontinuation.
Interpretation
Treatment with viltolarsen 40 or 80 mg/kg elicited an increasing trend in dystrophin expression and exon 53 skipping levels, and was safe and well tolerated. The decline in motor function appeared less marked in patients with higher dystrophin levels; this may warrant further investigation. This study supports the potential clinical benefit of viltolarsen.
Objective
Duchenne muscular dystrophy (DMD) is a progressive muscular disease characterized by chronic cycles of inflammatory and necrotic processes. Prostaglandin D2 (PGD2) is produced by hematopoietic PGD synthase (HPGDS), which is pathologically implicated in muscle necrosis. This randomized, double‐blind, placebo‐controlled early phase 2 study (NCT02752048) aimed to assess the efficacy and safety of the novel selective HPGDS inhibitor, TAS‐205, with exploratory measures in male DMD patients aged ≥5 years.
Methods
Patients were randomized 1:1:1 to receive low‐dose TAS‐205 (6.67–13.33 mg/kg/dose), high‐dose TAS‐205 (13.33–26.67 mg/kg/dose), or placebo. The primary endpoint was the change from baseline in a 6‐minute walk distance (6MWD) at Week 24.
Results
Thirty‐six patients were enrolled, of whom 35 patients were analysed for safety. The mean (standard error) changes from baseline to Week 24 in 6MWD were −17.0 (17.6) m in the placebo group (n = 10), −3.5 (20.3) m in the TAS‐205 low‐dose group (n = 11), and −7.5 (11.2) m in the TAS‐205 high‐dose group (n = 11). The mean (95% confidence interval) difference from the placebo group was 13.5 (−43.3 to 70.2) m in the TAS‐205 low‐dose group and 9.5 (−33.3 to 52.4) m in the TAS‐205 high‐dose group. No obvious differences were observed in the incidences of adverse events between treatment groups. No adverse drug reactions specific to TAS‐205 treatment were observed.
Interpretation
The HPGDS inhibitor TAS‐205 showed a favorable safety profile in DMD patients. Further research is required to examine the effectiveness of TAS‐205 in a larger trial.
We investigated whether long latency motor response induced by transcranial magnetic stimulation over the cerebellum (C-TMS) preferentially appears during a continuous visually guided manual tracking task, and whether it originates in a concomitantly evoked neck twitch. C-TMS or magnetic stimulation over the neck (N-MS) was delivered during one of four tasks: a continuous or discrete visually guided manual tracking task, or phasic or tonic contraction of the first dorsal interosseous muscle. The probability of long latency fluctuation of index finger movement induced by C-TMS was not significantly different from that induced by N-MS, but the probability of long latency fluctuation induced by C-TMS and that induced by N-MS was significantly higher than that induced by sham TMS during all the tasks. The probability of long latency electromyographic response in the first dorsal interosseous muscle induced by C-TMS was significantly higher than that induced by N-MS and that induced by sham TMS during the continuous visually guided manual tracking task. Such significant differences were not present during the other tasks. Long latency electromyographic response induced by C-TMS preferentially appears during the continuous visually guided manual tracking task and is not explained by a concomitantly evoked neck twitch.
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