Evaluating Progerinin with Lonafarnib for Hutchinson-Gilford Progeria Syndrome

A Phase 2a, Randomized, Open-Label Study to Determine the Optimal Dose and Evaluate the Safety, Tolerability, and Pharmacokinetics of Progerinin in Patients with Hutchinson-Gilford Progeria Syndrome (HGPS)

This study is testing a new drug called progerinin combined with lonafarnib to see if it helps children with Hutchinson-Gilford Progeria Syndrome feel better and stay safe while taking it.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 16 (estimated)
• Ages: 1 Year and up
• Sex: All
• Sponsor: PRG Science & Technology Co., Ltd. (industry)
• Locations: 1 site (Boston, Massachusetts)
• Trial ID: NCT06775041 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to determine the optimal dose and evaluate the safety, tolerability, and pharmacokinetics of progerinin when used in combination with lonafarnib in patients with Hutchinson-Gilford Progeria Syndrome (HGPS). A total of 10 subjects will be randomized in a 4:1 ratio to receive either progerinin plus lonafarnib or lonafarnib alone, with dose escalation based on individual responses. The study will assess two ascending doses of progerinin, and all subjects will continue taking lonafarnib, which is the standard of care. The trial will take place at Boston Children's Hospital, where participants will undergo regular assessments.

Who should consider this trial

Good fit: Ideal candidates include individuals aged 1 year and older with confirmed progerin-producing mutations associated with Hutchinson-Gilford Progeria Syndrome.

Not a fit: Patients without the specific progerin-producing mutations or those with a history of severe side effects from lonafarnib may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could improve outcomes and quality of life for patients with Hutchinson-Gilford Progeria Syndrome.

How similar studies have performed: While this approach is novel in combining progerinin with lonafarnib, previous studies have shown promise in treating HGPS with lonafarnib alone.

Eligibility criteria

Inclusion Criteria:

Subjects will be eligible for enrollment in the study only if they meet ALL the following criteria at time of Screening:

1. Subjects ≥ 1 year of age and weight ≥ 17.6 lb (8 kg).
2. Subject must have confirmatory mutational analysis showing the classic Hutchinson-Gilford Progeria Syndrome (HGPS) mutation (c. 1824 C\>T), nonclassic HGPS, Zmpset24 gene mutation, or other LMNA mutation (all subjects will have documentation of genetic testing prior to enrollment). \*Only subjects with progerin producing mutations will be eligible for randomization. Other PL are eligible to enroll as naïve subjects (see note for criterion #5).
3. Subject must display clinical signs of Progeria as per the clinical trial team.
4. Subject must be willing and able to come to Boston for appropriate assessments and examinations.
5. Subject must be taking lonafarnib for at least 4 months prior to enrollment and have no history of grade 3 or 4 side effects that can be probably or possibly attributed to lonafarnib for at least 2 months prior to enrollment.

   Note: Subjects with no prior treatment (i.e., no commercial or managed access program source) with lonafarnib may be enrolled to initiate treatment with lonafarnib monotherapy. These subjects will initiate lonafarnib therapy in preparation for an upcoming phase of the study following the completion of phase 2a. These subjects will be excluded from the analysis of this phase 2a study. These subjects must be at least 12 months of age per lonafarnib package insert.
6. Subjects must have had no recent fractures or major surgery (within four weeks).
7. Subject must have adequate organ and marrow function as defined by the following parameters:

   1. Blood: absolute phagocyte count (APC) (absolute neutrophil count \[ANC\] + bands + monocytes) \>1,000/μL, platelets \>75,000/μL (transfusion independent); hemoglobin \>9 g/dL.
   2. Renal: creatinine ≤ 1.5 times normal for age or Glomerular Filtration Rate (GFR) \>70 mL/min/1.73m2.
   3. Hepatic: bilirubin ≤1.5x upper limit of normal for age; Serum Glutamic Pyruvic Transaminase (SGPT) (Alanine Transaminase, \[ALT\]) \< and Serum Glutamic-Oxaloacetic Transaminase (SGOT) (Aspartate Aminotransferase, \[AST\]) ≤ 2.5x normal range for age.
8. The subject is willing to provide written informed assent form, when possible, to participate in the study after reading the informed assent form and the information provided and has had the opportunity to discuss the study with the investigator or designee. Additionally, the subject's legally authorized guardian (LAR) is willing to provide written informed consent.
9. The subject is able to communicate satisfactorily with the investigator and to participate in, and comply with, the requirements of the study.
10. The subject (or LAR) is able to understand the nature of the study and any potential hazards associated with participating in it.
11. Negative pregnancy test for female subjects of childbearing potential and those who have not been surgically sterilized or who do not have verbal or laboratory confirmation of two years postmenopausal status. Women of childbearing potential (WOCBP) and Women of non-childbearing potential are eligible to participate. Women of childbearing potential should use an acceptable method of birth control and agree to continue to use this method for the duration of the study and for 90 days after taking the last dose of Progerinin.

Acceptable methods of contraception include abstinence, female subject/partner's use of hormonal contraceptive (oral, implanted, or injected) in conjunction with a barrier method (WOCBP only) (e.g., diaphragm, cervical cap, male condom, and female condom and spermicidal foam, sponges, and film), female subject/partner's use of an intrauterine device (IUD), or if the female subject/partner is surgically sterile (e.g., bilateral tubal ligation, hysterectomy) or two years postmenopausal at time of screening. All male subjects/partners (excluding men who have been sterilized) must agree to consistently and correctly use a condom for the duration of the study and for 90 days after taking the study drug. In addition, subjects may not donate sperm for the duration of the study and for 90 days after taking study drug.

Exclusion Criteria:

Subjects meeting ANY of the following criteria at time of Screening will be excluded from enrollment:

1. Other than the drugs used in this protocol, other drugs targeted to treat Progeria are excluded. Drugs to treat symptoms of Progeria are permitted.
2. Subjects are taking medications that significantly affect the metabolism of Progerinin.
3. Subjects with an active bleeding diathesis or on oral anti-vitamin K medication (except low dose coumadin).
4. Subjects who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:

   1. known severely impaired lung function
   2. active (acute or chronic) or uncontrolled severe infections.
   3. liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis.
   4. history of hepatitis B or hepatitis C documented by history and confirmed by serology if positive for history.
5. Other concurrent severe and/or uncontrolled medical disease that could compromise participation in the study (i.e., uncontrolled diabetes, uncontrolled hypertension, severe infection, severe malnutrition, chronic liver or renal disease, active upper GI tract ulceration).
6. A known history of Human Immunodeficiency Virus (HIV) seropositivity or known immunodeficiency.
7. Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of Progerinin (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection). A nasogastric tube (NG tube) or gastric tube (G tube) is allowed.
8. Subjects who have known or suspected hypersensitivity to any of the excipients included in the formulation should not be treated.
9. Subjects who have used marijuana or other (Tetrahydrocannabinol) THC containing products either recreationally or for medical purposes within three months prior to entering the study.

Where this trial is running

Boston, Massachusetts

• Boston Children's Hospital — Boston, Massachusetts, United States (RECRUITING)

Study contacts

• Study coordinator: Kush Dhody, MD

Conditions: Hutchinson-Gilford Progeria Syndrome