Vamorolone trial in Duchenne muscular dystrophy shows dose-related improvement of muscle function

Abstract

Objective: To study vamorolone, a first-in-class steroidal anti-inflammatory drug, in Duchenne muscular dystrophy (DMD).

Methods: An open-label, multiple-ascending-dose study of vamorolone was conducted in 48 boys with DMD (age 4-<7 years, steroid-naive). Dose levels were 0.25, 0.75, 2.0, and 6.0 mg/kg/d in an oral suspension formulation (12 boys per dose level; one-third to 10 times the glucocorticoid dose in DMD). The primary goal was to define optimal doses of vamorolone. The primary outcome for clinical efficacy was time to stand from supine velocity.

Results: Oral administration of vamorolone at all doses tested was safe and well tolerated over the 24-week treatment period. The 2.0-mg/kg/d dose group met the primary efficacy outcome of improved muscle function (time to stand; 24 weeks of vamorolone treatment vs natural history controls), without evidence of most adverse effects of glucocorticoids. A biomarker of bone formation, osteocalcin, increased in vamorolone-treated boys, suggesting possible loss of bone morbidities seen with glucocorticoids. Biomarker outcomes for adrenal suppression and insulin resistance were also lower in vamorolone-treated patients with DMD relative to published studies of glucocorticoid therapy.

Conclusions: Daily vamorolone treatment suggested efficacy at doses of 2.0 and 6.0 mg/kg/d in an exploratory 24-week open-label study.

Classification of evidence: This study provides Class IV evidence that for boys with DMD, vamorolone demonstrated possible efficacy compared to a natural history cohort of glucocorticoid-naive patients and appeared to be tolerated.

Figure 1. Primary endpoint time to stand mean (±SE) velocity change from baseline

Brackets indicate mixed-model repeated-measures p values (black for comparisons to Cooperative International Neuromuscular Research Group Duchenne Natural History Study [DNHS] external comparator; blue for within-trial dose group comparisons).

Figure 2. Time to run/walk 10 m mean (±SE) velocity change from baseline

Brackets indicate mixed-model repeated-measures p values (black for comparisons to Cooperative International Neuromuscular Research Group Duchenne Natural History Study [DNHS] external comparator; blue for within-trial dose group comparisons).

Figure 3. Six-minute walk test mean (±SE) change from baseline

Brackets indicate mixed-model repeated-measures p values (within-trial dose group comparisons).

Figure 4. Time to climb mean (±SE) velocity change from baseline

Brackets indicate mixed-model repeated-measures p values (black for comparisons to Cooperative International Neuromuscular Research Group Duchenne Natural History Study [DNHS] external comparator).

Figure 5. Body mass index (BMI) z score mean (±SE) change from baseline (safety population)

Brackets indicate mixed-model repeated-measures p values (comparisons to Cooperative International Neuromuscular Research Group [CINRG] prednisone trial external comparator).