TY - JOUR
T1 - Oral 9-cis retinoid for childhood blindness due to Leber congenital amaurosis caused by RPE65 or LRAT mutations
T2 - An open-label phase 1b trial
AU - Koenekoop, Robert K.
AU - Sui, Ruifang
AU - Sallum, Juliana
AU - Van Den Born, L. Ingeborgh
AU - Ajlan, Radwan
AU - Khan, Ayesha
AU - Den Hollander, Anneke I.
AU - Cremers, Frans P.M.
AU - Mendola, Janine D.
AU - Bittner, Ava K.
AU - Dagnelie, Gislin
AU - Schuchard, Ronald A.
AU - Saperstein, David A.
N1 - Funding Information:
RKK, AKB, and GD are independent researchers (basic and clinical scientists) at academic institutions (McGill and John's Hopkins University), and worked as consultants of QLT on the drug development trial. RAS and DAS are consultants for QLT. DAS has an equity stake in Retinagenics (licensory to QLT of certain intellectual property rights relating to QLT 091001) and is an inventor on patents directly involved with the technology. Foundation Fighting Blindness Canada, Canadian Institutes for Health Research (CIHR), Fonds de la Recherche en Santee du Quebec (FRSQ), and Reseau Vision contributed to the genotyping of the patients by research grants to RKK. All other authors declare that they have no competing interests.
Publisher Copyright:
© 2014 Elsevier Ltd.
PY - 2014/10/25
Y1 - 2014/10/25
N2 - Background Leber congenital amaurosis, caused by mutations in RPE65 and LRAT, is a severe form of inherited retinal degeneration leading to blindness. We aimed to assess replacement of the missing chromophore 11-cis retinal with oral QLT091001 (synthetic 9-cis-retinyl acetate) in these patients.Methods In our open-label, prospective, phase 1b trial, we enrolled patients (aged ≥6 years) with Leber congenital amaurosis and RPE65 or LRAT mutations at McGill University's Montreal Children's Hospital. Patients received 7 days of oral QLT091001 (10-40 mg/m2 per day). We assessed patients at baseline and days 7, 9, 14, and 30, and then 2 months and every 2 months thereafter for up to 2·2 years for safety outcomes and visual function endpoints including Goldmann visual fields (GVF), visual acuity, and functional MRI assessment. We regarded patients as having an improvement in vision if we noted at least a 20% improvement in retinal area on GVF compared with baseline or a visual acuity improvement of five or more letters compared with baseline in two consecutive study visits (or any improvement from no vision at baseline). This study is registered with ClinicalTrials.gov, number NCT01014052.Findings Between December, 2009, and June, 2011, we enrolled and treated 14 patients aged 6-38 years who were followed up until March, 2012. Ten (71%) of 14 patients had an improvement in GVF areas (mean increase in retinal area of 28-683%). Six (43%) patients had an improvement in visual acuity (mean increase of 2-30 letters). Self-reported or parent-reported improvements in activities of daily living supported these findings. After 2 years, 11 (79%) patients had returned to their baseline GVF retinal area and ten (71%) had returned to baseline visual acuity letter values. Thus, three (21%) patients had a sustained GVF response and four (30%) had a sustained visual acuity response. Four patients had functional MRI scans, which correlated with visual response or absence of response to treatment. No serious adverse events occurred, although we noted transient headaches (11 patients), photophobia (11 patients), reduction in serum HDL concentrations (four patients), and increases in serum triglycerides (eight patients) and aspartate aminotransferase concentrations (two patients).Interpretation Non-invasive oral QLT091001 therapy is well tolerated, and can rapidly improve visual function in some patients with Leber congenital amaurosis and RPE65 and LRAT mutations.Funding QLT, Foundation Fighting Blindness Canada, CIHR, FRSQ, Reseau Vision.
AB - Background Leber congenital amaurosis, caused by mutations in RPE65 and LRAT, is a severe form of inherited retinal degeneration leading to blindness. We aimed to assess replacement of the missing chromophore 11-cis retinal with oral QLT091001 (synthetic 9-cis-retinyl acetate) in these patients.Methods In our open-label, prospective, phase 1b trial, we enrolled patients (aged ≥6 years) with Leber congenital amaurosis and RPE65 or LRAT mutations at McGill University's Montreal Children's Hospital. Patients received 7 days of oral QLT091001 (10-40 mg/m2 per day). We assessed patients at baseline and days 7, 9, 14, and 30, and then 2 months and every 2 months thereafter for up to 2·2 years for safety outcomes and visual function endpoints including Goldmann visual fields (GVF), visual acuity, and functional MRI assessment. We regarded patients as having an improvement in vision if we noted at least a 20% improvement in retinal area on GVF compared with baseline or a visual acuity improvement of five or more letters compared with baseline in two consecutive study visits (or any improvement from no vision at baseline). This study is registered with ClinicalTrials.gov, number NCT01014052.Findings Between December, 2009, and June, 2011, we enrolled and treated 14 patients aged 6-38 years who were followed up until March, 2012. Ten (71%) of 14 patients had an improvement in GVF areas (mean increase in retinal area of 28-683%). Six (43%) patients had an improvement in visual acuity (mean increase of 2-30 letters). Self-reported or parent-reported improvements in activities of daily living supported these findings. After 2 years, 11 (79%) patients had returned to their baseline GVF retinal area and ten (71%) had returned to baseline visual acuity letter values. Thus, three (21%) patients had a sustained GVF response and four (30%) had a sustained visual acuity response. Four patients had functional MRI scans, which correlated with visual response or absence of response to treatment. No serious adverse events occurred, although we noted transient headaches (11 patients), photophobia (11 patients), reduction in serum HDL concentrations (four patients), and increases in serum triglycerides (eight patients) and aspartate aminotransferase concentrations (two patients).Interpretation Non-invasive oral QLT091001 therapy is well tolerated, and can rapidly improve visual function in some patients with Leber congenital amaurosis and RPE65 and LRAT mutations.Funding QLT, Foundation Fighting Blindness Canada, CIHR, FRSQ, Reseau Vision.
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U2 - 10.1016/S0140-6736(14)60153-7
DO - 10.1016/S0140-6736(14)60153-7
M3 - Article
C2 - 25030840
AN - SCOPUS:84908353007
SN - 0140-6736
VL - 384
SP - 1513
EP - 1520
JO - The Lancet
JF - The Lancet
IS - 9953
ER -