Oral 9-cis retinoid for childhood blindness due to Leber congenital amaurosis caused by RPE65 or LRAT mutations: An open-label phase 1b trial

Robert K. Koenekoop, Ruifang Sui, Juliana Sallum, L. Ingeborgh Van Den Born, Radwan Ajlan, Ayesha Khan, Anneke I. Den Hollander, Frans P M Cremers, Janine D. Mendola, Ava K. Bittner, Gislin Dagnelie, Ronald A. Schuchard, David A. Saperstein

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1513-1520
Number of pages8
JournalThe Lancet
Volume384
Issue number9953
DOIs
StatePublished - Oct 25 2014

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Leber Congenital Amaurosis
Retinoids
Blindness
Mutation
Visual Fields
Visual Acuity
Magnetic Resonance Imaging
Retinaldehyde

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Koenekoop, R. K., Sui, R., Sallum, J., Van Den Born, L. I., Ajlan, R., Khan, A., ... Saperstein, D. A. (2014). Oral 9-cis retinoid for childhood blindness due to Leber congenital amaurosis caused by RPE65 or LRAT mutations: An open-label phase 1b trial. The Lancet, 384(9953), 1513-1520. https://doi.org/10.1016/S0140-6736(14)60153-7

Oral 9-cis retinoid for childhood blindness due to Leber congenital amaurosis caused by RPE65 or LRAT mutations : An open-label phase 1b trial. / Koenekoop, Robert K.; Sui, Ruifang; Sallum, Juliana; Van Den Born, L. Ingeborgh; Ajlan, Radwan; Khan, Ayesha; Den Hollander, Anneke I.; Cremers, Frans P M; Mendola, Janine D.; Bittner, Ava K.; Dagnelie, Gislin; Schuchard, Ronald A.; Saperstein, David A.

In: The Lancet, Vol. 384, No. 9953, 25.10.2014, p. 1513-1520.

Research output: Contribution to journalArticle

Koenekoop, RK, Sui, R, Sallum, J, Van Den Born, LI, Ajlan, R, Khan, A, Den Hollander, AI, Cremers, FPM, Mendola, JD, Bittner, AK, Dagnelie, G, Schuchard, RA & Saperstein, DA 2014, 'Oral 9-cis retinoid for childhood blindness due to Leber congenital amaurosis caused by RPE65 or LRAT mutations: An open-label phase 1b trial', The Lancet, vol. 384, no. 9953, pp. 1513-1520. https://doi.org/10.1016/S0140-6736(14)60153-7
Koenekoop, Robert K. ; Sui, Ruifang ; Sallum, Juliana ; Van Den Born, L. Ingeborgh ; Ajlan, Radwan ; Khan, Ayesha ; Den Hollander, Anneke I. ; Cremers, Frans P M ; Mendola, Janine D. ; Bittner, Ava K. ; Dagnelie, Gislin ; Schuchard, Ronald A. ; Saperstein, David A. / Oral 9-cis retinoid for childhood blindness due to Leber congenital amaurosis caused by RPE65 or LRAT mutations : An open-label phase 1b trial. In: The Lancet. 2014 ; Vol. 384, No. 9953. pp. 1513-1520.
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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.

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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