RAINBOWFISH: A study of risdiplam in newborns with presymptomatic spinal muscular atrophy (SMA)

Clinical Trials
73
Richard Finkel MD, Mohammad Al-Muhaizea , Michelle A. Farrar , Leslie Nelson PT, PhD, Alexandra Prufer , Laurent Servais MD, PhD, Yi Wang , Edmar Zanoteli , Laura Palfreeman , Muna El-Khairi , Ksenija Gorni MD, PhD, Heidemarie Kletzl , Marianne Gerber MD, Renata S Scalco , Enrico Bertini
1. Translational Neuroscience Program, St. Jude Children's Research Hospital, Memphis, TN, US, 2. Department of Neurosciences, King Faisal Specialist Hospital & Research Center-Riyadh, 3. Sydney Children’s Hospital and UNSW Sydney, Sydney, New South Wales, Australia, 4. UT Southwestern Medical Center, 5. Federal Uni Rio de Janeiro, 6. MDUK Oxford Neuromuscular Centre, 7. Children’s Hospital of Fudan University, 8. Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), 9. Roche Products Ltd, 10. Roche Products Ltd, 11. PDMA Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd, 12. Roche Pharmaceutical Research and Early Development, Roche Innovation Center Basel, 13. Pharma Development, Safety, F. Hoffmann-La Roche Ltd, 14. Pharma Development Neurology, F. Hoffmann-La Roche Ltd, 15. Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children’s Research Hospital IRCCS

Background:
Spinal muscular atrophy (SMA) is a severe, progressive neuromuscular disease caused by reduced levels of survival of motor neuron (SMN) protein due to deletions and/or mutations of the SMN1 gene. A second SMN gene, SMN2, produces only low levels of functional SMN protein. Risdiplam is a centrally and peripherally distributed oral SMN2 pre‑mRNA splicing modifier that increases the levels of functional SMN protein. Risdiplam (EVRYSDI™) has been approved by the FDA for the treatment of patients with SMA, aged 2 months and older.

RAINBOWFISH (NCT03779334) is an open-label, single-arm, multicenter global clinical study enrolling infants aged from birth–6 weeks of age (at first dose), regardless of SMN2 copy number. Infants will receive risdiplam for 24 months, followed by a 36-month extension. Primary analysis will be conducted at Month 12 of treatment in infants with two SMN2 copies and compound muscle action potential (CMAP) amplitude ≥1.5mV at baseline.

Objective:
To determine the efficacy, safety, pharmacokinetics (PK) and pharmacodynamics of risdiplam in infants with genetically diagnosed and presymptomatic SMA.

Results:
The primary endpoint is the proportion of infants sitting without support for at least 5 seconds after Month 12 of treatment (assessed by the Bayley Scales of Infant and Toddler Development, third edition). Secondary endpoints include the development of clinically manifested SMA, survival and permanent ventilation, achievement of motor milestones, motor function, growth measures, nutritional status, CMAP, PK, safety monitoring, and other clinical parameters.

The median age at first dose (range) for the first seven enrolled infants was 35 (16–40) days. We will report updated baseline demographics and baseline SMN protein data in enrolled infants with presymptomatic SMA. Additional preliminary data will also be presented.

Conclusion:
RAINBOWFISH will provide valuable information about the effects of risdiplam treatment at the presymptomatic stage in young infants with SMA. Recruitment for the study is ongoing worldwide.