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Mucopolysaccharidosis

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Adalimumab

Tumor Necrosis Factor Inhibitors

Participants first received Adalimumab 20 mg subQ every other week (weight 15 to \<30 kg) or 40 mg subQ every other week (weight ≥30 kg) for 16 weeks. Participants then received Placebo saline subQ (volume matching Adalimumab 20 mg or 40 mg subQ) every other week for 16 weeks.

Participants first received Placebo saline subQ (volume matching Adalimumab 20 mg or 40 mg subQ) every other week for 16 weeks. Participants then received Adalimumab 20 mg subQ every other week (weight 15 to \<30 kg) or 40 mg subQ every other week (weight ≥30 kg) for 16 weeks.

Subjects will be treated with adalimumab (20 mg \[weight 15-\<30 kg\] or 40 mg \[weight ≥30 kg\] administered subcutaneously \[subQ\] every other week) or placebo for 16 weeks, then cross-over to the other group for 16 weeks.

Placebo

Lynda E Polgreen, MD, MS

The purpose of the study is to collect preliminary data on whether the drug adalimumab (also called Humira) can decrease pain and stiffness, improve quality of life, and is safe in people with mucopolysaccharidosis type I, II, or VI. In this study people will be randomly assigned to one of two groups. One group will be treated with adalimumab the first 16 weeks of the study and then with a saline injection for the last 16 weeks of the study. The other group will start with the saline injection for 16 weeks and then switch to adalimumab for the last 16 weeks. The study subject and the study doctor and study coordinator will not know what group a subject is in until the study is done. Adalimumab is given as an injection, just under the skin, every 2 weeks. Both groups will have blood drawn at a screening visit, and then 7 more times over the 32 week study. There will be safety labs done (liver and immune function tests). Other safety tests include a chest X-ray and screening for tuberculosis exposure - these will be done at the screening visit and later in the study if there is concern for tuberculosis exposure or a persistent cough. The following will also be done at screening, the first, middle, and last study visits: 1) a pregnancy test in all girls 8 and older, 2) questionnaires that ask about pain, how MPS impacts social and physical function, and other quality of life questions, 3) height and weight. Finally, a physical exam, that includes for children and adolescents a check of where they are in puberty, will be done by a study physician at the first, middle, and last visits. There are risks to taking adalimumab that include redness and pain where the injection is given, a decreased ability to fight off infections, and others. The safety tests are designed to identify and decrease the risk associated with adalimumab. The study physicians believe that the potential benefit of adalimumab on pain, quality of life, and other MPS related problems outweigh the potential risks of treatment.

This is a randomized, pilot study consisting of a 32-week, crossover, double-blind, placebo-controlled treatment phase of subjects with Mucopolysaccharidosis (MPS) types I, II or VI treated with enzyme replacement therapy (ERT) and/or hematopoietic cell transplantation (HCT). Subjects will be treated with adalimumab (group 1) or placebo (group 2) for 16 weeks (i.e., 8 doses) then cross over to the other group for 16 weeks. Subjects will be treated with adalimumab (20 mg \[weight 15-\<30 kg\] or 40 mg \[weight ≥30 kg\] administered subcutaneously \[subQ\] every other week) or placebo for 16 weeks, then cross-over to the other group for 16 weeks. Laboratory evaluations and Children's Health Questionnaire - Parent Form 50 (CHQ-PF50) for subjects \<18 years of age or the Medical Outcomes Study Short Form-36 (SF-36) for subjects ≥18 years will be assessed at Week 16 and 32 to evaluate early treatment safety and efficacy. Safety will be assessed with laboratory evaluations at 4, 8, 20, and 24 weeks after treatment initiation, and with study visits at week 16 and 32, Physical function will be measured by the CHQ-PF50/SF-36, joint range of motion (ROM), 6-minute walk test (6MWT), and strength testing (hand-grip dynamometer) at baseline, 16, and 32 weeks. Joint inflammation will be measured by serum markers at baseline, 16, and 32 weeks. Anthropometric measurements will also be performed at Baseline and 16 and 32 weeks.

Effects of Adalimumab in Mucopolysaccharidosis Types I, II and VI

Pilot Study of the Effect of Adalimumab on Physical Function and Musculoskeletal Disease in Mucopolysaccharidosis Types I, II and VI

Children's Health Questionnaire - Parent Form 50 bodily pain (BP) standardized score for participants \< 18 years of age. Range is from 0 to 100 (no units) and standardization if determined by comparison to healthy age matched children. Lower values mean increased pain. The difference of change in BP standardized score from day 0 to week 16 during adalimumab treatment minus change in BP standardized score from day 0 to week 16 during placebo treatment is reported.

Children's Health Questionnaire - Parent Form 50 physical function (PF) standardized score for participants \< 18 years of age. Range is from 0 to 100 (no units) and standardization if determined by comparison to healthy age matched children. Lower values mean decreased physical function. The difference of change in PF standardized score from day 0 to week 16 during adalimumab treatment minus change in PF standardized score from day 0 to week 16 during placebo treatment is reported.

Percent of participants with a \>10 mm improvement in either "how you feel now" or "worst pain you had this week" on the VA in the PPQ during adalimumab versus during placebo by either parental or subject report. Range is 0-100 mm; lower number means less pain.

Number of joints with a \>5 degree more positive change during 16 weeks of adalimumab versus 16 weeks of placebo. A total of eight joints were measured.

Anti-laronidase antibodies for subjects with MPS I. Anti-idursulfase antibodies for subjects with MPS II.

Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center

20 mg subQ every other week (weight 15 to \<30 kg) 40 mg subQ every other week (weight ≥30 kg).

Adalimumab: Subjects will be treated with adalimumab (20 mg \[weight 15-\<30 kg\] or 40 mg \[weight ≥30 kg\] administered subcutaneously \[subQ\] every other week) or placebo for 16 weeks, then cross-over to the other group for 16 weeks.

Saline placebo injection

Placebo: Saline placebo

Adalimumab First, Then Placebo

Placebo First, Then Adalimumab

Total

Age, Categorical

Age, Continuous

Sex: Female, Male

Race (NIH/OMB)

United States

Region of Enrollment

Dr. Lynda Polgreen (PI)

This was a cross-over study so within-individual changes are reported.

Children's Health Questionnaire - Parent Form 50 Bodily Pain Standardized Score

Children's Health Questionnaire - Parent Form 50 Physical Function (PF) Standardized Score

Participants first received Placebo saline subQ (volume matching Adalimumab 20 mg or 40 mg subQ) every other week. Participants then received Adalimumab 20 mg subQ every other week (weight 15 to \<30 kg) or 40 mg subQ every other week (weight ≥30 kg) for 16 weeks.

Pain Measured by the Visual Analog Scale (VAS) in the Pediatric Pain Questionnaire (PPQ)

Participants first received Adalimumab 20 mg subQ every other week (weight 15 to \<30 kg) or 40 mg subQ every other week (weight ≥30 kg) for 16 weeks. Participants then received Placebo saline subQ (volume matching Adalimumab 20 mg or 40 mg subQ) every other week.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Effects of Adalimumab in Mucopolysaccharidosis Types I, II and VI	NCT02437253	Mucopolysacchar... Mucopolysacchar... Mucopolysacchar...	Adalimumab Placebo	5 Years -	Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
Effects of Adalimumab in Mucopolysaccharidosis Types I, II and VI	NCT02437253	Mucopolysacchar... Mucopolysacchar... Mucopolysacchar...	Adalimumab Placebo	5 Years -	Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center

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