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Primary Mitochondrial MyopathyPhase 3MMPOWER-3NCT03323749

A Trial to Evaluate Safety and Efficacy of Elamipretide Primary Mitochondrial Myopathy Followed by Open-Label Extension

A Phase 3 study testing elamipretide and elamipretide open label treatment in people with Primary Mitochondrial Myopathy, run by Stealth BioTherapeutics Inc. at 27 sites in 7 countries.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This is a multicenter phase 3 randomized, double-blind, parallel-group, placebo-controlled trial to evaluate the safety and efficacy of daily subcutaneous injections of elamipretide in subjects with primary mitochondrial myopathy. This will be followed by an open-label treatment extension. Read more about this study

Who is it for?
Ages 16 to 80 years
Conditions the study is for
Primary Mitochondrial Myopathy
What is being tested?
elamipretide and elamipretide open label treatment
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
218 participants
Where
27 sitesin 7 countries
Study dates
9 Oct 2017to 10 Feb 2020
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 80 years
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Willing and able to provide a signed informed consent form prior to participation in any trial-related procedures
  • Agrees to adhere to the trial requirements for the length of the trial, including the use of the elamipretide delivery system
  • Subject is ≥ 16 and ≤ 80 years of age
  • Diagnosed with PMM in the opinion of the investigator and confirmed by an Adjudication Committee
  • Woman of childbearing potential must agree to use a highly effective method of birth control

Who cannot join

  • Subject has myopathic signs and or/symptoms due to a neuropathic process or gait problem that would interfere with the 6 minute walk test (6MWT), in the opinion of the Investigator
  • Female who are pregnant, planning to become pregnant, or breastfeeding/lactating
  • At Screening, the estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m^2
  • Subject has undergone an in-patient hospitalization within the 30 days prior to the Baseline Visit or has a planned hospitalization or a surgical procedure during the trial.
  • Subject has clinically significant cardiac disease or prior interventional procedure and/or respiratory disease (medical history or current clinical findings) within 3 months of the Baseline Visit, in the opinion of the Investigator.
  • Subject has QTc elongation (using the correction factor utilized at the clinical site) defined as a QTc >450 msec in male subjects and >480 msec in female subjects.
Show all 26Show fewer
  • ECG evidence of acute ischemia, atrial fibrillation, or active conduction system abnormalities with the exception of any of the following:
  • First degree Atrioventricular bock (AV-block)
  • Second degree AV-block Type 1 (Mobitz Type 1 / Wenckebach type)
  • Right bundle branch block
  • Subject has severe vision impairment that, in the opinion of the Investigator, may interfere with their ability to complete all trial requirements
  • Subject has a seizure disorder that, in the opinion of the Investigator, may interfere with their ability to complete all trial requirements.
  • Active malignancy or any other cancer from which the subject has been disease-free for < 2 years.
  • Subject has a solid organ transplant and/or is currently receiving treatment with therapy for immunosuppression, in the opinion of the Investigator.
  • Subject has been previously diagnosed with human immunodeficiency virus (HIV), hepatitis B, or hepatitis C infection.
  • Subject has a history of a systemic eosinophilic illness and/or an eosinophil count >1,000 cells x10^6/L at the Screening Visit.
  • Subject is currently participating or has participated in an interventional clinical trial (i.e.,investigational product or device, stem cell therapy, gene therapy) within 30 days of the Baseline Visit; or is currently enrolled in a non-interventional clinical trial (except for SPIMM-300) at the Baseline Visit which, in the opinion of the Investigator, may be potentially confounding with results of the current trial (e.g., exercise therapy trial).
  • Subject has previously received elamipretide (MTP-131), for any reason.
  • Subject has a history of active substance abuse during the year before the Baseline Visit, in the opinion of the Investigator.
  • Subject has any prior or current medical condition that, in the judgment of the Investigator, would prevent the subject from safely participating in and/or completing all trial requirements.
  • PART 2:
  • Continuation Criteria:
  • Subjects must continue to be able and willing to adhere to the trial requirements.
  • Subject is appropriate to continue in Part 2 (i.e. subject was compliant in Part 1), in the opinion of the Investigator.
  • Subject has not had a serious adverse event (SAE)/serious adverse device effect (SADE) attributed to the elamipretide delivery system.
  • Subject has not permanently discontinued the elamipretide delivery system.

Trial locations and contacts

27 sites in 7 countries.

27 sites in 7 countries

United States13 sites
  • Akron Children's Hospital

    Akron, Ohio, 44308

  • Rare Disease Research, LLC

    Atlanta, Georgia, 30318

  • Children's Hospital Colorado

    Aurora, Colorado, 80045

  • Massachusetts General Hospital

    Boston, Massachusetts, 02114

  • Cleveland Clinical Neurological Institute

    Cleveland, Ohio, 44195

  • Baylor College of Medicine/Texas Children's Hospital

    Houston, Texas, 77030

  • University of Texas Health Science Center

    Houston, Texas, 77030

  • University of California San Diego

    La Jolla, California, 92093

  • Columbia University Medical Center

    New York, New York, 10032

  • Stanford University

    Palo Alto, California, 94304

  • Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Children's Hospital of Pittsburgh of UPMC

    Pittsburgh, Pennsylvania, 15224

  • Seattle Children's Hospital

    Seattle, Washington, 98105

Other trials in United States

Italy6 sites
  • IRCCS Institute of Neorological Sciences of Bologna, Bellaria Hospital

    Bologna, 40139

  • Azienda Ospedaliero Universitaria Policlinico G. Martino

    Messina, 98125

  • Istituto Nazionale Neurologico Carlo Besta

    Milan, 20133

  • Dipartimento Ambientale di Neuroscienze

    Pisa, 56126

  • Ospedale Pediatrico Bambin Gesù

    Rome, 00165

  • Istituto di Neurologia, Fondazione Policlinico Universitario A. Gemelli

    Rome, 00168

Other trials in Italy

Canada2 sites
  • McMaster University Medical Center

    Hamilton, Ontario

  • Adult Metabolic Diseases Clinic

    Vancouver, British Colombia

Other trials in Canada

Germany2 sites
  • University Hospital of Bonn

    Bonn, 53105

  • Klinikum der Universität München, Friedrich-Baur Institute

    Munich, 80336

Other trials in Germany

United Kingdom2 sites
  • MRC Centre for Neuromuscular Diseases

    London

  • Royal Victoria Infirmary

    Newcastle upon Tyne

Other trials in United Kingdom

Denmark1 site
  • Copenhagen Neuromuscular Center

    Copenhagen, DK-2100

Other trials in Denmark

Hungary1 site
  • Institute of Genomic Medicine and Rare Disorders

    Budapest, 1083

Other trials in Hungary

About this study

Official title: A Phase 3 Randomized, Placebo-Controlled Trial to Evaluate the Efficacy and Safety of Daily Subcutaneous Injections of Elamipretide in Subjects With Primary Mitochondrial Myopathy Followed by an Open-Label Treatment Extension

This is a multicenter phase 3 randomized, double-blind, parallel-group, placebo-controlled trial to evaluate the safety and efficacy of daily subcutaneous injections of elamipretide in subjects with primary mitochondrial myopathy. This will be followed by an open-label treatment extension.

Read the detailed description

Part 11 is a 24-week, randomized, double-blind, parallel-group, placebo-controlled assessment of the efficacy and safety of single daily subcutaneous (SC) doses of 40 mg elamipretide (vs placebo) administered with the elamipretide delivery system as a treatment for subjects with primary mitochondrial myopathy (PMM). Part 2 was to assess the long-term safety and tolerability of single daily SC doses of 40 mg elamipretide administered with the elamipretide delivery system for up to 144 weeks.

Being tested
elamipretide, placebo comparator, elamipretide open label treatment
Keywords
Myopathy, PMD, Primary Mitochondrial Disease, MTP-131, elamipretide
Medical subject headings
Muscular Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • elamipretideCombination product

    Also called MTP-131

    40 mg of elamipretide administered as once daily 0.5 mL subcutaneous injections for 24 weeks using the elamipretide delivery system

  • placebo comparatorCombination product

    Also called Placebo

    40 mg of placebo administered as once daily 0.5 mL subcutaneous injections for 24 weeks using the elamipretide delivery system

  • elamipretide open label treatmentCombination product

    40 mg of elamipretide administered as once daily 0.5 mL subcutaneous injections for up to 144 weeks using the elamipretide delivery system

Study groups in NCT03323749
Study groupRoleWhat they receive
Part 1: ElamipretideExperimental40 mg (0.5mL) elamipretide subcutaneous (SC) daily
Receives: Combination Product: elamipretide
Part 1: PlaceboPlacebo comparatorPlacebo SC daily
Receives: Combination Product: placebo comparator
Part 2: Elamipretide open labelExperimentalElamepretide 40 mg (0.5 mL) SC daily
Receives: Combination Product: elamipretide open label treatment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Six-minute Walk Test (6MWT)

    Change From Baseline in Distance Walked (meters) on the Six-Minute Walk Test by Visit

    Measured: Baseline to 24 weeks

  2. Total Fatigue Score on the on the Primary Mitochondrial Myopathy Symptom Assessment (PMMSA)

    Change from Baseline in Total fatigue score on the on the Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) by visit. Each individual item score ranges from 1 (none) to 4 (severe). The total fatigue score ranges from 4-16. Lower values represent a better outcome. The total fatigue score is the sum of question 1 through question 4 on the Primary Mitochondrial Myopathy Symptom Assessment.

    Measured: Baseline to 24 weeks

Secondary outcomes (4)
  1. Fatigue During Activities Score on the Primary Mitochondrial Disease Symptom Assessment (PMMSA).

    Change from baseline in Fatigue During Activities. Fatigue During Activities is the sum of question 2 (tiredness during activities) and question 4 (muscle weakness during activities.) The four response options are: 1=Not at all, 2=Mild, 3=Moderate, and 4=Severe. Raw scores for each subject range from 2-8. A lower score means a better outcome, with less fatigue. A higher score means a worse outcome, with more fatigue.

    Measured: Baseline to 24 weeks

  2. Neuro-QoL Fatigue Activities of Daily Living

    Change From Baseline in Neuro-QoL Fatigue Activities of Daily Living by Visit. Each individual item score ranges from 1-5. Total raw score for the entire item bank ranges from 19-95. Raw scores will be calibrated using Item Response Theory Model. Lower values represent a better outcome. Individual items will be summed to calculate total scores.

    Measured: Baseline to 24 weeks

  3. Change From Baseline in the Most Bothersome Symptom Score on the Primary Mitochondrial Myopathy Symptoms Assessment

    The item score rangers from 1 (none) to 4 (severe). Lower values represent a better outcome. The most bothersome score is the average of the identified most bothersome symptom of the Primary Mitochondrial Myopathy Symptom Assessment by each subject.

    Measured: Baseline to 24 weeks

  4. Neuro-QoL Fatigue Short Form Score

    Change From Baseline in Neuro-QoL Fatigue - Short Form: Total T-Scores by Visit. The Neuro-QoL Fatigue Short Form is comprised of the sum of the first 8 questions of the Neuro-QoL Item Bank v1.0 - Fatigue. Each question is scored as following: 1=Never, 2=Rarely, 3=Sometimes, 4=Often, and 5=Always. The questions include: I felt exhausted, I felt that I had no energy, I felt fatigued, I was too tired to do my household chores, I was too tired to leave the house, I was frustrated by being too tired to do the things I wanted to do, I felt tired, and I had to limit my social activity because I was tired. T-scores are calculated from the short form scoring table provided by the instrument authors (Neuro-QoL User Manual, 2015). T-score distributions rescale raw scores into standardized scores with a mean of 50 and a standard deviation (SD) of 10. Change from baseline: Negative numbers mean less fatigue, better outcome, positive score means more fatigue, worse outcome.

    Measured: 24 Weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Oct 2017
  2. Study start9 Oct 2017
  3. Primary completion10 Feb 2020
  4. Study completion10 Feb 2020

Why it stopped: Part1,double blind portion of the trial did not meet the primary end points

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
218 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03323749
Sponsor's protocol ID
SPIMM-301
Acronym
MMPOWER-3
Status last verified
Jan 2022
First submitted
12 Oct 2017
Last updated
24 Jan 2022
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Karaa A, Bertini E, Carelli V, Cohen B, Ennes GM, Falk MJ, Goldstein A, Gorman G, Haas R, Hirano M, Klopstock T, Koenig MK, Kornblum C, Lamperti C, Lehman A, Longo N, Molnar MJ, Parikh S, Phan H, Pitceathly RDS, Saneto R, Scaglia F, Servidei S, Tarnopolsky M, Toscano A, Van Hove JLK, Vissing J, Vockley J, Finman JS, Abbruscato A, Brown DA, Sullivan A, Shiffer JA, Mancuso M; MMPOWER-3 Trial Investigators. Genotype-specific effects of elamipretide in patients with primary mitochondrial myopathy: a post hoc analysis of the MMPOWER-3 trial. Orphanet J Rare Dis. 2024 Nov 21;19(1):431. doi: 10.1186/s13023-024-03421-5.

    PubMed 39574155
  • Karaa A, Bertini E, Carelli V, Cohen BH, Enns GM, Falk MJ, Goldstein A, Gorman GS, Haas R, Hirano M, Klopstock T, Koenig MK, Kornblum C, Lamperti C, Lehman A, Longo N, Molnar MJ, Parikh S, Phan H, Pitceathly RDS, Saneto R, Scaglia F, Servidei S, Tarnopolsky M, Toscano A, Van Hove JLK, Vissing J, Vockley J, Finman JS, Brown DA, Shiffer JA, Mancuso M; MMPOWER-3 Trial Investigators. Efficacy and Safety of Elamipretide in Individuals With Primary Mitochondrial Myopathy: The MMPOWER-3 Randomized Clinical Trial. Neurology. 2023 Jul 18;101(3):e238-e252. doi: 10.1212/WNL.0000000000207402. Epub 2023 Jun 2.

    PubMed 37268435

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing elamipretide and elamipretide open label treatment in people with Primary Mitochondrial Myopathy, run by Stealth BioTherapeutics Inc. at 27 sites in 7 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 26 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 24 Jan 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 27 sites in United States, Italy, Canada, Germany, United Kingdom and 2 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 2 Apr 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Six-minute Walk Test (6MWT) (time frame: Baseline to 24 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03323749, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jan 2022.

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