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Amyloid Transthyretin CardiomyopathyPhase 1NCT04360434

First-in-Human Study of NI006 in Patients With Amyloid Transthyretin Cardiomyopathy

A Phase 1 study testing NI006 in people with Amyloid Transthyretin Cardiomyopathy, run by Neurimmune AG at 6 sites in 4 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A phase 1, randomized, placebo-controlled, double-blind, dose escalation trial combining single-ascending dose and multiple-ascending dose phases of NI006 or placebo, followed by an open-label extension phase in subjects with Amyloid Transthyretin Cardiomyopathy (ATTR-CM). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Amyloid Transthyretin Cardiomyopathy
What is being tested?
NI006
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
46 participants
Where
6 sitesin 4 countries
Study dates
10 Feb 2020to 26 Jul 2023
Phase
Phase 1
Are there results?
None posted in the registry

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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Written informed consent obtained from the subject prior to any trial-related procedure indicating that he/she understands the purpose of, and procedures required for the trial and is willing to participate in it
  • Male or female subjects aged ≥18 years (and < 85 years only for cohort 7) at the time of obtaining informed consent and with confirmed availability for the scheduled trial visits
  • Confirmed ATTR-Cardiomyopathy diagnosis established by:
  • Polarizing light microscopy of green birefringent material in Congo red-stained tissue specimens and confirmed diagnosis of ATTR amyloidosis by IHC or mass spectrometry OR
  • positive bone scintigraphy using either DPD, HMDP or PYP, with cardiac signal intensity indicative of ATTR-Cardiomyopathy (early phase imaging: cardiac mediastinum ratio > 1.21; late phase imaging: Perugini Grade 2 or 3) and absence of gammopathy (negative serum and urine immunofixation electrophoresis plus normal free light chain serum ratio). If a gammopathy is detected, diagnosis must be established based on tissue biopsy as indicated above
  • Known genotype as follows:
Show all 20Show fewer
  • Known pathogenic TTR mutation for subjects with hereditary ATTR- Cardiomyopathy
  • Known negative genetic testing for a TTR mutation for subjects with sporadic, WT- ATTR-Cardiomyopathy
  • Chronic Heart Failure with all of the following characteristics:
  • LVEF ≥40%
  • LVWT ≥14 mm, measured by echocardiography
  • NT-proBNP level ≥600 pg/mL
  • Able to walk ≥150 meter in the 6-MWT
  • NYHA class III (applicable only for cohort 7)
  • No hospitalizations for cardiac disease for at least 30 calendar days prior to screening
  • General health status acceptable for a participation in a clinical trial with a Karnofsky Performance Status ≥60%
  • Stable pharmacological treatment of any other chronic condition for at least 30 calendar days prior to screening, with the exclusion of immunomodulatory and immunosuppressive treatments
  • ANC ≥1000 cells/mm³, platelet count ≥100,000 cells/mm³, and hemoglobin ≥10 g/dL
  • Women of childbearing potential must have a negative serum pregnancy test at screening and must agree to use highly effective physician-approved contraception from screening to 5 months after ending trial participation
  • Males must be surgically sterile or must agree to use highly effective physician-approved contraception throughout of the trial participation, and for 5 months after ending trial participation

Who cannot join

  • Amyloid light-chain amyloidosis or any other non ATTR amyloidosis
  • Heart failure corresponding to NYHA class IV
  • Uncontrolled hypertension with systolic pressure ≥180 mmHg or diastolic pressure ≥110 mmHg confirmed by 3 measurements in supine position recorded with 5 minutes break in between the measurements
  • Hypotension with systolic pressure ≤ 90 mmHg or diastolic pressure ≤ 60 mmHg confirmed by 3 measurements in supine position recorded with 5 minutes break in between the measurements
  • NT-proBNP ≥6'000 pg/mL (NT-proBNP ≥8'500 pg/mL applicable only for cohort 7)
  • Heart failure not predominantly caused by ATTR-Cardiomyopathy
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  • Any severe uncorrected valve disease
  • Chronic liver disease with liver function test abnormalities:
  • ALT and AST > 2.5 × ULN
  • Total bilirubin > 2 × ULN
  • Respiratory insufficiency requiring oxygen therapy
  • Renal insufficiency with eGFR < 30 mL/min/1.73 m2 using the CKD-EPI equation
  • Active malignancy with exception of the following:
  • Adequately treated basal cell carcinoma
  • Squamous cell carcinoma of the skin
  • In situ cervical cancer
  • Low risk prostate cancer with Gleason score < 7 and prostate specific antigen < 10 mg/mL
  • Any other cancer from which the subject has been disease-free for ≥ 2 years
  • Uncontrolled infection as per Investigator's judgement
  • Known HIV infection, seropositivity for HIV, hepatitis B and C as well as active hepatitis A
  • Autoimmune disease requiring immunosuppressive/modulating treatment in the last 2 years
  • History of organ transplantation or ventricular assist device
  • Polyneuropathy disability score > IIIA
  • Suspected or known intolerance/allergy to proteins or any components of the investigational medicinal product
  • Concomitant immunosuppressant therapy e.g., corticosteroids, prednisone, dexamethasone except as indicated in low dose (i.e., up to 10 mg prednisone or equivalent daily is allowed) for other medical conditions such as inhaled steroid for asthma
  • Use of the following drugs acting on TTR or ATTR: tolcapone, diflunisal, patisiran, inotersen, and long-term doxycycline, in the 30 calendar days prior to signing informed consent form. Tafamidis is permitted if it is given as standard of care in a stable dose for at least 30 calendar days prior to signing the informed consent form
  • Participation in another investigational clinical trial or intake of investigational drug within 30 calendar days before signing the informed consent form
  • Suspected or known drug or alcohol abuse
  • Serious psychiatric or any other medical condition (including laboratory abnormalities), which, in the opinion of the Investigator, makes the subject unsuitable for inclusion and puts the subject at an unacceptable risk
  • Subject is nursing or is considering becoming pregnant during the trial or in the 5 months after ending trial participation
  • Unwillingness or inability to adhere to the trial requirements
  • If subject is in any way dependent on Neurimmune AG or the principal Investigator or if the subject is accommodated in an establishment on judicial or administrative order
  • Employee or immediate family (spouse, parent, child or sibling, whether biological or legally adopted) of an employee of Neurimmune AG, the contract research organization or the trial site

Trial locations and contacts

6 sites in 4 countries.

6 sites in 4 countries

France3 sites
  • Hôpital Henri Mondor

    Créteil, 94000

  • CHU de Rennes - Hôpital Pontchaillou

    Rennes, 35033

  • CHU Toulouse - Hôpital Rangueil

    Toulouse, 31059

Other trials in France

Germany1 site
  • Universitätsklinikum Heidelberg

    Heidelberg, 69120

Other trials in Germany

Netherlands1 site
  • University Medical Center Groningen

    Groningen, 9713

Other trials in Netherlands

Spain1 site
  • Hospital Universitario Puerta de Hierro Majadahonda

    Majadahonda, 28222

Other trials in Spain

About this study

Official title: A Phase 1, First-in-Human, Double-Blind, Placebo-Controlled, Multicenter, Single and Multiple Ascending Dose Study of NI006 in Patients With Amyloid Transthyretin Cardiomyopathy Followed by an Open-Label Extension

A phase 1, randomized, placebo-controlled, double-blind, dose escalation trial combining single-ascending dose and multiple-ascending dose phases of NI006 or placebo, followed by an open-label extension phase in subjects with Amyloid Transthyretin Cardiomyopathy (ATTR-CM).

Read the detailed description

This phase 1, randomized, placebo-controlled, double-blind trial in subjects with Amyloid Transthyretin Cardiomyopathy (ATTR-CM) consists of single-ascending dose (SAD) and multiple-ascending dose (MAD) phases, followed by an open-label extension (OLE) phase.

In the SAD phase subjects are randomized in a 4:2 ratio to receive a single infusion of NI006 or placebo.

Subjects completing the SAD phase will be enrolled in the MAD phase upon evaluation of all available safety data and receive a maximum of 3 additional infusions of NI006 or placebo every 28 days.

Subjects completing the MAD phase will have the possibility to continue in an OLE phase with treatment up-titrations and switch from placebo to NI006 and receive up to 8 infusions of NI006 every 28 days.

Subjects of cohort 1 to 5 who received at least one dose of NI006 during the OLE phase will have the possibility for a second OLE phase (OLE2) after completing the OLE phase and receive up to 10 additional infusions of NI006 every 28 days.

In total, about 42 subjects are planned to be enrolled in 7 cohorts of 6 subjects each, at 6 ascending dose levels.

Being tested
NI006, Placebo
Keywords
ATTR, Transthyretin, Amyloidosis, Cardiomyopathy, ATTR-CM
Medical subject headings
Amyloidosis, Cardiomyopathies

What participants receive

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

  • NI006Drug

    NI006 will be administered intravenously

  • PlaceboDrug

    Formulation buffer of NI006, matching volume of NI006 doses will be administered intravenously

Study groups in NCT04360434
Study groupRoleWhat they receive
NI006ExperimentalDose escalation in up to 6 dose cohorts. Subjects will be administered a single dose of NI006 in the SAD, multiple doses of NI006 in the MAD and OLE phases.
Receives: Drug: NI006
PlaceboPlacebo comparatorSubjects will be administered a single dose of placebo in the SAD phase and multiple doses of placebo in the MAD phase. In the OLE phase, all subjects will be administered multiple doses of NI006.
Receives: Drug: Placebo

What is being measured

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

  1. Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram

    Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters (hematology, clinical chemistry, immunology, urinalysis), vital signs, electrocardiogram and echocardiogram

    Measured: 4 months

  2. Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram

    Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters (hematology, clinical chemistry, immunology, urinalysis), vital signs, electrocardiogram and echocardiogram

    Measured: 12 months

  3. Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram

    Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters (hematology, clinical chemistry, immunology, urinalysis), vital signs, electrocardiogram and echocardiogram

    Measured: additional up to 10 months

Secondary outcomes (14)
  1. NI006 pharmacokinetic profile and parameters - Cmax

    Maximum observed serum concentration (Cmax) of NI006

    Measured: 4 months

  2. NI006 pharmacokinetic profile and parameters - Tmax

    Time to maximum observed serum concentration (Tmax) of NI006

    Measured: 4 months

  3. NI006 pharmacokinetic profile and parameters - AUCinf

    Area under the serum concentration-time curve from zero to infinity (AUCinf) of NI006

    Measured: 1 month

  4. NI006 pharmacokinetic profile and parameters - CL

    Serum clearance (CL) of NI006

    Measured: 4 months

  5. NI006 pharmacokinetic profile and parameters - Vz

    NI006 apparent volume of distribution during terminal phase (Vz)

    Measured: 4 months

  6. NI006 pharmacokinetic profile and parameters - Vss

    NI006 apparent volume of distribution at steady state (Vss)

    Measured: 4 months

  7. NI006 pharmacokinetic profile and parameters - t½

    Terminal elimination half-life (t½) of NI006 in serum

    Measured: 4 months

  8. NI006 pharmacokinetic profile and parameters - AUCtau

    Area under the serum concentration-time curve from time zero to the end of the dosing interval after the first dose (AUCtau) of NI006

    Measured: 4 months

  9. NI006 pharmacokinetic profile and parameters - RaccCmax

    Accumulation ratio for maximum concentration (RaccCmax) of NI006 in serum

    Measured: 4 months

  10. NI006 pharmacokinetic profile and parameters - RaccAUC

    Accumulation ratio calculated from AUC (RaccAUC) of NI006 in serum

    Measured: 4 months

  11. NI006 pharmacokinetic profile and parameters - Ctrough

    Minimum observed concentration (Ctrough) of NI006 in serum

    Measured: 12 months

  12. NI006 OLE2 pharmacokinetic profile and parameters - Ctrough

    Minimum observed concentration (Ctrough) of NI006 in serum

    Measured: up to 10 months

  13. NI006 pharmacokinetic profile and parameters - dose-normalized Ctrough

    Dose-normalized minimum observed concentration (Ctrough) of NI006 in serum

    Measured: 12 months

  14. NI006 OLE2 pharmacokinetic profile and parameters - dose-normalized Ctrough

    Dose-normalized minimum observed concentration (Ctrough) of NI006 in serum

    Measured: up to 10 months

Timeline

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

  1. First posted24 Apr 2020
  2. Study start10 Feb 2020
  3. Primary completion26 Jul 2023
  4. Study completion26 Jul 2023

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 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
46 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04360434
Sponsor's protocol ID
NI006-101
Other IDs
2019-001932-80, 2019
Status last verified
Nov 2023
First submitted
11 Mar 2020
Last updated
3 Nov 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Kahr PC, Aus dem Siepen F, Lairez O, Donal E, Damy T, Kristen AV, Quarta CC, Mercuri MF, Keppner-Witter S, Herrmann-Keiner E, Tichy M, Michalon A, Grimm J, Nitsch RM, Hock C, Garcia-Pavia P, van der Meer P. Cliramitug for depletion of cardiac amyloid transthyretin: long-term follow-up of the NI006-101 trial. Nat Med. 2026 Jul;32(7):2639-2646. doi: 10.1038/s41591-026-04487-3. Epub 2026 Jun 26.

    PubMed 42362866
  • Garcia-Pavia P, Aus dem Siepen F, Donal E, Lairez O, van der Meer P, Kristen AV, Mercuri MF, Michalon A, Frost RJA, Grimm J, Nitsch RM, Hock C, Kahr PC, Damy T. Phase 1 Trial of Antibody NI006 for Depletion of Cardiac Transthyretin Amyloid. N Engl J Med. 2023 Jul 20;389(3):239-250. doi: 10.1056/NEJMoa2303765. Epub 2023 May 20.

    PubMed 37212440

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing NI006 in people with Amyloid Transthyretin Cardiomyopathy, run by Neurimmune AG at 6 sites in 4 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 20 inclusion and 33 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: finished, as of the sponsor's last update on 3 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in France, Germany, Netherlands, Spain. 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 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

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

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Number and proportion of treatment emergent adverse events and serious adverse events and clinically significant changes in laboratory parameters, vital signs, electrocardiogram and echocardiogram (time frame: 4 months). The study lists 3 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 NCT04360434, 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 3 Nov 2023.

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