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Spinal Muscular AtrophyPhase 3SAPPHIRENCT05156320

Efficacy and Safety of Apitegromab in Patients With Later-Onset Spinal Muscular Atrophy Treated With Nusinersen or Risdiplam

A Phase 3 study testing Apitegromab in people with Spinal Muscular Atrophy and Spinal Muscular Atrophy Type 3, run by Scholar Rock, Inc. at 50 sites in 9 countries.

Completed

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

Official record
Search all trials

Trial summary

This Phase 3 trial (Study SRK-015-003) was conducted in patients ≥2 years old at Screening, who were previously diagnosed with later-onset spinal muscular atrophy (SMA) (i.e., Type 2 and Type 3 SMA) and were receiving an approved survival motor neuron (SMN) upregulator therapy (i.e., either nusinersen or risdiplam)… Read more about this study

Who is it for?
Ages 2 to 21 years
What is being tested?
Apitegromab
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
188 participants
Where
50 sitesin 9 countries
Study dates
14 Apr 2022to 18 Dec 2024
Phase
Phase 3
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 2 to 21 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Males and females 2 through 21 years old at Screening.
  • Documented diagnosis of 5q SMA.
  • Diagnosed with later-onset SMA (i.e., Type 2 and Type 3 SMA) before receiving an approved SMN upregulator therapy (i.e., either nusinersen or risdiplam).
  • Must be Nonambulatory at Screening. Nonambulatory patients must be able to sit independently (sits up straight with head erect for at least 10 seconds; does not use arms or hands to balance body or support position) per World Health Organization (WHO) motor milestones definition at Screening.
  • Receiving one background therapy for SMA (i.e., either nusinersen or risdiplam) for the time period specified below and anticipated to remain on that same treatment throughout the trial:
  • If receiving the SMN upregulator therapy nusinersen, must have completed at least 10 months of dosing (i.e., completed the loading regimen and at least 2 maintenance doses) before Screening;
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  • If receiving the SMN upregulator therapy risdiplam, must have completed at least 6 months of dosing before Screening.
  • Motor Function Score (HFMSE) ≥10 and ≤45 at Screening.
  • Have no physical limitations that would prevent the patient from undergoing motor function outcome measures throughout the duration of the study.
  • Able to receive study drug infusions and provide blood samples through the use of a peripheral intravenous (IV) or a long-term IV access device that the patient has placed for reasons independent from the study throughout the duration of the study.
  • Able to adhere to the requirements of the protocol, including travel to the study center and completing all study procedures and study visits.
  • For patients who are expected to have reached reproductive maturity by the end of the study, adhere to study specific contraception requirements.

Who cannot join

  • Received ZOLGENSMA® (onasemnogene abeparvovec-xioi) at any time and previous treatment with apitegromab.
  • Use of invasive ventilation and tracheostomy.
  • Use of chronic daytime non-invasive ventilatory support for >16 hours daily in the 2 weeks prior to dosing, or anticipated to regularly receive such daytime ventilator support chronically over the duration of the study.
  • Any acute or co-morbid condition interfering with the well-being of the patient within 7 days of screening, including active systemic infection, the need for acute treatment or inpatient observation due to any reason.
  • Severe scoliosis and/or contractures at screening. Based on clinical judgement, any scoliosis or contractures present must be stable over the past 6 months, anticipated to be stable for the duration of the study and not prevent the patient from being evaluated on any functional outcome measures throughout the duration of the study.
  • Pregnant or breastfeeding.
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  • Major orthopedic or other interventional procedure, including spine or hip surgery, considered to have the potential to substantially limit the ability of the patient to be evaluated on any functional outcome measures, within 6 months prior to Screening, or anticipated for the duration of the study.
  • Prior history of a hypersensitivity reaction to a monoclonal antibody (mAb) or recombinant protein bearing an Fc domain (such as a soluble receptor-Fc fusion protein), apitegromab, or excipients of apitegromab.
  • Treatment with investigational drugs within 3 months prior to Screening.
  • Use of therapies with potentially significant muscle effects (such as androgens, insulin-like growth factor, growth hormone, systemic beta-agonist, botulinum toxin, or muscle relaxants or muscle-enhancing supplements) or potentially significant neuromuscular effects (such as acetylcholinesterase inhibitors) within 60 days prior to screening.
  • Nutritional status not stable over the past 6 months and not anticipated to be stable throughout the duration of the study.
  • Patient has any other condition, which in the opinion of the Investigator may compromise safety or compliance, would preclude the patient from successful completion of the study, or interfere with the interpretation of the results.

Trial locations and contacts

50 sites in 9 countries.

50 sites in 9 countries

United States26 sites
  • Children's Hospital Colorado

    Aurora, Colorado, 80045

  • The Johns Hopkins University

    Baltimore, Maryland, 21287

  • Children's of Alabama

    Birmingham, Alabama, 35233

  • Boston Children's Hospital

    Boston, Massachusetts, 02115

  • Ann & Robert H. Lurie Children's Hospital of Chicago

    Chicago, Illinois, 60611

  • Nationwide Children's Hospital

    Columbus, Ohio, 43205

  • Children's Medical Center Dallas

    Dallas, Texas, 75235

  • Helen DeVos Children's Hospital

    Grand Rapids, Michigan, 49503

  • University of Iowa

    Iowa City, Iowa, 52242

  • University of Kansas Medical Center

    Kansas City, Kansas, 66160

  • Children's Hospital of Los Angeles

    Los Angeles, California, 90027

  • University of Wisconsin School of Medicine and Public Health

    Madison, Wisconsin, 53705

  • St. Jude Children's Research Hospital

    Memphis, Tennessee, 38105

  • Columbia University, SMA Clinical Research Center

    New York, New York, 10032

  • Children's Hospital of The King's Daughters

    Norfolk, Virginia, 23507

  • Nemours Children's Hospital

    Orlando, Florida, 32827

  • Stanford University Medical Center

    Palo Alto, California, 94304

  • Childrens Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Phoenix Children's Hospital

    Phoenix, Arizona, 85016

  • Oregon Health & Sciences University

    Portland, Oregon, 97239

  • Gillette Children's Specialty Healthcare

    Saint Paul, Minnesota, 55101

  • University of Utah

    Salt Lake City, Utah, 84112

  • Rady's Children's Hospital/UCSD

    San Diego, California, 92123

  • Seattle Children's Hospital

    Seattle, Washington, 98105

  • Washington University School of Medicine in St. Louis

    St Louis, Missouri, 63110

  • Wake Forest Baptist Medical Center

    Winston-Salem, North Carolina, 27157

Other trials in United States

Italy5 sites
  • IRCCS Istituto Giannina Gaslini

    Genoa

  • A.O.U Policlinico G. Martino

    Messina, 98125

  • Foundation I.R.C.C.S. Carlo Besta Neurological Institute

    Milan, 20133

  • ASST Grande Ospedale Metropolitano Niguarda

    Milan, 20162

  • Centro Clinico Nemo Pediatrico Policlinico A. Gemelli-Università Cattolica Sacro Cuore

    Roma, 00168

Other trials in Italy

Germany4 sites
  • Universitätsklinikum Bonn

    Bonn, 53127

  • Universitätsklinikum Essen

    Essen, 45147

  • Universitaetsklinikum Freiburg

    Freiburg im Breisgau, 79106

  • Dr. von Haunersches Kinderspital

    Munich, 80337

Other trials in Germany

Belgium3 sites
  • UZ Gent

    Ghent, 9000

  • UZ Leuven

    Leuven, 3000

  • Chr de La Citadelle

    Liège, 4000

Other trials in Belgium

France3 sites
  • CHU Lille - Hôpital Jeanne de Flandre

    Lille, 59037

  • Hôpital Armand Trousseau, I-Motion

    Paris, 75012

  • CHU Toulouse - Hopital des Enfants

    Toulouse, 31059

Other trials in France

Poland3 sites
  • Uniwersyteckie Centrum Kliniczne w Gdańsku

    Gdansk, 80-001

  • Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu

    Poznan, 61-701

  • Instytut Pomnik - Centrum Zdrowia Dziecka: CZD Warszawa

    Warsaw, 04-736

Other trials in Poland

United Kingdom3 sites
  • Leeds Teaching Hospitals NHS Trust

    Leeds, LS1 3EX

  • Great Ormond Street Hospital for Children NHS Foundation Trust

    London

  • University of Oxford

    Oxford, OX3 0ER

Other trials in United Kingdom

Spain2 sites
  • Hospital Sant Joan de Déu

    Barcelona

  • Hospital Universitario y Politécnico La Fe

    Valencia

Other trials in Spain

Netherlands1 site
  • Universitair Medisch Centrum Utrecht

    Utrecht, 3584

Other trials in Netherlands

About this study

Official title: Phase 3, Double-Blind, Placebo-Controlled Trial to Evaluate the Efficacy and Safety of Apitegromab (SRK-015) in Patients With Later-Onset Spinal Muscular Atrophy Receiving Background Nusinersen or Risdiplam Therapy

This Phase 3 trial (Study SRK-015-003) was conducted in patients ≥2 years old at Screening, who were previously diagnosed with later-onset spinal muscular atrophy (SMA) (i.e., Type 2 and Type 3 SMA) and were receiving an approved survival motor neuron (SMN) upregulator therapy (i.e., either nusinersen or risdiplam), to confirm the efficacy and safety of apitegromab as an adjunctive therapy to nusinersen and evaluate the efficacy and safety of apitegromab as an adjunctive therapy to risdiplam.

Being tested
Apitegromab, Placebo
Medical subject headings
Muscular Atrophy, Spinal, Spinal Muscular Atrophies of Childhood, Neuromuscular Diseases, Muscular Atrophy, Atrophy, Neuromuscular Manifestations

What participants receive

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

  • ApitegromabDrug

    Also called SRK-015

    Apitegromab is a fully human anti-proMyostatin monoclonal antibody (mAb) of the immunoglobulin G4 (IgG4)/lambda isotype that specifically binds to human pro/latent myostatin with high affinity inhibiting myostatin activation. SRK-015 was administered every 4 weeks by intravenous (IV) infusion.

  • PlaceboDrug

    Placebo was administered every 4 weeks by intravenous (IV) infusion.

Study groups in NCT05156320
Study groupRoleWhat they receive
Main Efficacy Population (Apitegromab 10 mg/kg)ExperimentalAged 2-12 years at Screening. Participants were randomized to receive apitegromab 10 mg/kg for up to 52 weeks.
Receives: Drug: Apitegromab
Main Efficacy Population (Apitegromab 20 mg/kg)ExperimentalAged 2-12 years at Screening. Participants were randomized to receive apitegromab 20 mg/kg for up to 52 weeks.
Receives: Drug: Apitegromab
Main Efficacy Population (Placebo)Placebo comparatorAged 2-12 years at Screening. Participants were randomized to receive placebo for up to 52 weeks.
Receives: Drug: Placebo
Exploratory Subpopulation (Apitegromab)ExperimentalAged 13-21 years at Screening. Participants were randomized to receive apitegromab 20 mg/kg for up to 52 weeks.
Receives: Drug: Apitegromab
Exploratory Subpopulation (Placebo)Placebo comparatorAged 13-21 years at Screening. Participants were randomized to receive placebo for up to 52 weeks.
Receives: Drug: Placebo

What is being measured

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

  1. Main Efficacy Population: Change from Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) total score.

    The HFMSE assesses the physical abilities of patients with Type 2 and Type 3 SMA. It comprises of 33 items graded on a scale of 0, 1, or 2, where 0 denotes unable, 1 denotes performed with modification or adaptation, and 2 denotes performed without modification or adaptation. The overall score is the sum of the scores for all activities with a maximum achievable score of 66. Higher scores indicate increased motor function.

    Measured: Baseline up to 12 months.

Secondary outcomes (7)
  1. Main Efficacy Population: Change from Baseline in Revised Upper Limb Module (RULM) total score.

    The RULM is a 20 item assessment of upper limb function in nonambulatory patients with SMA that was performed for patients who were 30 months of age or older at baseline. The 19 scored items assess functions that relate to everyday life, such as pressing a button and picking up a token; these items are scored 0, 1, or 2, where 0 denotes unable, 1 denotes able with modification, and 2 denotes able with no modification. The maximum score achievable is 37. Higher scores increased great upper limb function.

    Measured: Baseline up to 12 months.

  2. Main Efficacy Population: Proportion of patients with ≥3-point change from Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) total score.

    The HFMSE assesses the physical abilities of patients with Type 2 and Type 3 SMA. It comprises of 33 items graded on a scale of 0, 1, or 2, where 0 denotes unable, 1 denotes performed with modification or adaptation, and 2 denotes performed without modification or adaptation. The overall score is the sum of the scores for all activities with a maximum achievable score of 66. Higher scores indicate increased motor function.

    Measured: Baseline up to 12 months.

  3. Main Efficacy Population: Change from Baseline in number of WHO motor development milestones attained at 12 months.

    Measured: Baseline up to 12 months.

  4. Main Efficacy Population and Exploratory Subpopulation combined: Incidence of Treatment Emergent Adverse Events (TEAEs) and Severe Adverse Events (SAEs) by severity.

    Measured: Baseline up to 12 months.

  5. Main Efficacy Population and Exploratory Subpopulation combined: Apitegromab concentrations in serum from blood samples.

    Measured: Baseline up to 12 months.

  6. Main Efficacy Population and Exploratory Subpopulation combined: Circulating latent myostatin concentrations in blood samples.

    Measured: Baseline up to 12 months.

  7. Main Efficacy Population and Exploratory Subpopulation combined: Presence or absence of Antidrug Antibody (ADA) against apitegromab in serum from blood samples.

    Measured: Baseline up to 12 months.

Timeline

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

  1. First posted14 Dec 2021
  2. Study start14 Apr 2022
  3. Primary completion18 Dec 2024
  4. Study completion18 Dec 2024

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
188 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05156320
Sponsor's protocol ID
SRK-015-003
Acronym
SAPPHIRE
Status last verified
Jan 2026
First submitted
1 Dec 2021
Last updated
22 Jan 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Crawford TO, Servais L, Mercuri E, Kolbel H, Kuntz N, Finkel RS, Krueger J, Batley K, Young SD, Marantz JL, Song G, Yao B, Zhao G, Rossello J, Tirucherai GS, Mazzone ES, Butterfield RJ, de la Banda MGG, Seferian AM, Sansone VA, De Waele L, van der Pol WL, Cances C, Pechmann A, Darras BT; SAPPHIRE Study Group. Safety and efficacy of apitegromab in nonambulatory type 2 or type 3 spinal muscular atrophy (SAPPHIRE): a phase 3, double-blind, randomised, placebo-controlled trial. Lancet Neurol. 2025 Sep;24(9):727-739. doi: 10.1016/S1474-4422(25)00225-X.

    PubMed 40818473

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Apitegromab in people with Spinal Muscular Atrophy and Spinal Muscular Atrophy Type 3, run by Scholar Rock, Inc. at 50 sites in 9 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 12 inclusion and 12 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 22 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 50 sites in United States, Italy, Germany, Belgium, France and 4 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?

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?

Main Efficacy Population: Change from Baseline in Hammersmith Functional Motor Scale Expanded (HFMSE) total score. (time frame: Baseline up to 12 months.). 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 NCT05156320, which also lists 1 linked publication.

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 22 Jan 2026.

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