Viridian Announces Positive Data from Ongoing Phase 1/2 Trial Evaluating VRDN-001 in Patients with Chronic Thyroid Eye Disease (TED)
Viridian Therapeutics announced positive preliminary data from its ongoing phase 1/2 clinical trial of VRDN-001, an investigational full antagonist antibody to the insulin-like growth factor 1 receptor (IGF-1R), in patients with chronic thyroid eye disease (TED). The company also announced an amendment to its ongoing THRIVE phase 3 trial design and provided an update on recent progress of its SC program candidates in TED.
“It is quite impressive that patients in the 10 mg/kg and 3 mg/kg dose cohorts experienced reductions in proptosis as well as improvements in their clinical activity scores after receiving just two infusions of VRDN-001,” Kimberly Cockerham, MD, an Oculoplastic Surgeon specializing in neuro-ophthalmology, orbital oncology and oculofacial restoration at the SENTA Clinic in San Diego, California, and an investigator on the VRDN-001 clinical trial, said in a company news release. “Importantly, VRDN-001 was generally well tolerated among all treated patients, who will continue to be evaluated for safety and durability of response. Thus far, these data suggest that VRDN-001 has the potential to become an important new treatment option for managing the signs and symptoms of TED.”
VRDN-001 – Phase 1/2 proof-of-concept trial in chronic TED
The proof-of-concept portion of the double-masked, placebo-controlled phase 1/2 trial evaluated two infusions of VRDN-001 administered intravenously (IV), 3 weeks apart, with clinical activity endpoints measured 6 weeks after the first infusion. VRDN-001 was evaluated at doses of 10 and 3 mg/kg, with each cohort designed to include six patients randomized to drug, and two patients randomized to placebo.
Participant eligibility criteria included: chronic TED with documented evidence of ocular symptoms or signs that began more than 1 year prior to screening (mean duration of 7.8 years), and proptosis of ≥3 mm above normal values for gender and race. Any clinical activity score (CAS, 0–7) was allowed for randomization (mean CAS was 3.3).
VRDN-001 was generally well tolerated by all drug treated patients in both dose cohorts. There were no reported serious adverse events (SAEs), including no hearing impairment or hyperglycemia events, in patients with chronic TED treated with VRDN-001 as of May 30, 2023, the most recent cutoff date for follow-up observation. The safety and tolerability profile was generally consistent with previously reported results in patients with active TED treated with VRDN-001.
VRDN-001 – Clinical activity data in chronic TED
Patients in the 10 mg/kg (n=6) and 3 mg/kg (n=6) cohorts who were treated with two doses of VRDN-001 were evaluated for changes in proptosis, CAS, and diplopia at week 6. Proptosis changes from baseline were measured both by exophthalmometry and magnetic resonance imaging (MRI, an exploratory measure). The company said it believes exophthalmometry and MRI together provide a robust assessment of changes in proptosis. The following activity was observed in the 10 mg/kg cohort (n=6), 3mg/kg cohort (n=6), and across both dose groups (n=12):
Proptosis:
- Patients treated with VRDN-001 had lower mean proptosis at baseline when compared with placebo (25.0 mm).
VRDN-001 10 mg/kg cohort (n = 6) | VRDN-001 3 mg/kg cohort (n = 6) | VRDN-001 combined 10 and 3 mg/kg (n = 12) | |
Mean baseline proptosis | 21.1 mm | 23.4 mm | 22.2 mm |
Mean reduction in proptosis from baseline (measured by exophthalmometry) | -1.8 mm | -1.5 mm | -1.6 mm |
Mean reduction in proptosis from baseline (measured by MRI*) | -1.5 mm | -2.6 mm | -2.0 mm |
Proptosis responder rate | 50% | 33% | 42% |
*Masked, centrally reviewed MRI; MRI data is preliminary, MRI data available for 4 of 6 VRDN-001 10 mg/kg treated patients, 4 of 6 VRDN-001 3 mg/kg treated patients, and 5 of 5 placebo-treated patients (mean reduction in proptosis by MRI = -0.2 mm for placebo).
CAS:
- Observed a 50% to 72% reduction in mean CAS at week 6 compared with mean baseline levels in patients treated with VRDN-001.
VRDN-001 10 mg/kg cohort (n = 6) | VRDN-001 3 mg/kg cohort (n = 6) | VRDN-001 combined 10 and 3 mg/kg (n = 12) | |
Mean baseline CAS | 2.5 | 4.0 | 3.3 |
Mean reduction in CAS from baseline, all patients (7-point measure) | -1.8 | -2.0 | -1.9 |
Mean reduction in CAS from baseline, patients CAS>0 at baseline* | -2.8 | -2.0 | -2.3 |
*2 patients from the VRDN-001 10 mg/kg cohort with CAS of 0 at baseline excluded from calculation.
Diplopia:
- Five out of the 12 VRDN-001 treated patients across both dose cohorts had diplopia
(double vision) at baseline. None of the patients treated with VRDN-001 achieved complete resolution of diplopia at week 6, defined as patients with baseline diplopia who achieved a score of 0 on the Gorman subjective diplopia scale.
“We continue to be enthusiastic over the clinical trial data we’re compiling on VRDN-001,” said Barrett Katz, MD, MBA, Chief Medical Officer at Viridian. “As shown previously in our proof-of-concept study in patients with active TED, and now in those with chronic disease, VRDN-001 appears to be generally well tolerated and shows clinically meaningful changes, making it a promising lead candidate in our mission to develop therapies to improve the lives of those with TED.”
THRIVE Phase 3 trials in TED
Following recent discussions with the FDA regarding Viridian’s proposal to amend the THRIVE phase 3 trial design, THRIVE will now include the VRDN-001 5-dose treatment regimen and placebo arms only. The trial design amendment reflects Viridian’s confidence in the 5-dose treatment regimen of VRDN-001 and takes into consideration key stakeholder feedback from the TED community expressing preference for a shortened treatment regimen compared to an 8-dose treatment regimen.
The primary efficacy endpoint for THRIVE, proptosis responder rate, will be evaluated at week 15. The company expects to announce topline results from the THRIVE Phase 3 trial in the middle of 2024.
Viridian plans to initiate the THRIVE-2 phase 3 trial to evaluate the safety and efficacy of VRDN-001 in patients with chronic TED in the third quarter of 2023. The company expects to announce topline results from the THRIVE-2 trial by year-end 2024.
Subcutaneous (SC) programs in TED
Viridian believes that data from the 3 mg/kg dose cohorts of VRDN-001 in patients with active or chronic TED validate a low-volume, SC product profile for the Company’s three SC candidates. The company’s recent progress and upcoming priorities for its SC programs, include:
- Completed the SC formulation work for all three SC programs, allowing for a concentration of 150 mg/mL for administration of a 300 mg/2 mL dose in its SC clinical trials.
- Filed an investigational new drug (IND) application for VRDN-003 and an IND amendment for VRDN-001 SC with the FDA in June 2023. Following clearance of the submissions, Viridian plans to initiate phase 1 trials of VRDN-003 and VRDN-001 SC in healthy volunteers in the third quarter of 2023, with initial data expected in the fourth quarter of 2023.
- Completed enrollment of the phase 1 healthy volunteer trial of VRDN-002 single IV and single SC dose cohorts.
- Initiation of a pen device supply agreement with an experienced drug delivery device manufacturer in the second half of 2023.
Viridian expects to select its lead subcutaneous program by year-end 2023 and to advance the program into a pivotal phase 2/3 trial in the middle of 2024.
VRDN-001, -002, and -003 are investigational therapies that are not approved for any use in any country.