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NCT00847379

Phase 2B Extension Study of Ataluren (PTC124) in Duchenne/Becker Muscular Dystrophy (DMD/BMD)

Terminated Phase 2 Results posted Last updated 15 July 2020
What this trial tests

Phase 2 trial testing Ataluren in Duchenne Muscular Dystrophy in 173 participants. Terminated before completion.

Timeline
31 January 2009
Primary endpoint
24 May 2010
24 May 2010

Quick facts

Lead sponsorPTC Therapeutics
PhasePhase 2
StatusTerminated
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment173
Start date31 January 2009
Primary completion24 May 2010
Estimated completion24 May 2010
Sites37 locations across France, Italy, Belgium, Sweden, United Kingdom, Germany, Israel, Canada

Drugs / interventions tested

Conditions studied

Sponsor

PTC Therapeutics — full company profile →

Who can join

5 and older, male only, with Duchenne Muscular Dystrophy or Becker Muscular Dystrophy. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Number of Participants With Treatment-Emergent Adverse Events (AEs) Primary · Baseline (Week 48 of Study 007) up to Week 102

An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Severity of an AE was classified as: mild (does not interfere with usual function), moderate (interferes to some extent with usual function) and severe (interferes significantly with usual function). Drug-related AEs: AEs with a possible or probable relationship to study drug. Serious AEs: death, a life-threatening AE, inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability or incapacity, a congenital anomal

Any AEs
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren52
Low-Dose Ataluren/High-Dose Ataluren49
Placebo/High-Dose Ataluren48
Overall Participants: High-Dose Ataluren149
Drug-related AEs
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren10
Low-Dose Ataluren/High-Dose Ataluren10
Placebo/High-Dose Ataluren22
Overall Participants: High-Dose Ataluren42
Serious AEs
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren0
Low-Dose Ataluren/High-Dose Ataluren1
Placebo/High-Dose Ataluren2
Overall Participants: High-Dose Ataluren3
Mild AEs
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren34
Low-Dose Ataluren/High-Dose Ataluren23
Placebo/High-Dose Ataluren26
Overall Participants: High-Dose Ataluren83
Moderate AEs
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren13
Low-Dose Ataluren/High-Dose Ataluren22
Placebo/High-Dose Ataluren19
Overall Participants: High-Dose Ataluren54
Severe AEs
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren5
Low-Dose Ataluren/High-Dose Ataluren4
Placebo/High-Dose Ataluren3
Overall Participants: High-Dose Ataluren12
Number of Participants With Clinically Significant Abnormal Laboratory Parameters Primary · Baseline (Week 48 of Study 007) up to Week 102

Laboratory parameters tests included hematology, biochemistry assay (hepatic, renal, and serum electrolyte values), adrenal assays, and urinalysis. Clinical significance was defined as per investigator's judgement.

GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren0
Low-Dose Ataluren/High-Dose Ataluren0
Placebo/High-Dose Ataluren0
Overall Participants: High-Dose Ataluren0
Change From Baseline in 6-Minute Walk Distance (6MWD) at Week 60 Secondary · Baseline (Week 48 of Study 007), Week 60

The 6MWD test was performed in a 30 meters long flat corridor, where the participant was instructed to walk as far as possible, back and forth around two cones, with the permission to slow down, rest, or stop if needed. Ambulation was assessed via the 6MWD test following standardized procedures by measuring the 6MWD in meters. Participants were not permitted to use assistive devices (walker, long leg braces, or short leg braces) during the 6MWD test.

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren351.60± 130.312
Low-Dose Ataluren/High-Dose Ataluren375.95± 98.976
Placebo/High-Dose Ataluren356.25± 109.369
Overall Participants: High-Dose Ataluren361.11± 113.760
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-17.23± 39.608
Low-Dose Ataluren/High-Dose Ataluren-10.50± 41.390
Placebo/High-Dose Ataluren-7.06± 50.121
Overall Participants: High-Dose Ataluren-11.56± 43.881
Change From Baseline in Mean Activity Period/Day/Visit at Week 60, as Assessed by Step Activity Monitoring (SAM) Secondary · Baseline (Week 48 of Study 007), Week 60

The SAM is a pedometer (worn on the ankle) that continuously records the number of steps per time interval. Participants were instructed to continue to wear the SAM for at least 9 consecutive days. SAM was used to record the number of strides/minute following each visit. A stride is the leg motion that begins when the foot with SAM leaves the floor and ends when the same foot touches the floor again (that is, a stride generally equals 2 steps). Mean activity period/day/visit was computed for each participant. For each day, an active period was defined as the first time after 3:00 AM that great

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren759.715± 77.5210
Low-Dose Ataluren/High-Dose Ataluren742.223± 107.7264
Placebo/High-Dose Ataluren747.464± 102.6531
Overall Participants: High-Dose Ataluren750.016± 96.1057
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren1.946± 61.2247
Low-Dose Ataluren/High-Dose Ataluren34.283± 88.1587
Placebo/High-Dose Ataluren-1.866± 93.0531
Overall Participants: High-Dose Ataluren10.991± 82.6356
Change From Baseline in Mean Total Step Count/Day/Visit During the Active Periods at Week 60, as Assessed by SAM Secondary · Baseline (Week 48 of Study 007), Week 60

The SAM is a pedometer (worn on the ankle) that continuously records the number of steps per time interval. Participants were instructed to continue to wear the SAM for at least 9 consecutive days. SAM was used to record the number of strides/minute following each visit. A stride is the leg motion that begins when the foot with SAM leaves the floor and ends when the same foot touches the floor again (that is, a stride generally equals 2 steps). Mean total step count/day/visit during the active periods was computed for each participant. For each day, an active period was defined as the first ti

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren4934.575± 2433.230
Low-Dose Ataluren/High-Dose Ataluren4543.766± 2051.300
Placebo/High-Dose Ataluren5175.330± 2307.436
Overall Participants: High-Dose Ataluren4883.613± 2272.108
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-357.679± 1232.109
Low-Dose Ataluren/High-Dose Ataluren-215.062± 1761.773
Placebo/High-Dose Ataluren-647.504± 1680.522
Overall Participants: High-Dose Ataluren-409.558± 1566.386
Change From Baseline in Mean Total Step Count/Hour During the Active Period at Week 60, as Assessed by SAM Secondary · Baseline (Week 48 of Study 007), Week 60

The SAM is a pedometer (worn on the ankle) that continuously records the number of steps per time interval. Participants were instructed to continue to wear the SAM for at least 9 consecutive days. SAM was used to record the number of strides/minute following each visit. A stride is the leg motion that begins when the foot with SAM leaves the floor and ends when the same foot touches the floor again (that is, a stride generally equals 2 steps). Mean total step count/hour during the active periods for the days in a visit was computed for each participant. For each day, an active period was defi

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren395.491± 200.7671
Low-Dose Ataluren/High-Dose Ataluren368.672± 155.6648
Placebo/High-Dose Ataluren420.684± 188.9124
Overall Participants: High-Dose Ataluren394.787± 183.0994
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-27.650± 87.8797
Low-Dose Ataluren/High-Dose Ataluren-34.693± 128.0609
Placebo/High-Dose Ataluren-54.755± 122.4142
Overall Participants: High-Dose Ataluren-39.010± 113.3481
Change From Baseline in Maximum Continuous 10-minute, 20-minute, 30-minute, and 60-minute Total Step Count at Week 60, as Assessed by SAM Secondary · Baseline (Week 48 of Study 007), Week 60

SAM is a pedometer (worn on the ankle) that continuously records the number of steps per time interval. Participants were instructed to continue to wear the SAM for at least 9 consecutive days. SAM was used to record the number of strides/minute following each visit. A stride is the leg motion that begins when the foot with SAM leaves the floor and ends when the same foot touches the floor again (that is, a stride generally equals 2 steps). The maximum continuous 10-minute, 20-minute, 30-minute, and 60-minute total step counts were computed for each participant. For each day, an active period

Baseline: 10-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren34.603± 12.4886
Low-Dose Ataluren/High-Dose Ataluren32.863± 8.8533
Placebo/High-Dose Ataluren35.256± 10.0379
Overall Participants: High-Dose Ataluren34.241± 10.5911
Change at Week 60: 10-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-1.140± 6.9584
Low-Dose Ataluren/High-Dose Ataluren-0.607± 7.2946
Placebo/High-Dose Ataluren-2.372± 7.1735
Overall Participants: High-Dose Ataluren-1.384± 7.1170
Baseline: 20-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren28.138± 11.0629
Low-Dose Ataluren/High-Dose Ataluren26.096± 7.9168
Placebo/High-Dose Ataluren28.323± 9.3133
Overall Participants: High-Dose Ataluren27.526± 9.5426
Change at Week 60: 20-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-1.459± 6.7165
Low-Dose Ataluren/High-Dose Ataluren-0.662± 6.2171
Placebo/High-Dose Ataluren-2.510± 6.4346
Overall Participants: High-Dose Ataluren-1.558± 6.4549
Baseline: 30-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren24.222± 9.9576
Low-Dose Ataluren/High-Dose Ataluren22.205± 7.1045
Placebo/High-Dose Ataluren24.498± 8.4938
Overall Participants: High-Dose Ataluren23.648± 8.6306
Change at Week 60: 30-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-1.400± 5.7605
Low-Dose Ataluren/High-Dose Ataluren-0.450± 5.6811
Placebo/High-Dose Ataluren-2.457± 5.9579
Overall Participants: High-Dose Ataluren-1.452± 5.8110
Baseline: 60-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren18.019± 7.8145
Low-Dose Ataluren/High-Dose Ataluren16.453± 5.6625
Placebo/High-Dose Ataluren18.599± 6.9509
Overall Participants: High-Dose Ataluren17.691± 6.8991
Change at Week 60: 60-minute total step count
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-0.977± 3.7328
Low-Dose Ataluren/High-Dose Ataluren-0.210± 4.7035
Placebo/High-Dose Ataluren-2.257± 5.1038
Overall Participants: High-Dose Ataluren-1.162± 4.5803
Change From Baseline in Percentage of Time During Active Period Spent at No Activity (0 Steps/Minute[Min]), Low Activity (Less Than or Equal to [≤]15 Steps/Min), Medium Activity (16-30 Steps/Min), and High Activity (Greater Than[>]30 Steps/Min) at Week 60 Secondary · Baseline (Week 48 of Study 007), Week 60

SAM is a pedometer (worn on the ankle) that continuously records the number of steps per time interval. Participants were instructed to continue to wear SAM for at least 9 consecutive days. SAM was used to record number of strides/minute following each visit. A stride is leg motion that begins when the foot with SAM leaves the floor and ends when the same foot touches the floor again. Percentage of time during active periods spent at no activity (0 steps/min), low activity (≤15 steps/min), medium activity (16-30 steps/min), and high activity (\>30 steps/min) were computed for each participant.

Baseline: Time spent at no activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren52.818± 14.4129
Low-Dose Ataluren/High-Dose Ataluren53.372± 12.2352
Placebo/High-Dose Ataluren50.006± 12.5263
Overall Participants: High-Dose Ataluren52.094± 13.1188
Change at Week 60: Time spent at no activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-0.051± 8.1776
Low-Dose Ataluren/High-Dose Ataluren0.830± 11.2481
Placebo/High-Dose Ataluren2.194± 7.8652
Overall Participants: High-Dose Ataluren0.985± 9.1467
Baseline: Time spent at low activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren30.677± 7.8531
Low-Dose Ataluren/High-Dose Ataluren31.170± 7.2431
Placebo/High-Dose Ataluren32.393± 7.2426
Overall Participants: High-Dose Ataluren31.392± 7.4462
Change at Week 60: Time spent at low activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren1.270± 5.8178
Low-Dose Ataluren/High-Dose Ataluren1.172± 8.3050
Placebo/High-Dose Ataluren0.252± 5.5885
Overall Participants: High-Dose Ataluren0.896± 6.6058
Baseline: Time spent at medium activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren10.248± 4.7620
Low-Dose Ataluren/High-Dose Ataluren10.119± 4.4344
Placebo/High-Dose Ataluren10.983± 4.6049
Overall Participants: High-Dose Ataluren10.442± 4.5901
Change at Week 60: Time spent at medium activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-0.542± 2.0960
Low-Dose Ataluren/High-Dose Ataluren-1.356± 3.7830
Placebo/High-Dose Ataluren-0.965± 3.3763
Overall Participants: High-Dose Ataluren-0.944± 3.1392
Baseline: Time spent at high activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren6.404± 4.5938
Low-Dose Ataluren/High-Dose Ataluren5.370± 3.4243
Placebo/High-Dose Ataluren6.673± 4.5847
Overall Participants: High-Dose Ataluren6.149± 4.2476
Change at Week 60: Time spent at high activity
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren-0.643± 2.2656
Low-Dose Ataluren/High-Dose Ataluren-0.520± 2.7196
Placebo/High-Dose Ataluren-1.506± 2.9904
Overall Participants: High-Dose Ataluren-0.898± 2.6913
Change From Baseline in Time to Stand From Supine Position at Week 60 Secondary · Baseline (Week 48 of Study 007), Week 60

If the time taken to perform this test exceeded 30 seconds or if a participant could not perform this test due to disease progression, a value of 30 seconds was used. Change from baseline data has been reported.

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren13.736± 11.3353
Low-Dose Ataluren/High-Dose Ataluren11.796± 10.3544
Placebo/High-Dose Ataluren12.398± 11.6010
Overall Participants: High-Dose Ataluren12.666± 11.0678
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren0.665± 3.0080
Low-Dose Ataluren/High-Dose Ataluren-0.187± 4.6289
Placebo/High-Dose Ataluren0.002± 4.6322
Overall Participants: High-Dose Ataluren0.166± 4.1373
Change From Baseline in Time to Walk/Run 10 Meters at Week 60 Secondary · Baseline (Week 48 of Study 007), Week 60

If the time taken to perform this test exceeded 30 seconds or if a participant could not perform this test due to disease progression, a value of 30 seconds was used. Change from baseline data has been reported.

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren8.143± 5.1475
Low-Dose Ataluren/High-Dose Ataluren6.986± 2.9995
Placebo/High-Dose Ataluren6.967± 3.5789
Overall Participants: High-Dose Ataluren7.384± 4.0530
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren1.441± 4.4822
Low-Dose Ataluren/High-Dose Ataluren0.547± 2.2058
Placebo/High-Dose Ataluren0.758± 2.6862
Overall Participants: High-Dose Ataluren0.922± 3.2905
Change From Baseline in Time to Climb 4 Stairs at Week 60 Secondary · Baseline (Week 48 of Study 007), Week 60

If the time taken to perform this test exceeded 30 seconds or if a participant could not perform this test due to disease progression, a value of 30 seconds was used. Change from baseline data has been reported.

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren9.077± 9.2543
Low-Dose Ataluren/High-Dose Ataluren6.738± 6.4069
Placebo/High-Dose Ataluren8.071± 9.2057
Overall Participants: High-Dose Ataluren7.984± 8.4076
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren0.831± 2.4664
Low-Dose Ataluren/High-Dose Ataluren0.696± 4.0707
Placebo/High-Dose Ataluren0.194± 2.5268
Overall Participants: High-Dose Ataluren0.574± 3.0898
Change From Baseline in Time to Descend 4 Stairs at Week 60 Secondary · Baseline (Week 48 of Study 007), Week 60

If the time taken to perform this test exceeded 30 seconds or if a participant could not perform this test due to disease progression, a value of 30 seconds was used. Change from baseline data has been reported.

Baseline
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren7.685± 8.9934
Low-Dose Ataluren/High-Dose Ataluren5.638± 5.5635
Placebo/High-Dose Ataluren6.641± 7.8591
Overall Participants: High-Dose Ataluren6.675± 7.6319
Change at Week 60
GroupValue95% CI
High-Dose Ataluren/High-Dose Ataluren1.167± 4.7624
Low-Dose Ataluren/High-Dose Ataluren0.626± 5.2567
Placebo/High-Dose Ataluren-0.648± 4.9202
Overall Participants: High-Dose Ataluren0.385± 5.0045

Adverse events — posted to ClinicalTrials.gov

Time frame: Baseline (Week 48 of Study 007) up to Week 102. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

High-Dose Ataluren/High-Dose Ataluren
Serious: 0/59 (0%)
Deaths:
Low-Dose Ataluren/High-Dose Ataluren
Serious: 1/57 (2%)
Deaths:
Placebo/High-Dose Ataluren
Serious: 2/57 (4%)
Deaths:
Overall Participants: High-Dose Ataluren
Serious: 3/173 (2%)
Deaths:

Serious adverse events (2 terms)

ReactionSystemHigh-Dose Ataluren/High-Do…Low-Dose Ataluren/High-Dos…Placebo/High-Dose AtalurenOverall Participants: High…
Femur fractureInjury, poisoning and procedural complications
HypertensionVascular disorders
Other adverse events (210 terms — click to expand)

ReactionSystemHigh-Dose Ataluren/High-Do…Low-Dose Ataluren/High-Dos…Placebo/High-Dose AtalurenOverall Participants: High…
VomitingGastrointestinal disorders
HeadacheNervous system disorders
DiarrhoeaGastrointestinal disorders
Disease progressionGeneral disorders
InfluenzaInfections and infestations
Abdominal painGastrointestinal disorders
NasopharyngitisInfections and infestations
Abdominal pain upperGastrointestinal disorders
FlatulenceGastrointestinal disorders
Upper respiratory tract infectionInfections and infestations
FallInjury, poisoning and procedural complications
CoughRespiratory, thoracic and mediastinal disorders
NauseaGastrointestinal disorders
Back painMusculoskeletal and connective tissue disorders
Muscular weaknessMusculoskeletal and connective tissue disorders
Pain in extremityMusculoskeletal and connective tissue disorders
AstheniaGeneral disorders
Gait disturbanceGeneral disorders
PyrexiaGeneral disorders
Joint contractureMusculoskeletal and connective tissue disorders
Ear infectionInfections and infestations
Gastroenteritis viralInfections and infestations
ArthralgiaMusculoskeletal and connective tissue disorders
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
Muscle tightnessMusculoskeletal and connective tissue disorders
Skin papillomaNeoplasms benign, malignant and unspecified (incl cysts and polyps)
EnuresisRenal and urinary disorders
RashSkin and subcutaneous tissue disorders
Nasal congestionRespiratory, thoracic and mediastinal disorders
DyspepsiaGastrointestinal disorders
FatigueGeneral disorders
GastroenteritisInfections and infestations
Otitis mediaInfections and infestations
LordosisMusculoskeletal and connective tissue disorders
Musculoskeletal chest painMusculoskeletal and connective tissue disorders
MyalgiaMusculoskeletal and connective tissue disorders
Attention deficit/hyperactivity disorderPsychiatric disorders
ConstipationGastrointestinal disorders
Stomach discomfortGastrointestinal disorders
RhinitisInfections and infestations

Most-reported serious reactions: Femur fracture, Hypertension.

Data from ClinicalTrials.gov NCT00847379 adverse events section.

Sponsor's own description

Duchenne/Becker muscular dystrophy (DMD/BMD) is a genetic disorder that develops in boys. It is caused by a mutation in the gene for dystrophin, a protein that is important for maintaining normal muscle structure and function. Loss of dystrophin causes muscle fragility that leads to weakness and loss of walking ability during childhood and teenage years. A specific type of mutation, called a nonsense (premature stop codon) mutation is the cause of DMD/BMD in approximately 10-15% of boys with the disease. Ataluren (PTC124) is an orally delivered, investigational drug that has the potential to overcome the effects of the nonsense mutation. This study is a Phase 2b extension trial that will evaluate the long-term safety of ataluren (PTC124) in boys with nonsense mutation DMD/BMD, as determined by adverse events and laboratory abnormalities. The study will also assess changes in walking, muscle function, and other important clinical and laboratory measures.

Publications & conference data

6 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Ataluren delays loss of ambulation and respiratory decline in nonsense mutation Duchenne muscular dystrophy patients.
    McDonald CM, Muntoni F, Penematsa V, Jiang J, et al · · 2022 · cited 45× · PMID 34791888 · DOI 10.2217/cer-2021-0196
  2. Measuring Habitual Physical Activity in Neuromuscular Disorders: A Systematic Review.
    Jimenez-Moreno AC, Newman J, Charman SJ, Catt M, et al · · 2017 · cited 22× · PMID 28269791 · DOI 10.3233/jnd-160195
  3. Current Genetic Survey and Potential Gene-Targeting Therapeutics for Neuromuscular Diseases.
    Chiu W, Hsun YH, Chang KJ, Yarmishyn AA, et al · · 2020 · cited 10× · PMID 33339321 · DOI 10.3390/ijms21249589
  4. Gene therapy for haemophilia.
    Sharma A, Easow Mathew M, Sriganesh V, Reiss UM. · · 2016 · cited 6× · PMID 27996087 · DOI 10.1002/14651858.cd010822.pub3
  5. Gene therapy for haemophilia.
    Sharma A, Easow Mathew M, Sriganesh V, Reiss UM. · · 2020 · cited 3× · PMID 32342499 · DOI 10.1002/14651858.cd010822.pub4
  6. Novel compounds for the treatment of Duchenne muscular dystrophy: emerging therapeutic agents.
    Wilton SD, Fletcher S. · · 2011 · cited 1× · PMID 23776365 · DOI 10.2147/tacg.s8762

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