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NCT04089566: DEVOTE

Study of Nusinersen (BIIB058) in Participants With Spinal Muscular Atrophy

Completed Phase 3 Results posted Last updated 5 June 2025
What this trial tests

Phase 3 trial testing Nusinersen in Muscular Atrophy, Spinal in 145 participants. Completed in 30 May 2024.

Timeline
26 March 2020
Primary endpoint
21 February 2024
30 May 2024

Quick facts

Lead sponsorBiogen
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designsequential
Maskingdouble
Primary purposetreatment
Enrollment145
Start date26 March 2020
Primary completion21 February 2024
Estimated completion30 May 2024
Sites45 locations across Italy, Colombia, Japan, Russia, Chile, Saudi Arabia, Estonia, Taiwan

Drugs / interventions tested

Conditions studied

Sponsor

Biogen — full company profile →

Who can join

7 Days and older, any sex, with Muscular Atrophy, Spinal. 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.

Part B Infantile-onset SMA: Change From Baseline in CHOP-INTEND Total Score for 50/28mg Nusinersen Versus CS3B Matched Sham Control Group Primary · Baseline, Day 183

The CHOP-INTEND test was designed to evaluate the motor skills of infants with significant motor weakness. It included 16 items (capturing neck, trunk, and proximal and distal limb strength), nine of which were scored 0, 1, 2, 3, or 4, five were scored as 0, 2, or 4, one was scored as 0, 1, 2, or 4, and one as 0, 2, 3, or 4 with higher scores indicating greater muscle strength and function. Total score was calculated as the sum of scores for each item. Total score ranged from 0 (worst possible score) and 64 (best possible score). The change from baseline to Day 183 in the CHOP-INTEND total score

GroupValue95% CI
Part B: Infantile-Onset SMA: 50/28 mg Nusinersen42.938.7 – 47.2
CS3B Matched Sham Control Group16.910.1 – 23.7
Parts A and C: Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious Adverse Events (TESAEs) Primary · Part A: From the first dose of the study drug up to Day 389, Part C: From the first dose of the study drug up to Day 361

An adverse event (AE) was any unfavorable \& unintended sign (including an abnormal assessment such as an abnormal laboratory value), symptom, or disease temporally associated with use of an investigational product, whether or not related to investigational product. An SAE was any untoward medical occurrence that at any dose resulted in death, in the view of Investigator, placed participant at immediate risk of death, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, resulted in a birth defect. AE and SA

TEAEs
GroupValue95% CI
Part A: Nusinersen 28/28 mg4
Part C: Nusinersen 50/28 mg37
TESAEs
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg6
Parts A and C: Number of Participants With Shifts From Baseline in Clinical Laboratory Parameters (Blood Chemistry Parameters) Primary · Parts A and C: Baseline up to Day 302

Blood chemistry parameters included protein, albumin, creatinine, blood urea nitrogen, bilirubin (total and direct), alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, glucose, calcium, phosphorus, bicarbonate, chloride, sodium, potassium, cystatin C, and creatine kinase. These parameters were flagged as low, normal, or high relative to parameter's normal range or as unknown if no result was available, by the Investigator. Here, shift to low indicates values that were normal, high or unknown at baseline and shifted to low values postbaseline

Alkaline Phosphatase Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg2
Alanine Aminotransferase Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg6
Aspartate Aminotransferase Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg8
Bicarbonate Shift to Low
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg6
Bicarbonate Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg2
Bilirubin Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg1
Indirect Bilirubin Shift to Low
GroupValue95% CI
Part A: Nusinersen 28/28 mg4
Part C: Nusinersen 50/28 mg12
Indirect Bilirubin Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg1
Parts A and C: Number of Participants With Shifts From Baseline in Clinical Laboratory Parameters (Hematology Parameters) Primary · Parts A and C: Baseline up to Day 302

Hematology parameters included complete blood cell count, with differential and platelet count, and absolute neutrophil count. These parameters were flagged as low, normal, or high relative to parameter's normal range or as unknown if no result was available, by the Investigator. Here, shift to low indicates values that were normal, high or unknown at baseline and shifted to low values postbaseline. Shift to high indicates values that were normal, low or unknown at baseline and shifted to high postbaseline values. The categories with at least one participant with shift from baseline in these pa

Basophils Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg2
Part C: Nusinersen 50/28 mg6
Basophils/Leukocytes Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg2
Part C: Nusinersen 50/28 mg6
Eosinophils Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg3
Eosinophils/Leukocytes Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg3
Part C: Nusinersen 50/28 mg9
Hematocrit Shift to Low
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg2
Hematocrit Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg0
Hemoglobin Shift to Low
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg3
Lymphocytes Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg1
Parts A and C: Number of Participants With Shifts From Baseline in Urinalysis Primary · Parts A and C: Baseline up to Day 302

Urinalysis included assessments of urine total protein, specific gravity, pH, protein, glucose, ketones, bilirubin, blood, red blood cells (RBC), white blood cells (WBC), epithelial cells, bacteria, casts and crystals. These parameters were flagged as low, normal, or high relative to parameter's normal range or as unknown if no result was available, by the Investigator. Here, shift to low indicates values that were normal, high or unknown at baseline and shifted to low values postbaseline. Shift to high indicates values that were normal, low or unknown at baseline and shifted to high postbasel

Specific Gravity Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg2
Part C: Nusinersen 50/28 mg1
pH Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg2
Protein High/positive
GroupValue95% CI
Part A: Nusinersen 28/28 mg4
Part C: Nusinersen 50/28 mg9
Glucose High/positive
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg2
Ketones High/positive
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg8
Occult Blood High/positive
GroupValue95% CI
Part A: Nusinersen 28/28 mg2
Part C: Nusinersen 50/28 mg4
RBC High/positive
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg1
WBC High/positive
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg2
Parts A and C: Number of Participants With Shifts From Baseline in Cerebrospinal Fluid (CSF) Parameters Primary · Part A: Baseline up to Day 269, Part C: Baseline up to Day 241

CSF parameters included cell count, total protein, and glucose. These parameters were flagged as low, normal, or high relative to parameter's normal range or as unknown if no result was available, by the Investigator. Here, shift to low indicates values that were normal, high or unknown at baseline and shifted to low values postbaseline. Shift to high indicates values that were normal, low or unknown at baseline and shifted to high values postbaseline. The categories with at least one participant with shift from baseline in these parameters are reported.

Glucose Shift to Low
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg2
Glucose Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg2
Protein Shift to Low
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg3
Protein Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg8
Erythrocytes Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg2
Part C: Nusinersen 50/28 mg8
Leukocytes Shift to High
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg6
Parts A and C: Number of Participants With Shifts From Baseline in Electrocardiograms (ECGs) Primary · Parts A and C: Baseline up to Day 302

The ECGs were assessed by the investigator to be normal, abnormal and abnormal AE. The number of participants with ECG shifts from normal to each of the categorical values denoting an abnormal scan (abnormal not AE, abnormal AE) was assessed. Shift from baseline to worst post-baseline values were reported. The categories with at least one participant with shift from baseline in ECG are reported.

Baseline: Normal; Postbaseline: Normal
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg10
Baseline: Normal; Post-baseline: Abnormal, not AE
GroupValue95% CI
Part A: Nusinersen 28/28 mg3
Part C: Nusinersen 50/28 mg12
Baseline: Abnormal, not AE; Post-baseline: Abnormal, not AE
GroupValue95% CI
Part A: Nusinersen 28/28 mg3
Part C: Nusinersen 50/28 mg17
Baseline: Unknown; Post-baseline: Abnormal, not AE
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg1
Parts A and C: Number of Participants With Abnormalities in Vital Sign Parameters Primary · Parts A and C: Baseline up to Day 302

Vital sign assessment included temperature, pulse rate, systolic blood pressure, diastolic blood pressure, and respiratory rate. As pre-specified in protocol, the criteria for determining potentially clinically relevant abnormalities in vital signs included: temperature \< 36.0 and \> 38.0 degrees Celsius (C), pulse rate \< 60 and \> 100 beats per minute (bpm), systolic blood pressure \[\< 90, \> 140 and \> 160 millimeters of mercury (mmHg)\], diastolic blood pressure \< 50, \> 90 and \> 100 mmHg and respiratory rate \< 12 and \> 20 breaths per minute. The categories with at least one particip

Temperature <36.0 C
GroupValue95% CI
Part A: Nusinersen 28/28 mg4
Part C: Nusinersen 50/28 mg13
Pulse rate <60 bpm
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg14
Pulse rate >100 bpm
GroupValue95% CI
Part A: Nusinersen 28/28 mg6
Part C: Nusinersen 50/28 mg19
Systolic blood pressure <90 mmHg
GroupValue95% CI
Part A: Nusinersen 28/28 mg4
Part C: Nusinersen 50/28 mg13
Systolic blood pressure >140 mmHg
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg3
Diastolic blood pressure <50 mmHg
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg7
Diastolic blood pressure >90 mmHg
GroupValue95% CI
Part A: Nusinersen 28/28 mg0
Part C: Nusinersen 50/28 mg1
Respiratory rate <12 breaths/min
GroupValue95% CI
Part A: Nusinersen 28/28 mg1
Part C: Nusinersen 50/28 mg7
Parts A and C: Change From Baseline in Growth Parameters (Body Height) Primary · Parts A and C: Baseline, Day 302
GroupValue95% CI
Part A: Nusinersen 28/28 mg7.2± 1.70
Part C: 50/28 mg Nusinersen0.8± 3.12
Part C: Change From Baseline in Growth Parameters (Head Circumference) Primary · Baseline, Day 302

As pre-specified in the protocol, head circumference was measured for participants with infantile-onset SMA only.

GroupValue95% CI
Part C: Nusinersen 50/28 mg2.0± NA
Part C: Change From Baseline in Growth Parameters (Chest Circumference) Primary · Baseline, Day 302

As pre-specified in protocol, chest circumference was measured for participants with infantile-onset SMA only.

GroupValue95% CI
Part C: Nusinersen 50/28 mg2.5± NA
Part C: Change From Baseline in Growth Parameters (Arm Circumference) Primary · Baseline, Day 302

As pre-specified in the protocol, arm circumference was measured for participants with infantile-onset SMA. Here, negative change from baseline indicated reduction in arm circumference.

GroupValue95% CI
Part C: Nusinersen 50/28 mg-1.0± NA

Adverse events — posted to ClinicalTrials.gov

Time frame: Part A: From first dose of the study up to Day 389 Part B: From first dose of the study up to Day 399 Part C: From first dose of the study up to Day 361. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Part A: 28/28 mg Nusinersen
Serious: 1/6 (17%)
Deaths: 0/6
Part B: Infantile-Onset SMA: 12/12 mg Nusinersen
Serious: 18/25 (72%)
Deaths: 6/25
Part B: Infantile-Onset SMA: 50/28 mg Nusinersen
Serious: 30/50 (60%)
Deaths: 10/50
Part B: Later-Onset SMA: 12/12 mg Nusinersen
Serious: 4/8 (50%)
Deaths: 0/8
Part B: Later-Onset SMA: 50/28 mg Nusinersen
Serious: 2/16 (13%)
Deaths: 0/16
Part C: 50/28 mg Nusinersen
Serious: 6/40 (15%)
Deaths: 0/40

Serious adverse events (69 terms)

ReactionSystemPart A: 28/28 mg NusinersenPart B: Infantile-Onset SM…Part B: Infantile-Onset SM…Part B: Later-Onset SMA: 1…Part B: Later-Onset SMA: 5…Part C: 50/28 mg Nusinersen
Respiratory failureRespiratory, thoracic and mediastinal disorders
PneumoniaInfections and infestations
Pneumonia aspirationInfections and infestations
Cardiac arrestCardiac disorders
BronchiolitisInfections and infestations
Covid-19Infections and infestations
Acute respiratory failureRespiratory, thoracic and mediastinal disorders
FallInjury, poisoning and procedural complications
Femur fractureInjury, poisoning and procedural complications
Sudden infant death syndromeGeneral disorders
Cardio-respiratory arrestCardiac disorders
Pneumonia viralInfections and infestations
Respiratory tract infectionInfections and infestations
Oxygen saturation decreasedInvestigations
AtelectasisRespiratory, thoracic and mediastinal disorders
Tracheostomy malfunctionInjury, poisoning and procedural complications
Traumatic haemothoraxInjury, poisoning and procedural complications
Gait disturbanceGeneral disorders
PyrexiaGeneral disorders
Organ failureGeneral disorders
Abortion spontaneousPregnancy, puerperium and perinatal conditions
LeukocytosisBlood and lymphatic system disorders
CardiomyopathyCardiac disorders
DysphagiaGastrointestinal disorders
Adenoviral upper respiratory infectionInfections and infestations
Other adverse events (222 terms — click to expand)

ReactionSystemPart A: 28/28 mg NusinersenPart B: Infantile-Onset SM…Part B: Infantile-Onset SM…Part B: Later-Onset SMA: 1…Part B: Later-Onset SMA: 5…Part C: 50/28 mg Nusinersen
Procedural headacheInjury, poisoning and procedural complications
COVID-19Infections and infestations
AstheniaGeneral disorders
PyrexiaGeneral disorders
Upper respiratory tract infectionInfections and infestations
Procedural painInjury, poisoning and procedural complications
ConstipationGastrointestinal disorders
HeadacheNervous system disorders
DysphagiaGastrointestinal disorders
MalnutritionMetabolism and nutrition disorders
CoughRespiratory, thoracic and mediastinal disorders
VomitingGastrointestinal disorders
NasopharyngitisInfections and infestations
FallInjury, poisoning and procedural complications
BronchitisInfections and infestations
PneumoniaInfections and infestations
Procedural vomitingInjury, poisoning and procedural complications
MyalgiaMusculoskeletal and connective tissue disorders
Muscle contractureMusculoskeletal and connective tissue disorders
Pain in extremityMusculoskeletal and connective tissue disorders
RashSkin and subcutaneous tissue disorders
Dermatitis diaperSkin and subcutaneous tissue disorders
Myocardial necrosis marker increasedInvestigations
Respiratory failureRespiratory, thoracic and mediastinal disorders
AnaemiaBlood and lymphatic system disorders
DizzinessNervous system disorders
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
Gastrooesophageal reflux diseaseGastrointestinal disorders
TonsillitisInfections and infestations
GastroenteritisInfections and infestations
Urinary tract infectionInfections and infestations
InfluenzaInfections and infestations
Otitis mediaInfections and infestations
BronchiolitisInfections and infestations
Pneumonia klebsiellaInfections and infestations
Stoma site infectionInfections and infestations
Viral infectionInfections and infestations
Viral upper respiratory tract infectionInfections and infestations
Klebsiella infectionInfections and infestations

Most-reported serious reactions: Respiratory failure, Pneumonia, Pneumonia aspiration, Cardiac arrest, Bronchiolitis, Covid-19, Acute respiratory failure, Fall.

Data from ClinicalTrials.gov NCT04089566 adverse events section.

Sponsor's own description

The primary objectives of this study are to examine the clinical efficacy of nusinersen administered intrathecally at higher doses to participants with spinal muscular atrophy (SMA), as measured by change in Children's Hospital of Philadelphia-Infant Test of Neuromuscular Disorders (CHOP-INTEND) total score (Part B); to examine the safety and tolerability of nusinersen administered intrathecally at higher doses to participants with SMA (Parts A and C). The secondary objectives of this study are to examine the clinical efficacy of nusinersen administered intrathecally at higher doses to participants with SMA (Parts A, B and C); to examine the effect of nusinersen administered intrathecally at higher doses to participants with SMA (Parts A and C); to examine the safety and tolerability of nusinersen administered intrathecally at higher doses to participants with SMA, to examine the effect of nusinersen administered intrathecally at higher doses compared to the currently approved dose in participants with SMA (Part B).

Publications & conference data

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

  1. Gene-based therapies for neurodegenerative diseases.
    Sun J, Roy S. · · 2021 · cited 126× · PMID 33526943 · DOI 10.1038/s41593-020-00778-1
  2. Spinal muscular atrophy: From approved therapies to future therapeutic targets for personalized medicine.
    Chaytow H, Faller KME, Huang YT, Gillingwater TH. · · 2021 · cited 103× · PMID 34337562 · DOI 10.1016/j.xcrm.2021.100346
  3. Landscape of small nucleic acid therapeutics: moving from the bench to the clinic as next-generation medicines.
    Liu M, Wang Y, Zhang Y, Hu D, et al · · 2025 · cited 62× · PMID 40059188 · DOI 10.1038/s41392-024-02112-8
  4. Restoring SMN Expression: An Overview of the Therapeutic Developments for the Treatment of Spinal Muscular Atrophy.
    Aslesh T, Yokota T, Yokota T. · · 2022 · cited 46× · PMID 35159227 · DOI 10.3390/cells11030417
  5. Therapy development for spinal muscular atrophy: perspectives for muscular dystrophies and neurodegenerative disorders.
    Jablonka S, Hennlein L, Sendtner M. · · 2022 · cited 37× · PMID 34983696 · DOI 10.1186/s42466-021-00162-9
  6. New therapies for spinal muscular atrophy: where we stand and what is next.
    Antonaci L, Pera MC, Mercuri E. · · 2023 · cited 30× · PMID 37067602 · DOI 10.1007/s00431-023-04883-8
  7. Scientific rationale for a higher dose of nusinersen.
    Finkel RS, Ryan MM, Pascual Pascual SI, Day JW, et al · · 2022 · cited 26× · PMID 35567345 · DOI 10.1002/acn3.51562
  8. Emerging Gene Therapy Approaches in the Management of Spinal Muscular Atrophy (SMA): An Overview of Clinical Trials and Patent Landscape.
    Ponomarev AS, Chulpanova DS, Yanygina LM, Solovyeva VV, et al · · 2023 · cited 22× · PMID 37762045 · DOI 10.3390/ijms241813743

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