Long-term Evaluation on Height and Weight in Patients With MPS II Who Started Treatment at < 6 Years of Age

• Elaprase for intravenous (IV) infusion (Drug), also known as Idursulfase: Patients enrolled in this study will receive once-weekly IV infusions of Elaprase at a dose of 0.5 mg/kg and will be followed for a minimum of 5 years after initiation of Elaprase treatment, or until they reach their 10th birthday, whichever is longer.Height and weight data from HOS will be utilized in the Primary Growth Analysis for this study.

Primary outcomes

• Height Overall [Prospective participants: From Baseline through End-of-Study (approximately 9.75 years); HOS participants followed up to a maximum of 9.5 years where participant data were accessed from the registry between the period of 08/01/07 to 02/06/22]: The effect of treatment on growth evaluated in terms of height. As pre-specified in the statistical analysis plan (SAP), descriptive analysis for this outcome measure was planned for the Combined Set and HOS Untreated Set arms and the assessment for Primary Growth Analysis was considered for the Combined Set in comparison to the HOS Untreated Set. The Combined Set included treated participants enrolled in this study (prospective participants) as well as treated participants from the HOS registry.
• Weight Overall [Prospective participants: From Baseline through End-of-Study (approximately 9.75 years); HOS participants followed up to a maximum of 9.5 years where participant data were accessed from the registry between the period of 08/01/07 to 02/06/22]: The effect of treatment on growth was evaluated, in terms of weight. As pre-specified in the SAP, descriptive analysis for this outcome measure was planned for the Combined Set and HOS Untreated Set arms and the assessment for Primary Growth Analysis was considered for the Combined Set in comparison to the HOS Untreated Set. The Combined Set included treated participants enrolled in this study (prospective participants) as well as treated participants from the HOS registry.
• Change From Baseline in Height Measured by Z-score [Prospective participants: From Baseline through End-of-Study (approximately 9.75 years); HOS participants followed up to a maximum of 9.5 years where participant data were accessed from the registry between the period of 08/01/07 to 02/06/22]: Z-score(standard score) for height was calculated as number of standard deviations(SD) by which mean height of each arm was above/below the mean height of the reference population.Z-scores were calculated based on World Health Organization Drug Dictionary(WHO-DD) growth charts(for age less or equal to\[≤\] 24 months) \& Centers for Disease Control \& Prevention(CDC) growth charts(for age more than\[>\]24 months) normal height-for-age data.Normal growth Z-score range: -1 to +1.Z-score:0 represents the reference mean \& 50th percentile.Z-score of more than or equal to(≥) +2 indicates above normal range \& taller than average \& Z-score ≤ -2 indicates shorter stature than average \& may indicate growth issues.Score is calculated as Z=(Actual value for participant in study-Mean value of healthy population)/(SD of healthy population).As per SAP,descriptive analysis was planned for Combined \& HOS Untreated Set arms, with Primary Growth Analysis assessed for Combined Set compared to HOS Untreated Set.
• Change From Baseline in Weight Measured by Z-score [Prospective participants: From Baseline through End-of-Study (approximately 9.75 years); HOS participants followed up to a maximum of 9.5 years where participant data were accessed from the registry between the period of 08/01/07 to 02/06/22]: Z-score (standard score) for weight was calculated as the number of SDs by which the mean weight of each arm was above or below the mean weight of the reference population. Z-scores were calculated based on WHO-DD growth charts (for age ≤ 24 months) \& CDC growth charts (for age > 24 months) normal weight-for-age data. The normal range for growth Z score is defined as -1 to +1. Z-score: 0 represents reference population mean and the 50th percentile. Positive Z-score of ≥ +2 indicates above average weight (overweight). Negative Z-score of ≤ -2 indicates below average weight (underweight). The score is calculated as Z=(Actual value for participant in study-Mean value of healthy population)/(SD of healthy population). As per SAP, descriptive analysis was planned for Combined \& HOS Untreated Set arms, with Primary Growth Analysis assessed for Combined Set compared to HOS Untreated Set.
• Number of Participants With Clinical Significant Abnormal Neurological Examination [From Screening to End-of-Study (approximately 9.75 years)]: A full physical examination will be performed with a thorough review of body systems. Physical examinations will include a review of the patient's general appearance, neurological examination, as well as evaluation of the body systems. Any abnormal change in findings will be recorded as an adverse event (AE).
• Number of Participants With Treatment-emergent Adverse Events (TEAE) [From screening to End-of-Study (approximately 9.75 years)]: An AE is any noxious, pathologic, or unintended change in anatomical, physiologic, or metabolic function as indicated by physical signs, symptoms, or laboratory changes occurring in any phase of a clinical study, whether or not considered product-related. This includes an exacerbation of a pre-existing condition. A TEAE is defined as an AE with an onset that occurs after receiving study drug.
• Number of Participants With Clinically Significant Abnormal Urinalysis Values [From screening to End-of-Study (approximately 9.75 years)]: Reported here is the number of participants with clinically significant abnormal values in urinalysis tests. Only tests with at least 1 participant with clinically significant abnormal values are reported. Participant was clinically significant abnormal if there was at least one abnormal and clinically significant post-baseline value.
• Number of Participants With Clinically Significant Abnormal Serum Chemistry Values [From screening to End-of-Study (approximately 9.75 years)]: Reported here is the number of participants with clinically significant abnormal values in serum chemistry tests. Only tests with at least 1 participant with clinically significant abnormal values are reported. Participant was clinically significant abnormal if there was at least one abnormal and clinically significant post-baseline value.
• Number of Participants With Clinically Significant Abnormal Hematology Values [From screening to End-of-Study (approximately 9.75 years)]: Reported here is the number of participants with clinically significant abnormal values in haematological tests. Only tests with at least 1 participant with clinically significant abnormal values are reported. Participant was clinically significant abnormal if there was at least one abnormal and clinically significant post-baseline value.

Secondary outcomes

• Observed Value of Height Velocity From Baseline to End of Study [Prospective participants: From Baseline till End-of-Study Treatment (approximately 9.75 years); HOS participants followed up to a maximum of 9.5 years where participant data were accessed from the registry between the period of 08/01/07 to 02/06/22]: Height velocity was calculated as the difference in height, divided by the difference in age between consecutive study visits.
• Observed Value of Weight Velocity From Baseline to End of Study [Prospective participants: From Baseline till End-of- Study Treatment (Approximately 9.75 years); HOS participants followed up to a maximum of 9.5 years where participant data were accessed from the registry between the period of 08/01/07 to 02/06/22]: Weight velocity was be calculated as the difference in weight, divided by the difference in age between consecutive study visits.
• Percent Change From Baseline for Urinary Glycosaminoglycans (uGAG) Levels Normalized to Urine Creatinine [Baseline to End-of-Study (Approximately 9.75 years)]: Urinary GAG levels were normalized to urine creatinine (normalized uGAG) and reported as mg uGAG/ millimoles (mmol) creatinine.
• Normalized uGAG Divided by Upper Llimit of Normal for Age (uGAG/ULN) Every 12 Months [Baseline to End-of-Study (Approximately 9.75 years)]: Normalized uGAG was divided by the upper limit of normal for age (uGAG/ULN), where the ULN for uGAG was obtained from Mayo Clinic.
• Liver Volume [Baseline up to 24 Months]: Liver volume was assessed using abdominal ultrasonography.
• Spleen Volume [Baseline up to 24 Months]: Spleen volume was assessed using abdominal ultrasonography.
• Joint Mobility, as Measured by Joint Range of Motion (JROM) Scores, Including Upper-Limb and Lower-Limb Joint Scores [From Baseline to End-of-Study (approximately 9.75 years)]: Global JROM (% normal range of motion \[ROM\]) is average of 11 ratios multiplied by 100. Ratios are Left/Right means of passive ROM in Shoulder (Flexion \[flex\]/Extension \[ext\], Abduction, Internal/External Rotation), Elbow (flex/ext), Wrist (flex/ext), Index Finger (flex/ext \[Combined Metacarpophalangeal joint, Proximal interphalangeal joint, Distal interphalangeal joint motion\]), Hip (flex/ext, Abduction, Internal/External Rotation), Knee(flex/ext) \& Ankle (Dorsiflexion) divided by normal range (reference: American Academy of Orthopedic Surgeons and American Medical Association). For reported values of upper limb (UL) \& lower limb (LL) scores, UL score is average of 3 joint scores in UL (shoulder-elbow-wrist) \& LL score is average of 3 joint scores in LL (hip-knee-ankle). Joint motion (in degrees) was averaged across both sides, divided by normal value \& multiplied by 100 to yield a percent score. Score >100% occurs when measured joint motion exceeds normal reference values.
• Distance Walked, as Measured by Six Minute Walk Test (6MWT) [From Baseline to End-of-Study (approximately 9.75 years)]: The 6MWT was conducted according to the American Thoracic Society guidelines for the 6MWT in participants who were able to walk. The distance achieved in meters was recorded.
• Quality of Life, as Measured by Hunter-Syndrome Functional Outcome in Clinical Understanding Scale (HS-FOCUS) [Baseline to End-of-Study (Approximately 9.75 years)]: The participant's QoL was assessed using the HS-FOCUS (shortened version) questionnaire. The HS-FOCUS (shortened version) questionnaire has 5 function domains (walking/standing, grip/reach, schooling/work, activities, and breathing). The scale of the 5 function domains ranges from 0 to 3, with a 3-score denoting highest disability: 0: with no difficulty;1: with some difficulty; 2: with much difficulty; 3: unable to do; Missing: Does not apply. The response option "Does not apply" is treated as "missing" with no score, the same as if the item had not been completed in the questionnaire. Higher scores indicate worse functional outcomes/greater disability.
• Impact of Illness on Ability to Function in Daily Life, as Measured by Childhood Health Assessment Questionnaire (CHAQ Parent Report) [Baseline to End-of-Study (approximately 9.75 years)]: Impact on ability to function in daily life was measured by the CHAQ (Parent Report). The CHAQ includes 30 items measured on a scale of 0 to 3: 0=without any difficulty; 1=with some difficulty; 2=with much difficulty; 3=Unable to do; Missing: Does not apply. It evaluates functional abilities across 8 domains (dressing, hygiene, arising, eating, walking, reach, grip and activities). The result is referred as Disability Index. The highest scoring item in each category determines the score for that category with higher scores indicating worse functioning/higher disability. The Discomfort Index and Health Status Index are measured on separate 15 cm scales. The distance from the left end of the scale to the respondent's mark is measured and multiplied by 0.2 to calculate the score (range 0-3). Discomfort and Health Status Index scores were rescaled to 0-100 scales. Higher scores indicate greater discomfort/worse health status.
• Adaptive Behavior, as Measured by the Vineland Adaptive Behavior Scales (VABS II) [Baseline to End-of-Study (approximately 9.75 years)]: Adaptive behavior was assessed using parent/caregiver report on the VABS-II, a standardized norm-referenced tool to evaluate adaptive behavior for ages 0-90.VABS-II has 1 composite score(Adaptive Behavior Composite \[ABC\]), reflecting overall adaptive ability.ABC comprises 4 domain scores in participants <7years old(Communication,Daily Living Skills,Socialization,\& Motor Skills)\& 3 domain scores in participants ≥7years of age(Communication,Daily Living Skills,\& Socialization).ABC standard score is derived from domain standard scores per VABS-II manual(not a simple sum/average of the reported standard scores).Domain scores are standard scores derived from combination of 11 subdomain scores according to VABS-II scoring rules/manual.Scale for ABC \& domain standard scores ranges between 20 \& 160.ABC \& domain scores have a normative mean=100,with SD=15 \& subdomain scores are normed with a mean=15 \& SD=3.Higher scores indicate better,while lower scores indicate worse adaptive functioning.
• Anti-Idursulfase Antibodies (ADA) in Serum [From Baseline to End-of-Study (Approximately 9.75 years)]: Blood samples were collected and analyzed for determination of anti-idursulfase antibodies every 6 months in SHP-ELA-401. Analysis of anti-idursulfase antibodies including neutralizing antibodies (NAb) was conducted using validated 3-tier immunoassay methods (screening, confirmatory, and titer).

Sex: Male, ages: any to 5 Years

Inclusion Criteria:

* Group 1: Prospective Patient Group

  1. The patient is male.
  2. The patient is Elaprase-naïve at study entry.
  3. The patient must have a documented diagnosis of MPS II. Of the 3 criteria below, the combinations (3a AND 3b) or (3a AND 3c) will be accepted as diagnostic of MPS II:

     1. The patient has a deficiency in I2S enzyme activity of ≤10% of the lower limit of the normal range as measured in plasma, fibroblasts, or leukocytes (based on the reference laboratory's normal range). AND
     2. The patient has a documented mutation in the I2S gene. OR
     3. The patient has a normal enzyme activity level of one other sulfatase as measured in plasma, fibroblasts, or leukocytes (based on the normal range of measuring laboratory).
  4. The patient will be <6 years of age at the start of Elaprase treatment.
  5. The patient, patient's parent(s) or legally authorized guardian(s) must have voluntarily signed an Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved informed consent form after all relevant aspects of the study have been explained and discussed. Consent of the patient's parent(s) or legally authorized guardian(s) and the patient's assent, as relevant, must be obtained.

Group 2: Retrospective Data Inclusion Criteria:

Retrospective Patient Group patients will be enrolled in HOS and not Study SHP-ELA-401; however, their growth data may be included in the analysis for Study SHP-ELA-401 if the following data inclusion criteria are met.

1. The patient is male.
2. The patient is enrolled in HOS.
3. The patient was <6 years of age at the start of Elaprase treatment.
4. The patient received Elaprase weekly treatment for at least 5 years.
5. The patient had a height assessment and a weight assessment documented within 3 months before or after Elaprase treatment start.
6. The patient has had annual height and weight assessments from start of Elaprase through age 10 years.
7. The patient, patient's parent(s), or legally authorized guardian(s) agree(s) to data collection.
8. The patient, patient's parent(s), or legally authorized guardian(s) must have signed an IRB/IEC-approved informed consent form after all relevant aspects of the HOS study have been explained and discussed. Consent of the patient's parent(s) or legally authorized guardian(s) and the patient's assent, as relevant, must be obtained.

Exclusion Criteria:

* Group 1: Prospective Patient Group

  1. The patient has received treatment with any investigational drug or device within the 30 days prior to study entry.
  2. The patient has received or is receiving treatment with idursulfase-IT.
  3. The patient has received growth hormones, a cord blood infusion, or a bone marrow transplant at any time.
  4. The patient has received blood product transfusions within 90 days prior to Screening.
  5. The patient is unable to comply with the protocol as determined by the Investigator.

Group 2: Retrospective Data Exclusion Criteria:

HOS patients that meet the following criteria are not eligible to be included into the Study SHP-ELA-401 Primary Growth Analysis:

1\. Patient was treated with growth hormone or other medications or interventions intended to promote growth in the time period covered by the analysis.

Participant flow

Outcome results

• Height Overall (Primary), Least squares mean, centimeter (cm): Combined Set 113.759 +/- 1.211; HOS Untreated Set 108.143 +/- 1.7668 (p = 0.011)
• Weight Overall (Primary), Least squares mean, kilograms (kg): Combined Set 25.164 +/- 0.8382; HOS Untreated Set 26.11 +/- 1.1647 (p =0.5106)
• Change From Baseline in Height Measured by Z-score (Primary), Mean, Z-score: Combined Set -1.135 +/- 1.3480; HOS Untreated Set -4.228 +/- 1.4616
• Change From Baseline in Weight Measured by Z-score (Primary), Mean, Z-score: Combined Set -1.161 +/- 1.3259; HOS Untreated Set -2.337 +/- 1.9014
• Number of Participants With Clinical Significant Abnormal Neurological Examination (Primary), Count of participants, Participants: Prospective Set 0
• Number of Participants With Treatment-emergent Adverse Events (TEAE) (Primary), Count of participants, Participants: Prospective Set 21
• Number of Participants With Clinically Significant Abnormal Urinalysis Values (Primary), Count of participants, Participants: Prospective Set 5
• Number of Participants With Clinically Significant Abnormal Serum Chemistry Values (Primary), Count of participants, Participants: Prospective Set 1
• Number of Participants With Clinically Significant Abnormal Hematology Values (Primary), Count of participants, Participants: Prospective Set 1
• Observed Value of Height Velocity From Baseline to End of Study (Secondary), Mean, centimeters (cm)/year: Combined Set 6.556 +/- 2.6803; Prospective Set 5.401 +/- 2.5815; HOS Untreated Set 6.557 +/- 2.5902
• Observed Value of Weight Velocity From Baseline to End of Study (Secondary), Mean, kilograms (kg)/year: Combined Set 2.475 +/- 1.4550; Prospective Set 1.772 +/- 1.2029; HOS Untreated Set 3.670 +/- 2.0005
• Percent Change From Baseline for Urinary Glycosaminoglycans (uGAG) Levels Normalized to Urine Creatinine (Secondary), Mean, percent change: Prospective Set -70.446 +/- 17.8741
• Normalized uGAG Divided by Upper Llimit of Normal for Age (uGAG/ULN) Every 12 Months (Secondary), Mean, Normalized uGAG/ULN: Prospective Set 5.052 +/- 1.0376
• Liver Volume (Secondary), Mean, milliliters (mL): Prospective Set 105.855 +/- 16.8925
• Spleen Volume (Secondary), Mean, mL: Prospective Set 104.593 +/- 29.9658
• Joint Mobility, as Measured by Joint Range of Motion (JROM) Scores, Including Upper-Limb and Lower-Limb Joint Scores (Secondary), Mean, percent score: Prospective Set 94.50 +/- 31.634
• Distance Walked, as Measured by Six Minute Walk Test (6MWT) (Secondary), Mean, meters: Prospective Set 224.2 +/- 178.42
• Quality of Life, as Measured by Hunter-Syndrome Functional Outcome in Clinical Understanding Scale (HS-FOCUS) (Secondary), Mean, score on a scale: Prospective Set 1.19 +/- 1.042
• Impact of Illness on Ability to Function in Daily Life, as Measured by Childhood Health Assessment Questionnaire (CHAQ Parent Report) (Secondary), Mean, score on a scale: Prospective Set 2.143 +/- 0.7334
• Adaptive Behavior, as Measured by the Vineland Adaptive Behavior Scales (VABS II) (Secondary), Mean, score on a scale: Prospective Set 48.1 +/- 19.07
• 1 more outcome measures not shown.

Adverse events

Time frame: From baseline until the end of study (up to approximately 9.75 years)

Serious adverse events by term

Other adverse events by term

• Study Protocol (PDF, 2016-08-05)
• Statistical Analysis Plan (PDF, 2025-08-27)

• Study Director, Study director, Shire

NIH grants: 2014