Pivotal trial dossier · BioIntel

A Study to Learn About the Effect of Higher Doses of Nusinersen (BIIB058) Given as Injections to Participants With Spinal Muscular Atrophy (SMA) Who Were Previously Treated With Risdiplam (ASCEND)

Biogen · Ph3 · NCT05067790   exact date enrolment complete
Readout due
2027-09-24
Ph3
Patients
45
actual
Sites
22
5 countries
Arms
1
na
Masking
None
blinding depth

Design

AllocationNa
MaskingNone
Primary purposeTreatment
Arms1
Planned duration68 months
Started2022-01-21

What is being measured

Endpoint classclinical scale
Primary outcomes1
Stated asChange in Total Revised Upper Limb Module (RULM) Score
Endpoint class is inferred from the sponsor's own wording of the primary outcome. Hard endpoints such as survival are generally harder to hit than scales or laboratory surrogates.

Population

ConditionSpinal Muscular Atrophy
Therapeutic areaneurology
Patient pre-selectionbiomarker / selected population
Modalitysmall_molecule_or_unspecified
SexALL

Evidence trail

Linked references0 on the registry record
Results postednot yet
Stopped earlyno

Reference-class base rate

46% – 51%
historical share of Phase 3 trials in this class that reached approval
This is a base rate, not a prediction about this trial. It is what happened to comparable trials historically. It is not a model fitted on outcomes — no outcome labels exist for trials that have not read out — and it uses none of this trial's own results.

How this number was reached

  1. Published Phase 3 → approval rate for neurology: 51.1% (Wong/Siah/Lo 2019) and 46.0% (BIO/Informa 2011–2020).
  2. Biomarker selection is present but is NOT applied: outside oncology the same split is ~null (60.2% vs 59.0%), so adjusting would invent an effect the evidence does not support.

Design flags

Flags are shown separately rather than folded into the number. Wood et al. (BMJ 2008) measured effect-size inflation, not approval probability, so multiplying it into an approval rate would misuse the finding.

Deliberately not adjusted for

Enrollment sizeno evidenced association with Phase 3 success
Number of sitesno evidenced association
Endpoint typeno evidenced association with success once area is held
Phase 2 designsingle-arm vs randomised Phase 2 does not predict Phase 3
Each of these is visible in the registry and each is evidenced to be null for Phase 3 success. Using them would add false precision.

Evidenced, but not in the registry

Sponsor approval track record51%→81% (Danzon 2005) — not a registry field
Orphan designationaOR 2.3 — zero CT.gov fields carry FDA designations
Phase 2 effect-size shrinkagerHR 0.73 — requires prior-trial results
The standing criticism, stated plainly. Hampson et al. (Pharmaceutical Statistics 2022;21(2):439–459, eight of nine authors at Novartis) argue that starting from industry rates and applying subjective adjustments "lacks transparency and fails to make full use of data from previous clinical trials". That criticism applies to this figure. The response here is to show every input and to refuse unsupported adjustments, not to claim the objection does not apply.
Rates: Wong, Siah & Lo, Biostatistics 2019 (CC BY 4.0; corrigendum values) and BIO/Informa/QLS Clinical Development Success Rates 2011–2020 (cited, not reproduced). MIT Project ALPHA is not used — its terms restrict use to governmental, charitable or social purposes and bar redistribution.