Risdiplam works by helping the body produce more survival motor neuron (SMN) protein throughout the body. This means fewer motor neurons - nerve cells that pass impulses from nerves to muscles to cause movement - are lost, which may improve how well muscles work in people with SMA. RO7204239 is an investigational anti-myostatin antibody that is designed to target myostatin. Myostatin plays an important role in the regulation of skeletal muscle size by controlling growth. Inhibiting myostatin may help muscles grow in size and strength. RO7204239 in combination with risdiplam, which is designed to increase the amount of SMN protein throughout the body, has the potential to further improve motor function and clinical outcomes for people living with SMA. This trial will study the safety and efficacy of RO7204239 in combination with risdiplam in patients with spinal muscular atrophy (SMA). The trial has two parts; Part 1 is the dose-finding part in SMA patients that are either ambulant (aged 2-10 years) or non-ambulant (aged 5-10 years) within separate cohorts, and Part 2 is the pivotal part in SMA patients aged 2-25 years that are ambulant.
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Part 1 - Percentage of participants with adverse events (AEs)
Timeframe: Up to 4.5 years
Part 1 - Incidence of relevant echocardiographic parameter z scores > 2
Timeframe: Up to 4.5 years
Part 1 - Serum concentration of RO7204239
Timeframe: Through Week 96
Part 1 - Time to maximum serum concentration (Cmax) of RO7204239
Timeframe: Through Week 96
Part 1 - Area under the curve (AUC) of RO7204239
Timeframe: Through Week 96
Part 1 - Trough concentration (Ctrough) of RO7204239
Timeframe: Through Week 96
Part 1 - Plasma concentration of risdiplam
Timeframe: Week 21
Part 1 - Plasma concentration of risdiplam metabolite (M1)
Timeframe: Week 21
Part 1 - Cmax of risdiplam
Timeframe: Week 21
Part 1 - AUC of risdiplam
Timeframe: Week 21
Part 1 - Ctrough of risdiplam
Timeframe: Week 21
Part 1 - Incidence of anti-drug antibodies (ADAs)
Timeframe: Through Week 96
Part 1 - Change from baseline in serum concentration of total myostatin
Timeframe: Through Week 85
Part 1 - Change from baseline in serum concentration of free latent myostatin
Timeframe: Through Week 85
Part 1 - Change from baseline in serum concentration of mature myostatin
Timeframe: Through Week 85
Part 1 - Percent change from baseline in the contractile area of skeletal muscle in the dominant thigh muscles as assessed by magnetic resonance imaging (MRI) in participants aged at least 5 years
Timeframe: Week 24 of combination treatment
Part 1 - Percent change from baseline in the contractile area of skeletal muscle in the dominant calf muscles as assessed by MRI in participants aged at least 5 years
Timeframe: Week 24 of combination treatment
Part 2 - Change from baseline in Revised Hammersmith Scale (RHS) total score
Timeframe: Week 72 of combination treatment (study Week 80)