The primary objective of the study is to confirm the clinical efficacy of epratuzumab in the treatment of subjects with moderate to severe general SLE despite standard of care treatments (ie, corticosteroids, and potentially antimalarials and…
ID
Source
Brief title
Condition
- Autoimmune disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The primary efficacy variable is the responder rate at Week 48 according to a
combined response index. This is a response variable (yes/no) evaluated at Week
48 incorporating the following criteria for achievement of responder status
(ie, all criteria must be met to achieve responder status):
* British Isle Lupus Assessment Group improvement, defined as BILAG As at
study entry improved to B/C/D, and BILAG Bs at study entry improved to C/D, and
no BILAG worsening in other BILAG organ systems such that there are no new
BILAG As or greater than 1 new BILAG B(s); and
* No worsening in the SLEDAI total score compared to study entry (defined as
no increase in SLEDAI total score); and
* No worsening in the physicians* global assessment of disease activity (*no
worsening* is defined as less than 10% worsening, equivalent to a 10mm increase
on a 100mm visual analog scale[VAS]) compared to study entry; and
* No changes in concomitant medications according to the following criteria:
* No increase of (or addition of a new) immunosuppressant or antimalarial
agent over Baseline (Week 0/Visit 2) levels, or initiation of any medication
listed in Table 7.4; or
* No increase in oral corticosteroid dose greater than 25% over Baseline (Week
0/Visit 2) levels from Week 0 to Week 8 for an SLE-related indication; or
* No increase in oral corticosteroids over Baseline (Week 0/Visit 2) levels
after Week 8 for an SLE-related indication; or
* No iv, intra-articular (ia), or intramuscular (im) injections of
corticosteroids which are SLE-related.
Secondary outcome
* Adverse Events * Serious Adverse Events * Laboratory Measurements * Pregnancy
Testing * Vital Signs * Body Mass * 12-Lead ECG * Data Safety Monitoring Board
Background summary
A total of 308 adults with moderate to severe SLE have been exposed to
epratuzumab in 5 completed studies (open label studies: 015 and SL0002; and
placebo controlled studies: SL0003/SL0004 and SL0007) and 2 ongoing open-label,
long-term, follow-up studies (SL0006 and SL0008). All of the clinical studies
in subjects with SLE were designed to allow subjects to continue using their
other standard SLE medications (corticosteroids, and possibly
immunosuppressants and antimalarials) while receiving adjunctive epratuzumab
treatment or PBO.
Study objective
The primary objective of the study is to confirm the clinical efficacy of
epratuzumab in the treatment of subjects with moderate to severe general SLE
despite standard of care treatments (ie, corticosteroids, and potentially
antimalarials and immunosuppressants) continued from Baseline.
Study design
This is a Phase 3, randomized, double-blind, placebo-controlled, multicenter
study to confirm the clinical efficacy and to evaluate the safety,
tolerability, and immunogenicity of epratuzumab in subjects with moderate to
severe general SLE. Qualifying subjects must have at least 1 BILAG level A
active body/organ system, or at least 2 BILAG level B active body/organ systems
at Baseline (Visit 1) among the BILAG-defined mucocutaneous, musculoskeletal,
or cardiorespiratory body systems as determined by the central independent
efficacy reader for BILAG data. In addition to these minimal SLE disease
requirements, subjects may have active SLE disease of BILAG level A and BILAG
level B in the other BILAG-defined body systems; however, subjects with severe
(BILAG A) renal or severe (BILAG A) central neuropsychiatric manifestation
(except for mononeuritis single/multiplex and/or polyneuropathy, provided they
are not new or worsening) at Baseline (Visit 1) as determined by the BILAG
Index (version 2004), will be excluded. The study includes a Screening Period,
lasting a maximum of 14 days, a double-blind Treatment Period, consisting of
four 12-week treatment cycles (48 weeks total duration), and a Safety Follow-Up
Visit for subjects not participating in the open-label extension study, SL0012.
During the Screening Period, subjects will be assessed for study selection
criteria. Subjects qualifying for the study according to the inclusion and
exclusion criteria will be randomized to treatment in a 1:1:1 ratio as follows:
* Epratuzumab 600mg infusions delivered QW for a total of 4 weeks (CMD 2400mg)
over four 12-week treatment cycles (ie, Weeks 0, 1, 2, 3, 12, 13, 14, 15, 24,
25, 26, 27, 36, 37, 38, and 39) * Epratuzumab 1200mg infusions delivered QOW
for a total of 4 weeks (CMD 2400mg) over four 12-week treatment cycles (ie,
Weeks 0, 2, 12, 14, 24, 26, 36, and38); and PBO infusions delivered QOW for a
total of 4 weeks over four 12-week treatment cycles (ie, Weeks 1, 3, 13, 15,
25, 27, 37, and 39) * PBO infusions delivered QW for a total of 4 weeks over
four 12-week treatment cycles (ie, Weeks 0, 1, 2, 3, 12, 13, 14, 15, 24, 25,
26, 27, 36, 37, 38, and 39) Following the infusions of the first treatment
cycle at Weeks 0, 1, 2, and 3, subjects will attend Treatment Period study
visit assessments at Weeks 4, 8, and 12. Subjects will undergo the infusions of
the second treatment cycle at Weeks 12, 13, 14, and 15, with similar assessment
visits at Weeks 16, 20, and 24. Subjects will undergo the infusions of the
third treatment cycle at Weeks 24, 25, 26, and 27 with assessment visits at
Weeks 28, 32, and 36. The fourth treatment cycle will consist of infusions at
Weeks 36, 37, 38, and 39 with assessment visits at Weeks 40, 44, and 48. Early
withdrawal and participation in SL0012 All subjects terminating prematurely
should complete the Early Withdrawal Visit (Week 48). Subjects terminating
prematurely at Week 16 (Visit 12) or later due to lack of efficacy will have
the option to continue in the open-label extension study, SL0012. Additionally
all subjects who complete SL0010 through Week 48 will have the option to
continue in the open-label extension study, SL0012. Subjects electing not to
enter SL0012 following completion or early termination from SL0010, will
continue follow-up for an additional 13 weeks after their final dose of study
drug, or a maximum of 4 weeks beyond
Week 48, with a final Safety Follow-Up Visit no later than Week 52 (±1 week)
within SL0010.
Intervention
There will be four 12-week treatment cycles. This means that you can be treated
with study drug up to16 times during the course of the study. Your
participation in the study will last approximately one year.
Study burden and risks
SL0010 is a Phase 3, multicenter, double blind, placebo controlled, parallel
group, randomized study. Epratuzumab will be compared to placebo because no
approved, active comparator is currently available. For each subject, the study
will last a maximum of 54 weeks and will consist of a Screening Period (lasting
a maximum of 14 days), a double blind Treatment Period consisting of four 12
week treatment cycles (48 weeks total), and a Safety Follow-Up Visit (for
subjects not participating in the open label extension study, SL0012) at 13
weeks from the final dose of study drug, or a maximum of 4 weeks beyond Week 48
(ie, no later than Week 52). This design is considered appropriate to provide
efficacy and safety data to support expeditious filing of the Biologic License
Application (BLA) for this fast track product, given the unmet need of SLE
patients and the risks of the currently available treatments. Based on
regulatory advice and available draft guidelines, a study duration of 1 year is
considered adequate to assess the durability of benefits of therapy given the
chronic nature of SLE.
1950 Lake Park Drive
Smyrna GA 30080
US
1950 Lake Park Drive
Smyrna GA 30080
US
Listed location countries
Age
Inclusion criteria
1. The subject must be at least 18 years old at the Screening Visit (Visit 1). 2. An Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved written Informed Consent form/authorization forms (as applicable) are signed and dated by the subject prior to the initiation of any study-specific assessment at Screening (Visit 1). 3. Adequate reading and writing abilities such that the subject can comprehend and answer the questions on the subject-completed assessments. 4. The subject is considered reliable, willing, and capable of adhering to the protocol, and visit schedule, according to the judgment of the investigator. 5. Women of childbearing potential must agree to use an acceptable method of birth control during the study and for a period of 3 months after their final dose of study drug. Acceptable forms of birth control include oral contraceptives (which must be stable for at least 1 full month prior to Screening [Visit 1], and should remain stable during the study), double-barrier methods, and the single-barrier methods of diaphragm with adjunct spermacide or condom with adjunct spermacide. Unacceptable methods include abstinence alone or condoms/diaphragm use without adjunct spermacide. Women not agreeing to use birth control must be surgically sterile (hysterectomy/oophrectomy or tubal ligation) or postmenopausal for at least 2 years prior to Screening (Visit 1). Women of childbearing potential are required to have a serum pregnancy test taken at Screening (Visit 1), which is confirmed to be negative by urine testing prior to the first dose of study drug at Week 0 (Visit 2). 6. The subject has positive results for antinuclear antibodies (ANAs) (titer *1:80) or anti-dsDNA at Screening (Visit 1) at the central laboratory using their testing methodologies. 7. The subject has SLE diagnosed by a physician, as defined by the most recent ACR revised criteria, such that at least 4 (not including Neurologic Disorder) of the 11 criteria are met. If positive for Neurologic Disorder criteria, a total of 5 of the 11 ACR criteria must be met. 8. The subject has active moderate to severe SLE disease activity, as demonstrated by BILAG level A disease activity in at least 1 body/organ system (except renal or neurological), or BILAG level B level disease activity in at least 2 body/organ systems if no BILAG level A disease is present. At least 1 of the BILAG A scores OR at least 2 of the BILAG B scores must be in the following BILAG body/organ systems: mucocutaneous, musculoskeletal, or cardiorespiratory. 9. The subject has active moderate to severe SLE disease activity as demonstrated by a SLEDAI total score of at least 6 at Screening (Visit 1). 10. Subjects receiving antimalarials must have been receiving them for at least 12 weeks prior to Screening/Baseline (Visit 1), with a stable dose regimen for at least 28 days (±1 day) prior to Week 0 (Visit 2) and the;first study drug infusion. 11. Subjects receiving immunosuppressants must be at a stable dose for at least 28 days (±1 day) prior to Visit 2 and the first study drug infusion. 12. Subjects must be receiving corticosteroids within the range of 5 to 60mg/day prednisone equivalents at a stable dose for at least 5 days (±1 day) prior to Week 0 (Visit 2) and the first study drug infusion, with the corticosteroid dose dependent on the investigator*s assessment of disease activity. This excludes the use of high-pulse doses of iv Solu-Medrol®. 13. Subjects receiving memantine, bromocriptine (Parlodel®), danazol, dapsone, dehydroepiandrosterone, or retinoids must be on a stable dose for 28 days (±1 day) prior to Week 0 (Visit 2) and the first study drug infusion.
Exclusion criteria
1. The subject has active, severe, neuropsychiatric SLE, defined as any neuropsychiatric element scoring BILAG level A disease, including but not limited to: new or worsening impaired level of consciousness, psychosis, delirium or confusional state, grand mal seizure (including status epilepticus), stroke or stroke syndrome, aseptic meningitis, ascending or transverse myelitis, cranial neuropathy, chorea, cerebellar ataxia, demyelinating syndromes or any other severe neurologic condition which, in the opinion of the investigator, would prevent the subject from completing protocol-required procedures and assessments. Mononeuritis single/multiplex and/or polyneuropathy are NOT exclusionary, even if they result in a CNS BILAG A score, provided they are not new or worsening at Screening (Visit 1).
2. The subject has active, severe, SLE disease activity which involves the renal system (defined by BILAG renal level A activity), serum creatinine >2.5mg/dL, or a clinically significant serum creatinine increase within the 4 weeks prior to Screening (Visit 1), or proteinuria >3.5g/day.
3.Female subjects who are breastfeeding, pregnant, or plan to become pregnant during the study or within 3 months following their final dose of study drug. 4.Evidence of an immunosuppressive state, including HIV infection, agammaglobulinemias, T-cell deficiencies, or HTLV-1.
5.Subjects with a history of chronic infections, including but not limited to subjects with concurrent acute or chronic viral hepatitis B or C. Also excluding subjects with a history of a recent serious or life-threatening infection or any current signs or symptoms that may indicate a significant infection at Screening (Visit 1), as per the investigator*s clinical judgment. Subjects must have completed any prior anti-infective therapy prior to the first dose of study drug with the exception of anti-infectives taken specifically for the treatment of acne, rosacea, onychomycosis, or vaginal yeast infections; for the prophylaxis of urinary tract infections; or prophylaxis for pre-surgical or pre-procedural reasons (including dental procedures). Note: minocycline may not be used for these purposes.
6.Subjects who, in the opinion of the investigator, are at a particularly high risk of significant infection due to their lifestyle and/or occupation.
7.Subjects with substance abuse/dependence or other concurrent medical conditions that could confound study interpretation or affect the subject*s ability to fully participate in the study.
8.Subjects receiving any live (includes attenuated) vaccination within the 8
the 8 weeks prior to Screening (Visit 1) (eg, inactivated influenza and pneumococcal vaccines are allowed but nasal influenza vaccination is not permitted).
9.Spontaneous or induced abortion, still or live birth within 4 weeks prior to Screening (Visit 1).
10. Use of oral anticoagulants (not including NSAIDs) within the 12 weeks prior to Screening (Visit 1).
11. Subject has a history of thromboembolic events (eg, myocardial infarction, cerebrovascular accident, deep vein thrombosis, pulmonary embolism) within 1 year of Screening (Visit 1) or subjects with known anti-phospholipid syndrome (Miyakis et al, 2006).
12. Significant hematologic abnormalities of hemoglobin <8.0 g/dL, or WBC <2000/mm3, or absolute neutrophil count <1500/mm3, or platelets <30,000/mm3 at Screening (Visit 1).
13. History of malignant cancer, except the following treated cancers: cervical carcinoma in situ, basal cell carcinoma, or dermatological squamous cell carcinoma.
14. Subject has used the prohibited medications, regardless of route, within the time frame (Wash-Out Period) listed in the table prior to Week 0 (Visit 2) and the first infusion of study drug. Subject has a history of treatment with investigational human or chimeric antibodies within 3 months prior to Screening (Visit 1); treatment with belimumab or CTLA4-Ig within 6 months prior to Screening; or treatment with rituximab or other anti-B-cell antibodies within 12 months prior to Screening. Subject has used investigational agents, not specified above or included in Table 7:4, including other investigational biologics or device products, within 3 months prior to Screening. Concomitant participation in studies where no product or device is administered/used may be allowed if discussed and approved by the medical monitor/UCB. If there are any questions regarding acceptable wash-out periods not mentioned, the investigator should contact the medical monitor.
15. Subject has previously participated in this study or has previously received epratuzumab treatment in or outside of another clinical study.
16. Subjects with any other condition which, in the investigator*s judgment, would make the subject unsuitable for inclusion in the study.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
Other | 1 |
EudraCT | EUCTR2010-018565-26-NL |
CCMO | NL35660.018.11 |