E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
SSc is a multi-system disorder of unknown etiology characterized by fibrosis and vascular obliteration in the skin and visceral organs. The pathogenesis of SSc involves immunologic mechanisms vascular damage and excessive accumulation of fibrosis in the skin and internal organs. As vascular damage progresses the microvascular bed in the skin and other sites is impaired, producing a state of chronic ischemia. SSc is commonly divided into the diffuse and limited form of the disease |
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MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To collect long-term efficacy, tolerability and safety data of bosentan in Systemic Sclerosis (SSc) patients suffering from ischemic digital ulcers (DU).
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E.2.2 | Secondary objectives of the trial | |
E.2.3 | Trial contains a sub-study | Information not present in EudraCT |
E.3 | Principal inclusion criteria |
Patients who have completed the full study period (24 to 36-week treatment period and 8-week follow up) of the RAPIDS-2 study.
Patients who either present DUs at the end of the RAPIDS-2 study period or develop new DUs thereafter until release of the RAPIDS-2 study results to investigators.
Male or female patients of 18 years of age and older - Women of childbearing potential must have a negative pre-treatment pregnancy test and use a reliable method of contraception during study treatment and for at least 3 months after study treatment termination. - Women not of childbearing potential are defined as postmenopausal (i.e., amenorrhea for at least 1 year), or surgically or naturally sterile.
Signed informed consent |
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E.4 | Principal exclusion criteria |
Systolic blood pressure < 85 mmHg.
Hemoglobin concentration < 75% of the lower limit of the normal range
AST and/or ALT values greater than 3 times the upper limit of normal
Pregnancy or breast-feeding
Body weight < 40 kg
Patient who received an investigational product within 1 month preceding screening
Patient with conditions that prevent compliance with the protocol or adhering to therapy
Moderate to severe hepatic impairment, i.e., Child-Pugh Class B or C
Known hypersensitivity to bosentan or any of the excipients
Treatment with any of the following: glibenclamide (glyburide), fluconazole, cyclosporine A, tacrolimus and any other calcineurin inhibitor 1 week prior to bosentan treatment |
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E.5 End points |
E.5.1 | Primary end point(s) |
EFFICACY endpoints:
Total number of new DUs per patient observed by the investigator at planned visits (a patient diary will be used to record DUs that might appear and disappear between two planned visits)
Time to complete healing of each baseline DU
Time to complete healing of each new DU
Change from baseline to each assessment carried out every 16 weeks in the Scleroderma Health Assessment Questionnaire (SHAQ) and in the composite of hand components of the SHAQ: grip, hygiene, dressing and grooming
Change from baseline to each assessment carried out every 16 weeks in overall hand pain related to finger ulcers
Change from baseline to each assessment carried out every 16 weeks in UK SSc Functional Score (UKFS)
If appropriate, exploratory endpoints, derived from the clinical database, will be analyzed based on data-driven considerations.
SAFETY/TOLERABILITY endpoints:
Adverse events up to 24 hours after last study medication
Serious adverse events up to 28 days after last study medication
AEs leading to permanent discontinuation of the study medication |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | Information not present in EudraCT |
E.6.2 | Prophylaxis | Information not present in EudraCT |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Information not present in EudraCT |
E.6.7 | Pharmacodynamic | Information not present in EudraCT |
E.6.8 | Bioequivalence | Information not present in EudraCT |
E.6.9 | Dose response | Information not present in EudraCT |
E.6.10 | Pharmacogenetic | Information not present in EudraCT |
E.6.11 | Pharmacogenomic | Information not present in EudraCT |
E.6.12 | Pharmacoeconomic | Information not present in EudraCT |
E.6.13 | Others | Information not present in EudraCT |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Information not present in EudraCT |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Information not present in EudraCT |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | Information not present in EudraCT |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Information not present in EudraCT |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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Treatment duration:
The study treatment for each patient lasts from his/her enrollment date until the end of the trial. If for example negative RAPIDS-2 results are released, based on the recommendations of the Steering Committee, the present study may be stopped. If RAPIDS-2 results are positive, the present study may be prolonged at the latest up to the commercialization of bosentan in ischemic DUs associated with SSc.
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | |
E.8.9.1 | In the Member State concerned months | 31 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 32 |