E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Cushing’s disease is rare disease that is caused by an adrenocorticotropic hormone (ACTH) secreting pituitary adenoma. The elevated ACTH secreted by these tumors stimulates the adrenal glands to produce excess cortisol, leading to the subsequent development of the clinical signs and symptoms of hypercortisolism. Cushing's disease is associated with severe morbidity and premature mortality and most commonly affects adults aged 20-50, primarily females |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10011651 |
E.1.2 | Term | Cushing's disease |
E.1.2 | System Organ Class | 10014698 - Endocrine disorders |
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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 assess the efficacy in terms of response to pasireotide 600 μg s.c. b.i.d. and 900 μg s.c. b.i.d. independently in patients with Cushing’s disease as measured by mean UFC ≤ 1.0 X ULN from baseline after 6 months of treatment |
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E.2.2 | Secondary objectives of the trial |
To assess •reduction of mean UFC to ≤ 1.0XULN at months 3 and 12 •time to first response •the effect on plasma ACTH and serum cortisol median UFC response •improvement in clinical signs •improvement in clinical symptoms of Cushing’s disease •the effect on tumor volume (MRI) •censor-adjusted response •pooled dose response •the response by dose group at intermediate visits •the effect on Quality of Life •the pharmacokinetics after s.c. b.i.d. administration •patient-related factors that may affect the pharmacokinetics or pharmacodynamics after s.c. b.i.d. dosing •potential relationships between pharmacokinetics and pharmacodynamics after s.c. b.i.d. dosing •the safety and tolerability of pasireotide s.c. in patients with Cushing’s disease Exploratory •pasireotide 600 μg s.c. b.i.d. and 900 μg s.c. b.i.d. dose response longitudinally •midnight salivary cortisol level relationship with mean UFC and cortisol by parametric and/or nonparametric correlation analysis
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
•Male or female patients aged 18 years or greater •Patients with confirmed diagnosis of ACTH-dependent Cushing’s disease, as evidenced by (1) mean UFC from four 24-hour urinary collections at least 1.5 times the upper limit of the laboratory normal range collected within 2 weeks; (2) morning plasma ACTH within the normal or above normal range; (3) either MRI confirmation of pituitary macroadenoma (greater than or equal to 1 cm) or inferior petrosal sinus gradient >3 after corticotrophin-releasing hormone (CRH) for those patients with a microadenoma (tumor less than 1 cm)*, or for patients who have had prior pituitary surgery, documentation confirming an ACTH staining adenoma. * if IPSS had previously been performed without CRH (e.g.with DDAVP), then a central to peripheral pre-stimulation gradient > 2 is required. If IPSS had not previously been performed, IPSS with CRH stimulation is required. •Patients with de novo Cushing’s disease can be included only if they are not considered candidates for pituitary surgery (e.g. poor surgery candidates, surgically unapproachable tumors, patients who refuse to have surgical treatment) •Confirmatory testing prior to IPSS (low-dose dexamethasone suppression testing or dexamethasone-CRH testing) has to be performed for patients with UFC ≤ 3.0 X ULN and a pituitary microadenoma in order to exclude possible pseudo-Cushing’s syndrome. •Karnofsky performance status ≥ 60 (i.e. requires occasional assistance, but is able to care for most of this personal needs) •For patients on medical treatment for Cushing’s disease the following washout periods must be completed before baseline efficacy assessments are performed •Inhibitors of steroidogenesis – ketoconazole, metyrapone, rosiglitazone: 1 week •Dopamine agonists - bromocriptine, cabergoline: 4 weeks •Octreotide LAR and Lanreotide autogel: 8 weeks •Lanreotide SR: 4 weeks •Octreotide - immediate release formulation: 1 week •Patients with a known history of impaired fasting glucose or Diabetes Mellitus (DM) may be included, however blood glucose and antidiabetic treatment must be monitored closely throughout the trial and adjusted as necessary
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E.4 | Principal exclusion criteria |
•Patients who have received pituitary irradiation within the last ten years prior to visit 1, as the onset time of the radiation effects cannot be determined •Patients who have been treated with mitotane during the last 6 months •Patients with compression of the optic chiasm causing any visual field defect, in order to exclude patients with a tumor causing chiasma compression requiring surgery •Patients with Cushing’s syndrome due to ectopic ACTH secretion •Patients with hypercortisolism secondary to adrenal tumors or Nodular (primary) bilateral adrenal hyperplasia •Patients who have a known inherited syndrome as the cause for hormone over secretion (i.e. Carney Complex, McCune-Albright syndrome, MEN-1) •Patients with a diagnosis of glucocorticoid-remedial aldosteronism (GRA) •Patients who are hypothyroid and not on adequate replacement therapy •Patients who have undergone major surgery within 1 month •Patients with symptomatic cholelithiasis •Diabetic patients on antidiabetic medications whose fasting blood glucose is poorly controlled as evidenced by HbA1C >8% •Patients with abnormal coagulation (PT or PTT elevated by 30% above normal limits) •Patients receiving anticoagulants that affect PT or PTT •Patients who have congestive heart failure (NYHA Class III or IV), unstable angina, sustained ventricular tachycardia, symptomatic bradycardia, advanced heart block, history of acute MI less than one year prior to study entry or clinically significant impairment in cardiovascular function. •Patients with risk factors for torsade de pointes, i.e. patients with a baseline QTc >480 ms, hypokalemia, family history of long QT syndrome, and concomitant medications known to prolong QT interval •Patients with liver disease such as cirrhosis, chronic active hepatitis, or chronic persistent hepatitis, or patients with ALT/AST more than 2 X ULN, serum creatinine >2.0 X ULN, serum bilirubin >2.0 X ULN, serum albumin < 0.67 X LLN •Patients with WBC <3 X 109/L; Hgb <13 g/dL for males and <12 g/dL for females; PLT <100 X 109/L •Patients who have any current or prior medical condition that can interfere with the conduct of the study or the evaluation of its results in the opinion of the investigator or the sponsor’s medical monitor •Female patients who are pregnant or lactating, or are of childbearing potential and not practicing a medically acceptable method for birth control. Female patients must use barrier contraception with condoms. If oral contraception is used, the patient must have been practicing this method for at least two months prior to enrollment and must agree to continue the oral contraceptive throughout the course of the study and for one month after the last dose of study drug. Male patients who are sexually active are required to use condoms during the study and for 1 month afterwards •History of immunocompromise, including a positive HIV test result (Elisa and Western blot). A HIV test will not be required, however, previous medical history will be reviewed •Patients who have a history of alcohol or drug abuse in the 6 month period prior to receiving pasireotide •Patients who have given a blood donation (of 400 ml or more) within 2 months before receiving pasireotide •Patients who have participated in any clinical investigation with an investigational drug within 1 month prior to dosing and patients who have previously been treated with pasireotide •Known hypersensitivity to somatostatin analogues •Patients with active malignant disease within the last five years (with the exception of basal cell carcinoma or carcinoma in situ of the cervix) •Patients with the presence of active or suspected acute or chronic uncontrolled infection •Patients with a history of non-compliance to medical regimens or who are considered potentially unreliable or will be unable to complete the entire study
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of patients in each independent treatment arm with <1.0 X ULN at month 6. Patients unblinded at the month 3 assessment will be considered non-responders. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
Randomization to different doses of pasireotide |
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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 | No |
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.8.5.1 | Number of sites anticipated in the EEA | 70 |
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 | No |
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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Patients will have the option to receive therapy as long as they continue to demonstrate benefit and do not experience unacceptable toxicity. |
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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 | |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 6 |