E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
Autoimmune inflammatory disease of the small intestine |
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E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
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 | 10045365 |
E.1.2 | Term | Ulcerative colitis |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the efficacy of AEB071 in the treatment of active, moderate to severe ulcerative colitis in patients who have failed conventional therapy using mesalamine or steroids. |
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E.2.2 | Secondary objectives of the trial |
1. To evaluate the safety, tolerability and pharmacokinetics of AEB071 given as an oral drug at 300 mg for two weeks twice a day followed by 200 mg for two weeks twice a day in ulcerative colitis patients.
2. To explore the relationship between AEB071 pharmacokinetics, clinical efficacy outcomes, pharmacodynamic markers and potential biomarkers. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Males and females 18-75 years of age with an established diagnosis of ulcerative colitis are eligible for the study.
2. Female patients of child-bearing potential must be concurrently using two acceptable methods of contraception, (e.g. intra-uterine device plus condom, spermicidal gel plus condom, diaphragma plus condom, etc.) from the time of screening and for the duration of the study, through study completion and for 1 month following study completion.
3. Patients must have active, moderate to severe disease with a Partial Mayo Score between 5 and 10 (inclusive), with a score of at least 2 on either stool frequency or rectal bleeding and a Modified Baron Score of at least 2 upon endoscopic examination with the disease extending at least 25 cm from the anal verge.
4. Patients must have responded poorly to conventional therapy. Poor response is considered to be any of the following:
• the continuous requirement for intermittent, oral steroid therapy of more than 20 mg methylprednisolone or equivalent per day for more than 3 months (including steroid dependence defined as relapse within 3 months after stopping).
• the requirement for ≥ 2 g mesalamine per day.
• the failure to remain symptom-free on maintenance medication of azathioprine or 6-
mercaptopurin (an adequate course is considered to be at least 12 weeks of treatment).
Patients that do not tolerate mesalamine or steroid therapy will also be included. Doses of steroids and mesalamine, where topical therapy is not allowed, will be frozen at the time of screening and may be continued unchanged. The maximum allowed daily steroid dose is 20 mg methylprednisolone (or equivalent steroid dose). Other maintenance medications like azathioprine or 6-mercaptopurin will be continued unchanged throughout the study period.
5. Patients must be able to communicate well with the investigator, to understand and comply with the requirements of the study and to understand and sign written informed consent. |
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E.4 | Principal exclusion criteria |
1. Previous treatment with biologics (e.g. anti TNF-α) within the last 3 months or use of any other investigational drug within the previous 1 month.
2. Hypersensitivity to AEB071 compound.
3. Weight of less than 50 kg or more than 150 kg.
4. Ongoing treatment with antibiotics, cyclosporine, methotrexate, tacrolimus or rectally administered corticosteroid or 5-aminosalicylate containing medication. Eligible patients must have stopped cyclosporine, methotrexate and tacrolimus at least 8 weeks and antibiotics and rectal topical therapy at least 2 weeks prior to study entry.
5. Patients with active or history of clinically significant cardiac abnormalities, for example:
•Patients requiring drugs with QT-prolonging properties (e.g. antiarrhythmic drugs, such as amiodarone, sotalol, dofetilide, quinidine, procainamide, disopyramide).
•Patients with sustained heart rate <50 bpm or >90 bpm after resting in supine position for 5 minutes.
•Patients with hypokalemia, QTc >470msec, long QT-syndrome (own or with a family history) or with a family history of sudden unexplained death. •Patients with implanted cardiac pacemaker or defibrillator.
•Patients with left branch bundle block (LBBB), and patients with known history of congestive heart failure (NYHA class II to IV) or known left-ventricular dysfunction (LVEF < 45%).
•History of tachyarrhythmia e.g., supraventricular tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia, ventricular flutter, ventricular fibrillation.
•History of myocardial infarction within the previous 12 months; uncontrolled or unstable angina pectoris.
•History of syncope.
6. Patients who are requiring the administration of strongly interacting drugs of the CYP450 3A4/5 system (See Appendix 6).
7. Positive results for the detection of enteropathogens (including Salmonella, Yersinia, Shigella, Camplylobacter, EHEC and C. difficile).
8. Laboratory findings showing:
• Aspartate aminotransferase, alanine aminotransferase and bilirubin higher than 3 times the upper limit of normal,
• Alkaline phosphatase higher than 2 times the upper limit of normal,
• Absolute neutrophil count of <1,500/mm3, an absolute leukocyte count <2,500/mm3 or platelets <75,000/mm3.
9. Patients who have been diagnosed with primary sclerosing cholangitis are excluded from the study.
10. History of renal trauma, glomerulonephritis or patients with one kidney. Presence of clinically significant proteinuria, active sediments,
casts or WBCs in urine.
11. Clinical signs and symptoms of toxic megacolon.
12. Presence or history of major chronic inflammatory autoimmune diseases, e.g. SLE.
13. History of alcohol or drug abuse.
14. Pregnant or breastfeeding women are excluded.
15. Donation or loss of 400 mL or more of blood within 8 weeks prior to dosing.
16. Administration of live vaccines within 6 months prior to dosing.
17. A positive HIV (ELISA and Western blot) test result, Hepatitis B surface antigen (HBsAg) or Hepatitis C test result.
18. Significant illness within the two weeks prior to dosing or any active systemic infection or medical condition that may require treatment or therapeutic intervention during the study.
19. History of malignancy (other than basal cell carcinoma or adequately treated carcinoma-in-situ of the cervix).
20. Presence or history of underlying metabolic, endocrine, hematologic, pulmonary, cardiac, blood, renal, hepatic, infectious, psychiatric or gastrointestinal conditions which, in the opinion of the investigator, immunocompromise the patient and/or place the patient at unacceptable risk for participation in a study of an immunomodulatory therapy.
21. Positive purified protein derivative (PPD) tuberculin skin test reaction (PPD 5 TU [tuberculin units] or as according to local standard practice) of ≥ 5 mm induration at baseline (Day -4 to Day -1), according to national guidelines. PPD tuberculin test results that were obtained within 2 months prior to screening can be used. Patients who have a positive PPD skin test with a documentation of Bacillus Calmette-Guérin (BCG) vaccination or those who are at low environmental risk for tuberculosis (TB) infection and/or reactivation (in the opinion of the Investigator) and have a negative chest X-ray can be included. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is clinical remission 4 weeks after treatment initiation, defined as a Modified Baron Score of 0 or 1 and a Partial Mayo Score of 0 or 1. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Clinical remission 4 weeks after treatment initiation |
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E.5.2 | Secondary end point(s) |
Change from baseline in partial Mayo score 4 weeks after treatment initiation |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | Yes |
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) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
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 | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
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.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 20 |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 30 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 30 |