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    Clinical Trial Results:
    A multi-center, open label, 24-month treatment study to establish the safety, tolerability, efficacy, pharmacokinetics and pharmacodynamics of canakinumab (anti-IL-1 beta antibody) in patients with NOMID / CINCA syndrome

    Summary
    EudraCT number
    2008-001429-32
    Trial protocol
    Outside EU/EEA  
    Global end of trial date
    17 Feb 2011

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2016
    First version publication date
    28 Jul 2015
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CACZ885D2201
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00770601
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Novartis Pharma AG
    Sponsor organisation address
    CH-4002, Basel, Switzerland,
    Public contact
    Clincal Disclosure Office, Novartis Pharma AG, +41 613241111,
    Scientific contact
    Clincal Disclosure Office, Novartis Pharma AG, +41 613241111,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-000060-PIP01-07
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    17 Feb 2011
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    17 Feb 2011
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The primary objective of the study was to assess the proportion of patients experiencing a relapse (CNS relapse and/or inflammatory relapse) during 6-month open label administration of canakinumab in patients with NOMID / CINCA syndrome.
    Protection of trial subjects
    The study was in compliance with the ethical principles derived from the Declaration of Helsinki and in compliance with all International Conference on Harmonization (ICH) Good Clinical Practice (GCP) Guidelines. All the local regulatory requirements pertinent to safety of trial subjects were followed. The subjects were treated as in routine care. In order to avoid relapse, dose adjustments with canakinumab were allowed during the course of the study, as detailed in the protocol.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    26 Jan 2009
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 7
    Worldwide total number of subjects
    7
    EEA total number of subjects
    0
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    1
    Adolescents (12-17 years)
    4
    Adults (18-64 years)
    2
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 1 centre in United States

    Pre-assignment
    Screening details
    A total of 7 subjects were screened and 6 subjects were randomised into the study, as one subject withdrew consent before dosing.

    Period 1
    Period 1 title
    Overall period
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    The study was open label, hence no blinding was performed.

    Arms
    Arm title
    Canakinumab
    Arm description
    Subjects received body-weight stratified dosage of canakinumab treatment at 300 mg (for subjects weighing more than 40 kg) and at 4 mg/kg (in children with body weight less than or equal to 40 kg) s.c. every 4-8 weeks as per investigator discretion for a treatment period of 6 months. The first 3 NOMID patients enrolled received a dose of 150 mg (>40 kg) and 2 mg/kg for children <40 kg. Since this dose was insufficient to fully control the symptoms of the disease the 300 mg / 4mg/kg dose was introduced by Protocol Amendment 2.
    Arm type
    Experimental

    Investigational medicinal product name
    Canakinumab
    Investigational medicinal product code
    ACZ885
    Other name
    Pharmaceutical forms
    Powder for solution for injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Canakinumab s.c. solution (300 mg or 4 mg/kg) was administered every 8 weeks.

    Number of subjects in period 1 [1]
    Canakinumab
    Started
    6
    Completed
    6
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: The number of subjects reported in the baseline period (N=6) are different from the worldwide number (N=7) enrolled in the trial, as 1 subject withdrew consent before first dosing.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Canakinumab
    Reporting group description
    Subjects received body-weight stratified dosage of canakinumab treatment at 300 mg (for subjects weighing more than 40 kg) and at 4 mg/kg (in children with body weight less than or equal to 40 kg) s.c. every 4-8 weeks as per investigator discretion for a treatment period of 6 months. The first 3 NOMID patients enrolled received a dose of 150 mg (>40 kg) and 2 mg/kg for children <40 kg. Since this dose was insufficient to fully control the symptoms of the disease the 300 mg / 4mg/kg dose was introduced by Protocol Amendment 2.

    Reporting group values
    Canakinumab Total
    Number of subjects
    6 6
    Age categorical
    Units: Subjects
        Children (2-11 years)
    1 1
        Adolescents (12-17 years)
    3 3
        Adults (18-64 years)
    2 2
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    18.7 ( 8.09 ) -
    Gender categorical
    Units: Subjects
        Female
    2 2
        Male
    4 4

    End points

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    End points reporting groups
    Reporting group title
    Canakinumab
    Reporting group description
    Subjects received body-weight stratified dosage of canakinumab treatment at 300 mg (for subjects weighing more than 40 kg) and at 4 mg/kg (in children with body weight less than or equal to 40 kg) s.c. every 4-8 weeks as per investigator discretion for a treatment period of 6 months. The first 3 NOMID patients enrolled received a dose of 150 mg (>40 kg) and 2 mg/kg for children <40 kg. Since this dose was insufficient to fully control the symptoms of the disease the 300 mg / 4mg/kg dose was introduced by Protocol Amendment 2.

    Primary: Percentage of subjects with complete remission and relapse after 6 months of cankinumab treatment

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    End point title
    Percentage of subjects with complete remission and relapse after 6 months of cankinumab treatment [1]
    End point description
    The primary endpoint of the study was the proportion of patients experiencing a relapse(CNS relapse and/or inflammatory relapse)during 6-month open label administration of canakinumab in patients with NOMID / CINCA syndrome. Complete remission consisted of inflammatory remission and CNS remission. 1) Inflammatory (systemic) remission was defined as follows (all criteria to be fulfilled): -Serum CRP AND SAA ≤ 10 mg/L AND -daily diary score (mean score/week) ≤ 2. 2) CNS remission was defined as follows: Headache score (from the daily diary, mean score/week) < 0.5 AND, when a lumbar puncture was performed: Normal values of white cell count (WBC) (≤15 cells/mm3) in CSF. The primary analysis was performed on all subjects randomised and received at least one dose of study drug. No patient was in stable full remission state as defined by the protocol.
    End point type
    Primary
    End point timeframe
    Month 6
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Only descriptive summary statistics was planned for this outcome measure.
    End point values
    Canakinumab
    Number of subjects analysed
    0 [2]
    Units: Percentage of subjects
    Notes
    [2] - No patient was in stable full remission state as defined by the protocol
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse Events are collected from First Patient First Visit (FPFV) until Last Patient Last Visit (LPLV).  All Adverse events are reported in this record from First Patient First Treatment until Last Patient Last Visit.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    13.1
    Reporting groups
    Reporting group title
    Canakinumab
    Reporting group description
    Subjects received bodyweight stratified dosage of canakinumab treatment at 300 mg (for subjects weighing more than 40 kg) and at 4 mg/kg (in children with body weight less than or equal to 40 kg) s.c. for every 4-­8 weeks as per investigator discretion for a treatment period of 6 months.

    Serious adverse events
    Canakinumab
    Total subjects affected by serious adverse events
         subjects affected / exposed
    1 / 6 (16.67%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Infections and infestations
    Staphylococcal infection
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Canakinumab
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    6 / 6 (100.00%)
    General disorders and administration site conditions
    Condition aggravated
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Pyrexia
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    3
    Reproductive system and breast disorders
    Amenorrhoea
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Nasal congestion
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Oropharyngeal pain
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    2
    Investigations
    Blood albumin increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood albumin decreased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    2
    Basophil count increased
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    Blood alkaline phosphatase increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood chloride increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood creatine phosphokinase decreased
         subjects affected / exposed
    3 / 6 (50.00%)
         occurrences all number
    4
    Blood creatine phosphokinase increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood creatinine decreased
         subjects affected / exposed
    5 / 6 (83.33%)
         occurrences all number
    6
    Blood glucose increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood triglycerides increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood uric acid decreased
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    C-reactive protein increased
         subjects affected / exposed
    3 / 6 (50.00%)
         occurrences all number
    4
    CSF protein increased
         subjects affected / exposed
    4 / 6 (66.67%)
         occurrences all number
    4
    CSF neutrophil count increased
         subjects affected / exposed
    5 / 6 (83.33%)
         occurrences all number
    6
    Haematocrit decreased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Eosinophil count increased
         subjects affected / exposed
    3 / 6 (50.00%)
         occurrences all number
    4
    CSF white blood cell count increased
         subjects affected / exposed
    5 / 6 (83.33%)
         occurrences all number
    6
    Haemoglobin decreased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Heart rate increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    High density lipoprotein decreased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Monocyte count increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Lymphocyte count increased
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    Platelet count decreased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Neutrophil count increased
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    3
    Platelet count increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    White blood cell count increased
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    Red blood cell sedimentation rate increased
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    Red blood cell count increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Joint injury
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    Procedural pain
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    3 / 6 (50.00%)
         occurrences all number
    3
    Headache
         subjects affected / exposed
    4 / 6 (66.67%)
         occurrences all number
    8
    Sinus headache
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Memory impairment
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Thrombocytopenia
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Ear and labyrinth disorders
    Ear pain
         subjects affected / exposed
    2 / 6 (33.33%)
         occurrences all number
    2
    Eye disorders
    Conjunctivitis allergic
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Lacrimation increased
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Vision blurred
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Nausea
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Gastrooesophageal reflux disease
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    2
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Pityriasis rosea
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Eczema
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Rash
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    3 / 6 (50.00%)
         occurrences all number
    3
    Joint stiffness
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Costochondritis
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Infections and infestations
    Ear infection
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Fungal infection
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Influenza
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Localised infection
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Subcutaneous abscess
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1
    Sinusitis
         subjects affected / exposed
    1 / 6 (16.67%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Jun 2009
    The starting dose of canakinumab treatment in NOMID subjects was modified (300 mg for subjects > 40 kg and 4 mg/kg for children ≤ 40 kg), and the treatment period was extended by additional 6 months.
    09 Dec 2009
    Reduction of the dosing interval from every 8 weeks to every 4 to 8 weeks.
    09 Feb 2010
    Extension period was prolonged from 6 months to 18 months, resulted in a total of 24 months treatment period.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    Study was terminated prematurely due to multiple protocol amendments for change in study design; limited number of subjects; availability of sufficient clinical data for higher doses of drug and lack of severe NOMID subjects for further evaluation.
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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