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    Clinical Trial Results:
    Double-blind, randomised, placebo-controlled multicentre phase III clinical study followed by open-label phase on the efficacy and tolerability of budesonide 3 mg effervescent tablet in patients with resistant oral chronic GvHD

    Summary
    EudraCT number
    2008-004562-10
    Trial protocol
    DE   AT   FR   SE   IT   CZ  
    Global end of trial date
    20 Jul 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    26 Aug 2018
    First version publication date
    26 Aug 2018
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    BUM-5/GVH
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT00887263
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Dr. Falk Pharma GmbH
    Sponsor organisation address
    Leinenweberstr. 5, Freiburg, Germany, 79108
    Public contact
    Department of Clinical Research, Dr. Falk Pharma GmbH, 49 761 1514-0, zentrale@drfalkpharma.de
    Scientific contact
    Department of Clinical Research, Dr. Falk Pharma GmbH, 49 761 1514-0, zentrale@drfalkpharma.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    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?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    11 Jul 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    20 Jul 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    20 Jul 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    • To compare the efficacy and tolerability of budesonide 3 mg effervescent tablet (9 mg/day) vs. placebo for the treatment of patients with resistant oral chronic graft versus host disease (cGvHD) • To study safety and tolerability in the form of adverse events and laboratory parameters
    Protection of trial subjects
    Close supervision of subjects by implementing interim visits every 14 days (during 12 weeks double-blind phase) and then every 2 to 12 weeks (during 40 weeks open-label phase) to guarantee their safety and wellbeing. Prior to recruitment of patients, all relevant documents of the clinical study were submitted and proved by the Independent Ethics Committees (IECs) responsible for the participating investigators. Written consent documents embodied the elements of informed consent as described in the Declaration of Helsinki, the ICH Guidelines for Good Clinical Practice (GCP) and were in accordance with all applicable laws and regulations. The informed consent form and patient information sheet described the planned and permitted uses, transfers and disclosures of the patient's personal data and personal health information for purposes of conducting the study. The informed consent form and the patient information sheet further explained the nature of the study, its objectives and potential risks and benefits as well as the date informed consent was given. Before being enrolled in the clinical trial, every patient was informed that participation in this trial was voluntary and that he/she could withdraw from the study at any time without giving a reason and without having to fear any loss in his/her medical care. The patient’s consent was obtained in writing before the start of the study. By signing the informed consent, the patient declared that he/she was participating voluntarily and intended to follow the study protocol instructions and the instructions of the investigator and to answer the questions asked during the course of the trial.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    30 Mar 2009
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Ethical reason, Regulatory reason
    Long term follow-up duration
    5 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 8
    Country: Number of subjects enrolled
    Turkey: 6
    Country: Number of subjects enrolled
    Israel: 16
    Country: Number of subjects enrolled
    Switzerland: 13
    Country: Number of subjects enrolled
    Poland: 4
    Country: Number of subjects enrolled
    Austria: 10
    Country: Number of subjects enrolled
    Czech Republic: 5
    Country: Number of subjects enrolled
    France: 1
    Country: Number of subjects enrolled
    Germany: 88
    Country: Number of subjects enrolled
    Italy: 32
    Worldwide total number of subjects
    183
    EEA total number of subjects
    140
    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)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    172
    From 65 to 84 years
    11
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    In total 189 patients were enrolled. Thereof 186 patients were randomised to treatment with budesonide or placebo. A total of 184 patients received at least one dose of study medication. 183 patients are included in full analysis set (one patient without erythema and ulcers had to be excluded).

    Pre-assignment
    Screening details
    Screening criteria: 1. Signed informed consent 2. Aged 18 to 75 years 3. Oral cGvHD of erosive and/or ulcerative type

    Period 1
    Period 1 title
    Double-blind phase (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor
    Blinding implementation details
    Budesonide and placebo effervescent tablets had same appearance/taste to guarantee double-blinding.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A
    Arm description
    Budesonide 3 mg effervescent tablet 3 times daily
    Arm type
    Experimental

    Investigational medicinal product name
    Budesonide 3 mg effervescent tablet
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Effervescent tablet
    Routes of administration
    Oromucosal use
    Dosage and administration details
    1 budesonide 3 mg effervescent tablet 3 times daily; rinse for at least a duration of 10 minutes

    Arm title
    Arm B
    Arm description
    Placebo effervescent tablet 3 times daily
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo 3 mg effervescent tablet
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Effervescent tablet
    Routes of administration
    Oromucosal use
    Dosage and administration details
    1 placebo effervescent tablet 3 times daily; rinse for at least a duration of 10 minutes

    Number of subjects in period 1
    Arm A Arm B
    Started
    89
    94
    Completed
    54
    50
    Not completed
    35
    44
         Consent withdrawn by subject
    5
    6
         Adverse event, non-fatal
    9
    7
         other
    2
    2
         Lack of efficacy
    19
    29

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Double-blind phase
    Reporting group description
    -

    Reporting group values
    Double-blind phase Total
    Number of subjects
    183 183
    Age categorical
    183 patients were randomised and treated aged 18 to 72 years.
    Units: Subjects
        Adults (18-64 years)
    172 172
        From 65-84 years
    11 11
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    46.3 ± 13.5 -
    Gender categorical
    Units: Subjects
        Female
    75 75
        Male
    108 108

    End points

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    End points reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Budesonide 3 mg effervescent tablet 3 times daily

    Reporting group title
    Arm B
    Reporting group description
    Placebo effervescent tablet 3 times daily

    Primary: Objective Response

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    End point title
    Objective Response
    End point description
    The primary efficacy variable was the proportion of patients showing objective response at the final/withdrawal visit.
    End point type
    Primary
    End point timeframe
    12 weeks double-blind Treatment
    End point values
    Arm A Arm B
    Number of subjects analysed
    89
    94
    Units: Patients
    38
    30
    Statistical analysis title
    Confirmative analysis
    Statistical analysis description
    Confirmative comparison between Arm A (budesonide) and Arm B (placebo)
    Comparison groups
    Arm A v Arm B
    Number of subjects included in analysis
    183
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    Method
    Parameter type
    Risk difference (RD)
    Point estimate
    0.108
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -0.032
         upper limit
    0.247

    Secondary: Median time to 1st occurrence of objective response

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    End point title
    Median time to 1st occurrence of objective response
    End point description
    Reporung Group 2 (Arm B): upper Limit of CI has to be empty, but system does not allow empty field nor NA. Thus, we entered fictive value of 100.00.
    End point type
    Secondary
    End point timeframe
    NA
    End point values
    Arm A Arm B
    Number of subjects analysed
    89
    94
    Units: day
    median (confidence interval 95%)
        days
    58 (43.0 to 83.0)
    86 (67.0 to 100.00)
    Statistical analysis title
    Kaplan-Meier analysis
    Comparison groups
    Arm B v Arm A
    Number of subjects included in analysis
    183
    Analysis specification
    Pre-specified
    Analysis type
    other
    Method
    Parameter type
    Hazard ratio (HR)
    Point estimate
    1.539
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.007
         upper limit
    2.353

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were assessed from baseline to final visit.
    Adverse event reporting additional description
    Treatment-emergent adverse events.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    13.0
    Reporting groups
    Reporting group title
    Arm A
    Reporting group description
    Budesonide 3 mg effervescent tablet 3 times daily

    Reporting group title
    Arm B
    Reporting group description
    Placebo effervescent tablet 3 times daily

    Serious adverse events
    Arm A Arm B
    Total subjects affected by serious adverse events
         subjects affected / exposed
    15 / 90 (16.67%)
    12 / 94 (12.77%)
         number of deaths (all causes)
    2
    0
         number of deaths resulting from adverse events
    2
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute myeloid leukaemia recurrent
         subjects affected / exposed
    1 / 90 (1.11%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Injury, poisoning and procedural complications
    Hip fracture
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Rehabilitation therapy
         subjects affected / exposed
    1 / 90 (1.11%)
    3 / 94 (3.19%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Circumcision
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dental operation
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    PUVA
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Pericardial effusion
         subjects affected / exposed
    2 / 90 (2.22%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myopericarditis
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    1 / 90 (1.11%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Keratitis
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dacryostenosis acquired
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Obliterative bronchiolitis
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Skin ulcer
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    2 / 90 (2.22%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Adenoviral haemorrhagic cystitis
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rotavirus infection
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia influenzal
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Subcutaneous abscess
         subjects affected / exposed
    1 / 90 (1.11%)
    0 / 94 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Dacryocystitis
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lung infection
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Cachexia
         subjects affected / exposed
    0 / 90 (0.00%)
    1 / 94 (1.06%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Arm A Arm B
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    82 / 90 (91.11%)
    84 / 94 (89.36%)
    Immune system disorders
    Graft versus host disease
         subjects affected / exposed
    7 / 90 (7.78%)
    15 / 94 (15.96%)
         occurrences all number
    7
    15
    Chronic graft versus host disease
         subjects affected / exposed
    11 / 90 (12.22%)
    3 / 94 (3.19%)
         occurrences all number
    11
    3
    Acute graft versus host disease in skin
         subjects affected / exposed
    3 / 90 (3.33%)
    5 / 94 (5.32%)
         occurrences all number
    3
    5
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    7 / 90 (7.78%)
    4 / 94 (4.26%)
         occurrences all number
    7
    4
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    7 / 90 (7.78%)
    11 / 94 (11.70%)
         occurrences all number
    7
    11
    Musculoskeletal and connective tissue disorders
    Muscle spasms
         subjects affected / exposed
    7 / 90 (7.78%)
    1 / 94 (1.06%)
         occurrences all number
    7
    1
    Infections and infestations
    Oral candidiasis
         subjects affected / exposed
    11 / 90 (12.22%)
    6 / 94 (6.38%)
         occurrences all number
    11
    6
    Nasopharyngitis
         subjects affected / exposed
    6 / 90 (6.67%)
    7 / 94 (7.45%)
         occurrences all number
    6
    7
    Oral herpes
         subjects affected / exposed
    4 / 90 (4.44%)
    9 / 94 (9.57%)
         occurrences all number
    4
    9
    Bronchitis
         subjects affected / exposed
    6 / 90 (6.67%)
    4 / 94 (4.26%)
         occurrences all number
    6
    4

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    03 Apr 2009
    Exclusion criterion "hepatic function" adapted. Follow-up visit added.
    21 May 2010
    Exclusion criterion concurrent treatment for muscosal lesions adapted (allowance of prophylactic treatment to prevent infection). Extracorporeal photochemotherapy allowed if unsuccessful 6 months before inclusion. Treatment with posaconazole allowed.
    12 Apr 2012
    Inclusion of patients with oral cGvHD only and no need for systemic immunosuppression allowed. Additional country: USA
    15 Apr 2014
    List of expected adverse drug reactions updated. Contact details of medical expert updated.

    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.
    Double-blind phase (period 1) reported only. System does not allow to report open-label phase (period 2) since number of patients of period 2 is higher than number of completers of period 1. All data will be published.
    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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