E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
axial spondyloarthritis (axial SpA) |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10051265 |
E.1.2 | Term | Spondyloarthropathy |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10002557 |
E.1.2 | Term | Ankylosing spondylitis and other inflammatory spondylopathies |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue 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 |
The primary objective of the study is to demonstrate the efficacy of CZP administered sc at the doses of CZP 200mg every 2 weeks and CZP400mg every 4 weeks after a loading dose of CZP 400mg at Weeks 0, 2, and 4 on the signs and symptoms of active axial SpA. |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives of the study are to assess the effects on safety and tolerability and to demonstrate the effects of CZP on:
• Health outcomes
• Partial remission
• Spinal mobility
• Structural damage and inflammation in the subpopulation of subjects with MRI
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Subject must be at least 18 years old at the Screening Visit.
2. An Institutional Review Board (IRB)/Independent Ethics Committee (IEC) approved written informed consent is signed and dated by the subject.
3. The subject is considered reliable, willing and capable of adhering to the protocol, visit schedule, and medication intake according to the judgment of the Investigator.
4. Female subjects must be either postmenopausal for at least 1 year, surgically incapable of childbearing, or effectively practicing an acceptable method of contraception (either oral/parenteral/implantable hormonal contraceptives, intrauterine device or barrier and spermicide). Abstinence only is not an acceptable method. Subjects must agree to use adequate contraception during the study and for at least 10 weeks (or longer if required by local regulations) after the last dose of study treatment. Male subjects must agree to ensure they or their female partner(s) use adequate contraception during the study and for at least 10 weeks (or longer if required by local regulations) after the subject receives their last dose of study treatment.
5. Subjects must have a documented diagnosis of adult onset axial SpA of at least 3 months’ symptom duration as defined by the specified ASAS criteria. Fifty percent of the study population who meet the ASAS criteria should NOT fulfill the modified NY criteria for definite diagnosis of AS (as stated in the protocol).
6. Subjects must have active disease as defined in the protocol.
7. Subjects must have been intolerant to or had an inadequate response to at least 1 nonsteroidal anti inflammatory drug (NSAID). Inadequate response to an NSAID is defined as lack of response to at least 30 days of continuous NSAID therapy at the highest tolerated dose of the administered NSAID or the lack of response to treatment with at least 2 NSAIDs at the maximum tolerated dose for 2 weeks each. |
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E.4 | Principal exclusion criteria |
Subject:
1. has previously participated in this study or has previously received CZP treatment in or outside of another clinical study.
2. has participated in another study of a medication or a medical device under investigation within the last 3 months or is currently participating in another study of a medication or medical device under investigation.
3. has history of chronic alcohol abuse or drug abuse within the last year.
4. has any medical or psychiatric condition that, in the opinion of the Investigator, can jeopardize or would compromise the subject’s ability to participate in this study.
5. has a known hypersensitivity to any components of CZP, placebo or with a history of an adverse reaction to polyethylene glycol (PEG).
6. must not have total spinal ankylosis (“bamboo spine”), a diagnosis of any other inflammatory arthritis eg, RA, systemic lupus erythematosus, sarcoidosis, or a known diagnosis of fibromyalgia.
7. must not have a secondary, noninflammatory condition that in the Investigator’s opinion is symptomatic enough to interfere with evaluation of the effect of study drug on the subject’s primary diagnosis of axial SpA.
8. must not have used the medications in the manner as detailed by the exclusion criteria in the protocol.
9. must not have received any nonbiological therapy for axial SpA not listed in section "Prior medications exclusion" of the protocol within or outside a clinical study in the 3 months or within 5 half lives prior to the Baseline Visit (whichever is longer).
10. must not have received any experimental biological agents other than those permitted in section "Prior medications exclusion" of the protocol.
11. must not have received previous treatment with a PEGylated compound that resulted in a severe hypersensitivity reaction or an anaphylactic reaction.
12. may not have been exposed to more than 1 TNF antagonist prior to the Baseline Visit and may not be a primary failure to any TNF antagonist therapy (as defined in the protocol).
13. may not have been exposed to more than 2 previous biological agents for axial SpA.
14. Female who are breastfeeding, pregnant or plan to become pregnant during the study or within 3 months following the last dose of the investigational product.
15. with a history of chronic or recurrent infections (more than 3 episodes requiring antibiotics or antivirals during the preceding year), recent serious or life–threatening infection within the 6 months prior to the Baseline Visit (including herpes zoster), hospitalization for any infection in the last 6 months or any current sign or symptom that may indicate an infection.
16. with known TB disease, high risk of acquiring TB infection, or latent TB infection, as defined in the protocol.
17. with concurrent acute or chronic viral hepatitis B or C or with known human immunodeficiency virus (HIV) infection.
18. with known history of or current clinically active infection with Histoplasma, Coccidiodes, Paracoccidioides, Pneumocystis, nontuberculous mycobacteria, Blastomyces, or Aspergillus.
19. must not have a history of an infected joint prosthesis at any time with that prosthesis still in situ.
20. receiving any live (includes attenuated) vaccination within the 8 weeks prior to Baseline.
21. with a high risk of infection in the Investigator’s opinion.
22. with a history of a lymphoproliferative disorder including lymphoma or current signs and symptoms suggestive of lymphoproliferative disease.
23. with concurrent malignancy or a history of malignancy (subjects with less than 3 excised basal cell carcinomas or with cervical carcinoma in situ successfully surgically treated more than 5 years prior to Screening may be included).
24. with Class III or IV congestive heart failure as per the New York Heart Association (NYHA) 1964 criteria.
25. with a history of, or suspected, demyelinating disease of the central nervous system.
26. having had major surgery (including joint surgery) within 8 weeks prior to Screening, or having planned surgery within 6 months after entering the study.
27. with a current or recent history, as determined by the Investigator, of severe, progressive, and/or uncontrolled renal, hepatic, hematological, endocrine, pulmonary, cardiac, or neurological disease.
28. with clinically significant laboratory abnormalities (as defined in the protocol).
29. with any other condition which, in the Investigator’s judgment, would make the subject unsuitable for inclusion in the study.
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary efficacy variable: ASAS20 response at Week 12.
Pharmacokinetic and pharmacodynamic variables:
- Certolizumab pegol plasma concentrations at periods defined in the protocol.
- Anti-CZP antibodies at periods defined in the protocol.
- Dickkopf-related protein 1 (DKK1) and sclerostin levels may be analyzed for exploratory biomarker research using selected samples collected for measurement of CZP plasma concentration
Safety variables:
- adverse events,
- serious adverse events,
- vital signs,
- physical examination findings,
- signs and symptoms of latent or active tuberculosis,
- measurements of laboratory parameters (hematology, biochemistry and urinalysis),
- pregnancy testing |
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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 | No |
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 | 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 | Yes |
E.8.1.7.1 | Other trial design description |
from week 24 to 48: no placebo, dose-blind for subjects/investigators and from week 48: open-label |
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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 | 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 | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 65 |
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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The end of the study is defined as the date of the last visit of the last subject in the study. |
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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 | 4 |
E.8.9.1 | In the Member State concerned months | 3 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 4 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 0 |