E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Polymyalgia rheumatica |
Polimialgia reumatica |
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E.1.1.1 | Medical condition in easily understood language |
Polymyalgia rheumatica |
Polimialgia reumatica |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10036099 |
E.1.2 | Term | Polymyalgia rheumatica |
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 |
- To assess the efficacy of a single dose of AIN457 after 2 weeks as measured by the polymyalgia rheumatica activity score; - To assess the efficacy of a single dose of ACZ885 (canakinumab) after 2 weeks as measured by the polymyalgia rheumatica activity score. |
• Valutare l`efficacia di una singola somministrazione di AIN457 a 2 settimane attraverso il punteggio totale di attivita' della polimialgia reumatica • Valutare l`efficacia di una singola somministrazione di ACZ885 a 2 settimane attraverso il punteggio totale di attivita' della polimialgia reumatica |
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E.2.2 | Secondary objectives of the trial |
- To assess the time to partial clinical response, time to complete response and time to first flare in patients who respond to a single dose of AIN457 or ACZ885 (canakinumab); - To assess the effect of AIN457 and ACZ885 on the number of flares over a 6 month period; - To assess the effect of AIN457 and ACZ885 on the cumulative and/or mean steroid dose over a 6 month period; - To assess the safety and tolerability of AIN457 and ACZ885 in patients with polymyalgia rheumatic; - To characterize the PKs of AIN457 and ACZ885 in patients with polymyalgia rheumatic; - To compare the initial response to AIN457 and ACZ885 with the response after redosing of AIN457 and ACZ885; - To assess the effect on health-related quality of life (HAQ, SF-36); - To assess the potential for immunogenicity induced by ACZ885 / AIN457 in PMR patients. |
• Valutare il tempo alla risposta clinica parziale, alla risposta clinica completa ed il tempo alla prima recidiva in pazienti con risposta positiva ad una singola dose di AIN457 o ACZ885 • Valutare l`effetto di AIN457 e ACZ885 sul numero di recidive a 6 mesi • Valutare l`effetto di AIN457 e ACZ885 sulla dose cumulativa e/o media di steroidi a 6 mesi • Valutare il profilo di sicurezza e tollerabilita' nei pazienti con polimialgia reumatica in trattamento con AIN457 o ACZ885 • Caratterizzare il profilo di farmacocinetica di AIN457 o ACZ885 nei pazienti con polimialgia reumatica • Comparare la risposta iniziale ad AIN457 o ACZ885 rispetto al ritrattamento successivo con AIN457 o ACZ885 • Valutare l`effetto sulla qualita' della vita legata alla salute (HAQ, SF-36) • Valutare il potenziale immunogenico di AIN457 o ACZ885nei pazienti con polimialgia reumatica |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patients must be aged `¥50 and `¤85 at time of consent. 2. Patients with newly diagnosed PMR as well as patients with a history of PMR or previous PMR episodes treated with corticosteroids. Corticosteroid treatment must not have been within 3 months of the screening visit. 3. All female subjects must have negative pregnancy test results at screening (serum) and baseline (urine). Women of childbearing potential (WoCBP) must be using simultaneously doublebarrier or two acceptable methods of contraception, (e.g. intra-uterine device plus condom, spermicidal gel plus condom, diaphragm plus condom, etc., hormonal contraception as either oral or implantable is acceptable as one form), from the time of screening and for the duration of the study, through study completion and for 4 months following study completion and for 6 months post last dose of AIN457 / ACZ885 (canakinumab). Women on hormone contraception should be on this regimen for at least 2 months prior to study start. Postmenopausal females must have had no regular bleeding for at least two (2) years prior to initial dosing. If menopause is confirmed by a plasma FSH level of <40 IU/L at screening, pregnancy test will only be required at screening or consistent with menopause per local laboratory, pregnancy tests will be required before each infusion. Female subjects who report surgical sterilization must have had the procedure at least six (6) months prior to initial dosing. Surgical sterilization procedures should be supported with clinical documentation made available to the sponsor and/or Principle Investigator and noted in the Relevant Medical History / Current Medical Conditions section in the eCRF. If female subjects have male partners who have undergone vasectomy, the vasectomy must have occurred more than six (6) months prior to first dosing. Periodic abstinence (e.g. calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception. 4. Male subjects must be using two highly effective methods of contraception, comprising a barrier method condom or occlusive cap plus spermicide) plus ensure use by the female partner of a second method of contraception. These measures should be in place for the entire duration of the study up the Study Completion visit, and males should refrain from fathering a child in at least 6 months post last dose of AIN457/ACZ885 (canakinumab) 5. Patients must meet all of the following criteria (based on BSR guideline on PMR): • Age `¥ 50 and `¤85 years • CRP > 1.0 mg/dl OR ESR > 30 mm/hr • New bilateral shoulder and/or hip pain • Early Morning stiffness `¥ 60 min (at least 60 minutes) • Duration of illness > 1 week (at the time of initial diagnosis) 6. Patient must be able to understand and communicate with the investigator, to understand and comply with the requirements of the study and must give a written, signed and dated informed consent before any study assessment is performed. 7. All patients receiving current vaccinations, especially influenza and pneumococcal as clinically indicated can be included. Patients should not receive any live vaccines (this includes nasal-spray flu vaccine) within 12 weeks before study entry and within 12 weeks of the last dose of AIN457 or ACZ885 (canakinumab). 8. Subjects must weigh at least 50 kg to participate in the study, and must have a body mass index (BMI) within the range of 17 to 35 kg/m2. See Appendix 3 of this protocol for BMI ranges. |
• Pazienti con nuova diagnosi di PMR o pazienti con anamnesi positiva per PMR o pazienti con precedenti episodi ascrivibili a PMR trattati con corticosteroidi. Il trattamento con corticosteroidi non deve essere avvenuto nei 3 mesi precedenti alla visita di screening • Pazienti di eta' compresa tra 50 e 85 anni (estremi inclusi) con o PCR `¥ 1.0 mg/L oppure o VES `¥ 30 mm/h o Dolore bilaterale di nuova insorgenza alle spalle e/o anche o Rigidita' mattutina di durata uguale o superiore a 60 min o Durata della malattia superiore ad 1 settimana • Test PPD 5 U o QuantiFERON negativo allo screening (`¤5 mm di indurazione) |
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E.4 | Principal exclusion criteria |
- Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive hCG laboratory test (>5 mIU/mL); - Men who are planning to initiate a pregnancy while enrolled in the study or for 4 months following completion of the study, or who are not willing to follow the restrictions in inclusion criterion 3. Male or female patients who plan to conceive during the time course of the study and 6 months post last infusion of AIN457/ACZ885 (canakinumab); - Presence of rheumatoid arthritis or other inflammatory arthritic processes (features of GCA (Giant Cell Arthrtitis), spondyloarthropathies, Osteoarthritis, symptomatic shoulder capsulitis), connective tissue disease, drug-induced myopathies, chronic pain syndromes, as assessed by base line screening including TSH, CK, RF, CCP, ANA, serum protein electrophoresis, urinalysis; - History of PMR and Previous PMR episodes treated with steroids; - Previous exposure to methotrexate or other immune suppressive agent within 3 months prior to randomization; - Previous exposure to AIN457 or ACZ885 (canakinumab) or other biologic targeting IL-17, IL-17 receptor, IL-1b or IL-1β receptor, or use of any investigational drug and/or devices within 4 weeks prior to randomization or 5 half-lives of the investigational agent, whichever is longer and for any other limitation of pariticipation based on local regulations; - Active systemic infections during the last two weeks (exception: common cold) prior to randomization or current use of antibiotics. |
• Evidenza di infezioni attive o uso corrente di antibiotici • Anamnesi positiva per infezioni da HIV, HCV o HBV • Trattamento pregresso con MTX o altre terapie immunosoppressive durante i 3 mesi precedenti alla visita basale • Anamnesi positiva per neoplasie durante i 5 anni precedenti l`entrata in studio, ad eccezione di carcinoma a cellule squamose o basali non metastatico trattato con successo, e/o carcinoma localizzato in situ della cervice uterina • Evidenza allo screening (e confermato dal reperto laboratoristico sulla base di TSH, CK, FR, CCP, ANA, elettroforesi delle proteine, analisi delle urine) di artrite reumatoide o altri processi artritici infiammatori, malattie del connettivo, miopatie indotte da farmaco, disordini endocrini o neurologici, sindromi da dolore cronico Per maggiori dettagli consultare i paragrafi 5.1 e 5.2 del protocollo originale. |
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E.5 End points |
E.5.1 | Primary end point(s) |
PMR-AS on Day 15 |
PMR-AS al giorno 15 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Secondary End Point - To assess the time to partial clinical response, time to complete response and time to first flare in patients who respond to a single dose of AIN457 or ACZ885 (canakinumab) using the PMR activity score. - To assess the effect of AIN457 and ACZ885 (canakinumab) on the number of flares over a 6 month period using the PMR activity score at 6 month timepoint. - To assess the effect of AIN457 and ACZ885 (canakinumab) on the cumulative and/or mean steroid dose over a 6 month period comparing the steroid use due to flares in patients after 6 months. - To assess the safety and tolerability of AIN457 and ACZ885 (canakinumab) in patients with polymyalgia rheumatica by monitoring different standard lab parameters throughout the study period and collecting information on adverse events including infections from these patients. - To characterize the PKs of AIN457 and ACZ885 (canakinumab) in patients with polymyalgia rheumatica measured in blood serum samples. - To compare the initial response to AIN457 and ACZ885 (canakinumab) with the response after re-dosing of AIN457 and ACZ885 (canakinumab) using the PMR activity scores measured at these timepoints. - To assess the effect on health-related quality of life (HAQ, SF-36) by completion of respective patient reported outcome questionnaires. - To assess the potential for immunogenicity induced by ACZ885 (canakinumab) / AIN457 in PMR patients measured in blood serum samples. |
• Valutare il tempo alla risposta clinica parziale, alla risposta clinica completa ed il tempo alla prima recidiva in pazienti con risposta positiva ad una singola dose di AIN457 o ACZ885 • Valutare l`effetto di AIN457 e ACZ885 sul numero di recidive a 6 mesi • Valutare l`effetto di AIN457 e ACZ885 sulla dose cumulativa e/o media di steroidi a 6 mesi • Valutare il profilo di sicurezza e tollerabilita' nei pazienti con polimialgia reumatica in trattamento con AIN457 o ACZ885 • Caratterizzare il profilo di farmacocinetica di AIN457 o ACZ885 nei pazienti con polimialgia reumatica • Comparare la risposta iniziale ad AIN457 o ACZ885 rispetto al ritrattamento successivo con AIN457 o ACZ885 • Valutare l`effetto sulla qualita' della vita legata alla salute (HAQ, SF-36) • Valutare il potenziale immunogenico di AIN457 o ACZ885nei pazienti con polimialgia reumatica |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
As described in the Secondary end point. |
Come descritto nell'End point secondario. |
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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 | Yes |
E.6.11 | Pharmacogenomic | Yes |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Immunogenicity |
Immunogenicita' |
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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 | Yes |
E.8.1.4 | Double blind | No |
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.8.2.4 | Number of treatment arms in the trial | 3 |
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 | 5 |
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 | No |
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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LVLS : 18/APR/2012 |
LVLS : 18/04//2012 |
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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 | 0 |
E.8.9.1 | In the Member State concerned months | 7 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 14 |
E.8.9.2 | In all countries concerned by the trial days | 0 |