E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Juvenile Idiopathic Arthritis Associated Uveitis |
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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 | 10046851 |
E.1.2 | Term | Uveitis |
E.1.2 | System Organ Class | 10015919 - Eye 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 compare how effective the use of adalimumab, in combination with methotrexate versus methotrexate alone with regard to controlling disease activity in refractory uveitis associated with juvenile idiopathic arthritis. |
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E.2.2 | Secondary objectives of the trial |
- To evaluate the short term safety and tolerability of adalimumab in combination with methotrexate versus methotrexate alone with regards to complications of treatment, adverse events and laboratory assessments - To determine quality of life and cost effectiveness of adalimumab in combination with methotrexate versus methotrexate alone in patients with severe arthritis associated juvenile idiopathic arthritis - To determine clinical effectiveness of adalimumab in combination with methotrexate versus methotrexate alone with regards to underlying juvenile idiopathic arthritis disease activity - To determine the durability and magnitude of adalimumab efficacy response to sustaining inactive disease and achieve complete clinical remission - To determine the long term safety of adalimumab in combination with methotrexate versus methotrexate alone - To assess the efficacy of treatment with adalimumab to permit concomitant medication reduction, in particular steroids - To assess clinic |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
A participant is eligible for the trial based upon at least one eye fulfilling the eligibility criteria. - Children and young people aged ≥2- ≤18 years fulfilling the ILAR diagnostic criteria for JIA (all subgroups that have uveitis) - At the time of trial screening the participant must have active anterior uveitis, defined as a "sustained grade of cellular infiltrate in anterior chamber of SUN criteria grade ≥1 + or more during the preceding 4 weeks therapy despite MTX and corticosteroid (both systemic and topical therapy) - Failed MTX (min dose of 10mg/ m2) for a minimum of 12 weeks - Disease modifying immunosuppressive drugs, other than MTX, discontinued at least 4 weeks before receiving the first dose of adalimumab. The dose of MTX must be stable for at least 12 weeks prior to the screening visit. - Written informed consent of participant or parent/ legal guardian, and assent where appropriate - Participant and parent/ legal guardian willing and able to comply with protocol requirements - For participants of reproductive potential (males and females), use of a reliable means of contraception throughout their trial participation. Post pubertal females must have a negative serum pregnancy test within 10 days before the first dose of trial drug. |
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E.4 | Principal exclusion criteria |
Uveitis without a diagnosis of JIA Currently on adalimumab or has previously failed on adalimumab. Have been on other biologic agent within previous 5 half-lives of agent (For other biologic agents and their wash out periods, (refer to protocol supplementary document #10) More than 6 topical steroid eye drops per day at randomisation (this dose must have been stable for at least 4 weeks prior to screening visit) For patients on Prednisone or Prednisone equivalent, change of dose within 30 days prior to randomisation For patients on Prednisone or Prednisone equivalent with a dose >0.2mg/kg per day Intra-articular joint injections within four weeks prior to randomisation Any ongoing chronic or active infection (including infective uveitis) or any major episode of infection requiring hospitalisation or treatment with intravenous antibiotics within 30 days or oral antibiotics within 14 days prior to the screening evaluation History of active tuberculosis of less than 6 months treatment or untreated latent TB Participant has history of central nervous system (CNS) neoplasm, active CNS infection, demyelinating disease, or any progressive or degenerative neurological disease Poorly controlled diabetes or persistently poorly controlled severe hypertension (>95th percentile for height / age) as deemed by the treating physician Previous history of malignancy Intraocular surgery within the 3 months prior to screening (cataract/ glaucoma/ vitrectomy) Intra-ocular or peri-ocular corticosteroids within 30 days prior to randomisation. History of ocular herpetic disease Pregnant or nursing female Demonstrations of clinically significant deviations in any of the following laboratory parameters: Platelet count < 100,000/mm3 Total white cell count < 4000 cells/mm3 Neutrophils < 1000 cells/mm3 AST or ALT > 2 x upper limit of normal (ULN) or serum bilirubin > 2x the ULN Glomerular filtration rate (GFR) of < 90 mL/min/1.73m2 [GFR (ml.min/1.73 m2 BSA) = 0.55 x height (cm)/plasma creatinine (mg/dl)] Hematocrit <24% Having been administered a live or attenuated vaccine within three months prior to screening Previous randomisation into the SYCAMORE trial to either arm of the trial. . |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is ‘time to treatment failure’. Treatment failure is defined by ONE or more of the following: 1)Anterior segment inflammatory score grade (SUN criteria) a)Following at least 3 months of therapy: i)2-Step increase in SUN cell activity score (AC Cells) over 2 consecutive readings ii)Sustained non-improvement with entry grade of 3 or greater for 2 consecutive readings iii)Only partial improvement (1 grade) with sustained development of other ocular co-morbidity* iv)Sustained scores as recorded at entry grade measured over 2 consecutive readings (grades 0.5 to 2) still present after 6 months of therapy. v)Worsening of existing (on enrolment) ocular co-morbidity after 3 months 2) Use of Concomitant Medications: At any time, requirement to use concomitant medications in manner out with pre-defined acceptable criteria, or any of the concomitant medications not allowed * Ocular co-morbidities are defined as: i)Disc swelling and/or Cystoid Macular Oedema (CMO) as gauged clinically and where possible by OCT evidence; and/or: ii)Sustained raised intraocular pressure (<25mm Hg) over 1 month not responding to single ocular hypotensive agent, and/or: iii)Sustained hypotony (<6 mm Hg) over 1 month, and/or iv)Development of unexplained reduction in vision (LogMar) of 15 letters (in the event of cataract participants will remain in trial, also if cataract surgery is required. Failure will still remain as described in endpoints above). |
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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 | No |
E.6.7 | Pharmacodynamic | No |
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) | 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 | No |
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 | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 16 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
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 trial will be considered as the date of the final database lock. However, the trial may be closed prematurely by the Trial Steering Committee (TSC), on the recommendation of the Independent Data and Safety Monitoring Committee. Should the trial be closed prematurely, all active participants (receiving treatment or in follow-up) will be called in for a final follow-up visit and assessments will be undertaken as per schedule. |
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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 | 7 |
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 | 7 |
E.8.9.2 | In all countries concerned by the trial days | 0 |