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    Clinical Trial Results:
    A multicenter, randomized, double-blinded, parallel-group, placebocontrolled study to assess the efficacy and safety of skeletal muscle-derived cell implantation in female patients with stress urinary incontinence

    Summary
    EudraCT number
    2010-021871-10
    Trial protocol
    DE   CZ   BG   AT   IT   GB  
    Global end of trial date
    09 Sep 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    14 Jul 2023
    First version publication date
    14 Jul 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    IC-01-01-05-004
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Innovacell Biotechnologie AG
    Sponsor organisation address
    Mitterweg 24, Innsbruck, Austria, 6020
    Public contact
    N/A, Innovacell AG, 0043 512573680, office@innovacell.com
    Scientific contact
    N/A, Innovacell AG, 0043 6765184115, office@innovacell.com
    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
    10 Mar 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    09 Sep 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    09 Sep 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The main objective is to show superiority of skeletal muscle-derived cells (SMDCs) over placebo in female patients with SUI
    Protection of trial subjects
    This study was conducted in full accordance with the International Conference of Harmonisation Good Clinical Practice (GCP) Consolidated Guideline (E6) and any applicable national and local laws and regulations.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Aug 2012
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Romania: 145
    Country: Number of subjects enrolled
    Austria: 5
    Country: Number of subjects enrolled
    Bulgaria: 248
    Country: Number of subjects enrolled
    Czechia: 34
    Country: Number of subjects enrolled
    Germany: 42
    Country: Number of subjects enrolled
    United Kingdom: 2
    Worldwide total number of subjects
    476
    EEA total number of subjects
    474
    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)
    476
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Approximately 29 centers were targeted to be involved in DE, AT, RO, BG, CZ, and UKin conducting the study. Finally 31 centers had participated in the recruitment of patients.

    Pre-assignment
    Screening details
    The study was a multinational, multicenter, randomized, double-blind, placebo-controlled study with parallel-group design. Patients were randomized in a double-blind manner to one of the following groups: Cell group or Placebo group in a ratio of 2:1 (cell group: placebo group). 476 patients were screened and 377 patients were randomized.

    Period 1
    Period 1 title
    Overall Study (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
    The randomization of patients to one of the two treatment groups was done via an Interactive Voice Response System (IVRS), which assigned the respective unique randomization number to each patient. The IVRS was furthermore used for emergency unblinding, management of IMP shipments as well as for re-ordering of biopsy transportation kits.

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Placebo
    Arm description
    cell-free medium
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for solution for injection
    Routes of administration
    Intramuscular use
    Dosage and administration details
    Placebo, injection of cell-free suspension into to external urethral sphincter.

    Arm title
    SMDC
    Arm description
    cell therapy 0.2 x 10e6 cells / 2 mL, injected into the external urethral sphincter
    Arm type
    Experimental

    Investigational medicinal product name
    Skeletal muscle-derived cells (SMDCs)
    Investigational medicinal product code
    ICES13
    Other name
    Pharmaceutical forms
    Solution for solution for injection
    Routes of administration
    Intramuscular use
    Dosage and administration details
    0.2 x 106 cells / 2 mL SMDCs injected into the external urethral sphincter

    Number of subjects in period 1 [1]
    Placebo SMDC
    Started
    125
    252
    Completed
    113
    235
    Not completed
    12
    17
         Consent withdrawn by subject
    12
    17
    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: 99 patients were screen failures and did not undergo randomization.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Placebo
    Reporting group description
    cell-free medium

    Reporting group title
    SMDC
    Reporting group description
    cell therapy 0.2 x 10e6 cells / 2 mL, injected into the external urethral sphincter

    Reporting group values
    Placebo SMDC Total
    Number of subjects
    125 252 377
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    55.8 ( 11.6 ) 54.7 ( 11.2 ) -
    Gender categorical
    Units: Subjects
        Female
    125 252 377
        Male
    0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Placebo
    Reporting group description
    cell-free medium

    Reporting group title
    SMDC
    Reporting group description
    cell therapy 0.2 x 10e6 cells / 2 mL, injected into the external urethral sphincter

    Primary: IEF reduction response (75% reduction)

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    End point title
    IEF reduction response (75% reduction)
    End point description
    Response was defined as a reduction in the incontinence episode frequency (IEF) of 75% from baseline (Visit 0) to Visit 4. The IEF was calculated as the number of incontinence episodes that occurred during 7 days preceding a visit.
    End point type
    Primary
    End point timeframe
    12 months post implantation
    End point values
    Placebo SMDC
    Number of subjects analysed
    114
    243
    Units: number of patients
    33
    37
    Statistical analysis title
    Difference between placebo and SMDCs
    Statistical analysis description
    Response was defined as a reduction in the incontinence episode frequency (IEF) of 75% from baseline (Visit 0) to Visit 4. The IEF was calculated as the number of incontinence episodes that occurred during 7 days preceding a visit.
    Comparison groups
    Placebo v SMDC
    Number of subjects included in analysis
    357
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.263 [1]
    Method
    Fisher exact
    Parameter type
    Mean difference (net)
    Confidence interval
    Variability estimate
    Standard deviation
    Notes
    [1] - Threshold for significance at 0.025 level.

    Primary: I-QoL total score

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    End point title
    I-QoL total score
    End point description
    End point type
    Primary
    End point timeframe
    12 months post implantation
    End point values
    Placebo SMDC
    Number of subjects analysed
    114 [2]
    243 [3]
    Units: Improvement total score
        arithmetic mean (standard deviation)
    26.13 ( 25.14 )
    26.35 ( 25.18 )
    Notes
    [2] - 12 months post implantation data only available for 114 patients
    [3] - 12 months post implantation data only available for 243 patients
    Statistical analysis title
    Difference between placebo and SMDCs
    Comparison groups
    Placebo v SMDC
    Number of subjects included in analysis
    357
    Analysis specification
    Pre-specified
    Analysis type
    superiority
    P-value
    = 0.47 [4]
    Method
    t-test, 1-sided
    Parameter type
    Mean difference (final values)
    Confidence interval
    Notes
    [4] - Threshold for significance at 0.025 level

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AEs have been collected from study start (first patient in) to 12 months post implantation. Serious Adverse Events have been collected for up to 24 months post implantation.
    Adverse event reporting additional description
    377 patients were randomized within the study. The safety set includes 369 patients. Patients that were randomized but no biopsy or cell implantation has been performed were excluded from the safety set. For non serious adverse event reporting only procedure related AEs are shown below.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    18.1
    Reporting groups
    Reporting group title
    SMDC
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    SMDC Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    11 / 247 (4.45%)
    10 / 122 (8.20%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Thymoma
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Marginal zone B cell lymphoma
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Breast cancer
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cervix carcinoma
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Ovarian cancer
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Fracture Lumbar Vertebra
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Drug dispensed to wrong patient
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Acute left ventricular failure
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Surgical and medical procedures
    Cholecystectomy
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Lumbosacral radiculitis
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Myasthenia gravis
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Peripheral nerve paresis
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Reproductive system and breast disorders
    Brest haematoma
         subjects affected / exposed
    2 / 247 (0.81%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Painful defecation
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Nephrolithiasis
         subjects affected / exposed
    0 / 247 (0.00%)
    2 / 122 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteoarthritis
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Sigmadiverticulitis
         subjects affected / exposed
    2 / 247 (0.81%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Postoperative intramuscular abdominal wall infection
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Abszess vaginal lips
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    SMDC Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    10 / 247 (4.05%)
    10 / 122 (8.20%)
    Investigations
    Bacterial test positive
         subjects affected / exposed
    2 / 247 (0.81%)
    0 / 122 (0.00%)
         occurrences all number
    2
    0
    C-reactive protein increased
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Injury, poisoning and procedural complications
    Procedural pain
    Additional description: Implantation or biopsy related
         subjects affected / exposed
    2 / 247 (0.81%)
    2 / 122 (1.64%)
         occurrences all number
    2
    2
    Urinary retention postoperative
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Procedural hypotension
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences all number
    0
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    0 / 247 (0.00%)
    2 / 122 (1.64%)
         occurrences all number
    0
    2
    Puncture site pain
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    1 / 247 (0.40%)
    2 / 122 (1.64%)
         occurrences all number
    1
    2
    Abdominal pain upper
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Hepatobiliary disorders
    Hepatic steatosis
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Renal and urinary disorders
    Urethral disorder
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences all number
    0
    1
    Blood urine present
         subjects affected / exposed
    0 / 247 (0.00%)
    1 / 122 (0.82%)
         occurrences all number
    0
    1
    Dysuria
         subjects affected / exposed
    4 / 247 (1.62%)
    0 / 122 (0.00%)
         occurrences all number
    4
    0
    Stress urinary incontinence
    Additional description: worsening of symptoms
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Nephrolithiasis
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Haemorrhage urinary tract
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Haematuria
         subjects affected / exposed
    1 / 247 (0.40%)
    0 / 122 (0.00%)
         occurrences all number
    1
    0
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    2 / 247 (0.81%)
    1 / 122 (0.82%)
         occurrences all number
    2
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    24 Sep 2010
    Protocol version 2.0 has been submitted to Bulgaria (approval date: 28-Jul-2011), Czech Republic (approval date: 02-Aug-2011), Romania (not approved) and Germany (not approved). Initial submission of regulatory package according to local requirements
    21 Oct 2011
    Protocol version 3.0 has been submitted to Bulgaria (approval date: 15-Mar-2012), Czech Republic (approval date: 27-Jan-2012), Romania (approval date: 03-Sep-2012), Austria (approval date: 16-Mar-2012), United Kingdom (not approved) and Germany (not approved). Non-responders as identified based on the IEF at study end (Visit 4, Day 365 ± 14) will be offered a cell therapy in the scope of a subsequent, separate open-label study.
    20 Mar 2012
    Protocol version 4.0 has been submitted to Bulgaria (approval date: 03-Oct-2014), Czech Republic (approval date: 18-Nov-2014), Romania (approval date: 11-Dec-2014), Austria (approval date: 05-Aug-2014), United Kingdom (not approved) and Germany (18-Apr-2012). Inclusion of 24 months follow-up: the follow-up phase consisted of three additional clinical visits: (start visit (SV), V5 (after 18 months of implantation) and visit 6 (after 24 months of implantation).

    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.
    None reported
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    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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