E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Anemic Patients With IPSS Low- or Intermediate-1-Risk Myelodysplastic Syndromes |
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E.1.1.1 | Medical condition in easily understood language |
Anemic Patients With Myelodysplastic Syndromes |
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E.1.1.2 | Therapeutic area | Diseases [C] - Blood and lymphatic diseases [C15] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10002272 |
E.1.2 | Term | Anemia |
E.1.2 | System Organ Class | 100000004851 |
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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 demonstrate that epoetin alfa treatment is better at improving anemia outcome (as evaluated by Erythroid response – International Working Group [IWG] 2006) in subjects with International Prognostic Scoring Systems (IPSS) Low- or Intermediate-1-risk myelodysplastic syndromes (MDS), compared with placebo, through Week 24. |
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E.2.2 | Secondary objectives of the trial |
The secondary objectives include: - For responders at Week 24, observe the duration of the response through Week 48. - To assess the proportion of responders at Week 24 maintaining response through Week 48 (as measured by Erythroid response – IWG 2006). - To compare time to first RBC transfusion, transfusion-free intervals, and number of RBC units transfused. - To measure and compare changes in patient-reported outcome (PRO)/quality of life from baseline via the Functional Assessment of Cancer Therapy - Anemia/Fatigue (FACT-An) and EuroQol 5-dimension (EQ-5D) questionnaires. - To collect medical resource utilization data that may be used in future economic modeling (the construction and reporting of the economic model will be conducted separately from this study). Overall safety will also be assessed. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Male or female subject at least 18 years of age;
2. Criterion modified per amendment; 2.1. Criterion modified per amendment; 2.2. Diagnosis of MDS according to WHO or FAB pathologic classification (confirmed via bone marrow aspirate/biopsy) within 12 weeks prior to screening/during screening phase; Note: If there is any sign of disease progression, a bone marrow aspirate/biopsy should be repeated during the screening phase.
3. Criterion modified per amendment; 3.1. Criterion modified per amendment. 3.2. Documentation of an IPSS score indicating Low- or Intermediate-1-risk disease within 12 weeks prior to screening/during screening phase; Note: If there is no sign of disease progression, an IPSS score based on bone marrow sample obtained up to 12 weeks before screening can be used for documentation.
4. Criterion modified per amendment; 4.1. Criterion modified per amendment; 4.2. Hemoglobin concentration at screening and baseline (before the first dose of study drug) of 10.0 g/dL or less; Note: Assessment should be based on untransfused hemoglobin, ie, the subject did not receive a RBC transfusion within the previous 2 weeks (if the subject was transfused within 2 weeks before screening or between screening and baseline a maximum hemoglobin concentration of 10.5 g/dL at screening or at baseline is acceptable).
5. Criterion modified per amendment 5.1 Screening serum erythropoietin concentration of less than 500 mU/mL; Note: Any subject with screening serum erythropoietin concentration >500 mU/mL can be retested once if the investigator has reason to believe that this is an unusual erythropoietin concentration for the subject.
6. Criterion modified per amendment; 6.1. RBC transfusion requirement of less than or equal to 4 RBC units over the last 8 weeks before randomization;
7. Screening Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2;
8. Adequate iron stores, defined as serum ferritin greater than 100 ng/mL, transferrin saturation greater than 20%, or both, measured within the 2-week screening period, or adequate iron stores as demonstrated by recent (within 12 weeks) bone marrow examination with iron stain;
9. Criterion modified per amendment; 9.1 Documentation of adequate vitamin B12 and folate levels (above the lower limit of the reference range for the laboratory performing the assay), measured at screening and/or baseline. Note: If the levels are below the lower limit at screening, and the subject has a confirmed diagnosis of MDS based on the bone marrow sample, subjects may be resupplied with vitamin B12 and/or folate during the screening period (resupply should be started without delay) and have levels retested so that the results would be available at baseline (before randomization); such subjects with adequate levels from results available at baseline will be eligible for enrollment.
10. Female subjects with reproductive potential must be surgically sterile, abstinent, or practicing an effective method of birth control (eg, prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method [spermicidal jelly or foam with condoms or diaphragm], contraceptive patch, male partner sterilization) before entry and throughout the study and have a negative urine or serum beta-human chorionic gonadotropin (hCG) pregnancy test at screening (all female subjects with reproductive potential) and at Week 24 (female subjects with reproductive potential continuing in the treatment extension phase);
11. Willingness to adhere to the prohibitions and restrictions specified in this protocol;
12. Subjects (or their legally acceptable representatives) must sign an informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study.
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E.4 | Principal exclusion criteria |
1. Anemia attributed to factors other than MDS (including hemolysis, chronic renal failure, hepatitis, gastrointestinal bleeding);
2. Secondary MDS (ie, MDS arising after chemotherapy, immunotherapy or radiation therapy/exposure);
3. Criterion modified per amendment; 3.1. History of malignancy except in situ skin basal cell carcinoma or carcinoma in situ of the cervix or breast curatively treated;
4. Criterion modified per amendment; 4.1 Prior therapy with any ESA (including innovative ESAs and biosimilar ESAs for approved indications or for investigational use) in the last 8 weeks before randomization;
5. Criterion modified per amendment; 5.1 Prior use of approved or experimental agents for the treatment of MDS; Note: This restriction pertains to agents that are intended to directly influence the proliferation of the malignant clone in the bone marrow and altering the course of the disease (eg, hypomethylating agents, lenalidomide, chemotherapy etc). Different treatments that aim to treat the cytopenias caused by MDS are not exclusionary in the cases where exclusion criteria 4 and 10 are not met.
6. History (within 6 months) of DVT (including proximal and distal), pulmonary embolism, or other venous thrombosis;Note: prior superficial thrombophlebitis is not an exclusion criterion.
7. Clinically significant, uncontrolled disease or dysfunction of the pulmonary, cardiovascular, endocrine, neurologic, gastrointestinal, or genitourinary systems not attributable to MDS;
8. Criterion modified per amendment; 8.1 Uncontrolled hypertension (defined as a systolic pressure of 160 mmHg or higher, or a diastolic pressure of 110 mmHg or higher, or both); Note: Pertains to a history of uncontrolled hypertension, as reported by the subject or their physician (eg, general practitioner, cardiologist). A single high blood pressure measurement at screening or baseline, which can be indicative of white coat syndrome, will not be exclusionary.
9. Criterion modified per amendment; 9.1. Use of androgens or corticosteroids for the treatment of MDS within the 2 weeks before screening; androgen or corticosteroid use is allowed for other underlying concomitant diseases (eg, rheumatoid arthritis)
10. Criterion modified per amendment; 10.1. Prior (within 2 weeks before screening) treatment with G-CSF or granulocyte-macrophage colony-stimulating factor (GM-CSF) for the treatment of neutropenia; Note: in case of neutropenic fever, use of these agents is not an exclusion criterion.
11. Known history of human immunodeficiency virus (HIV) seropositivity;
12. Criterion modified per amendment; 12.1 History (within 6 months before screening) of cerebrovascular accident (including ischemic, embolic, and hemorrhagic cerebrovascular accident), transient ischemic attack, acute coronary syndrome (including myocardial ischemia, unstable angina, Q-wave myocardial infarction, non-Q-wave myocardial infarction), or other arterial thrombosis; Note: Subjects with stable angina should be asymptomatic under normal daily effort with or without treatment, there should be no ischemic changes on resting ECG and the onset of the angina should not be within 6months before screening. Subjects who had ischemic heart disease (IHD) but underwent percutaneous transluminal coronary angioplasty (PTCA) are allowed in the study. It is strongly recommended, when indicated, that subjects who have IHD or have had PTCA be receiving antiaggregant treatment as prophylaxis.
13. Known history of inherited conditions that predispose the subject to thrombosis (eg, AT3 deficiency, Factor V Leiden);
14. New-onset seizures (within 3 months before randomization) or poorly controlled seizures;
15. Pregnancy or breastfeeding;
16. Known hypersensitivity to mammalian cell-derived products or to human albumin;
17. Use of experimental agents or devices for any reason within 4 weeks before randomization;
18. Major infection requiring hospitalization and antibiotic use within 2 weeks before randomization;
19. Major surgery within 4 weeks before randomization or planned major surgery during the study period;
20. Planned stem cell harvest of bone marrow or high dose chemotherapy with stem cell transplantation during the study period;
21. Previous bone marrow or stem cell transplantation;
22. History of PRCA and/or antibody against erythropoietin;
23. Employee of the investigator or study center, with direct involvement in the proposed study or other studies under the direction of that investigator or study center and family members of the employees or the investigator
24. Have been receiving iron chelation therapy for 6 months or more at screening for iron overload caused by blood transfusion. |
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E.5 End points |
E.5.1 | Primary end point(s) |
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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) |
The secondary efficacy endpoints are:
1/ Maintenance of Erythroid response
2/ Duration of response
3/ Time to first Red Blood Cell transfusion
4/ Transfusion-free intervals
5/ Number of Red Blood Cell units transfused
6/ Quality of life as measured by Functional Assessment of Cancer Therapy-Anemia/Fatigue (FACT-An) questionnaire
7/ Quality of life as measured by EuroQol 5-dimension (EQ-5D) questionnaire
8/ Drug Consumption
9/ Duration of Hospitalization
10/ Number and duration of medical care encounters |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1/ every 4 weeks from week 24 to week 48
2/ every 4 weeks after week 24
3/ from baseline to study end (week 28 for non responders, week 54 for responders or 4 weeks after early withdrawal)
4/ from baseline to study end (week 28 for non responders, week 54 for responders or 4 weeks after early withdrawal)
5/ from baseline to study end (week 28 for non responders, week 54 for responders or 4 weeks after early withdrawal)
6/ at baseline, week 24 and week 48
7/ at baseline, week 24 and week 48
8/ every 4 weeks from baseline to week 48
9/ every 4 weeks from baseline to week 48
10/ every 4 weeks from baseline to week 48
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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 | 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) | 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 | 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.8.2.4 | Number of treatment arms in the trial | 2 |
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.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 32 |
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 |
France |
Germany |
Greece |
Italy |
Russian Federation |
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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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last visit of last subject |
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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 | |
E.8.9.1 | In the Member State concerned months | 24 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial months | 24 |