E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Systemic lupus erythematosus (SLE) |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Body processes [G] - Immune system processes [G12] |
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 | 10042945 |
E.1.2 | Term | Systemic lupus erythematosus |
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 | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Evaluate the safety of 6.0 mg/kg and 12 mg/kg SM101 per week in SLE patients with or without a history of lupus nephritis. |
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E.2.2 | Secondary objectives of the trial |
Evaluate the efficacy and pharmacokinetics (PK) of 6.0 mg/kg and 12 mg/kg SM101 per week in SLE patients with or without a history of lupus nephritis. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Inclusion criteria 1.Patient has provided written informed consent prior to any study-related procedure 2.Male or female adult patients aged 18 years or older 3.Patients with a body weight between ≥ 40 kg and ≤ 100 kg 4.At least 4 criteria of the American College of Rheumatology (ACR) revised criteria (APPENDIX 1) documented in the medical history 5.A SELENA-SLEDAI score of at least 6 within 8 weeks prior to the first IP dosing. A subpopulation will fulfil in addition the following criteria for lupus nephritis: a) A history of class III, IV, or a combination of these with class V glomerulonephritis, within 60 months prior to first IP dosing confirmed by a renal biopsy according to the International Society of Nephrology (ISN) and the Renal Pathology Society (RPS) [APPENDIX 2]. The patient had never a pure class V or VI glomerulonephritis during the disease course AND b) Proteinuria between > 0.2 to ≤ 3.5 g/day at SCR 6.Patients with a present serological active status defined as abnormal laboratory values from the last 2 local serum samples for the following parameters: a) serum antibodies against double-stranded DNA (anti-dsDNA) above upper limit of normal (ULN) OR/AND b) complement component 3 (C3) below lower limit of normal (LLN) Abnormality will be confirmed by a central laboratory during screening. 7.Patients with immunosuppressant SLE treatment (if any) other than listed under 8. have completed their SLE therapy prior to first IP dosing as follows: a) B-cell depleting agents (e.g. rituximab, epratuzumab, etc.) for ≥ 48 weeks b) B-cell modifying agents (e.g. belimumab, atacicept, etc.) for ≥ 24 weeks c) Intravenous immunoglobulins (IVIGs) for ≥ 12 weeks d) All other immunosuppressive SLE treatment (e.g. metho-trexate, cyclophosphamide, cyclosporine, tacrolimus, etc.) for ≥ 8 weeks 8.Patients with a stable maintenance immunosuppressant SLE treatment (if any) within 4 weeks prior to first IP dosing consisting of: ≤ 20 mg/day prednisone (or equivalent) alone or in combination with either a) ≤ 2 mg/kg/day azathioprine (AZA) OR b) ≤ 2 g/day mycophenolate mofetil (MMF) [or equivalent] 9.The maintenance immunosuppressant SLE treatment is intended to remain stable during the clinical trial but at least within 4 weeks after the first IP dosing 10.Patients with a stable adjuvant maintenance SLE treatment (if any) such as antimalarias, angotensin-converting enzyme (ACE) inhibitors, non-steroid anti-inflammatory drugs (NSAIDs), cyclooxygenase inhibitors, anticoagulation- and antiplatelet agents, hormone replacement therapy, etc. within 4 weeks prior to first IP dosing. The adjuvant maintenance SLE treatment is intended to remain stable during the clinical trial but at least within 4 weeks after first IP dosing 11.Women of childbearing potential must have a negative serum pregnancy test within 3 weeks preceding the first dose of IP and a negative urine pregnancy test on study day 1 12.Both women of childbearing potential and men must use a medically acceptable method of contraception (APPENDIX 7) prior to inclusion, throughout the study, and within 12 weeks after IP discontinuation 13.Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2, with a life expectancy of at least 9 months (APPENDIX 8) |
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E.4 | Principal exclusion criteria |
1.Female patients who are nursing or pregnant, who may be pregnant, or who contemplate pregnancy during the study period 2.Patients with active SLE neurological disorder documented according to the ACR SLE criteria as listed in APPENDIX 1 within 12 weeks prior to first IP dosing 3.Patients with non-lupus related renal diseases or microthrombotic disease associated with antiphospolipid syndrome 4.Patients with known active retroviral infection such as as human immunodeficiency virus (HIV), hepatitis B or C 5.Patients with other acute infections (except minor infections such as common cold) within 4 weeks prior to first IP dosing 6.Patients with a glomerular filtration rate (GFR) of < 45 mL/min/1.73 m2 7.Patients with inadequate liver function expressed as at least one of the following: a) Aspartate aminotransferase (AST) > 3 times ULN OR b) Alanine aminotransferase (ALT) > 3 times ULN OR c) Serum bilirubin > 3 times ULN 8.Any kind of disorder that compromises the ability of the patient to give written informed consent and/or to comply with all study procedures 9.Known hypersensitivity to any recombinant E. coli-derived product or IP excipients (Polysorbat 20, Mannitol, Sucrose) 10.Patients participating in a concurrent clinical trial or treated with another IP within 4 weeks or five terminal half-lives (whichever is longer) prior to first IP dosing 11.History of alcohol or drug abuse within the previous 5 years 12.Any condition which in the judgment of the Investigator would place the patient at undue risk or interfere with the results of the study 13.Patients with an active malignancy 14.Patients with active, serious, life-threatening diseases |
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E.5 End points |
E.5.1 | Primary end point(s) |
Incidence of adverse events (AEs) during the study period according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4 |
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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) |
Efficacy Kidney parameters •Change in proportion of patients with proteinuria (urine protein > 0.2, > 0.5, > 1.0 and > 2.0 g/day) from screening (SCR) to end of week 4, 12 and 24 •Percent change of urine protein from SCR to end of week 4, 12 and 24 •Percent change of glomerular filtration rate (GFR) from SCR to end of week 4, 12 and 24 •Change in proportion of patients with active urine sediment defined as ≥ 5 white blood cell (WBC) count/high power field (HPF) or ≥ 5 red blood cell (RBC) count/HPF or ≥ 1 cellular cast from SCR to end of week 4, 12 and 24 •Percent change of urinary neutrophil gelatinase-associated lipocalin (uNGAL) from SCR to end of week 4, 12 and 24 •Proportion of patients with a complete or partial renal SLE response according to the Renal Response Index (RRI) from SCR to end of week 4, 12 and 24 •Incidence of end-stage renal disease (ESRD) requiring dialysis or renal transplantation from SCR to end of week 24 Serology parameters •Percent change of anti-double-stranded DNA-antibodies (anti-dsDNA), anti-complement-component C1q-antibodies (anti-C1q), C3 and C4 concentration from SCR to end of week 4, 12 and 24 •Proportion of patients with a serological SLE response, defined as: a) ≥ 25% increase of C3 level and b) ≥ 25% decrease in anti-dsDNA concentration from SCR at end of week 4, 12 and 24 Numerical scoring parameters •Renal activity score according to RRI from SCR to end of week 4, 12 and 24 •Absolute change of the Safety of Estrogen in Lupus Erythematosus National Assessment version of the Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score from SCR to end of week 4, 12 and 24 (refer to APPENDIX 3 for the SLEDAI form) •Absolute change of British Isles Lupus Assessment Group (BILAG) score from SCR to end of week 4, 12 and 24 •Absolute change of the Physician Global Assessment (PGA) score from SCR to end of week 4, 12 and 24 •Proportion of patients with a clinical SLE response (defined as reduction of at least 4, 5, 6 or 7 points in the SELENA-SLEDAI score from SCR) at end of week 4, 12 and 24 •Proportion of patients with flared defined as ≥ 1 new BILAG A score or ≥ 2 new BILAG B score from SCR to end of week 24 •Time to flare defined as ≥ 1 new BILAG A score or ≥ 2 new BILAG B scores from SCR to end of week 24 •Proportion of patients with no worsening (< 0.3 point increase from SCR) in the PGA score to end of week 24 Treatment parameters •Proportion of patients requiring rescue medication, defined as increase in concomitant immunosuppression or new immunosuppressant therapy including corticosteroids from day 1 to end of week 24 •Total number of rescue medication intake from day 1 to end of week 24 •Cumulative dose of overall immunosuppressive SLE treatment including corticosteroids from day 1 to end of week 24 •Proportion of patients with dose reduction of overall immunosuppressive SLE treatment including corticosteroids from day 1 to end of week 24 Other •Number of unscheduled hospital days from day 1 to end of week 24 •IP PK parameters at end of week 1 and 4 |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
From baseline to end of week 4, 12 and 24 except; Incidence of end-stage renal disease (ESRD) requiring dialysis or renal transplantation from baseline to end of week 24 Proportion of patients with flares defined as 1 new BILAG A score or 2 new BILAG B scores from baseline to end of week 24 Time to flare defined as 1 new BILAG A score or 2 new BILAG B scores from baseline to end of week 24 Proportion of patients with no worsening (< 0.3 point increase from baseline) in the PGA score to end of week 24 Treatment parameters from baseline to end of week 24 Number of unscheduled hospital days from baseline to end of week 24 Investigational product PK parameters at end of week 1 and 4 |
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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 | Yes |
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 | 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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 33 |
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 |
Australia |
Belgium |
France |
Germany |
Italy |
Netherlands |
Poland |
Spain |
United Kingdom |
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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 the 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 | 1 |
E.8.9.1 | In the Member State concerned months | 8 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 8 |
E.8.9.2 | In all countries concerned by the trial days | 0 |