E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
a primary immunodeficiency as defined by the ESID and validated by a reference centre :
• X-linked agammaglobulinemia (XLA)
• Common variable immunodeficiency (CVID)
|
|
E.1.1.1 | Medical condition in easily understood language |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10010112 |
E.1.2 | Term | Common variable immunodeficiency |
E.1.2 | System Organ Class | 100000004870 |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | HLT |
E.1.2 | Classification code | 10036700 |
E.1.2 | Term | Primary immunodeficiency syndromes |
E.1.2 | System Organ Class | 100000004870 |
|
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 16.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10001471 |
E.1.2 | Term | Agammaglobulinemia |
E.1.2 | System Organ Class | 100000004870 |
|
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 |
To assess the efficacy of I10E in preventing acute serious bacterial infections |
|
E.2.2 | Secondary objectives of the trial |
To assess the safety, efficacy, pharmacokinetic of I10E |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Both genders
2. Age between 2 to 65 year old
3. Has an humoral primary immunodeficiency as defined by the ESIDs1
and validated by the reference centers :
· X-linked agammaglobulinemia (XLA)
· Common variable immunodeficiency (CVID)
4. The requirement of IVIG therapy at a dose between 0.2 to 0.8 g/kg
and at administration interval of 3-weeks or 4-weeks may be
considered medically necessary for the treatment of the patient
condition
5. Patient already under IgG replacement therapy with a stable dosage
and with 3 documented trough levels ³ 4 g/l within 6 months prior to
the introduction of I10E (trough levels should have been performed at
3 to 8 weeks interval between samples or naïve. All these patients
must be stabilized under I10E during the first 6 months during the
study with IgG trough levels ³ 6 g/L).
6. Written informed consent obtained prior to any study-related
procedure and study product administration from either the patient or
the patient's legal representative
7. If required by national regulation, registered with a social security or
health insurance system |
|
E.4 | Principal exclusion criteria |
1. Patient already under IgG replacement therapy with no 3 documented
trough levels ³ 4 g/l within 6 months prior to the introduction of I10E
or patient with 3 documented Ig G trough level not performed within
defined 3 to 8 weeks interval between samples.
2. Known allergy or history of serious adverse reaction to any IgG
3. Known hypersensitivity to the active substance or to any of the
excipients
4. Patient with known antibodies to IgA
5. Chronic renal insufficiency or creatinine clearance values < 80
ml/min in adult patients (Modified Diet in Renal Disease) or < 60
ml/min in paediatric patients (Schwartz formula)
6. History of cardiac insufficiency (NYHA III/IV), cardiomyopathy,
congestive heart failure, or severe hypertension
7. History of thrombotic episodes (including deep vein thrombosis,
myocardial infarction, cerebrovascular accident, pulmonary
embolism) within the last 12 months
8. Loop diuretic treatment within the last week before inclusion
9. Any additional cause of immunodeficiency, other than a primary
immunodeficiency (as acquired immunodeficiency, neutropenia,
malignancy of lymphoïd cells, allogeneic hematopoïetic stem cell
transplantation)
10. Need of routine premedication by corticosteroid before IgG
infusions
11. Acute infection requiring antibiotics within one week before
inclusion
12. Immunosuppressive agents, including anti-CD20 antibodies, within
the last 6 months
13. Need of therapy with forbidden medication (steroid bolus,
prophylactic antibiotic) that cannot be discontinued during the study
14. Protein-loosing enteropathy characterised by serum protein levels <
60 g/l and serum albumin levels < 30 g/l or nephrotic syndrome
characterised by proteinuria ³ 3.5 g/24 hours, serum protein levels <
60 g/l and serum albumin levels < 30 g/l
15. Any serious medical conditions that would interfere with the
clinical assessment of I10E or prevent the patient to comply with the
protocol requirements
16. Patient known to be infected with hepatitis B virus, hepatitis C virus,
or human immunodeficiency virus.
17. Malignant disease other than a adequately treated basal cell or
squamous cell skin carcinoma or in situ cervix carcinoma
18. Administration of another investigational product within the last
month
19. Exposure to blood products or derivatives other than commercial
IgG, within 3 months prior to inclusion.
20. Pregnant with positive results on a HCG-based pregnancy blood test
(> 12 years) or breastfeeding woman, or woman of childbearing
potential with no effective contraception (injectable, patch or
combined oral estro-progestative or progestative contraceptives,
intra-uterine devices of type 'copper T' and levonorgest releasing IU
systems, depot intramuscular medroxyprogesteron, subcutaneous
implants of progestative contraceptives implants).
21. Blood levels of total bilirubin > 2 x upper limit of normal range,
alanine aminotransferase (ALT) or aspartate amino transferase (AST)
> 3 x upper limit of normal range.
22. Anticipated poor compliance of patient with study procedures |
|
E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is the number of acute serious bacterial infections
(aSBI) per patient and per year (annualized rate) as defined by the FDA
guidance 70 FR 72124 and evaluated by the DSMB:
• bacteraemia or sepsis,
• bacterial meningitis,
• osteomyelitis / septic arthritis,
• bacterial pneumonia,
• visceral abscess. |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
1) Efficacy criteria
Serum total IgG trough levels:
• Total IgG trough concentrations will be measured by nephelemetry
(central lab) in serum obtained from blood samples collected prior to
each infusion from all included patients during the 12 month-study
period. In addition, distribution of IgG sub-classes and content of
clinically relevant antibodies will be assessed.
• Descriptive relationship between total IgG trough levels and serious
all infections.
Other efficacy criteria will be assessed both by investigator and patients
follow-up diaries (annualized rate) :
• Number of all infections per patient and per year: annualized rate of
documented of serious and non-serious bacterial infections
• Number of days missed from work or school due to infections,
• Number of days hospitalized related to infections,
• Number of days with use of antibiotics related to infections,
• Number of fever episodes related to infections
2) Safety criteria
Adverse events (AEs), serious (SAEs) and non serious adverse events
from all subjects followed throughout the clinical studies will be
recorded and reported regardless of whether the AE is determined to
be related to the product or not by the investigator (Pre-medication is
discouraged to avoid masking AEs).
Safety evaluation will include the monitoring of the following items:
• Vital signs (blood pressure, heart rate, temperature) will be
monitored by the study nurse during infusions within 30 mn
after the end of the infusion
• Laboratory tests including direct Coombs' test will be
monitored at each visit
• Adverse events that occurred during infusions will be noted
by the study nurse or the investigator
• Adverse events that occurred during intervals between
infusions will be recorded by the patients in their diaries and
reviewed by the investigator at each visit.
• Renal function, hepatic function and blood cells will be
monitored by biological tests.
3) Pharmacokinetics (PK)
|
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
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 | Yes |
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) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
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 | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
E.8.3 |
Will this trial be conducted at a single site globally?
| No |
E.8.4 | Will this trial be conducted at multiple sites globally? | Yes |
E.8.6 Trial involving sites outside the EEA |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | Specify the countries outside of the EEA in which trial sites are planned |
France |
Czech Republic |
Hungary |
Lithuania |
Poland |
Serbia |
Ukraine |
|
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
|
End of the study will be last patient last visit |
|
E.8.9 Initial estimate of the duration of the trial |
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 | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |