E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Digestive System Diseases [C06] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 17.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10011401 |
E.1.2 | Term | Crohn's disease |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal 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 |
The primary objective of the study is to assess the safety and tolerability of long-term open-label (OL) tofacitinib therapy in subjects with CD. |
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E.2.2 | Secondary objectives of the trial |
• To evaluate the effect of OL tofacitinib maintenance therapy on clinical remission in subjects with CD.
• To evaluate the effect of OL tofacitinib maintenance therapy on quality-of-life in subjects with CD.
• To evaluate the effect of OL tofacitinib maintenance therapy on biomarkers as measured by CRP and fecal calprotectin.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subjects must meet all of the following inclusion criteria to be eligible for enrollment into the study:
1. Subjects who complete 26-week maintenance treatment of the A3921084 study or subjects who withdraw early due to A3921084 study treatment failure
2. Women of childbearing potential must test negative for pregnancy prior to study enrolment.
3. Sexually active females of childbearing potential are required to use adequate contraceptive methods during the study period and until completion of the follow-up procedures. No specific contraceptive measures are required in male subjects during study participation (Further description of the requirements and a list of contraceptives considered effective and acceptable for use in this trial are found in Section 4.4 Life Style Guidelines of the protocol).
4. Subjects who are willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
5. Evidence of a personally signed and dated informed consent document(s) indicating that the subject (or a legal representative) has been informed of all pertinent aspects of the study. |
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E.4 | Principal exclusion criteria |
Subjects presenting with any of the following will be excluded from the study:
1. Subjects who have been discontinued due to protocol violation(s) (as determined by the Sponsor) in the A3921084 study.
2. Subjects who were discontinued from the A3921084 study due to an adverse event that was not related to Crohn's disease.
3. Evidence of active (draining) fistulae, intrabdominal or perineal collection or abscess at Baseline (MRI imaging is not required for entry to this study unless clinically indicated).
4. Subjects with evidence of or suspected liver disease ie, liver injury due to methotrexate or primary sclerosing cholangitis.
5. Subjects with evidence of blood dyscrasias at Baseline visit (as assessed by the laboratory results from Week 26 or early discontinuation visit from the A3921084 study):
• Hemoglobin levels <9.0 g/dL
• An absolute white blood cell (WBC) count of <3.0 x 10 to the power of 9/L (<3000/mm3) or absolute neutrophil count of <1.2 X 10 to the power of 9/L (<1200/mm3) or absolute lymphocyte count of <0.5 x 10 to the power of 9/L (<500/mm3).
• Thrombocytopenia, as defined by a platelet count <100 x 10 to the power of 9/L (<100,000/mm3).
6. Subjects who have been scheduled to receive any live or attenuated virus vaccination during study period and for 6 weeks after last dose of study drug. (see Section 4.4.4 of the protocol for further information on avoidance of household contacts who may be vaccinated with live virus).
7. Women who are pregnant or breastfeeding or planning pregnancy during the study period.
8. Subjects with estimated GFR ≤40 mL/min based on Cockcroft-Gault calculation from Week 26 or early discontinuation visit from the A3921084 study.
9. Subjects with total bilirubin, AST or ALT more than 1.5 times the upper limit of normal from Week 26 or early discontinuation visit from the A3921084 study.
10. Subjects with current or recent history of severe, progressive, or uncontrolled renal, hepatic, hematological, gastrointestinal, metabolic (including uncontrolled hypercholesterolemia), endocrine, pulmonary, cardiac, or neurological disease.
11. Baseline 12-lead ECG (from Week 26 or early discontinuation visit from the A3921084 study) that demonstrates clinically relevant abnormalities which may affect subject safety or interpretation of study results (ie, baseline QTcF >450 ms, complete LBBB, acute or indeterminate age myocardial infarction, 2nd-3rd degree AV block, or serious bradyarrhythmias or tachyarrhythmias; see Appendix 3 of the protocol).
12. Subjects who are expected to receive prohibited concomitant medications (see Appendix 2 of the protocol) including medications that are either moderate to potent CYP3A4 inducers or inhibitors during the study period.
13. Subjects who, in the opinion of the investigator or Pfizer, will be uncooperative or unable to comply with study procedures.
14. Subjects who are investigational site staff members or relatives of those site staff members or subjects who are Pfizer employees directly involved in the conduct of the trial.
15. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study.
16. Subjects who are participating in or interested in participating in other investigational studies during study A3921086. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Safety Endpoints
- Incidence and severity of adverse events.
- Incidence and severity of clinical laboratory abnormalities, and change from baseline in clinical laboratory values.
- Incidence of clinically significant changes in physical examination from baseline.
- Incidence of vital sign abnormalities and changes from baseline in vital sign measures.
- Incidence of electrocardiogram (ECG) abnormalities and change from baseline in ECG measurements during treatment.
- Summary of adjudicated cardiovascular endpoints.
- Summary of malignancies confirmed by central laboratory pathologist over-read of biopsies.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
All safety endpoints are measured at every clinic visit throughout the duration of the study (52 weeks) |
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E.5.2 | Secondary end point(s) |
Efficacy endpoints
- Sustained clinical remission at both Week 24 and Week 48.
- The proportion of all subjects in clinical remission and sustained clinical remission at Week 48.
- The proportions of subjects in clinical remission and sustained clinical remission among subjects in clinical remission at A3921086 baseline.
- The proportion of subjects in clinical remission and sustained clinical remission among subjects in clinical response or clinical remission at A3921086 baseline.
- The median time to relapse among subjects in clinical remission at baseline.
- CDAI scores over time and change from baseline
- The proportion of subjects achieving a steroid-free clinical remission at Week 48.
- Corticosteroid use over time.
- Serum CRP and fecal calprotectin over time and change from baseline.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
All efficacy endpoints are measured at times specified in above section. |
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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 | Yes |
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 | Yes |
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 | 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 | 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 | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
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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.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 49 |
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 |
Austria |
Bulgaria |
Canada |
Croatia |
Czech Republic |
France |
Germany |
Greece |
Hungary |
India |
Israel |
Japan |
Korea, Republic of |
Netherlands |
Romania |
South Africa |
Spain |
Ukraine |
United States |
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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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EOT in all participating countries is defined as LSLV. EOT in a member state of the EU is defined as time at which it is deemed that sufficient subjects have been recruited & completed the study as stated in regulatory application (ie, Clinical Study Application) & ethics application in the Member State (MS). Poor recruitment (recruiting less than anticipated number in the CTA) by a MS is not a reason for premature termination but is considered a normal conclusion to the study in that MS |
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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 | 2 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 12 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 12 |