E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) |
Polirradiculoneuropatía desmielinizante inflamatoria crónica (PDIC) |
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E.1.1.1 | Medical condition in easily understood language |
Chronic inflammatory demyelinating polyneuropathy (CIDP) |
Polineuropatía desmielinizante inflamatoria crónica (PDIC) |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nervous System Diseases [C10] |
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 | 10057645 |
E.1.2 | Term | Chronic inflammatory demyelinating polyradiculoneuropathy |
E.1.2 | System Organ Class | 10029205 - Nervous system 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 |
To evaluate the effect of fingolimod 0.5 mg daily compared with placebo on delaying disability progression, in patients with CIDP, measured by the time to the first confirmed worsening on the adjusted Inflammatory Neuropathy Cause and Treatment (INCAT) Disability Scale. A confirmed worsening is defined as an increase by 1 point or more on the adjusted INCAT Disability Scale from the value at Baseline. |
Evaluar el efecto del tratamiento con fingolimod 0,5 mg/día, en comparación con placebo, en cuanto al retraso de la progresión de la discapacidad en pacientes con PDIC, determinado mediante el tiempo transcurrido hasta el primer episodio de empeoramiento confirmado en la Escala de discapacidad de causa y tratamiento de la neuropatía inflamatoria (INCAT) ajustada. Se considera empeoramiento confirmado el aumento de un punto o más, con respecto al valor basal, en la escala de discapacidad INCAT ajustada. |
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E.2.2 | Secondary objectives of the trial |
- to assess the change in grip strength from Baseline to Month 6/End-of-Treatment (whichever occurs first) in CIDP patients on fingolimod as compared with those on placebo - to assess the change in Rasch-Built Linearly Weighted Overall Disability Scale (R-ODS) from Baseline to Month 6/End-of-Treatment (whichever occurs first) in CIDP patients on fingolimod as compared with those on placebo - to evaluate safety and tolerability of fingolimod compared with placebo in patients with CIDP |
- Evaluar la variación de la fuerza de prensión desde el momento basal hasta el mes 6/final del tratamiento (lo que ocurra antes) en los pacientes con PDIC tratados con fingolimod en comparación con los tratados con placebo. - Evaluar la variación de la Escala de discapacidad general ponderada linealmente elaborada y según el modelo de Rasch (R-ODS, Rasch-Built Linearly Weighted Overall Disability Scale) desde el momento basal hasta el mes 6/final del tratamiento (lo que ocurra antes) en los pacientes con PDIC tratados con fingolimod en comparación con los tratados con placebo. - Evaluar la seguridad y la tolerabilidad del fingolimod en comparación con placebo en pacientes con PDIC. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Inclusion Criteria 1. written informed consent must be obtained before any assessment is performed 2. Either confirmed diagnosis of typical CIDP as defined by the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) Task Force First Revision Or one of the following forms of atypical CIDP: - pure motor CIDP - MADSAM (Lewis-Sumner syndrome) - CIDP in association with MGUS IgG or IgA but not IgM MGUS 3. disability defined by an INCAT Disability Scale score of 1-9 or, if INCAT score is 0, a documented history of disability sufficient to require treatment within the past 2 years following reduction or interruption of CIDP treatment 4. receiving IVIg treatment (minimal dose equivalent to 0.4 g/kg every 4 weeks) or corticosteroids (minimal dose equivalent to prednisone 10 mg/day) treatment prior to the screening visit 5. history of relapsing or progressive clinical course upon interruption or reduction of therapies within 1 year prior to Screening 6. male or female, aged 18 years or older at Screening |
1. Deberá obtenerse el consentimiento informado antes de realizar cualquier evaluación. 2. Diagnóstico confirmado de PDIC típica según la definición de la primera revisión del grupo de trabajo de la EFNS/PNS o bien una de las siguientes variantes atípicas de PDIC: - PDIC motora pura. - MADSAM (síndrome de Lewis-Sumner). - PDIC asociada a GMSI de tipo IgG o IgA, pero no a GMSI de tipo IgM. 3. Discapacidad, definida por una puntuación de 1 a 9 en la Escala de discapacidad INCAT o, si la puntuación de esta última es 0, por antecedentes documentados de discapacidad suficiente como para necesitar tratamiento en los dos últimos años tras una reducción o interrupción del tratamiento de la PDIC. 4. Estar en tratamiento con IgIV (dosis mínima equivalente a 0,4 g/kg cada 4 semanas) o corticoesteroides (dosis mínima equivalente a 10 mg de prednisona/día) antes de la visita de selección. 5. Antecedentes de recidiva o evolución clínica progresiva al interrumpir o reducir el tratamiento en el año anterior a la visita de selección. 6. Varones o mujeres de 18 años o mayores en el momento de la selección. |
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E.4 | Principal exclusion criteria |
Exclusion Criteria 1. other chronic demyelinating neuropathies, including: - Distal Acquired Demyelinating Symmetric Neuropathy (DADS) - Multifocal Motor Neuropathy with conduction block (MMN) - pure sensory CIDP - hematopoietic malignancy except for MGUS IgG or IgA 2. conditions in which the pathogenesis of the neuropathy may be different from CIDP such as: Lyme disease, POEMS syndrome, osteosclerotic myeloma, Castleman's disease 3. treatment with: - plasma exchange within 2 months of randomization - immunosuppressive/chemotherapeutic medications: - azathioprine, cyclophosphamide, cyclosporine, mycophenolate, etanercept, methotrexate within 6 months of randomization - Rituximab in the 2 years prior to randomization - other immunosuppressive medications (including mitoxantrone, alemtuzumab, cladribine) at any time - hematopoietic stem cell transplantation at any time 4. a CIDP relapse or significant worsening of symptoms within 2 months of randomization. |
Criterios de exclusión: 1. Otras neuropatías desmielinizantes crónicas, como: - Neuropatía desmielinizante adquirida distal y simétrica (DADS) - Neuropatía multifocal motora (NMM) con bloqueo de la conducción - PDIC sensitiva pura - Neoplasias malignas hematopoyéticas distintas de la GMSI de tipo IgG o IgA. 2. Situaciones en las que la patogenia de la neuropatía es diferente a la de la PDIC, como la enfermedad de Lyme, el síndrome de POEMS, el mieloma osteoesclerótico o la enfermedad de Castleman 3. Tratamiento con: - Plasmaféresis en los dos meses previos a la aleatorización. - Inmunodepresores y antineoplásicos: - azatioprina, ciclofosfamida, ciclosporina, micofenolato, etanercept o metotrexato en los seis meses anteriores a la aleatorización - rituximab en los dos años anteriores a la aleatorización - otros inmunodepresores (como mitoxantrona, alemtuzumab, cladribina) en cualquier momento - Trasplante de células madre hematopoyéticas en cualquier momento. 4. Recidiva de la PDIC o empeoramiento importante de los síntomas en los dos meses anteriores a la aleatorización. |
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E.5 End points |
E.5.1 | Primary end point(s) |
Delay of disease progression, measured by time to first confirmed worsening on the adjusted INCAT disability scale by 1 point or more from the value at baseline, in patients who were being treated with IVIG and/or corticosteroids prior to study start. |
Retraso de la progresión de la enfermedad, determinado mediante el tiempo transcurrido hasta el primer episodio de empeoramiento confirmado en la Escala de discapacidad INCAT ajustada en 1 punto o más desde el valor en la visita basal, en pacientes que recibieron tratamiento con IVIG o corticosteroides antes del inicio del estudio. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
time to event |
Tiempo hasta el episodio |
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E.5.2 | Secondary end point(s) |
1) The change in grip strength from baseline in CIDP patients on fingolimod as compared with those on placebo. Grip strength measurements will be done using a vigorimeter 2) The change from baseline for Rasch-Built Linearly Weighted Overall Disability Scale (R-ODS). This questionnaire was constructed using the patients perception of their ability to perform daily and social activities 3) Safety and tolerability of fingolimod compared with placebo in patients with CIDP. Measured by AE/SAE, hematology and biochemistry lab tests, vital signs, ECG, and pulmonary function test. |
1) La variación con respecto al valor basal de la fuerza de prensión en pacientes con PDIC que reciben fingolimod en comparación con los pacientes que reciben placebo. Las medidas de la fuerza de prensión se harán utilizando un vigorómetro. 2) La variación con respecto al valor basal según la Escala de discapacidad general ponderada linealmente elaborada y según el modelo de Rasch (R-ODS, Rasch-Built Linearly Weighted Overall Disability Scale). Este cuestionario se creó empleando la percepción del paciente sobre su capacidad para realizar las actividades sociales y diarias. 3) La seguridad y la tolerabilidad del fingolimod en comparación con placebo en pacientes con PDIC, determinada mediante los AA y AAG, los análisis clínicos de hematología y bioquímica, las constantes vitales, el ECG y las pruebas funcionales respiratorias. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1) Month 6/ End of treatment 2) Month 6/ End of treatment 3) End of study |
1) Mes 6/ Final del tratamiento 2) Mes 6/ Final del tratamiento 3) Final del estudio |
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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 | 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 | 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) | 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 | 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 | 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 | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 40 |
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 |
Canada |
France |
Germany |
Greece |
Israel |
Italy |
Japan |
Netherlands |
Norway |
Poland |
Spain |
United Kingdom |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |