E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
This trial will test the efficacy of Kepivance in the prevention of new autoimmune diseases in patients who have multiple sclerosis (MS)who are being treated with alemtuzumab. |
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E.1.1.1 | Medical condition in easily understood language |
Multiple Sclerosis (MS) patients who may develop new diseases due to an over-active immune system as a result of treatment with alemtuzumab |
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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 | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10058948 |
E.1.2 | Term | Nephritis autoimmune |
E.1.2 | System Organ Class | 10038359 - Renal and urinary disorders |
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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 | 10049046 |
E.1.2 | Term | Autoimmune thyroiditis |
E.1.2 | System Organ Class | 10014698 - Endocrine disorders |
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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 | 10061664 |
E.1.2 | Term | Autoimmune disorder |
E.1.2 | System Organ Class | 10021428 - Immune system disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10068004 |
E.1.2 | Term | Autoimmune hyperthyroidism |
E.1.2 | System Organ Class | 10014698 - Endocrine disorders |
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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 | 10050245 |
E.1.2 | Term | Autoimmune thrombocytopenia |
E.1.2 | System Organ Class | 10005329 - Blood and lymphatic system 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 this trial is to determine if Kepivance can prevent patients with multiple sclerosis from developing new autoimmune diseases after treatment with alemtuzumab. |
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E.2.2 | Secondary objectives of the trial |
Our secondary objective is to determine if Kepivance can boost the function of the thymus in adult humans. The thymus is a gland that sits in the neck. Its function is to make new immune cells. If Kepivance can boost the function of the thymus gland this has important implications for a number of patient groups - for example patients who have reduced numbers of immune cells due to HIV infection, or because of treatment with chemotherapy drugs. |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
The dose escalation sub-study is included as part of the main study protocol and submission, therefore the title, date and version remain the same as the main study. The objective of the sub-study is to identify the maximum tolerated dose of Kepivance in patients with Multiple Sclerosis, receiving treatment with Alemtuzumab. The dose identified as part of this sub-study will be used in the main study to treat a further 37 patients (37 Kepivance patients plus the 3 patients treated at the maximum tolerated dose in the sub-study) |
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E.3 | Principal inclusion criteria |
To be included in the trial the patient must have/be: • Male or non-pregnant, non-lactating female patients • Aged between 18 and 50 years inclusive • Diagnosis of MS using McDonald’s criteria, including diagnostic MRI • Onset of first MS symptoms within 10 years • EDSS score 0.0 to 5.0 (inclusive) at screening • At least 2 clinical episodes of MS in the 2 years prior to study entry, with at least 1 attack within 12 months, which may have occurred whilst on disease-modifying therapy, such as beta interferon therapy or glatiramer acetate. • Serum IL-21 ≥230pg/mL. Apart from the IL-21 inclusion criterion, the details of patient selection are identical to those adopted in the phase 3 trials of alemtuzumab (CARE MS1 and MS2). This ensures that the results of this trial can be generalised to these patient groups. |
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E.4 | Principal exclusion criteria |
The presence of any of the following will preclude patient inclusion: •Any progressive form of multiple sclerosis •Previous thymectomy •Previous treatment with alemtuzumab, mitoxantrone, cyclophosphomide, cladribine, rituximab or any other immunosuppressant or cytotoxic therapy (other than steroids) •History of malignancy •Personal history of clinically significant autoimmune disease, other than multiple sclerosis (including but not limited to: thyroid disease, immune cytopenias, inflammatory bowel disease, diabetes, lupus, severe asthma) •Intolerance of pulsed corticosteroids, especially a history of steroid psychosis •Major systemic disease or other illness that would, in the opinion of the investigator, compromise patient safety or interfere with the interpretation of study results. •Seropositivity for human immunodeficiency virus (HIV) •Past or present hepatitis B infection (positive hepatitis B serology) •Pregnant women or male and female patients who do not agree to use effective contraception during the study. Reliable and effective contraceptive method(s) include: intrauterine device (IUD), hormonal based contraception, surgical sterilisation, abstinence, or double barrier contraception i.e. condom and occlusive cap (diaphragm or cervical cap with spermicide). • Medical, psychiatric, cognitive or other conditions that, in the investigator's opinion, compromise the patient's ability to understand the patient information, to give informed consent, to comply with the trial protocol, or to complete the study. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary endpoint is incidence of clinical autoimmunity within 30 months of starting treatment with alemtuzumab. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Patients will be assessed for development of autoimmunity at all routine study visits - Months 1,3 6,9,12,13, 15,18,21,24,27,30. In addition patients will have monthly full blood counts to screen for the development of immune thrombocytopenia. The primary endpoint will be assessed once all patients have completed 30 months on study. |
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E.5.2 | Secondary end point(s) |
• Percentage of naive T cells • Safety outcomes - incidence and nature of adverse events • Percentage of central memory T cells, effector memory T cells and T effector memory RA cells - as determined by flow cytometry • Frequency of recent thymic emigrants (defined by co-expression of CD45RA and CD31 in CD4+ T cells, and by CD45RA and CD103 in CD8+ T cells) - as determined by flow cytometry • T cell receptor (TCR) clonality - as determined by CDR3 spectratyping • Thymic function - as determined by measuring TRECs • Thymic volume and density - as assessed by non-contrast helical CT scans of the thymus performed at baseline, then again at 6 months following treatment. The scans will be analysed by a blinded thoracic radiologist who will perform a quantitative computer based analysis in order calculate thymic volume and density. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Safety assessment and recording of all adverse events will be performed throughout the study, and reviewed at all study visits- Months 1,3 6,9,12,13, 15,18,21,24,27, and 30. CT scans of the chest, to measure thymic volume and density, will be performed at baseline and month 6. Immunological assays of thymic function will be performed at baseline and again at months 1,3 6,9,12,13, 15,18,21,24,27, and 30. |
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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 | Yes |
E.6.3 | Therapy | Yes |
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) | 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 | 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
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 1 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
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 | 5 |
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 | 5 |
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 |