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    Clinical Trial Results:
    A Phase 3, Multicenter, Randomized, Double-blind Study to Determine the Safety and Efficacy of MMX Mesalamine/Mesalazine in Pediatric Subjects with Mild to Moderate Ulcerative Colitis, in Both Acute and Maintenance Phases

    Summary
    EudraCT number
    2013-001744-65
    Trial protocol
    GB   HU   SK   NL   PL   DE   BE  
    Global end of trial date
    28 Nov 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    09 Jun 2019
    First version publication date
    09 Jun 2019
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    SPD476-319
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02093663
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Shire
    Sponsor organisation address
    300 Shire Way, Lexington, United States, MA 02421
    Public contact
    Study Director, Shire, 1 866-842-5335, ClinicalTransparency@shire.com
    Scientific contact
    Study Director, Shire, 1 866-842-5335, ClinicalTransparency@shire.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    Yes
    EMA paediatric investigation plan number(s)
    EMEA-001406-PIP01-12
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    Yes
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    12 Apr 2019
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    28 Nov 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Primary objective was to assess clinical response in double-blind acute (DBA) phase and maintenance of clinical response in double-blind maintenance (DBM) phase of the study to Multi Matrix System (MMX®) mesalamine/mesalazine between a low and high dose in children and adolescents aged 5 to 17 years who were in remission with mild to moderate ulcerative colitis (UC).
    Protection of trial subjects
    Study was conducted in accordance with International Council for Harmonisation of Good Clinical Practice, the principles of the Declaration of Helsinki, as well as other applicable local ethical and legal requirements.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    12 Dec 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 10
    Country: Number of subjects enrolled
    Hungary: 19
    Country: Number of subjects enrolled
    Israel: 8
    Country: Number of subjects enrolled
    Poland: 58
    Country: Number of subjects enrolled
    Slovakia: 3
    Country: Number of subjects enrolled
    United Kingdom: 9
    Worldwide total number of subjects
    107
    EEA total number of subjects
    89
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    10
    Adolescents (12-17 years)
    97
    Adults (18-64 years)
    0
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted at 50 study centers and 33 sites consented at least 1 subject between 12 December 2014 (first subject first visit) and 28 November 2018 (last subject last visit).

    Pre-assignment
    Screening details
    Study conducted in three phases as double blind acute (DBA), open label acute (OLA), and double blind maintenance (DBM) phase. Overall, 107 subjects enrolled and entered into DBA or DBM directly and eligible subjects entered into DBM phase after DBA or OLA through DBA. Total, 105 subjects received treatment and 65 completed.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator
    Blinding implementation details
    Study included double-blind treatment in the DBA phase and DBM phase.

    Arms
    Arm title
    Overall Study
    Arm description
    Subjects with partial ulcerative colitis disease activity index (UC-DAI) greater than equal to (>=) 2 and mucosal appearance = 2 or 3 entered the DBA phase; with UC-DAI between 1 and 2 entered the OLA phase, after completing DBA phase; with UC-DAI less than equal to (<=) 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects who had a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBA and DBM phase, subjects received 900 to 2400 milligram per day (mg/day) (low dose) and 1800 to 4800 mg/day (high dose) of MMX mesalamine / mesalazine tablet orally once daily for 8 and 26 weeks respectively. During OLA phase, subjects received the high dose for 8 weeks.
    Arm type
    Experimental

    Investigational medicinal product name
    MMX mesalamine/mesalazine
    Investigational medicinal product code
    SPD476
    Other name
    MMX mesalamine/mesalazine,
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    During the DBA and DBM phase, subjects received 900 to 2400 mg/day (low dose) and 1800 to 4800 mg/day (high dose) of MMX mesalamine / mesalazine tablet orally once daily for 8 and 26 weeks respectively. During OLA phase, subjects received the high dose for 8 weeks.

    Number of subjects in period 1
    Overall Study
    Started
    105
    Subjects entered directly to DBM
    52 [1]
    Subjects entered DBM via DBA
    27 [2]
    Subjects entered DBM via OLA
    8 [3]
    Completed
    65
    Not completed
    40
         Adverse event, non-fatal
    7
         Not enrolled to DBM
    4
         Lost to follow-up
    1
         Missing
    1
         Other (Unspecified)
    4
         Lack of efficacy
    23
    Notes
    [1] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: This milestone was added to provide more detailed input.
    [2] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: This milestone was added to provide more detailed input.
    [3] - The number of subjects at this milestone seems inconsistent with the number of subjects in the arm. It is expected that the number of subjects will be greater than, or equal to the number that completed, minus those who left.
    Justification: This milestone was added to provide more detailed input.

    Baseline characteristics

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    Baseline characteristics reporting groups [1]
    Reporting group title
    Overall Study
    Reporting group description
    Subjects with partial ulcerative colitis disease activity index (UC-DAI) greater than equal to (>=) 2 and mucosal appearance = 2 or 3 entered the DBA phase; with UC-DAI between 1 and 2 entered the OLA phase, after completing DBA phase; with UC-DAI less than equal to (<=) 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects who had a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBA and DBM phase, subjects received 900 to 2400 milligram per day (mg/day) (low dose) and 1800 to 4800 mg/day (high dose) of MMX mesalamine / mesalazine tablet orally once daily for 8 and 26 weeks respectively. During OLA phase, subjects received the high dose for 8 weeks.

    Notes
    [1] - The number of subjects reported to be in the baseline period is not equal to the worldwide number of subjects enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Not all the enrolled subjects were treated, 107 subjects were enrolled and 105 subjects were treated.
    Reporting group values
    Overall Study Total
    Number of subjects
    105
    Age categorical
    Units: Subjects
    Age continuous
    Safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product.
    Units: years
        arithmetic mean (standard deviation)
    14.1 ( 2.55 ) -
    Gender categorical
    Safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product.
    Units: Subjects
        Female
    53 53
        Male
    52 52
    Race (NIH/OMB)
    Safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product.
    Units: Subjects
        American Indian or Alaska Native
    0 0
        Asian
    3 3
        Native Hawaiian or Other Pacific Islander
    0 0
        Black or African American
    1 1
        White
    101 101
        More than one race
    0 0
        Unknown or Not Reported
    0 0
    Ethnicity (NIH/OMB)
    Units: Subjects
        Hispanic or Latino
    1 1
        Not Hispanic or Latino
    104 104
        Unknown or Not Reported
    0 0

    End points

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    End points reporting groups
    Reporting group title
    Overall Study
    Reporting group description
    Subjects with partial ulcerative colitis disease activity index (UC-DAI) greater than equal to (>=) 2 and mucosal appearance = 2 or 3 entered the DBA phase; with UC-DAI between 1 and 2 entered the OLA phase, after completing DBA phase; with UC-DAI less than equal to (<=) 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects who had a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBA and DBM phase, subjects received 900 to 2400 milligram per day (mg/day) (low dose) and 1800 to 4800 mg/day (high dose) of MMX mesalamine / mesalazine tablet orally once daily for 8 and 26 weeks respectively. During OLA phase, subjects received the high dose for 8 weeks.

    Subject analysis set title
    Double-Blind Acute (DBA) phase: low dose
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects with partial UC-DAI >= 2 and mucosal appearance = 2 or 3 entered the DBA phase. During the DBA low dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 900, 1200, 1800, 2400 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 8 weeks respectively.

    Subject analysis set title
    Double-Blind Acute (DBA) phase: high dose
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects with partial UC-DAI >= 2 and mucosal appearance = 2 or 3 entered the DBA phase. During the DBA high dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 1800, 2400, 3600, 4800 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 8 weeks respectively.

    Subject analysis set title
    Double-Blind Maintenance (DBM) phase: low dose
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects with partial UC-DAI <= 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects with a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBM low dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 900, 1200, 1800, 2400 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 26 weeks respectively.

    Subject analysis set title
    Double-Blind Maintenance (DBM) phase: high dose
    Subject analysis set type
    Safety analysis
    Subject analysis set description
    Subjects with partial UC-DAI <= 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects with a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBM high dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 1800, 2400, 3600, 4800 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 26 weeks respectively.

    Primary: Number of Subjects With Clinical Response During Double-blind Acute Phase at Week 8

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    End point title
    Number of Subjects With Clinical Response During Double-blind Acute Phase at Week 8
    End point description
    Clinical response was defined as partial ulcerative colitis disease activity index (UC-DAI) lesser then or equal to (<=) 1 with rectal bleeding equal to =0, stool frequency lesser then or equal to (<=) 1 and physician’s global assessment (PGA=0). Number of subjects with clinical response during double-blind acute phase was reported. Double-blind acute phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind acute phase.
    End point type
    Primary
    End point timeframe
    Week 8
    End point values
    Double-Blind Acute (DBA) phase: low dose Double-Blind Acute (DBA) phase: high dose
    Number of subjects analysed
    27
    26
    Units: Subjects
    10
    17
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis ( last observation carried forward [LOCF] and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Acute (DBA) phase: low dose v Double-Blind Acute (DBA) phase: high dose
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    = 0.074 [2]
    Method
    Chi-squared corrected
    Parameter type
    Odds ratio (OR)
    Point estimate
    3.83
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    1.22
         upper limit
    11.98
    Notes
    [1] - Due to the difference in conclusions between the 95% CIs and the continuity corrected chi-square test, a post-hoc analysis was conducted to re-analyze the clinical response at week 8 using the uncorrected chi-squared test. The p-value based on the uncorrected chi-square test was 0.038, which is consistent with there being a difference between treatment arms.
    [2] - P-value was based on continuity corrected chi-squared test. This inconsistency between the 95% CI and the p-value is likely due to the relatively small sample size, and different statistical methods give different results.

    Primary: Number of Subjects With Clinical Response During Double-blind Maintenance Phase at Week 26

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    End point title
    Number of Subjects With Clinical Response During Double-blind Maintenance Phase at Week 26
    End point description
    Clinical response was defined as partial UC DAI <= 1 with rectal bleeding=0, stool frequency <= 1, and PGA=0. Number of subjects with clinical response during double-blind maintenance phase was reported. Double-blind maintenance phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind maintenance phase.
    End point type
    Primary
    End point timeframe
    Week 26
    End point values
    Double-Blind Maintenance (DBM) phase: low dose Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects analysed
    42
    45
    Units: Subjects
    23
    24
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis ( LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Maintenance (DBM) phase: low dose v Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects included in analysis
    87
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.981 [3]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Odds ratio (OR)
    Point estimate
    0.99
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.42
         upper limit
    2.34
    Notes
    [3] - P-value was based on a Cochran-Mantel-Haenszel test stratified by prior response status.

    Secondary: Number of Subjects With Clinical and Endoscopic Response During Double Blind Acute Phase at Week 8 Using Central Reading

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    End point title
    Number of Subjects With Clinical and Endoscopic Response During Double Blind Acute Phase at Week 8 Using Central Reading
    End point description
    Clinical and endoscopic response was defined as UC-DAI <=2 with rectal bleeding=0 and stool frequency <=1 and PGA=0, and with mucosal healing (endoscopy score <=1) at least a 1-point reduction in endoscopy score from baseline based on central reading. Number of subjects with clinical and endoscopic response was reported. Double-blind acute phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind acute phase. Subjects with missing data at week 8 were assumed not to have had a clinical response. Subjects who completed week 8 but did not have central reading endoscopies at both baseline and week 8 were excluded.
    End point type
    Secondary
    End point timeframe
    Week 8
    End point values
    Double-Blind Acute (DBA) phase: low dose Double-Blind Acute (DBA) phase: high dose
    Number of subjects analysed
    27
    26
    Units: Subjects
    1
    3
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Acute (DBA) phase: low dose v Double-Blind Acute (DBA) phase: high dose
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.4 [4]
    Method
    Fisher exact
    Parameter type
    Difference in proportions
    Point estimate
    50
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -19.3
         upper limit
    100
    Notes
    [4] - P-value was calculated based on Fisher's exact test

    Secondary: Number of Subjects With Clinical and Endoscopic Response During Double Blind Acute Phase at Week 8 Using Local Reading

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    End point title
    Number of Subjects With Clinical and Endoscopic Response During Double Blind Acute Phase at Week 8 Using Local Reading
    End point description
    Clinical and endoscopic response was defined as UC-DAI <=2 with rectal bleeding=0 and stool frequency <=1 and PGA=0, and with mucosal healing (endoscopy score <=1) at least a 1-point reduction in endoscopy score from baseline based on local reading. Number of subjects with clinical and endoscopic response was reported. Double-blind acute phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind acute phase. Subjects with missing data at week 8 were assumed not to have had a clinical response. Subjects who completed week 8 but did not have central reading endoscopies at both baseline and week 8 were excluded.
    End point type
    Secondary
    End point timeframe
    Week 8
    End point values
    Double-Blind Acute (DBA) phase: low dose Double-Blind Acute (DBA) phase: high dose
    Number of subjects analysed
    27
    26
    Units: Subjects
    1
    4
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Acute (DBA) phase: low dose v Double-Blind Acute (DBA) phase: high dose
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.333 [5]
    Method
    Fisher exact
    Parameter type
    Difference in proportions
    Point estimate
    50
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -19.3
         upper limit
    100
    Notes
    [5] - P-value was based on a Fisher's exact test.

    Secondary: Change from Baseline in Daily Ulcerative Colitis Scale (DUCS) Score During Double-Blind Acute Phase

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    End point title
    Change from Baseline in Daily Ulcerative Colitis Scale (DUCS) Score During Double-Blind Acute Phase
    End point description
    Change in the DUCS score from baseline to Week 8 during DBA phase was reported. DUCS score was to measure 7 specific signs or symptom and one impact (abdominal pain, nocturnal stool, daytime stool, blood in stool, diarrhea, urgency, tiredness) of UC with each item score ranged from 0 (worst) to 10 (best) with the overall score ranged from 0 (worst) to 70 (best) based on the responses. DBA phase safety analysis set consisted of randomized subjects who has taken at least 1 dose of investigational product during the DBA phase. Here n = number of subjects evaluable for this outcome at the specified time point for the respective reporting group.
    End point type
    Secondary
    End point timeframe
    Baseline to Week 8
    End point values
    Double-Blind Acute (DBA) phase: low dose Double-Blind Acute (DBA) phase: high dose
    Number of subjects analysed
    27
    26
    Units: score on the scale
    arithmetic mean (standard error)
        Baseline (n = 27, 26)
    32.2 ( 2.86 )
    31.6 ( 2.88 )
        Week 2 (n = 24, 23)
    -14.1 ( 3.80 )
    -13.2 ( 3.50 )
        Week 4 (n = 20, 22)
    -15.6 ( 3.96 )
    -16.7 ( 4.01 )
        Week 8 (n = 18, 22)
    -18.2 ( 4.40 )
    -23.1 ( 3.59 )
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Acute (DBA) phase: low dose v Double-Blind Acute (DBA) phase: high dose
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.168 [6]
    Method
    ANCOVA
    Parameter type
    Difference in Least squares Mean
    Point estimate
    -5.4
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -13.1
         upper limit
    2.4
    Notes
    [6] - P-value was based on an analysis of covariance (ANCOVA) including treatment arm as a factor and baseline DUCS score as a covariate.

    Secondary: Number of Subjects With Improvement in Pediatric Ulcerative Colitis Activity Index (PUCAI) Score During Double-blind Acute Phase at Week 8

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    End point title
    Number of Subjects With Improvement in Pediatric Ulcerative Colitis Activity Index (PUCAI) Score During Double-blind Acute Phase at Week 8
    End point description
    PUCAI is a physician-administered measure that focuses on 6 key signs and symptoms of UC and activity limitations producing a total score ranging from 0-85 with higher scores being worse. Recommended cut-off scores to differentiate disease activity are <10 (remission); 11-30 (mild); 31-64 (moderate) and >65 (severe). Subjects with an improvement (change of greater than or equal to (>=)20 points) in pediatric ulcerative colitis activity index (PUCAI) score. Double-blind acute phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind acute phase.
    End point type
    Secondary
    End point timeframe
    Week 8
    End point values
    Double-Blind Acute (DBA) phase: low dose Double-Blind Acute (DBA) phase: high dose
    Number of subjects analysed
    27
    26
    Units: Subjects
    10
    16
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Acute (DBA) phase: low dose v Double-Blind Acute (DBA) phase: high dose
    Number of subjects included in analysis
    53
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.131 [7]
    Method
    Chi-squared corrected
    Parameter type
    Difference in proportions
    Point estimate
    24.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.6
         upper limit
    50.6
    Notes
    [7] - P-value was based on a continuity-corrected chi-squared test. PUCAI Score was compared between treatment arms using a continuity corrected chi-squared test. Expected cell counts are very low (< 5), then Fisher’s Exact Test is alternative method.

    Secondary: Number of Subjects With Clinical and Endoscopic Response During Double-Blind Maintenance Phase at Week 26 Using Central Reading

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    End point title
    Number of Subjects With Clinical and Endoscopic Response During Double-Blind Maintenance Phase at Week 26 Using Central Reading
    End point description
    Clinical and endoscopic response was defined as UC-DAI <=2 with rectal bleeding=0, stool frequency <=1, PGA=0, and with mucosal healing (endoscopy score <=1) based on central reading at Week 26. Number of subjects with clinical and endoscopic response during double-blind maintenance phase at Week 26 using central reading was reported. Double-blind maintenance phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind maintenance phase.
    End point type
    Secondary
    End point timeframe
    Week 26
    End point values
    Double-Blind Maintenance (DBM) phase: low dose Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects analysed
    42
    45
    Units: Subjects
    13
    11
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Maintenance (DBM) phase: low dose v Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects included in analysis
    87
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.539 [8]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Difference in proportions
    Point estimate
    -6.5
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -25.3
         upper limit
    12.3
    Notes
    [8] - P-value was based on a CMH test adjusted by prior response status.

    Secondary: Number of Subjects With Clinical and Endoscopic Response During Double-Blind Maintenance Phase at Week 26 Using Local Reading

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    End point title
    Number of Subjects With Clinical and Endoscopic Response During Double-Blind Maintenance Phase at Week 26 Using Local Reading
    End point description
    Clinical and endoscopic response was defined as UC-DAI <= 2 with rectal bleeding=0, stool frequency <= 1, PGA=0, and with mucosal healing (endoscopy score <= 1) based on local reading. Number of subjects who had maintained clinical and endoscopic response during double-blind maintenance phase at week 26 using Local reading was reported. Double-blind maintenance phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind maintenance phase.
    End point type
    Secondary
    End point timeframe
    Week 26
    End point values
    Double-Blind Maintenance (DBM) phase: low dose Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects analysed
    42
    45
    Units: Subjects
    18
    12
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Maintenance (DBM) phase: low dose v Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects included in analysis
    87
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.129 [9]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Difference in proportions
    Point estimate
    -16.2
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -36
         upper limit
    3.6
    Notes
    [9] - P-value was based on a Cochran-Mantel-Haenszel (CMH) test adjusted by prior response status.

    Secondary: Change from Baseline in DUCS Score During Double-Blind Maintenance Phase

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    End point title
    Change from Baseline in DUCS Score During Double-Blind Maintenance Phase
    End point description
    DUCS score was to measure 7 specific signs or symptom and one impact (abdominal pain, nocturnal stool, daytime stool, blood in stool, diarrhea, urgency, tiredness) of UC with each score range from 0 (worst) to 10 (best) with the overall score ranging from 0 (worst) to 70 (best) based on the responses. Change from Baseline in DUCS score during double-blind maintenance phase at week 13 and Week 26 were reported. Double-blind maintenance phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind maintenance phase. Here n = number of subjects evaluable for this outcome at the specified time point for the respective reporting group.
    End point type
    Secondary
    End point timeframe
    Baseline, Week 13, and Week 26
    End point values
    Double-Blind Maintenance (DBM) phase: low dose Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects analysed
    41
    45
    Units: score on the scale
    arithmetic mean (standard error)
        Baseline (n = 41, 45)
    5.8 ( 1.37 )
    4.6 ( 0.79 )
        Week 13 (n = 30, 34)
    1.7 ( 1.61 )
    -0.1 ( 0.89 )
        Week 26 (n = 26, 32)
    1.3 ( 1.19 )
    4.4 ( 1.79 )
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Maintenance (DBM) phase: low dose v Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects included in analysis
    86
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.182 [10]
    Method
    ANCOVA
    Parameter type
    Difference in Least squares Mean
    Point estimate
    3
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -1.4
         upper limit
    7.4
    Notes
    [10] - P-value was based on an analysis of covariance (ANCOVA) including treatment arm and with prior response status.

    Secondary: Number of Subjects With Remission at PUCAI Score During Double-Blind Maintenance Phase at Week 26

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    End point title
    Number of Subjects With Remission at PUCAI Score During Double-Blind Maintenance Phase at Week 26
    End point description
    PUCAI is a physician-administered measure that focuses on 6 key signs and symptoms of UC and activity limitations producing a total score ranging from 0-85 with higher scores being worse. Recommended cut-off scores to differentiate disease activity are <10 (remission); 11-30 (mild); 31-64 (moderate) and >65 (severe). Double-blind maintenance phase safety analysis set consisted of randomized subjects who had taken at least 1 dose of investigational product during the double-blind maintenance phase.
    End point type
    Secondary
    End point timeframe
    Week 26
    End point values
    Double-Blind Maintenance (DBM) phase: low dose Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects analysed
    42
    45
    Units: Subjects
    29
    27
    Statistical analysis title
    Statistical analysis 1
    Statistical analysis description
    Study was not powered to detect differences between treatment groups and other sensitivity analysis (LOCF and complete case) intended to examine the robustness of the treatment estimate. This was an estimation study, and p-values were presented as descriptive statistics.
    Comparison groups
    Double-Blind Maintenance (DBM) phase: low dose v Double-Blind Maintenance (DBM) phase: high dose
    Number of subjects included in analysis
    87
    Analysis specification
    Pre-specified
    Analysis type
    other
    P-value
    = 0.194 [11]
    Method
    Cochran-Mantel-Haenszel
    Parameter type
    Difference in proportions
    Point estimate
    -9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -29.1
         upper limit
    11
    Notes
    [11] - P-value was based on a CMH test adjusted by prior response status. Subjects with remission (PUCAI <10) at double-blind maintenance phase at Week 26 was compared between treatment arms using a CMH test stratifying by Week 8 responder status.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From start of study drug administration up to follow-up (up to Week 27)
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    16.1
    Reporting groups
    Reporting group title
    Double-Blind Acute (DBA) Phase: Low Dose
    Reporting group description
    Subjects with partial UC-DAI >= 2 and mucosal appearance = 2 or 3 entered the DBA phase. During the DBA low dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 900, 1200, 1800, 2400 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 8 weeks respectively.

    Reporting group title
    Double-Blind Acute (DBA) Phase: High Dose
    Reporting group description
    Subjects with partial UC-DAI >= 2 and mucosal appearance = 2 or 3 entered the DBA phase. During the DBA high dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 1800, 2400, 3600, 4800 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 8 weeks respectively.

    Reporting group title
    Open-Label Acute (OLA) Phase: High Dose
    Reporting group description
    Subjects with partial UC-DAI between 1 and 2 entered the OLA phase, after completing DBA phase. Subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 1800, 2400, 3600, 4800 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 8 weeks respectively during the high dose OLA phase

    Reporting group title
    Double-Blind Maintenance (DBM) Phase: Low Dose
    Reporting group description
    Subjects with partial UC-DAI <= 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects with a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBM low dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 900, 1200, 1800, 2400 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 26 weeks respectively.

    Reporting group title
    Double-Blind Maintenance (DBM) Phase: High Dose
    Reporting group description
    Subjects with partial UC-DAI <= 1 and mucosal appearance = 0 or 1 entered the DBM phase directly. Also, subjects with a clinical response (partial UC-DAI <= 1) after completion of DBA phase or OLA phase entered into the DBM phase. During the DBM high dose phase subjects weighing 18 to <= 23 kg, >23 to <=35 kg, >35 to <= 50 kg, >50 to <= 90 kg received 1800, 2400, 3600, 4800 mg/day of MMX mesalamine / mesalazine tablet orally once daily for 26 weeks respectively.

    Serious adverse events
    Double-Blind Acute (DBA) Phase: Low Dose Double-Blind Acute (DBA) Phase: High Dose Open-Label Acute (OLA) Phase: High Dose Double-Blind Maintenance (DBM) Phase: Low Dose Double-Blind Maintenance (DBM) Phase: High Dose
    Total subjects affected by serious adverse events
         subjects affected / exposed
    4 / 27 (14.81%)
    0 / 26 (0.00%)
    3 / 18 (16.67%)
    3 / 42 (7.14%)
    2 / 45 (4.44%)
         number of deaths (all causes)
    0
    0
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    0
    0
    Injury, poisoning and procedural complications
    Injury corneal
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Retinal injury
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Road traffic accident
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Spinal compression fracture
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Abdominal pain upper
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Colitis ulcerative
         subjects affected / exposed
    2 / 27 (7.41%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
    0 / 1
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Dyspepsia
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Enteritis
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pyelonephritis
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Double-Blind Acute (DBA) Phase: Low Dose Double-Blind Acute (DBA) Phase: High Dose Open-Label Acute (OLA) Phase: High Dose Double-Blind Maintenance (DBM) Phase: Low Dose Double-Blind Maintenance (DBM) Phase: High Dose
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    15 / 27 (55.56%)
    15 / 26 (57.69%)
    12 / 18 (66.67%)
    25 / 42 (59.52%)
    25 / 45 (55.56%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Melanocytic naevus
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    General disorders and administration site conditions
    Inflammation
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    1
    0
    Pyrexia
         subjects affected / exposed
    2 / 27 (7.41%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences all number
    2
    1
    0
    0
    1
    Reproductive system and breast disorders
    Dysmenorrhoea
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    2 / 42 (4.76%)
    2 / 45 (4.44%)
         occurrences all number
    0
    1
    0
    4
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    2 / 27 (7.41%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    1 / 45 (2.22%)
         occurrences all number
    2
    0
    0
    1
    1
    Epistaxis
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Hiccups
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Oropharyngeal pain
         subjects affected / exposed
    2 / 27 (7.41%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    1 / 42 (2.38%)
    3 / 45 (6.67%)
         occurrences all number
    2
    0
    1
    1
    3
    Rhinorrhoea
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    3 / 45 (6.67%)
         occurrences all number
    0
    0
    0
    0
    3
    Psychiatric disorders
    Restlessness
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences all number
    0
    1
    0
    0
    2
    Vitamin D decreased
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Injury, poisoning and procedural complications
    Arthropod bite
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Joint dislocation
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    Lower limb fracture
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Nervous system disorders
    Dizziness
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    Headache
         subjects affected / exposed
    2 / 27 (7.41%)
    2 / 26 (7.69%)
    0 / 18 (0.00%)
    2 / 42 (4.76%)
    2 / 45 (4.44%)
         occurrences all number
    2
    2
    0
    3
    6
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    1 / 18 (5.56%)
    1 / 42 (2.38%)
    1 / 45 (2.22%)
         occurrences all number
    0
    1
    1
    1
    1
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    1 / 27 (3.70%)
    2 / 26 (7.69%)
    1 / 18 (5.56%)
    3 / 42 (7.14%)
    5 / 45 (11.11%)
         occurrences all number
    1
    2
    1
    5
    6
    Abdominal pain lower
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Abdominal pain upper
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    3 / 42 (7.14%)
    1 / 45 (2.22%)
         occurrences all number
    0
    1
    0
    3
    1
    Cheilosis
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    Colitis ulcerative
         subjects affected / exposed
    6 / 27 (22.22%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    5 / 42 (11.90%)
    8 / 45 (17.78%)
         occurrences all number
    6
    0
    1
    5
    9
    Constipation
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Diarrhoea
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    2 / 45 (4.44%)
         occurrences all number
    1
    0
    0
    1
    2
    Dyspepsia
         subjects affected / exposed
    1 / 27 (3.70%)
    3 / 26 (11.54%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences all number
    1
    3
    0
    0
    2
    Mouth ulceration
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Nausea
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    1 / 18 (5.56%)
    2 / 42 (4.76%)
    1 / 45 (2.22%)
         occurrences all number
    0
    1
    1
    2
    1
    Vomiting
         subjects affected / exposed
    2 / 27 (7.41%)
    1 / 26 (3.85%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    3 / 45 (6.67%)
         occurrences all number
    2
    1
    1
    0
    8
    Hepatobiliary disorders
    Cholecystitis
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    1
    0
    0
    0
    0
    Skin and subcutaneous tissue disorders
    Acne
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Eczema
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    2 / 18 (11.11%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    2
    0
    0
    Back pain
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    1 / 45 (2.22%)
         occurrences all number
    1
    0
    0
    1
    1
    Neck pain
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Torticollis
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    1 / 27 (3.70%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    1 / 42 (2.38%)
    0 / 45 (0.00%)
         occurrences all number
    1
    1
    0
    1
    0
    Ear infection
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Gastroenteritis viral
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0
    Gastrointestinal infection
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences all number
    0
    0
    1
    0
    1
    Nasopharyngitis
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    3 / 42 (7.14%)
    6 / 45 (13.33%)
         occurrences all number
    0
    0
    0
    4
    6
    Pharyngitis
         subjects affected / exposed
    1 / 27 (3.70%)
    2 / 26 (7.69%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences all number
    1
    2
    0
    0
    1
    Rhinitis
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    1 / 45 (2.22%)
         occurrences all number
    1
    0
    0
    0
    1
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    2 / 18 (11.11%)
    1 / 42 (2.38%)
    1 / 45 (2.22%)
         occurrences all number
    1
    0
    2
    1
    1
    Urinary tract infection
         subjects affected / exposed
    1 / 27 (3.70%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    1 / 42 (2.38%)
    1 / 45 (2.22%)
         occurrences all number
    2
    0
    1
    1
    1
    Viral infection
         subjects affected / exposed
    1 / 27 (3.70%)
    2 / 26 (7.69%)
    0 / 18 (0.00%)
    2 / 42 (4.76%)
    1 / 45 (2.22%)
         occurrences all number
    1
    2
    0
    2
    1
    Viral upper respiratory tract infection
         subjects affected / exposed
    0 / 27 (0.00%)
    1 / 26 (3.85%)
    0 / 18 (0.00%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    1
    0
    0
    0
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    0 / 27 (0.00%)
    0 / 26 (0.00%)
    1 / 18 (5.56%)
    0 / 42 (0.00%)
    0 / 45 (0.00%)
         occurrences all number
    0
    0
    1
    0
    0

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Dec 2013
    Amendment-1 • Added visit (weeks 2-4) to Double-blind Maintenance Phase for drug dispensing purposes; revised subsequent visit numbers. • Corrected terminology for subject disease state in the primary and secondary objectives for the Double-blind Maintenance Phase from “with mild to moderate UC” to “who are in remission.” • Removed normal mucosal appearance criterion from “general” exclusion criteria; added to the individual exclusion criteria of the Double-blind Acute Phase. Created individual exclusion criterion for the Double-blind Maintenance Phase. • Specified in re-randomization criteria that subjects may be re-randomized into the Double-blind Maintenance Phase if they turned 18 during participation in either Acute Phase of the study. • Removed text regarding sensitivity analysis of the primary endpoint from “Double Blind Maintenance Phase” section of the protocol in Section 9.8. Also removed text from Synopsis regarding sensitivity analysis of the primary endpoint. Replaced with the newly created Sensitivity Analyses of the Primary Endpoint section. • Changed Double-blind Maintenance Phase primary efficacy endpoint test from chi-squared test to Mantel-Haenszel test with stratification by responder details. • Included Physician’s Global Assessment at week 2 and week 4 of the Double-blind Acute Phase. • Corrected ages for questions and responses for rectal bleeding and stool frequency in e-diary for both versions: children and adolescents (ages 11- 17 years) and caregivers of children (children aged 5-10 years). Specified version of e-diary to be utilized in the case of a change in subject age during the study. Also updated age groups for Global Change in Health questionnaire. • Full Analysis sets have been changed to the Safety Analysis sets. • Removed double-blind Acute Phase Full Analysis Set and Double-blind Maintenance Phase Full Analysis Set.
    14 Jul 2014
    Amendment-2 • Corrected definition of Clinical Response by removing “Week 8”. • “Continuity-corrected” chi-squared test was added to the method to test the primary/secondary endpoints. • Revised number of active study sites from 35 to 43 • Added comment to footnotes to clarify that final visit of Double-blind Acute Phase and of the Open-label Acute Phase will be used as Week 0 for the subject’s next phase of participation. • Text amended to allow for data from an endoscopy performed within 7 days prior to the screening visit (visit 1) to be used in place of an endoscopy performed during the screening visit (Visit 1) or baseline visit (visit 2) for subjects entering the double-blind acute phase. • Added weight assessment to the end of the Double-blind Maintenance Phase. • Added clarification that an additional endoscopy is not required for subjects enrolling into the Double-blind Maintenance Phase from the Double-blind Acute Phase or the Open-label Acute Phase. • Clarified naming of laboratory assessments. • Detail added to clarify the baseline timepoint for each study phase.
    03 Feb 2015
    Amendment-3 • Added Shire and CRO contact information for SAE reporting. • Increased maximum duration of screening period from 10 to 14 days. • Updated approximate number of study sites from 43 to 48. • Added pharmacokinetic blood sampling. • Updated approximate number of countries participating in the study from 9 to 8. • Added exploratory endpoint for pharmacokinetic assessment. • Clarification of additional care of subjects added. • Added text to allow for a stool sample obtained per standard of care within 24 hours prior to the Screening Visit (Visit 1), to be used for screening stool assessments.
    28 Nov 2016
    Amendment-4 • Updated approximate number of subjects to be screened. • Added text indicating that enrollment in the Double-blind Maintenance Phase will be considered complete once 80 subjects have been randomized into this phase. • Increased maximum duration of screening period from 14 to 21 days. • Clarified eligibility criteria for Double-blind Acute Phase and Double-blind Maintenance Phase to indicate that all 3 components of the UC-DAI score are required as well as assessment of the mucosal appearance (endoscopy score). • Generated new study design flow chart to increase clarity on determination of eligibility for entry into each of the 3 treatment phases. • Updated Exclusion criteria. • Added a column and a row to the Schedule of Assessments to increase clarity and awareness for sites that it is recommended that site staff telephone subjects within 4 to 7 days prior to the Baseline Visit and prior to each site visit to remind subject or the subject’s caregiver to enter their UC-DAI symptoms (rectal bleeding and stool frequency) into their e-diaries every night. This was previously only mentioned in Sections 7.1 and 7.2. • Added a footnote indicating that subjects may bring in a standard of care stool sample (if collected within 24 hours) for screening assessments and evaluations. • Updated assessment time points in schedule of assessments for Double-blind Acute Phase, Open-label Acute Phase, and Double-blind Maintenance Phase.
    10 Apr 2017
    Amendment-5 • Modified to indicate that “at least” 80 subjects will be enrolled in the Double-blind Maintenance Phase of the study. • After agreement with US FDA in September 2018, the sample size for the DBA phase was reduced to 53 subjects due to difficulties with recruitment. • Subgroup analyses for the primary endpoint were added to explore efficacy by weight group and Week 8 responder status. • Added text to indicate that, for the DBM phase, secondary endpoints of the proportion of subjects who had maintained a clinical and endoscopic response at Week 26 using central reading, and using local reading endoscopies, the CMH test was not performed if the number of subjects with central reading endoscopy data was insufficient. The number and percentage of subjects with clinical and endoscopic response were presented by treatment arm. • Added text to indicate that more data were required to perform the psychometric analysis of the DUCS for children and caregivers; therefore, the need to perform these analyses will be considered in the future. • Removed planned duration of enrollment period as this is not accurate for individual subject participation. • Removed text describing sample size calculations as this study is not powered to detect differences between treatment groups. • Added AE assessment during scheduled telephone calls and on Visit 5 • Expanded the window for acceptance of historical endoscopy results from 7 days to 21 days prior to the Screening Visit.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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