E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Degenerative disc disease |
|
E.1.1.1 | Medical condition in easily understood language |
Degenerative disc disease |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10070241 |
E.1.2 | Term | Degenerative disc disease |
E.1.2 | System Organ Class | 100000018941 |
|
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 is to assess the safety and efficacy of ALLOB® in spinal fusion over 12 months in spinal fusion in patients with symptomatic disc disease of the lumbar spine.
Safety:
Subjects will be systematically assessed for the potential occurence of any AE and SAE related or not to the treatment (i.e., ALLOB®/β-TCP mix or surgical procedure), using subject open questionnaires, physical examinations and laboratory measurements.
Efficacy:
The efficacy of the treatment will be evaluated at Month 12:
- clinically (functional disability): the improvement in ODI 2.1a vs. baseline visit
-radiologically (progression of the lumbar fusion): the mean Lumbar Fusion Score as assessed by CT-scan. |
|
E.2.2 | Secondary objectives of the trial |
-Number (%) of patients requiring a rescue surgery at Month 6, 9, 12
-Improvement in ODI 2.1a at each follow-up visit (vs. baseline visit)
-Improvement in Back and Leg Pain VAS at each follow-up visit (vs. baseline visit)
-Improvement in Global Disease Evaluation VAS at each follow-up visit (vs. baseline visit)
-Lumbar fusion progression using the Lumbar Fusion Score as assessed by CT-scan at Month 3, 6, 12 (vs. baseline value)
-Mean time to lumbar fusion as assessed by CT-scan
-Evolution of the intervertebral mobility at Month 3, 6, 9, 12 (vs. baseline visit)
-Integrity of instrumentation and surrounding bones at Month 3, 6, 9, 12
-Evolution of segmental lordosis at Month 3, 6, 9, 12 (vs. baseline visit)
-Evolution of lumbar lordosis at Month 3, 6, 9, 12 (vs. baseline visit)
-Evolution of disc height at Month 3, 6, 12 (vs. baseline value)
-Loss of blood during procedure
-Operating time
-Number of per-operative and post-operative complications
-Duration of hospital stay |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Man or woman aged 18 to 75 years (inclusive)
- Diagnosed with lumbar degenerative disc disease
- Symptomatic with an ODI 2.1a score ≥ 30
- Demonstrated radiologically
- Requiring a single level lumbar fusion (L1 to S1)
- Unresponsive to non-operative treatment (e.g., medication, physical therapy) for at least 6 months at the time of screening
- Capable to provide a written, dated, and signed informed consent and to understand and comply with the study requirements
|
|
E.4 | Principal exclusion criteria |
Current symptoms and/or signs related to the disease under study
- More than one previous spinal surgery at the involved lumbar level
- Previous failed fusion at the involved lumbar level
- Local active or latent infection at the involved lumbar level
- Requiring surgery at more than one-level of the lumbar spinal region within the next 12 months
- Diagnosis of non-union, fracture or tumour at the involved lumbar level
- Diagnosis of multilevel scoliosis or adjacent segment syndrome at the lumbar spine
- Diagnosis of high-grade isthmic/lytic spondylolisthesis (grade > III) requiring multi-level lumbar fusion
Current or previous diagnoses, signs and/or symptoms
- Highly communicable diseases (i.e., HIV, active hepatitis B or C (defined as positive HBs Ag and/or positive PCR), active tuberculosis, syphilis)
- Global sepsis
- Severe renal (defined as a creatinine clearance value < 30 ml/min, calculated with the Cockcroft-Gault formula) or hepatic impairment (defined as alanine aminotransferase or aspartate aminotransferase ≥ 3 times the upper normal limit)
- Severe diabetes (defined as HbA1C > 8%)
- Severe allergy or anaphylaxis
- Known allergy to gentamicin
- Medical condition that can inhibit bone healing (e.g., severe osteoporosis (as defined by T-score <-3 or presence of 2 or more fractures), Paget’s disease, osteomalacia)
- Medical condition that could interfere with study participant assessment (e.g., neuromuscular disease, psychiatric disease, paraplegia)
- Active autoimmune disease (e.g., sclerodermia, Sjögren syndrome, lupus)
- Current or past (within 5 years) malignant neoplasia (except non-metastatic thyroid cancer and non-melanoma skin cancer)
- Poor general health or concomitant disease that would place the patient in excessive risk to surgery (i.e., significant circulatory or pulmonary problems, or cardiac disease)
- History of organ or bone marrow transplantation
- History of hypersensitivity to human biological material including blood and blood derived products, documented clinically or by laboratory tests
Current or previous treatment
- Previous treatment with ALLOB®
- Participation (within 3 months of screening) in another clinical study involving a pharmacological agent
- Current or past treatment (within 5 years of screening) for cancer or blood dyscrasia, including but not limited to chemotherapy, radiotherapy, immunotherapy, biotherapy, haematopoietic growth factors and/or anti-angiogenesis treatment
- Current (within 6 months of screening) illicit drug abuse (as per local law)
Safety aspects concerning female subjects with childbearing potential
- Positive Urine Pregnancy test
- Pregnancy
- Breast-feeding
- Woman with childbearing potential not willing or not able to use reliable contraceptive method for at least 6 weeks prior to screening and during the whole study period (reliable contraceptive methods include orally administered hormonal contraceptives, intrauterine device or surgical intervention (e.g., tubal ligation)
Other exclusion criteria
- Body Mass Index (BMI) ≥ 35 kg/m2
- Clinically relevant abnormal ECG (>6-lead or according to standard of care at the hospital), as judged by the Investigator or any medically qualified member of the study care team
- Unable to undergo general anaesthesia or a surgical intervention
|
|
E.5 End points |
E.5.1 | Primary end point(s) |
Safety criteria:
At each visit, subjects will be assessed for the potential occurence of any AE or SAE related to the product or to the procedure, using patient open non-directive questionnaires, vital signs and laboratory measurements.
Efficacy criteria:
The efficacy of the treatment will be evaluated at Month 12:
- Clinically (functional disability): the improvement in ODI 2.1a vs. baseline visit
Radiologically (progression of the lumbar fusion): the mean Lumbar Fusion Score as assessed by CT-scan |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
The following time points will be used to evaluate over the 12-month follow-up period:
- Clinical endpoints at baseline and at 6 weeks, 3, 6, 9 and 12 months
- Radiological endpoints at baseline and at 3, 6, 9 and 12 months.
Safety endpoints will be determined at each scheduled visit over the 12-month follow-up period.
|
|
E.5.2 | Secondary end point(s) |
The other endpoints will be:
- Number (percentage) of patients requiring a rescue surgery at Month 6, 9 and 12
- Improvement in ODI 2.1a at each follow-up visit (vs. baseline visit)
- Improvement in Back and Leg Pain VAS at each follow-up visit (vs. baseline visit)
- Improvement in Global Disease Evaluation VAS at each follow-up visit (vs. baseline visit)
- Lumbar fusion progression using the Lumbar Fusion Score as assessed by CT-scan at Month 3, 6 and 12 (vs. baseline value)
- Mean time to lumbar fusion as assessed by CT-scan
- Evolution of the intervertebral mobility at Month 3, 6, 9 and 12 (vs. baseline visit)
- Integrity of instrumentation and surrounding vertebral bones at Month 3, 6, 9 and 12
- Evolution of segmental lordosis at Month 3, 6, 9 and 12 (vs. baseline visit)
- Evolution of lumbar lordosis at Month 3, 6, 9 and 12 (vs. baseline visit)
- Evolution of disc height at Month 3, 6 and 12 (vs. baseline value)
- Loss of blood during procedure
- Operating time
- Number of per-operative and post-operative complications
- Duration of hospital stay
|
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
Efficacy endpoints will be determined at each scheduled visit over the 12-month follow-up period. |
|
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 | No |
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 | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
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 | 8 |
E.8.5 | The trial involves multiple Member States | No |
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 | No |
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
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 6 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |