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    Clinical Trial Results:
    A Double-Blind, Randomized, Parallel-Group, Active Control Study to Compare the Efficacy and Safety of CHS-0214 Versus Enbrel® in Subjects With Chronic Plaque Psoriasis (CHS-0214-04) (RaPsOdy)

    Summary
    EudraCT number
    2014-000444-14
    Trial protocol
    DE   GB   PL  
    Global end of trial date
    27 Apr 2016

    Results information
    Results version number
    v1(current)
    This version publication date
    13 May 2017
    First version publication date
    13 May 2017
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CHS-0214-04
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02134210
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Coherus BioSciences, Inc.
    Sponsor organisation address
    333 Twin Dolphin Drive, Suite 600, Redwood City, United States, CA 94065
    Public contact
    Barbara K. Finck, Coherus BioSciences, Inc., +1 650 649 3530,
    Scientific contact
    Barbara K. Finck, Coherus BioSciences, Inc., +1 650 649 3530,
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    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?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    31 May 2016
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    27 Jul 2015
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Apr 2016
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of Part 1 of this study was to compare the efficacy and safety of CHS-0214 and Enbrel (EU) 50 mg given twice a week (BIW) for 12 weeks. The primary objective of Part 2 of this study was to compare the safety and durability of response of CHS-0214 and Enbrel (EU) 50 mg given once a week (QW) from 13 weeks up to 47 weeks of treatment.
    Protection of trial subjects
    The study was conducted in accordance with the Declaration of Helsinki and with all applicable laws and regulations of the locale and country where the study was conducted, and in compliance with the International Conference on Harmonisation E6 Good Clinical Practice Guidelines. The rationale of the study, procedural details, and investigational goals were explained to each subject, along with potential risks and benefits. Each subject was assured of his/her right to withdraw from the study at any time. Prior to the initiation of any study procedures, each subject signed and dated an approved informed consent form.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    16 Jun 2014
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety, Efficacy
    Long term follow-up duration
    12 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 201
    Country: Number of subjects enrolled
    Germany: 24
    Country: Number of subjects enrolled
    Canada: 74
    Country: Number of subjects enrolled
    Australia: 18
    Country: Number of subjects enrolled
    Israel: 14
    Country: Number of subjects enrolled
    South Africa: 48
    Country: Number of subjects enrolled
    United States: 142
    Worldwide total number of subjects
    521
    EEA total number of subjects
    225
    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)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    486
    From 65 to 84 years
    35
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    4-week screening period (Weeks -4 to 0)

    Period 1
    Period 1 title
    Part 1
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CHS-0214
    Arm description
    Subjects were assigned the treatment as randomized.
    Arm type
    Experimental

    Investigational medicinal product name
    CHS-0214
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    A 50 mg dose of CHS-0214 was administered twice a week (BIW) by subcutaneous (SC) injection, from Week 0 Day 0 through Week 12.

    Arm title
    Enbrel (EU)
    Arm description
    Subjects were assigned the treatment as randomized.
    Arm type
    Active comparator

    Investigational medicinal product name
    Enbrel (EU)
    Investigational medicinal product code
    Other name
    etanercept
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    A 50 mg dose of Enbrel (EU) was administered twice a week (BIW) by subcutaneous (SC) injection, from Week 0 Day 0 through Week 12.

    Number of subjects in period 1
    CHS-0214 Enbrel (EU)
    Started
    261
    260
    Completed
    255
    241
    Not completed
    6
    19
         Consent withdrawn by subject
    4
    8
         TB test positive
    -
    1
         Physician decision
    -
    1
         Disease progression
    -
    1
         Adverse event, non-fatal
    -
    5
         other
    -
    2
         Lost to follow-up
    2
    -
         Protocol deviation
    -
    1
    Period 2
    Period 2 title
    Part 2
    Is this the baseline period?
    No
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Carer

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    CHS-0214
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    CHS-0214
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subjects continued in the blinded groups to which they were originally randomized. A 50 mg dose of CHS-0214 was administered once a week (QW) by subcutaneous (SC) injection, for maintenance, from Week 13 through Week 47.

    Arm title
    Enbrel (EU)
    Arm description
    -
    Arm type
    Safety

    Investigational medicinal product name
    Enbrel (EU)
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    Subjects continued in the blinded groups to which they were originally randomized. A 50 mg dose of Enbrel (EU) was administered once a week (QW) by subcutaneous (SC) injection, for maintenance, from Week 13 through Week 47.

    Number of subjects in period 2
    CHS-0214 Enbrel (EU)
    Started
    255
    241
    Completed
    227
    211
    Not completed
    28
    30
         TB test positive
    1
    3
         Consent withdrawn by subject
    14
    8
         Disease progression
    2
    5
         Adverse event, non-fatal
    5
    4
         Development of malignancy
    -
    1
         Pregnancy
    1
    -
         Did not return for follow up visit
    1
    1
         Lost to follow-up
    4
    7
         Protocol deviation
    -
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    CHS-0214
    Reporting group description
    Subjects were assigned the treatment as randomized.

    Reporting group title
    Enbrel (EU)
    Reporting group description
    Subjects were assigned the treatment as randomized.

    Reporting group values
    CHS-0214 Enbrel (EU) Total
    Number of subjects
    261 260 521
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    246 240 486
        From 65-84 years
    15 20 35
        85 years and over
    0 0 0
    Gender categorical
    Units: Subjects
        Female
    76 80 156
        Male
    185 180 365
    Subject analysis sets

    Subject analysis set title
    CHS-0214 - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized prior to the dosing suspension who had completed 12 weeks of study drug at the time of the suspension, and subjects randomized after dosing was resumed and received 1 or more doses of study drug. This was the primary efficacy analysis population.

    Subject analysis set title
    Enbrel (EU) - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized prior to the dosing suspension who had completed 12 weeks of study drug at the time of the suspension, and subjects randomized after dosing was resumed and received 1 or more doses of study drug. This was the primary efficacy analysis population.

    Subject analysis sets values
    CHS-0214 - FAP Part 1 Enbrel (EU) - FAP Part 1
    Number of subjects
    228
    228
    Age categorical
    Units: Subjects
        In utero
    0
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
    0
        Newborns (0-27 days)
    0
    0
        Infants and toddlers (28 days-23 months)
    0
    0
        Children (2-11 years)
    0
    0
        Adolescents (12-17 years)
    0
    0
        Adults (18-64 years)
    217
    213
        From 65-84 years
    11
    15
        85 years and over
    0
    0
    Age continuous
    Units:
        
    ±
    ±
    Gender categorical
    Units: Subjects
        Female
    66
    71
        Male
    162
    157

    End points

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    End points reporting groups
    Reporting group title
    CHS-0214
    Reporting group description
    Subjects were assigned the treatment as randomized.

    Reporting group title
    Enbrel (EU)
    Reporting group description
    Subjects were assigned the treatment as randomized.
    Reporting group title
    CHS-0214
    Reporting group description
    -

    Reporting group title
    Enbrel (EU)
    Reporting group description
    -

    Subject analysis set title
    CHS-0214 - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized prior to the dosing suspension who had completed 12 weeks of study drug at the time of the suspension, and subjects randomized after dosing was resumed and received 1 or more doses of study drug. This was the primary efficacy analysis population.

    Subject analysis set title
    Enbrel (EU) - FAP Part 1
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The Full Analysis Population (FAP) included all subjects randomized prior to the dosing suspension who had completed 12 weeks of study drug at the time of the suspension, and subjects randomized after dosing was resumed and received 1 or more doses of study drug. This was the primary efficacy analysis population.

    Primary: Mean percent change in PASI from baseline (last non-missing value prior to first dose) at Week 12.

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    End point title
    Mean percent change in PASI from baseline (last non-missing value prior to first dose) at Week 12.
    End point description
    This was the primary endpoint intended to support the Marketing Authorization Application in the European Union.
    End point type
    Primary
    End point timeframe
    Baseline (last non-missing value prior to first dose) to Week 12.
    End point values
    CHS-0214 - FAP Part 1 Enbrel (EU) - FAP Part 1
    Number of subjects analysed
    228
    228
    Units: Mean percent change
        arithmetic mean (standard deviation)
    -76.7 ± 21.1
    -73.4 ± 25
    Statistical analysis title
    Analysis of Mean Percent Change in PASI at Week 12
    Comparison groups
    CHS-0214 - FAP Part 1 v Enbrel (EU) - FAP Part 1
    Number of subjects included in analysis
    456
    Analysis specification
    Pre-specified
    Analysis type
    equivalence [1]
    Method
    Parameter type
    Estimated treatment difference, weighted
    Point estimate
    -3.41
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    -7.67
         upper limit
    0.84
    Variability estimate
    Standard error of the mean
    Dispersion value
    2.171
    Notes
    [1] - Cochran-Mantel-Haenszel (CMH) procedure stratified by the randomization strata. Equivalence was established if the limits of the 2-sided 95% CI were completely within the pre-specified equivalence range.

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From Baseline to Week 48
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.0
    Reporting groups
    Reporting group title
    CHS-0214
    Reporting group description
    -

    Reporting group title
    Enbrel (EU)
    Reporting group description
    -

    Serious adverse events
    CHS-0214 Enbrel (EU)
    Total subjects affected by serious adverse events
         subjects affected / exposed
    7 / 261 (2.68%)
    10 / 260 (3.85%)
         number of deaths (all causes)
    0
    0
         number of deaths resulting from adverse events
    0
    0
    Investigations
    Transaminases increased
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Intraductal proliferative breast lesion
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Foot fracture
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Angina pectoris
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Atrial fibrillation
         subjects affected / exposed
    2 / 261 (0.77%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac failure
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Chest pain
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Faecaloma
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhoidal haemorrhage
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Inguinal hernia
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Oesophageal varices haemorrhage
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Epistaxis
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pickwickian syndrome
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Psoriasis
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthritis
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Back pain
         subjects affected / exposed
    0 / 261 (0.00%)
    1 / 260 (0.38%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Osteoarthritis
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Bartholin's abscess
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Lobar Pneumonia
         subjects affected / exposed
    1 / 261 (0.38%)
    0 / 260 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 2%
    Non-serious adverse events
    CHS-0214 Enbrel (EU)
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    191 / 261 (73.18%)
    198 / 260 (76.15%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    6 / 261 (2.30%)
    4 / 260 (1.54%)
         occurrences all number
    7
    5
    Blood creatine phosphokinase increased
         subjects affected / exposed
    11 / 261 (4.21%)
    11 / 260 (4.23%)
         occurrences all number
    12
    11
    Hepatic enzyme increased
         subjects affected / exposed
    5 / 261 (1.92%)
    7 / 260 (2.69%)
         occurrences all number
    5
    9
    Vascular disorders
    Hypertension
         subjects affected / exposed
    13 / 261 (4.98%)
    14 / 260 (5.38%)
         occurrences all number
    13
    14
    Nervous system disorders
    Headache
         subjects affected / exposed
    8 / 261 (3.07%)
    10 / 260 (3.85%)
         occurrences all number
    8
    16
    General disorders and administration site conditions
    Injection site bruising
         subjects affected / exposed
    7 / 261 (2.68%)
    8 / 260 (3.08%)
         occurrences all number
    13
    8
    Injection site reaction
         subjects affected / exposed
    11 / 261 (4.21%)
    46 / 260 (17.69%)
         occurrences all number
    18
    80
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    6 / 261 (2.30%)
    3 / 260 (1.15%)
         occurrences all number
    6
    3
    Toothache
         subjects affected / exposed
    2 / 261 (0.77%)
    6 / 260 (2.31%)
         occurrences all number
    2
    7
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    8 / 261 (3.07%)
    9 / 260 (3.46%)
         occurrences all number
    9
    9
    Psoriasis
         subjects affected / exposed
    10 / 261 (3.83%)
    13 / 260 (5.00%)
         occurrences all number
    10
    13
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    7 / 261 (2.68%)
    4 / 260 (1.54%)
         occurrences all number
    7
    5
    Back pain
         subjects affected / exposed
    6 / 261 (2.30%)
    4 / 260 (1.54%)
         occurrences all number
    6
    4
    Infections and infestations
    Influenza
         subjects affected / exposed
    11 / 261 (4.21%)
    11 / 260 (4.23%)
         occurrences all number
    12
    12
    Nasopharyngitis
         subjects affected / exposed
    40 / 261 (15.33%)
    42 / 260 (16.15%)
         occurrences all number
    54
    56
    Pharyngitis
         subjects affected / exposed
    5 / 261 (1.92%)
    7 / 260 (2.69%)
         occurrences all number
    5
    7
    Sinusitis
         subjects affected / exposed
    4 / 261 (1.53%)
    10 / 260 (3.85%)
         occurrences all number
    4
    12
    Upper respiratory tract infection
         subjects affected / exposed
    24 / 261 (9.20%)
    27 / 260 (10.38%)
         occurrences all number
    25
    29
    Urinary tract infection
         subjects affected / exposed
    8 / 261 (3.07%)
    13 / 260 (5.00%)
         occurrences all number
    11
    14

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 Jun 2014
    - Study name RaPsOdy was added at the end of the study title - All secondary endpoints were added - Inclusion and exclusion criteria were edited to better define the selection of the study population - Added development of malignancy while on study as a reason for subject withdrawal - Added instruction that subjects who discontinued early would return for all Part 1 study visits - Clarified that “dropouts” referred to subjects who discontinued early and who were randomized but not treated - Revised instructions for used syringes - Edited language around prior and concomitant medications - Clarified that the same Investigator/clinician should have conducted the PASI for each subject at each visit - Added clarification that injection site reactions should have only been reported as adverse events if they were observed by study personnel - Changed Grade 4 adverse event definition from “severe” to “life-threatening” - Clarified that subjects with an indeterminate QuantiFERON-TB Gold test result could have had the test repeated once, and if negative, could have participated in the study
    06 Nov 2014
    - Prohibited administration of a live vaccine within 4 weeks prior to screening - Added language to clarify text around study drug accountability and retention as a safety measure, and to maintain consistency with the product insert of etanercept - Updated testing methods for positive HIV results
    11 Mar 2015
    - Revised enrollment numbers - Clarified that a subject’s last dose is at Week 47 - Added text to clarify requirements for the use of abstinence as a means of birth control - Added requirement that study personnel should visually inspect syringes for particulate matter and/or discoloration prior to dispensing study drug - Clarified TB testing entry criteria and what results permitted a repeat test - Clarified when subjects should have returned for follow-up after last dose of study drug - Added an explanation on how to manage subjects who were enrolled prior to study drug suspension - Prohibited systemic steroids within 4 weeks of randomization - Clarified that subjects who were off study drug during the study drug suspension period could have resumed study drug regardless of how many doses were missed - Expanded the 2 primary endpoints of the study - Added a description of adverse event outcomes - Added language to allow continuation into an open-label extension study in select countries - Redefined the Full Analysis Population and Safety Population
    21 Sep 2015
    - Added durability of response as an efficacy variable for Part 2 - Added detailed information to the interpretation of QuantiFERON-TB Gold testing and how subjects who had an intermediate or low positive result should be managed - Added language stating that the Sponsor may review A/B unblinded Part 1 analyses to assess if the results can support the project regulatory strategy and may release the assessment publically

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    30 Oct 2014
    During the conduct of the study, enrollment and dosing of subjects was voluntarily suspended by the Sponsor. During routine visual inspection of study drug in storage, 4 syringes containing CHS-0214 from a lot in use in Study CHS-0214-04 were observed to contain small dark particles. In the interest of patient safety, dosing of the ongoing Phase 3 clinical trials was immediately stopped, and an investigation was initiated to determine the cause and incidence of the observed particulate. A chemical analysis by an independent laboratory determined that the particles were not the result of drug product instability or formulation. Upon conclusion of the investigation, the lot was replaced in clinical inventory, and enrollment and dosing were resumed.
    05 Nov 2014

    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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