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    Clinical Trial Results:
    A Double-Blinded, Multi-Center, Randomized, Placebo-Controlled Study to Investigate the Efficacy and Safety of Injectafer® (Ferric Carboxymaltose) in the Treatment of Restless Legs Syndrome (RLS)

    Summary
    EudraCT number
    2015-001521-16
    Trial protocol
    HU   CZ   PL   ES  
    Global end of trial date
    02 Jan 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    24 Apr 2021
    First version publication date
    24 Apr 2021
    Other versions
    Summary report(s)
    2015-001521-16_CSR Synopsis_26Nov2018

    Trial information

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    Trial identification
    Sponsor protocol code
    1VIT14037
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02397057
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Luitpold Pharmaceuticals, Inc.
    Sponsor organisation address
    800 Adams Avenue, Norristown, United States, PA 19403
    Public contact
    Mark Falone, American Regent, mfalone@americanregent.com
    Scientific contact
    Mark Falone, American Regent, mfalone@americanregent.com
    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
    10 Oct 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    02 Jan 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    02 Jan 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this study is to evaluate the efficacy and safety of an IV Injectafer® in subjects with Restless Leg Syndrome (RLS).
    Protection of trial subjects
    Subjects were informed by the Investigator about the nature of the study, along with the aims, methods, anticipated benefits, potential hazards, and discomfort that participation may have entailed. Written informed consent was obtained from subjects. The study protocol and the informed consent form were submitted to the Independent Ethics Committee (IEC) or Institutional Review Board (IRB) for review and approval before study initiation. The study was conducted in accordance with recognized international scientific and ethical standards, including but not limited to the International Conference on Harmonization guideline for Good Clinical Practice (ICH GCP) and the original principles embodied in the Declaration of Helsinki.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    05 Nov 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Poland: 52
    Country: Number of subjects enrolled
    Spain: 18
    Country: Number of subjects enrolled
    Czechia: 4
    Country: Number of subjects enrolled
    Hungary: 15
    Country: Number of subjects enrolled
    United States: 76
    Country: Number of subjects enrolled
    Ukraine: 44
    Worldwide total number of subjects
    209
    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)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    142
    From 65 to 84 years
    66
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    The study was conducted in the US and Europe between 19 February 2015 and 22 January 2017.

    Pre-assignment
    Screening details
    The screening period, starting at Day -7 and following obtainment of informed consent/assent, was of maximum 9 days to allow for all screening results to be obtained and validated.

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Active treatment
    Arm description
    On Day 0 and Day 5, subjected received 750 mg active investigational medicinal product, Injectafer®, intravenously at 100 mg/mL.
    Arm type
    Experimental

    Investigational medicinal product name
    Injectafer®
    Investigational medicinal product code
    Injectafer®
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    750 mg solution for intravenous administration

    Arm title
    Placebo
    Arm description
    On Day 0 and Day 5, subjects received 15 mL placebo (standard saline solution) IV push.
    Arm type
    Placebo

    Investigational medicinal product name
    Placebo
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    15 ml, IV push

    Number of subjects in period 1
    Active treatment Placebo
    Started
    105
    104
    Completed
    94
    91
    Not completed
    11
    13
         Consent withdrawn by subject
    6
    7
         Physician decision
    -
    1
         Death
    1
    -
         Not specified
    -
    1
         Adverse event
    -
    1
         Lost to follow-up
    4
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Active treatment
    Reporting group description
    On Day 0 and Day 5, subjected received 750 mg active investigational medicinal product, Injectafer®, intravenously at 100 mg/mL.

    Reporting group title
    Placebo
    Reporting group description
    On Day 0 and Day 5, subjects received 15 mL placebo (standard saline solution) IV push.

    Reporting group values
    Active treatment Placebo Total
    Number of subjects
    105 104 209
    Age categorical
    Mean age of all subjects was 57.6 years (23 years to 85 years).
    Units: Subjects
        Adults (18-64 years)
    71 71 142
        From 65-84 years
    34 32 66
        85 years and over
    0 1 1
    Gender categorical
    Units: Subjects
        Female
    70 71 141
        Male
    35 33 68

    End points

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    End points reporting groups
    Reporting group title
    Active treatment
    Reporting group description
    On Day 0 and Day 5, subjected received 750 mg active investigational medicinal product, Injectafer®, intravenously at 100 mg/mL.

    Reporting group title
    Placebo
    Reporting group description
    On Day 0 and Day 5, subjects received 15 mL placebo (standard saline solution) IV push.

    Primary: IRLS total score

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    End point title
    IRLS total score
    End point description
    Change in IRLS total score from baseline to Day 42.
    End point type
    Primary
    End point timeframe
    Baseline Day 42
    End point values
    Active treatment Placebo
    Number of subjects analysed
    105 [1]
    103 [2]
    Units: n/a
        least squares mean (confidence interval 95%)
    -8.0 (-9.6 to -6.4)
    -4.8 (-6.5 to -3.2)
    Notes
    [1] - 2 subjects in placebo group treated with active substances but not analyzed in FAS
    [2] - 2 subjects in placebo group treated with active substances but not analyzed in FAS
    Statistical analysis title
    IRLS total score
    Comparison groups
    Active treatment v Placebo
    Number of subjects included in analysis
    208
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.0043
    Method
    ANOVA
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Day 0 to Day 365
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    17.0
    Reporting groups
    Reporting group title
    Active treatment
    Reporting group description
    -

    Reporting group title
    Placebo
    Reporting group description
    -

    Serious adverse events
    Active treatment Placebo
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 107 (5.61%)
    4 / 101 (3.96%)
         number of deaths (all causes)
    1
    0
         number of deaths resulting from adverse events
    0
    0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Colon cancer stage IV
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Injury, poisoning and procedural complications
    Forearm fracture
         subjects affected / exposed
    0 / 107 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Syncope
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cerebral haemorrhage
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Haemorrhagic stroke
         subjects affected / exposed
    0 / 107 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Chronic obstructive pulmonary disease
         subjects affected / exposed
    0 / 107 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Cellulitis
         subjects affected / exposed
    0 / 107 (0.00%)
    1 / 101 (0.99%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Diabetes mellitus inadequate control
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gout
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hypophosphataemia
         subjects affected / exposed
    1 / 107 (0.93%)
    0 / 101 (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
    Active treatment Placebo
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    72 / 107 (67.29%)
    34 / 101 (33.66%)
    Investigations
    Alanine aminotransferase increased
         subjects affected / exposed
    5 / 107 (4.67%)
    1 / 101 (0.99%)
         occurrences all number
    5
    1
    Blood pressure increased
         subjects affected / exposed
    5 / 107 (4.67%)
    1 / 101 (0.99%)
         occurrences all number
    5
    1
    Aspartate aminotransferase increased
         subjects affected / exposed
    3 / 107 (2.80%)
    1 / 101 (0.99%)
         occurrences all number
    3
    1
    Blood phosphorus decreased
         subjects affected / exposed
    3 / 107 (2.80%)
    0 / 101 (0.00%)
         occurrences all number
    3
    0
    Gamma-glutamyl transferase increased
         subjects affected / exposed
    3 / 107 (2.80%)
    3 / 101 (2.97%)
         occurrences all number
    3
    3
    Vascular disorders
    Flushing
         subjects affected / exposed
    6 / 107 (5.61%)
    0 / 101 (0.00%)
         occurrences all number
    6
    0
    Hot flush
         subjects affected / exposed
    5 / 107 (4.67%)
    1 / 101 (0.99%)
         occurrences all number
    5
    1
    Hypertension
         subjects affected / exposed
    0 / 107 (0.00%)
    3 / 101 (2.97%)
         occurrences all number
    0
    3
    Nervous system disorders
    Headache
         subjects affected / exposed
    5 / 107 (4.67%)
    6 / 101 (5.94%)
         occurrences all number
    5
    9
    Paraestesia
         subjects affected / exposed
    3 / 107 (2.80%)
    1 / 101 (0.99%)
         occurrences all number
    3
    1
    Dizziness
         subjects affected / exposed
    8 / 107 (7.48%)
    1 / 101 (0.99%)
         occurrences all number
    8
    1
    General disorders and administration site conditions
    Feeling hot
         subjects affected / exposed
    6 / 107 (5.61%)
    0 / 101 (0.00%)
         occurrences all number
    6
    0
    Fatigue
         subjects affected / exposed
    4 / 107 (3.74%)
    0 / 101 (0.00%)
         occurrences all number
    4
    0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    10 / 107 (9.35%)
    1 / 101 (0.99%)
         occurrences all number
    12
    1
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    3 / 107 (2.80%)
    1 / 101 (0.99%)
         occurrences all number
    3
    1
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    0 / 107 (0.00%)
    2 / 101 (1.98%)
         occurrences all number
    0
    2
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    1 / 107 (0.93%)
    2 / 101 (1.98%)
         occurrences all number
    1
    2
    Muscle spasms
         subjects affected / exposed
    2 / 107 (1.87%)
    0 / 101 (0.00%)
         occurrences all number
    2
    0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    4 / 107 (3.74%)
    4 / 101 (3.96%)
         occurrences all number
    4
    4
    Upper respiratory tract infection
         subjects affected / exposed
    4 / 107 (3.74%)
    1 / 101 (0.99%)
         occurrences all number
    4
    1
    Respiratory tract infection
         subjects affected / exposed
    3 / 107 (2.80%)
    3 / 101 (2.97%)
         occurrences all number
    4
    3
    Metabolism and nutrition disorders
    Hypophosphataemia
         subjects affected / exposed
    8 / 107 (7.48%)
    1 / 101 (0.99%)
         occurrences all number
    9
    1
    Decreased appetite
         subjects affected / exposed
    4 / 107 (3.74%)
    0 / 101 (0.00%)
         occurrences all number
    4
    0
    Hyperglycaemia
         subjects affected / exposed
    3 / 107 (2.80%)
    2 / 101 (1.98%)
         occurrences all number
    3
    2

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    13 Jul 2015
    Amendment (13 July 2015) included the following key changes: • Day 28 was added to the remote contact by phone procedure. • Interactive Web Response/Electronic Data Capture was updated to IRT. • The C-SSRS was added. • Stratification of subjects by RLS medication-related augmentation was added. • Definition of intervention was updated. • RLS therapy prior to screening was revised to specify subjects should be on monotherapy for RLS. Exclusion criterion #5 (subjects with multiple sclerosis) was added. • Stratification factor for the CMH test was changed to region (US, EUR). • Information on the natural history, disease understanding, and treatment guidance for RLS was updated. • Length of the study was adjusted from approximately 12½ months to approximately 12 months. • Procedure for tapering from current RLS medication posttreatment was added. • An RLS subject diary to record progress was added to the study procedures. • The following study procedures were added to Day 365 (End of Study): o Contact IRT to complete subject from study. o If the subject terminated early or the Day 365 phosphorus value was below the lower limit of normal, the subject should have returned (as directed by the Investigator) for a repeat blood sample until the value was back within normal limits. • Reporting of SAEs was updated to specify any SAE was to be reported within 24 hours of the Investigator becoming aware of the event. Time off pre-enrollment prescribed RLS medications was added to the secondary efficacy endpoints
    02 Jun 2016
    Amendment (02 June 2016) included the following key changes: • Further details were added to the RLS tapering treatment regimen: o Day 6 was added to the timing of tapering from prescribed RLS medication. o The subject was to be maintained on the lowest dose level attained at the end of the tapering period and that dose was to remain stable for the duration of the subject’s participation in the study. • A +2-day window was added to the 7-day screening period. • The time frame for keeping the RLS diary was updated to starting at screening. • Additional dosing details were revised to specify that central laboratory results obtained during the Day 42 or Day 168 visit could have been used to qualify a subject for additional dosing if those laboratory tests had occurred with 14 days of the first dose of study drug. • An interim analysis of efficacy was added.

    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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