E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Systemic sclerosis (scleroderma) (SSc) is a chronic connective tissue disorder of unknown aetiology characterized by widespread microvascular damage and excessive deposition of collagen in the skin and internal organs . Pulmonary fibrosis and pulmonary hypertension appear as the leading causes of mortality and patients with SSc have considerable morbidity from their disease due to skin fibrosis, Raynaud’s phenomenon and damage to the gastrointestinal tract, lungs, heart and kidneys. |
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E.1.1.1 | Medical condition in easily understood language |
Systemic sclerosis is caused by a build up of fibrous and collagen deposits in the skin and internal organs leading to damage to internal organs particularly the lung and heart. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Skin and Connective Tissue Diseases [C17] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10012941 |
E.1.2 | Term | Diffuse scleroderma |
E.1.2 | System Organ Class | 100000004859 |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 18.0 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10074034 |
E.1.2 | Term | Generalised scleroderma |
E.1.2 | System Organ Class | 100000004859 |
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E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The primary objective of this study is to evaluate in patients suffering from diffuse cutaneous SSc (DcSSc) the effect of 800mg and 1200mg IVA337 daily on the skin compared to placebo. The modified Rodnan Skin Score (MRSS) will be used to determine the changes in skin.
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E.2.2 | Secondary objectives of the trial |
Secondary objectives include additional efficacy evaluations (details in the protocol), assessment of adverse events (AEs), and determination of population PK parameters of IVA337 in patients.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Systemic sclerosis according to ACR/EULAR 2013 criteria
• Diffuse cutaneous SSc subset (LeRoy’s criteria)
• Diagnosis within the past 3 years as defined by the first non-Raynaud’s symptom
• MRSS between 10 and 25
• Aged between 18 and 75 years
• Informed consent documented by signature |
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E.4 | Principal exclusion criteria |
• Unstable treatment with corticosteroids or immunosuppressive agents (stable therapy for more than 3 months with prednisone ≤ 10 mg, methotrexate≤ 20 mg/w, azathioprine ≤ 150 mg/d, mycofenolate mofetil ≤ 2g/d, or leflunomide ≤ 20 mg/d is acceptable)
• Cyclophosphamide during the past 6 months
• Requirement of IV prostanoids for critical ischemia or pulmonary hypertension in the last 3 months
• Renal insufficiency defined by a creatinine clearance of less than 30 ml/min and/or past/current renal crisis
• Hepatic impairment i.e. primary biliary cirrhosis and unexplained persistent liver function abnormality,
• Gallbladder disease
• Severe cardiac (LVEF <45%) and/or pulmonary disease (FVC < 50% or pulmonary hypertension proven by right heart catheterisation)
• History of heart failure, symptomatic coronary artery disease, significant ventricular tachyarrhythmia, stent placement, coronary artery bypass surgery, and/or myocardial infarction.
• Recipient of solid organ transplant
• Gastrointestinal involvement preventing oral administration of study drug
• Chronic infections, positive serology for infection with hepatitis B or C.
• Pregnancy, Lactation. Woman of childbearing potential unwilling to use a medically acceptable form of birth control
• History of malignancy within the last 5 years, except for resected basal or squamous cell carcinoma, treated cervical dysplasia, or treated in situ cervical cancer
• A recent history of alcohol or drug abuse, non-compliance with other medical therapies
• Participation in a clinical study involving another investigational drug or device within 4 weeks before the Pre-treatment Visit
• Laboratory parameters at the pre-treatment visit showing any of the following abnormal results: transaminases > 2x the upper limit of normal (ULN) and/or bilirubin > 2x ULN; neutrophil count < 1,500/mm3; platelet count < 100,000/mm3; haemoglobin < 9 g/dL
• Contraindications to the class of drugs under study (PPAR agonists), e.g. known hypersensitivity or allergy to class of drugs or the investigational product (see IB 2015)
• Any condition or treatment, which in the opinion of the investigator, places the subject at unacceptable risk as a patient in the trial (Please consider the precautions and warnings described in the IB 2015) |
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E.5 End points |
E.5.1 | Primary end point(s) |
Primary outcome is the mean change of the Modifed Rodnan Skin Score (MRSS) from baseline to week 48 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
• MRSS response rates; improvers are defined by a reduction ≥5 points and ≥25 % of MRSS
• Overall progression of the disease: defined as absence of rescue therapy and absence of severe organ involvement (see definition below)
• Change in pulmonary function (FVC% predicted and cDLCO% predicted)
• Changes in patient reported outcomes (SHAQ, UCLA SCTC GIT, PROMIS29, SF36)
• Digital ulcer net burden (defined as total number of ulcers at a certain time point minus number of ulcers at baseline) and proportion of patients who do not develop new ulcers
• Cochin Hand Function Scale
• Physician and patient global assessments of disease activity over the past week (VAS)
• Change in the Combined Response Index for Systemic Sclerosis (CRISS), consisting of five variables: MRSS, FVC % predicted, physician and patient global assessments, and HAQ-DI score (from SHAQ patient reported outcome)
• Need for escape therapy (% patients)
• Severe organ involvement (% patients) defined by
• New renal crisis OR
• New or worsened clinically symptomatic and significant heart disease, considered secondary to DcSSc OR
• Relative decline in FVC % predicted by ≥ 10% or relative decline in FVC % predicted between 5 to < 10% with associated relative decline in DLCO % predicted by ≥ 15%, provided that the decline in FVC results in FVC <75% of predicted OR
• New or worsening of gastrointestinal disease requiring hospitalization or new requirement for parenteral nutrition OR
• Critical digital ischemia of the extremities promoting the necrosis or gangrene
• Active polyarthritis defined by tender joints > 8 and swollen joints > 6 OR
• New onset of tendon friction rubs
SAFETY
• Frequency and type of AEs
• Lab tests: mean change and frequency of values outside the normal range
OTHER
• Changes in Raynaud phenomenon (Raynaud’s condition score)
• Mean changes in activity biomarkers
• Population pharmacokinetics
• Follow-up: There is a follow-up visit to evaluate any changes that might occur within 12 weeks after completion of the treatment. The performed assessments listed in the Schedule of Study Procedures refer to safety and efficacy. |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Throughout the study at weeks, 2, 4, 8, 12, 16, 24, 28, 32, 40, 48, 60 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | Yes |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | Yes |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
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 | 11 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 34 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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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
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last visit of last subject |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 2 |