E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Neurogenic detrusor overactivity (NDO) |
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E.1.1.1 | Medical condition in easily understood language |
-not being able to control urination (incontinence)
-strong urge to urinate |
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E.1.1.2 | Therapeutic area | Body processes [G] - Biological Phenomena [G16] |
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 | 10012547 |
E.1.2 | Term | Detrusor hyperreflexia |
E.1.2 | System Organ Class | 100000004857 |
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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 | 10059617 |
E.1.2 | Term | Overactive bladder |
E.1.2 | System Organ Class | 100000004857 |
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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 |
To evaluate the efficacy of mirabegron after multiple-dose administration in the pediatric population. |
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E.2.2 | Secondary objectives of the trial |
To evaluate the safety and tolerability of mirabegron after multiple-dose administration in the pediatric population.
To evaluate the pharmacokinetics of mirabegron after multiple-dose administration in the pediatric population.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Independent Ethics Committee (IEC)/Institutional Review Board (IRB)-approved written Informed Consent and privacy language as per national regulations must be obtained from the subject and/or from the subject’s parent(s) or legal guardian(s) prior to any study-related procedures (including discontinuation of prohibited medication, if applicable); assent by the subject is given as required by local law.
2. Subject is male or female from 3 to less than 18 years of age.
3. Subject has a body weight of ≥ 11 kg.
4. Subject suffers from NDO confirmed by urodynamic investigation at baseline. The diagnosis of NDO must be confirmed by the presence of at least 1 involuntary destrusor contraction > 15 cm H2O from baseline destrusor pressure, and/or a decrease in compliance leading to an increase in baseline detrusor pressure of > 20 cm H2O.
5. Subject has been using CIC for at least 4 weeks prior to visit 1/screening.
6. Subject has a current indication for drug therapy to manage NDO.
7. Subject is able to take the study drugs in accordance with the protocol.
8. Female subject must either:
Be of nonchildbearing potential:
- Clearly premenarchal or in the judgment of the investigator is premenarchal,
- Documented surgically sterile,
or, if of childbearing potential:
- Agree not to try to become pregnant during the study and for 28 days after the final study drug administration,
- And have a negative pregnancy test at visit 1/screening and at visit 3/baseline,
- And, if sexually active must agree to use a highly effective method of birth control, which includes established use of oral, injected or implanted hormonal methods of contraception, OR placement of an intrauterine device (IUD) or intrauterine system (IUS). Birth control must be practiced from visit 1/screening and continuing throughout the study period, and for 28 days after the final study drug administration.
9. Male subject and their female spouse/partner who are of childbearing potential must be using a highly effective method of birth control, which includes established use of oral, injected or implanted hormonal methods of contraception, placement of an IUD or IUS. Birth control must be practiced from visit 1/screening and continuing throughout the study period, and for 28 days after the final study drug administration.
10. Female subject must not be breastfeeding from visit 1/screening until 28 days after last study drug administration.
11. Subject and subject’s parent(s)/legal guardian(s) agree that the subject will not participate in another interventional study while participating in the study.
12. Subject and subject’s parent(s)/legal guardian(s) are willing and able to comply with the study requirements and with the concomitant medication restrictions.
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E.4 | Principal exclusion criteria |
1. Subject has a known genitourinary condition (other than NDO) that may cause overactive
contractions or incontinence (e.g., bladder extrophy, urinary tract obstruction, urethral
diverticulum or fistula) or kidney/bladder stones or another persistent urinary tract
pathology that may cause urinary symptoms.
2. Subject has one of following gastrointestinal problems: partial or complete obstruction, decreased motility such as paralytic ileus, subject at risk of gastric retention.
3. Subject has a urinary indwelling catheter within 4 weeks prior to visit 1/screening.
4. Subject has a surgically treated underactive urethral sphincter.
5. Subject has vesico-ureteral reflux grade 3 to 5.
6. Subject has undergone bladder augmentation surgery.
7. Subject receives electrostimulation therapy, if started within 30 days before visit 1/screening or is expected to start during the study period. Subjects who are on an established regimen may remain on this for the duration of the study.
8. Subject suffers from a symptomatic urinary tract infection (UTI) at baseline (symptomatic is defined as pain, fever, hematuria, new onset foul-smelling urine). If present at visit 1/screening or diagnosed between visit 1/screening and visit 3/baseline, the UTI should be treated successfully (clinical recovery) prior to baseline. If a symptomatic UTI is present at baseline, all baseline assessments are allowed to be postponed for a maximum of 7 days until the UTI is successfully treated (clinical recovery).
9. Subject has a (mean) resting pulse rate >99th percentile.
10. Subject has an established hypertension and systolic or diastolic blood pressure greater than the 99 th percentile of the normal range determined by sex, age, and height, plus mmHg.
11. Subject has a risk of QT prolongation (e.g., hypokalemia, long QT syndrome [LQTS]; or family history of LQTS, exercise-induced syncope).
12. Subject has severe renal impairment (estimated glomerular filtration rate [eGFR] according to Larsson equation < 30 mL/min).
13. Subject’s aspartate aminotransferase (AST) or alanine aminotransferase (ALT) is greater than or equal to 2 times the upper limit of normal (ULN) or total bilirubin greater than or equal to 1.5 times the ULN according to age and sex.
14. Subject has a history or presence of any malignancy prior to visit 1/screening.
15. Subject has known or suspected hypersensitivity to mirabegron, any of the excipients used in the current formulations or previous severe hypersensitivity to any drug.
16. Subject has participated in another clinical trial (and/or has taken an investigational drug within 30 days (or 5 half-lives of the drug, or the limit set by national law, whichever is longer) prior to visit 1/screening.
17. Subject uses any of the following prohibited medications (after start of washout):
• Any medication, other than the study drug, used for the management of NDO;
• Any drugs that are sensitive cytochrome (CYP) 2D6 substrates with a narrow therapeutic index or sensitive P-glycoprotein (P-gp) substrates
• Any strong cytochrome P450 (CYP) 3A4 inhibitors if the subject has a mild to moderate renal impairment (eGFR 30 – 89 mL/min).
18. Subject has been administered intravesical botulinum toxin; except if given > 4 months prior to visit 1/screening and the subject experiences symptoms comparable to those existing prior to the botulinum toxin injections.
19. Subject has any other condition, which in the opinion of the Investigator, precludes the subject’s participation in the study.
20. Subject’s parent/legal guardian is an employee of the Astellas Group, the Contract Research Organization (CRO) involved, or the investigator site executing the study.
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E.5 End points |
E.5.1 | Primary end point(s) |
Efficacy: Change from baseline in maximum cystometric capacity (MCC) after 24 weeks of treatment (based on filling urodynamics) |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Efficacy: Visit 8, week 24 of efficacy treatment period |
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E.5.2 | Secondary end point(s) |
Efficacy
Based on filling urodynamics:
Change from baseline at visit 5/week 4 and visit 8/week 24 in:
• MCC (only visit 5/week 4)
• Bladder compliance (∆V/∆P)
• Number of overactive detrusor contractions (> 15 cm H20) until end of filling
• Detrusor pressure at end of filling
• Filling volume until first overactive detrusor contraction (> 15 cm H20)
Based on e-diary:
Change from baseline at visit 4/week 2, visit 5/week 4, visit 6/week 8, visit 7/week 12, visit 8/week 24, visit 9/week 36 and visit 10/ week 52 (EOT/EOS) in:
• Average catheterized volume per catheterization
• Maximum catheterized volume
• Maximum catheterized daytime volume
• Average morning catheterized volume (based on first catheterization after subject woke up)
• Mean number of leakage episodes per day (day and night time)
• Number of dry (leakage-free) days/7 days (day and night time)
Based on questionnaires:
• Change from baseline at visit 8/week 24 and visit 10/week 52 (EOT/EOS) in Pediatric Incontinence Questionnaire (PIN-Q)
• Change from baseline at visit 8/week 24 and visit 10/week 52 (EOT/EOS) in Patient Global Impression of Severity Scale (PGI-S)
• Acceptability questionnaire at visit 5/week 4, visit8/week 24 and visit 10/week 52 (EOT/EOS)
• Clinician Global Impression of Change (CGI-C) at visit 8/week 24 and visit 10/week 52 (EOT/EOS)
Safety
● Incidence and severity of treatment-emergent adverse events (TEAEs)
● Change from baseline in vital signs (clinic measurements): systolic blood pressure, diastolic blood pressure, pulse rate and temperature at visit 5/week 4, visit 7/week 12, visit 8/week 24 and visit 10/week 52 (EOT/EOS)
● Change from baseline in vital signs (self blood pressure measurement SBPM): systolic blood pressure, diastolic blood pressure, pulse rate at visit 4/week 2, visit 5/week 4, visit 6/week 8, visit 7/week 12, visit 8/week 24, visit 9/week 36 and visit 10/week 52 (EOT/EOS) and on 2 consecutive days at around 1 and 2 weeks after start of dosing with PED25 (day 1) and after up titration to PED50 (visit 4/week 2, visit 5/week 4 or visit 6/week 8), if not already covered by the scheduled visit 4/week 2 and/or visit 5/week 4 SBPM.
● Change from baseline in hematology and biochemistry tests at visit 7/week 12 and visit 10/week 52 (EOT/EOS) and urinalysis tests at visit 5/week 4, visit 7/week 12, visit 8/week 24 and visit 10/week 52 (EOT/EOS)
● Change from baseline in ECG parameters at visit 5/week 4 and visit 10/week 52 (EOT/EOS)
● Change from baseline to visit 10/week 52 (EOT/EOS) in upper urinary tract ultrasound assessment
● Change from baseline in eGFR at visit 7/week 12 and visit 10/week 52 (EOT/EOS)
Pharmacokinetic parameters will be determined at visit 5/week 4, visit 6/week 8, visit 7/week 12, visit 8/week 24 and/or visit 9/week 36: Cmax, tmax, AUC24, Ctrough, CL/F and Vz/F. Additional pharmacokinetic parameters may be calculated based on the model used.
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
For Efficacy and Safety end-points - See E.5.2
Pharmacokinetics: PK samples will be taken at 2 visits between visit 5/week 4 and visit 10/week 52 (EOT/EOS), when steady state has been reached |
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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 | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
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 | Yes |
E.8.2.3.1 | Comparator description |
Compared to parameter values at baseline |
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E.8.2.4 | Number of treatment arms in the trial | 1 |
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 | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 20 |
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 |
Australia |
Belgium |
Brazil |
Colombia |
Croatia |
Denmark |
Israel |
Korea, Republic of |
Latvia |
Lithuania |
Malaysia |
Mexico |
Norway |
Philippines |
Poland |
Romania |
Serbia |
Singapore |
Slovakia |
Taiwan |
Turkey |
Jordan |
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E.8.7 | Trial has a data monitoring committee | Yes |
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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The last subject’s last protocol-defined assessment will mark the end of the study. |
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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 | 3 |
E.8.9.1 | In the Member State concerned months | 2 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 2 |
E.8.9.2 | In all countries concerned by the trial days | 0 |