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    Summary
    EudraCT Number:2015-004347-39
    Sponsor's Protocol Code Number:E2006-G000-304
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2018-12-10
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedItaly - Italian Medicines Agency
    A.2EudraCT number2015-004347-39
    A.3Full title of the trial
    A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Active Comparator, Parallel-Group Study of the Efficacy and Safety of Lemborexant in Subjects 55 Years and Older with Insomnia Disorder
    Studio multicentrico, randomizzato, in doppio cieco, controllato con placebo, con farmaco di confronto attivo, a gruppi paralleli per valutare l'efficacia e la sicurezza di Lemborexant in soggetti di età pari o superiore a 55 anni che soffrono di insonnia
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Lemborexant for the treatment of insomnia disorder in older individuals
    Lemborexant per il trattamento dell'insonnia in individui in età avanzata
    A.3.2Name or abbreviated title of the trial where available
    Lemborexant for the treatment of insomnia disorder in older individuals
    Lemborexant per il trattamento dell'insonnia in individui in età avanzata
    A.4.1Sponsor's protocol code numberE2006-G000-304
    A.5.1ISRCTN (International Standard Randomised Controlled Trial) NumberISRCTN00000000
    A.5.2US NCT (ClinicalTrials.gov registry) numberNCT00000000
    A.5.3WHO Universal Trial Reference Number (UTRN)U0000-0000-0000
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorEISAI LIMITED
    B.1.3.4CountryUnited Kingdom
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportEisai Ltd.
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationEisai Ltd.
    B.5.2Functional name of contact pointMedical Information
    B.5.3 Address:
    B.5.3.1Street AddressMosquito Way
    B.5.3.2Town/ cityHatfield
    B.5.3.3Post codeAL10 9SN
    B.5.3.4CountryUnited Kingdom
    B.5.4Telephone number+44 (0) 845 676 14
    B.5.5Fax number+44 (0) 845 676 14
    B.5.6E-mailLMedInfo@eisai.net
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namelemborexant
    D.3.2Product code E2006
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNlemborexant
    D.3.9.1CAS number 1369764-02-2
    D.3.9.2Current sponsor codeE2006
    D.3.9.4EV Substance CodeSUB177370
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number5
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Ambien CR (Zolpidem Tartrate Extended Release(ER))
    D.2.1.1.2Name of the Marketing Authorisation holderSanofi Aventis US LLC
    D.2.1.2Country which granted the Marketing AuthorisationUnited States
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNAmbien CR
    D.3.9.1CAS number 99294-93-6
    D.3.9.2Current sponsor code-
    D.3.9.3Other descriptive nameZOLPIDEM TARTRATE
    D.3.9.4EV Substance CodeSUB05192MIG
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number6.25
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 3
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product namelemborexant
    D.3.2Product code E2006
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNlemborexant
    D.3.9.1CAS number 1369764-02-2
    D.3.9.2Current sponsor codeE2006
    D.3.9.4EV Substance CodeSUB177370
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number10
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8 Placebo: 3
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Treatment for insomnia disorder
    Trattamento per l'insonnia
    E.1.1.1Medical condition in easily understood language
    Insomnia
    Insonnia
    E.1.1.2Therapeutic area Psychiatry and Psychology [F] - Behaviours [F01]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10022437
    E.1.2Term Insomnia
    E.1.2System Organ Class 10037175 - Psychiatric disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Demonstrate using polysomnography (PSG) that 10 mg lemborexant (LEM10) is superior to zolpidem tartrate ER 6.25 mg (Ambien CR; ZOL) on objective sleep maintenance as assessed by wake after sleep onset in the second half of the night (WASO2H) after the last 2 nights of 1 month of treatment in subjects 55 years and older with insomnia disorder
    Dimostrare usando polisonnografia (PSG) che lemborexant in dose da 10 mg (LEM10) è superiore a zolpidem tartrato ER in dose da 6,25 mg (Ambien CR; ZOL) nel mantenimento oggettivo del sonno valutato in base a veglia successiva all'insorgenza del sonno nella seconda metà della notte (WASO2H) dopo le ultime 2 notti di 1 mese di trattamento in soggetti di età pari e superiore a 55 anni che soffrono di insonnia
    E.2.2Secondary objectives of the trial
    Demonstrate that 5 mg lemborexant (LEM5) is superior to ZOL on objective sleep maintenance as assessed by WASO2H after the last 2 nights of treatment.
    Demonstrate that LEM5 or LEM10 or both LEM5 and LEM10 are superior to ZOL on postural stability in the morning after the first 2 nights of treatment
    Dimostrare che lemborexant (LEM5) in dose da 5 mg è superiore a ZOL nel mantenimento oggettivo del sonno valutato in base a WASO2H dopo le ultime 2 notti di trattamento.
    Dimostrare che LEM5 o LEM10 o sia LEM5 che LEM10 sono superiori a ZOL nella stabilità posturale al mattino dopo le prime 2 notti di trattamento.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Male age 65 years or older or female, age 55 years or older at the time of informed consent
    2. Meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for Insomnia Disorder, as follows:
    o Complains of dissatisfaction with nighttime sleep, in the form of difficulty staying asleep and/or awakening earlier in the morning than desired despite adequate opportunity for sleep (Note that if the complaint is limited to difficulty initiating
    sleep, the subject is not eligible)
    o Frequency of complaint ≥ 3 times per week
    o Duration of complaint ≥ 3 months
    o Associated with complaint of daytime impairment
    3. At Screening: History of subjective WASO (sWASO) typically ≥ 60 minutes on at least 3 nights per week in the previous 4 weeks
    4. At Screening: Reports regular time spent in bed, either sleeping or trying to sleep, between 7 and 9 hours
    5. At Screening: Reports habitual bedtime, defined as the time the subject attempts to sleep, between 21:00 and 24:00 and habitual waketime between 05:00 and 09:00
    6. At Screening and at check-in before the first PSG during the Run-in Period: ISI score ≥15
    7. Confirmation of current insomnia symptoms as determined from responses on the Sleep Diary on the 7 most recent mornings (minimum 5 of 7 for eligibility) before the second screening visit, such that sWASO ≥ 60 minutes on at least 3 of the 7 nights
    8. Confirmation of regular bedtime and waketime as determined from responses on the Sleep Diary on the 7 most recent mornings before the second screening visit, such that neither bedtime, (defined as the time the subject attempts to try to sleep), nor waketime (defined as the time the subject gets out of bed for the day) deviates more than 1 hour on more than 2 nights from the calculated MHB or median habitual waketime, respectively, from the Screening Sleep Diary entries
    9. Confirmation of sufficient duration of time in bed (TIB), as determined from responses on the Sleep Diary on the 7 most recent mornings before the second screening visit, such that there is not more than 2 nights with TIB duration < 7 hours or > 9 hours
    10. During the Run-in Period: Reconfirmation of insomnia symptoms, as determined from responses on the Sleep Diary on the 7 most recent mornings before the first PSG during the Run-in Period, such that sWASO ≥ 60 minutes on at least 3 of the 7 nights
    11. During the Run-in Period: Reconfirmation of regular bedtimes and waketimes as defined in Inclusion Criterion 8
    12. During the Run-in Period: Reconfirmation of sufficient duration of TIB as defined in Inclusion Criterion 9
    13. During the Run-in Period: Objective (PSG) evidence of insomnia as follows:
    a) WASO average ≥ 60 minutes on the 2 consecutive PSGs, with neither
    night < 45 minutes AND
    b) SE average ≤ 85% on the 2 consecutive PSGs, with neither night >87.5%
    14. Willing and able to comply with all aspects of the protocol, including staying in bed for at least 7 hours each night
    15. Willing not to start a behavioral or other treatment program for the treatment of insomnia during the subject’s participation in the study
    1. Maschio con un'età pari o superiore a 65 anni o femmina con un'età pari o superiore a 55 anni al momento dell’ottenimento del consenso informato
    2. Soddisfa i criteri del Manuale di diagnostica e statistica delle malattie mentali, quinta edizione, per l'insonnia, come segue:
    o Lamenta insoddisfazione riguardo al sonno notturno in forma di difficoltà a restare addormentato e/o di risveglio anticipato al mattino nonostante l'opportunità adeguata di riposo (Si noti che se il disturbo è limitato a difficoltà a prendere sonno il soggetto non è eleggibile)
    o Frequenza del disturbo ≥ 3 volte alla settimana
    o Durata del disturbo ≥ 3 mesi
    o Associazione a segnalazione di compromissione diurna
    3. Allo Screening: Anamnesi di WASO soggettiva (sWASO) solitamente ≥ 60 minuti in almeno 3 notti a settimana nelle 4 settimane precedenti
    4. Allo Screening: Segnala tempo regolare trascorso a letto, o dormendo o cercando di dormire, compreso tra 7 e 9 ore
    5. Allo Screening: Segnala un orario abituale di coricamento, definito come l'ora in cui il soggetto cerca di dormire, tra le 21.00 e le 24.00, e un orario di risveglio abituale tra le 05.00 e le 09.00
    6. Allo Screening e al check-in prima della prima PSG durante il Periodo di run-in: Punteggio ISI ≥15
    7. Conferma di attuali sintomi di insonnia come stabilito dalle risposte sul Diario del sonno nelle 7 mattine più recenti (minimo di 5 su 7 per l'eleggibilità) prima della seconda visita di screening, tale che sWASO > 60 minuti in almeno 3 delle 7 notti
    8. Conferma di orario di coricamento e del risveglio regolare come stabilito dalle risposte sul Diario del sonno nelle 7 mattine più recenti prima della seconda visita di screening, tale che né l'orario di coricamento (definito come l'ora in cui il soggetto tenta di addormentarsi) né l'orario del risveglio (definito come l'ora in cui il soggetto si alza dal letto al mattino) si discostino di più di 1 ora in più di 2 notti rispettivamente dal MHB o dall'orario abituale di risveglio mediano calcolati, rispettivamente, in base alle voci del Diario del sonno allo screening
    9. Conferma di durata sufficiente del tempo trascorso a letto (TIB), come stabilito dalle risposte nel Diario del sonno nelle 7 mattine più recenti prima della seconda visita di screening, tale che non vi siano più di 2 notti in cui la durata del tempo trascorso a letto sia < 7 o > 9 ore
    10. Durante il Periodo di run-in: Riconferma dei sintomi dell'insonnia come stabilito dalle risposte riportate nel Diario del sonno nelle 7 mattine più recenti prima della prima PSG durante il Periodo di run-in, tale che sWASO ≥ 60 minuti in almeno 3 delle 7 notti
    11. Durante il Periodo di run-in: Riconferma di orario di coricamento e del risveglio regolari come definiti nel Criterio di inclusione 8
    12. Durante il Periodo di run-in: Riconferma di durata sufficiente del tempo trascorso a letto (TIB) come definito nel Criterio di inclusione 9
    13. Durante il Periodo di run-in: Evidenza oggettiva (PSG) di insonnia, come segue:
    a) media WASO ≥ 60 minuti alle 2 PSG consecutive con nessuna notte < 45 minuti, E
    a) media SE ≤ 85% alle 2 PSG consecutive con nessuna notte > 87,5 %
    14. Volontà e capacità di aderire a tutti gli aspetti del protocollo, incluso rimanere a letto per almeno 7 ore ogni notte
    15. Volontà di non iniziare un programma comportamentale o altro programma di trattamento per il trattamento dell'insonnia durante la partecipazione del soggetto allo studio
    E.4Principal exclusion criteria
    1. A current diagnosis of sleep-related breathing disorder (including obstructive sleep apnea with or without continuous positive airway pressure [CPAP] treatment), periodic limb movement disorder, restless legs syndrome, circadian rhythm sleep disorder, or narcolepsy, or an exclusionary score on screening instruments to rule out individuals with symptoms of certain sleep disorders other than insomnia as follows: (revised per Amendment 01)
    a. STOPBang score ≥5
    b. International Restless Legs Scale score ≥16
    c. Epworth Sleepiness Scale score >10 (revised per Amendment 01)

    2. Reports symptoms potentially related to narcolepsy that in the clinical opinion of the investigator indicates the need for referral for a diagnostic evaluation for the presence of narcolepsy (revised per Amendment 01)

    3. On the MUPS, (a) a history of symptoms of Rapid Eye Movement (REM) Behavior Disorder, sleep-related violent behavior, sleep-driving, or sleep-eating, or (b) symptoms of another parasomnia that in the investigator's opinion make the subject unsuitable for the study

    4. Apnea-Hypopnea Index > 15 or Periodic Limb Movement with Arousal Index > 15 as measured on the PSG at the second screening visit

    5. Beck Depression Inventory – II (BDI-II) score >19 at Screening

    6. Beck Anxiety Inventory (BAI) score >15 at Screening

    7. Habitually naps during the day more than 3 times per week

    8. Is a female of childbearing potential
    Note: All females will be considered to be of childbearing potential unless they are postmenopausal (defined as amenorrheic for at least 12 consecutive months, are in the appropriate age group, and are postmenopausal without other known or suspected cause), or have been sterilized surgically (ie, bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, all with surgery at least 1 month before dosing)

    9. Excessive caffeine use that in the opinion of the investigator contributes to the subject’s insomnia, or habitually consumes caffeine-containing beverages after 18:00 and is unwilling to forego caffeine after 18:00 for the duration of his/her participation in the study

    15. Current evidence of clinically significant disease (eg, cardiac; respiratory including chronic obstructive pulmonary disease, acute and/or severe respiratory depression; gastrointestinal including severe hepatic impairment; renal including severe renal impairment; neurological including myasthenia gravis; psychiatric disease; malignancy within the past 5 years other than adequately treated basal cell carcinoma) or chronic pain that in the opinion of the investigator(s) could affect the subject’s safety or interfere with the study assessments, including the ability to perform tasks on the cognitive PAB. Subjects for whom a sedating drug would be contraindicated for safety reasons because of the subject’s occupation or activities are also excluded. (revised per Amendment 01)

    16. Comorbid nocturia resulting in frequent need to get out of bed to use the bathroom during the night

    17. Any history of a medical or psychiatric condition that in the opinion of the investigator(s) could affect the subject’s safety or interfere with the study assessments, including the ability to perform the PAB

    18. Any suicidal ideation with intent with or without a plan, at the time of or within 6 months before the eC-SSRS administration during the Prerandomization Phase (ie, answering “Yes” to questions 4 or 5 on the Suicidal Ideation section of the eC-SSRS)

    20. Scheduled for surgery during the study

    21. Used any prohibited prescription or over-the-counter concomitant medications within 1 week or 5 half-lives, whichever is longer, before the first dose of study medication (Run-in Period). (revised per Amendment 01)

    22. Used any modality of treatment for insomnia, including cognitive behavioral therapy or marijuana within 1 week or 5 half-lives, whichever is longer, before the first dose of study medication (Run-in Period) (revised per Amendment 01)

    23. Failed treatment with suvorexant (Belsomra®) (efficacy and/or safety) following treatment with an appropriate dose and of adequate duration in the opinion of the investigator
    1. Una attuale diagnosi di disturbo della respirazione correlato al sonno (inclusa apnea ostruttiva nel sonno associata o meno a trattamento con pressione positiva continua delle vie aeree [CPAP]), disturbo da movimento periodico degli arti, sindrome della gambe senza riposo, disturbo del ritmo circadiano del sonno o narcolessia o un punteggio che implica esclusione rilevato dagli strumenti di screening per escludere individui con sintomi propri di alcuni disturbi del sonno diversi dall'insonnia, come segue (modifica tramite Emendamento 01):
    a. Punteggio del questionario STOPBang ≥5
    b. Punteggio sulla Scala internazionale della sindrome delle gambe senza riposo ≥16
    c. Punteggio >10 sulla Scala di Epworth relativa alla sonnolenza (modifica tramite Emendamento 01)

    2. Segnala sintomi potenzialmente correlati a narcolessia, che in base all'opinione clinica dello sperimentatore indica la necessità di consulto per una valutazione diagnostica per la presenza di narcolessia (modifica tramite Emendamento 01)

    3. In base a MUPS, (a) un’anamnesi di sintomi di disturbo comportamentale con movimento rapido degli occhi (Rapid Eye Movement - REM), comportamento violento correlato al sonno, guidare nel sonno o mangiare nel sonno, o (b) sintomi di un'altra parasonnia che secondo l'opinione dello sperimentatore renda il soggetto inadatto per lo studio

    4. Indice di apnea-ipopnea > 15 o Indice di movimento periodico degli arti associato a risveglio >15 misurato con PSG alla seconda visita di screening

    5. Questionario sulla depressione di Beck – II (BDI-II) punteggio >19 allo Screening

    6. Questionario sull'ansia di Beck (BAI) punteggio >15 allo Screening

    7. Fa abitualmente sonnellini durante il giorno per più di 3 volte la settimana

    8. È una donna in età fertile
    Nota: Tutti i soggetti di sesso femminile saranno considerati in età fertile a meno che non si trovino in post-menopausa (definita come almeno 12 mesi consecutivi di amenorrea, nella fascia d’età adeguata e senza altra causa nota o sospetta) o siano stati sottoposti a sterilizzazione chirurgica (ossia legatura bilaterale delle tube, isterectomia totale o ooforectomia bilaterale, tutte eseguite mediante intervento chirurgico almeno 1 mese prima del dosaggio).

    9. Fa uso eccessivo di caffeina che secondo l'opinione dello sperimentatore contribuisce all'insonnia del soggetto o consuma abitualmente bevande contenenti caffeina dopo le 18:00 e non è disposto/a a rinunciare alla caffeina dopo le 18:00 per la durata della sua partecipazione allo studio

    15. Attuale evidenza di malattia clinicamente significativa (per esempio cardiaca; respiratoria inclusa broncopneumopatia cronica ostruttiva, depressione respiratoria acuta e/o grave; gastrointestinale, inclusa grave compromissione epatica; renale, inclusa grave compromissione renale; neurologica inclusa miastenia grave; malattia psichiatrica; tumore maligno entro gli ultimi 5 anni, diverso da carcinoma basocellulare adeguatamente trattato) o dolore cronico che secondo l'opinione dello/degli sperimentatore/i potrebbe influire sulla sicurezza del soggetto o interferire con le valutazioni dello studio, inclusa la capacità di svolgere compiti previsti dalla PAB cognitiva. Sono esclusi anche i soggetti per cui un farmaco sedativo sarebbe controindicato per motivi di sicurezza a causa dell'occupazione o delle attività del soggetto. (modifica tramite Emendamento 01)

    16. Nicturia concomitante che determina frequente necessità di alzarsi dal letto per andare in bagno durante la notte

    17. Eventuale anamnesi di condizione medica o psichiatrica che a giudizio dello/gli sperimentatore/i potrebbe influire sulla sicurezza del soggetto o interferire con la valutazione dello studio, inclusa la capacità di svolgere la PAB.

    18. Eventuale intenzione suicida con o senza un piano al momento della o entro 6 mesi prima della somministrazione di eCSSRS durante la Fase di pre-randomizzazione (ossia risposta“Sì” alle domande 4 o 5 della sezione Intenzione suicida dell'eC-SSRS)

    20. Intervento chirurgico programmato durante lo studio

    21. Ha usato qualsiasi farmaco concomitante su prescrizione o da banco vietato entro 1 settimana o 5 emivite, qualunque sia il periodo più lungo, prima della prima dose di farmaco in studio (Periodo di run-in). (L’Appendice 3 del protocollo riporta un elenco dei farmaci concomitanti vietati) (modifica tramite Emendamento 01)

    22. Ha usato qualsiasi modalità di trattamento per l'insonnia, inclusa terapia comportamentale cognitiva o marijuana entro 1 settimana o 5 emivite, qualunque sia il periodo più lungo, prima della prima dose di Farmaco in studio (Periodo di run-in) o tra lo Screening e la Randomizzazione (diverso dal farmaco in studio durante il Periodo di run-in) (modifica tramite Emendamento 01)

    23. Ha fallito il trattamento con suvorexant (Belsomra®) (efficacia e/o sicurezza) dopo il trattamento con una dose appropriata e di durata adeguata a giudizio dello sperimentatore
    E.5 End points
    E.5.1Primary end point(s)
    Change from baseline of mean WASO2H on Days 29 and 30 of LEM10 compared to ZOL
    Variazione rispetto alla baseline della WASO2H media nei Giorni 29 e 30 di LEM5 rispetto a ZOL
    E.5.1.1Timepoint(s) of evaluation of this end point
    WASO2H on Days 29 and 30
    WASO2H ai giorni 29 e 30
    E.5.2Secondary end point(s)
    Change from baseline of mean WASO2H on Days 29 and 30 of LEM5 compared to ZOL

    Change from baseline on the postural stability test of mean units of body sway on Days 2 and 3 of LEM5 and LEM10 compared to ZOL

    Additional Secondary Endpoints

    Change from baseline of mean SE, WASO, and TST on Days 1 and 2 and Days 29 and 30 of LEM5 and LEM10 compared to ZOL

    Change from baseline mean of subjective Sleep Diary variables including sSOL, sWASO, sSE and sTST over the first 7 and last 7 nights of the
    Treatment Period of LEM5 and LEM10 compared to ZOL

    Change from baseline of mean LPS on Days 1 and 2 and Days 29 and 30 of LEM5 and LEM10 compared to ZOL

    Change from baseline of mean LPS, SE, WASO, WASO2H, and TST on Days 1 and 2 and Days 29 and 30 of LEM5 and LEM10 compared to PBO

    Change from baseline mean of subjective Sleep Diary variables including sSOL, sWASO, sSE and sTST over the first 7 and last 7 nights of the
    Treatment Period of LEM5 and LEM10 compared to PBO

    Proportion of responders on Days 1 and 2 and Days 29 and 30 (PSG), and over the first 7 nights and last 7 nights of treatment (Sleep Diary), to LEM5 and LEM10 compared to ZOL and PBO, such that
    o Objective sleep onset response is defined as LPS ≤ 20 minutes (provided mean baseline LPS was > 30 minutes)
    o Subjective sleep onset response is defined as sSOL ≤ 20 minutes (provided mean baseline sSOL was > 30 minutes)
    o Objective sleep maintenance response is defined as WASO ≤ 60 minutes (provided mean baseline WASO was > 60 minutes and is reduced by > 10 minutes compared to baseline)
    o Subjective sleep maintenance response is defined as sWASO ≤ 60 minutes (provided mean WASO was > 60 minutes and is reduced by > 10 minutes compared to baseline)

    Safety and tolerability of LEM

    Change from baseline of the score from items 4-7 on the ISI at Day 31 of LEM5 and LEM10 compared to ZOL and PBO

    Change from baseline on the FSS score at Day 31 of LEM5 and LEM10 compared to ZOL and PBO

    Change from baseline of mean power of attention, mean continuity of attention, mean quality of memory, and mean speed of memory retrieval on Days 2 and 3
    Variazione rispetto alla baseline della WASO2H media nei Giorni 29 e 30 di LEM5 rispetto a ZOL

    Variazione rispetto alla baseline del test di stabilità posturale delle unità medie di oscillazione corporea nei Giorni 2 e 3 di LEM5 e LEM10 rispetto a ZOL

    Endpoint secondari aggiuntivi

    Variazione rispetto alla baseline di SE, WASO, e TST medi nei Giorni 1 e 2 e nei Giorni 29 e 30 di LEM5 e LEM10 rispetto a ZOL

    Variazione rispetto alla media basale di variabili soggettive del Diario del sonno che includono sSOL, sWASO, sSE e sTST nelle prime 7 e nelle ultime 7 notti del Periodo di trattamento con LEM5 e LEM10 rispetto a ZOL

    Variazione rispetto alla baseline di LPS media nei Giorni 1 e 2 e nei Giorni 29 e 30 di LEM5 e LEM10 rispetto a ZOL

    Variazione rispetto alla baseline di LPS, SE, WASO, WASO2H, e TST nei Giorni 1 e 2 e nei Giorni 29 e 30 di LEM5 e LEM10 rispetto a PBO

    Variazione rispetto alla media basale di variabili soggettive del Diario del sonno che includono sSOL, sWASO, sSE e sTST nelle prime 7 e nelle ultime 7 notti del Periodo di trattamento con LEM5 e LEM 10 rispetto a PBO

    Percentuale dei responder nei Giorni 1 e 2 e Giorni 29 e 30 (PSG), e nell'arco delle prime 7 notti e delle ultime 7 notti di trattamento (Diario del sonno), al trattamento con LEM5 e LEM10 rispetto a ZOL e PBO, tale che
    o La risposta oggettiva di insorgenza del sonno è definita come LPS ≤ 20 minuti (purché la LPS media basale fosse > 30 minuti)
    o La risposta soggettiva di insorgenza del sonno è definita come sSOL ≤ 20 minuti (purché la sSOL media basale fosse > 30 minuti)
    o La risposta oggettiva di mantenimento del sonno è definita come WASO ≤ 60 minuti (purché la WASO media basale fosse > 60 minuti e si sia ridotta di > 10 minuti rispetto alla baseline)
    o La risposta soggettiva di mantenimento del sonno è definita come sWASO ≤ 60 minuti (purché la WASO media basale fosse > 60 minuti e si sia ridotta di > 10 minuti rispetto alla baseline)

    Sicurezza e tollerabilità di LEM

    Variazione rispetto alla baseline del punteggio ottenuto dalle voci da 4 a 7 dell''ISI il Giorno 31 di LEM5 e LEM10 rispetto a ZOL e PBO

    Variazione rispetto alla baseline del punteggio della FSS il Giorno 31 di LEM5 e LEM10 rispetto a ZOL e PBO

    Variazione rispetto alla baseline di potenza dell'attenzione media, continuità di attenzione media, qualità della memoria media e velocità di recupero dalla memoria media nei Giorni 2 e 3
    E.5.2.1Timepoint(s) of evaluation of this end point
    WASO2H on Days 29 and 30
    Postural stability test of mean units of body sway on Days 2 and 3 SE, WASO, and TST on Days 1 and 2 and Days 29 and 30
    Subjective Sleep Diary variables including sSOL, sWASO, sSE and sTST over the first 7 and last 7 nights of the Treatment Period
    LPS on Days 1 and 2 and Days 29 and 30
    LPS, SE, WASO, WASO2H, and TST on Days 1 and 2 and Days 29 and 30
    Subjective Sleep Diary variables including sSOL, sWASO, sSE and sTST over the first 7 and last 7 nights of the Treatment Period
    Responders on Days 1 and 2 and Days 29 and 30 (PSG), and over the first 7 nights and last 7 nights of treatment (Sleep Diary)
    ISI at Day 31
    FSS score at Day 31
    Power of attention, continuity of attention, quality of memory, and speed of memory retrieval on Days 2 and 3
    WASO2H ai Giorni 29 e 30
    Test di stabilità posturale delle unità medie di oscillazione corporea nei Giorni 2 e 3 di SE, WASO e TST nei Giorni 1 e 2 e Giorni 29 e 30
    Variabili soggettive del Diario del sonno che includono sSOL, sWASO, sSE e sTST nelle prime 7 e nelle ultime 7 notti del Periodo di trattamento
    LPS nei Giorni 1 e 2 e nei Giorni 29 e 30
    LPS, SE, WASO, WAS02H, e TST nei Giorni 1 e 2 e Giorni 29 e 30
    Variabili soggettive del Diario del sonno che includono sSOL, sWASO, sSE e sTST nelle prime 7 e nelle ultime 7 notti del Periodo di trattamento
    Responder nei Giorni 1 e 2 e Giorni 29 e 30 (PSG), e nell'arco delle prime 7 notti e delle ultime 7 notti di trattamento (Diario del sonno)
    ISI il Giorno 31
    Punteggio FSS il Giorno 31
    Potenza dell'attenzione media, continuità di attenzi
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy No
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response Yes
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial4
    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.8.4.1Number of sites anticipated in Member State concerned7
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA45
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Canada
    France
    Germany
    Italy
    Spain
    United Kingdom
    United States
    E.8.7Trial 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
    LVLS
    LVLS
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months1
    E.8.9.2In all countries concerned by the trial days19
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1Number of subjects for this age range: 1
    F.1.1.1In Utero Information not present in EudraCT
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) Information not present in EudraCT
    F.1.1.3Newborns (0-27 days) Information not present in EudraCT
    F.1.1.4Infants and toddlers (28 days-23 months) Information not present in EudraCT
    F.1.1.5Children (2-11years) Information not present in EudraCT
    F.1.1.6Adolescents (12-17 years) Information not present in EudraCT
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 380
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 570
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations No
    F.3.3.1Women of childbearing potential not using contraception Information not present in EudraCT
    F.3.3.2Women of child-bearing potential using contraception Information not present in EudraCT
    F.3.3.3Pregnant women Information not present in EudraCT
    F.3.3.4Nursing women Information not present in EudraCT
    F.3.3.5Emergency situation Information not present in EudraCT
    F.3.3.6Subjects incapable of giving consent personally Information not present in EudraCT
    F.3.3.7Others Information not present in EudraCT
    F.4 Planned number of subjects to be included
    F.4.1In the member state38
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 250
    F.4.2.2In the whole clinical trial 950
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    none
    nessuno
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2016-08-10
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-12-15
    P. End of Trial
    P.End of Trial StatusCompleted
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