E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Leber’s Hereditary Optic Neuropathy / LHON is a maternally inherited loss of vision due to atrophy of the optic nerve. It typically presents in young adults, mostly men, as painless acute or subacute visual failure of both eyes in quick succession. The estimated prevalence is approximately 2.2 per 100,000 (Mascialino et al., 2012) and LHON is thus an Orphan Disease according to EU and US criteria. |
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E.1.1.1 | Medical condition in easily understood language |
Raxone is a medicine used to treat Leber’s hereditary optic neuropathy (LHON), a rare hereditary disease that can lead to blindness. |
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E.1.1.2 | Therapeutic area | Diseases [C] - Eye Diseases [C11] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10062951 |
E.1.2 | Term | Leber's hereditary optic atrophy neuropathy |
E.1.2 | System Organ Class | 100000004850 |
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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 |
To assess efficacy of Raxone® in the promotion of recovery or stabilization of visual acuity in patients treated with Raxone® ≤1 year after the onset of symptoms, compared to an external natural history control group of idebenone naïve patients |
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E.2.2 | Secondary objectives of the trial |
• To assess efficacy of Raxone® in the promotion of recovery or stabilization of vision in LHON patients treated with Raxone® >1 year after the onset of symptoms, compared to an external natural history control group of idebenone naïve patients
• To compare the promotion of recovery or stabilization of visual acuity in LHON patients treated with Raxone® ≤1 and >1 year after the onset of symptoms
• To assess the influence of mutation on the promotion of recovery or stabilization of visual acuity in LHON patients treated with Raxone®
• To assess the influence of time since onset of symptoms prior to the initiation of treatment with Raxone® on the promotion of recovery or stabilization of visual acuity in LHON patients
• To assess the influence of duration of treatment with Raxone® on changes in visual acuity in LHON patients
• To assess safety of long-term treatment of LHON patients with Raxone®
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
The following criteria should be assessed during Baseline Visit before randomization. If any does not apply, the patient must not be included in the study:
1. Impaired visual acuity in affected eyes due to LHON
2. No explanation for visual loss besides LHON
3. Age≥12 years
4. Onset of symptoms ≤5 years prior to Baseline
5. Confirmation of either G11778A, G3460A or T14484C LHON mtDNA (for the ITT population, not required for enrolment)
6. Written informed consent obtained from the patient
7. Ability and willingness to comply with study procedures and visits
8. Women of Childbearing Potential (WCBP) who have a negative urine or serum pregnancy test at Baseline visit and who are willing to use a highly effective contraceptive measure and maintain it until treatment discontinuation |
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E.4 | Principal exclusion criteria |
The following criteria should be checked during Baseline Visit before randomization. If any applies, the patient must not be included in the study:
1. Patient has provided natural history data to the Case Record Survey (SNT-CRS-002)
2. Any previous use of idebenone
3. Any other cause of visual impairment (e.g. glaucoma, diabetic retinopathy, AIDS related visual impairment, cataract, macular degeneration, etc.) or any active ocular disorder (uveitis, infections, inflammatory retinal disease, thyroid eye disease, etc.)
4. Known history of clinically significant elevations (greater than 3 times the upper limit of normal) of AST, ALT or creatinine
5. Patient has a condition or is in a situation which, in an investigator’s opinion may put the patient at significant risk, may confound study results or may interfere significantly with the patient’s participation in the study
6. Participation in another clinical trial of any investigational drug within 3 months prior to Baseline
7. Hypersensitivity to the active substance or to any of the following excipients (as listed in section 6.1 of Raxone SmPC): Lactose monohydrate, Microcrystalline cellulose, Croscarmellose sodium, Povidone K25, Magnesium stearate, Colloidal silica, Macrogol 3350, Poly(vinyl alcohol), Talc, Titanium dioxide, Sunset yellow FCF (E110).
8. Women who are pregnant or have a positive pregnancy test at Baseline visit
9. Women who are breastfeeding |
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of eyes with clinically relevant recovery of VA from Baseline or in which Baseline VA better than 1.0 logMAR was maintained at Month 12 in patients treated with Raxone® ≤1 year after the onset of symptoms, compared to matching external natural history control group
Clinically Relevant Recovery (CRR) is defined as a change from “off-chart” visual acuity (VA) to at least 1.6 logMAR value or an improvement of at least 0.2 logMAR value within “on-chart”.
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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) |
• Components of the primary endpoint:
- Proportion of eyes with CRR of VA from Baseline at Month 12 compared to matching external natural history control group
- Proportion of eyes in which Baseline VA better than 1.0 logMAR was maintained at Month 12 compared to matching external natural history control group
• Proportion of eyes in patients treated with Raxone® >1 year after the onset of symptoms with CRR of VA from Baseline or in which Baseline VA better than 1.0 logMAR was maintained at Month 12 compared to external natural history control group, in all patients and classified by mutation
• Proportion of eyes and patients treated with Raxone® ≤1 year after the onset of symptoms with CRR of VA from Baseline or in which Baseline visual acuity better than 1.0 logMAR was maintained following 6, 18 and 24 months of treatment with Raxone® compared to matching external natural history control group, in all patients and classified by mutation
• Proportion of eyes/patients treated with Raxone® ≤1 year or >1 year after the onset of symptoms with “Off-chart” VA at Baseline in whom VA improves to better than 1.60 logMAR by Month 6, 12, 18 and 24
• Proportion of eyes/patients treated with Raxone® ≤1 year or >1 year after the onset of symptoms with VA in the categories of better than 1.0 logMAR, 1.0 to 1.68 logMAR and above 1.68 logMAR at each assessment time point up to Month 24
• Safety as assessed by AE count and laboratory analyses during the study |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | No |
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) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
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 | No |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 25 |
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 |
Austria |
Belgium |
Bulgaria |
Germany |
Italy |
Poland |
Portugal |
Spain |
United Kingdom |
United States |
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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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last visit of the last subject undergoing the trial |
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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 | 1 |
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 | 1 |