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    Summary
    EudraCT Number:2015-004631-13
    Sponsor's Protocol Code Number:MBCT206
    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:2018-02-22
    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 number2015-004631-13
    A.3Full title of the trial
    A Phase IIa, two-part, randomised, multi-centre, multinational, double-blind, placebo-controlled, parallel group study to compare the efficacy and safety of BCT197 when added on to standard of care for the treatment of acute respiratory exacerbations of chronic obstructive pulmonary disease (COPD) requiring hospitalisation in adults.
    Studio di Fase IIa, in due parti, randomizzato, multicentrico, multinazionale, in doppio cieco, controllato con placebo, a gruppi paralleli per confrontare l’efficacia e la sicurezza di BCT197 aggiunto allo standard di cura per il trattamento dell’esacerbazione della broncopneumopatia cronica ostruttiva (BPCO) che richiede ricovero ospedaliero negli adulti.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A study to compare the efficacy and safety of BCT197 when it is used together with current treatments for acute respiratory exacerbations of chronic obstructive pulmonary disease (COPD) that result in hospitalisation in adults
    Studio per confrontare l'efficacia e la sicurezza di BCT197 quando viene usato
    insieme al trattamento corrente per gravi riacutizzazioni della
    broncopneumopatia cronica ostruttiva (BPCO) che portano al ricovero in ospedale
    negli adulti
    A.3.2Name or abbreviated title of the trial where available
    A study to compare the efficacy and safety of BCT197 when it is used together with current treatment
    Studio per confrontare l'efficacia e la sicurezza di BCT197 quando viene usato insieme al trattament
    A.4.1Sponsor's protocol code numberMBCT206
    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 SponsorMEREO BIOPHARMA GROUP LTD
    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 supportMereo BioPharma 1 Ltd
    B.4.2CountryUnited Kingdom
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationICON Clinical Research
    B.5.2Functional name of contact pointProject Management
    B.5.3 Address:
    B.5.3.1Street AddressSouth County Business Park
    B.5.3.2Town/ cityLeopardstown
    B.5.3.3Post codeDublin 18
    B.5.3.4CountryIreland
    B.5.4Telephone number+353 1 291 2000
    B.5.5Fax number+353 1 247 6260
    B.5.6E-mailKaren.VanHulst@iconplc.com
    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 nameBCT197 20mg capsule rigide di gelatina
    D.3.2Product code BCT197
    D.3.4Pharmaceutical form Capsule, hard
    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 INNAcumapimod
    D.3.9.1CAS number 836683-15-9
    D.3.9.2Current sponsor codeBCT197
    D.3.9.4EV Substance CodeSUB31871
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    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 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 nameBCT197 25mg capsule rigide di gelatina
    D.3.2Product code BCT197
    D.3.4Pharmaceutical form Capsule, hard
    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 INNAcumapimod
    D.3.9.1CAS number 836683-15-9
    D.3.9.2Current sponsor codeBCT197
    D.3.9.4EV Substance CodeSUB31871
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number25
    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 nameBCT197 50mg capsule rigide di gelatina
    D.3.2Product code BCT197
    D.3.4Pharmaceutical form Capsule, hard
    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 INNAcumapimod
    D.3.9.1CAS number 836683-15-9
    D.3.9.2Current sponsor codeBCT197
    D.3.9.4EV Substance CodeSUB31871
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number50
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Acute exacerbations of chronic obstructive pulmonary disease
    Riacutizzazioni gravi della broncopneumopatia cronica ostruttiva
    E.1.1.1Medical condition in easily understood language
    Worsening of respiratory function in patients with chronic obstructive pulmonary disease
    Peggioramento della funzione respiratoria in pazienti con broncopneumopatia
    cronica ostruttiva
    E.1.1.2Therapeutic area Diseases [C] - Respiratory Tract Diseases [C08]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level LLT
    E.1.2Classification code 10010953
    E.1.2Term COPD exacerbation
    E.1.2System Organ Class 100000004855
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the efficacy of two different dosing regimens of BCT197 added to standard of care (SoC) versus placebo added to SoC in the treatment of acute respiratory exacerbations of COPD that required hospitalisation by comparison of change in forced expiratory volume in 1 second (FEV1) from Baseline (pre-dose) to Day 7.
    Valutare l'efficacia di due diversi regimi di dosaggio di BCT197 aggiunto a standard di cura (’Standard of Care’, SoC) verso placebo aggiunto a standard di cura nel trattamento di esacerbazioni respiratorie acute della BPCO che hanno richiesto il ricovero, mediante confronto del cambiamento del volume espiratorio forzato in 1 secondo (FEV1) dal basale (pre-dose) al Giorno 7.
    E.2.2Secondary objectives of the trial
    - To evaluate the efficacy and tolerability of two different dosing regimens of BCT197 added to SoC versus placebo added to SoC in treatment of an acute exacerbation of COPD.

    - Safety and tolerability of BCT197
    - Please see protocol for exploratory objectives
    Per valutare l'efficacia e la tollerabilità di due diversi regimi di
    dosaggio di BCT197 aggiunto allo standard di cura rispetto al placebo aggiunto allo standard di cura nel
    trattamento di una grave riacutizzazione della BPCO.
    - Sicurezza e tollerabilità di BCT197
    - Si prega di guardare il protocollo per gli obiettivi esplorativi
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Male and female adults aged ≥ 40 years
    2. Written informed consent obtained prior to any study-related procedure
    3. Presence of an active exacerbation of the ongoing COPD requiring hospitalisation for treatment:
    “A sustained worsening of the patient’s condition (dyspnoea, cough and/or sputum production/purulence), from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD that includes prescriptions of systemic corticosteroids and/or antibiotics and need for hospitalisation”
    4. Subjects with a documented diagnosis of COPD category C or D (post-bronchodilator [BD] FEV1< 50%) at least 12 months prior to the Screening Visit (according to GOLD document updated 2015)
    o At least one documented pulmonary function test (PFT) in the last 12 months (the most recent PFT performed in the last 12 months outside an exacerbation and results with curves should be recorded in the case report form (CRF) and filed as source document)
    5. Current smokers or ex-smokers who stopped smoking at least 6 months prior to the Screening Visit, with a smoking history of at least 10 pack-years (pack-years = [number of cigarettes per day x number of years/20])
    6. A post-BD FEV1 < 50% of the predicted normal value and a post-BD FEV1/forced vital capacity (FVC) < 0.7 at least 10 to 15 min after four puffs (4 x 100 μg) of salbutamol pressurised metered dose inhaler (pMDI)
    7. Subjects will need to perform the post-BD spirometry at Baseline on presentation at Visit 1. Subjects who cannot perform the Baseline spirometry will be randomised into the study as long as their prior spirometry (the most recent PFT performed in the last 12 months outside an exacerbation) has a post-BD FEV1 <50% and a FEV1/FVC <0.7
    8. A documented history of at least one moderate or severe COPD exacerbation in the 12 months preceding the Screening Visit that required antibiotics and/or systemic corticosteroid (addition or increment on subject current use) as defined below:
    o “A sustained worsening of the patient’s condition (dyspnoea, cough and/or sputum production/purulence), from the stable state and beyond normal day-to-day variations, that is acute in onset and necessitates a change in regular medication in a patient with underlying COPD that includes prescriptions of systemic corticosteroids and/or antibiotics or need for hospitalisation”
    o Also, documented visits to an emergency department due to COPD exacerbation are considered acceptable to fulfil this criterion.
    9. Current regular treatment for COPD (categories C and D according to GOLD guidelines, updated 2015) for at least 2 months prior to the Screening Visit with either:
    o Inhaled corticosteroids/long-acting β2-agonist combination, long-acting muscarinic antagonist without regular use of short-acting muscarinic antagonist (short-acting muscarinic antagonist allowed if used as needed [PRN]) or
    o Inhaled corticosteroids/long-acting β2-agonist combination, without regular use of short-acting muscarinic antagonist (short-acting muscarinic antagonist allowed if used PRN) or
    o Inhaled corticosteroids/long-acting muscarinic antagonist combination, without regular use of shortacting β2-agonist (SABA) (short-acting β2-agonist allowed if PRN) or
    o Inhaled long-acting β2-agonist and inhaled long-acting muscarinic antagonist or
    o Subjects under monotherapy with long-acting muscarinic antagonist.
    10. Ideally subjects should be screened, randomised and dosed on the same day. Where information is not available, the Screening period can be extended to a maximum of 24 hours before Randomisation and dosing.
    1. Adulti di sesso maschile e femminile di età ≥ 40 anni
    2. Consenso informato scritto ottenuto prima di qualsiasi procedura correlata allo studio
    3. La presenza di un’esacerbazione attiva della BPCO in corso che richieda ricovero per il trattamento:
    “Prolungato peggioramento delle condizioni del paziente (dispnea, tosse e/o produzione di espettorato/purulenza) rispetto allo stato stabile a al di là delle normali variazioni giornaliere, che insorge acutamente e richiede una modificazione del trattamento abituale in un paziente affetto da BPCO preesistente tale da includere la prescrizione di corticosteroidi sistemici e/o antibiotici e la necessità di ricovero”4. Soggetti con una diagnosi documentata di BPCO di categoria C o D (post-broncodilatatore [BD] FEV1< 50%) almeno 12 mesi prima della visita di screening (secondo il documento GOLD aggiornato 2015)
    o Almeno un test sulla funzione polmonare (FFP) documentato negli ultimi 12 mesi (PFT più recente eseguito negli ultimi 12 mesi al di fuori di un’esacerbazione e i risultati con curve dovrebbero essere registrati nella scheda di raccolta dati (CRF) e archiviati quali documento sorgente)
    5. Fumatori attuali o ex-fumatori che abbiano smesso di fumare almeno 6 mesi prima della visita di screening, con un’anamnesi di fumo di almeno 10-anni-pacchetto (anni-pacchetto = [numero di sigarette al giorno x numero di anni/20])6. FEV1 post-BD < 50% del valore normale previsto e FEV1post-BD/capacità vitale forzata (FVC) <0,7 almeno da 10 a 15 min dopo quattro inalazioni (4 x 100 μg) di inalatore di dosi misurate (pMDI) di salbutamolo pressurizzato 7. I soggetti dovranno eseguire la spirometria post-BD al basale alla presentazione alla Visita 1. I soggetti che non possono eseguire la spirometria al basale verranno randomizzati nello studio sempre che la loro precedente spirometria (PFT più recente eseguito negli ultimi 12 mesi al di fuori di un esacerbazione) abbia un FEV1 post-BD <50% e un FEV1/FVC <0,7
    8. Anamnesi documentata di almeno un’esacerbazione moderata o grave della BPCO nei 12 mesi precedenti alla visita di screening che abbia richiesto antibiotici e/o corticosteroide sistemico (aggiunta o incremento dell’uso attuale da parte del soggetto) come definito di seguito:
    o “Prolungato peggioramento delle condizioni del paziente (dispnea, tosse e/o produzione di espettorato/purulenza) rispetto allo stato stabile a al di là delle normali variazioni giornaliere, che insorge acutamente e richiede una modifica del trattamento abituale in un paziente affetto da BPCO preeesistente tale da includere la prescrizione di corticosteroidi sistemici e/o antibiotici o la necessità di ricovero”.
    o Inoltre, le visite documentate presso un reparto di pronto soccorso a causa della riacutizzazione della BPCO sono considerate accettabili per soddisfare questo criterio. 9. Regolare trattamento corrente della BPCO (categorie C e D secondo le linee guida GOLD, aggiornate 2015) per almeno 2 mesi prima della visita di screening con:
    o Combinazione di corticosteroidi per inalazione/β2-agonista a lunga durata d’azione, antagonista muscarinico a lunga durata d’azione senza uso regolare di antagonista muscarinico a breve durata d’azione (antagonista muscarinico a breve durata d’azione ammesso se usato come necessario [PRN]) o
    o Combinazione di corticosteroidi per inalazione/β2-agonista a lunga durata d’azione, senza uso regolare antagonista muscarinico a breve durata d’azione (antagonista muscarinico a breve durata d’azione ammesso se usato PRN) o
    o Combinazione di corticosteroidi per inalazione/antagonista muscarinico a lunga durata d’azione, senza uso regolare di β2-agonista a breve durata d’azione (SABA) (β2-agonista a breve durata d’azione ammesso se PRN) o
    o β2-agonista a lunga durata d’azione inalato e antagonista muscarinico inalato a lunga durata d’azione o
    o Soggetti sottoposti a monoterapia con antagonista muscarinico a lunga durata d’azione.10. Idealmente i soggetti dovrebbero essere sottoposti a screening, randomizzati e trattati nello stesso giorno. Se le informazioni non sono disponibili, il periodo di screening può essere esteso fino ad un massimo di 24 ore prima della randomizzazione e del dosaggio.
    E.4Principal exclusion criteria
    1. Current diagnosis of asthma, history of allergic rhinitis or atopic disease
    2. Subjects who have already completed treatment for the current exacerbation of COPD.
    3. Subjects who have been treated with or require use of the following medications (Refer to Table 10-1 in protocol).
    4. Subjects currently requiring intensive care unit (ICU) and/or mechanical ventilation
    5. Subjects treated with non-cardioselective β-blockers in the 10 days preceding the Screening Visit. Those subjects may enter the study after non-selective β-blockers withdrawal and/or cardioselective β-blockers
    intake for at least 10 days before Randomisation
    6. Subjects treated with long-acting anti-histamines unless taken at stable regimen at least 2 months prior to Screening and to be maintained constant during the study, or if taken as PRN
    7. Subjects requiring long term (at least 12 hours daily) oxygen therapy for chronic hypoxemia
    8. Known respiratory disorders other than COPD which may impact the efficacy of the study drug according to the investigator’s judgement. This can include but is not limited to α-1 antitrypsin deficiency, active tuberculosis, lung cancer, bronchiectasis, sarcoidosis, lung fibrosis, pulmonary hypertension and interstitial
    lung disease
    9. Subjects who have had pulmonary lobectomy or lung volume reduction surgery or lung transplantation
    10. Subjects who have had a vaccination in the last 30 days prior to study start
    11. Subjects who have a clinically significant cardiovascular condition (including, but not limited to, unstable ischemic heart disease, New York Heart Association (NYHA) Class III/IV, left ventricular failure, acute myocardial infarction); or the current exacerbation is due to a cardiovascular condition
    12. An abnormal and clinically significant 12-lead ECG which may impact the safety of the subject according to the investigator’s judgement at Screening or Baseline
    13. Subjects whose 12-lead ECG shows QTcF > 450 msec at Screening and at Randomisation visits; ECG does not need to be repeated if Screening and Randomisation visit are on the same day
    14. Medical diagnosis of narrow-angle glaucoma, prostatic hypertrophy or bladder neck obstruction that in the opinion of the investigator would prevent use of anti-cholinergic agents
    15. History of hypersensitivity to anti-cholinergics, β2-agonist, corticosteroids or any of the excipients contained in any of the formulations used in the study which may raise contra-indications or impact the efficacy of the study drug according to the investigator’s clinical judgement
    16. Clinically significant laboratory abnormalities indicating a significant or unstable concomitant disease which may impact the efficacy or the safety of the study drug according to the investigator’s clinical judgement
    17. Subjects with liver enzyme alterations (serum alanine aminotransferase and/or aspartate aminotransferase > 2 x upper limit of normal [ULN], bilirubin > 1.5 ULN)
    18. Impairment of renal function (defined as creatinine clearance (CrCL) < 60 mL/min (estimated by Cockcroft-Gault)
    19. Concomitant use of the CYP3A inhibitors including, but not limited to macrolide antibiotics and of the calcium channel blockers verapamil and diltiazem; consumption of grapefruit will also be excluded
    1. Diagnosi attuale di asma, anamnesi di rinite allergica o patologia atopica
    2. Soggetti che abbiano già completato il trattamento per l’attuale esacerbazione della BPCO
    o Soggetti il cui trattamento per l’esacerbazione attuale (corticosteroidi sistemici o antibiotici) sia stato avviato più di 24 ore prima della randomizzazione
    3. I soggetti che siano stati trattati con o che richiedano l'uso dei seguenti farmaci (Fare riferimento alla Tabella 10-1 del protocollo):
    o Un ciclo di steroidi sistemici di più di 3 giorni per l’esacerbazione della BPCO nelle 4 settimane precedenti l'attuale esacerbazione
    o Un ciclo di antibiotici per l’esacerbazione della BPCO di più di 7 giorni nelle 4 settimane prima dell'esacerbazione attuale
    o Inibitori della fosfodiesterasi di tipo 3/4 (PDE3/PDE4)
    o Qualsiasi trattamento inibitore della proteina p38 chinasi mitogeno-attivata (p38)
    o Uso di antibiotici per un’infezione dell'apparato respiratorio inferiore (ad es. polmonite) nelle 4 settimane precedenti l’esacerbazione attuale (eccetto il trattamento dell’esacerbazione attuale, ma non di più di 2 giorni)
    o Soggetti che abbiano ricevuto antibiotici macrolidi entro le precedenti 48 ore
    o Soggetti che richiedano bloccanti del canale di calcio.
    4. Soggetti che attualmente richiedano ventilazione in unità di terapia intensiva e/o ventilazione meccanica
    5. Soggetti trattati con beta-bloccanti non-cardioselettivi nei 10 giorni precedenti la visita di screening. Tali soggetti possono essere ammessi allo studio dopo ritiro dai β-bloccanti non selettivi e/o assunzione di β-bloccanti cardioselettivi per almeno 10 giorni prima della randomizzazione
    6. I soggetti trattati con anti-istamine a lunga durata d’azione a meno che non siano assunte a regime stabile almeno 2 mesi prima dello screening e da mantenersi costanti durante lo studio, o se prese come PRN
    7. Soggetti che necessitino terapia con ossigeno a lungo termine (almeno 12 ore al giorno) per ipossiemia cronica
    8. Noti disturbi respiratori diversi dalla BPCO che possano influire sull’efficacia del farmaco in studio a giudizio dello sperimentatore, tra cui, a titolo esemplificativo ma non esaustivo: deficit di α-1-antitripsina, tubercolosi attiva, neoplasia polmonare, bronchiectasia, sarcoidosi, fibrosi polmonare, ipertensione polmonare e malattia interstiziale polmonare
    9. Soggetti che siano stati sottoposti a lobectomie polmonari o a chirurgia per la riduzione del volume polmonare o trapianto polmonare
    10. Soggetti che abbiano ricevuto una vaccinazione negli ultimi 30 giorni prima dell’inizio dello studio
    11. Soggetti affetti da una condizione cardiovascolare clinicamente significativa (compresa, ma non limitatamente, malattia cardiaca ischemica instabile, New York Heart Association (NYHA) Classe III/IV, insufficienza ventricolare sinistra, infarto miocardico acuto); o se l’attuale esacerbazione è dovuta ad una condizione cardiovascolare
    12. Un ECG a 12 derivazioni anomalo e clinicamente significativo che possa influire sulla sicurezza del soggetto a giudizio dello sperimentatore allo screening o al basale
    13. Soggetti il cui ECG a 12 derivazioni mostra QTcF > 450 msec alle visite di screening e di randomizzazione; l’ECG non deve essere ripetuto se la visita di screening e la visita di randomizzazione vengono effettuate nello stesso giorno
    14. Diagnosi medica di glaucoma ad angolo stretto, ipertrofia prostatica o ostruzione del collo della vescica che, a giudizio dello sperimentatore, impedirebbe l'uso di agenti anti-colinergici
    15. Anamnesi di ipersensibilità ad anti-colinergici, β2-agonista, corticosteroidi o ad uno qualsiasi degli eccipienti contenuti in una qualsiasi delle formulazioni utilizzate nello studio che possa sollevare controindicazioni o influire sull'efficacia del farmaco secondo l’opinione clinica dello sperimentatore
    16. Anomalie di laboratorio clinicamente significative che indicano una malattia concomitante significativa o instabile che potrebbe influire sull’efficacia o sulla sicurezza del farmaco in studio secondo l’opinione clinica dello sperimentatore
    17. Soggetti con alterazioni degli enzimi del fegato (alanina aminotransferasi nel siero e/o aspartato aminotransferasi > 2 volte il limite superiore del valore normale [ULN], bilirubina > 1,5 ULN)
    18. Compromissione della funzione renale (definita come clearance della creatinina (CrCL) < 60 mL/min (stimata da Cockcroft-Gault)
    19. L'uso concomitante di inibitori di CYP3A, tra cui, a titolo esemplificativo ma non esaustivo, gli antibiotici macrolidi (troleandomicina, eritromicina, claritromicina, roxitromicina e cloramfenicolo) e dei bloccanti del canale di calcio verapamil e diltiazem; il consumo di pompelmo sarà inoltre escluso
    E.5 End points
    E.5.1Primary end point(s)
    Change in FEV1 from Baseline (pre-dose) at Day 7.
    Variazione del FEV1 dal basale (pre-dose) al Giorno 7.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Please refer to protocol (Table 9-1 Schedule of Assessments).
    Si faccia riferimento al protocollo (tabella 9-1 Schedule of Assessments).
    E.5.2Secondary end point(s)
    1. Comparison of forced expiratory volume in 1 second (FEV1) on Days 3,
    10, and 14
    2. Normalisation evaluation of spirometry parameter (FEV1, FVC, and
    FEV1/FVC) response over time (performed daily from Days 1 to 7, 10,
    and 14, and Weeks 8, 12 and 26) compared with the most recent test
    performed within the last 12 months outside an exacerbation (pre-study
    FEV1 , FVC, and FEV1/FVC value)
    3. Time taken to improvement of 100 mL in FEV1 compared to Baseline
    versus placebo
    4. Comparison of AUC of FEV1 over time among groups
    5. Change in RR over time (performed daily from Days 1 to 7, 10 and 14)
    among groups6. Change in RR on Days 3, 7, 10 and 14 among groups
    7. Time to improvement based on EXACT-PRO total score
    8. Comparison of AUC of EXACT-PRO over time among groups
    9. Number of COPD-related deaths during the study
    10. Number of moderate/severe COPD-related exacerbations during the
    study
    11. Time to next moderate/severe COPD exacerbation
    12. Change from Baseline at each inter-visit period and over the entire
    period of the study in the average EXACT-PRO total score and domain
    scores13. Number of times each subject required rescue therapy (salbutamol
    or fenoterol) during the study
    14. Time from hospitalisation until the subject is medically ready for
    discharge
    15. Nonlinear mixed effects pharmacokinetic/pharmacodynamics
    (PK/PD) models evaluating the relationship between BCT197 exposure
    and efficacy/safety endpoints.Safety:
    1. TEAEs/SAEs (from first dose of study drug until study completion)
    2. Evaluation of the incidence of pneumonia from first dose of study drug
    until completion
    3. TEAEs of special interest (liver enzymes [ALT, AST, bilirubin total and
    fractions]); rash, acneiform dermatitis, headache and pruritus)4. Vital signs (oral body temperature, RR, heart rate (HR), pulse rate,
    blood oxygen [measured using a pulse oximeter], systolic and diastolic
    blood pressure)
    5. QTc intervals and ECG findings (arrhythmias, conduction blocks,
    changes in ST segment) at Baseline, from Day 1 to Day 7, 10, 14, and at
    Weeks 8, 12 and 26
    6. Laboratory data including sputum cultures and eosinophil
    percentages.
    1. Confronto del volume espiratorio forzato in 1 secondo (FEV1) nei Giorni 3, 10 e 14
    2. Valutazione della normalizzazione della risposta del parametro di spirometria (FEV1, FVC e FEV1/FVC) nel tempo (eseguiti quotidianamente dai Giorni 1 a 7, 10 e 14, e alle Settimane 8, 12 e 26) in confronto con il test più recente effettuato negli ultimi 12 mesi al di fuori di un’esacerbazione (valore FEV1, FVC e FEV1/FVC pre-studio)
    3. Tempo impiegato fino al miglioramento di 100 mL in FEV1 rispetto al basale verso placebo
    4. Comparazione della AUC del FEV1 nel tempo tra i gruppi
    5. Variazione della RR nel tempo (eseguita quotidianamente dai Giorni 1 a 7, 10 e 14) fra i gruppi
    6. Variazione della RR ai Giorni 3, 7, 10 e 14 tra i gruppi
    7. Tempo fino a miglioramento basato su punteggio totale EXACT-PRO
    8. Comparazione della AUC di EXACT-PRO nel tempo tra i gruppi
    9. Numero di decessi correlati alla BPCO durante lo studio
    10. Numero di esacerbazioni moderate/gravi correlate alla BPCO durante lo studio
    11. Tempo fino alla successiva esacerbazione della BPCO moderata/grave
    12. Variazione dal basale ad ogni periodo inter-visita e per tutto il periodo dello studio del punteggio totale medio EXACT-PRO e dei punteggi medi per sezione
    13. Numero di volte in cui ogni soggetto ha richiesto terapia di salvataggio (salbutamolo o fenoterolo) durante lo studio
    14. Tempo dal ricovero fino a quando il soggetto è pronto/a dal punto di vista medico per la dimissione
    15. Modelli ad effetti misti non-lineari di farmacocinetica/farmacodinamica (PK/PD) per la valutazione del rapporto tra esposizione a BCT197 ed endpoint di efficacia/sicurezza.Sicurezza:
    1. TEAE [eventi avversi dovuti al trattamento]/SAE [eventi avversi gravi] (dalla prima dose del farmaco in studio fino al completamento dello studio)
    2. Valutazione dell'incidenza di polmonite dalla prima dose del farmaco in studio fino al completamento
    3. TEAE di interesse speciale (enzimi epatici [(ALT, AST, bilirubina totale e frazioni]); eruzione cutanea, dermatite acneiforme, cefalea e prurito)
    4. Segni vitali (temperatura corporea orale, RR, frequenza cardiaca (FC), frequenza del polso, ossigeno nel sangue – misurato attraverso un pulsossimetro - pressione sanguigna sistolica e diastolica) e parametri di laboratorio
    5. Gli intervalli QTc e risultati ECG (aritmie, blocchi di conduzione, cambiamenti nel segmento ST) al basale, dal Giorno 1 al Giorno 7, 10, 14 e alle Settimane 8, 12 e 26
    6. Dati di laboratorio comprese colture di espettorato e percentuali di eosinofili.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Please refer to protocol (Table 9-1 Schedule of Assessments).
    Si faccia riferimento al protocollo (Tabella 9-1 Schedule of Assessments).
    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 No
    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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    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) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial3
    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 concerned4
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA61
    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
    Bulgaria
    Czech Republic
    Germany
    Hungary
    Italy
    Latvia
    Poland
    Romania
    Russian Federation
    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 months9
    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 months9
    E.8.9.2In all countries concerned by the trial days0
    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: 108
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 162
    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 Yes
    F.3.3.1Women of childbearing potential not using contraception Yes
    F.3.3.2Women of child-bearing potential using contraception No
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state45
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 186
    F.4.2.2In the whole clinical trial 270
    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 Decision2016-06-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-04-07
    P. End of Trial
    P.End of Trial StatusCompleted
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