E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Fabry disease (α-galactosidase A deficiency) |
Enfermedad de Fabry (déficit de alfa-galactosidasa) |
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E.1.1.1 | Medical condition in easily understood language |
Fabry disease |
Enfermedad de Fabry |
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E.1.1.2 | Therapeutic area | Body processes [G] - Genetic Phenomena [G05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 19.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10016016 |
E.1.2 | Term | Fabry's disease |
E.1.2 | System Organ Class | 10010331 - Congenital, familial and genetic disorders |
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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 evaluate the safety and efficacy of PRX-102 compared to agalsidase beta in Fabry disease patients with impaired renal function. |
Evaluar la seguridad y la eficacia de PRX-102 en comparación con agalsidasa beta en pacientes con enfermedad de Fabry y disfunción renal |
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E.2.2 | Secondary objectives of the trial |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Pharmacokinetics (PK) sub-study. |
Sub-estudio de Farmacocinética (PK) |
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E.3 | Principal inclusion criteria |
Eligible subjects must fulfill the following inclusion criteria: 1. Symptomatic adult Fabry disease patients, age 18-60 years a. Plasma and/or leucocyte alpha galactosidase activity (by activity assay) less than 30% mean normal levels b. One or more of the described characteristic features of Fabry disease: i. neuropathic pain, ii. cornea verticillata, iii. clustered angiokeratoma 2. Screening eGFR by CKD-EPI equation 40 to 90 mL/min/1.73 m2 3. Linear negative slope of eGFR of ≥ 2 mL/min/1.73 m2 based on at least 3 serum creatinine values over approximately 1 year (range of 9 to 18 months, including the value obtained at the screening visit) 4. Treatment with a dose of 1 mg/kg agalsidase beta per infusion every 2 weeks for at least one year and at least 80% of 13 (10.4) mg/kg total dose over the last 6 months 5. Female patients and male patients whose co-partners are of child-bearing potential agree to use a medically accepted method of contraception, not including the rhythm method. |
Para ser aptos, los sujetos deben cumplir los siguientes criterios de inclusión: 1. Pacientes con enfermedad de Fabry sintomática, con edades entre 18 y 60 años. a. Actividad de la alfa-galactosidasa en el plasma o en los leucocitos (mediante análisis de actividad) de menos del 30 % de los valores normales medios. b. Uno o varios de los rasgos característicos descritos de la enfermedad de Fabry: i. dolor neuropático, ii. córnea verticillata, iii. angioqueratomas en grupos. 2. TFGe en la selección mediante la ecuación CKD-EPI de 40 a 90 ml/min/1,73 m2. 3. Pendiente lineal negativa de la TFGe de ≥ 2 ml/min/1,73 m2 en función de al menos 3 valores de creatinina en suero en aproximadamente 1 año (intervalo de 9 a 18 meses, incluido el valor obtenido en la visita de selección). 4. Tratamiento con una dosis de 1 mg/kg de agalsidasa beta por infusión cada 2 semanas durante al menos un año y al menos un 80 % de la dosis total de 13 (10,4) mg/kg en los últimos 6 meses. 5. Pacientes de sexo femenino y masculino cuyas parejas estén en edad fértil y acepten el uso de un método anticonceptivo aceptado desde el punto de vista médico, sin incluir el método del ritmo. |
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E.4 | Principal exclusion criteria |
The presence of any of the following excludes a subject from study enrollment: 1. History of anaphylaxis or Type 1 hypersensitivity reaction to agalsidase beta 2. History of renal dialysis or transplantation 3. History of acute kidney injury in the 12 months prior to screening, including specific kidney diseases (e.g., acute interstitial nephritis, acute glomerular and vasculitic renal diseases); non-specific conditions (e.g, ischemia, toxic injury); as well as extrarenal pathology (e.g., prerenal azotemia, and acute postrenal obstructive nephropathy) 4. Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy initiated or dose changed in the 4 weeks prior to screening 5. Urine protein to creatinine ratio (UPCR) > 0.5 g/g and not treated with an ACE inhibitor or ARB 6. Cardiovascular event (myocardial infarction, unstable angina) in the 6 month period before randomization 7. Congestive heart failure NYHA Class IV 8. Cerebrovascular event (stroke, transient ischemic attack) in the 6 month period before randomization 9. Known history of hypersensitivity to Gadolinium contrast agent 10. Female subjects who are pregnant, planning to become pregnant during the study, or are breastfeeding 11. Presence of any medical, emotional, behavioral or psychological condition that, in the judgment of the Investigator and/or Medical Director, would interfere with the patient’s compliance with the requirements of the study |
La presencia de alguno de los criterios siguientes excluye al sujeto de la inscripción en el estudio: 1. Antecedentes de anafilaxis o reacción de hipersensibilidad de tipo 1 a la agalsidasa beta. 2. Antecedentes de diálisis o trasplante renal. 3. Antecedentes de lesión renal aguda en los 12 meses anteriores a la selección, incluidas nefropatías específicas (p. ej., nefritis intersticial aguda, enfermedades renales glomerulares y vasculares agudas); afecciones inespecíficas (p. ej., isquemia, lesión tóxica); así como patología extrarrenal (p. ej., azotemia prerrenal y nefropatía obstructiva postrenal). 4. Tratamiento con inhibidor de la enzima de conversión de la angiotensina (ECA) o bloqueador del receptor de la angiotensina (BRA) iniciado o dosis cambiada en las 4 semanas previas a la selección. 5. Cociente proteínas/creatinina en orina (UPCr) > 0,5 g/g y no tratado con un inhibidor de la ECA ni un BRA. 6. Acontecimiento cardiovascular (infarto de miocardio, angina inestable) en el periodo de 6 meses previo a la aleatorización. 7. Insuficiencia cardiaca congestiva de clase IV de la NYHA. 8. Acontecimiento cerebrovascular (ictus, accidente isquémico transitorio) en el periodo de 6 meses previo a la aleatorización. 9. Antecedentes conocidos de hipersensibilidad a un medio de contraste con gadolinio. 10. Sujetos de sexo femenino que estén embarazadas, planeen quedarse embarazadas durante el estudio o que estén en periodo de lactancia. 11. Presencia de cualquier problema médico, emocional, conductual o psicológico que, a juicio del investigador o del director médico, interferiría en el cumplimiento del paciente de los requisitos del estudio. |
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E.5 End points |
E.5.1 | Primary end point(s) |
The primary efficacy parameter is the comparison of the mean annualized change (slope) in estimated glomerular filtration rate (eGFRCKD-EPI) between treatment groups.
Safety endpoints: Changes from baseline in: Clinical laboratory tests Physical examination Assessment of the injection site ECG Treatment-emergent adverse events Ability to taper off infusion pre-medication throughout the first 3 months of the study Requirement for use of pre-medication overall to manage infusion reactions Treatment-emergent anti-PRX-102 antibodies Treatment-emergent anti-agalsidase beta antibodies |
El parámetro principal de la eficacia es la comparación del cambio medio anualizado (pendiente) en la tasa de filtración glomerular estimada (TFGe-CKD-EPI) entre grupos de tratamiento. Criterios de valoración de la seguridad: • Análisis clínicos • Exploración física • Evaluación de la zona de inyección • ECG • Acontecimientos adversos surgidos durante el tratamiento • Capacidad para disminuir de forma gradual la premedicación para la infusión a lo largo de los primeros 3 meses del estudio • Requisito de uso de la premedicación en general para tratar las reacciones a la infusión • Anticuerpos anti-PRX-102 surgidos durante el tratamiento • Anticuerpos anti-agalsidasa beta surgidos durante el tratamiento |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Efficacy will be determined by the slope of eGFR over the course of the study. Two analyses of efficacy will be performed – at 12 and 24 months of treatment
The eGFR endpoint is calculated based on serum creatinine and the serum creatinine will be collected in the following visits - screening - V1 baseline - All odd numbered visits |
La eficacia se determina por la pendiente de TFGe en el transcurso del estudio. Dos análisis de eficacia se llevarán a cabo a los 12 y 24 meses de tratamiento El punto final de TFGe se calcula en función de la creatinina en suero y la creatinina en suerose recoge en las siguientes: visitas de screening - V1 línea de inicio - Todas las visitas impare |
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E.5.2 | Secondary end point(s) |
Secondary efficacy endpoints: Left Ventricular Mass Index (g/m2) by MRI Plasma Lyso-Gb3 Plasma Gb3 Urine Lyso-Gb3 Protein/Creatinine ratio spot urine test Frequency of pain medication use Exercise tolerance (Stress Test) Short Form Brief Pain Inventory (BPI) Mainz Severity Score Index (MSSI) Quality of life EQ-5D-5L |
Criterios secundarios de valoración de la eficacia: • Índice de masa del ventrículo izquierdo (g/m2) mediante RM • Lyso-Gb3 en plasma • Gb3 en plasma • Lyso-Gb3 en orina • Cociente proteínas/creatinina en prueba puntual de orina • Frecuencia de uso de analgésicos • Tolerancia al ejercicio (prueba de esfuerzo) • Cuestionario abreviado para la evaluación del dolor (Brief Pain Inventory, BPI) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
In addition to the primary efficacy comparison described above, a series of secondary efficacy analyses will be performed to compare groups on the secondary outcomes of interest. |
Además de la comparación de la eficacia principal descrita anteriormente, se realizará una serie de análisis secundarios de la eficacia para comparar los grupos en cuanto a los resultados de interés secundarios. |
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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 | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 1 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 13 |
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 |
Canada |
Czech Republic |
Germany |
Hungary |
Netherlands |
Norway |
Paraguay |
Spain |
Turkey |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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LVLS |
Ultima visita del último paciente |
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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 | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |