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    Clinical Trial Results:
    BI 695501 versus Humira® in patients with active Crohn’s disease: a randomized, double-blind, multicenter, parallel group, exploratory trial comparing efficacy, endoscopic improvement, safety, and immunogenicity

    Summary
    EudraCT number
    2016-000612-14
    Trial protocol
    DE   GB   CZ   GR   HR  
    Global end of trial date
    13 May 2019

    Results information
    Results version number
    v2(current)
    This version publication date
    25 Dec 2020
    First version publication date
    15 May 2020
    Other versions
    v1
    Version creation reason
    • New data added to full data set
    Addition of NCT Number in section Trial Information.

    Trial information

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    Trial identification
    Sponsor protocol code
    1297.4
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02871635
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Boehringer Ingelheim
    Sponsor organisation address
    Binger Strasse 173, Ingelheim am Rhein, Germany, 55216
    Public contact
    Boehringer Ingelheim, Call Center, Boehringer Ingelheim, 001 8002430127, clintriage.rdg@boehringer-ingelheim.com
    Scientific contact
    Boehringer Ingelheim, Call Center, Boehringer Ingelheim, 001 8002430127, clintriage.rdg@boehringer-ingelheim.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    07 Jun 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    30 Apr 2019
    Global end of trial reached?
    Yes
    Global end of trial date
    13 May 2019
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of this trial was to compare the clinical efficacy of BI 695501 with EU-approved Humira at Week 4 in patients with active Crohn’s disease.
    Protection of trial subjects
    Only patients that met all the study inclusion and none of the exclusion criteria were to be randomized in the study. All patients were free to withdraw from the clinical trial at any time for any reason given. Close monitoring of all patients was adhered to throughout the trial conduct.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    15 Dec 2016
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Belarus: 9
    Country: Number of subjects enrolled
    Bosnia and Herzegovina: 3
    Country: Number of subjects enrolled
    Czechia: 51
    Country: Number of subjects enrolled
    Germany: 2
    Country: Number of subjects enrolled
    United Kingdom: 5
    Country: Number of subjects enrolled
    Greece: 7
    Country: Number of subjects enrolled
    Croatia: 9
    Country: Number of subjects enrolled
    Israel: 33
    Country: Number of subjects enrolled
    Poland: 53
    Country: Number of subjects enrolled
    Russian Federation: 49
    Country: Number of subjects enrolled
    Serbia: 19
    Country: Number of subjects enrolled
    Turkey: 14
    Country: Number of subjects enrolled
    Ukraine: 34
    Country: Number of subjects enrolled
    United States: 77
    Worldwide total number of subjects
    365
    EEA total number of subjects
    127
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    352
    From 65 to 84 years
    13
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    This was an exploratory, randomized, 56-week, double-blind, parallel arm, multiple dose, active comparator trial of BI 695501 and EU-approved Humira, with a 48-week treatment period and a 10-week follow-up period (starting after last dose of trial medication at Week 46) in patients with moderately to severely active Crohn's Disease (CD)

    Pre-assignment
    Screening details
    The trial consisted of a screening period of up to a maximum of 28 days, a 48-week treatment period consisting of an induction period from baseline to Week 4 and a maintenance period from Week 5 to Week 48, and a 10-week safety follow-up period (starting after last dose of trial medication at Week 46).

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Double blind
    Roles blinded
    Subject, Investigator, Monitor, Data analyst, Carer, Assessor

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    BI 695501
    Arm description
    Patients randomized to BI 695501 received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders (Crohn's Disease Activity Index (CDAI) decrease of ≥70 compared to baseline), patients continued to receive BI 695501 every 2 weeks until the end of the treatment (EoT) period (Week 46). Patients were administered with a loading dose of 160 milligram (mg) BI 695501 on Day 1, followed by 80 mg BI 695501 2 weeks later (Day 15), and thereafter 40 mg BI 695501 every 2 weeks until Week 46. Trial medication was administered by subcutaneous (SC) injection.
    Arm type
    Experimental

    Investigational medicinal product name
    BI 695501
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    BI 695501 was provided in sterile, preservative-free, non-pyrogenic, single-use pre-filled syringes (PFS) containing 40 mg of BI 695501 per 0.8 milliliter (mL). On Day 1, 4 PFS were used (total of 160 mg); on Day 15 (Week 2), 2 PFS were used (total of 80 mg); and thereafter (Week 4, then every 2 weeks until Week 46 if the patient was eligible to enter the maintenance phase, 1 PFS was used per injection.

    Arm title
    Humira EU
    Arm description
    Patients randomized to EU-approved Humira received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders, patients continued to receive EU-approved Humira until Week 22 and then switched to receive BI 695501 every 2 weeks from Week 24 until the EoT period (Week 46). Patients were administered with a loading dose of 160 mg EU-approved Humira on Day 1, followed by 80 mg EU-approved Humira 2 weeks later (Day 15), and 40 mg EU-approved Humira every 2 weeks until Week 22. Patients were then switched to receive 40 mg BI 695501 every 2 weeks from Week 24 until Week 46. Trial medication was administered by SC injection.
    Arm type
    Active comparator

    Investigational medicinal product name
    EU-approved Humira
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    The EU-approved Humira was provided in sterile, preservative-free, non-pyrogenic, single use PFS containing 40 mg of adalimumab per 0.8 mL or 40 mg of adalimumab per 0.4 mL (old and new formulations, respectively, approved to be comparable). On Day 1, 4 PFS were used (total of 160 mg); on Day 15 (Week 2), 2 PFS were used (total of 80 mg); and thereafter (Week 4, then every 2 weeks until Week 22 if the patient was eligible to enter the maintenance phase), 1 PFS was used per injection.

    Number of subjects in period 1 [1]
    BI 695501 Humira EU
    Started
    72
    75
    Completed
    54
    56
    Not completed
    18
    19
         Consent withdrawn by subject
    3
    4
         Physician decision
    1
    1
         Adverse event, non-fatal
    4
    4
         Primary lack of efficacy
    4
    4
         Secondary lack of efficacy
    2
    1
         Pregnancy
    -
    2
         Lost to follow-up
    1
    2
         Protocol deviation
    3
    1
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: This table is based on the randomized set and not on the subjects enrolled

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    BI 695501
    Reporting group description
    Patients randomized to BI 695501 received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders (Crohn's Disease Activity Index (CDAI) decrease of ≥70 compared to baseline), patients continued to receive BI 695501 every 2 weeks until the end of the treatment (EoT) period (Week 46). Patients were administered with a loading dose of 160 milligram (mg) BI 695501 on Day 1, followed by 80 mg BI 695501 2 weeks later (Day 15), and thereafter 40 mg BI 695501 every 2 weeks until Week 46. Trial medication was administered by subcutaneous (SC) injection.

    Reporting group title
    Humira EU
    Reporting group description
    Patients randomized to EU-approved Humira received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders, patients continued to receive EU-approved Humira until Week 22 and then switched to receive BI 695501 every 2 weeks from Week 24 until the EoT period (Week 46). Patients were administered with a loading dose of 160 mg EU-approved Humira on Day 1, followed by 80 mg EU-approved Humira 2 weeks later (Day 15), and 40 mg EU-approved Humira every 2 weeks until Week 22. Patients were then switched to receive 40 mg BI 695501 every 2 weeks from Week 24 until Week 46. Trial medication was administered by SC injection.

    Reporting group values
    BI 695501 Humira EU Total
    Number of subjects
    72 75 147
    Age categorical
    The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    68 74 142
        From 65-84 years
    4 1 5
        85 years and over
    0 0 0
    Age Continuous
    The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication
    Units: years
        arithmetic mean (standard deviation)
    37.4 ± 13.44 33.2 ± 11.52 -
    Sex: Female, Male
    Units: Participants
        Female
    33 31 64
        Male
    39 44 83
    Race (NIH/OMB)
    The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication
    Units: Subjects
        American Indian or Alaska Native
    0 0 0
        Asian
    1 0 1
        Native Hawaiian or Other Pacific Islander
    0 0 0
        Black or African American
    1 1 2
        White
    69 74 143
        More than one race
    0 0 0
        Unknown or Not Reported
    1 0 1
    Ethnicity (NIH/OMB)
    The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication
    Units: Subjects
        Hispanic or Latino
    1 0 1
        Not Hispanic or Latino
    69 67 136
        Unknown or Not Reported
    2 8 10
    Crohn’s Disease Activity Index score at baseline
    Crohn’s Disease Activity Index (CDAI) is a validated instrument to measure disease severity in Crohn’s disease. The CDAI is composed of 8 factors (Number of liquid stools, abdominal pain, general well being, extra-intestinal complications, antidiarrheal drugs, abdominal mass, hematocrit, body weight) the score is calculated by adding up the scores of the 8 factors after adjustment with a weighting factor. Higher CDAI scores indicating more active disease. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication
    Units: Score
        arithmetic mean (standard deviation)
    307.3 ± 76.69 303.6 ± 64.39 -

    End points

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    End points reporting groups
    Reporting group title
    BI 695501
    Reporting group description
    Patients randomized to BI 695501 received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders (Crohn's Disease Activity Index (CDAI) decrease of ≥70 compared to baseline), patients continued to receive BI 695501 every 2 weeks until the end of the treatment (EoT) period (Week 46). Patients were administered with a loading dose of 160 milligram (mg) BI 695501 on Day 1, followed by 80 mg BI 695501 2 weeks later (Day 15), and thereafter 40 mg BI 695501 every 2 weeks until Week 46. Trial medication was administered by subcutaneous (SC) injection.

    Reporting group title
    Humira EU
    Reporting group description
    Patients randomized to EU-approved Humira received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders, patients continued to receive EU-approved Humira until Week 22 and then switched to receive BI 695501 every 2 weeks from Week 24 until the EoT period (Week 46). Patients were administered with a loading dose of 160 mg EU-approved Humira on Day 1, followed by 80 mg EU-approved Humira 2 weeks later (Day 15), and 40 mg EU-approved Humira every 2 weeks until Week 22. Patients were then switched to receive 40 mg BI 695501 every 2 weeks from Week 24 until Week 46. Trial medication was administered by SC injection.

    Primary: Percentage of Patients With a Clinical Response (CDAI Decrease of ≥70 Compared With Baseline) at Week 4

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    End point title
    Percentage of Patients With a Clinical Response (CDAI Decrease of ≥70 Compared With Baseline) at Week 4
    End point description
    The Crohn’s Disease Activity Index (CDAI) is a validated instrument to measure disease severity in Crohn’s Disease (CD). The CDAI score is a sum of the 8 factors (number of liquid stools, abdominal pain, general well-being, extra-intestinal complications, antidiarrheal drugs, abdominal mass, hematocrit and body weight) after adjustment with a weighting factor. Higher CDAI scores indicating more active disease. The CDAI decrease at Week 4 was assessed as the decrease relative to baseline measurement, patients with a decrease ≥70 were responders. Percentage=least squares means per treatment group back transformed using inverse logit function. Missing data were imputed according to non-responder imputation (NRI) and last observation carried forward (LOCF). The full analysis set (FAS) contained all randomized patients who received at least 1 dose of trial medication, and had all efficacy measures relevant for the CDAI, measured at baseline and at least once postbaseline.
    End point type
    Primary
    End point timeframe
    Week 4
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    68
    72
    Units: Percentage
        number (not applicable)
    88.0
    93.1
    Statistical analysis title
    Estimate for relative risk
    Statistical analysis description
    Was analyzed using a log-linked binomial model, described as: response to treatment at Week 4 = treatment+prior infliximab exposure+screening Simple Endoscopic Score for Crohn's Disease (SES-CD)
    Comparison groups
    BI 695501 v Humira EU
    Number of subjects included in analysis
    140
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.945
    Confidence interval
         level
    90%
         sides
    2-sided
         lower limit
    0.87
         upper limit
    1.028
    Statistical analysis title
    Estimate for relative risk
    Statistical analysis description
    Was to be analyzed using a log-linked binomial model, described as: response to treatment at Week 4 = treatment+prior infliximab exposure+screening Simple Endoscopic Score for Crohn's Disease (SES-CD)
    Comparison groups
    BI 695501 v Humira EU
    Number of subjects included in analysis
    140
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.945
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.856
         upper limit
    1.044

    Secondary: Percentage of Patients in Clinical Remission (CDAI <150) at Week 24

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    End point title
    Percentage of Patients in Clinical Remission (CDAI <150) at Week 24
    End point description
    The CDAI is a validated instrument to measure disease severity in CD. The CDAI score is a sum of the 8 factors (number of liquid stools, abdominal pain, general well-being, extra-intestinal complications, antidiarrheal drugs, abdominal mass, hematocrit and body weight) after adjustment with a weighting factor. Higher CDAI scores indicating more active disease. Patients with CDAI <150 at Week 24 were considered as clinical remission cases. Percentage=least squares means per treatment group back transformed using inverse logit function. Missing data were imputed according to NRI and LOCF. The full analysis set (FAS) contained all randomized patients who received at least 1 dose of trial medication, and had all efficacy measures relevant for the CDAI, measured at baseline and at least once postbaseline.
    End point type
    Secondary
    End point timeframe
    at Week 24
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    68
    72
    Units: Percentage
        number (not applicable)
    68.6
    76.2
    Statistical analysis title
    Estimate for relative risk
    Statistical analysis description
    Was to be analyzed using a log-linked binomial model, described as: response to treatment at Week 24 = treatment+prior infliximab exposure+screening Simple Endoscopic Score for Crohn's Disease (SES-CD)
    Comparison groups
    BI 695501 v Humira EU
    Number of subjects included in analysis
    140
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.9
    Confidence interval
         level
    90%
         sides
    2-sided
         lower limit
    0.751
         upper limit
    1.078
    Statistical analysis title
    Estimate for relative risk
    Statistical analysis description
    Was to be analyzed using a log-linked binomial model, described as: response to treatment at Week 24 = treatment+prior infliximab exposure+screening Simple Endoscopic Score for Crohn's Disease (SES-CD)
    Comparison groups
    BI 695501 v Humira EU
    Number of subjects included in analysis
    140
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Risk ratio (RR)
    Point estimate
    0.9
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.725
         upper limit
    1.116

    Secondary: Percentage of Patients With a Clinical Response (CDAI Decrease of ≥70 Compared With Baseline) at Week 24

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    End point title
    Percentage of Patients With a Clinical Response (CDAI Decrease of ≥70 Compared With Baseline) at Week 24
    End point description
    The CDAI is a validated instrument to measure disease severity in CD. The CDAI score is a sum of the 8 factors (number of liquid stools, abdominal pain, general well-being, extra-intestinal complications, antidiarrheal drugs, abdominal mass, hematocrit and body weight) after adjustment with a weighting factor. Higher CDAI scores indicating more active disease. The CDAI decrease at Week 24 was assessed as the decrease relative to baseline measurement, patients with a decrease ≥70 were responders. Percentage=least squares means per treatment group back transformed using inverse logit function. Missing data were imputed according to NRI and LOCF. The full analysis set (FAS) contained all randomized patients who received at least 1 dose of trial medication, and had all efficacy measures relevant for the CDAI, measured at baseline and at least once postbaseline.
    End point type
    Secondary
    End point timeframe
    Week 24
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    68
    72
    Units: Percentage
        number (not applicable)
    87.4
    87.4
    Statistical analysis title
    Estimate for relative risk
    Statistical analysis description
    Was to be analyzed using a log-linked binomial model, described as: response to treatment at Week 24 = treatment+prior infliximab exposure+screening Simple Endoscopic Score for Crohn's Disease (SES-CD)
    Comparison groups
    BI 695501 v Humira EU
    Number of subjects included in analysis
    140
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Risk ratio (RR)
    Point estimate
    1
    Confidence interval
         level
    90%
         sides
    2-sided
         lower limit
    0.871
         upper limit
    1.148
    Statistical analysis title
    Estimate for relative risk
    Statistical analysis description
    Was to be analyzed using a log-linked binomial model, described as: response to treatment at Week 24 = treatment+prior infliximab exposure+screening Simple Endoscopic Score for Crohn's Disease (SES-CD)
    Comparison groups
    BI 695501 v Humira EU
    Number of subjects included in analysis
    140
    Analysis specification
    Pre-specified
    Analysis type
    Method
    Parameter type
    Risk ratio (RR)
    Point estimate
    1
    Confidence interval
         level
    95%
         sides
    2-sided
         lower limit
    0.848
         upper limit
    1.178

    Secondary: Percentage of Patients With Adverse Events (AEs), Serious AEs (SAEs), and AEs of Special Interest (AESIs)

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    End point title
    Percentage of Patients With Adverse Events (AEs), Serious AEs (SAEs), and AEs of Special Interest (AESIs)
    End point description
    Analysis of AEs focused on treatment-emergent AEs (TEAEs). For the period 1 ‘Baseline – Week 24’, TEAEs were defined as AEs that started or worsened on or after first dose of trial medication and prior to date of the Week 24 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients who discontinued treatment before Week 24. For the period 2 ‘Week 24 – Week 46’, TEAEs were defined as AEs that started or worsened on Week 24 visit and prior to or on Week 56 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients discontinuing treatment prior to Week 46. TEAEs and SAEs (including investigator-assessed trial medication-related TEAEs) and AESIs are reported. The following were considered an AESI: hepatic injury, anaphylactic reactions, serious infection and hypersensitivity reactions. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    End point type
    Secondary
    End point timeframe
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    72
    75
    Units: Percentage
    number (not applicable)
        TEAE -Period 1
    62.5
    56.0
        serious TEAE - Period 1
    8.3
    10.7
        AESI TEAE - Period 1
    2.8
    2.7
        TEAE - Period 2
    43.1
    45.3
        serious TEAE - Period 2
    2.8
    12.0
        AESI TEAE - Period 2
    2.8
    2.7
    No statistical analyses for this end point

    Secondary: Percentage of Patients With Infections

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    End point title
    Percentage of Patients With Infections
    End point description
    The percentage of patients with TEAEs for infections and serious infections are reported. For the period 1 ‘Baseline – Week 24’, TEAEs were defined as AEs that started or worsened on or after first dose of trial medication and prior to date of the Week 24 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients who discontinued treatment before Week 24. For the period 2 ‘Week 24 – Week 46’, TEAEs were defined as AEs that started or worsened on Week 24 visit and prior to or on Week 56 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients discontinuing treatment prior to Week 46. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    End point type
    Secondary
    End point timeframe
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    72
    75
    Units: Percentage
    number (not applicable)
        Period 1
    23.6
    22.7
        Period 2
    19.4
    22.7
    No statistical analyses for this end point

    Secondary: Percentage of Patients With Serious Infections

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    End point title
    Percentage of Patients With Serious Infections
    End point description
    The percentage of patients with TEAEs for infections and serious infections are reported. For the period 1 ‘Baseline – Week 24’, TEAEs were defined as AEs that started or worsened on or after first dose of trial medication and prior to date of the Week 24 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients who discontinued treatment before Week 24. For the period 2 ‘Week 24 – Week 46’, TEAEs were defined as AEs that started or worsened on Week 24 visit and prior to or on Week 56 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients discontinuing treatment prior to Week 46. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    End point type
    Secondary
    End point timeframe
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    72
    75
    Units: Percentage
    number (not applicable)
        Period 1
    2.8
    2.7
        Period 2
    1.4
    4.0
    No statistical analyses for this end point

    Secondary: Percentage of Patients Who Experienced Hypersensitivity Reactions

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    End point title
    Percentage of Patients Who Experienced Hypersensitivity Reactions
    End point description
    The percentage of patients with TEAEs for hypersensitivity reactions is reported. For the period 1 ‘Baseline – Week 24’, TEAEs were defined as AEs that started or worsened on or after first dose of trial medication and prior to date of the Week 24 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients who discontinued treatment before Week 24. For the period 2 ‘Week 24 – Week 46’, TEAEs were defined as AEs that started or worsened on Week 24 visit and prior to or on Week 56 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients discontinuing treatment prior to Week 46. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    End point type
    Secondary
    End point timeframe
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    72
    75
    Units: Percentage
    number (not applicable)
        Period 1
    5.6
    2.7
        Period 2
    2.8
    6.7
    No statistical analyses for this end point

    Secondary: Percentage of Patients Who Experienced Drug Induced Liver Injury (DILI)

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    End point title
    Percentage of Patients Who Experienced Drug Induced Liver Injury (DILI)
    End point description
    The percentage of patients with TEAEs for DILIs is reported. For the period 1 ‘Baseline – Week 24’, TEAEs were defined as AEs that started or worsened on or after first dose of trial medication and prior to date of the Week 24 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients who discontinued treatment before Week 24. For the period 2 ‘Week 24 – Week 46’, TEAEs were defined as AEs that started or worsened on Week 24 visit and prior to or on Week 56 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients discontinuing treatment prior to Week 46. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    End point type
    Secondary
    End point timeframe
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    72
    75
    Units: Percentage
    number (not applicable)
        Period 1
    0.0
    0.0
        Period 2
    0.0
    0.0
    No statistical analyses for this end point

    Secondary: Percentage of Patients With Injection Site Reactions

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    End point title
    Percentage of Patients With Injection Site Reactions
    End point description
    The percentage of patients with TEAEs for injection site reactions is reported. For the period 1 ‘Baseline – Week 24’, TEAEs were defined as AEs that started or worsened on or after first dose of trial medication and prior to date of the Week 24 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients who discontinued treatment before Week 24. For the period 2 ‘Week 24 – Week 46’, TEAEs were defined as AEs that started or worsened on Week 24 visit and prior to or on Week 56 visit or within 10 weeks (70 days, inclusive) after last dose of trial medication for patients discontinuing treatment prior to Week 46. The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    End point type
    Secondary
    End point timeframe
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    End point values
    BI 695501 Humira EU
    Number of subjects analysed
    72
    75
    Units: Percentage
    number (not applicable)
        Period 1
    0.0
    6.7
        Period 2
    1.4
    1.3
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    From first administration of trial medication until 10 weeks after last administration, up to a maximum of 56 weeks.
    Adverse event reporting additional description
    The Safety Analysis Set (SAF) contained all randomized patients who received at least 1 dose (full or partial) of trial medication.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    22.0
    Reporting groups
    Reporting group title
    BI 695501 (Baseline - Week 24 + 10 Weeks [70 days])
    Reporting group description
    Patients randomized to BI 695501 received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders (CDAI decrease of ≥70 compared to baseline), patients continued to receive BI 695501 every 2 weeks until the end of the treatment (EoT) period (Week 46). Patients were administered with a loading dose of 160 milligram (mg) BI 695501 on Day 1, followed by 80 mg BI 695501 2 weeks later (Day 15), and thereafter 40 mg BI 695501 every 2 weeks until Week 46. Trial medication was administered by subcutaneous (SC) injection.

    Reporting group title
    Humira (Baseline - Week 24 + 10 Weeks [70 days])
    Reporting group description
    Patients randomized to EU-approved Humira received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders, patients continued to receive EU-approved Humira until Week 22 and then switched to receive BI 695501 every 2 weeks from Week 24 until the EoT period (Week 46). Patients were administered with a loading dose of 160 mg EU-approved Humira on Day 1, followed by 80 mg EU-approved Humira 2 weeks later (Day 15), and 40 mg EU-approved Humira every 2 weeks until Week 22. Patients were then switched to receive 40 mg BI 695501 every 2 weeks from Week 24 until Week 46. Trial medication was administered by SC injection.

    Reporting group title
    BI 695501 (Week 24 - Week 46 + 10 Weeks [70 days])
    Reporting group description
    Patients randomized to BI 695501 received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders (CDAI decrease of ≥70 compared to baseline), patients continued to receive BI 695501 every 2 weeks until the end of the treatment (EoT) period (Week 46). Patients were administered with a loading dose of 160 milligram (mg) BI 695501 on Day 1, followed by 80 mg BI 695501 2 weeks later (Day 15), and thereafter 40 mg BI 695501 every 2 weeks until Week 46. Trial medication was administered by subcutaneous (SC) injection.

    Reporting group title
    Humira (Week 24 - Week 46 + 10 Weeks [70 days])
    Reporting group description
    Patients randomized to EU-approved Humira received treatment every 2 weeks until Week 4 when they were assessed for clinical response. If classified as responders, patients continued to receive EU-approved Humira until Week 22 and then switched to receive BI 695501 every 2 weeks from Week 24 until the EoT period (Week 46). Patients were administered with a loading dose of 160 mg EU-approved Humira on Day 1, followed by 80 mg EU-approved Humira 2 weeks later (Day 15), and 40 mg EU-approved Humira every 2 weeks until Week 22. Patients were then switched to receive 40 mg BI 695501 every 2 weeks from Week 24 until Week 46. Trial medication was administered by SC injection.

    Serious adverse events
    BI 695501 (Baseline - Week 24 + 10 Weeks [70 days]) Humira (Baseline - Week 24 + 10 Weeks [70 days]) BI 695501 (Week 24 - Week 46 + 10 Weeks [70 days]) Humira (Week 24 - Week 46 + 10 Weeks [70 days])
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 72 (8.33%)
    8 / 75 (10.67%)
    2 / 72 (2.78%)
    9 / 75 (12.00%)
         number of deaths (all causes)
    0
    0
    0
    0
         number of deaths resulting from adverse events
    0
    0
    0
    0
    Injury, poisoning and procedural complications
    Joint injury
         subjects affected / exposed
    1 / 72 (1.39%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Nervous system disorders
    Multiple sclerosis
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Pregnancy, puerperium and perinatal conditions
    Ruptured ectopic pregnancy
         subjects affected / exposed
    0 / 72 (0.00%)
    1 / 75 (1.33%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Crohn's disease
         subjects affected / exposed
    2 / 72 (2.78%)
    5 / 75 (6.67%)
    1 / 72 (1.39%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 5
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Anal fistula
         subjects affected / exposed
    1 / 72 (1.39%)
    1 / 75 (1.33%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Large intestinal haemorrhage
         subjects affected / exposed
    0 / 72 (0.00%)
    1 / 75 (1.33%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Small intestinal obstruction
         subjects affected / exposed
    0 / 72 (0.00%)
    1 / 75 (1.33%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Dyspepsia
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Pancreatitis chronic
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Skin and subcutaneous tissue disorders
    Dermatitis
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Palmoplantar pustulosis
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Pruritus
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Pyoderma gangrenosum
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Rash erythematous
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Joint swelling
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Musculoskeletal pain
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Infections and infestations
    Acute sinusitis
         subjects affected / exposed
    1 / 72 (1.39%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Anal abscess
         subjects affected / exposed
    0 / 72 (0.00%)
    1 / 75 (1.33%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Postoperative wound infection
         subjects affected / exposed
    0 / 72 (0.00%)
    1 / 75 (1.33%)
    0 / 72 (0.00%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Pulmonary tuberculosis
         subjects affected / exposed
    1 / 72 (1.39%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Psoas abscess
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    1 / 72 (1.39%)
    0 / 75 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Rotavirus infection
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 72 (0.00%)
    0 / 75 (0.00%)
    0 / 72 (0.00%)
    1 / 75 (1.33%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 3
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    BI 695501 (Baseline - Week 24 + 10 Weeks [70 days]) Humira (Baseline - Week 24 + 10 Weeks [70 days]) BI 695501 (Week 24 - Week 46 + 10 Weeks [70 days]) Humira (Week 24 - Week 46 + 10 Weeks [70 days])
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    23 / 72 (31.94%)
    16 / 75 (21.33%)
    13 / 72 (18.06%)
    12 / 75 (16.00%)
    Investigations
    Weight increased
         subjects affected / exposed
    4 / 72 (5.56%)
    1 / 75 (1.33%)
    3 / 72 (4.17%)
    0 / 75 (0.00%)
         occurrences all number
    5
    2
    3
    0
    Gastrointestinal disorders
    Crohn's disease
         subjects affected / exposed
    4 / 72 (5.56%)
    3 / 75 (4.00%)
    0 / 72 (0.00%)
    2 / 75 (2.67%)
         occurrences all number
    4
    3
    0
    2
    Abdominal pain
         subjects affected / exposed
    3 / 72 (4.17%)
    2 / 75 (2.67%)
    1 / 72 (1.39%)
    5 / 75 (6.67%)
         occurrences all number
    4
    2
    1
    5
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    6 / 72 (8.33%)
    0 / 75 (0.00%)
    2 / 72 (2.78%)
    0 / 75 (0.00%)
         occurrences all number
    6
    0
    2
    0
    Infections and infestations
    Respiratory tract infection
         subjects affected / exposed
    5 / 72 (6.94%)
    3 / 75 (4.00%)
    0 / 72 (0.00%)
    3 / 75 (4.00%)
         occurrences all number
    5
    3
    0
    3
    Upper respiratory tract infection
         subjects affected / exposed
    3 / 72 (4.17%)
    5 / 75 (6.67%)
    2 / 72 (2.78%)
    1 / 75 (1.33%)
         occurrences all number
    4
    6
    2
    2
    Nasopharyngitis
         subjects affected / exposed
    2 / 72 (2.78%)
    2 / 75 (2.67%)
    5 / 72 (6.94%)
    3 / 75 (4.00%)
         occurrences all number
    2
    2
    5
    3

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Mar 2017
    • Number of sites and countries were updated to reflect the current trial status. • It was clarified that the local hematocrit value was to be used to determine CDAI score at Week 4 (Visit 4) so that clinical response could be determined immediately, the hematocrit value from the central laboratory assessment at Week 8 (Visit 6) was to be used to determine CDAI at Week 12 (Visit 8), and weight was to be measured at all visits where physical examination was not being performed, for use in CDAI determination. • Inclusion criterion 1c was amended to make the severity of disease, as defined by CDAI, consistent with endoscopic evaluation. Eligible patients had to have evidence of mucosal ulcers in at least 1 segment of the ileum or colon. • The term “initial isolate ileitis” was updated to “isolated ileal disease”. • Inclusion criterion 2 was amended to clarify that only infliximab was allowed as first-line anti-tumor necrosis factor (TNF) therapy; previous treatment with other anti-TNF therapies (specifically certolizumab) were not permitted. • The process to be used for primary analysis was clarified to state that efficacy data was to be included up to the Week 4 visit only and all available data for safety and other endpoints were to be included up to the data cut-off date. • Appendix 10.1 (Medication Blinding Procedure for Third Party Blinding) was updated to align the protocol with instructions included in the trial Pharmacy Manual.
    12 Dec 2017
    •Trial methodology and related statistical method, and sample size calculations were updated to reflect an exploratory trial design. The design change allowed trial objectives to be achieved with a smaller number of evaluable subjects (65 in each group) and reduced total sample size of approximately 130 (from approximately 286). • Tuberculosis(TB) testing: Additional TB testing was included for Week 24 (Visit 14), before switching from Humira to BI 6995501, to clarify whether incidence of possible positive TB tests was linked to the comparator or test product. New text was included to clarify TB testing and subsequent follow up during the trial and exclusion criterion 8 was updated to emphasize that TNF inhibitor use was allowed. • Exclusion criterion 10 was updated to remove reference to positive anti-adalimumab antibodies at baseline to clarify that results of antidrug antibodies were not available at time of inclusion. • Description of CDAI assessment was amended to clarify the days patients were required to keep a symptom diary prior to each assessment. • Text was added to End of Treatment visit description to state that in event of early discontinuation, a patient was to receive treatment as deemed appropriate by the investigator and in accordance with applicable guidance. • Appendix 10.1 (Medication Blinding Procedure for Third Party Blinding) was updated to clarify how to handle used syringes in accordance with medical requirements and to align the protocol with instructions included in the trial Pharmacy Manual. • Additional table footnote was added to Appendix 10.2 (List of Laboratory Tests) to clarify that pathogens other than mandatory list may have been identified. • Due to trial design change, additional text was included in Appendix 10.3 (Details About the Statistical Considerations) to clarify that standard rules for noninferiority margin selection were not to be applied but, magnitude of preserved historical treatment effect was to be used. 

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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