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    Summary
    EudraCT Number:2016-001447-39
    Sponsor's Protocol Code Number:AB15003
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Restarted
    Date on which this record was first entered in the EudraCT database:2020-10-22
    Trial 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 number2016-001447-39
    A.3Full title of the trial
    A 24-week with possible extension, prospective, multicenter, randomized, double blind, placebo-controlled, 2-parallel group with a randomization 1:1, phase 3 study to compare efficacy and safety of oral masitinib to placebo in treatment of patients with Smouldering or Indolent Severe Systemic mastocytosis with handicap, unresponsive to optimal symptomatic treatment
    Studio prospettico, multicentrico, randomizzato, in doppio cieco, controllato verso placebo, a 2 gruppi paralleli con randomizzazione 1:1, della durata di 24 settimane con possibile estensione, di fase 3 sull’efficacia e la sicurezza di masitinib orale a confronto con placebo nel trattamento di pazienti affetti da mastocitosi sistemica grave intermedia o indolente con handicap, non responsiva a trattamento sintomatico ottimale
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A 24-week with possible extension study to compare efficacy and safety of oral masitinib to placebo in treatment of patients with Smouldering or Indolent Severe Systemic mastocytosis
    Studio della durata di 24 settimane,con possibile estensione, per confrontare l'efficacia e la sicurezza di masitinib orale rispetto a placebo nel trattamento di pazienti affetti da mastocitosi sistemica grave intermedia o indolente
    A.3.2Name or abbreviated title of the trial where available
    -
    -
    A.4.1Sponsor's protocol code numberAB15003
    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 SponsorAB SCIENCE
    B.1.3.4CountryFrance
    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 supportAB Science
    B.4.2CountryFrance
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationAB Science
    B.5.2Functional name of contact pointChief executive officer
    B.5.3 Address:
    B.5.3.1Street Address3 avenue George V
    B.5.3.2Town/ cityParis
    B.5.3.3Post code75008
    B.5.3.4CountryFrance
    B.5.4Telephone number47202311
    B.5.5Fax number47202411
    B.5.6E-maila.moussy@ab-science.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 nameMasitinib mesilate
    D.3.2Product code [AB1010 Tablets]
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMasitinib mesilate
    D.3.9.1CAS number 790299-79-5
    D.3.9.2Current sponsor codeAB1010
    D.3.9.3Other descriptive name4-[(4-methyl-1-piperazinyl)methyl]-N-[4-methyl-3-[[4-(3-pyridinyl)-2- thiazolyl]amino]phenyl]-benzamide, methane sulphonic acid salt. AB1010base; AB 1003
    D.3.9.4EV Substance CodeSUB32266
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    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 nameMasitinib mesilate
    D.3.2Product code [AB1010 Tablets]
    D.3.4Pharmaceutical form Tablet
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPOral use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNMasitinib mesilate
    D.3.9.1CAS number 790299-79-5
    D.3.9.2Current sponsor codeAB1010
    D.3.9.3Other descriptive name4-[(4-methyl-1-piperazinyl)methyl]-N-[4-methyl-3-[[4-(3-pyridinyl)-2-thiazolyl]amino]phenyl]-benzamide, methane sulphonic acid salt. AB1010base; AB 1003
    D.3.9.4EV Substance CodeSUB32266
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number200
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin Yes
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) No
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product Information not present in EudraCT
    D.3.11.3.2Gene therapy medical product Information not present in EudraCT
    D.3.11.3.3Tissue Engineered Product Information not present in EudraCT
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) Information not present in EudraCT
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product Information not present in EudraCT
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product No
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    D.8 Placebo: 1
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    D.8 Placebo: 2
    D.8.1Is a Placebo used in this Trial?Yes
    D.8.3Pharmaceutical form of the placeboTablet
    D.8.4Route of administration of the placeboOral use
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Smouldering or Indolent Severe Systemic Mastocytosis with handicap unresponsive to optimal sympomatic treatment
    Mastocitosi sistemica grave intermedia o indolente con handicap, non responsiva a trattamento sintomatico ottimale
    E.1.1.1Medical condition in easily understood language
    Systemic Mastocytosis
    Mastocitosi sistemica
    E.1.1.2Therapeutic area Diseases [C] - Blood and lymphatic diseases [C15]
    MedDRA Classification
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    Cumulative response on 3 handicaps (Pruritus, Flush, Depression) from week 8 to week 24.
    • Handicaps are defined as: Pruritus score greater than or equal to 9, number of Flushes per week greater than or equal to 8, Depression HAMD score greater than or equal to 19.
    • Response on a handicap is defined as an improvement greater than or equal to 75% for Pruritus, Flushes and Depression (HAMD Score).
    For all the patients, the response at each study visit (5 visits from week 8 to week 24) will be calculated on each handicap present at Baseline (among pruritus, flushes, depression) as defined above.
    Sensitivity analysis will be performed from week 8 to week 48.
    In case of rescue medication to manage a handicap, all subsequent measures will be considered as “fail”.
    Risposta cumulativa su 3 handicap (prurito, vampate di calore, depressione) dalla settimana 8 alla settimana 24.
    • Gli handicap sono definiti come: punteggio del prurito maggiore o uguale a 9, numero di vampate di calore alla settimana maggiore o uguale a 8, punteggio relativo alla depressione (scala HAM-D) maggiore o uguale a 19.
    • Per risposta su un handicap si intende un miglioramento maggiore o uguale a 75% per prurito, vampate di calore e depressione (scala HAM-D).
    Il calcolo della risposta verrà effettuato per tutti i pazienti in occasione di ogni visita dello studio (5 visite dalla settimana 8 alla 24) per ogni handicap presente al basale (limitatamente a prurito, vampate di calore, depressione) in base alle definizioni sopra riportate.
    Sarà eseguita un’analisi di sensibilità dalla settimana 8 alla settimana 48.
    In caso di ricorso a terapia di salvataggio per la gestione di un handicap, le misurazioni successive verranno considerate come “fallimento terapeutico”.
    E.2.2Secondary objectives of the trial
    1.• Cumulative response on 4 handicaps (Pruritus, Flushes, Depression, FSS) from w 8 to w 24
    • Cumulative response on 4 handicaps (Pruritus, Flushes, Depression, FIS) from w 8 to w24
    • Cumulative response on 2 handicaps (Pruritus, Flush) from w 8 to w24
    • Cumulative response on each of the individual handicaps from w 8 to w 24.
    Response on above mentioned handicaps is defined as an improvement greater than or equal to75%.

    2. Biological and Skin Parameters:
    • Tryptase Level: change from baseline at week 24 in serum tryptase level
    • Urticaria Pigmentosa:
    - “Darier Sign” disappearance (Yes/No) (week 12 to week 24)
    - Body Surface Area (BSA) (week 12 to week 24).

    3. Quality of Life
    1. • Risposta cumulativa su 4 handicap ((prurito, vampate di calore, depressione, FSS) dalla settimana 8 alla settimana 24
    • Risposta cumulativa su 4 handicap (prurito, vampate di calore,depressione, FIS) dalla settimana 8 alla settimana 24
    • Risposta cumulativa su 2 handicap (prurito, vampate di calore) dalla settimana 8 alla settimana 24
    • Risposta cumulativa su ciascuno dei singoli handicap dalla settimana 8 alla settimana 24.
    La risposta relativa agli handicap sopra citati è definita come un miglioramento maggiore o uguale a 75%.

    2. Parametri biologici e cutanei:
    • Livello di triptasi: variazione del livello sierico di triptasi dal basale alla settimana 24
    • Orticaria pigmentosa:
    - scomparsa del “segno di Darier” (Sì/No) (dalla settimana 12 alla settimana 24)
    - Superficie corporea (dalla settimana 12 alla settimana 24).

    3. Qualità della vita
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1. Patient with one of the following documented mastocytosis:
    • Smouldering Systemic Mastocytosis (SSM)
    • Indolent Systemic Mastocytosis (ISM)
    2. An excess of mast cells or a presence of abnormal mast cells in at least two organs (among skin, bone-marrow and GI Tract)
    3. Patients meet the used classification of systemic mastocytosis (SM) based on the presence of one of the three criteria:
    • Bone marrow biopsy and/or aspirate associated with at least a sign of abnormality of mast cells:
    - Abnormal aggregates of mast cells in a sample in bone marrow:
    The criterion is deemed satisfied if the aggregate:
    i) is quantified and is strictly above 15 mast cells per aggregated (corresponding to WHO major criterion), or
    ii) is not quantified but is described as nodule, seat, cluster, focus, or granuloma and therefore pathological;
    - more than or equal to 25% atypical mast cells in a sample of bone marrow (corresponding to WHO minor criterion);
    - c-Kit point mutation at codon 816 in bone marrow (corresponding to WHO minor criterion);
    - Abnormal mast cells in the sample of bone marrow while microscopic testing that can be described by the following words: Spindled; Abnormal; Atypical; Fusiform; Dystrophic; Pathologic; Dysmorphic (corresponding to WHO minor criterion);
    - Abnormal immunohistochemistry signs: mast cells in bone marrow express CD2 or/and CD25 present (corresponding to WHO minor criterion);
    - Abnormal infiltration of mast cells in the bone marrow:
    The criterion is deemed satisfied if the infiltration:
    i) is quantified and is strictly above 3% in the biopsy, or
    ii) is not quantified but is abnormal as described with infiltration, accumulation of mast cells, or proliferation and therefore pathological.
    • Detection of c-Kit 816 mutation in the bone marrow without evidence of mast cells in bone marrow but with evidence of c-Kit 816 mutation in skin, justifying clonality;
    • Excess of mast cells in digestive organs.
    4. Patient with severe symptoms of mastocytosis over the 14-day run-in period defined as at least one of the following:
    • Pruritus score greater than or equal to 9
    • Number of flushes per week greater than or equal to 8
    • Hamilton rating scale for depression (HAMD-17) score greater than or equal to 19
    5. Patient with documented treatment failures of his/her symptom (s) (within last two years) with at least two of the symptomatic treatments used at optimized dose (Minimal duration of each treatment should be at least 8 weeks):
    • Anti-H1
    • Anti-H2
    • Proton pump inhibitor
    • Antidepressants
    • Cromoglycate Sodium
    • Antileukotriene
    6. Patients must be on a stable dose of Anti-H1 for a minimum of 4 weeks before screening and should remain at a stable dose throughout the study period. For other symptomatic treatments, if the patient takes Corticosteroids, Anti-H2 or PPI or Antidepressants or Cromoglycate Sodium or Antileukotriene, the treatment must have started at least 4 weeks before Screening and must be stable throughout the study.
    7. Age between 18 to 75 years (inclusive).
    8. Weight > 45 kg and BMI between 18 and 35 kg/m2
    9. Contraception:
    • The patient and his/her partner must use a highly effective method during the study and for 3 months and 1 week after the last treatment intake (for details on contraceptive methods refer to the study protocol).
    10. Patient must be able and willing to comply with study visits and procedures.
    11. Patient able to understand, sign, and date the written informed consent form at the screening visit prior to any protocol-specific procedures.
    12. Patient able to understand the patient card and follow the patient card procedures in case of signs or symptoms of severe neutropenia or severe cutaneous toxicity.
    1. Pazienti con una delle seguenti forme di mastocitosi documentata:
    • Mastocitosi sistemica intermedia
    • Mastocitosi sistemica indolente
    2. Accumulo di un numero eccessivo di mastociti o presenza di mastociti anomali in almeno due organi (tra cute, midollo osseo e tratto gastrointestinale)
    3. I pazienti devono soddisfare uno dei tre seguenti criteri:
    • Biopsia e/o aspirato midollare con almeno un segno di anomalia dei mastociti:
    - Aggregati mastocitari anomali in un campione di midollo osseo:
    Il criterio è considerato soddisfatto se l’aggregato:
    i) è quantificato e il valore è rigorosamente superiore a 15 mastociti per aggregato oppure
    ii) non è quantificato ma è descritto come nodulo, sito, cluster, focus o granuloma, e pertanto patologico;
    - morfologia atipica di 25% o più dei mastociti in un campione di midollo osseo;
    - mutazione puntiforme del gene c-Kit a livello del codone 816 nel midollo osseo;
    - mastociti anomali nel campione di midollo osseo riscontrati nel corso di analisi microscopica, che possono essere descritti con i seguenti termini: “allungati”;
    anomali”; “atipici”; “fusiformi”; “distrofici”; “patologici”; “dismorfici”;
    - segni di anomalia riscontrati mediante tecniche di immunoistochimica: espressione da parte dei mastociti del midollo osseo di CD2 e/o CD25;
    - infiltrazione anomala di mastociti nel midollo osseo.
    Il criterio è considerato soddisfatto se l’infiltrazione:
    i) è quantificata ed è rigorosamente superiore al 3% nella biopsia, oppure
    ii) non è quantificata ma è “anomala”, in quanto descritta con i termini “infiltrazione”, “accumulo di mastociti” oppure “proliferazione”, e pertanto patologica.
    • Presenza di mutazione di c-Kit in pos. 816 nel midollo osseo, senza evidenza di mastociti nel midollo osseo ma con evidenza di mutazioni di c-Kit in pos.
    816 nella cute, a dimostrazione della clonalità
    • Eccesso di mastociti negli organi dell’apparato digerente
    4. Pazienti che manifestano gravi sintomi di mastocitosi nel periodo di run-in di 14 giorni, ossia presenza di almeno uno dei seguenti fattori:
    • Punteggio del prurito maggiore o uguale a 9
    • Numero di vampate di calore alla settimana maggiore o uguale a 8
    • Punteggio HAM-D-17 maggiore o uguale a 19
    5. Pazienti con fallimento documentato del trattamento del/dei sintomo/i (negli ultimi 2 anni) per almeno 2 delle terapie sintomatiche usate alla dose ottimale
    (ciascuna terapia deve aver avuto una durata almeno di 8 settimane):
    • anti-H1
    • anti-H2
    • inibitore di pompa protonica
    • antidepressivi
    • sodio cromoglicato
    • antagonista dei recettori leucotrienici
    6. I pazienti devono essere in trattamento con una dose stabile di anti-H1 da almeno 4 settimane prima dello screening, e devono rimanere in trattamento con una dose stabile per tutta la durata dello studio. Per quanto riguarda le altre terapie sintomatiche, se il paziente assume corticosteroidi, anti-H2 o PPI o antidepressivi o sodio cromoglicato o un antagonista dei recettori leucotrienici, il trattamento deve aver avuto inizio almeno 4 settimane prima dello screening e la dose deve essere
    mantenuta stabile per tutta la durata dello studio
    7. Età compresa tra 18 e 75 anni
    8. Peso > 45 kg e BMI compreso tra 18 e 35 kg/m2
    9. Contraccezione:
    Il/la paziente e il/ la partner devono usare un metodo altamente efficace di controllo delle nascite per tutta la durata dello studio e per i 3 mesi e 1 settimana successivi all'’ultima dose del trattamento (per i dettagli relativi ai metodi contraccettivi fare riferimento al protocollo)
    10. Il paziente deve essere disposto e in grado di soddisfare le richieste connesse alle visite e alle procedure dello studio
    11. Il paziente deve essere in grado di comprendere e firmare il consenso informato
    12. Il paziente è in grado di comprendere le informazioni riportate sul tesserino per il paziente e di seguire le procedure in esso descritte.
    E.4Principal exclusion criteria
    1. Cutaneous mastocytosis, SM associated with hematological neoplasm, Mast Cell Leukemia and Aggressive SM.
    2. Previous treatment with any Tyrosine Kinase Inhibitor.
    3. Any change in the symptomatic treatment of SM, including the systemic corticosteroids, or administration of any new treatment for SM within 4 weeks prior to screening.
    4. Treatment with any investigational agent within 8 weeks prior to screening.
    5. Recent history of severe cardiovascular disease including acute myocardial infarction, unstable angina pectoris, coronary revascularization procedure, congestive heart failure of NYHA Class III or IV, stroke, including a transient ischemic attack, edema of cardiac origin and left ventricular ejection fraction less than or equal to 50%.
    6. Patient who had major surgery within 2 weeks prior to screening visit.
    7. Known hypersensitivity to masitinib or to any of its excipients.
    8. Patient taking concomitant treatment or therapies associated with severe drug-induced skin toxicity.
    9. Female patients who are pregnant or are breastfeeding.
    10. Patient with following laboratory results out of the ranges detailed below at screening:
    • Absolute neutrophil count (ANC) less than or equal to 1.5 x 109/L
    • Haemoglobin less than or equal to 10 g/dL
    • Platelets (PLT) less than or equal to 100 x 109/L
    • Albuminemia less than or equal to 1 x LLN
    11. Patient with history of hepatic disorders, recent alcohol abuse or recent history of hepatic impairment defined as hepatic transaminase levels >3 x ULN or total bilirubin level > 1.5 x ULN
    12. Patient with severe pre-existing renal impairment, or with abnormal laboratory results from local laboratory assessments at screening:
    • Creatinine clearance < 60 mL/min (Cockcroft and Gault formula)
    • Proteinuria > 30 mg/dL (1+) on dipstick; in case of the proteinuria greater than or equal to 1+ on the dipstick, 24 hours proteinuria must be > 1.5g/24 hours
    13. Vulnerable population defined as:
    • Life expectancy < 6 months
    • Patient with < 5 years free of malignancy.
    • Patient with known diagnosis of human immunodeficiency virus (HIV) infection.
    14. Patient with history of poor compliance, or current or past psychiatric disease that might interfere with the ability to comply with the study procedures or give informed consent according to the judgment of the investigator or institutionalized by court decision.
    15. Patient with any condition that the physician judges could be detrimental to patient participating in this study; including any clinically important deviations from normal clinical laboratory values or concurrent medical conditions.
    16. Patients who have received live vaccine within 30 days prior to first IMP administration.
    17. Patients treated concomitantly with strong inducers of CYP3A4, substrates of CYP3A4 with a narrow therapeutic index, or inhibitors of CYP2C8.
    1. Mastocitosi cutanea, MS associata a neoplasia ematologica, leucemia mastocitaria e MS aggressiva.
    2. Trattamento precedente con qualsiasi inibitore della tirosin-chinasi.
    3. Qualsiasi cambiamento relativo al trattamento sintomatico della MS, inclusi i corticosteroidi sistemici, o la somministrazione di qualsiasi nuovo trattamento per la MS nelle 4 settimane precedenti lo screening.
    4. Trattamento con qualsiasi medicinale sperimentale nelle 8 settimane precedenti lo screening.
    5. Grave malattia cardiovascolare nell’anamnesi prossima, inclusi infarto miocardico acuto, angina pectoris instabile, procedura di rivascolarizzazione coronarica, scompenso cardiaco congestizio di classe III o IV secondo la classificazione NYHA (New York Heart Association), ictus, incluso attacco ischemico transitorio, edema di origine cardiaca e frazione di eiezione del ventricolo sinistro minore o uguale a 50%.
    6. Paziente sottoposto a intervento chirurgico maggiore nelle 2 settimane precedenti la visita di screening.
    7. Ipersensibilità nota a masitinib o a uno qualsiasi dei suoi eccipienti.
    8. Paziente sottoposto a trattamenti o terapie concomitanti associate a grave tossicità cutanea indotta da medicinali.
    9. Donne in gravidanza o in allattamento.
    10. Paziente i cui risultati di laboratorio per i seguenti parametri non rientrano allo screening nei range indicati di seguito:
    • conta assoluta dei neutrofili (Absolute Neutrophil Count, ANC) minore o uguale a 1,5 x 109/L
    • emoglobina minore o uguale a 10 g/dL
    • conta piastrinica (PLT) minore o uguale a 100 x 109/L
    • albuminemia minore o uguale a 1 x il limite inferiore della norma (Lower Limit of Normal, LLN)
    11. Paziente con patologie epatiche o recente abuso di alcolici in anamnesi, oppure compromissione epatica nell’anamnesi prossima, definita come livelli di transaminasi epatiche >3 x il limite superiore della norma
    (Upper Limit of Normal, ULN) o livello di bilirubina totale > 1,5 x l'ULN
    12. Paziente con grave compromissione renale preesistente o con risultati anomali alle analisi effettuate presso il laboratorio locale allo screening:
    • clearance della creatinina < 60 mL/min (formula di Cockcroft e Gault)
    • proteinuria > 30 mg/dL (1+) al dipstick; in caso di proteinuria maggiore o uguale a 1+ al dipstick, la proteinuria nelle 24 ore deve essere > 1,5 g/24 ore
    13. Appartenenza a una popolazione vulnerabile, definita come:
    • Aspettativa di vita < 6 mesi
    • Paziente libero da neoplasia maligna da meno di 5 anni.
    • Paziente con diagnosi nota di infezione da virus da immunodeficienza umana (HIV).
    14. Paziente con storia di scarsa aderenza o con patologia psichiatrica in corso o pregressa che potrebbe interferire con la sua capacità di attenersi alle procedure dello studio o di fornire il consenso informato in base al giudizio dello sperimentatore, oppure paziente istituzionalizzato per decisione di un giudice.
    15. Paziente con qualsiasi condizione che, in base al giudizio del medico, potrebbe avere ripercussioni negative sul paziente, in caso di partecipazione a questo studio, inclusa qualsiasi deviazione clinicamente importante dai valori normali di laboratorio, o qualsiasi condizione clinica concomitante.
    16. Pazienti sottoposti a vaccinazione con vaccino vivo nei 30 giorni precedenti la somministrazione della prima dose di farmaco in studio.
    17. Pazienti trattati in concomitanza con forti induttori del CYP3A4, substrati di CYP3A4 con un indice terapeutico ristretto, o inibitori di CYP2C8.
    E.5 End points
    E.5.1Primary end point(s)
    Cumulative response on 3 handicaps (Pruritus, Flush, Depression) from week 8 to week 24.
    • Handicaps are defined as: Pruritus score greater than or equal to 9, number of Flushes per week greater than or equal to 8, Depression HAMD score greater than or equal to 19.
    • Response on a handicap is defined as an improvement greater than or equal to 75% for Pruritus, Flushes and Depression (HAMD Score).
    For all the patients, the response at each study visit (5 visits from week 8 to week 24) will be calculated on each handicap present at Baseline (among pruritus, flushes, depression) as defined above.
    Sensitivity analysis will be performed from week 8 to week 48.
    In case of rescue medication to manage a handicap, all subsequent measures will be considered as “fail”.
    Risposta cumulativa su 3 handicap (prurito, vampate di calore, depressione) dalla settimana 8 alla settimana 24.
    • Gli handicap sono definiti come: punteggio del prurito maggiore o uguale a 9, numero di vampate di calore alla settimana maggiore o uguale a 8, punteggio relativo
    alla depressione alla scala HAM-D maggiore o uguale a 19.
    • Per risposta su un handicap si intende un miglioramento maggiore o uguale a75% per prurito, vampate di calore e depressione (punteggio alla scala HAM-D).
    Il calcolo della risposta verrà effettuato per tutti i pazienti in occasione di ogni visita dello studio (5 visite dalla settimana 8 alla settimana 24) per ogni handicap
    presente al basale (limitatamente a prurito, vampate di calore, depressione) in base alle definizioni sopra riportate.
    Sarà eseguita un’analisi di sensibilità dalla settimana 8 alla settimana 48.
    In caso di ricorso a terapia di salvataggio per la gestione di un handicap, tutte le misurazioni successive verranno considerate come “fallimento terapeutico”
    E.5.1.1Timepoint(s) of evaluation of this end point
    W8 to W24
    Dalla settimana 8 alla settimana 24
    E.5.2Secondary end point(s)
    1. Handicap:
    • Cumulative response on 4 handicaps (Pruritus, Flushes, Depression, FSS) from week 8 to week 24. Handicaps for this cumulative response are defined as: Pruritus score greater than or equal to 9, number of Flushes per week greater than or equal to 8, Depression HAMD score greater than or equal to 19, FSS greater than or equal to 36.
    • Cumulative response on 4 handicaps (Pruritus, Flushes, Depression, FIS) from week 8 to week 24. Handicaps for this cumulative response are defined as: Pruritus score greater than or equal to 9, number of Flushes per week greater than or equal to 8, Depression HAMD score greater than or equal to 19, FIS greater than or equal to75.
    • Cumulative response on 2 handicaps (Pruritus, Flush) from week 8 to week 24. Handicaps for this cumulative response are defined as: Pruritus score greater than or equal to 9 and number of Flushes per week greater than or equal to 8.
    • Cumulative response on each of the individual handicaps from week 8 to week 24:
    - Pruritus (Handicap defined as Pruritus Score greater than or equal to 9);
    - Flushes (Handicap defined as Flushes greater than or equal to 8);
    - Depression (Handicap defined as HAMD greater than or equal to 19);
    - Fatigue Severity Scale (FSS) (Handicap defined as FSS greater than or equal to 36);
    - Fatigue Impact Scale (FIS) (Handicap defined as FIS greater than or equal to 75).
    Response on above mentioned handicaps is defined as an improvement greater than or equal to 75%.
    Sensitivity analysis will be performed from week 8 to week 48.

    2. Biological and Skin Parameters:
    • Tryptase Level:
    - Change from baseline at week 24 in serum tryptase level;
    - Response: Defined as a diminution of at least 25% in tryptase level at week 24.
    • Urticaria Pigmentosa:
    - “Darier Sign” disappearance (Yes/No) (week 12 to week 24);
    - Body Surface Area (BSA) (week 12 to week 24).
    Sensitivity analysis for “Darier Sign” disappearance (Yes/No) and Body Surface Area (BSA) will be performed from week 12 to week 48.

    3. Quality of Life:
    • MC-QoL Questionnaire (27 questions)
    • MC-QoL questionnaire must be completed by patient for quality of his/her life for past two (2) weeks.
    Sensitivity analysis will be performed from week 8 to week 48.
    Additional analysis will be elaborated in the Statistical Analysis Plan which will be approved before the Data Base Lock.

    Criteria for Safety Occurrence of IMP-related and unrelated Adverse Events (AEs)/Serious Adverse Events (SAEs).
    Changes in physical examination including vital signs (blood pressure, pulse rate), weight and ECG.
    Changes in clinical laboratory tests (biochemistry, haematology, urinalysis).; 1. Handicap:
    • Risposta cumulativa su 4 handicap (prurito, vampate di calore, depressione, FSS) dalla settimana 8 alla settimana 24. Gli handicap relativi a questa risposta cumulativa sono definiti come: punteggio del prurito maggiore o uguale a 9, numero di vampate di calore alla settimana maggiore o uguale a 8, punteggio relativo alla depressione alla scala HAM-D maggiore o uguale a 19, FSS maggiore o uguale a 36.
    • Risposta cumulativa su 4 handicap (prurito, vampate di calore, depressione, FIS) dalla settimana 8 alla settimana 24. Gli handicap relativi a questa risposta cumulativa sono definiti come: punteggio del prurito maggiore o uguale a 9, numero di vampate di calore alla settimana maggiore o uguale a 8, punteggio relativo alla depressione alla scala HAM-D maggiore o uguale a 19, FIS maggiore o uguale a 75.
    • Risposta cumulativa su 2 handicap (prurito, vampate di calore) dalla settimana 8 alla settimana 24. Gli handicap relativi a questa risposta cumulativa sono definiti come: punteggio del prurito maggiore o uguale a 9 e numero di vampate di calore alla settimana maggiore o uguale a 8.
    • Risposta cumulativa su ciascuno dei singoli handicap dalla settimana 8 alla settimana 24:
    - Prurito (handicap definito come punteggio del prurito maggiore o uguale a 9);
    - Vampate di calore (handicap definito come vampate di calore maggiore o uguale a 8);
    - Depressione (handicap definito come punteggio alla scala HAMD maggiore o uguale a 19);
    - Fatigue Severity Scale (FSS) (handicap definito come FSS maggiore o uguale a 36);
    - Fatigue Impact Scale (FIS) (handicap definito come FIS maggiore o uguale a 75).
    La risposta relativa agli handicap sopra citati è definita come un miglioramento maggiore o uguale a 75%.
    Si eseguirà un’analisi di sensibilità dalla settimana 8 alla settimana 48.

    2. Parametri biologici e cutanei:
    • Livello di triptasi:
    - variazione del livello sierico di triptasi dal basale alla settimana 24;
    - Risposta: definita come una diminuzione almeno pari al 25% del livello di triptasi alla settimana 24.
    • Orticaria pigmentosa:
    - scomparsa del “segno di Darier” (Sì/No) (dalla settimana 12 alla settimana 24);
    - superficie corporea (dalla settimana 12 alla settimana 24).
    Si eseguirà un’analisi di sensibilità per la scomparsa del “segno di Darier” (Sì/No) e la superficie corporea dalla settiman
    E.5.2.1Timepoint(s) of evaluation of this end point
    Week 8 to Week 96
    Dalla settimana 8 alla settimana 96
    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 Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic Yes
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open No
    E.8.1.3Single blind No
    E.8.1.4Double blind Yes
    E.8.1.5Parallel group Yes
    E.8.1.6Cross over No
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) No
    E.8.2.2Placebo Yes
    E.8.2.3Other No
    E.8.2.4Number of treatment arms in the trial2
    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 EEA50
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA Information not present in EudraCT
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Canada
    France
    Germany
    Italy
    Lithuania
    Netherlands
    Poland
    Romania
    Russian Federation
    Spain
    Ukraine
    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 years4
    E.8.9.1In the Member State concerned months0
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years4
    E.8.9.2In all countries concerned by the trial months0
    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.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 120
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 20
    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 No
    F.3.3.2Women of child-bearing potential using contraception Yes
    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 state50
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 110
    F.4.2.2In the whole clinical trial 140
    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)
    Patients will be monitored and treated according to local clinical practice.
    I pazienti saranno seguiti e trattati in accordo alla pratica clinica locale.
    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 Decision2021-02-23
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2020-11-19
    P. End of Trial
    P.End of Trial StatusRestarted
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