E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Rheumatoid arthritis, seronegative spondylo arthritis, Crohn's Disease, Ulcerative Colitis |
Artrite Reumatoide, Spondiloartrite sieronegativa, Morbo di Crohn, Colite Ulcerosa |
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E.1.1.1 | Medical condition in easily understood language |
Rheumatoid arthritis, seronegative spondylo arthritis, Crohn's Disease, Ulcerative Colitis |
Artrite Reumatoide, Spondiloartrite sieronegativa, Morbo di Crohn, Colite Ulcerosa |
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E.1.1.2 | Therapeutic area | Diseases [C] - Musculoskeletal Diseases [C05] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10002556 |
E.1.2 | Term | Ankylosing spondylitis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10039073 |
E.1.2 | Term | Rheumatoid arthritis |
E.1.2 | System Organ Class | 10028395 - Musculoskeletal and connective tissue disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10011401 |
E.1.2 | Term | Crohn's disease |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 20.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10075634 |
E.1.2 | Term | Acute haemorrhagic ulcerative colitis |
E.1.2 | System Organ Class | 10017947 - Gastrointestinal disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To demonstrate that the switch from Infliximab RMP (Remicade®) to Infliximab biosimilar (Remsima®), in patients who consent their study participation, does not determine, after 40 weeks of treatment (T3), an increase of the percentage of patients ADA positive≥ 20% in comparison with that measured at T0. |
Dimostrare che lo switch da Infliximab RMP (Remicade®) ad Infliximab biosimilare (Remsima®), nei pazienti che accettano di partecipare allo studio, non determina dopo 40 settimane di trattamento (T3) un incremento nella percentuale di pazienti ADA positivi superiore al 20% rispetto alla stessa percentuale rilevata al T0. |
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E.2.2 | Secondary objectives of the trial |
The following subpopulations are defined: RA+AS for rheumatic disease, CD+UC for bowel disease. The objectives are: To assess the rate of change in the proportion of patients ADA+ before vs after the switch in subpopulations and in the overall study population. To assess for each pathology the therapeutic equivalence of Infliximab RMP and Infliximab biosimilar, through Clinical Indices and laboratory parameters measured at T-1 and T0 and after the switch at T1, T2 and T3 . To assess the equivalence of sieric level of ADAs at T0 and T3, in subpopulations and in the overall study population. To assess the equivalence of sieric level of Infliximab among values measured before vs after the switch. To assess the safety and tolerability of Infiximab biosimilar with respect to rate of AE and changes in vital signs and hematochemical parameters in subpopulations and in the overall study population.
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Si definiscono le seguenti sottopopolazioni: AR+AS per patologia reumatica, MC+CU per patologie intestinali. Gli obiettivi sono: Valutare nella popolazione globale di studio e nelle sottopopolazioni la variazione nella percentuale di pazienti ADA+ prime e dopo lo switch. Valutare per singola patologia l’equivalenza terapeutica di Infliximab RMP e Infliximab biosimilare, mediante indici clinici e parametri di laboratorio specifici per patologia, a T-1 e T0 e ai tempi T1, T2 e T3, dopo lo switch. Valutare, nella popolazione globale e nelle sottopopolazioni, la sostanziale equivalenza del livello sierico di ADAs a T0 e T3. Valutare, nella popolazione globale e nelle sottopopolazioni, la sostanziale equivalenza dei livelli sierici di Infliximab. Valutare, nella popolazione globale e nelle sottopopolazioni, la sicurezza e tollerabilità dell’Infliximab biosimilare in termini di incidenza di EA e andamento dei segni vitali e parametri ematochimici.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. age ≥18 years 2. diagnosis of a. Rheumatoid Arthritis according to ACR criteria (1987 e 2010) OR b. Sieronegative spondiloarthritis (Ankylosing Spondylitis or Sponsiloarthritis (Psoriasic Arthritis) according to ASAS criteria 2009 OR c. Inflammatory Disease confirmed by endoscopic and histological criteria 3. Treatment with Infliximab RMP (Remicade®) for at least 6 months with stable dosage at least in the last two infusions. 4. Stable clinical response at the time of inclusion in the study (T-1) [stability is defined as reduction ≥30% of the disease activity scores in comparison with the start of treatment with Infliximab RMP (Remicade®)] 5. In case of concomitant therapy with immunosuppressive drugs (azatioprine/6 mercaptopurine, methotrexate o leflunomide), their dosage should be stable at least in the last 2 months. 6. In case of concomitant systemic therapy with steroids their dosage should be stable at least in the last 2 months and ≤7.5 mg/die of prednisone (or equivalent) 7. Any concomitant drug for diseases other than those under study should be at a stable dosage for at least 4 weeks before the study inclusion.
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1. età≥18 anni 2. pazienti con diagnosi di: a. Artrite Reumatoide secondo i criteri dell’ American College of Rheumatology (1987 e 2010) oppure b. Spondiloartrite sieronegativa (Spondilite anchilosante o Spondiloartrite/Artrite psoriasica) secondo i criteri ASAS 2009 oppure c. IBD confermata da criteri endoscopici ed istologici 3. pazienti in trattamento con Infliximab RMP (Remicade®) da almeno 6 mesi con dosaggio stabile almeno nelle ultime 2 infusioni 4. pazienti con malattia in fase stabile di risposta clinica al momento dell’inclusione nel presente studio (T-1) [viene definita fase stabile una riduzione ≥30% degli score di attività di malattia rispetto all’inizio del trattamento con Infliximab RMP (Remicade®)] 5. nel caso di pazienti in trattamento concomitante con farmaci immunosoppressori (azatioprina/6 mercaptopurina, metotrexato o leflunomide) questi farmaci devono essere a dosaggio stabile almeno negli ultimi 2 mesi 6. nel caso di pazienti in trattamento con steroidi sistemici questi devono essere a dosaggio stabile almeno negli ultimi 2 mesi e ≤7.5 mg/die di prednisone (o equivalente) 7. qualsiasi farmaco concomitante per patologie differenti da quelle in studio deve essere a dosaggio stabile da almeno 4 settimane prima dell’ingresso nello studio.
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E.4 | Principal exclusion criteria |
1. Active Infectious diseases 2. Severe comorbidities (known malignancy except for basal cell carcinoma, congestive heart failure NYHA grade III/IV, liver and/or hepatobiliary disease, renal disease) 3. Pregnancy or breast feeding 4. Any underlying condition which, in the opinion of the Investigator, might contrarindicate the switch to Remsima®
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1. malattie infettive in fase attiva 2. gravi co-morbidità (neoplasie con esclusione del carcinoma basocellulare cutaneo, insufficienza cardiaca congestizia di grado III/IV secondo la NYHA, malattie epatiche e/o epato-biliari, malattie renali) 3. gravidanza o allattamento 4. qualunque condizione che a giudizio del medico sperimentatore possa controindicare lo switch da infliximab a Remsima®.
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E.5 End points |
E.5.1 | Primary end point(s) |
Sieric level of Anti Drug Antibody measured by ELISA test (LISA-TRACKER Duo Infliximab). |
Per la determinazione quantitativa dei livelli sierici di ADAs sarà utilizzato un test immuno-enzimatico (ELISA) denominato LISA-TRACKER Duo Infliximab (Diametra, THERADIAG). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
T0 (Switch) and T3 |
T0 (Switch) e T3 |
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E.5.2 | Secondary end point(s) |
Indices of disease activity: Rheumatoid Arthritis: DAS 28 and CDAI; Spondyloarthritis: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), ASDAS (Ankylosing Spondylitis Disease Activity Index), LEI (Leeds Enthesitis Index) and only for Psoriatic Arthritis DAPSA (Disease Activity Psoriatic Arthritis), PSAID12 (Psoriatic Arthritis Impact of Disease); Crohn’s Disease: HBI (Harvey Bradshow Index); Ulcerative Colitis pMAYO (partial MAYO). Indices of quality of life/functional status: Rheumatoid Arthritis: HAQ (Health Assessment Questionnaire); Spondyloarthritis: BASFI: (Bath Ankylosing Spondylitis Functional Index); Crohn’s Disease and Ulcerative Colitis: IBDQ (Inflammatory Bowel Disease Questionnaire). Sieric level of infliximab and Anti Drug Antibody measured by ELISA test (LISA-TRACKER Duo Infliximab).
Ematochemical parameters (hemocrome + formula, ERS and CRP, GPT, GGT and GOT, ALP, creatinine only for patients with rheumatological diseases). Vital signs (blood pressure, body temperature, heart rate) Physical examination Adverse events Anti-Drug Antibodies
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Le variabili di efficacia sono rappresentate dagli indici di attività di malattia e di qualità della vita/stato funzionale specifici per la patologia di inclusione, livelli sierici di infliximab e ADAs. Indici di attività di malattia: 1. Artrite reumatoide: DAS 28 e CDAI 2. Spondiloartriti: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), ASDAS (Ankylosing Spondylitis Disease Activity Index), LEI (Leeds Enthesitis Index), e solo per pazienti con spondiloartrite psoriasica: DAPSA (Disease Activity Psoriatic Arthritis), PSAID12 (Psoriatic Arthritis Impact of Disease) 3. Malattia di Crohn: HBI (Harvey Bradshow Index) 4. Colite ulcerosa: pMAYO (partial MAYO) Indici di qualità della vita e stato funzionale: 1. Artrite Reumatoide: HAQ (Health Assessment Questionnaire) 2. Spondiloartriti: BASFI: (Bath Ankylosing Spondylitis Functional Index) 3. Malattia Di Crohn e Colite Ulcerosa: IBDQ (Inflammatory Bowel Disease Questionnaire) Livelli sierici: Per la determinazione quantitativa dei livelli sierici di principio attivo e di ADAs sarà utilizzato un test immuno-enzimatico (ELISA) denominato LISA-TRACKER Duo Infliximab (Diametra, THERADIAG).
La valutazione di sicurezza sarà effettuata attraverso esami ematochimici, rilevazione dei segni vitali e degli eventi avversi. Gli ADA oltre a rappresentare un parametro per la valutazione dell’efficacia (vedi sopra) rappresentano anche un parametro in termini di tollerabilità. 1. Esami ematochimici : Emocromo con formula, VES e PCR, ALT, GGT saranno misurati in occasione di tutte le visite dello studio. In aggiunta, per i soli pazienti di Reumatologia, verranno misurati AST, Fosfatasi Alcalina, Creatinina 2. Segni vitali: Pressione arteriosa, temperatura corporea e frequenza cardiaca misurate come da pratica clinica in occasione di tutte le visite dello studio 3. esame obiettivo generale: anormalità alla visita di inclusione saranno registrate in anamnesi mentre quelle rilevate in corso di studio e non prima evidenziate saranno registrate come eventi avversi. 4. eventi avversi
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
T-1, T0 (Switch), T1, T2 and T3 |
T-1, T0 (Switch), T1, T2 e T3 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
Equivalence in terms of immunogenicity and clinical response in real world
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Equivalenza in termini di immunogenicità e risposta clinica in pratica clinica |
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E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | No |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Yes |
E.8.1.7.1 | Other trial design description |
cross over a singolo braccio |
single-arm cross over study |
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E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 1 |
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 | 10 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 10 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
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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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 6 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 6 |
E.8.9.2 | In all countries concerned by the trial days | 0 |