E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Paroxysmal nocturnal haemoglobinuria (PNH) |
|
E.1.1.1 | Medical condition in easily understood language |
Paroxysmal nocturnal haemoglobinuria (PNH) |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Immune System Diseases [C20] |
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 | 10034042 |
E.1.2 | Term | Paroxysmal nocturnal haemoglobinuria |
E.1.2 | System Organ Class | 10038359 - Renal and urinary disorders |
|
E.1.3 | Condition being studied is a rare disease | Yes |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
The objectives of the study are: • To assess the safety and tolerability of Coversin for all patients for the duration of the study. • To assess efficacy of the dosage regimen to reduce haemolysis and control the signs and symptoms thereof, in PNH subjects as manifested by: i. Serum lactic dehydrogenase (LDH) change from baseline (day 1) to day 28 ii. Haemoglobin (Hb) at day 28 and day 90, absolute and change from baseline iii. Number of blood transfusions iv. Quality of Life - EORTC QLQ-C30 at day 1 (baseline), 7, 14, 21, 29, 60 and 90 days v. Quality of Life – EQ-5D-5L at baseline day 1 (baseline) up to day 60 and then at day 90.
• To determine whether self-injection by subjects with PNH is well-accepted and the home care nursing supervision period sufficient using a (non validated) questionnaire at day 29 and day 90. |
|
E.2.2 | Secondary objectives of the trial |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Patients with a diagnosis of PNH confirmed by flow cytometry who, in the opinion of the Investigator, would benefit from treatment with a complement C5 inhibitor 2. Aged 18 and above. No upper age limit 3. Males and females of childbearing potential must agree to use an adequate method of contraception. Females will have a negative pregnancy test before entry to the study 4. Body weight ≥50kg 5. The patient has given voluntary written informed consent 6. Willing to receive immunisation against Neisseria meningitidis and antibiotic prophylaxis in accordance with the local practice of the PI at the trial site. Antibiotic prophylaxis must continue until at least 14 days after the end of complement inhibition by Coversin. |
|
E.4 | Principal exclusion criteria |
1. Prior use of eculizumab (Soliris®) within 3 months of entry is prohibited 2. Any other drug acting directly on the complement system is prohibited 3. Chemotherapeutic agents within 3 months of enrolment in the study is prohibited 4. Tizanidine, if using ciprofloxacin prophylaxis is prohibited 5.Known sensitivity to the excipients of meningococcal vaccines, ciprofloxacin or any other antibiotic being administered for purposes of meningitis prophylaxis 6. Participation in other clinical trials within 4 weeks of signing the consent form 7. Known allergy to ticks or severe reaction to arthropod venom (e.g. bee or wasp venom) 8. History of active systemic autoimmune diseases other than the target condition. Dermatologic diseases such as psoriasis will not be a reason for exclusion unless there are associated systemic symptoms such as arthritis 9. Any systemic disorder that could interfere with the evaluation of the study treatment (e.g. severe renal or hepatic disease that in the opinion of the Investigator would affect the outcome of the study or interfere with interpretation of results) 10. Failure to satisfy the investigator of fitness to participate for any other reason or any condition that, in the opinion of the Investigator, could increase the subject's risk by participating in the study or confound the outcome of the study
|
|
E.5 End points |
E.5.1 | Primary end point(s) |
Primary Efficacy Endpoint: Reduction in serum LDH to less than or equal to 1.8 times the upper limit of normal (ULN) for the Investigator's reference laboratory or 500 I U/L whichever is the lower from Day 1 (pre-dose) to Day 28
|
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
Reduction in serum LDH measured on Days 1 (baseline) to Day 28. |
|
E.5.2 | Secondary end point(s) |
Secondary Efficacy Endpoints: • Reduction of LDH to Day 28 of 50% or less of the mean of all pre-dose measurements taken within 14 days of commencing Coversin treatment. If only one result is available during that period it should be used. • Reduction in CH50 from Day 1 pre-dose to Days 7, 14, 21, 28, 60 and 90 • Reduction in serum LDH to less than or equal to 1.8 times the upper limit of normal (ULN) for the Investigator’s reference laboratory or 500 I U/L whichever is the lower at Day 60 and at Day 90 • Increase in Hb Day 1 – Day 90 • Change in EORTC QLQ C30 score from Day 1 (baseline) to days 7, 14, 21, 29, 60 and 90 • Change in EQ-5D-5L from baseline Day 1 (baseline) to Day 60 and then at Day 90.
Safety Endpoints: •Frequency, type and relationship of AEs and SAEs to treatment. •Out of range laboratory parameters (haematology and chemistry). •Vital signs (blood pressure, body temperature and pulse). •ECG abnormalities pre dose – Day 90 (A resting pre-dose ECG taken within 7 days of first dose will be compared with ECGs taken 1- 6 hours post-dose and at 90 days of treatment with Coversin) •Change in weight or percentage body fat will be noted pre-dose and at Day 90. •Injection site reaction and lymph node inspection. •Anti-coversin antibody production. |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
LDH measured from Day 1 (baseline) to Day 28. Reduction in CH50 -Day 1, 7, 14, 21, 28, 60, 90. HB-measured from Day 1 to Day 90. EORTC QLQ C30 measured from Day 1 (baseline) to Days 7, 14, 21, 29, 60 and 90. EQ-5D-5L measured from Day 1 (baseline) to Day 60 and then at Day 90.
AEs, SAEs, injection site reaction, lymph node inspection collected daily. Vital signs (blood pressure, body temperature and pulse) measured weekly from Day 0 to Day 90. Change in weight or body fat measured at Day 1 and Day 90. |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
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 | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
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 | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 8 |
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 | No |
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
|
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 14 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 15 |
E.8.9.2 | In all countries concerned by the trial days | 0 |