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    Summary
    EudraCT Number:2016-002938-73
    Sponsor's Protocol Code Number:ARGX-113-1602
    National Competent Authority:Italy - Italian Medicines Agency
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2018-02-22
    Trial results View 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 number2016-002938-73
    A.3Full title of the trial
    A Randomized, Double blind, Placebo Controlled Phase II Study to Evaluate the Safety, Efficacy, and Pharmacokinetics of ARGX 113 in Patients with Myasthenia Gravis who have Generalized Muscle Weakness.
    Studio di fase II, randomizzato, in doppio cieco, controllato con placebo, per valutare la sicurezza, l’efficacia e la farmacocinetica di ARGX-113 in pazienti affetti da miastenia gravis con debolezza muscolare generalizzata.
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    A Study of the safety and effectiveness of ARGX-113 in Patients with Myasthenia Gravis who have Generalized Muscle Weakness
    Studio della sicurezza e dell’efficacia di ARGX-113 in pazienti affetti da miastenia gravis con debolezza muscolare generalizzata.
    A.3.2Name or abbreviated title of the trial where available
    NA
    ND
    A.4.1Sponsor's protocol code numberARGX-113-1602
    A.5.4Other Identifiers
    Name:ndNumber:nd
    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 SponsorARGEN-X BVBA
    B.1.3.4CountryBelgium
    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 supportArgenx BVBA
    B.4.2CountryBelgium
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationargenx BVBA
    B.5.2Functional name of contact pointRegulatory
    B.5.3 Address:
    B.5.3.1Street AddressIndustriepark Zwijnaarde 7, Building C
    B.5.3.2Town/ cityZwijnaarde
    B.5.3.3Post code9052
    B.5.3.4CountryBelgium
    B.5.4Telephone number003293103400
    B.5.5Fax number003293103499
    B.5.6E-mailregulatory@argenx.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 nameARGX-113
    D.3.2Product code ARGX-113
    D.3.4Pharmaceutical form Concentrate for solution for infusion
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMP
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.9.1CAS number 1821402-21-4
    D.3.9.2Current sponsor codeARGX-113
    D.3.9.3Other descriptive nameARGX-113
    D.3.9.4EV Substance CodeSUB180001
    D.3.10 Strength
    D.3.10.1Concentration unit mg/ml milligram(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number20
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    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 Yes
    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
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Myasthenia Gravis who have Generalized Muscle Weakness
    Miastenia Gravis con generalizzata debolezza muscolare
    E.1.1.1Medical condition in easily understood language
    Myasthenia Gravis who have Generalized Muscle Weakness
    Miastenia Gravis con generalizzata debolezza muscolare
    E.1.1.2Therapeutic area Body processes [G] - Immune system processes [G12]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 20.0
    E.1.2Level PT
    E.1.2Classification code 10028417
    E.1.2Term Myasthenia gravis
    E.1.2System Organ Class 10029205 - Nervous system disorders
    E.1.3Condition being studied is a rare disease Yes
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    To evaluate the safety and tolerability of ARGX 113.
    Valutare la sicurezza e la tollerabilità di ARGX-113.
    E.2.2Secondary objectives of the trial
    •To evaluate the clinical effect of ARGX 113 using:
    o Myasthenia Gravis Activities of Daily Living (MG ADL) score.
    o Quantitative Myasthenia Gravis score (QMG).
    o Myasthenia Gravis Composite score (MGC).
    •To evaluate the impact of ARGX 113 on quality of life using 15 item quality of life scale for Myasthenia Gravis (MGQoL15r [revised version]).
    •To investigate the pharmacokinetics (PK) of ARGX-113.
    •To assess the pharmacodynamic (PD) markers (e.g., total immunoglobulin G (IgG) and subtypes, anti acetylcholine receptor [AChR] antibodies).
    •To evaluate the immunogenicity of ARGX 113.
    • Valutare l’effetto clinico di ARGX-113 utilizzando:
    o Punteggio delle Attività della vita quotidiana specifiche per la miastenia grave (Myasthenia Gravis Activities of Daily Living, MG-ADL).
    o Punteggio quantitativo della miastenia grave (Quantitative Myasthenia Gravis, QMG).
    o Punteggio composito della miastenia grave (Myasthenia Gravis Composite, MGC).
    • Valutare l’impatto di ARGX-113 sulla qualità della vita mediante la versione revisionata della scala sulla qualità della vita a 15 voci specifica per la miastenia grave (Myasthenia Gravis Quality of Life-15 item-revised version, MGQoL15r).
    • Investigare la farmacocinetica (pharmacokinetics, PK) di ARGX-113.
    • Valutare i marcatori farmacodinamici (pharmacodynamic, PD) (ad es. immunoglobuline G [IgG] totali e sottotipi, anticorpi anti-recettore dell’acetilcolina [anti acetylcholine receptor, AChR]).
    • Valutare l’immunogenicità di ARGX-113.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    1.Have the ability to understand the requirements of the study, provide written informed consent (including consent for the use and disclosure of research-related health information), and comply with the study protocol procedures (including required study visits).
    2.Male or female patients aged ≥18 years.
    3.Diagnosis of autoimmune MG with generalized muscle weakness meeting the clinical criteria for diagnosis of MG as defined by the Myasthenia Gravis Foundation of America (MGFA) Clinical Classification
    Class II, III or IVa, and likely not in need of a respirator for the duration of the study as judged by the Investigator. The confirmation of the diagnosis should be documented and supported by:
    • Positive serologic test for anti-AChR antibodies before Screening and
    • at least 1 of the following 3 tests:(i) History of abnormal neuromuscular transmission test demonstrated
    by single-fiber electromyography or repetitive nerve stimulation or
    (ii) History of positive edrophonium chloride test, or
    (iii) Patient has demonstrated improvement in MG signs on oral
    cholinesterase inhibitors as assessed by the treating physician.
    4.A total score of ≥5 on the MG ADL at Screening and Baseline with more
    than 50% of this score attributed to non-ocular items.
    5.Patients are required to be on a stable dose of their MG treatment prior
    to randomization. For patients receiving AZA, other NSIDs, steroids,
    and/or cholinesterase inhibitors as concomitant medications the
    following conditions will apply:
    •AZA: treatment initiated at least 12 months ago and no dose changes in
    the last 6 months before Screening.
    •Other NSIDs (e.g., methotrexate, cyclosporine, tacrolimus,
    mycophenolate mofetil, and cyclophosphamide): treatment initiated at
    least 6 months ago and no dose changes in the last 3 months before
    Screening.
    •Steroids: treatment initiated at least 3 months prior to and no dose changes in the last month before Screening.
    •Cholinesterase inhibitors: to be on a stable dose for >2 weeks before Screening. Note: cholinesterase inhibitors must be held for at least 12 hours
    consistent with the revised manual for the QMG test as recommended by the Myasthenia Gravis Foundation of America Inc [MGFA]1, before the
    MGQoL15r, MG ADL, QMG, and MGC assessments.
    6.Females of childbearing potential must have a negative serum pregnancy test at Screening and a negative urine pregnancy test at Visit 1 prior to administration of IMP. Female of childbearing potential are defined as all female participants unless they are postmenopausal (defined by continuous amenorrhea) for at least 2 years with a Follicle
    stimulating hormone (FSH) >40 IU/L or are surgically sterile (i.e., who had a hysterectomy, bilateral oophorectomy, or have current documented tubal ligation or any other permanent female sterilization
    procedure). Determination of FSH levels can be used to confirm postmenopausal status in amenorrheic patients not on hormonal replacement therapy if the test result is within the postmenopausal range per the central laboratory.
    7.Female participants of childbearing potential must agree to use a highly effective method of contraception (i.e., pregnancy rate of less than 1% per year) during the study and for 90 days after the
    discontinuation of the IMP. Adequate contraceptive methods include combined hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal), progestogen-only hormonal
    contraception associated with inhibition of ovulation (oral, injectable, implantable), intrauterine devices (IUDs), intrauterine hormonereleasing system (IUS), true sexual abstinence (when this is in line with
    the preferred and usual lifestyle of the participant), bilateral tubal occlusion, or a female participant who is not of childbearing potential. Female participants and female partners of male study participants using
    a hormonal contraceptive must also use a barrier method (i.e., condom or occlusive cap [diaphragm or cervical/vault caps]) and should have been stable on their hormonal contraceptive treatment for at least 4
    weeks before Screening.
    8.Sterilized male patients who have had vasectomy a year back with documented aspermia post procedure can be included. In addition, male patients must be advised not to donate sperm during this period from
    signing of Informed Consent Form (ICF), throughout the duration of the study, and for 90 days after the last administration of IMP. Nonsterilized male patients who are sexually active with a female partner of childbearing potential must use effective method of double barrier contraception (e.g., condom with spermicidal cream or jelly, 1 hormonal plus 1 barrier method or 2 simultaneous barrier methods). Male patients practicing true sexual abstinence (when this is in line with the preferred and usual lifestyle of the participant) can be included.
    1. Capacità di comprendere i requisiti dello studio, fornire il consenso informato scritto (compreso il consenso all’utilizzo e alla divulgazione di informazioni sanitarie correlate alla ricerca) e attenersi alle procedure previste dal protocollo dello studio (comprese le visite dello studio).
    2. Pazienti di sesso maschile o femminile di età ≥18 anni.
    3. Diagnosi di MG autoimmune associata a debolezza muscolare generalizzata che soddisfi i criteri clinici per la diagnosi di MG di Classe II, III o IVa secondo la classificazione clinica MGFA. I pazienti non dovrebbero, inoltre, avere bisogno di un respiratore per la durata dello studio secondo l’opinione dello Sperimentatore.
    La conferma della diagnosi dovrà essere attestata e avvalorata da:
    • Positività al test sierologico per gli anticorpi anti-AChR prima dello Screening e
    • ad almeno 1 dei seguenti 3 test:
    (i) anamnesi di test anomalo per la trasmissione neuromuscolare dimostrato da una elettromiografia di singola fibra o stimolazione nervosa ripetuta, oppure
    (ii) anamnesi di positività al test dell’edrofonio cloruro, oppure
    (iii) il paziente ha dimostrato un miglioramento nei segni della MG con trattamento a base di inibitori orali della colinesterasi, valutato dal medico curante.
    4. Punteggio totale dell’MG-ADL ≥5 allo Screening e al Basale, con più del 50% di tale punteggio attribuibile a voci non riferite agli aspetti visivi.
    5. I pazienti dovranno assumere una dose stabile del loro trattamento per l’MG prima della randomizzazione. Per i pazienti che ricevono AZA, altri NSID, steroidi e/o inibitori della colinesterasi come farmaci concomitanti varranno le seguenti condizioni:
    • AZA: il trattamento dovrà essere iniziato almeno 12 mesi prima e non saranno consentite modifiche relative al dosaggio negli ultimi 6 mesi precedenti allo Screening.
    • Altri NSID (ad es. metotrexato, ciclosporina, tacrolimus, micofenolato mofetile e ciclofosfamide): il trattamento dovrà essere iniziato almeno 6 mesi prima e non saranno consentite modifiche relative al dosaggio negli ultimi 3 mesi precedenti allo Screening.
    • Steroidi: il trattamento dovrà essere iniziato almeno 3 mesi prima e non saranno consentite modifiche relative al dosaggio nell’ultimo mese precedente allo Screening.
    • Inibitori della colinesterasi: la dose dovrà essere stabile per >2 settimane prima dello Screening.
    Nota: gli inibitori della colinesterasi dovranno essere mantenuti per almeno 12 ore in accordo con il manuale aggiornato per il test QMG come raccomandato da MGFA1, prima delle valutazioni MGQoL15r, MG-ADL, QMG e MGC.
    6. Le donne potenzialmente fertili dovranno risultare negative al test di gravidanza su siero allo Screening e al test di gravidanza sulle urine alla Visita 1 prima della somministrazione dell’IMP. Le donne potenzialmente fertili saranno considerate come tutti i partecipanti di sesso femminile, a meno che non siano in post-menopausa (definita in base ad amenorrea continua) da almeno 2 anni con un ormone follicolo-stimolante (FSH) >40 UI/L o rese sterili chirurgicamente (devono essersi quindi sottoposte a isterectomia, ooforectomia bilaterale oppure legatura delle tube attuale documentata o qualsiasi altra procedura di sterilizzazione femminile permanente). La determinazione dei livelli di FSH potrà essere usata per confermare lo stato di post-menopausa nelle pazienti amenorroiche che non assumono la terapia ormonale sostitutiva qualora il risultato del test rientrasse nell’intervallo di post-menopausa secondo il laboratorio centrale.
    7. Le partecipanti potenzialmente fertili dovranno acconsentire all’uso di un metodo contraccettivo altamente efficace (ovvero, un tasso di gravidanza <1% annuo) durante lo studio e per i 90 giorni successivi all’interruzione dell’IMP. Metodi contraccettivi adeguati includono: contraccezione ormonale combinata associata all’inibizione dell’ovulazione (orale, intravaginale, transdermica), contraccezione ormonale a base di solo progesterone associata all’inibizione dell’ovulazione (orale, iniettabile, impiantabile), dispositivi intrauterini, sistemi intrauterini a rilascio di ormoni (IUS), astinenza sessuale completa (se rientra nello stile di vita preferito e abituale della partecipante), occlusione tubarica bilaterale o infertilità della partecipante. Le partecipanti e le compagne dei partecipanti allo studio che fanno uso di un contraccettivo ormonale dovranno utilizzare anche un metodo barriera (ad es. preservativo o cappuccio occlusivo [diaframma o cappuccio cervicale]) e aver assunto in maniera stabile il loro trattamento contraccettivo ormonale per almeno 4 settimane prima dello Screening.
    8. Potranno essere inclusi pazienti di sesso maschile sterilizzati che si siano sottoposti a vasectomia con aspermia post-procedura documentata. Inoltre, i pazienti di sesso maschile saranno tenuti a non donare sperma durante tale periodo a partire dalla firma del Modulo di consenso informato, per tutta la durata dello studio e per 90 giorni successivi.
    E.4Principal exclusion criteria
    1.Females who are pregnant or lactating.
    2.MGFA Class I, IVb, and V.
    3.Have an active infection, a recent serious infection (i.e., requiring
    injectable antimicrobial therapy or hospitalization) within the 8 weeks
    prior to Screening; or history of or known infection with human
    immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus
    (HCV), or Mycobacterium tuberculosis. Patients must have negative test
    results for HBV surface antigen, HBV core antibody, HCV antibody, HIV 1
    and 2 antibodies, and a negative QuantiFERON® TB Gold test at
    Screening. Patients with an indeterminate QuantiFERON® TB Gold result
    will be allowed one retest; if not negative on retesting, the patient will
    be excluded.
    4.At Screening, have clinically significant laboratory abnormalities or as
    below:
    •Aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
    >2 x upper limit of normal (ULN).
    •Total serum bilirubin of >1.5 x ULN (except for Grade 1
    hyperbilirubinemia solely due to a medical diagnosis of Gilbert's
    syndrome).
    •Serum creatinine >1.5 mg/dL and creatinine clearance <50 ml/min
    (using the Chronic Kidney Disease Epidemiology [CKD-EPI]-Creatinine
    formula).
    •Clinically significant proteinuria (i.e.,> 3x ULN)
    •Hemoglobin ≤9 g/L
    •Thyroid stimulating hormone or thyroglobulin outside of the central
    laboratory normal range
    •International normalized ratio (INR) or activated partial
    thromboplastin time (aPTT) >1.2x ULN
    •Total immunoglobulin G level <6 g/L.
    5.Body Mass Index (BMI) at screening ≥ 35 kg/m2.
    6.Use of rituximab, belimumab, eculizimab or any monoclonal antibody
    for immunomodulation within 6 months prior to first dosing. Patients
    with prior exposure to rituximab must have CD19 counts within the
    normal range per the central laboratory at Screening.
    7.Use of any biological therapy or investigational drug within 3 months
    or 5 half-lives of the drug (whichever is longer) before Screening.
    8.Immunoglobulins given by IV (IVIg), or intramuscular route, or
    plasmapheresis/plasma exchange (PE) within 4 weeks before Screening.
    9.Have known autoimmune disease other than MG that would interfere
    with the course and conduct of the study (such as uncontrolled thyroid
    disease or severe RA).
    10.Have received vaccinations within 4 weeks before Screening or have
    any vaccinations planned during the study.
    11.Have a history of malignancy, including malignant thymoma, or
    myeloproliferative or lymphoproliferative disorders at any time, unless
    deemed cured by adequate treatment with no evidence of recurrence for
    ≥5 years before Screening. Patients with completely excised
    nonmelanoma skin cancers (such as basel cell carcinoma or squamous
    cell carcinoma) or cervical carcinoma in situ would be permitted at any
    time.
    12.Have a history of cerebrovascular accident or myocardial infarction
    within the last 12 months before Screening, or current severe/unstable
    angina, arrhythmia, symptomatic congestive heart failure New York
    Heart Association (NYHA) class III or IV, or uncontrolled hypertension.
    13.Have clinical evidence of significant unstable or uncontrolled acute or
    chronic diseases (i.e., cardiovascular, pulmonary, hematologic,
    gastrointestinal, endocrinologic, hepatic, renal, neurologic, malignancy,
    or infectious diseases) which, in the opinion of the Investigator, could
    confound the results of the study or put the patient at undue risk.
    14.Major past surgery (e.g., heart valve replacement, hip replacement)
    that, in the opinion of the Investigator, poses a risk to patient's safety or
    interferes with the study evaluation, procedures or completion.
    15.Thymectomy when performed < 3 months prior to screening.
    16.History or presence of alcoholism or drug/chemical/substance abuse
    within 2 years before Screening per Investigator's opinion.
    1. Donne in stato di gravidanza o allattamento.
    2. MGFA di Classe I, IVb e V.
    3. Presenza di un’infezione attiva, un’infezione grave recente (che richiede, cioè, una terapia antimicrobica iniettabile o di un ricovero) nelle 8 settimane precedenti allo Screening, oppure un’anamnesi di o infezione nota da virus dell’immunodeficienza umana (human immunodeficiency virus, HIV), virus dell’epatite B (hepatitis B virus, HBV), virus dell’epatite C (hepatitis C virus, HCV) o Mycobacterium tuberculosis. I pazienti dovranno risultare negativi al test per antigene di superficie dell’HBV, anticorpo anti-core di HBV, anticorpo anti-HCV, anticorpi anti-HIV 1 e 2 e al test QuantiFERON®-TB Gold allo Screening. I pazienti che presentano un risultato indeterminato al test QuantiFERON®-TB Gold potranno effettuare nuovamente il test; qualora non risultassero nuovamente negativi, verranno esclusi.
    4. I pazienti che allo Screening presenteranno anomalie di laboratorio clinicamente significative oppure:
    • Aspartato aminotransferasi (aspartate aminotransferase, AST) e alanina aminotransferasi (alanine aminotransferase, ALT) >2 volte il limite superiore della normalità (upper limit of normal, ULN).
    • Bilirubina sierica totale >1.5 volte l’ULN (ad eccezione dell’iperbilirubinemia di Grado 1 dovuta esclusivamente a una diagnosi medica della sindrome di Gilbert).
    • Creatinina sierica >1,5 mg/dl e clearance della creatinina <50 ml/min (utilizzando la formula dell’epidemiologia della malattia renale cronica relativa alla creatinina [Chronic Kidney Disease Epidemiology [CKD-EPI]).
    • Proteinuria clinicamente significativa (ovvero, >3 volte l’ULN).
    • Emoglobina ≤9 g/dl.
    • Valori dell’ormone tireostimolante o della tireoglobulina al di fuori dell’intervallo di normalità del laboratorio centrale.
    • Rapporto normalizzato internazionale (International Normalized Ratio, INR) o tempo di tromboplastina parziale attivata (activated Partial Thromblastin Time, aPTT) >1,2 volte l’ULN.
    • Livello di immunoglobulina G totale <6 g/l.
    5. Indice di massa corporea (IMC) ≥35 kg/m2 allo Screening.
    6. Uso di rituximab, belimumab, eculizumab o qualsiasi anticorpo monoclonale immunomodulante nei 6 mesi precedenti alla prima somministrazione. I pazienti precedentemente esposti a rituximab dovranno avere conte di CD19 allo Screening che rientrino nell’intervallo di normalità secondo il laboratorio centrale.
    7. Uso di qualsiasi terapia biologica o farmaco sperimentale nei 3 mesi o nelle 5 emivite del farmaco (a seconda di quale duri di più) precedenti allo Screening.
    8. Immunoglobuline somministrate per via EV (IVIg) o per via intramuscolare, oppure plasmaferesi/scambio plasmatico (PE) nelle 4 settimane precedenti allo Screening.
    9. Presenza di malattia autoimmune nota diversa da MG che potrebbe interferire con l’avanzamento e la conduzione dello studio (come ad esempio una malattia tiroidea non controllata o artrite reumatoide [AR] grave).
    10. Pazienti che hanno ricevuto vaccinazioni nelle 4 settimane precedenti allo Screening o che prevedono di sottoporsi a vaccinazioni nel corso dello studio.
    11. Anamnesi di neoplasia, compreso il timoma maligno, o disturbi mieloproliferativi o linfoproliferativi in qualsiasi momento, a meno che non siano considerati curati con un trattamento adeguato senza alcuna evidenza di recidiva per ≥5 anni prima dello Screening. I pazienti con tumori cutanei diversi da melanoma completamente escissi (quali carcinoma a cellule basali o carcinoma a cellule squamose) o carcinoma in situ della cervice potranno essere ammessi in qualsiasi momento.
    12. Anamnesi di evento cerebrovascolare o infarto miocardico negli ultimi 12 mesi prima dello Screening, oppure angina grave/instabile in corso, aritmia, insufficienza cardiaca congestizia sintomatica di classe III o IV secondo la New York Heart Association (NYHA) o ipertensione non controllata.
    13. Presenza di un’evidenza clinica di malattie acute o croniche significative instabili o non controllate (cioè malattie cardiovascolari, polmonari, ematologiche, gastrointestinali, epatiche, renali, neurologiche, neoplasie o malattie infettive) che, a giudizio dello Sperimentatore, potrebbero confondere i risultati dello studio o esporre il paziente a un rischio eccessivo.
    14. Precedente intervento chirurgico maggiore (ad es. sostituzione di valvole cardiache, protesi all’anca) che, a giudizio dello Sperimentatore, metterebbe a rischio la sicurezza del paziente o potrebbe interferire con le valutazioni, le procedure o il completamento dello studio.
    15. Timectomia se eseguita <3 mesi prima dello Screening.
    16. Anamnesi o presenza di alcolismo o abuso di farmaci/sostanze chimiche/stupefacenti nei 2 anni precedenti allo Screening secondo l’opinione dello Sperimentatore.
    E.5 End points
    E.5.1Primary end point(s)
    •Evaluate the incidence and severity of adverse events (AEs) and serious AEs (SAEs).
    •Evaluate vital signs, ECG, and laboratory assessments.
    • Valutare l’incidenza e la gravità degli eventi avversi (EA) e degli eventi avversi seri (serious adverse event, SAE).
    • Valutare segni vitali, elettrocardiogramma (ECG) e analisi di laboratorio.
    E.5.1.1Timepoint(s) of evaluation of this end point
    Various time points throughout the study
    Diversi punti temporali durante lo studio
    E.5.2Secondary end point(s)
    •Score change from Baseline (defined as the score immediately prior to
    first dose at Visit 1) at Visits 3, 5, 7, 9, 10, 11, 12, 14, and 16 for the
    following:
    o MG ADL
    o QMG
    o MGC
    o MGQoL15r
    •Maximum reduction from Baseline across visit days for MG-ADL, QMG,
    MGC, and MGQoL15r score.
    •Pharmacokinetic parameters of ARGX 113 including maximum observed
    concentration (Cmax), time of maximum concentration (tmax),
    concentration prior to dosing (Ctrough), half-life (t1/2,λz), and
    accumulation ratio (Rac).
    •Evaluation of PD markers: total IgG (and subtypes) and anti AChR
    antibodies.
    •Evaluate the incidence of anti drug antibodies (ADA) to ARGX 113.
    •Exploratory pharmacogenetic assessments in patients who sign a
    separate pharmacogenetic ICF to examine FcRn polymorphisms.
    • Variazione del punteggio rispetto al basale (definito come il punteggio immediatamente precedente alla prima dose alla Visita 1) alle Visite 3, 5, 7, 9, 10, 11, 12, 14 e 16 riferita a quanto segue:
    o MG-ADL
    o QMG
    o MGC
    o MGQoL15r
    • Riduzione massima rispetto al basale tra le varie visite per il punteggio relativo a MG-ADL, QMG, MGC e MGQoL15r.
    • Parametri farmacocinetici di ARGX-113, compresi concentrazione massima osservata (Cmax), tempo alla concentrazione massima (tmax), concentrazione precedente alla somministrazione (Cmin), emivita, (t1/2,λz) e tasso di accumulo (Rac).
    • Valutazione dei marcatori PD: IgG totali (e sottotipi) e anticorpi anti-AChR.
    • Valutazione dell’incidenza degli anticorpi anti-farmaco (anti-drug antibodies, ADA) diretti contro ARGX-113.
    • Valutazioni farmacogenetiche esplorative nei pazienti che firmano un ICF separato per la farmacogenetica al fine di analizzare i polimorfismi di FcRn.
    E.5.2.1Timepoint(s) of evaluation of this end point
    Various time points throughout the study
    Diversi punti temporali durante lo studio
    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 Yes
    E.6.7Pharmacodynamic Yes
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic Yes
    E.6.11Pharmacogenomic No
    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) Yes
    E.7.3Therapeutic confirmatory (Phase III) No
    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 No
    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 concerned3
    E.8.5The trial involves multiple Member States Yes
    E.8.5.1Number of sites anticipated in the EEA12
    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
    Belgium
    Canada
    Italy
    Netherlands
    Poland
    Spain
    Sweden
    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 years1
    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 years1
    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.1.1Number of subjects for this age range: 1
    F.1.1.1In Utero Information not present in EudraCT
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) Information not present in EudraCT
    F.1.1.3Newborns (0-27 days) Information not present in EudraCT
    F.1.1.4Infants and toddlers (28 days-23 months) Information not present in EudraCT
    F.1.1.5Children (2-11years) Information not present in EudraCT
    F.1.1.6Adolescents (12-17 years) Information not present in EudraCT
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 22
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 2
    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 Yes
    F.3.3.2Women of child-bearing potential using contraception No
    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 state3
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 16
    F.4.2.2In the whole clinical trial 24
    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)
    None. Subject will continue with routine care.
    Nessuno. Il soggetto proseguirà con cure di routine.
    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 Decision2016-12-01
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2016-11-10
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2017-10-20
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